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Email sent by Wessex LMCs, on 22 Nov 2015

Date sent: Sunday 22 November 2015

Email sent by Wessex LMCs, on 22nd Nov 2015

Despite the mild weather the inevitable rise in demand that happens every winter has started. This could prove to be one of the most difficult winters for the NHS with the current state of NHS finances and the potential for disruption caused by the Junior doctors industrial action.

In many areas general practice has performed amazingly well in terms of the growing demand and some of the increases in A/E attendance and avoidable hospital admissions have grown far less in our area than other parts of the country and to continue this work we need additional resources.

It is of great concern to see the reported deficits that NHS Trusts and CCG are declaring after 6 months.  The danger is that because general practice and community services are not funded on an activity based contract, all the effort is focused on hospital deficits and the major problems that general practice currently faces gets ignored.  I can assure you that this won't be the case in Wessex as we are currently actively engaging with the CCGs.

These updates are circulated to all GPs and practice managers in Wessex and are stored on the LMC website. The LMC is your local representative body and we represent all GPs whether they are partners, salaried GPs or locums. We also represent general practice in the broadest sense at a local level. In the complex world of the NHS, occasionally we need to remind people that CCGs and GP provider companies play an important role but they do not represent GPs, that is the role of the LMC.



1. Care Quality Commission

2. Extended Opening over Christmas / New Year

3. Death Certification and Cremation Forms

4. Skin Cancer

5. Wessex LMCs Cancer Conference 2016

6. Sessional GPs

7. Self-Care for Patients

8. Industrial Action by Junior Doctors

9. Practice Nurse Revalidation

10. Practice Manager Supporters

11. Paediatrics – Useful Information for GPs

12. SMS Text messaging

13. A tip from a GP

14. GP electronic annual practice declaration (eDec) - England 

15. Latest GPC guidance notes

16. Support available from the Royal Medical Benevolent Fund 


1. Care Quality Commission

The LMC has been contacted by a number of GPs and practice managers who are concerned about the proposed fee increases that CQC has announced recently.

The consultation on the proposed fee structure runs till the 15th January 2016. The LMC would recommend that each and every practice responds to the consultation.

The BMA is consulting with their members and is intending to robustly challenging the proposed fee increases. 

The reason given for the increases are that the Government expects the regulator to recover the costs of the inspections from the providers. The LMC’s view is all the costs should be met by the NHS and not individual GPs, after all we did not ask for this regulation it was introduced by the Government.

At a minimum the amount paid should be fully reimbursed.   Click here for more information

Table 1:  Proposed Fee Increases

  Current Fee Proposed Fee 2016/17 Estimated Fee2017/18

Single Practice

5,001 – 10,000 Patients

£725.00 £2574.00 £4839.00
Practice with 5 Sites £2681.00 £9518.00





2. Extended Opening over Christmas / New Year

There was some concern that the problems that existed last year relating to extended opening and Christmas would re occur this year and be made even more complex with Boxing Day falling on a Saturday.  There is clearly much concern about how the NHS will cope when routine services are not available for four consecutive days (25th, 26th, 27th and 28th). 

If you provide extended hours opening on Boxing Day or Monday the 28th or Saturday 2nd January, you may wish to move these hours to another day within the Christmas/New Year period.

This change needs to be supported by your CCG and should align with the broader plans being agreed by the System Resilience Group (SRGs) in your area.


3. Death certification and cremation forms - what are we doing wrong?

It is now apparent that the current system of death and cremation certification will be unchanged for the foreseeable future.

In a recent audit at a crematorium in Wessex, they found that there were problems with about 10% of the Cremation Forms completed.

The most common error is that the doctor does not give their full name of at least one person who nursed the deceased during their final illness, in Question 14.

Responses such as ‘nursing staff at Nursing Home’ or ‘D/N Sarah‘ or ’community nursing team’ cannot be accepted on legal forms, when the instructions in the question are quite explicit that full names and addresses are required.

The next most frequent failings relate to the cause of death. In a number of cases, the description of the symptoms and other conditions which led to the doctor’s conclusions about the cause of death, required in Question 9, are inadequate, and is often merely a re-statement of the causes of death given in Question 11.

The other significant problem is the is the cause of death in Question 11 being given solely as ‘Old Age’, ‘Multi-organ Failure’, or ‘Frailty of Old Age’.

Although the coroner will accept these causes for death certificate purposes, the Ministry of Justice has instructed they are unacceptable for cremation certificate purposes, in the absence of more specific pathological causes of death being given in section 1b or 1c, or, exceptionally, if the certificate is being given by the usual doctor or a partner, specific contributory causes in section 2.

