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LMC Email update - Dec 2014

Date sent: Thursday 4 December 2014

Email sent by Wessex LMCs, on Wednesday, 3 Dec 2014

What a great couple of weeks we have had in general practice!

There was the Daily Mail article entitled “GPs are part of the NHS’s problem and not the solution” written by a Surgeon by the name of Professor Merion Thomas, described as a Sarcoma expert from the Royal Marsden Hospital, London.

This clearly makes him an expert on all things related to general practice.

For the full article please click here.

This article will have been read by many of our patients, who may not see it for what it is, a one sided, ill informed rant, by someone who has little idea of what goes on in the real world, let alone general practice (this is the polite version of my opinion, the full version would get me into significant trouble).

He has based much of his article on the CQC report that was published regarding recent inspections in general practice. 

The publication of the so called “Intelligent Monitoring” report by CQC has not only damaged the reputation of many excellent practices by labeling them as high risk (when by any objective assessment they are far from this) but also I believe this has significantly damaged the credibility of CQC.

Despite these issues, I remain very optimistic about the future of general practice.

General practice will evolve, as it has done in the past.  I am all too aware of the difficulties that we all face in terms of rising workload with insufficient resources to meet those demands and my practice is not immune to these challenges.

General Practice cannot be allowed to fail because if we do, then the rest of the NHS has no prospect of survival, despite the comments made by a Consultant Surgeon in the Daily Mail recently (see above).

Major change in general practice has taken place in past following:

In 2015 the major change will result from the implementation of the Five-Year forward plan.


1. So what does 2015 hold for general practice?

2. Five-year NHS Plan

3. Think of the agenda as personalised population based care – what does that mean?

4. The Chancellor's Autumn Statement

5. Prime Minister Challenge Fund

6. What is the LMC doing to try and help you?

     a. Provider conference early in New Year

     b. Two Practice Manager Conferences

     c. Premises

     d. IT Conference

     e. Cancer Conference

     f. Revalidation toolkit 

     g. Closer working with Wessex GP Education Trust (WPGET)

7. NHS Property Services Lease: update for practices

8. Extension to enhanced service for MenC Freshers vaccination programme

9. Seasonal influenza vaccinations for patients with learning disabilities

10. Sessional GPs e-newsletter 

11. Armed Forces Covenant

12. PSA Read Code Change

1. So what does 2015 hold for general practice?

Over the last couple of months it would appear that the Politicians and the NHS has become aware of the plight of general practice and the funding constrains that we have to work under. 

NHS England has launched a review of general practice but this will probably take the best part of 18 months to report.

It would seem unlikely that we are going to receive a significant uplift in our core funding in the near future.   But this does not mean there are not opportunities, there are many and our future may depend on how we embrace them.

2. Five-Year – NHS Plan

NHS England to spend a ‘much higher proportion’ of budget on general practice over next five years. 

This was the headline in Pulse following the publication of the plan.

The LMC’s response to this can be found by following the link.

What seems certain is that additional funding will not be forthcoming to provide more of general practice in its current form.  

There will be much greater emphasis on the following:

This is where additional funding will become available. These services could be provided by individual practices but it is far more realistic for groups of practices working together to provide these services.

Most practices have reached saturation point in terms of work, therefore these services cannot be provided by the existing workforce. We need to attract new people, to help provide these additional services.   This is all about making general practice a better place to work and establish more services that help and support GPs delivering high quality care to our patients.


3. Think of the agenda as, personalised population based care – what does that mean?

Personalised care – probably needs little explanation but continuity of care, with the holistic approach when you have knowledge of a person and their family is not only important to patients and GPs but is recognised by NHS England and the Government as important for patients and there is good evidence that this helps to achieve better outcomes.

Population based care, develops the approach of GPs being responsible for individual patients, practices being responsible for registered patients and CCGs being responsible for populations of 100,000 – 700,000 but the bit that is missing is co-ordinating and organising care for natural populations of 30-60,000. So consider the needs of the population of your town rather than just your registered patients.

What is becoming very clear is that there is a need to look at “out of hospital” care in a different way.

If you look at your neighboring practices, you may be part of a locality, what could you achieve if you lead out of hospital care for your population?

There is a need to align general practice, walk in centres, ambulance services, NHS 111 and Accident and Emergency.  This cannot be achieved at practice level but must be undertaken in larger groups.  The development of Urgent Care Centres should help practices with their unsustainable workloads.

If you looked at your locality how would you organise diabetic care to meet the needs of your patients? 

Could you organised services for patients with COPD and asthma in a different way and improve the care using resources that traditionally have been hospital based?

If your locality we able to manage the community services resource what would you do differently?

