LMC Update Sept 2017
Date sent: Sunday 17 September 2017
Email sent by Wessex LMCs, on Sunday, 15th Sep 2017
I am sorry that this is another long email but there seems to be so much going on at the moment.
I would like to start off this email update asking you to think about our role in society and the privileged position we have as a result of that and this comes about because of our professionalism.
Statutory responsibility vs professional obligations - a personal view
I am proud to be a GP and have enjoyed being part of a respected profession for over 30 years. General Practice has never been "just a job" and has always been a vocation and a profession. Being part of the community and working as a family doctor makes us unique, call me old fashioned but I still consider that it is an honour and a privilege to be a GP.
Over the last few years we have all found that our working lives have got busier and the demands on us have increased significantly. This is not only in terms of clinical time but the administrative burden has become, at times, unmanageable. I therefore support the BMA’s work to try and help resolve the unnecessary additional workload for GPs.
You will have seen the recent BMA advice on requests for information about patients from the Police.
The Police can always request information from a Practice with the patient’s consent. However, there is also a public interest test and you are permitted to release information without consent in certain circumstance. This could be to prevent a serious crime (a public interest test) or it may be authorised via the use of a DP2 form, which needs to be signed by a Senior Police Officer.
You should only give the minimum, or relevant, information, to satisfy the request: there is a difference between disclosing general information about a patient, and releasing copies of a patient’s medical record. The golden rule is for both the Practice and the Police to be able to justify the release of information being in the public interest.
In the past the advice was that Practices could not charge for the release of this information as Practices saw this as part of their professional duty and it would need to be an Inspector or above who had to sign a DP2
The recent BMA advice has taken a new interpretation on the law that relates to the release of patient information and has suggested that practices can charge a fee for this information and that the DP2 needs to be signed by a Superintendent or above.
This has already caused significant problems for the Police forces locally and hence in Hampshire all Practices have received a letter from the Police about this.
As the law has not changed and does not define that a DP2 needs a Superintendent’s signature it is difficult to understand why the advice has changed. I have discussed the matter with the BMA and they are in discussion with the senior Police representatives for England and hope to reach a satisfactory outcome shortly.
So where does this leave us?
I go back to the start of this topic. I may not have a statutory responsibility to provide information to the Police, in the public interest, without charging them a fee and I could insist that to make their life more difficult I would ask a Superintendent to sign the DP2 but my feelings of professional duty tells me that I should continue to work as before and provide this information without charge and accept the DP2 with an Inspector's signature. In return, I would expect to continue the positive and professional relationship that I have with the Police locally.
Each situation needs to be examined carefully and the balance struck between the two. Each of us must be prepared to justify our actions either to the Information Commissioner's Office, if release of information was later deemed a data protection breach but also to our patients and the public if any harm resulted from us withholding information from the Police in the vital work that they do. It is sometimes a difficult judgement but one that, as professionals, we must be prepared to make.
My advice is to continue with the previous BMA position and release information with a signed DP2 without charge, which can be signed by an Inspertor whilst the negotiations continue between the Police and BMA.
1.  Support your Practice Manager
2. Frailty - Batch Coding
4. Wessex LMCs Practice Health Check Diagnostic Tool - national endorsement
5. Practical Paediatrics for GPs and Nurses
6. Useful website - Children and Infectious diseases
7. Wessex LEaD Update
8. Measles immunisation for non-immune healthcare workers
9. GP Consultant Exchange
10. GPC's Sessional GP Newsletter
11. Publication of GP Earnings and Expenses
12. Support for Practices with Community Health Partnership (CHP) and NHS Property Service issues (NHS PS)
1. Support your Practice Manager
I am keen to draw your attention to a new programme for Practice Managers that we have developed using monies from GPFV. It is based on the training needs we found from running Practice Manager Appraisals and has been developed by PMs for PMs.
Currently this is available to Dorset and Hampshire & IoW as it is being funded by Health Education Wessex. We are in discussion with Health Education South West to expand this to cover Bath & NE Somerset, Swindon and Wiltshire.
One of our Practice Manager Supporters will be bringing case studies from the GPFV to each day to add some practical application and will also be able to support the PMs following the course.
Your PM can choose to attend one, two , or more days depending on their needs and we do hope that you will encourage them to attend. It is not often PMs get these sorts of opportunities!