Otherwise the coroner needs to confirm, in each individual case, that they do not feel the cause of death is actually unascertained, and that Old Age, Multi Organ Failure, or Frailty of Old Age is acceptable.


4. Skin Cancer - Inaapropriate requests

We have been informed by the Skin Cancer Multi-Disciplinary Team at Southampton University Foundation Trust that several patients have been offered destructive treatment for naevi without histopathological analysis.

In some cases the registered GP has been sent a 'disclaimer ' or 'consent' to sign taking responsibility for this treatment. 

It is the unanimous opinion of the Dermatology Unit at Southampton that no GP should sign any such disclaimer/consent, or in any other way condone such action.

The reasoning is twofold. Either one inadvertently mis-treats a melanoma with potentially disastrous results. Southampton has only recently had two mildly suspicious looking 'moles', seen by very experienced consultant dermatologists and carefully checked dermoscopically that have turned out to be thick melanomas. This will occur in any specialist centre anywhere in the country.

The other eventuality, which is not uncommon, is that the area re-pigments and the post 'burn' artefact looks like a melanoma - a so called 'pseudo'- melanoma. One is then left with a 'recurrence' without knowing the original histology and for which one sometimes cannot know, even with histology, if there was a melanoma or is a new melanoma.

It is therefore the unanimous view that destructive treatment of any naevus, or indeed any lesion that could potentially be a naevus, without histopathological analysis is entirely unacceptable and contravenes our understanding of both NICE guidance and basic good practice in dermatology.

Sent for and on behalf of Southampton University Hospital Skin Cancer Multi-disciplinary Team

(Any queries please contact Dr Adam Rosen -


5. Wessex LMCs Cancer Conference 2016

Cancer is such an important part of modern general practice, yet good courses that meet the needs of the average GP are few and far between.

The LMC has arranged two very successful Cancer Conferences in the past. These were organised specifically to address the common questions that GPs asked. The LMC worked closely with the local Cancer Network and the McMillan Cancer Trust to put on these events.

We are therefore pleased to work with the Cancer Network and McMillan Cancer Trust again to organise our third conference which will focus on emergency presentation of cancers and the new 2WW cancer referral guidelines.

The conference will take place on Wednesday 2nd March 2016, at Holiday Inn, Winchester. 

To avoid disappointment book early as over 50% of the places were booked within a few days of opening the event for booking.

For more details please click here – Wessex Cancer Conference.


6. Sessional GPs newsletter

Wessex LMCs represents over 3000 GP working in over 500 practices. Of these about 1000 are sessional GPs. There are more salaried GPs than locums. Two of the LMC’s Medical Directors are Sessional GPs.

Wessex LMCs is the overarching organisation that exists to serve the 3 Local Medical Committees:

Each committee is formed of elected representatives of a defined geographical area. Some are partners and some are Sessional GPs. In addition each committee has 2 specific posts for sessional GPs.

Currently we have excellent representation from a number of Sessional GPs. If you want to get more involved in representing your colleagues there will be the opportunity as elections for each Committee will take place in the New Year.

The BMA publish a regular Sessional GP newsletter - click here for details.


7. Self Care

The BMA supports self care for patients and have published guidance, FAQs and a blog to highlight the importance of self care, to coincide with the national self care week in England 16-22 November. The guidance provides some easy tips for patient on how best to self care such as:

1. Colds, flu and most sore throats do not need antibiotics and can be treated at home.

2. Order repeat prescriptions and book your flu jab in good time.

3. Get advice from your pharmacist.

4. Check online for information and advice.

The Patient Liaison Group (PLG) has published self-care FAQs for patients and a blog from the PLG chair. Further advice and resources for practices are available on the Self Care Forum website. 

Click on the following link for more information:  Self Care Forum website.


8. Industrial Action by Junior Doctors

The BMA has recently announced the outcome of the ballot of junior doctors.  The vote was overwhelmingly in favour of taking industrial action, including a full walk out. 

GP Trainees who are working in general practice and choose to join in the industrial action would involve not attending their practice on any days of action.

The BMA council recently approved the release of the dates, times and type of action. These will be:

Emergency Care only – 8am, Tuesday 1 December to 8am, Wednesday 2 December 2015
Full walkout – 8am to 5pm, Tuesday 8 December 2015
Full walkout – 8am to 5pm, Wednesday 16 December 2015

As yet it is unclear how many junior doctors will take action on each day and how each hospital will provide cover for this. One thing is clear which is general practice has no capacity to pick up additional work.

We will be working with the CCGs and hospitals and ensure you are provided with timely information updates.


9. Practice Nurse Revalidation

Revalidation for all nurses including practice nurses is starting on 1.4.16.

