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Wessex LMCs email update - 28th May 2017

Date sent: Sunday 28 May 2017

Email sent by Wessex LMCs, on 28th May 2017

 

With the tragic events that occurred in Manchester this week, we can reflect on our troubles and such events put our issues into perspective. I am sure our thoughts and prayers go out to the families and friends who have lost loved ones. In addition there will be many who attended the concert who will have physical and mental injuries caused by this pointless and callous atrocity. 

Our thoughts are also with the GPs and Practices in and around Manchester who will be dealing with the aftermath of the bombing, now and into the future.

 

The LMC remains concerned about the level of recruitment and retention in general practice.

We cannot wait for national solutions, the problems are evident and facing many practices now.  The GP Forward View is providing much needed support and resources to help practices who are vulnerable and facing severe challenges. There is investment in the training of the workforce and in methods of working more efficiently. But we need to retain and expand our workforce to meet the demands we are all experiencing.

The NHS GP Health Scheme is now available in our area and is being used - click here for details.

The New Models of Care is having an impact in some of our localities with additional services and resources being made available to support general practice. For example a new frailty service has been commissioned in the New Forest, which with help and support practices with the growing number of elderly patients.

The investment in extended opening delivered at scale (£6 per patient) could have a beneficial effect if it is truly supportive of practices and is embedded in the locality.  If it is commissioned and works like a traditional walk-in-centre it will provide another point of access but have little impact on practices or hospitals as has been demonstrated in the past.

There is no one solution for us but we need to take advantage of things that are happening both locally and nationally and use them to benefit both our patients and our practices.

The LMC is well aware of the vacancies that exist in many practices and also that we need to recruit the next generation of GPs and retain the older GPs.

At the national LMC Conference I had the privilege of talking to a number of GP Trainees from around the country. What came over loud and clear was where they had had a positive experience in a training practice, supportive environment, enthusiastic GPs and wider practice teams, felt valued then they were positive about their future and the role they could play in our profession going forward. If t their experience is a negative one where they do not feel valued, the GPs in the practice are negative about general practice and the future  we cannot expect to retain these young GPs. The quality of training in Wessex is very high and I believe we produce many high quality GPs for the future we just need to find better ways of retaining them!

 

Contents

1. New Medical Director

2. Speed dating - could this be the solution to our problems?

3. Practice Manager Conferences

4. Learning Disabilities Conference (Hants and IoW)

5. Capitation Payments and Registrations

6. Capita and Primary Care Support England (PCSE) - NHS England

7. Frailty and the end of the AUA DES

8. The Coroner - Medical Certificate Certification of Death (MCCD)

9. Cyber attack

10. Advice to Diabetic Patients

11. RCGP’s Scientific Foundation Board is now open for applications for grants of up to £20,000 for primary care research

12. The Cameron Fund

 

1. New Medical Director

Dr Andy Purbrick has joined the LMC as an additional Medical Director with a particular focus in Dorset. Andy trained at St Bartholomew’s Hospital Medical School and completed his GP training on the Poole VTS. He works as a partner in the Hadleigh Practice in Poole, where he is a trainer and is involved in medical student training. He has been a Partner since July 2002.

 

2. Speed dating - could this be the solution to our problems?

Last week the LMC held a "speed dating event" for GPs and Practices.  In response to the recruitment challenges we arranged an evening where practices could meet prospective partners or employed GPs. We decided to trail this in Dorset.  There were 20 practices who each had a table and about 20 GPs attended who ranged from GP Trainees, Locums and even some more mature GPs who had left a Practice but wanted a new role in general practice.  The event went really well, with most practices getting several people interested in what the practice had to offer with follow up visits arranged by most.

What I found really interesting talking to the practices as well as the GPs was that when we face difficult times practices, given the opportunity, can be so innovative, I was really impressed in the thought and different approaches these practices had taken, I was quite close to applying to a couple of the practices myself. In addition, talking to the GPs looking for roles, there is a workforce out there, maybe not enough, but they can be attracted if we can find roles that are mutually beneficial. 