Wessex LMCs Practice Manager Programme for Hampshire, IOW & Dorset
An interactive, practical programme for Practice Managers in Hants, IOW and Dorset. Learn & apply theory and knowledge to your own practice in a dynamic and supportive environment
This unique programme has been developed following the results of 136 Practice Manager Appraisals that were carried out all around the country in Spring 2017.
Using funds from the GPFV that have been assigned for Practice Managers, Wessex LMCs have worked with NHSE & HEE (Wessex CEPN) to produce this programme which has been designed by the people who it is aimed at – practice managers.
This programme is for all managers who want to know there is evidence and background for the learning they are receiving - and that will be for half the session. The rest of the session is all about practical application and looking at case studies where some simple changes have had great effect in practices all over the country. These are to take back to your practice and try.
It is anticipated that the delegates will already be experienced in their practice and have worked as a Practice/Business Manager there for at least 12 months. Some pre-learning is assumed, and if the delegate does not already have the background knowledge, podcasts/websites and papers will be recommended to be viewed before the event.
This programme is to suit the delegate and to provide them with as much resource as possible to use back in the practice. Wessex LMCs has recruited 10 Practice Manager Supporters who will have spent time looking for useful case studies and examples for each of the training days to enable the application of the knowledge learned at the event to be easy to apply. As all PMs know, there is so much out there to look at – but no time to do this!
Following the training day, all delegates will have access to the PM Supporters who can mentor and support them through any challenges that they might face in applying their new knowledge to their practice.
Each day costs £85 per delegate (and NHSE are adding £126 to this to meet the total cost)
Please choose to attend as many or as few as you like, and you are welcome to mix up attending in Dorset and Hampshire if you want to – a ‘pick and mix’ approach!
As a GP value you Practice Manager or as a PM yalue yourself and your role enough to take time out of your busy schedule to give yourself some thinking space and learn with your peers in a supportive, dynamic environment…and notice the change!
Booking on multiple events
You can see an overview of all the Hampshire events click here where you can book on several events for one person and just enter their details and pay once. For the Dorset events, the link to see all is here click here . Or you can book on the events individually using the links on the flyer.
- Supporting the Individual
- Difficult Conversations with Staff & “Managing Up
- Managing Poor Performance & Absence
- Stress Management & Personal Resilience (2 day course)
- Time Management (half a day course)
- Supporting the Team
- Influencing and Negotiating Skills
- Delegation & Organisation
- Managing and Implementing Change
- Coaching, Mentoring & Empowering
- Supporting the Practice
- The GP Contract, Commissioning and Regulation
- Making and Writing a Business Case
- How well are we doing?
We want these courses to give you confidence, education and resources to make a positive change in your practice and we want to support you in all that you do.
2. Frailty - Batch Coding
The aim of the GMS 2017/18 frailty contractual requirement is to:
Proactively identify older people (aged 65 and older) who are living with severe or moderate frailty using an evidenced based tool. People identified will be offered a small number of key evidence-based interventions:
• Annual medication review (severe)
• Annual falls risk identification and promoting the use of the additional information in the Summary Care Record (severe and moderate, where this is identified as clinically appropriate).
It require practices to code clinical interventions for this group.
Using the electronic frailty index (eFI)
The contractual requirement is to identify populations at risk of being frail, by degree, using an evidence based tool supplemented by clinical judgement. In the vast majority of cases NHS England anticipate the risk stratification tool to be the validated eFI as this is widely available in GP Electronic Patient Record Systems (EPRS).
It is important to understand that eFI identifies people at risk of frailty, but cannot on its own make a diagnosis of frailty. The diagnosis of frailty requires the judgement of a clinician, taking into account an individual’s complete clinical picture.
Some GP EPRS are configured to convert the eFI index result directly into a diagnostic (Read) code for the electronic health record (EHR). Batch-coding is where this process is undertaken for cohorts of people, effectively automating clinical diagnosis without clinician judgement. To support appropriate follow up action, it is important that the eFI index result is subject to clinical review before entry into the EHR.
NHS England is aware that some practices have batch-coded a Read code diagnosis of frailty. It is recommended that this should not be done for the following reasons:
1. eFI is not a clinical diagnostic tool: it is a population risk stratification tool
2. Automated diagnostic coding without clinical judgement will lead to inappropriate diagnosis of frailty with direct consequences for patient care
3. Such practise does not meet the contractual requirement which includes clinician judgement to diagnose severe or moderate frailty
4. Patients incorrectly diagnosed with frailty may be subject to inappropriate clinical interventions or future care planning based on a wrong diagnosis.
