Email sent by Wessex LMCs, on Monday, 21st Mar 2016
Date sent: Monday 21 March 2016
Email sent by Wessex LMCs to all GPs and Practice Managers, on Monday, 21st March 2016
We are probably about to enter one of the most significant year for the NHS since its introduction in 1948.
The 5 Year Forward View (5YFV) published in October 2014 was clear in stating that the funding of general practice needed to be stabilised within 2 years. It also stated that general practice and community services had lacked investment over the last few years and that the future will mean greater investment in these areas.
It has been reported that many hospital trusts will be in financial deficit by the end of this financial year. The total amount of this deficit is estimated as beng between £2-2.5bn (about 2% of the NHS's annual budget).
The additional £3.4bn the NHS is going to receive following the Government's Comprehensive Spending review will be divided between creating stabilisation of the system - and then incentivising transformation. The hospitals may be facing a financial deficit in monetary terms but general practice faces a huge deficit in resources that are required to provide safe and effective primary care to our patients.
The Wessex Charter for General Practice was produced by Wessex LMCs to describe a number of solutions that could be undertaken to make general practice a more sustainable model to build on for the future. This Charter is being used in our discussions with the CCGs, the Area Team locally and is contributing to the national debate about what is needed in a package of support measure that Government announced would be published in the near future.
The NHS is currently working on geographically based Sustainability and Transformation Plans (STPs). These have to be produced by June and are bringing together the leaders from NHS England, CCGs, Hospital Trusts, Community Providers, the Ambulance Service, the Local Authority and General Practice (it is the LMC that represents general practice at a local level and has sought a place in the development of these important plans).
I am sorry this email is so long but there are a number of areas to update you on - please see below.
1. LMC Developments
The LMC has recently appointed a Practice Nurse advisor to help us to provide you with the best possible service.
This update includes details of the Lunch and Learn presentations that the LMC produces and Wessex Local Education and Training activity.
2. Publication of GP earnings
This comes into effect at the end of March and the LMC is receiving lots of questions from practices about what they have to publish about their earnings. I hope this will answer some of your questions.
3. Wessex LMCs - 3rd Cancer Conference
The LMC recently held a conference focusing on the new McMillan referral guidance and explored the progress being made in terms of survival and emergency presentations of cancers.
4. Be Clear on Cancer - Blood in Pee National Campaign
An update on 3rd national campaign on urological cancers.
5. Zika Virus
An update from Public Health about this virus.
6. Revalidation for Nurses
Are you prepared for your nurses to be revalidated - how can you help them?
7. Online access to patient records
Are you prepared for your contractual requirements at the end of this month?
8. FREE e-learning in IT - provided by the CSU for all those working in Primary Care in Hampshire and the IoW
An opportunity to access free training for a number of Microsoft Office products.
9. GPC Sessional Newsletter
You can access the latest Sessional GPs newsletter.
10. General Practice in Italy
Do you know anything about Italian general practice, are there any comparisons with UK general practice?
1. LMC Developments
Practice Nurse Advisor
We are delighted to have successfully appointed Helene Irvine as our Practice Nurse Advisor. She is a very experienced nurse currently working as an Advanced Nurse Practitioner and is also a member of the RCGP team who advise practices who are in Special Measures following an inspection by CQC.
Helene’s is a one year post initially and works for the LMC one day per week and her work will be focused in three areas:
Supporting the nursing teams in Wessex LMCs
Building relationships with HEE, CCG nurse leads, Public Health etc
Advising LEaD on nurse education and training.
Lunch and Learn
The ‘Lunch and Learn’ concept is becoming more and more popular.
Practices like to be able to buy a resource for only £30 that is up to date, relevant and can help the whole practice learn at one time. They like the flexibility that they have over when and where they run the session and new to the range are resources on:
- Mental Capacity Act
- Accessible Information Standards
Both of which are free to practices in Wessex
Other Lunch and Learn modules include:
- Chaperone Training
- Customer Service Skills
- Dementia - Free
- Emergencies in General Practice
- Equality and Human Rights in General Practice
- Information Governance
- Practice Nurse Revalidation - Free
- Understanding Conflict
For any information on local training courses to cover any of the above, please do not hesitate to contact Louise Greenwood on email@example.com
Wessex Local Education and Development - has been an important part of the range of services that we offer to our Practices. The aim was to provide good quality education and training at an affordable price with a particular focus on Practice Managers, Nurses and administrative staff. Although there is some GP education there are many others who provide services in this area such as the RCGP.
