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LMC Email Update 2015

Date sent: Sunday 11 October 2015

 Email sent by the LMC to all GPs and Practice Managers in Wessex

I do not need to tell you of the major challenges that the NHS in general and general practice specifically faces currently or the potential consequences that this may cause if nothing is done to address this. The only thing  that is certain is that change is happening and that change will accelerate, the main questions for me is what does this mean for general practice and how much influence will we have over that change?

This week Acute Trusts have declared that they are facing significant financial shortfalls, expected to be close to £1bn this year. In reality this is less than 1% of the total NHS budget but the hospitals already receive close to 50% of the total NHS budget. The shortfall will mean that the NHS is facing a very difficult winter.  In the past much of the winter pressures have been met by general practice yet we are one of the few places that has not received winter pressure money.

The solution to this problem is not providing additional funding to the hospitals but to invest more money in general practice and out of hospital care and this includes health and social care. Hence why the "New Models of Care" are essential to the future of the NHS.

Sorry to add to your reading material but thought there were a number of important messages to relay to you.

Remember if you use the  MyLMC learning diary which is available

at https://www.fourteenfish.com/about/learningdiary, you can simply email this email update

to learning@mylmc.co.uk and it will appear in your leaning diary, you can reflect on some of the items and then use this towards your appraisal.

We reached a milestone recently when  the Daily Mail published an article that is not attacking GPs but identifies the problems we face with less GPs than we need and the threat of a mass exodus of junior doctors to New Zealand and Australia. It is a shame it has taken them so long to write such an article but I have no doubt they will return to their normal stance and blame GPs for every issue that takes place in the NHS.

At the recent Conservative Party Conference the Prime Minister re-stated the Government's policy to make general practice available over a seven day period.   It should be remembered that general practice is already available over a seven day period, practices offer this service from 8am to 6.30pm on weekdays and during extended opening and then the GP Out of Hours service offer this facility at all other times. 

The LMC's view is that 7 day access to general practice cannot be delivered at practice level.  It could be delivered at the level of a natural community but only if this attracted additional resources and was fully funded.  In addition, the development of this service should be voluntary and not part of the core GMS or PMS.

In the past the demand on general practice and Accident and Emergency was recognised and a number of walk-in centres were introduced. The evidence showed that although they saw a significant number of patients the demand on general practice and Accident and Emergency did not fall.

So any new 7 day service needs to be seen as an extension of existing general practice and must have a shared clinical record with the patient's registered practice. In addition, the service needs to add capacity to local practices to support and aid them. The service would overlap with the OOHs service and this would need to be addressed.

I am sure more details will be published in the coming weeks.

 

Contents

1. PMS Review 

2. Local Workforce Issues - A Future Model?

3. New Models of Care - Vanguard Update - An Opportunity or Threat?

4. New vision for a modernised general practice

5. Updated Guidelines on malaria prevention in UK travellers 

6. Acute Paediatic Survey 

7. Sessional GPs e-Newsletter 

8. Meningococcal B for infants – FAQs

9. Updated PGD and PSD guidance 

 

1. PMS Reviews

The PMS Reviews are expected to be completed by 1st April 2016.

The LMC has been working closely with and supporting many practices and groups of practices through this process. In addition, the LMC has been working with all the CCGs and NHS England to ensure the process follows national guidelines.  

This process has shown that a number of practices are financially worse off by being PMS and are in the process of returning to GMS.

As part of this process, agreement needs to be reached about where the money removed from PMS budgets will be reinvested.  The Guidance is clear that the money must be reinvested in general practice at the level of the CCG and this investment must be across both GMS and PMS practices.  The LMC is discussing reinvestment with all CCGs currently.

These reviews are difficult for all practices, particularly when they are being undertaken at a time when general practice is under such great pressure.

The LMC is working to ensure all of the funding remains within GP practice services, supports existing work that is unfunded, creates as little additional work as possible and without excessive monitoring.

If you are a PMS practice and need help and have not already contacted the LMC please do so.

 

2. Local Workforce Issues - A Future Model?

Much has been written in recent months about the crisis in general practice due to difficulties in recruiting to and retaining the workforce, changing working patterns, increasing care demands and bureaucracy in the system of care. The debate has appeared in the popular press. Whilst rarely out of the headlines or journals, there is arguably more ‘heat than light’ in identifying ways forward. This lack of clarity prompted the Southampton GP Education Unit and Wessex LMCs to jointly commission an exploratory study to seek the experiences of GPs in the locality of working in general practice today, and ask them to look ahead to the future. 

