Email sent by Wessex LMCs, on Sunday, 21st Feb 2016
Date sent: Sunday 21 February 2016
Email sent by Wessex LMCs, on Sunday, 21st Feb 2016
If general practice is to address the challenges we faces then we need of solutions and not empty promises or political spin.
The Editorial in this weeks BMJ is entitled - "If general practice fails, the whole NHS fails" - this article is written by two eminent GPs, Sir Sam Evernington and Professor Martin - click here to read the editorial.
I have been stating this fact for some time and we have reached a point in time that this statement will be tested unless general practice receives significant additional investment and accepts that there will need to an evolution of the way that care is delivered by general practice, community services and hospitals.
Earlier this week I published a "Wessex Charter for General Practice" - this was intended to stimulte discussion and provide hope to many. The feedback for GPs and Practice Mangaers has been really positive.
We need solutions to be delivered at a national, regional and local level.
NHS England and CCGs need to act now before it is too late.
What can you do to help?
In Wessex we have many good MPs who care about their community and the public services that are provided to their constituents.
A number of practices who are struggling to recruit and retain GPs have met with there local MP to discuss these problems. Consider contacting your MP and arrange for them to visit your practice to discuss the challenges that you face but also present them with some solutions that you think would address this problem - the Wessex Charter for General Practice may be a good place to start!
- GP Contract Changes 2016/7
- Meningitis B Vaccination
- Zika guidance for primary care
- New referral system of medical suitability of gun owners
- Patient Group Directions and Patient Specific Directions
GP contract changes 2016/7
These changes need to be considered in the context of two linked but separate processes.
Firstly there is an annual review of a contract that could involve minor changes. This happens every year to the GMS and PMS contract.
The second and currently the more important discussion has to be about addressing the major challenges that general practice faces. This includes workload, recruitment and retention and developing a service that is safe, effective and one in which starts to attract new GPs and retains older one.
The first part was the announcement on Friday of the GMS Contract changes for 2016/7
These changes will apply to GMS and PMS practices.
We know that general practice will be facing a significant increase in employers National Insurance costs, CQC fees, Indemnity cover and superannuation. GPs have seen their income fall year on year since 2006 whereas the rest of the NHS has received the Public Sector uplift of 1%.
The aim of negotiations this year was to ensure that cost of additional expenses were met in full and the changes to the contract should be minimal.
The contract changes for 2016/17 are far fewer than in previous years, and in keeping with two key resolutions passed at the special conference in January; to minimise the disruption of annual contract changes to practices and that the reimbursement of GP expenses must be properly funded. This agreement provides for increased core resources and reimbursement of expenses to an extent not achieved in recent years, and should help support practice financial pressures. The headline agreed changes are:
- A £220m investment of new funding in the contract – more than double that last year – and seven times greater than in 2014/15
- Recognition of GP expenses, which for the first time has taken account of individual components that include rises in Care Quality Commission (CQC) fees, indemnity costs, national insurance contributions, superannuation and increased utility and other charges
- An intended 1% net pay uplift.
- A 28% increase in vaccination and immunisation fees from £7.64 to £9.80.
- Ending of the imposed dementia enhanced service, therefore reducing the workload and bureaucracy of this flawed scheme, and with resources going into global sum.
- No new clinical workload requirements and no changes to QOF indicators or thresholds.
- A commitment from NHS England to explore a national strategy to manage demand through self-care and appropriate signposting of patients to services .
- A commitment to explore ending QOF and the Avoiding Unplanned Admissions enhanced service in 2017/18
Full details are available on the GPC homepage.
The second part is the "rescue package for general practice"
At the recent special conference of LMCs a motion calling for the GPC to negotiate a "rescue package for general practice" within 6 months and if this could not be achieved there would be a call for a ballot of the profession to submit undated resignations.
Recently the Secretary of State said:
’General practice is the jewel in the crown of the NHS, but it’s one we’ve neglected for too long. 2016 will be the year that we make steps towards hiring more GPs, in order to fill our ambition of 5,000 more doctors working in general practice.’
In 2013 Accident and Emergency Departments were struggling and we immediately given a £500m bail out. Accident and Emergency Departments see approximately 24 million people per year this is compared to the 340,000,000 seen in general practice.
General practice needs additional resources and they are needed now, they also need to be recurrent to have the desired impact.
Meningitis B Vaccination
The LMC is receiving a lot of emails from practices asking about Meningitis B vaccination. Because of the recent publicity many parents whose children fall outside the current cohort who are entitled to NHS vaccination are asking if the practice can vaccinate their child outside
Dear Colleagues (practice managers) please could you circulate the following information regarding MenB within your practice.
Meningitis B Petition and media coverage
Practice staff will be aware that there is currently media coverage regarding a petition to Parliament for all children under 11 to be given Men B vaccine. This has gained impetus following endorsement by Matt Dawson, whose son also contracted meningitis (although it should be noted that this was with a different strain for which there is already a comprehensive vaccination programme).
