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Email sent by Wessex LMCs, on Thursday 21st April 2016

Date sent: Thursday 21 April 2016

Email sent by Wessex LMCs, on Thursday, 21st April 2016

Another email I am afraid, I started to put one or two things together and seemed to be overtaken with topics that I thought worthy of sharing, so once again sorry about the length of my email.

Today an important document has been published called General Practice - Forward View - please click here.  This is too important to be embedded in an email about many different things and will be the subject of a detailed analysis in the next few days.

As we enter a new financial year we await the Government's announcement on a package of measures to make general practice sustainable.  It is clear that there is not one simple solution and for most GPs it is about reducing the workload to a manageable size, therefore regaining some control of the working day, which might then encourage younger doctors to join the profession and persuade older GPs who have the wisdom and experience (well a few do!) to remain in the profession. Whatever action and funding the Government is prepared to undertake it is clear that general practice will also need to change over the coming years.

You may not have heard of the Sustainability and Transformation Plan (STP) but this is going to be critical to our future.  The NHS receives a little over £100bn per year.  This year there is an additional £3.4bn which is intended to help deliver the Five Year Forward Plan and invest more in 'out of hospital care', particularly in general practice and community services.  It has been decided that £1.8bn of this fund for 2016/7 will be used to ensure the sustainability of hospitals (used to address financial deficits).  The rest of the funding will be used to help with transformation.  

Commissioners and providers have been asked to develop a plan called an STP and this will provide the blue print for the development and transformation of health systems in England over the next 5 years. In Wessex we have 3 STPs being developed and these are  Hampshire and the IoW, Dorset and Bath, Swindon and Wiltshire.  In terms of providers the acute hospitals, community providers and the Local Authorities are represented on these groups. The LMC, as the only representative of general practice as providers, has secured a place on all 3 STP Groups.

It is early days but the LMC is making it clear that the current problems with sustainability is not just about hospitals, that general practice and community services are equally important and could be argued more important as in the last 5 years the vast majority of additional funding has gone into hospitals and if general practice and community services fail hospitals will be overwhelmed.


1. Skill-mix in General Practice - what are the training needs?

2. Sessional GPs Newsletter

3. Firearms and Shotgun Licences

4. Improved care for children - potential to reduce workload

5. Acute Kidney Injury

6. Policies to check before a CQC Visit

7. Prostate Cancer 

8. Macmillan Cancer GP and the Cancer Network

9. Urgent Prescription for General Practice  

10. Hospital test results – please use national templates

11. QoF Update for 2016/7

12. Accessible Information Standard



1. Skill-mix in General Practice - what are the training needs?

The Government has promised 5000 additional GPs by 2020. This target is not going to be met. If we accept that the major problem that general practice faces is workload which is out of control and is directly responsible for younger GPs not wanting to join the profession and older GPs leaving, then if we are unable to train 5000 additional GPs then who else can we train and how many?

There is good evidence that Advanced Nurse Practitioners, Pharmacists, Mental Health Workers, MSK Specialists and Physicians Assistants etc. can all make a significant impact to the practice team and support GPs by taking on some of the work traditionally carried out by GPs.

I sit on the Board of Health Education Wessex and we have been discussing the future training needs of Allied Health Professionals.  We need your help to evaluate the scale of support each of these groups could provide to general practice.

I am working closely with Dr Stuart Ward, a GP from Chandlers Ford, who is developing proposals on the future training needs for general practice on behalf of the Academic Health Science Network.

If you would like to help, it would be enormously useful if you could download the form attached to this email.  If over a one week period you could then record the number of patients that needed to be seen by a GP and those that could have be seen by another person and identify which professional group that would be.  The form is simple and I have used it for a week in my practice.  It only takes 2-3 seconds per patient to make a mark on the form.

For the patients I have seen about 1/3 could have been managed by one of the groups detailed above.

If you are willing to help please email Julia Carthew -  providing your name and  address and she will send you SAE to return your forms.  It would be interesting if the whole practice could undertake this task over a one week period.


2. Sessional GPs Newsletter

Please see a link to the latest GPC's Sessional GPs e-newsletter - click here


3. Firearms and Shotgun Licences

Since the new firearms process went live from 1st April, the BMA and the LMC has received a very large number of complaints from GPs regarding fees payable for responding to the initial letter received from the police.