Please support your nurses with this, as they are naturally anxious about this new system – as were you when it started for GPs!

There is no national funding for this, unlike the GP appraisal system, so it will be necessary for the nurses to find another nurse to 'reflect' with and a manager to 'confirm ' their Revalidation evidence. Time will need to be provided for both the reflection and the confirming as these need to be face-to-face meetings.

Lots more info is on our free Lunch and Learn training resource – click here or contact Louise Greenwood on: 


10. Practice Managers Supporters

Does your Practice Manager need assistance with delegation and time management?

These are two issues seen by our Practice Manager Supporters as they meet with Practice Managers and so the LMC has given our Practice Manager Supporters training in both these areas - do encourage your Practice Manager to contact them for a chat and some top tips. More information and contact details please click here

The Practice Manager Supporters can also run the appraisal for your Practice Manager. It can be very valuable for them to spend protected time with another Practice Manager discussing their current issues and forming a professional development plan.

More information is available, please click here  or contact


11. Paediatrics – Useful Information for GPs

In the face of increasing numbers of children presenting to Primary Care and Emergency Department, a Wessex-wide resource ( has been developed for parents and healthcare staff (focusing on children aged under 5 years), aiming to:-

Acute Trusts are in the process of implementing these pathways imminently. The website is being marketed to parents through local authorities and media campaigns and the pathways have been embedded 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.  Parents are less likely to re-present if they are given consistent, explicit safety-netting advice from a trusted source.

In collaboration with parents, GPs and hospital staff, all the material on the website will be formally reviewed in 6 months time and amended as required.

Please take a moment to look at the website ( – 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.

When I get back to the surgery the first thing I am going to do is add this website to my favourites and create a shortcut on my computer.


I have already downloaded the App on my iPhone and iPad

 for the Apple App Click here                            for the Android App Click here 



12. SMS Text messaging

As you are aware the responsibility for funding the SMS text messaging service became a responsibility of CCGs from the 1st October 2015. 

The national agreement reached between NHS England and the BMA was that this service should be continue and there that there would be no degradation of any existing service provided before October 2015. This means the service your practice recieved pre October 2015 should remain in place in terms of functionality.  

This is an NHS service that practices should yuse responsibiliy and they should not be charged for.


13. GP electronic annual practice declaration (eDec) - England 

NHS England has written to practices to confirm the 2015/16 GP electronic annual practice declaration (eDec) will be open for submissions from Wednesday 4 November to Wednesday 16 December 2015. Practices are required to submit their eDec electronically through the primary care website: 

GPC provided comments on the draft eDec to help minimise the burden on practices. About 80% of the declaration has been prepopulated with responses provide from last year’s collection and the remainder are new questions. A number of questions within the eDec are marked as voluntary, and, although NHS England encourages practices to complete all questions, practices can leave the voluntary questions blank if preferred. 

Completion of the eDec is an NHS England requirement under the Assurance Framework for Primary Medical Services. The LMC recommends practices complete the eDec by the deadline. 

Practices should contact their NHS England regional team with any technical difficulties accessing or using the eDec.


14. A tip from a GP

I thought I’d share our EMIS web template with you & colleagues encorporating the paediatric website which I thought was excellent – it should be easy to import  into any EMIS web system then people can adapt & choose to use or not: I’ve found it has saved me a lot of time & typing.

Could also be used as a small bit of evidence of work going on for AUA, CQC or however else one feels reasonable to use

Please see attached document

I would like to thank Dr Gordon Turner from Leybourne Surgery for sending this to me.


15. Latest GPC guidance notes

The following guidance notes have been recently issued by the GPC and are available on the BMA website: 

 Focus on local implementation of new models of care 

 Focus on phasing out seniority payments 

 Guidance and FAQs on out of area registrations 

 Guidance on Patient registration for GP practices 

Guidance on subject access requests for insurance purposes 

 Principles for sharing local electronic patient records for direct patient care 


16. Support available from the Royal Medical Benevolent Fund 

The Royal Medical Benevolent Fund, the charity for doctors, medical students and their families, has just released its Annual ReviewRMBF website.. In 2014-15 the RMBF helped 212 beneficiaries with financial support, nearly 50% of whom were GPs or GP trainees. The charity has been helping doctors and their families for nearly 180 years, giving support through times of adversity and hardship which may have been caused, for example, by personal tragedy, financial problems, ill health or an accident. Reaching the doctors who are most in need continues to be both a top priority and a challenge for the charity. You can contact the RMBF if you are in need of financial support or if you know of a colleague who may need help – please visit the


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


Attached file: Safety-netting.xml

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