Louise Greenwood, the Education, Training and Development Manager for Wessex LEaD has done a great job since she started with us to build up an excellent portfolio of courses, conferences and online training modules.
For example in November and December 2015 there were Courses delivered in 39 different locations with 23 different topics.
There have been over 800 lunch and learn online modules download. The reputation of these resources has spread far and wide as some practices outside Wessex are now using them, which all helps to fund additional modules. If there are any areas that we have not covered then please let Louise know on firstname.lastname@example.org
2. Publication of GP net earnings
This became a contractual requirement from 1st April 2015 and there is a requirement to publish this on your practice website annually starting with the year 2014/5 by the 31st March 2016.
The publication of earnings has generated a significant amount of questions and a degree of anger in some quarters.
The first thing to point out is that there is no requirement to publish individual income. The income is the average for all the GPs working in the practice including Partners and Salaried GPs and practices must publish the number of Full Time and Part Time GPs.
All earnings are pre tax,and are net of practice expenses (for contractors).
The income should only include NHS income for providing services to patients and will include funding from NHS England, CCGs and Public Health but do not include private income or notional or cost rent. Please look at page 14 and 15 of this document - click here which gives you a detailed table of what is included and excluded.
Calculating practice income
The guidance is vague in its description of what income and expenditure is to be included and excluded. In summary, all core income and expenditure will be included net of directly attributable costs (costs of delivering the service). This is basically the sum of income from:
GMS Global Sum/PMS or APMS Baseline
nationally determined Enhanced Services
From this total practices need to subtract the costs of delivering these services and general practice administrative expenses including staff costs, telephone, printing and postage, professional fees and professional subscriptions.
The items to be excluded from the calculation are:
Locally Commissioned Enhanced Services (these include IUCDs and additional income from Minor Surgery and Extended Hours above the NES and DES basic payments)
any premises income (Rent and Rates reimbursements)
any teaching income (including training grants)
any other income from sources outside of the practice i.e. CCG income
private fee income. Any expenditure related to these services is also to be excluded.
NHS Collaborative Fees
The calculation of the mean GP earnings should include all those who have worked for 6 or more months in the practice during 2014/5. For this purpose full time is defined as those who work 8 or more sessions.
An example of the calculation of the mean earning
|Type of GP||GP earnings net of expenses||Total|
|5 Full time GPs||£90,000||£450,000|
|3 Part time GPs||As per above||£160,000|
|3 Salaried GPs||£72,000||
Total Earning for the practice are therefore £754,000 and there are 11 GPs therefore the mean earnings are £754,000/11 = £68,545.
It is worth adding that a FT GP will often work 60 hours a week, so the £90,000 figure equates to an hourly rate of £28.
The statement on this website would read:
" The average pay for GPs working in the Newtown Surgery in 2014/5 was £68,545 calculated before tax and national insurance. This is for 11 doctors who worked in the practice for 6 or more months 5 worked full time and 6 were part time."
Some practices have privately said that have no intention in complying with this requirement and it is unfair that it applies only to GPs. The publication of earnings for those whose work is funded via the public sector is now a requirement but this is for roles at defined levels and not for individuals. In addition practices will be required to declare compliance on publishing the required details on their website and in practice leaflets in the annual practice e-declaration.
Your accountant should be able to help you with this calculation.
3. Wessex LMCs - 3rd Cancer Conference
On the 2nd of March about 150 GPs attended our 3rd Conference focused on Cancer. The conference was organised and provided in partnership with the McMillan Cancer. The focus of the conference was on two week referrals and the emergency presentation of cancer.
All the presentations can be found on the LMC website - click here.
Cancer is the commonest cause of premature death (defined as those who die aged less than 75). About 50% of people develop cancer and of these 50% will survive at least 10 years. Despite the facts the NHS spends less that 6% of its total budget on cancer.
We all know that the earlier the stage in diagnosis the better the survival rates will be . Therefore there is a focus on what is called "stage shift", to work towards better access to diagnostics, specialist assessment, raise awareness etc. to improve survival by diagnosis cancer at an earlier stage.