This paper is detailed work looking at the survey results followed by interviews with a number of GPs to explore themes. A proposal is then made of a future career model. This article has been published in a more concise form in the BJGP October 2015

The full article can be found here: Local workforce issues in general practice: a way ahead Final Report

Related Reading:

Wessex LMCs Recruitment

 

3. New Models of Care - Vanguard Update - An Opportunity or Threat?

In the Wessex LMCs area there are three Vanguards - the Isle of Wight, North East Hampshire and Farnham and Southern Hampshire.  Each area is progressing with a number of projects under the broad title of the "New Models of Care".  Two of the areas are working under the broad banner of "Primary and Acute Care Systems (PACS)" and one as a "Multi-Speciality Community Provider (MCP)", they are essentially one and the same thing with different emphasis on the involvement of different parties.

For the latest news on what is happening in the Southern Hampshire MCP - please click here.

The LMC believes that the future success of the NHS in being one of the best healthcare systems in the world (a statement by the Commonwealth Fund) there needs to be a much greater focus on out of hospital care.  All countries grappling with the tirad of increasing demand, an ageing population and greater pressure on funding have come to the same conclusion - the answer is not to invest more in hospital based care, the resources need to be made available in a robust out of hospital system.

The NHS has the great advantage with the system of general practice, envied by many other countries, the "Jewel in the Crown" of the NHS, but all too often taken for granted, undervalued and in recent years under resourced.

The future has to be building on the practice unit, consisting of the registered list but we also need to work together in natural communities.  It is estimated that 90% of patient contacts occur in primary care (over 340,000,000 per year in general practice alone and increasing year on year). So if we are to develop an out of hospital model, to be effective it has to be led by general practice and other community based services need to either  become part of an extended practice team or directly supporting general practice.

Having discussed the Vanguard programme and the New Models of Care with all our CCGs many are looking to develop similar models and this includes Dorset, Wiltshire and Swindon.  Portsmouth and Southampton are also looking at the potential opportunities.

The three hospitals in Dorset have recently joined the Acute Trust Vanguard Programme and the impact this will have on general practice is currently unknown.

The LMC is only too aware of the major challenges that local GPs face with recruitment and retention, falling income, rising demands. Despite these factors the LMC remains optimistic that solutions can be found and there is a lot of great work going on in our region that if replicated would answer many of our problems.  The major challenge is to secure the resources needed to implement many of these ideas.

The LMC will keep working locally and nationally to try to secure these resources and share ideas as widely as possible.

The LMC will ask the areas that have Prime Minister Challenge Funds and/or Vanguard status to provide more information that we can share with all in the Wessex Region.

4. New Vision for a Modernised General Practice

The BMA’s GP committee has launched a new vision for a modernised general practice that meets the expanding needs of patients across England.

The following is based on the largest consultation undertaken by the BMA of GPs and feedback from patients.

Responsive, safe and sustainable: Towards a new future for general practice recommends key practical changes to GP services to create a locally driven service with a flexible, expanded infrastructure. It also seeks to address the unprecedented challenges of rising patient demand and a decade of underinvestment that is undermining the ability of GPs to deliver effective care to their patients.

The key recommendations in the new vision include:

Please see the attached document.

 

 

5. Updated Guidelines on Malaria Prevention in UK Travellers 

The Advisory Committee on Malaria Prevention (ACMP), an expert advisory committee of Public Health England (PHE) has updated its guidelines on malaria prevention for medical professionals and other travel medicine advisors based in the UK. The key changes are: 

 updated guidance on the use of insect repellent and sun protection 

 clarification on the use of hydroxychloroquine 

 updated guidance on the use of anticoagulants with antimalarials 

 updated guidance on the use of doxycycline in epilepsy 

 changes to the country recommendations for Vietnam and Malaysian Borneo, and clarifications on the recommendations for India 

 clarification of advice for travellers moving through areas where different antimalarials are recommended 

Undertaking a stringent individual risk assessment 

Recommendations for antimalarials should be appropriate for the destination and tailored to the individual, taking into account possible risks and benefits to the traveller. As part of an individual stringent risk assessment, it is essential that a full clinical history is obtained, detailing current medication, significant health problems and any known drug allergies. A suggested risk assessment template is included with the guidelines. 

ACMP position on the use of mefloquine 

Falciparum malaria is a common, preventable and life-threatening infection. Mefloquine is an extremely effective antimalarial and is currently recommended as one of a number of antimalarials for travellers to high risk areas following an individual risk assessment. During the ACMP meeting in June, the committee reviewed current evidence on the use of mefloquine (proprietary name Lariam), including data provided by the manufacturer Roche, and recommendations on the use of mefloquine for malaria prevention made by other countries. The ACMP concluded that all the currently available evidence had been examined and, on the basis of this, determined that there should be no changes to existing ACMP recommendations regarding mefloquine. 