In Wessex we have great practices and fantastic GPs and hence the "speed dating" event has I hope helped to forge some new relationships.  The LMC will reflect and evaluate (not sure what that means but thought that might impress the educators amongst you) and we will potentially hold more events next year spread around Wessex.

I would like to pay tribute to the hard work and dedication of all those who work for the LMC who put in so much effort to make these events possible.  

 

3. Practice Manager Conferences

Each year the LMC arranges two Practice Manager Conferences, the first of these was held last week and we have the second one in a couple of weeks time. Over 150 Practice Managers gathered in Sutton Scotney for the first of these events.

The day included an excellent presentation from the Beacon Medical Practice from Devon,  a group covering about 40,000 patients, a super partnership and one of the pilot sites for the Primary Care Home - click here for more information on the Primary Care Home.  They talked about merging practices, working at scale across a number of sites.  They also explained how they had made a positive difference to their GPs and the lives of their patients. They described how they had brought back the "fun" in their practice and they were now able to recruit GPs. 

I hope to interview the Business Manager from the Practice in the near future and will share this via a Podcast.

Another presentation was done by Sheinaz Stansfield, a Practice Manager and Partner and  Fellow of NHSE Sustainable Improvement Team. She talked about "making time in General Practice & diversifying your practice workforce".  This provided a lot of information and if you could bottle her energy and enthusiasm we would easily solve all the problems in the NHS!

These two presentations were from different ends of the country - Beacon Medical Practice  - click here for their website and Sheinaz from Gateshead.

Both of these presentations in their own way reinforced much of the work that has been done in Wessex.  The future will be built on the registered list of patients at the level of a practice. Neighborhoods or natural communities will evolve with populations of 30-50,000, where practices will work together or in some cases merge, being provided with more resources and services embedded in general practice to support an out of hospital model provided at scale.  This does not need to be a threat to practices and must be supportive of practices.

What always impresses me at these events is the dedication, quality and enthusiasm that exists in our Practice Managers. As GPs, I really do not believe that we give enough credit to Practice Managers.  They are one of our most valuable resources, and their commitment and determination needs to be recognised by us all. 

 

4. Learning Disabilities Conference (Hants and IoW)

The LMC has been working closely with the Hampshire CCGs and Learning Disabilities Community Teams to improve the quality of care for this very vulnerable group and to support GPs and Practices in this work.

There is concern that there is a variable uptake across Hampshire for the Learning Disability Directed Enhanced Service (DES). The funding for this DES was increased from £116 to £140 per patient in April 2017.

In addition one of the consequences of the media coverage of learning disabilities and the additional risks they run in terms of ill health and premature death has led to far greater scrutiny in the care provided these patients by all organisations including general practice. This is particularly true of premature deaths.

The LMC believes that this could make practices vulnerable and therefore the conference is aiming to be helpful and make it easier for practices to provider the LD DES and also provided some updates relating to other aspects of caring for patients with learning disabilities.

The agenda for the meeting is attached.

There are currently 100 people booked on the course, there are a only few places left, so if you want to come to this event, please book as soon as possible.

 

5. Capitation Payments and Registrations

You may have read about the issues that relate to QoF and the calculation of prevalence for 2016/7. LMCs have been told that this situation has been resolved.

In my practice, we noticed a problem in November where we were getting a number of patients where the registration was identified as “pending”. We were told this was not a problem as it was caused by the medical records issues with Capita. By the end of December this number was growing and again we were informed the situation was being resolved. By the end of March my practice had 366 patients whose registration were pending. There are therefore massive implications in terms of a practices capitation payment that are based on the registered list on the 1st day of each quarter. In addition most DESs and local contracts are based on list size and QoF payments are based on prevalence and also the value of each point is calculated on the list size on 1st January each year.

My practice eventually found the problem was related to the IT transaction limit for new registrations – this was increased and the problem was resolved in terms of registration within 48 hours. But now the practice is faced with significant financial loss. My practice is working with the CCG and NHS England to resolve this issue. I was told that I was the only practice that had been affected by this.

