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LMC Update

Date sent: Tuesday 24 January 2017

Email sent by Wessex LMCs, on Tuesday 24th Jan 2017

Life can only get better from now on, apparently Monday 16th January was known as Blue Monday because it was the most depressing day of the year!  

This is because the Christmas and the New Year celebrations are over with, the evenings remain dark and it is often wet outside.  Apparently it has nothing to do with the number of ambulances stacked up outside local hospitals or the number of patients waiting on a trolley in A/E and definitely nothing to do with general practice.

I try and keep up with all the young GPs who are into the modern communication methods (apparently faxing is old technology) such as Twitter and Facebook.  I confess that I do have a Facebook account but not really sure how to use it. I do belong to 2 Facebook Groups, one called Resilient GP with over 6500 members and the other called GP Survival which has over 6000 members. This can be a useful forum for GPs to mutually support each other. I try and be helpful by answering some questions and to offer an explanation to some of the challenges that we face.  Unfortunately one of the downsides to the modern forms of communications is a few people can get carried away and place the blame of the problems we face at those who are trying to be helpful.  

There are those on these groups who are very critical of GP leadership whether this be at national level of the GPC/BMA or at a local level with LMCs. I suppose history tells us repeatedly that when we face difficult times some will look to blame their leaders rather than look to the real cause of the problems.

I can assure you that your LMC is working very hard to support you and your practice and we are sparing no effort to address the problems that we all face. 


1. LMC Roadshow

2. Media coverage of general practice

3. Pharmacists working in general practice

4. Gluten-free products - should GPs prescribe these?

5. Atypical practices

6. Firearms certification

7. NHS GP Health Service

1. LMC GPC Roadshow

This meeting will take place on Wednesday 8th February at the Holiday Inn in Winchester , starting at 7.30pm finishing at 9pm. Food will be available from 7pm.  The demand for this event means that a significant number of places have already gone. If you would like to attend the meeting please book your place by emailing -

Please only book a place if you are able to attend and if your plans change let us know. At recent LMC conferences a number of GPs booked places but then did not attend and this means that others who wanted to attend were denied a place and the LMC had to fund the place that was unfilled.


2. Media coverage of general practice

We are barely into the New Year and the profession is faced with further media onslaught of negative coverage about general practice. 

The media seem to be sympathetic to the pressure that hospitals face but rather than realising this pressure it is reflected 10 fold in general practice aznd they seem to think that we are an easy target to blame for all the woes that currently exist in the NHS.

I recently had ITN News filming in my surgery on a busy Monday morning and the crew were amazed at the demand that a practice has to cope with.

The problem that hit the headlines recently came about as a direct result of some of the data published in the National Audit Office’s (NAO) report on “Improving patients access to general practice”.

The full report can be accessed by clicking here.

The key facts in the report are as follows:

The report goes on to recognise that most of the contact people have with the NHS is with general practice and that this is often the first step patients take in diagnosing and treating health conditions.

Some of the key findings are:

Inequalities in the funding of local areas

Funding should be allocated equitably according to needs so that local areas have an equal opportunity to provide good access.  The problem is that the current system fails to do that . The current system means that the difference between the lowest and highest funded areas is £63 per person (47%).  This variation will be reduced by 2020/1 to about half (26%).

It is worth reflecting on how the £9.3bn is invested in general practice.


Core funding                         52%

Enhanced services               11%

Premises                                9%

Dispensing drugs                   8%

QoF                                        7%

OOHs                                     5%

Others                                    7%

(this includes IM&T)


LMC Comment:

This is an important report that has been produced by a well respected Independent Parliamentary Body.

The part of the report that the media focused on was the practices who close for a half day a week and then are paid to provide additional opening hours to meet the needs of their patients.

On the surface this may seem to be unacceptable and poor value for money for the NHS but there may be justifiable reasons why some practice do close. 

Consider a rural practice where their are lots of commuters, there may be a need for access outside core hours but the demand during the day is such that a practice can still deliver its contractual requirement by working with a local practice who covers the requirement to deliver essential services on one afternoon per week. 

All practices should consider there opening times and if the practice closes during core hours not only be able to justify the reasons for this but also ensure that they deliver essential services during the time the practice is closed.  I am not aware of many practices that close for a ½ day per week (this does not include branch sites) in Wessex.

