Wessex LMCs Email Update - Aug/Sept 2017
Date sent: Thursday 31 August 2017
Wessex LMCs Update
I always think this is a rather strange time of year when the days are getting shorted and the summer is coming to an end. The 1st September is the meteorological first day of Autumn where as the astronomical first day is the 22nd September. Yet we have just had one of the hottest August Bank Holidays on record. It all goes to show what a strange world that we live in.
In my practice, the thing that is currently focusing our minds is the imminent arrival of about 4,000 flu vaccines.
For most, the flu vaccination programme is a well-oiled machine where the majority of the at-risk population are vaccinated in a very short period of time. Last year the Pharmacies were invited to expand the groups that they were allowed to vaccinate. Despite significant concern expressed by the profession, in most areas, the uptake increased slightly and most practices maintained their previous vaccination rates.
1. Flu vaccination
Most practices have developed a programme that they simply repeat each year, as that works for their patients, but here are some suggestions that might help you.
2. Income tax - Annual Allowance - everyone should read this!
The LMC would recommend that all GPs and practices use specialist Medical Accountants. There will be some unexpected large tax bills coming to some GPs this year because of their reduced annual tax allowance, will this affect you? Are you prepared? - This section should be read and you may need to discuss this with your Accountant.
3. Wessex LMCs' Mental Health day
Following previous successful events focused on cancer, dementia and cardiovascular disease and with the introduction via the GP Forward View of new services to help and support GPs with Mental Health problems, the LMC thought we would arrange an event that would look at how we can look after our own mental health and well-being, then inform you of the new services available for GPs and finally cover a number of topics about mental health that would be useful for GPs.
4. LMC Annual Conference
Once again we have an excellent programme with a range of national and local speakers including the current Chair of the RCGP, Professor Helen Stokes-Lampard. Dominic Hardy the newly appointed Head of Primary Care for NHS England (responsible for delivering the GP Forward View), Dr Berge Balian GP and Medical Director of the Symphony Vanguard in Yeovil.
5. GPC's Sessional Newsletter
The August newsletter is now available.
6. GPs - the next generation
For those of us in the later part of our career, it is important that we nurture the next generation of GPs, not only to ensure that our profession is served well in the future but also some of us are entering that aged when we will need good quality general practice to look after us in our old age, there is a vested interest!
This is a national initiative which we are helping to bring to Wessex.
7. Get your patients walking
Public Health England recently published some quite damning information about the lack of exercise people aged between aged 40-60 take per day. Sir Muir Gray, a well respected clinician, recently described that lack of exercise as one of the greatest risks to this groups' health.
A new free App has been developed – Active 10 – which helps people achieve the goal – which GPs should be recommending to their patients to help build up levels of activity.
8. The Future of Clinical Education in Wessex
There has been much discussion about the role of GP tutors and what will happen to GP education - this may provide you with some useful information.
9. A day in the life of a GP
Have you read a positive story in a newspaper about general practice? Well here is one - think about contacting your local paper and see if they are interested in producing a similar article based around a local practice and or GP..
10. Future planning templates
Another initiative to help GPs and a collaboration between different providers.
11. Experienced GPs wanted
As an LMC we have Practice Manager supporters who work with the LMC and are an excellent resource to help and support othe rPractice Managers and Practices but what about GPs.......
1. Flu Vaccination
Ensure you start your programme early and engage with your care homes and commit to dates to vaccinate. Last year some Pharmacies approached care homes and offered “to help hard pressed practices” and undertook all the vaccinations in that home without the GPs being aware.
The practices that performed best in the past, were those that had some set dates where they had “mass vaccination” clinics, for example on a Saturday morning but then had flexibility with some smaller clinics or individual appointments at a variety of times. It can be quite a challenge to vaccinate 700-1,000 patients in one morning but many of us manage this year after year. Consider how you can provide a service that is better than other providers.
- Getting your PPG involved in helping to organise the patients.
- Provide a leaflet to patients when they arrive – informing them of possible side effects, contra indications etc.
