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LMC Email update

Date sent: Wednesday 10 April 2019

The new financial year started two weeks ago yet many questions about the new contract, Primary Care Networks and Indemnity remain.

In this email I will try and help with some of these answers as well as some other important information.

Contents:

1. Primary Care Networks.

You will have seen lots of information about PCNs, this provides an LMC view. Remember these are an extension of your practice based in a local community and therefore important for your future.

2. Wessex Local Medical Committees GP Supporters Programme

A really successful LMC initiative both for practices who have been helped over the last 12 months but also an opportunity for experienced GPs who are looking for a new challenge.

3. Practice Manager Appraisals

Lots about GPs but lets not forget our Practice managers, they need our support as well.

4. Indemnity

State Backed indemnity now in place but we still are getting lots of questions - a couple of answers.

5. The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

This is a request to help us to help you to collect more data about workload.

6. The Professional Record Standards Body (PRSB)

This provides those who are interested to contribute to a national survey about clinical records.

7. Opportunity to take part in the surprise study - all related to palliative care

This important research being undertaken by UCL on behalf of Marie Curie Palliative Care - an opportunity to contribute and also gain some CPD in addition might help with the focus on palliative care in the GP contract changes.

8. GP 'Coffee and Catch up' sessions

This is a new initiative launched by our GP Fellows aimed at GPs who is juggling work and childcare or planning parental leave and wondering how to connect with others locally with the same challenges?

9. Are you a GP new to Wessex/recently moved here?

Have you moved during current parental leave and wondering how to start connecting in the area?

 

1. Primary Care Network DES

PCNs commence on 1st July 2019 and the first year aims to establish the PCN and to start to recruit the new workforce with the majority of the service requirement starting in April 2020 onwards.

LMC Comment: The LMC strongly supports PCNs, as a way of supporting practices and providing a greater focus to deliver care within a defined community. Think of this year as a set up period, although many of our areas have been working as clusters, localities or networks, in which case we do not want to tread water for a year or even worse go backwards. Therefore, all Commissioners need to continue to support and invest in locality working.

Who can hold a PCN Contract?

It has to be a GP practice(s) who hold a registered list and provides in-hours primary medical services (i.e. essential services).

By the 15th May all practices should have agreed who will be part of their PCN and submitted this information to the CCG.

A typical PCN will have the following:

It is important that there is 100% coverage – so practices cannot be left out or isolated.

LMC Comment: We know practices are already discussing their PCN and have largely agreed how this might look. Remember it must also reflect local communities and be inclusive. You cannot decide to exclude a practice in the middle of your patch because you have poor relationships with them!

We must all learn to ‘play nicely’ together to gain the significant benefits on offer to practices and our patients.

A national network data sharing agreement will be produced nationally and made available shortly.

Federations cannot hold a PCN Contract - the contract is an extension of the practice contract and hence why it is DES.

By signing up to the PCN Agreement and agreeing to be a participating member of the PCN the practice will receive £1.76 per weighted patient per year.

Any change to the Network Area or membership of the PCN after July 2019 will require the agreement of the Commissioners.

The Network Area must cover a boundary that makes sense to its:

PCNs would not normally cross CCG, STP or ICS boundaries, but there may be exceptions to this such as where the practice boundary, or branch surgery, crosses the current CCG boundaries.

The Network DES will be updated every year until at least 2024.

It is expected that commissioners might want to commission local Supplementary Network Services as an agreed supplement to the Network Contract DES, supported by additional local resource.

The PCN Clinical Director

The PCN must appoint a named and accountable clinical director. It will normally be a GP working in one of the member practices and will be accountable to the member practices. The clinical director role can be shared and could be held by a nurse. It is up to the member practices how they appoint, select or elect the clinical director.

The clinical director will be expected to work with other local clinical directors of PCNs and will play an important role in shaping the ICS or STP and help primary care shape the local healthcare system.

What will the clinical director be required to do?

LMC Comment: This is an important role and must receive support from their colleagues locally. It is important that the majority of their time is spend supporting and delivering care within their PCN and not spend all their time attending external meetings.

Data and analytics

Practices within the PCN must put in place processes to share clinical and non-clinical data to help to determine the health needs of their patients. A national template will be published in due course.

For 2019/20 practices within the PCN should collect, share and aggregate data to help the PCN in 2020/1 to:

This is clearly not something a PCN will be able to do alone and will need external support from the Commissioners and wider system to deliver.

Subcontracting

The regulations remain the same as they do for services delivered under GMS or PMS Contracts. If PCN services are subcontracted, for example extended hours delivered by a federation rather than individual contracts or PCNs, the PCN should inform the Commissioners, who may require details of the arrangement to be shared and could decline under certain circumstances.