It is worth reflecting on some key messages in this report that goes far beyond the practices that close for ½ a day a week including:


3. Pharmacists working in general practice

NHS has recently advertised the next stage of the programme to create an additional 1,500 pharmacists working in general practice by 2020 and this is back by £112m of national funding.

The first phase was launched in July 2015 and led to 490 more clinical pharmacists working from GP surgeries across the country.

The evidence strongly supports the value of having clinical pharmacists working in practices as part of the practice team.

For more details – click here.


4. Gluten-free products - should GPs prescribe these?

The LMC has been contacted by a number of GPs recently as CCGs have informed practices in some areas  that they are going to stop practices prescribing gluten free products and medication that is available OTC.

The LMC agrees with the principle that patients should be encouraged to access OTC medicines and pharmacist advice prior to consultation with a GP and we are happy to support the CCG in working with practices and patient groups to encourage this.

However, the CCG has no authority to stop general practitioners prescribing  either gluten free products or OTC products that are available on an NHS script.

Gluten free foods are now widely available and are much less expensive than they once were so again we are happy to support efforts to encourage people to buy these products themselves. 

The LMC would agree that the products that are prescribed should included essential foods such as bread and pasta but probably would not include biscuits etc. Practices should also ensure that they are prescribing appropriate amounts for an individual to consume and not to feed a whole family.

The Regulations (GMS and PMS) are clear.

A registered patient has a right under the regulations to request an FP10 and the contractor “shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under contract by issuing to that patient a prescription form” (GMS regs – Schedule 6, Part 3 , Para 39 (1): PMS regs – Schedule 4 – Prescribing, Para 1.2).

If a patient asks a GP to prescribe an item and that item is available on an NHS prescription then the GP is bound by legislation to issue the patient with a prescription on an FP10, if they believe it is clinically appropriate to do so.

The ACBS regulations define conditions for which gluten free foods are necessary and may be prescribed. If a GP follows the CCG's proposal to refuse to prescribe these products, then they will be in regulatory and contractual breach and open to risk of action by the Ombudsmen and the GMC in addition to the commissioner of their GMS or PMS contract.

The LMC supports the Scottish model whereby general practice no longer supplies gluten free products the responsibility lies with the Pharmacies.


5. Atypical practices

There is no doubt that general practice and the wider community services have not received the investment that is required to keep pace with the rising demand. This has been acknowledged in the GPFV by Simon Stevens the Chief Executive of NHS England. General practice receives funding on a weighted capitation basis and this is calculated using a complex formula. The formula means that some practices do very badly because of their population weighting.  This is particularly stark in practices that have a very young population and University practices.

NHS England has recently produced guidance for commissioners relating to atypical practices – if you wish to read this guidance – click here

and then look at the bottom of the page to see the link to the guidance.



6. Firearms Certification

This single issue has probably caused more emails, questions and expressions of anger than any other single topic over the last 12 months.  I think GPs have been placed in an extremely difficult position.

The GPC hopes to release new guidance in the next month, and I hope this will address many of the concerns that we all have.

There is a balance here because a review carried out in 2014 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.

It is important to understand that it is the police who decide whether to issue a Firearms licence or not, the role of the GP is to supply factual information.


7. NHS GP Health Service

As part of NHS England’s commitment to support GPs and GP trainees who wish to remain in or return to clinical practice after a period of ill health, the new NHS GP Health Service will launch on 30 January 2017.

The Hurley Group Partnership will be the service provider and it will be available throughout England. This service is separate to the primary care OHS (occupational health services) click here for more details, which is offered to GPs, dentists, pharmacists and opticians as individual performers and available to other primary care staff via a fee for service or block contract paid for by their employer.

A dedicated website will go live on the launch date and vulnerable GPs will be able to contact the service directly and seek the confidential support they need. Further information about the service is available on NHS England’s website. This will be updated further on 30 January and will include the link to the dedicated website.


8. Sessional GPs e-newsletter - UK

Please find a link to this month’s edition of the Sessionals newsletter, which this month focuses on, amongst other things, Capita and the NHS Pension, Indemnity arrangements for sessional GPs, and death in service benefits for sessionals.

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


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Updated on 24 January 2017 1052 views