- Use the opportunity to collect QoF data – use the leaflet to ask about alcohol and smoking data.
- Online services will help practices – use the leaflet to collect email addresses and mobile phone numbers and get consent to share data.
- Have an admin person working with each clinician – increases productivity as they can enter all the data.
- Offer the shingles and pnuemovax to the at risk groups at the same time.
- Use the opportunity to achieve some of your QoF targets, blood pressures etc – these can be easily checked, potentially use a clinician or HCA to do this.
What used to be winter pressure is now becoming an all the year-round pressure. It is therefore really important that we maintain our physical and mental wellbeing.
2. Income Tax - Annual Allowance - everyone should read this!
As an LMC we meet every 3 months with the specialists Medical Accountants and Solicitors and also Chartered Surveyors. This is really helpful in terms of discussing topics of mutual interest in their specialist areas and allows the LMC to provide information relating to a number of key issues that are going on in general practice.
General practice finance is more complex than it has ever and practices and individual GPs would be wise to have an accountant that specialises in general practice.
The following was prepared for the LMC by two of our specialist Accountants - Sally Sidaway from RSM UK Tax and Accounting Limited and Roger Morgan from Sandersons.
"One of the main topics of conversation at GP practice meetings this year should be unfortunately, the ‘Tapering of the Annual Allowance limit’ with regard to pensions. New rules from 2016/2017 are leading to huge increases to many GP’s tax bills from January 2018 onwards. GP’s ignore this legislation at their peril!
2015/2016 in contrast saw the majority of GP’s escape an Annual Allowance tax charge but the goalposts have now moved and this should be a clear message that you have taken and understood from your accountant or IFA.
2016/2017 saw the introduction of tapering of the annual allowance limit. Those earning over £110,000 may well see their annual allowance limit reducing from £40,000 down to a possible £10,000 depending on individual levels of total income. When this happens unused relief that may have been generated in 2015/2016 and earlier years is likely to be used up in full in 2016/2017 which may mitigate a tax charge but very often will not remove it altogether. This is real extra tax that will need to be paid for no extra growth in pension when a GP retires. The extra tax for 2016/2017 is payable in January 2018 and the position will be potentially worsened due to the knock on effect to the first payment on account towards 2017/2018 tax.
The tax year 2017/2018 gets worse as most higher earners will by that point have no unused relief left to offset and the CPI rate which will be used as part of the dynamising calculation is based on the September 2017 factor. September 2016 saw a factor of 1%, it is largely expected September 2017 will be higher thus giving more growth to pension pots. As an extra point it should be noted that the growth rate in the new 2015 scheme is in fact faster than in the 1995 scheme so individuals in this scheme will see pension growth at a faster rate. A small growth in inflation with no other changes can have a large effect on annual allowance growth.
We are advised by the Specialist Medical Accountants acting for a number of our GP’s that the increases in tax liabilities that they are seeing as a result of these rules are often staggering in size and this is an area that must be looked at very carefully.
If you have not been asked to already your first step is to download a Total Rewards Statement from NHS pensions website. You will need a government gateway login first to enable you to do this. Make sure this has been forwarded to your accountant for careful review. The Total Reward Statements will not be fully up to date they are likely to be live to 31st March 2015 but your accountant should be able to extrapolate forward from this with your last two years’ pensionable earnings.
Whereas Life Time Allowance planning may well be a conversation that you need to have with your IFA, your accountant has a duty to review your Annual Allowance position if information can be obtained in order that your Income Tax Return can be prepared as accurately as possible. It is not advisable to await statements setting out your position from NHS pensions agency as under the current system these will be sent out after the date at which your Income Tax return has to be submitted. As always if with hindsight extra tax is found to be due, HMRC will charge interest on late payment of tax and there could be the possibility of penalties.
Eventually NHS pensions Agency should advise you of your Annual Allowance breach although this cannot be relied upon without request.