I have now heard from 2 other practices which have been similarly effected. So we are not unique.

If your practice has been similarly been affected please can you let me know.

 

6. Capita and Primary Care Support England (PCSE) - NHS England

The LMC is well aware of the various problems practices have had with Capita.

As an LMC we are in close contact with the PCSE lead for NHSE and many of the issues are being resolved although some are still ongoing. The LMC has also developed a good relationship with a number of key people working for Capita.

Once the 16/17 year end has closed we will be disseminating a spreadsheet for completion by all practices with outstanding issues so that we can address these either individually or on mass. 

It is worth noting that there was £2m added to the Global Sum or PMS funding in recognition of the problems practices have faced with Capita.

 

7. Frailty and the end of the AUA DES

The LMC has had a significant number of questions about what practices are required to do as a result of the contractual changes.

The practice is expected use a tool of their choice to identify people with moderate or severe frailty. One tool which is easy to use an quite simple is the Rockford Frailty Score, click here for the document.  For practice who use TPP SystmOne there is an electronic Frailty Index (eFI) that can be run. For the eFI - click here.

I have been using the Rockford Frailty Scale in my practice for some time and it is simple and easy to use. I have also recently run the eFI and added the codes to patient records for those with moderate and severe frailty. A word of warning, patients do not seem to like the term frail (but there is no current better alternative) and some of those who appear in the moderately frail group do so because of the factors detailed in the document about eFI but in reality on a fuller assessment are not frail - so it is a guide and not an absolute diagnosis.

For those patients with severe frailty the practice will undertake an annual review providing a medication review and where clinically appropriate discuss whether the patient had fallen within the last 12 months. In addition the enhanced summary care record (SCR) should be promoted by seeking informed consent to activate the enhanced summary record.

The practice will need to code these clinical interventions.

The data that will be reported includes the number of patients with a record of:

So all practices should have an agreed system to identify and record these patients, to record the information and ensure that patients who have had a fall and that this fact is recorded.

Does your practice have a system of activation of the patients enhanced summary care record?

The severely frail are almost certainly patients who you are already seeing on a fairly regular basis.

 

8. The Coroner - Medical Certificate Certification of Death (MCCD)

In Wessex there has recently been a number of changes to the Coroners. Although the Coroners work with the various laws that relate to this, they each have their own interpretations on how this applies to their area.

Recently Dorset LMC met the new Coroner for Dorset who has moved from Manchester. These discussions were far ranging, very helpful and we will be producing some explicit guidance about this in the near future. It was clear from the discussions that there were a number of specific issues that many GPs were confused by.

When a patient dies it is the statutory duty of the doctor who has attended in the last illness to issue a MCCD. There is no clear definition of “attended” but it is generally accepted to mean a doctor who has cared for the patient during the illness that led to the death and so is familiar with the patient’s medical history, investigations and treatment.

MCCD cannot be completed by another healthcare professional, this would require a change in the law to enable this to happen.

I am aware that many GPs get called to a Care Home because the patient had not been seen in the last 2 weeks. Often you may be at a care home and you are asked as you pass the door you just look in at a patient so if they die you can complete a MCCD. This is inappropriate and you would not be able to complete the MCCD unless you have been actively involved in that patient’s care.

When completing the MCCD can I politely remind you that 1a,b, c and 2 should not be a list of all the medical conditions but should be a list of diagnoses that contributed to the death of that patient.

When completing a MCCD you should try and avoid using:

 

9. Cyber attack

The recent cyber attack on the NHS was potentially disastrous and many areas enacted their Major Incident Plan. I am pleased to say that the impact locally was minimal. We believe that less than 5% of practices were affected. In some areas of the country general practice were without electronic clinical records for 2 days.

Many of our CCGs have a robust system of remotely updating practice computer software. This resulted in most practices having the software to stop the attack.