Dr Richard Roope, a local GP and national lead for cancer for the RCGP and Cancer Research UK, was positive about the improvements that have been delivered over the last 5 years, with better outcomes and earlier diagnosis, so some really positive news for our patients and for the work that general practice does, but we still lag behind many countries in Europe. It is sad that when questions were raised about the variation in cancer diagnosis and survival the Media and Politicians used this to suggest it was the fault of the GPs and we needed league tables to identify the worse "offenders" - naming and shaming was clearly the way to sort this problem out. Perhaps looking at the amount each country spends on health, the number of doctors there are per 1000 patients, access to diagnostics should be considered? It is predictable that when the evidence was published about the improved survivals and the significant progress that has been made in the UK there was little or no coverage in the national Media or positive comments made by our Politicians.
An interesting quote that was used was -
“One person can make a difference, and everyone should try.”
John F. Kennedy
Dr Laura Watson, one of the local McMillan Cancer leads presented a local study has looked into 70 cancer patients who presented as an emergency and tried to understand the reasons for the potential delay in diagnosis. This was a small study but about 10% of these cases the diagnosis was delayed for a variety of reason and in a further 10% there possibly identifiable reasons please see below:
•not presenting to the GP
•missed appointments / declined investigations
Primary Care factors
•Absence of safety netting
•No follow up after missed appointments or tests
•Symptoms masked by co-morbidities
•False reassurance from negative tests / investigations
Secondary Care / pathway factors
•The lack of timely access to diagnostic investigations
•Patients already under secondary care / recently investigated
•Patients who do not fit 2ww criteria
•Referral into 2ww pathway from secondary care
I am sure most GPs have seen the McMillan rapid referral guideline for cancer, which are excellent, if not click here. These are excellent and worthy of a discussion in your practice.
In my practice we held a number of informal meetings over a few months. We divided the topics and selected a GP to lead the discussion. It was decided to choose the GP who probably knew least about a cancer and they were expected to prepare the topic using these guidelines. I have 7 female GPs working in my practice so very cruelly they gave me gynaecolocical cancers - (i rarely see any women with gynae problems any more) - having said that I found it very useful and it did make me read about an important area of general practice that I have become de-skilled in.
We were privileged to have Professor Willie Hamilton, a GP from Exeter and internationally known expert in the field of of how the NHS manages cancer diagnosis. The important take home messages for me from Willie's presentation were:
1. GPs are doing a great job and despite the Media criticism, we should be proud of what we have achieved with better outcomes, earlier diagnosis etc but we need to do better.
2. Guidelines are useful but there is something which we all know is equally important, namely "gut feeling" or a "sixth sense". How often have you picked up an important clinical condition, yet objectively the signs and symptoms and rigid adherence to a guideline would not have led you to this conclusion? This is not because you are psychic but relies on experience, knowledge, an enquiring mind and the understanding that medicine is not an exact science. Our clinical hunches come from diagnostic and analytical reasoning and recognising subtle variation in disease patterns.
Rather than be critical all the time of the profession the Media and Politicians should value what what have as a nation.
4. Be Clear on Cancer - Blood in Pee National Campaign
‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor’
Each year, around 17,450 people in England are diagnosed with bladder or kidney cancer and approximately 7,600 die from these cancers. If bladder and kidney cancers are diagnosed at the earliest stage, one year survival is as high as 92-96%, at a late stage it drops to just 27-37%.
This campaign follows on from two previous national campaigns that took place in October 2013 and October 2014.
Results to date show improved public awareness. The October 2014 campaign highlighted the following;
6/10 people who were aware of the cancer advertising spontaneously mentioned ‘blood in pee’ as a cancer symptom (62% increase from 31% pre campaign)
There was a 34% increase in the number of urgent GP referrals for suspected urological cancers when comparing October-December 2014 to October-December 2012.
What impact will this have on services?
Following the 2014 campaign, Trusts saw an average increase of six urgent GP referrals for suspected urological cancers per week. The peak of referrals took place two months after the campaign activity started.
Further information can be obtained from the campaign briefing sheet which can be found here - click here
Your support is vital to earlier diagnosis of cancer
- Talk about the campaign – It may prompt people who have previously ignored blood in their urine to make an appointment with their doctor.
- Make the most of available support – The NICE Suspected Cancer: Recognition and Referral guidance was published in June 2015 and can be found here https://www.nice.org.uk/guidance/ng12.
- Encourage your colleagues to support the campaign – Ensure everyone is aware of the campaign so they can support it. There are separate briefing sheets for nurses, practice teams, pharmacy teams, local authorities and community partners here http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/be-clear-on-cancer/blood-in-pee-campaign/resources-and-tools.
- Promote the campaign – Put up the poster and display the leaflets in your workplace. You can order more leaflets via the website https://campaignresources.phe.gov.uk/resources/campaigns/43-blood-in-pee/overview or call 0300 123 1002.