Self Assessment tax is clear that the individual remains responsible for declaring all tax due, NHS pensions agency will not be in any way responsible . Beware also:
The NHS pension saving statement setting out any breach will not have considered any non NHS pension contributions made.
b) Will be potentially many months after the tax is due giving a nasty shock of tax effectively payable immediately.
c) This is retrospective, once a tax charge has arisen it cannot be reversed if you know in advance what is likely to happen you have a chance to take mitigating action.
d) In a number of cases the tax numbers are enormous and facility to pay this tax will need careful planning.
e) These rules are not only a problem for GP’s with big pension pots who are near end of career, many young GP’s are also being hit where earnings are high.
If you are not getting the right advice on this area of your tax and pension affairs please consider your position very carefully. There are ways to mitigate the tax and you need to consider if any of these are appropriate to you.
Below is a real example of Dr Smith (name changed to protect identity)
In 2016/17 it was estimate that Dr Smith had unused pension relief brought forward of £14,017. However her tapered annual allowance for the year is calculated at £18,189 and it was estimate her deemed growth in her pension at £65,857. She therefore has ‘excess’ contributions of £33,651 (calculated as £65,857 less £18,189 and less £14,017) which gives rise to a tax charge of £13,460 for that year.
For 2017/18 (assuming she remains a member of the scheme for the whole year) and estimating CPI at 2.5% (we won’t know this figure until September) the position is worse. She has now exhausted any unused relief from previous years. Her accountant estimated her deemed pension growth ay £72,202 and her tapered Annual Allowance at £15,485. If she had done nothing her excess for the year will be £57,717 resulting in a tax charge of £23,086.
Some of the AA tax charge can be paid by the pension scheme but not all. The GP partners do not receive any extra drawings to cover this tax and it is therefore a direct hit on the cash available to them to draw. The NHS pension scheme cannot advise the value of their pensions at the beginning and end of the year (and many GP’s are unable to access their Total Reward Statements at all at present) so all of these figures are our best estimates based on the information known to us at this time. We have to make an entry on their tax returns to declare the potential liability and as you can see we are talking some very significant figures. Dr Smith’s views are similar to most partners reactions that we are getting at the moment so I am sure you will be hearing a lot more about this over the coming months.
3. Wessex LMCs' Mental Health day
Thursday November 30th – Salisbury Racecourse
The Wessex LMCs' Mental Health Conference is aimed at raising greater awareness of mental health. We want to help GPs and nurses to look after themselves, know where to find help and update their knowledge. We want to get this topic on the table. We want to talk about it. We want to make a difference!! This does not mean this is a group therapy session and you do not need to be suffering from a mental health problem to attend.
As we all know we are working in challenging times - mental health being an important issue for GPs and their patients. With approximately 30% of a GPs workload made up of mental health conditions, many such as those with personality or eating disorders and perinatal mental health problems can be time consuming and very challenging and anxiety and depression are both very common. That aside, the LMC are also seeing an increase in GPs with stress, burnout and mental health issues.
This innovative event will start off with how we can all protect ourselves from stress, burnout and maintain our own mental health and wellbeing. There will then be a section on the General Practitioner Health Programme, the new service which is already being widely used in Wessex with excellent outcomes. We will then cover a number of mental health problems that are commonly seen in General Practice including the management of anxiety and depression.
The day will be concluded with a talk from Simon Weston CBE, the Welsh Guardsman who survived some horrific injuries as a result of his ship being bombed during the Falkland’s War. Those who have heard him talk before, which I have, will find this both inspiring and humbling and an excellent way to conclude our day.
Hopefully you will find this conference an inspiring start towards making that difference!! We would therefore recommend that you book early as interest in this conference is already significant and places are limited.
This event is free to Wessex GP Education Trust (WGPET) members.
The places are limited and getting booked up quickly so if you wish to attend I would suggest you book your place soon. Please click on the following link to book and secure your place - click here .
4. LMC Annual Conference
This is taking place on Wednesday 1st November at Norton Park Hotel in Sutton Scotney (just off the A34).
As always we have some excellent speakers and aim to cover a wide range of topics including
Professor Helen Stokes-Lampard – the Chair of the RCGP
Dr Johnny Marshall – a GP in Buckinghamshire, and National Association of Primary Care – talking about Primary Care Home – working together in populations of 30-50,000.
