LMC EMAIL UPDATE - June 2015
Date sent: Sunday 31 May 2015
Email sent by Wessex LMCs, on Sunday, 31st May 2015
We have now got over the General Election and the many promises that the political parties made about the NHS in general and general practice specifically. I hope we will now get down to some serious discussions about how to provide a high quality and sustainable service for our patients. The politicians need to deliver on their promises.
I get a little frustrated that the focus is always about the sustainability of hospitals. Recently many hospitals have declared that during this year they will face a financial deficit. The implication being that they will need more funding to provide services throughout the year. If this is delivered out of existing resources then it will mean that hospitals will gain a bigger "slice of the cake" and general practice, community services and mental health will receive even less.
If general practice is not sustainable then the rest of the NHS will never cope with the additional workload that will ensue.
Change is coming and general practice will not be immune from this. No change will not be an option, but can we embrace change and make general practice a great place to work again and start attracting the younger doctors to join us once again?
I still believe general practice is a fantastic career, and feel that being a GP is an honour and privilege and would recommend it to any young doctor but we need to find solutions to the issues of workload, morale and resources to support practices in delivering care to their registered population.
There was talk about an additional £8bn for the NHS post general election, well perhaps the Government could invest £3bn a year in general practice, another £3bn in community services and £2bn in hospital based care.
1. LMC Conference
2. RCGP's Blueprint for general practice
3. Sharing information for the benefit of patients
4. Chaperone Training
5. Female genital mutilation
6. Ebola - GPs need to remain vigilant
7. Vanguard, Multi Professional Community Provider or new models of care - do you want to know more?
1. The LMC Conference
Each year in May, the LMCs in the four Home Countries meet to debate the important issues of the day.
The important issues that were debated this year include CQC, recruitment and retention, sustainability of general practice, funding, 7 day working, premises, QoF and salaried contracts to name a few.
Dr Chaand Nagpaul, the Chair of the GPC gave an excellent address to conference and this can be seen in full by clicking here.
This year we had more local GPs leading debates and proposing motions than we have had for some time. It is also encouraging to see the younger GPs getting involved and leading some of the important debates about the future of the profession.
This was the last year of Mike Ingram's Chairmanship of the LMC Conference. Each year at the Conference dinner the Chair proposes a toast - this year Mike gave a personal rendition of " I am the Tory model of a modern general practitioner" - it is well worth viewing on You Tube - click here.
2. The RCGP's Blueprint for General Practice
The RCGP recently published a document called A Blueprint for General Practice - click here to read the document.
The key proposals in "Building a new deal for general practice": include:
- Increase the funding for general practice from 8% to 11% - an increase of £3 billion or £50 per patient
- To grow the GP workforce by 8000
- Give GPs the time to focus on patient care
- Allow GPs time to innovate
- Improve GP premises
This document builds on the NHS England document "Five Year Forward View" which made a case for a new deal for general practice and committed to providing additional funding for general practice and community services.
The arguments for increase funding are compelling, especially when you see the increase in funding that secondary care has received in recent years compared to the fall in funding received by primary care (both general practice and community services) it is therefore no surprise that we face such challenging times.
The RCGP published a document in November 2014 that was written by Deloitte called - Spend to save:The economic case for improving access to general practice - the report is far more interesting than the title and offers a number of potential solutions that the New Models of Care should consider implementing on a much wider scale.
The document states that Increased government spending on general practice could lead to a saving of up to £1.9bn to the NHS across the UK by 2020.
Calculations by the RCGP show that increasing spending on general practice across the UK by £72m each year – to pay for such things as more GPs and practice nurses – could lead to a saving of up to £375m each financial year, rising to annual savings of up to £708m by the end of 2019/20. The RCGP figures are based on research it commissioned from Deloitte in 2014, which estimates that short-term savings generated through increased spending on general practice could amount to up to £447m annually.
Between 2006 to 2013 the number of GPs grew by 4% compared to a 27% increase in hospital doctors. Over the same time period the number of consultation in general practice increased from 280,000.000 to 340,000,000 and increase of 18% - so it is hardly surprising that an increase in in the workforce of 4% is struggling to cope with an 18% increase in workload. Since 2013 the recruitment and retention of GPs have got much worse, therefore the 4% growth has been wiped out and is probably now significantly lower with many practices unable to fill all the sessions they need.
An increase in the workforce by 8000 GPs within 5 years seems a significant challenge. This can happen if additional funding is made available, we look more widely than just GPs and recruit more nurses, MSK specialists, clinical pharmacists and mental health worker all to work in general practice supporting GPs and patients. Making general practice a great place to work with a manageable workload with sufficient resources is the key to success.