Dementia is a a key issue, how would your locality deliver services and integrate with OPMH in terms of diagnosis, support and management.


4. The Chancellor's Autumn Statement

In the Chancellor's Autumn statement an additional £2 Billion has been allocated to the NHS with £1.2 Billion allocated to general practice.  Over the next 4 years £250 million will be spent on premises each year - to develop services to meet the out of hospital agenda.  A further £200 million will be made available via the transformation fund to start the process of change as described in the Five-Year plan.

The key message is that transformation will take place and there will be resources made available to enable this to happen.

How do we survive as practices?

How can we benefit from the funding and reforms and how will this reduce our current workload and deliver better care for our patents?

If we are not able or prepared to lead “out of hospital” care then in my view, others will do this could be the private sector, a acute hospital or a Community Trust – who is most likely to help and support practices?

We need to lead and we must demand the investment and resources to achieve this end.

Working at scale and being part of a large group will give us a seat at the table and the ability to be an equal partner with hospitals, community providers and the Ambulance Service.  This does not happen at the present time.


5. Prime Minister Challenge Fund

Earlier in the year £50m was made available to groups of practices in the Prime Minister’s Challenge fund.  Unfortunately despite some strong bids locally none of our bids from Wessex were successful.

The second stage of the Prime Minister Challenge Fund was announced recently with a further £100m being made available:

Follow the link

They are looking for bids from  populations ranging from 30,000 up to that of a CCG.

NHS England is seeking innovative bids to offer more access to GP services; particularly at weekends and outside ‘normal’ practice working hours.


6. What is the LMC doing to try and help you?


a. Provider conference early in New Year

It has been clear to us for some time that individual practices cannot compete with the Ambulance Service or hospitals when additional funds are available, such as winter pressures. 

We are also aware that many Public Health contracts that are held by general practice for sexual health and NHS Health Checks are being considered for alternative types of contracts that would essentially means contracting with a larger organisation and then sub contracting to practices.

The out of hospital agenda cannot be met by individual practices working in isolation, we need to be working in larger groups and provider organisations are one way to deliver those services and support practices.


b. Two Practice Manager Conferences

In February the LMC has organised two conferences for Practice Managers that will take place on the 10th and 26th February.  Once agin we hope to offer you lots of useful and interesting help and advice.

If you wish to attend I would suggest you book your place soon as the places are filling up fast.


c. Premises

To deliver an effective service to your patients you need to provide these from premises that are fit for purpose.  Over the last few years there has been little or no money available to build new premises and practices have struggled with leases, new landlords, improvement grants and notional vs. cost rent.

The future looks slightly more promising, in that NHS England is going to invest £250m a year for the next 4 years to invest in GP premises and develop out of hospital treatments, this money comes from fines imposed on Banks.

Less and less GPs want to be owner-occupiers and some GPs are put off Partnership because of the risk of taking on a lease.

The LMC will be organising a Premises Conference in the next few months to help practices with many of these issues.

More details will be sent out shortly.


d. IT conference

We have held three IT Conferences in the last couple of years, all have been over subscribed and we had very positive feedback from them.

We are organising a further IT Conference that will take place at St Mary’s Stadium in Southampton on May12th.

More details will be sent out shortly.


e. Cancer Conference

The LMC has organised two cancer conferences, these were well attended and we received excellent feedback, largely because we set the agenda and worked with the Cancer Network to ensure the topics covered were very relevant to general practice.

We have been asked to work with one or two areas to organise a further conference this is currently in the negotiation phase!


f. Revalidation toolkit 

The LMC working with Fourteen Fish have recently released a free iPhone and iPad app to accompany their appraisal toolkit. 

The App can be used without an Internet connection and synchronises automatically with your learning diary on the Revalidation Toolkit or myLMC websites. When it comes to your appraisal you can the simply push relevant entries into the appraisal part of the toolkit.

Add CPD, PDP (personal development plan), Quality Improvement Activities, Significant Events, Colleague Feedback, Patient Feedback and Additional entries. You can edit existing entries and add reflection and assign CPD credits. 

Just like the learning diary on the toolkit, you can assign entries to your different scopes of work (e.g. GP, Teacher) and create tags to help organise your entries.

The app is designed to be fast and simple to use.

More information:

Download from the Apple App Store:




g. Closer work with Wessex GP Education Trust (WPGET)

Many GPs in Dorset, Hampshire and the Isle of Wight are members of WGPET.  

WGPET is responsible for funding a significant amount of GP education in the region.

With the development of Wessex LMC’s Education and Training service we have been working very closely with WGPET. Both organisations recognise that there would be great merit in the LMC and WGPET working far more closely together and therefore a decision has been made to relocate WGPET from its current base in New Milton to the LMC Offices in Chandlers Ford.