Dominic Hardy- Recently appointed Director of Primary Care for NHS England
Dr Berge Balian a GP in Somerset and Medical Director of the Somerset Symphony Accountable Care System
Bill Gillespie – Chief Executive of Wessex Acaedemic Health Science Network – talking about innovation in general practice.
We always like to showcase some practice example of things that are happening in general practice that make a difference so this year we have two such presentations:
The Leg Club – these are community based services often delivered in a church hall – where patients with leg ulcers are seen by practice and community nurses supported by the local community – the evidence is healing rates are much improved, patients like it as there is a significant social component and it saves time and money!
The prescribing pod – an innovative service in Swindon
There are only a few places left – so if you want to come, book your place soon!
5. GPC's Sessional Newsletter
Here is the link for this month’s newsletter from the Sessional GP Subcommittee - click here .
6. GPs - the next generation
Last year a GP trainee called Dr Nishma Manek became a Clinical Fellow to Dr Arvind Madan (also a GP and Director of Primary Care at NHS England). During her time in this post, I had the honour and privilege in meeting with her and spent some time discussing the challenges that are faced by the younger GPs - but also what the potential solutions are.
I have always been impressed when meeting with the GP Trainees and the first 5 GPs in terms of their energy, enthusiasm and wish to develop and evolve a specialty that I believe is one of the best jobs you can do (I have just completed 30 years in my practice and am lucky enough to still enjoy working as a GP). It is not without its problems, and that is why I have found working for the LMC trying to find solutions to our problems as a great balance to my work as a GP.
Nish talked to me about an innovative programme she was establishing called the 'Next Generation GP' - click here for more information. I was so inspired by what Nish was trying to achieve that the Wessex LMCs offered to fund a couple of our younger GPs to attend these event. The feedback we have received was really positive. The events were all held in London, which is an issue for many of those who might want to attend but do not work in London.
I am currently working with Nish and Richard Weaver from Health Education England (Wessex) to create a similar programme based in Wessex aimed at GP trainees and newly qualified GPs. We hope to "enrol" up to 40 GPs/trainees during the Autumn to start the programme at the end of the year.
Richard and I will send out more definitive information once we have more details, but the reason for including this in my email is to ensure these regular emails are reaching all the GP trainees and also the first 5 GPs. Could you therefore ask any Trainee of younger GPs if they get my email updates, if not they are not on our database, please ask them to email me at firstname.lastname@example.org and I will ensure that they are added to this.
7. Get your patients walking
Last week Public Health England published a report that estimated four out of every ten of the 40 to 60 year-olds do not even manage a brisk 10-minute walk each month.
Inactivity in middle age:
Adults in England 40-60 years old:
- 41% do not manage one brisk 10 min walk per month
- 1 in 6 deaths linked to inactivity
- 15% reduction in risk of early death from at least one brisk 10 min walk per day
- 20% less active than we were in the 1960s
- 15 miles less walked a year on average than two decades ago
All of this will lead to more work for us so perhaps we should be promoting this through our practices.
West Hampshire CCG have an initiative supported by practices called “Get Hampshire Walking”, more info available - click here .
It is hoped that this will make a positive impact.
8. The Future of Clinical Education in Wessex
Historically the Wessex area has been well provided for, with a large variety of educational events provided by the Wessex Faculty of the RCGP, Refresher Courses, organised by the GP Tutors, practice based events with some Consultant led events provided with the local NHS or private hospitals. Add to that some web based learning provided by the RCGP, the BMA and more locally by Fourteen Fish and the LMC.
More information below.
Wessex LMCs have become very involved in Practice Manager, Practice Nurse and Administrative Staff training by creating part of our organisation called Wessex LEaD, superbly led by Louise Greenwood. For example there are over 30 events available in the next month. Our aim is to provide good quality events at a reasonable price. Any surplus generated from courses is then invested in more educational events.