PCN Workforce

The PCN Contract is one way by which the current workload in general practice can be addressed by expanding the workforce.

As part of the PCN DES you will be able to access new funding for an expanded workforce. There are certain staffing groups included in this:

This funding is for new staff only, you cannot transfer any existing member of practice staff to this scheme. This is because NHS England are looking to expand the workforce and not substitute funding this has been described as additionality.

The only exception is the national scheme for Clinical Pharmacists where practices received a tapering contribution to the funding for these individuals.

It also means that if local schemes are in place and these staff groups are employed then this should continue irrespective of who the employer is i.e. additionality applies to CCGs as well as practices.

The new workforce could be employed by a lead practice, a Federation, a Community provider, the Voluntary Sector or a Local Authority. The PCN remains responsible for ensuring the PCN Network contract is delivered by these new staff members. The PCN will be responsible for any tax or VAT liabilities.

The PCN will receive 100% reimbursement for the Social prescriber and 70% for all other new staff groups up to a maximum amount for each person in each group. As time goes on and the additional staff groups are added PCNs will have the option of employing, for example more Clinical Pharmacists and less of another staff group.

To gain the reimbursement the new staff members must:

Clinical Pharmacists

They need to be enrolled in or qualified in an accredited training pathway and able to practice and prescribe safely in a primary care setting.

Key responsibilities:

All clinical pharmacists should be part of a professional clinical network and have access to clinical supervision. As the number of clinical pharmacists working within a PCN increases it would then be expected to have a range of experiences within that team.

Social Prescribing Link Worker

As part of the PCN team they will take referrals in 2019/20 from PCN members and from 2020/1 onwards this will be expanded to other agencies.

What will Social Prescribing Link Workers do?

Referrals to the Social Prescriber will need to be coded in the clinical records.

Key responsibilities of the Social Prescribing Link worker:

PCNs need to assure themselves that organisations that they refer people to have basic safeguarding procedures in place for vulnerable individuals

LMC Comment: The way to look at this is to consider this to be a staff budget entitlement, you employ the staff you require in the areas agreed and you will be able to draw down funding. These staff will expand your workforce and should be delivering services for you that help with your workload. There will be some requirements for them to support and deliver services that are required under the PCN DES.

Extended Hours

This will become a responsibility of the PCN from 1st July and transferred from practices. Currently about 75% of practices deliver the DES and by making this a PCN requirement there will be a 100% coverage. The Practice DES was funded at £1.90 per patient, when this becomes a PCN DES the funding is decreased to £1.45 per patient despite the requirements remaining the same. The additional 45p per patient has been added to the core funding for all practices and therefore not lost.

These appointments can be delivered by GPs, Nurses or HCA with a reasonable number of these appointments being face-to-face, with the rest provided by telephone, video or online consultations or a mixture of these methods.

All member practices need to be involved in the planning of these services, but it is up to the PCN in terms of how they are delivered.

LMC Comment:This is the start of a process of reforming access. By 2021 the £6 per patient for improved access will be transferred to PCNs and over the next year there will be a review of access. Work together within your PCN and where appropriate work with your Federation to ensure this funding is used efficiently.

Network Financial Entitlement

Payments under the PCN DES will be made will be made to a bank account of a single nominated practice or provider who holds a GMS, PMS or APMS contract.

Clinical Director

Funded at 0.25WTE for a population of 50,000 and will be varied depending on the size of the PCN. This equates to £0.514 per patient. This will be paid monthly.

PCN Funding

The PCN will receive £1.50 per patient, paid monthly based on the registered population on 1st January 2019. First payment will be the end of July and this will be backdated to 1st April.

Workforce (additional roles reimbursement sum)

The payment will be monthly in arrears (the July payment will be received at the end of August).

For 2019/20 each PCN irrespective of their size will receive reimbursement for 1 WTE Clinical Pharmacist and 1 WTE Social prescriber. If your PCN already has sufficient of one of these groups, then you can employ more of the other but you must gain the agreement of the Commissioner.

Remember from 2020/1 each PCN will receive a maximum reimbursement for the agreed staff groups based on their weighted population.

Extended hours

Described above.

Monitoring

As with any significant investment of public money there needs to be an assurance process and it is hoped that the monitoring does not become bureaucratic and wherever possible is automated and hence the important of coded entries in the patient records.

Network member practices will be required to use the relevant SNOMED codes, as published in the supporting Business Rules on the NHS Digital website ( http://www.hscic.gov.uk/qofesextractspecs ) to record:

 

2. WESSEX LOCAL MEDICAL COMMITTEES GP SUPPORTER PROGRAMME

Are you considering reducing your commitment to general practice, retiring or changing your role?