The RCGP is seeking a reduction in red tape and bureaucracy, to reduce the burden placed on general practice by CQC and to consider replacing QoF.
There is a call to pilot employing a clinical pharmacist at practice level see press release - the use of clinical pharmacist is common practice in hospitals and in general practice, pharmacists could contribute to the management of long term conditions, managing repeat prescribing, reviewing patients with multiple medications etc.
The RCGP is very supportive of the New Models of Care, especially the Multi Professional Community Provide (MCP) where it is clinically led and integrates with community services.
3. Sharing of information
Recently the Hampshire and Isle of Wight LMC agreed that in the best interest of patients there was a need for health and social care to work together for the benefit of the individual patients (as mandated by Caldicott 2).
GPs remained concerned about access to medical records as they remain the data controller.
We are moving to a single assessment of patients - a process developed between community services and social services. This is to stop
duplication and improve efficiency and benefit the patients.
Trials of the social worker accessing the Hampshire Health Record with appropriate consent have been show to benefit patients and reduce the need to ask GPs for reports.
In a practice non clinical staff need access to the records for administrative tasks and the same is true for social care, social workers do not work in isolation.
The LMC agreed that patients should have the ultimate say in who can access their records. So a person who works for the Local Authority supporting the social worker could access a patient¹s records but only if:
1. The patient explicitly consented to this.
2. The Local Authority person not in a registered profession must have explicit Information Governance training and be fully aware of the implications of not following the agreed process.
3. The Local Authority hold a list of those who have access to the Hampshire Health Record and ensure they have Information Governance training.
4. Practices would be updated as to what was happening.
5. There would need to be a change in the documentation for the Hampshire Health Record to reflect this change.
The LMC is currently working with the Local Authority to implement this.
4. Chaperone Training
The LMC have just launched a new Lunch and Learn Training Resource for our practices on Chaperone Training.
These resources offer a different way of practices training their staff as it enables you, on behalf of the practice, to deliver training over a lunchtime, or at any time to suit you, by giving you all the materials you need.
When you purchase the Lunch & Learn package you will receive access to a PowerPoint presentation and all the accompanying relevant training materials.
Benefits of the Lunch & Learn packages:
- They are more cost effective than face to face training
- They can be run whenever & wherever suits you
- They can be run as a multi-disciplinary meeting, with specific groups of staff or with individuals
- When training is being done as a practice, useful practice-wide decisions and discussions can result
- They can be run with new staff as part of their induction
- They will be updated by the authors of the training package so you can feel reassured that you are delivering accurate training
- By using the package’s original material, a consistent message will be portrayed to staff who have the training sessions at different times.
This training resource looks at the role of the chaperone, their importance and the practice policies in regards to chaperoning.
The chaperone is present to support the patient and the clinician. CQC are very keen to know how practices deal with chaperones in their practice as it is a question of patient safety.
There are real examples in the presentation to encourage discussion and re-enforce the learning.
By the end of the training, all attending should be aware of the importance of the chaperone, how to act as or with one, and the practice should have a timescale to develop a practice policy.
To access this training please click here https://www.wessexlmcs.com/lunchandlearn
Chaperone Training is now our 6th resource in this series - all available at £30 each to be used as many times as you like. The Dementia one is free!
Any questions please email: firstname.lastname@example.org
5. Female genital mutilation (FMG) (sometimes referred to as female circumcision)
FGM refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.
The practice is illegal in the UK.
It has been estimated that over 20,000 girls under the age of 15 are at risk of female genital mutilation (FGM) in the UK each year, and that 66,000 women in the UK are living with the consequences of FGM. However, the true extent is unknown, due to the "hidden" nature of the crime.
The girls may be taken to their countries of origin so that FGM can be carried out during the summer holidays, allowing them time to "heal" before they return to school. There are also worries that some girls may have FGM performed in the UK.
Female genital mutilation is child abuse.
The Department of Health has issued guidance around current requirements on NHS staff in relation to FGM.
Following publication of the Data Standard on 2nd April 2014, it became mandatory for any NHS healthcare professional to record (write down) within a patient’s clinical record if they identify through the delivery of healthcare services that a woman or girl has had FGM. The requirement is to record FGM in a patient’s healthcare record only if and when it is identified during the delivery of any NHS healthcare.
The current procedure to follow is detailed in the document from the Department of Health (Dec 2014):
Children and vulnerable adults: If any child (under-18s) or vulnerable adult in your care has symptoms or signs of FGM, or if you have good reason to suspect they are at risk of FGM having considered their family history or other relevant factors, they must be referred using standard existing safeguarding procedures, as with all other instances of child abuse.