All practices need to learn from this. I would politely suggest that you review your practice's Business Continuity Plan. In addition I would suggest you have a plan for what your surgery would do if you lost your practice computer system for 24-48 hours. This should include how you would manage urgent and emergency care, prescribing and potential access to blood results and hospital correspondence.

 

10. Advice to Diabetic Patients

(Information taken from a press release issued by the Isle of Wight Medicines Management lead).

How do you advise your diabetic patients to manage their symptoms if they experience hypoglycaemia?

Were you aware that there were significant changes to Lucozade that was introduced in April 2017?

People with diabetes who are at risk of hypoglycemia are being warned of the recent changes to the glucose drink ‘Lucozade’ which could put their health at risk if they are not aware.

Lucozade is commonly used as a treatment choice for symptoms of hypoglycemia which means ‘low blood glucose levels’. For people that take ‘Lucozade Energy Original’ for diabetes, they should be aware that from April 2017, it contains 50 per cent less glucose therefore 200mls will be needed to treat the hypoglycaemia.

Alternative treatments include 1 bottle of Glucojuice which contains the set amount of 15g of fast acting glucose or 4-5 Glucotabs or 5-7 Dextrose tablets. All the above contain the correct amount of fast acting glucose to safely treat a hypoglycaemic episode.

is vitally important for people to be aware of the recent change to the glucose level in Lucozade to ensure they are able to treat their hypo symptoms quickly, safely and effectively to avoid further complications.

For a period of time there will be both old and new stock of Lucozade on sale, so check the label before you buy, if it says 8.9g per 100mls of carbohydrate, it is the new stock.”

Symptoms known as 'Hypos' can come on quickly and can vary from person to person. Common symptoms include feeling shaky, sweating, hunger, tiredness, headaches, blurred vision, a lack of concentration and feeling tearful, irritable or moody. They tend to only occur when you take either insulin or certain types of tablets examples of which are Gliclazide, Tolbutamide and Repaglinide.

Things your patients can do to prevent a hypo include:

More information about Diabetes and Hypoglycemia is available at www.nhs.uk and www.diabetes.ork.uk

 

11. RCGP’s Scientific Foundation Board is now open for applications for grants of up to £20,000 for primary care research

Any GP, primary healthcare professional or university-based researcher may apply for a grant for scientific research to be undertaken in the UK. High priority is given to applications from new researchers who have not previously been funded or pilot studies and short term studies lasting up to about 18 months.

Deadline for applications: 31 July 2017, 12:00 noon. For more information please visit the RCGP website : or contact them by email: SFB@rcgp.org.uk or telephone 020 3188 7594.

 

12. The Cameron Fund

The Cameron Fund is the one Medical Charity that helps only GPs and not other members of the profession.

They offer financial help to our colleagues in real financial need, which can arise totally unexpectedly. This year they have helped the spouse and young children, of a GP trainee who was killed in a car crash; a young GP and his family affected by a very severe physical illness such that he was unable to work for many months; a number of doctors off work with mental health problems; and some colleagues who have run into trouble with the GMC.

In 2016 the Cameron Fund gave financial help amounting to £375k to 226 beneficiaries, 30 more than in 2015.

Wessex LMCs were recently identified at the national LMC conference as being  "a shining example, with many practices signing up to a 3p per patient levy that brings in about £35k for the Fund - by far the largest donation, and several other LMCs have followed their example"

This is a great testament to  the GPs and Practices in Wessex. 

I believe it is an honour and privilege to be a GP - it is not easy, but when you see the impact on families following the tragic events in Manchester or listen to the help provided to our colleagues and families through the Cameron Fund, we are very fortunate to have chosen such a great career.

General Practice is the solution for the NHS and not the problem, so the challenge to us and to the wider system is to make general practice a better place to work, with an expanded workforce, adequate resources and we can attract the best to ensure general practice and primary care has resilience, sustainability and remains the essential building block for the NHS.

Best wishes

Nigel

 

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

www.wessexlmcs.com

 

Attached file: 2. Master Agenda (Timings Only).pdf

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Updated on 28 May 2017 800 views