Could you help a practice who is struggling?

The LMC recruited 10 GPs in 2018 and we are looking to recruit more GPs into the exciting role.

LMCs is acutely aware of the increasing number of practices that are really struggling and finding it difficult to recruit new staff and sometimes short term locums, which inevitably means that the situation they find themselves in just gets worse and becomes impossible to turn around.

many what is needed is an experienced GP who can come in and assist for a short period of time to help the practice get back on its feet. The help needed will vary from practice to practice - seeing patients is a must, but assistance with leadership, providing the headspace to think about different ways of working, help to explore working at scale or even merging, plus the provision of advice on practice finance, governance etc. are all needed too.

Could you be that experienced GP?

Due to the demand for the GP supporters programme, we are looking to expand the pool of GPs that we can call upon. The commitment asked for depends on each practice’s requirements but can be flexible to fit in around your own personal situation. We have a mixture of GP partners, salaried and locums as GP supporters already in practices and you’d also have the support and training from Wessex LMCs for areas you that you are perhaps not so familiar with.

We’re not looking for GPs that know everything about all subjects, if you have some knowledge and experience in any of the areas above and are willing to share this as well as see some patients, then you are just what we are looking for.

More information on the GP Supporters programme can be found here: https://www.wessexlmcs.com/gpsupporters

For an informal chat about the role please contact Carole Cusack on 023 8025 3874 or email: carole.cusack@wessexlmcs.org.uk

If you believe this may be a role for you then please send an email with a CV/letter to: carole.cusack@wessexlmcs.org.uk 

 

3. Practice Manager Appraisals

Supporting your Business or Practice Manager

We are currently holding GPFV monies to support our PMs with the opportunity to have a peer to peer appraisal run by one of our PM Supporters

Feedback from the appraisals has been excellent, with comments like:

“I have had a very difficult 6-7 months and I had lost my confidence and 'mojo’ . The session helped focus me on a way forward to help me cope with the pressures I have at the Practice and helped me take a different view of things. It was thought provoking and enlightening and I feel so much more positive about the future”

With so much going on, it is easy for PMs to lose touch with where they want to go and what their own future looks like. Typically, PMs spend so much time looking after others and their practices, that they forget to look after themselves!

Please encourage your managers to take advantage of our offer to get alongside them to coach/mentor them or run a peer appraisal for them. And if it helps, we can do this for your Deputy PMs too.

For some inspiration on how an appraisal helped Jane, one of our PMs - do have a look at this short clip - click here

If you would like to find out more about the process, please click here 

If you have any queries at all about this, please do contact:  louise.greenwood@wessexlmcs.org.uk

 

4. Indemnity

Many GPs have found the new Indemnity issues confusing.

For clarity, NHS Resolution will cover GPs (and other Clinical and Administrative staff) for negligence claims for NHS Primary Care work.

NHS Resolution does not cover representation in criminal investigations, Coroners Inquests, GMC Hearings, complaints to the Ombudsman, patient complaints or for private work. Therefore GPs will want to retain cover from the MDU, MPS or MDDUS for these issues.

The MPS website has been rather confusing.

The MPS Professional protection will cover you for the above mentioned issues which arise from NHS primary care work. In this section the MPS require information about any NHS minor surgery, joint injection, insertion of intra uterine contraceptive devices etc. as the premium for this is slightly higher than for those who do not undertake these 'high risk' procedures.

For MPS members requiring cover for private non NHS work (e.g. medical reports, cremation forms, good Samaritan acts, private minor surgery  etc) they require members to take out claims protection cover. Completion of this request form has a question about 'high risk' procedures done privately NOT NHS minor surgery procedures.

 

Nurses and HCAs

The LMC has been asked by several Practices about the cover for their HCAs and Nurses when providing private services. All of the questions were from MDU members and therefore we have met with the MDU and sought their clarification, their reply is below.

Where a practice nurse or HCA has occasional involvement in the provision of fee-paying services to the practice's own registered patients (and only very occasionally to non-registered patients such as temporary residents) then our GP members could seek our assistance if a claim were to be brought against the practice in relation to that activity (assuming the nurse/HCA does not have their own indemnity in place for the work). In the event that there were non-MDU partners in the partnership then we would expect to share the costs of defence of the matter proportionately with other indemnity providers involved.

The fee-paying services should be those that are usually provided by an NHS general practice to its patient population - such as travel vaccinations, completing insurance reports etc.