5. Zika Virus
Although the problems associated with the Zika Virus in South America are not in the news at the moment I am aware that GPs are still getting enquiries from patients and this will increase the closer we get to the Olympics which will take place in August of this year in Brazil.
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 via the following link on the PHE website: click here
6. Revalidation for Nurses
The LMC has been aware that following the introduction of appraisals and revalidation for GPs that eventually this process would be applied to other healthcare professionals. As I am sure you are aware revalidation and appraisals will apply to nurses from 1st April 2016.
Louise Greenwood, the LMC's Local Education and Training Development Manager (Wessex LEad) has been working closely with Health Education Wessex and the Nursing and Midwifery Council to understand, prepare and develop training for nurses in relation to revalidation. In recognition of this work in this area, Louise won an national award from the Royal College of Nursing last year.
Click here for more information about Nurse Revalidation which is available on the LMC website (always a good source of information about a wide variety of topics).
The LMC has always taken an active role in supporting GPs with appraisals and revalidation. The LMC has worked closely with Dr Duncan Walling (ex GP and Medical Director of Wessex LMCs) to develop a range of tools for GPs. These includes:
1. Multi-Source Feedback (MSF) - there have now been over 3000 completed surveys with 50,000 people contributing to the feedback.
2. Patient Feed back - there have now been over 2500 completed surveys, with over 100,000 responses from patients.
3. Revalidation toolkit - this is widely used by GPs in Wessex.
As part of the professional feedback - the LMC has helped develop questionnaires for GPs, Medical Leaders, Medical Educators, Practice Managers and Practice Nurses. The Nurse feedback can be used for Nurse appraisals and revalidation.
There are other tools available, for example some GPs use Clarity and they have developed a toolkit for nurses.
The reason that the LMC supports the products that have been produce by Fourteen Fish are that the products have been designed to be easy to use and are available at an affordable price, as an LMC we have played a significant part in development and implementation, ensuring they are fit for purpose and the LMC gains some income from the surveys. The income the LMC earns from these products is then used to support the GPs and Practices of Wessex.
A document is attached to provide you with more information about Nurse Revalidation - produced by Fourteen Fish.
7. Online Access to Patient Records
Practices have until the 31st March 2016 to enable online access to patients' detailed coded records. This is a contractual requirement. In some parts of the country we are aware that only about 50% of practices have enabled this facility.
I know there are concerns that have been expressed by GPs and Practice Managers but in practices who have enabled this for sometime they have experienced few problems.
You can download online resources here:
Royal College of General Practitioners (RCGP) - there are some very useful resources on this site including a video and toolkit.
Whilst promoting online access to clinical records I am sure we need to make greater use of online booking and online requesting of prescriptions, both of which have the potential to reduce the workload at practice level.
8. FREE e-learning in IT
The CSU have released some FREE e-learning modules for all working in primary care in Hampshire and IOW:.
The content is:
Microsoft Office Essentials
and there are various levels (1-3) in each category.
(Please note that you do need adobe shockwave installed to access the modules - details on the attachment)
I hope this will be useful.
If you have any queries at all about it - please contact
9. GP Sessional Newsletter
The March edition of the sessional GP e-newsletter was published yesterday, a copy of which is below and also available Click here.
10. Italian General Practice
There is a organisation which probably few have heard of called UEMO or the European Union of General Practitioners/Family Physicians. This body represents all GPs and Family Physicans working within the EU. Although we often believe that UK general practice is unique (which I believe it is) it is sometimes worth looking at what other countries provide.
The current President of UEMO (who is an Italian working in a practice in North Italy) attended a recent GPC meeting and presented some thoughts and insights to the current challenges that face us all.
In Italy 50% of practices are single handed, they offer services from 8am to 8pm Monday to Friday and between 8am and 2pm on a Saturday. They have personal lists up to a maximum of 1500 patients. They are paid on a capitation basis. Their last contractural review was 7 years ago and the profession is currently in dispute with the Government. There was a stike in December 2015 with more planned but these have been delayed to allow more time for negotiations with the Government. There is a move to create large practices in Italy.
Although the sytems of general practice are quite different in each country there is clearly some interesting parallels.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: Zika-virus-guidance-for-primary-care-February-2016-FINAL.pdf
Attached file: NMC-Revalidation-by-FourteenFish(1).pdf
Attached file: CSU-GP-eLearning-Brochure-for-Hants-and-IOW.docx