Details on the use of mefloquine in travellers, including contraindications and drug interactions are detailed in section 4.2.4 of the revised guidelines, which is available on the PHE website.

 

6. Acute Paediatic Survey 

Wessex LMCs worked with Dr Sanjay Patel, Consultant in Paediatric Infectious Diseases and Immunology and the Project lead - Wessex healthier together: Improving the Quality of Care for Children and Young People in Wessex, to distribute a survey to all GPs relating to the acute care of children.

Below is a message from Sanjay....

Many thanks to all of you who completed the on-line survey about acute paediatric care (results can be found on the website  www.healthiertogetherwessex.nhs.uk

In addition to GPs/GP practice nurses, we have also surveyed parents, front-line hospital staff and community paediatric nurses from across Wessex. Responses were very similar, with all groups proposing similar strategies for improving how paediatric care is delivered across the region. These include:-

i) The development of standardised symptom based resources for parents when faced with an ‘unwell’ child.

ii) Standard guidance on assessing and managing common paediatric presentations.

iii) Clearer guidance for GPs on local referral pathways for children presenting acutely.

In light of these suggestions, and in the face increasing numbers of children presenting to primary care and ED, we have developed resource for parents and healthcare staff (focusing on children aged under 5 years), aiming to:-

1) empower parents when faced with an ‘unwell’ child (ideally to empower them to manage children with self-limiting conditions at home)

2) signpost parents to appropriate local services, if indicated

3) promote consistent management strategies and healthcare messages across the urgent care pathway, through the development of clinical pathways and safety netting material across primary and secondary care (fever, D+V, bronchiolitis, asthma/wheeze, head injury and abdominal pain). These have been developed by professionals (GPs, paediatricians, community nurses) from across Wessex and have been through an extensive Wessex-wide consultation process.

Acute Trusts are in the process of implementing these pathways imminently. We are promoting the website to parents through local authorities and media campaigns and embedding the material into undergraduate and postgraduate education (health visitors, paramedics, ANPs, midwives, doctors). However, the most effective strategy for getting parent buy-in is if they are signposted to the material whenever they have contact with a healthcare profession.  We know that parents are less likely to represent if they are given consistent, explicit safety-netting advice from a trusted source.

In collaboration with parents, GPs and hospital staff, we are planning to review all the material on the website in 6 months time and to amend as required. Please take a moment to look at the website (www.healthiertogetherwessex.nhs.uk) – not only will you find useful material that can be shown to parents during a consultation, but in addition, clear guidance on local referral pathways for children presenting acutely (including child protection) and contact details for your local paediatric service.

Feedback/comments can be provided directly on the website. I look forward to meeting some of you at some of the upcoming TARGET meeting across Wessex.

 

 

7. Sessional GPs e-Newsletter 

The sessional GPs e-newsletter was sent out yesterday and is available on the BMA website. 

The main items this month are news on the national occupational health service for GPs suffering from stress and burnout, and an update on what we are doing to change the unfair rules on death in service benefits for locum GPs. It also features news and information aimed at supporting sessional GPs as well as blogs from sessional GPs, including one this month from sessional GPs subcommittee member Mary Anne Burrow on doing out-of-hours work

 

8. Meningococcal B for infants – FAQs

NHS Employers have updated their vaccs and imms FAQs in relation to meningococcal B for infants to explain the eligible age cohort (2 – 13 months), as well as a catch-up cohort up to 2 years for children born on or after 1 May 2015.
 The FAQs also explain what practices can do if parents approach them about having children outside of the cohort vaccinated privately:

Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how?


A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice. 


In addition to this FAQ, the GPC would like to reiterate the advice that whilst GPs can provide private prescriptions, they are not allowed to charge their own NHS patients and we would therefore recommend that patients (outside the cohort) access a comprehensive private service provided by another practice or service provider, who would then be able to charge an appropriate fee for this private service.

If you have any questions please email GPC at info.gpc@bma.org.uk.

9. Updated PGD and PSD Guidance 

The GPC’s guidance on Patient Group Directions (PGD) and Patient Specific Directions (PSD) in General Practice has been updated to clarify the rules regarding private PGDs. 

The guidance is available on the Drugs and Prescribing page on the BMA website.

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: Patient-Group-Directions-Patient-Specific-Directions.pdf

Attached file: Solutions-for-general-practice-23-Sep.pdf

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Updated on 14 October 2015 1470 views