Were a nurse or HCA to be involved in a dedicated private clinic providing services to non-registered patients or the provision of other services such as occupational health, cosmetic procedures or slimming clinics then the GPs involved would need to contact us to discuss the appropriate subscription to indemnify all those involved in that work.

 

5. The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

During the Partnership Review it was clear that a significant issue general practice has when making a case for the increase in workload faced by GPs was the lack of data. One of the recommendations in my final report was that there needed to be more investment in and support from the profession in providing this information.

General practices are dealing with an unprecedented level of workload that has not been backed up with hard evidence till this date. As a result of this the Royal College of GP’s in collaboration with Surrey Heartlands have embarked on an NHS England funded project to create a workload observatory. The Observatory aims to collect real-time evidence on current workload levels as well as provide a picture of the complexity of cases that are increasingly seen in general practice.

The project also includes many benefits to practices that are listed below:

For more information click here

 

6. The Professional Record Standards Body (PRSB)

The PRSB is conducting a national survey to help define a core set of information about a person that needs to be shared to support safe, high quality joined-up care and help people take greater control of their health and care. We would like your help.

Making sure that the right information is available whenever and wherever it is needed for care means information needs to be recorded in a standardised way. Standards enable digital systems to share information without losing or changing its meaning. Not all information will be used all the time and a professional's access will be determined by their role and need.

This survey is designed for completion by patients and public as well as professionals. Please share with all interested parties.

https://www.surveymonkey.co.uk/r/PRSBcoreinformationset

 

7. Opportunity to take part in the surprise study - all related to palliative care

This study has been developed as part of a European working group looking at the Surprise Question. The Surprise Question is an introspective approach which usually involves clinicians asking themselves the question, 'Would you be surprised if this patient were to die in the next 12 months?'

GPs needed for research by the Marie Curie Palliative Care Research Department University College London (UCL) looking at how the “Surprise Question” is used in practice. You will be asked to review 20 patient summaries. It will take approximately 30 minutes to complete. For participating, you have the option to receive feedback on your results in addition to a certificate of participation. For more details, see the website:http://bit.ly/thesurprisestudy  .

 

8. GP “Coffee and Catch up” Sessions

Are you a GP who is juggling work and childcare or planning parental leave and wondering how to connect with others locally with the same challenges?

Come and share your experiences and learn from others in a GP “Coffee and Catch up” session which is an informal drop in session over tea/coffee and cake with facilities for children to play.

We have recently run a maternity workshop for those on maternity leave or planning maternity leave to increase awareness and resilience. It was very successful and was oversubscribed so we want to extend our support offer across the Wessex patch to other GPs including those working, on parental leave or currently caring for young children.

Children are welcome at these events being held across Wessex.

A GP Fellow from Wessex LMCs will be hosting the event.

For further details and to book at your nearest venue see below:

Dorchester Event: https://www.wessexlmcs.com/events/8857

Winchester Event: https://www.wessexlmcs.com/events/8858

Swindon Event: https://www.wessexlmcs.com/events/8859

Portsmouth Event: https://www.wessexlmcs.com/events/8860

Salisbury Event: https://www.wessexlmcs.com/events/8861

Wimborne Event: https://www.wessexlmcs.com/events/8862

Welcome to Wessex” Event

 

9. Are you a GP new to Wessex/recently moved here?

Have you moved during current parental leave and wondering how to start connecting in the area?

Moving to a new area can be challenging and difficult. Wessex LMCs would like to make that transition easier. This event will give you an opportunity for networking and to ask questions over a relaxed and informal lunch.

You will be able to meet Wessex LMCs staff who will help you with any queries you may have regarding your working life within the Wessex LMCs area as well as the opportunity to meet other individuals such as appraisal staff and find out about local education provision and how to find courses.

We also hope that this will give you an opportunity to connect with other GPs new to the Wessex LMCs area.

We very much look forward to seeing you there,

This is a FREE event. With a light lunch and refreshments provided.

Location details

Wessex LMCs

Churchill House, 122-124 Hursley Road, Chandlers Ford, Eastleigh, SO53 1JG

Book online at https://www.wessexlmcs.com/events/8869

 

Thank you for your help.

Best wishes

Nigel

Dr Nigel Watson

Chief Executive

Wessex LMCs

Churchill House, 122-124 Hursley Rd

Chandler's Ford, Eastleigh

Hants. SO53 1JB (Registered Office)

Tel: 02380253874

Mobile: 07825173326

www.wessexlmcs.com

 

Attached file: Newsletter recruitment v1.0 2018.08.09-1 - Read-Only.pptx

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Updated on 10 April 2019 156 views