Wessex has been one of the few areas that has retained GP Tutors, but with the financial pressures that are faced by Health Education England (HEE) these posts will be lost shortly.
The LMC is therefore in discussion with HEE, the Wessex Appraisal Service, Wessex GP Education Trust (WGPET) and other interested parties to try and ensure that the current level of high quality education resources are retained and developed.
Royal College of General Practice
To access this you have to be a member of the College, there are some excellent resources, some focused on clinical aspects of care and some non clinical in addition to Essential Knowledge Updates and Challenges and GP self tests - click here .
British Medical Association
To access this you need to be a member of the BMA - the education components are delivered through the BMJ and contains an excellent range of educational programmes - click here .
This company was set up some years ago by Dr Duncan Walling, previously a GP and Medical Director of Wessex LMCs. Despite defecting to the IT sector the LMC works closely with Duncan and Fourteen Fish who produced the Appraisal Toolkit and worked with the LMC to produce the MSF and PSQ for appraisal and revalidation.
Fourteen Fish also produce some excellent Videos - some are aimed at Nurses and Midwives, with a focus on revalidation, appraisals and revalidation for GPs including an excellent free learning diary (which I use extensively), there are also videos for GPs in training and finally something called Fish TV which is a YouTube channel used for interviews and education - episode 8 is an interview about the future of general practice with a local GP - click here .
For Fourteen Fish Videos - click here .
We have produced a number of Lunch and Learns which are aimed more at Practices than individual GPs, some are free and some attract a small charge. Although these are aimed at our GPs and practices a significant number of practices outside our area also purchase these training packages.
The contents includes:
- Adult and child safeguarding - level 1
- Accessible information standards
- Chaperone training
- Customer service standards
- Emergencies in general practice
- Equality and Human rights in general practice
- Information Governance
- Mental Capacity Act
- Practice health check
- Practice nurse revalidation
- Understanding conflict
Click here for more information.
9. A day in the life of a GP
In the past, the national media seemed to spend much of its time attacking GPs and general practice. Over the last year there has been some more stories about the current challenges that we all face and these have been more positive.
Often the local media focuses more on human interest stories and is keener to publish positive stories rather than trying to find an angle to discredit individuals or organisations.
My local paper has been running a series of articles called "A day in the life of...". The first article was about an Agister - in the New Forest the Verderers' Court was established in Medieval times. The Verderers regulate "commoning" and certain forms of development on the New Forest. (A commoner is a person who owns a property within the New Forest that has certain rights attached to the property, such as keeping horses, cattle, sheep or pig on the common land within the New Forest).
A team of Agisters is appointed by the Verderers to deal with the daily management and welfare of the Commoners’ stock, including dealing with road accidents involving ponies, cattle, donkeys or pigs.
I was approached by a reporter to be the second victim to explore the "Day in the life of a GP". The reporter spent a day in my practice shadowing me and then published an article about her experience of that day. Click here to read the article - p.s. sorry about my desk being untidy - having seen the picture I have now sorted it out!
I have received some great feedback from patients and others about how the article has made them realise how hard GPs work, the challenges we face and now have a greater understanding of why it can sometimes be difficult to get an appointment.
10. Future Planning Template
These are a set of electronic forms designed to help GPs collect important information about your wishes and needs in one place. These simple forms are available for use by any Practice . The forms have various parts that can be used to collect Chronic Care Management, End of Life or Avoiding Admission information.
The template can be downloaded from the website and are available for EMIS and TPP - they can be found at http://www.futureplanning.org.uk/
11. Experienced GPs wanted
Some practices are reporting that they are now beginning to be able to recruit GPs and Practice Nurses but we are all too aware of others where this is not the case. Practices that are really struggling find it difficult to recruit new staff and sometime short term locums, this then means that the situation they find themselves in just gets worse and becomes impossible to turn it around. For many what they need is an experience GP who can go in an help for a short period of time, often funded via the resilience scheme to help the practice get back on its feet.
If you are such a GP who could help and are free for short term sessions and are experienced and prepared to take on a challenge please can you contact me via email so we could have a discussion about this - email@example.com.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)