The BMA will therefore be issuing amended guidance (see below) on the BMA website - click here - which clearly states that it is up to the GP to decide whether to undertake the work with or without charging a fee.  

Fees for responding to the Police letter regarding firearms

Following the introduction of the new firearms licensing process GPs have already raised considerable concerns  over the process and whether or not they can charge a fee for responding to the letter from the Police, indicating whether they have any concerns and have placed a code on the patient’s medical record.

BMA revised guidance on fees

The response to the Police’s letter indicating whether there are any concerns and that a code on the patient’s medical record as been added is not part of a GP’s contract. It is therefore up to the GP to assess how best to proceed taking on board the following factors and guidance:

1.      The work involved in responding to the letter is minimal and therefore can be undertaken easily without delay and without a fee.

2.      The work involved in responding to the letter requires time and resources from the practice that necessitate a fee to be charged to the patient (the Police should not be charged). The BMA would advise GPs to seek confirmation from the patient that they are in agreement to pay a fee before undertaking the work so not to cause additional confusion or delay. If there is a delay owing to this and you are unable to respond to the letter within the 21 days, please notify the police of this.

3.      No one in the practice is available (e.g. on holiday or off sick) to complete the work within 21 days. Please notify the police without delay.

4.      The practice does not have the capacity to undertake the work within the 21 days. Please notify the police without delay.

 5.      That the GP has a conscientious objection to gun ownership and no other GP in the practice is available or able to undertake the work. Please notify the police without delay.


4. Improved care for children - potential to reduce workload

In the past quite a lot of publicity has been given to the pressures that are placed on hospitals by those who need access to healthcare. Hospitals have seen a significant rise in the rates of urgent care paediatric presentations over the last couple of years.  This increase has also been seen in general practice.

I am sure we would all agree that it would be helpful if parents/carers had greater confidence in managing self-limiting conditions at home, and where necessary they could be signposted to the appropriate help. One of the challenges can be where advice is at best inconsistent and sometimes in conflict. It would be helpful if healthcare professionals provided a consistent message.

Would you like to reduce the number of children who attend your surgery for self-limiting conditions?

The LMC has been working with local Paediatricians and Children's Services in the "Wessex Healthier Together" project - click here for more information.

Resources available include:





Why not add a link to your practice website and add a link to the Wessex Healthier Together Facebook page?

I have downloaded all the safety net advice sheets and linked them to our Clinical System and have already handed out two advice sheets to two grateful parents.



5. Acute Kidney Injury (AKI)

The NHS England Patient Safety alert recommended April 2016 as the launch date for primary care AKI reporting.  Shortly electronic alerts for AKI will be sent to primary care.  This reporting has been in operation within secondary care for over a year and NHS England has set April 2016 as the date for the launch of this reporting for primary care. The AKI stage (I, II or III) will appear as part of the ‘Renal Profile’ in the biochemistry reports.

In 2009 National Confidential Enquiry into Patient Outcomes and Death  (NCPOD)  in its publication ‘Adding Insult to Injury’ reported the need for further improvement in the care of patients who have AKI as part of their overall clinical presentation and in 2013 NICE CG 169 published its recommendation for further improvement in AKI care.

Identification and management of AKI is part of basic clinical care but yet another area requiring more attention in the care of our patients. To help with this process a brief guide, based on NICE recommendations, it attached to this email.

How many of us will stop diuretics, ACE Inhibitors or NSAIDs if patients have a potential dehydrating illness?  Do we advise "sick days" in admission avoidance plans?

This advice not only applies to how we manage our patients but also gives clear advice about those who have been found to have AKI following an acute hospital admission.



6. Policies to check before a CQC Visit

This article that was recently published in Medeconomics may be of help for those who have not had their visit yet - click here


7. Prostate Cancer 

Updated guidance for GPs on PSA testing for prostate cancer - click here


8. Macmillan Cancer GP and the Cancer Network

The Wessex Strategic Clinical Network (see below for more information about the SCNs) are very fortunate to have developed a really strong relationship with Macmillan locally and as such have funding to support 9 posts across Hampshire, Dorset and the Isle of Wight for GPs to work alongside the network to improve cancer services.

Two of GP team are moving to different areas of focus clinically and have therefore decided to step down from their Macmillan posts. From 1st June the SCN will have a total of 4 sessions per week to offer out to GPs across Hampshire and Dorset who may wish to take up work alongside the network.