NHS England and BMA/NHS Employers advice on batch-coding
NHS England advice is not to use eFI batch-coding for the reasons given above. NHS England refers practices to the published guidance on the intended process for converting a risk of frailty identified by the eFI to a coded clinical diagnosis of frailty using clinical judgement.
The supporting guidance issued jointly by the BMA and NHS Employers reinforces the importance of using clinical judgement to confirm the diagnosis of moderate frailty in a person so identified by the eFI before entry onto the patients’ record and for those diagnosed with severe frailty the requirement for a clinical review.
3. Wessex LMCs Practice Health Check Diagnostic Tool - national endorsement
As a team we are here to support you and your practice.
The LMC works really hard to ensure that we find solutions to the problems that we all face.  There is little use all of us saying how difficult our jobs are (even though that is the absolute truth) and simple become the victim, we need to find things that can help us find solutions.
Over a year ago your LMC team started to design a toolkit to help practices look at many aspects of their organisation.  We were helped by our Practice Manager supporters and the toolkit was used in the Vulnerable Practice Scheme locally in addition to the Resilience Scheme.
The RCGP and NHS England  have looked at the toolkit and now endorsed it and are promoting it nationally.
Having national recognition for this hard work and innovation is a great tribute to those who work for the LMC to help you.
Click here for the toolkit and the lunch and learn.
4. Practical Paediatrics for GPs and Nurses
This event was develop in partnership with the LMC.
This one-day course is targeted at all professionals in general practice involved in the provision of care to children. We would encourage all Primary Care staff to attend, including Nurses, Advanced Nurse Practitioners, and GPs. The day will consist of a mixture of lectures and workshops.
Main Speaker: Dr James Edelman
Plus other members of the Regional Faculty of Paediatric Education, Innovation & Research
For more information please click here .
5. Useful website - Children and Infectious diseases
Do you every get asked whether a child can go to school or nursery if they have Conjunctivitis, Hand, Foot and Mouth Disease  or how long do they need to be off if they have Chicken Pox?
Locally there is an excellent website with resources for Healthcare Professionals and Parents called Healthier Together - click here to view the website.  This is also available as an App which should be compulsory for all Parent to download on their smartphone.
If you want to access information about which infectious disease need to be off school or not - click here.
I have downloaded the App and added the website to my favourites on my PC in my consulting room.
6. Wessex LEaD Update
Louise Greenwood recently met with NHS England nationally to discuss the work we have been doing in Wessex with regard to PM Appraisals. This was a national pilot led by Wessex LMCs and involved several other LMCs and received very strong support especially for the PMs who had the appraisal.
She hopes to encourage NHSE to roll out Wessex LMC’s Appraisal Programme for PMs to all PMs in Wessex (and further) with GPFV monies. If we have some positive news on this we will let you know. Louise has also been asked to speak to PMs at the Londonwide LMC PM Conference about peer appraisal and it’s benefits.
As a result of the Appraisal project, Louise is working with the Banes, Wiltshire and Swindon STP area and Thames Valley and Wessex Leadership Academy to launch a PM programme funded by NHSE. It is early days yet but the programme hopes to be aimed at managers who are already experienced PMs, but who would like to stretch themselves a little further and learn how to liaise with other stakeholders, shadow fellow managers in other organisations and learn more about the integrated health and social care system
Dorset and Hampshire will have their own programme developed in conjunction with HEE ( Wessex) and NHSE and delivered by True North. This will be a pick and mix menu of training run across 24 days with 12 topics that PMs can choose to attend all of , a little of, or none of! One of our PM Supporters will be attending each of the days, to bring in relevant case studies and evidence from the 10 high impact actions that will help the PMs plan how they might bring their learning back into the practice and into reality. The PM Supporter will also be able to support the PM introduce any changes.
The topics for all this training are the result of the needs shown by the appraisees during the project.
Wessex LMCs is delighted to offer support to Practice Managers through our Practice Manager Supporters who are based throughout Wessex.
Practice Manager Supporters provide ad hoc advice and support to their practice manager colleagues, and offer learning opportunities to support Continuous Professional Development for PMs. The PM Supporters offer coaching and mentoring to new and experienced practice managers, and have specific training to enable them to appraise fellow practice managers.  They offer support in person, via email or on the telephone.