This is initially often to the local Children’s Services or the Multi-Agency Safeguarding Hub, though local arrangements may be in place. Additionally,
when a patient is identified as being at risk of FGM, this information must be shared with the GP and health visitor as part of safeguarding actions (See
section 47 of the 1989 Children Act).
Adults: There is no requirement for automatic referral of adult women with to adult social services or the police. Healthcare professionals should
be aware that a disclosure may be the first time that a woman has discussed her FGM with anyone. Referral to the police must not be introduced as an
automatic response when identifying adult women with FGM, and each case must continue to be individually assessed. The healthcare professional
should seek to support women by offering referral to community groups for support, clinical intervention or other services as appropriate, for example
through an NHS FGM clinic. The wishes of the woman must be respected at all times. If she is pregnant, the welfare of her unborn child or others in her
extended family must also be considered at this point as they are potentially at risk and action must be taken accordingly.
6. Ebola - GPs need to remain vigilant
I have recently been contacted by the Department of Health's Public Health Department asking the LMC to remind GPs that while the risk of Ebola in the UK remains low, it is important that GPs remain vigilant and prepared in case someone with possible Ebola symptoms presents at your practice. In particular, we should remember things like:
·the procedures we must follow if someone presents with possible symptoms of Ebola
·ensuring we have the tools and confidence to help improve public understanding of Ebola
·awareness of how it is transmitted and why it is extremely unlikely to spread within the UK
·where to find the relevant PHE guidance on .
Ebola - Five simple steps for GPs to follow
The Ebola outbreak in West Africa has claimed thousands of lives. While the risk in the UK remains low, GPs need to be prepared for a person who may have Ebola presenting at their practice. Your role is to carry out the initial verbal assessment of the patient.
If a patient telephones to say they are unwell and have visited an affected area in the past 21 days or reports a fever of 37.5°C or above or has a history of fever within the past 24 hours, don’t visit or invite the patient to surgery but follow these five simple steps:
Call the patient immediately to confirm travel history and gather further clinical details.
Discuss the case with the local microbiologist/virologist/infectious diseases consultant and take their advice about further assessment of your patient. If they meet the criteria for possible Ebola, refer them to the local emergency department for clinical assessment.
Inform the emergency department so they can prepare a safe patient assessment area.
For the transfer to hospital, alert the ambulance service to the possibility of Ebola so they can prepare the vehicle and appropriate Personal Protective Equipment.
Alert the local Public Health England local health protection team.
If a patient attends your surgery, isolate them in a single side room immediately. You should then:
- Clinically assess the patient without any physical contact.
- Confirm travel history and/or whether the patient reports being unwell or has a fever of 37.5°C or above or history of fever within the past 24 hours.
- Follow the same steps as if the patient has telephoned.
Once the patient has been transferred, any potentially contaminated areas (including the room in which the patient was isolated, any toilet they used etc.) should not be used until a diagnosis of Ebola has been excluded. This may take twelve hours. Advice on decontaminating premises can be sought from the Public Health England local health protection team.
See attached document for links.
7. Vanguard, Multi Professional Community Provider (MCP), or new models of care - do you want to know more?
I am getting quite a lot of questions about this, what the difference is between the Vanguard programme, the MCP and new models of care?
The Vanguard Programme was an initiative launched by NHS England in late 2014, asking for proposals to develop new models of care that could be tried and tested and then evolve to menu of options that would be available more widely.
The Vanguard sites have been told to be radical and the double it! If there are barriers to change remove them - or work with NHS England and the Regulators (Monitor and CQC).
There is a real opportunity to develop models that will have real impact.
The current models being developed are:
1. Multi specialty community provider (MCP)
2. Primary and Acute Care System (PACS)
3. Care homes
4. Small hospital
There are currently 29 Vanguard sites in England and 3 of these are in Wessex.
The Isle of Wight
The CCG, local authority, St Mary's Hospital, One Wight Health GP Federation and General Practice are working together their programme is called "My full life" although this is a PACS model it is becoming increasingly clear that the distinction between PACS and MCP is theoretical rather than what is happening in reality.
North East Hampshire and Farnham
The CCG is working with general practice, Frimley Park Hospital, Southern Health (community provider) and the local authority. More detail of the work they are undertaking will be available shortly.
This is a large MCP with 3 localities, East Hampshire, SW New Forest and Gosport, with a further locality looking to join shortly.
This is a partnership between general practice, the GP provider companies and Southern Health (community provider) working closely with the local hospitals (both community and acute), the local authority and the voluntary sector.
I am producing a regular "flash report" which is a brief but regular summary of things that are happening, sent to local GPs, consultants and anyone else who is interested - click here to see my latest "Flash Report". If you would like to be added to the mailing list for this report please email me.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)