One vacancy is based in Dorset and we are looking for a GP who is currently working in practice, but would be able to work up to two sessions per week with the network, focused on the living with and beyond cancer agenda.

The other post can be based in Dorset or Hampshire and we would be looking for someone to be more of a ‘Wessex wide’ representative, working alongside the existing network to develop our improvement programmes.

For more information please contact:

Sally Rickard  email:

Strategic Clinical Network Manager

NHS England (Wessex)

I am sure many GPs have never heard of the Clinical Senate or the Strategic Clinical Networks (SCNs).

NHS England was established in April 2013 as a direct result of the Health and Social Care Act 2012. Its key aim was to secure the best possible health outcomes for patients, by making them the priority in every decision taken.

NHS England oversees the twelve Strategic Clinical Networks (SCNs) and Clinical Senates, as set out in ‘The Way Forward: Strategic Clinical Networks and Clinical Senates’. Within NHS England there are four regional teams (North, Midlands and East, London and South), and within the NHS South there are seven Area Teams, of which Wessex is one. The Wessex Area Team hosts the Wessex Clinical Senate and SCNs.

For more information - click here


 9. Urgent Prescription for General Practice                       

The BMA has just published a third wave of heat map survey results from its Urgent Prescription for General Practice campaign - click here.

At a time when large numbers of practices across the country are struggling with vacancies, this heat map reveals the desperate situation of practices unable even to obtain locum cover to provide essential services to patients.

Most GP practices – about 90 per cent in England – have struggled to recruit locums in the past year. Almost half of practices (46 per cent) have had trouble finding locums ‘frequently’ and a further 40 per cent have had trouble ‘occasionally’. The South and South West are the worst affected areas, with 61 per cent and 57 per cent ‘frequently’ having trouble finding locums.

Only one in 10 practices said they did not need locum cover at all. See the latest infographics - click here.

This inability to recruit locums is exacerbating the workload crisis in general practice, as partners and salaried GPs have to try to absorb an increasingly unmanageable amount of work.

GP locums do an outstanding job of stepping in to provide care at short notice but it is clear there is no longer enough to cover the widening gaps in the GP workforce. The Government needs to provide practices with support rather than sanction, and should make it clear to the public that the reason GP practices struggle to provide enough appointments and adequate access is because there are already too few GPs. 

Crucially, this survey’s findings demand the Government addresses this GP workforce shortage head on and delivers its promised support package for general practice.



10. Hospital test results – please use national templates

Following NHS England’s recently published guidance on standards for the communication of patient diagnostic test results on discharge from hospital, the key principle is 'the clinician who orders the test is responsible for reviewing, acting and communicating the result and actions taken to the GP and patient even if the patient has been discharged'. This reinforces joint guidance between the GPC and the BMA consultants committee.

I urge practices to resist any imposition of inappropriate work, by using the templates designed by GPC. You can access these on the BMA website, including:

– An existing Quality First template to reject inappropriate requests to follow up hospital investigations

– A  new template  to send copies of test results back to hospitals to ensure/confirm they have been actioned by the requesting clinician.

– A new template to let the CCG know if the above principles are being breached, so that appropriate commissioning levers can be applied



11. QoF update for 2016/7

The BMA webpage ( has been updated to reflect the minor amendments made to QOF for 2016-17, which are:

An adjustment to the value of a QOF point taking account of population growth and relative changes in practice list size from 1 January 2015 to 1 January 2016. The national average list size as of 1 January 2016 is 7460 and the value of a QOF point for 2016/17 will be £165.18

You will also be aware that as part of the negotiations for the 2017-18 contract, NHS Employers and GPC have agreed to explore ending QOF in its entirety.



12. Accessible Information Standard

The "Accessible Information Standard" aims to ensure that disabled people have access to information they can understand and the communication support they may need. Practices in England are expected to follow the Standard by 31 July 2016. Please see attached.


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: Focus-on-the-Accessible-Information-Standard-April-2016-FINAL.pdf

Attached file: CS40006_Wessex_AKI_Primary_Care_Guidelines_A4_FINAL[1].pdf

Attached file: CS40977_Wessex_AKI_Primary_Care_Top_Ten_Tips_A4_FINAL_WEB.pdf

Attached file: 160322-WPC-Project-Alternative-Professional-Questionnaire-v05-draft[1].docx

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Updated on 26 April 2016 1830 views