The Practice Manager Supporters will work in a completely confidential way, but are duty bound to take forward any issues that are brought to their attention that may be unsafe in any way. They are not able to offer any legal advice, but will assist in signposting their colleagues towards useful resources and assistance. They will contact new Practice Managers to introduce themselves and offer any support that they might need.
The PM Supporters will respond to your request for help as quickly as they can, but are all working practice managers themselves, so if your request is urgent, it would be best to ring the LMC office on 023 8025 3874.
The PM Supporters are financed for two sessions per month by the LMC, to support the practices and the LMC office is open 5 days per week.  There is a lot of experience in the office, and all staff members of the LMC are keen to offer support and help with any query that you might have.
We have recruited 4 new supporters.
Do contact us at the office if your PM would like to chat anything through with them or if they would like some specific advice or guidance. For more information - click here .
The new PM Supporters are:
Jenny Partridge (NE Hants and Farnham CCG)
Nicky Maule (Chawton Park Surgery, N Hants CCG)
Jane Dawes ( Blackmore Vale, N Dorset)
Matt Perkins – (Baron on Sea, West Hants CCG)
7. Measles immunisation for non-immune healthcare workers
Measles is highly infectious - the most infectious of all diseases transmitted through the respiratory route. Measles can be severe, particularly in immunosuppressed individuals and young infants. It is also more severe in pregnancy, and increases the risk of miscarriage, stillbirth or preterm delivery
Public Health England issued National Measles Guidelines in August 2017 - click here .
It states that “All healthcare workers (including receptionists, ambulance workers etc.) should have satisfactory evidence of protection against measles to protect both themselves and their patients. Satisfactory evidence of protection includes documentation of having received two or more doses of measles containing vaccine and/or a positive measles IgG antibody test.”
Any patient over the age of 16 who has not received 2 doses of MMR is eligible to receive the vaccine on the NHS and this can be given by the patient’s own GP, attracting a fee of £9.80 as per the SFE.
It should be noted that people born before 1970 are likely to have immunity from exposure or single vaccine but this doesn’t preclude them from having MMR if in doubt.
8. GP Consultant Exchange
Some years ago I spent a day in the hospital shadowing a Consultant Ophthalmologist and then he spent a day in my surgery - sitting in during consultations, home visits, practice meetings etc.  We both found it very interesting and a valuable learning experience.  I have repeated this with an Orthopaedic Surgeon, a Paediatrician and also a Care of the Elderly Consultant and these exchanges were also both interesting and valuable learning experiences.
The LMC has arranged a Consultant GP exchange in Portsmouth which was also very popular and successful.
The LMC is currently working on a GP Consultant exchange with Poole Hospital.
Attached is a letter from Southampton CCG who are arranging and exchange with the Consultants at University Hospital Southampton. The LMC is supporting this initiative.
9. GPC's Sessional GPs Newsletter
The September issue has now been published - please click here.
There is an excellent blog by Claire Gerada about the GP Health Service and stress and burnout.  Claire is one of the speakers at our Mental Health conference in November.
There are some useful tips about appraisals for sessional GPs and also the pros and cons of locum work.
10. Funding of General Practice
This week the GPC have published our analysis of the funding of general practice in England . You may recall that In 2016 the BMA called for 11% of the NHS budget in England to be invested in general practice, to tackle the growing crisis caused by nearly a decade of underinvestment by successive governments. A little over one year on, the GPC are reviewing the outlook for general practice funding in England between now and 2020/21, and considering whether planned investment over the coming four years as part of the General Practice Forward View (GPFV) is likely to meet the 11% target asked for by the GPC.
The  analysis shows that even if the GPFV funding is delivered in full, investment in general practice is likely to fall significantly short of that 11% target.
11. Publication of GP Earnings and Expenses
This week the GPC published an analysis of the GP Earnings and Expenses Report 2015/16. The document is attached to this email.
12. Support for Practices with Community Health Partnership (CHP) and NHS Property Service issues (NHS PS)
The GPC has been working hard to resolve many of these issues.  There are three letters attached from the GPC that might help you.
In addition the GPC have created a webpage for practices with useful guidance, please follow this link - click here.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: GP & Consultant Liaison Scheme 2017- GPs Letter.pdf
Attached file: Wessex LMCs Practice Manager Programme flyer v2.docx
Attached file: Letter to practices re CHP letter FINAL.pdf
Attached file: 20170425 Covering Letter to GP Tenants.pdf