The Department of Health have issued the following statement:
"Our thoughts are with Faye's family at this difficult time.
"When any new immunisation programme is introduced, there has to be a date to determine eligibility - a decision based on the best independent clinical recommendation to ensure we can protect those children most at risk of MenB.
"When our nationwide MenB vaccination programme was introduced last year, England became the first country to protect our babies from this devastating disease. All children who are now aged up to 9 months should have been offered the vaccine."
The Department of Health is advised on immunisation matters, including the effectiveness and cost-effectiveness of new vaccines by the independent expert body, the Joint Committee on Vaccination and Immunisation (JCVI) - https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation. The JCVI advised that the Meningococcal B vaccination programme should aim to protect infants before they reach five months of age because this is when the risk is greatest. The vaccine is first offered to children from 2 months of age.
MenB immunisation was introduced from 1 September for those babies who are due to receive their primary immunisations starting at 2 months of age on or after 1 September 2015 (i.e. those born on or after 1 July 2015), with a one-off catch-up programme for those infants born from 1 May 2015 to 30 June 2015.
Children who are now aged up to 9 months should have been offered the vaccine.
When any new immunisation programme is introduced, there has to be a cut-off date to determine eligibility. We recognise that families with children outside the eligible age groups will be naturally disappointed, but there is no other way of realistically starting new programmes.. At the same time, the number of children vaccinated will continue to increase as the programme grows and by next year, one year olds and many two year olds will also be protected by the vaccine.
(Please note: Men B vaccine is also recommended for administration to patients in certain at risk groups in addition to the primary childhood programme detailed above – see full details in the Green Book).
Private administration of MenB vaccine
We realise that parents are very likely to approach practices requesting private administration of the MenB vaccine. It should be noted that GPs cannot administer vaccines on a private basis to patients on their own practice lists.
It is not appropriate for NHS England to advise of or signpost to any private suppliers of these vaccines as these suppliers act outside of the NHS and we cannot therefore assure that they are following the required standards for the safe storage, supply and administration of these medicines.
There is also currently a shortage of supply of the Men B vaccine, and although this does not affect supply to the national programme via ImmForm, it may affect access to private supplies.
Contact by parents does, however, present an opportunity for practices to check the child’s immunisation status and to offer any immunisations that the child may have previously missed to ensure they are as fully protected as possible against other strains of meningitis and other diseases with potentially serious consequences (HiB/MenC/PCV/MMR etc). We would encourage practices to do this wherever possible – particularly in light of the fact that we understand that the currently publicised case relating to Matt Dawson’s son involved a different vaccine preventable strain.
If Practices have any queries regarding this or any other vaccination programmes please contact the Screening and Immunisation Team at firstname.lastname@example.org
Please do not contact the local Child Health Teams as they are not able to assist with clinical matters or those relating to eligibility.
Further information can be found at https://www.gov.uk/government/collections/meningococcal-b-menb-vaccination-programme
Zika guidance for primary care
This is joint guidance between PHE, the BMA and RCGP and gives information and advice for practices when approached by patients who have travelled, or may be planning to travel to affected countries, and focuses on risks for pregnant women.
Further information about the Zika virus and countries affected is available on the PHE website - click here.
New referral system of medical suitability of gun owners
In 2014 Wessex LMCs were working with the Home Office piloting the use of an Icon on a patient's electronic medical record to help GPs by flagging up that the patient held a firearms licence.
Please see the LMC website for further details - click here.
Discussions have been continuing nationally because a review of deaths caused by shooting where the person committing the offence held a firearms license, in each case if was found that the person committing the crime had a significant health issue.
A safer system for firearms licensing is being introduced in April to improve information sharing between GPs and police and to reduce the risk that a medically unfit person may have a firearm or shotgun certificate. At present, the police usually only contact an individual’s GP before the issue of the certificate if the applicant has declared a relevant medical condition. After the certificate is granted there is no reminder system to inform the GP that the patient they are seeing is a gun owner.
From 1 April 2016:
- Police will ask every firearm applicant’s GP if the patient suffers from specific health issues, such as depression or dementia.
- GPs will be asked to place a firearm reminder code on the patient’s record. This means the GP will know the person is a gun owner, and they can inform the police licensing department if the patient’s health deteriorates after the gun licence is issued.
- New guidance will be published to help GPs and police operate the new system. Responsibility for deciding if a person is suitable to hold a firearm certificate remains with the police.
The new system was developed after the BMA raised concerns about weaknesses in the current process with the Home Office. It has been developed by the BMA, RCGP and the police, in conjunction with shooting associations and the Information Commissioners Office.
Patient Group Directions and Patient Specific Directions
The GPC guidance Patient Group Directions and Patient Specific Directions in General Practice has been redrafted to clarify the position of PSDs, confirming that they do not necessarily have to be in written form, but can also be a verbal instruction.
The new guidance is attached, and is also available on the BMA website via the following link: Click here
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)