7. NHS Property Services Lease: update for practices

NHS Property Services (NHSPS) is circulating a lease that is being framed a 'standard lease' which it is saying has the backing of the BMA. Although the GPC has had a number of discussions with NHSPS about developing a standard lease, the GPC has not agreed to a standard lease nor endorsed one.

The GPC advises all practices in NHSPS properties that they should under no circumstances sign any current standard lease or other document from NHSPS without receiving full legal advice in order to understand the consequences of signing the lease.

To help explain some of the risks of the lease, the GPC has partnered with BMA Law to put together a short guidance note about leases and provides an outline of the headline issues and key provisions arising from the draft lease.

It covers:

• break clauses

• rent reviews

• relocation

• repairing obligations

• sharing occupation

• alterations

• security of tenure.

Our advice to all practices if they are asked to sign or agree a lease would be that they inform GPC and seek independent legal advice on the document.

The GPC is seeking clarification with NHSPS on the exact nature of this document and the scope of its intended use.


8. Extension to enhanced service for MenC Freshers vaccination programme

The enhanced service for the MenC Freshers vaccination programme is extended until March 2015 due to reported outbreaks. Area teams will be informing all practices of the extension shortly. Participating practices can continue to vaccinate patients. Practices who have not signed upmust be offered the opportunity to do so.

More information can be found online.


9. Seasonal influenza vaccinations for patients with learning disabilities

Area teams and NHS England have received a number of queries from area teams and practices to clarify the position on flu vaccinations for patients with a learning disability. Although this cohort is included in the service specification under the category for ‘neurological conditions’, the line ‘using clinical judgement’ has been causing some confusion.

As such, NHS England intends to send out a bulletin to clarify this. GP practices should be aware of information material to support the drive to offer vaccinations to people with learning disabilities.


10. Sessional GPs e-newsletter 

The first edition of the sessional GPs e-newsletter was sent out last week, and will from now on be distributed on a monthly basis.

The first newsletter focuses on the implications of the 15/16 GP contract agreement for sessional GPs, a survey on sessional GP experiences of appraisal and revalidation and some guidance on the relationship between sessional GPs and LMCs.

The newsletter is available on the BMA website.


11. Armed Forces Covenant

We have been asked by NHS England to draw attention to the commitments of the Armed Forces Covenant that came into effect through the Armed Forces Act 2011 and NHS England has passed on the following information.

The Armed Forces Covenant is regarded as the ‘contract’ between the population of the UK, the Government and all those who serve or have served in the UK armed forces and their families. The Covenant notes that the armed forces fulfil a responsibility on behalf of the population and the Government, sacrificing some civilian freedoms, facing danger and, sometimes, suffering serious injury or death as a result of their duty. Families also play a vital role in supporting the operational effectiveness of the armed forces. In return, the Covenant states that the whole nation has a moral obligation to the members of the armed forces together with their families.

Those who serve in the armed forces, whether regular or reserve, those who have served in the past, and their families, should face no disadvantage compared to other citizens in the provision of public and commercial services. Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.

Veterans should receive priority treatment where it relates to a condition which results from their service in the armed forces, subject to clinical need.

Those injured in service, whether physically or mentally, should be cared for in a way which reflects the nation’s moral obligation to them whilst respecting the individual’s wishes. For those with concerns about their mental health, where symptoms may not present for some time after leaving service, the ambition is that they should be able to access services with health professionals who have an understanding of armed forces culture.

For GPs, asking, READ coding and recording if patients have served in the armed forces, or are part of the wider armed forces community (family, reservist, etc.) will help their patients get better access to the full breadth of NHS services; including some that are specifically focussed on this cohort (e.g.the Reserves Medical Assessment Programme). It may give access to specific veteran-focused funding (eg prosthetics or mental health) and further charitable services (eg mental health).

The best Read Code to use is ‘History relating to Military Service’ Xa8Da.

This knowledge will also enable GPs to access their prior medical records; a précis of which should be provided by the new veteran on leaving their respective service and registering with an NHS GP. The registration and recording helps the referral process, as well as the commissioning and planning of appropriate services.

Further information is also available via NHS Choices.


12. PSA Read Code Change

I thought I ought to highlight this to everyone, the Department of Health has instructed laboratories to change the READ code used for reporting PSA levels to practices.

For years PSA values have been reported using 43Z2, over the last few weeks they are now being reported using 43Z22

This may have patient safety implications at Practice level, as practices may be monitoring the original code, and looking at patterns of change in the old code. 

Patients either with known Ca Prostate or who are being monitored with a raised PSA for consideration regarding treatment are affected.


Best wishes


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


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Updated on 04 December 2014 1884 views