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LMC update - October 2017 - part 2

Date sent: Tuesday 24 October 2017

The LMC is the only  statutory body that represents GPs at a local level. This has been the case since 1911 when the local representation committee of panel doctors (the name give to the GPs of that era) were included in the National Insurance Act of 1911 introduced by Lloyd-George who was the Chancellor of the Exchequer, a post he held prior to becoming Prime Minister. 

Our power and influence does not come from our statutory function but from the level of support we receive from those who we represent. It is also important that bodies we work with respect and value the relationship we have with them.

To be effective in our role of supporting and representing you, we must have your respect and that is gained by us  having knowledge and wisdom and using that wisely, sharing information, communicating well, being able to find solutions to the many problems that we face , working with CCGs, NHS England etc but also being able to challenge them when necessary.

Representing 3000 GPs working in over 450 practice means that we cannot please everyone all the time but I hope that you can see that all we do is to support general practice  both in terms of individual GPs and the profession.

You elect a local LMC representative, who will sit on one of the three committees in Wessex,  namely Dorset LMC,  Hampshire and the IoW LMC and Bath & NE Somerset, Swindon and Wiltshire LMC.  

Each committee has a two year term and they individually elect a Chair and one or more Vice Chairs.   The Chairs and Vice Chairs are the Directors of Wessex LMCs Ltd and form the Board who employ the Chief Executive, Medical Director and Directors of Primary Care.   The Board hold me to account for the services we deliver to the GPs, practices the wider profession and also in terms of negotiating with all NHS and non NHS organisations.

In the new year there will be a new round of elections for the LMC Committees if you wish to represent your colleague you will be getting information shortly  about how you can stand, what is involved and the funding that is available.


1. Indemnity

This is a key issue for general practice as it is become a major barrier to GPs not only joining the profession but also to retaining them and providing some flexibility in terms of the number of sessions a GP is available.

2. New patient leaflet - Primary to Secondary Care leaflet

This is another contribution to helping practices - print some of these an give one to every person you refer.

3. Next Generation of GP Leaders

This is a great programme for emerging young leaders. We are one of the first areas to support this programme and would encourage all GPs with an interest to get involved. There are still a limited number of spaces left - so book now to avoid disappointment.

4. Sessional GPs - some useful information

Another excellent contribution from Zoe Norris and her Sessional GP committee at the GPC.

5. New Models of Care

Some great videos interviewing GPs about what the New Models of Care Programme has achieved for them and their practices. Dr Donal Collins - GP lead in Gosport is one of those who has been interviewed.

6. Cervical Screening Incentive Scheme - Educational Practice Visits

Rates are falling in some areas - here is the opportunity to increase your uptake and also gain some funding.

7. National recognition for the work undertaken by a local GP

Wessex is a name that is frequently mentioned at a national level because of all the work that is done to support GPs and practices and it is great to recognise individuals who have been recognised nationally for their individual contributions.


1. Indemnity

The most important issue in terms of the future of general practice is workload - this is the number one reason that GPs are giving as their reason for leaving the profession prematurely and is a major reason for younger doctors not choosing a career in general practice.

We have all seen the annual cost rise year on year at a faster rate than inflation. 

When calculating any compensation payment the courts apply the Discount Rate, with the percentage linked in law to returns on the lowest risk investments, typically Index Linked Gilts. This year the Discount Rate has changed and will fall from 2.5% to minus 0.75%. This will lead to larger compensation payouts and will have a knock on effect to those seeking Indemnity cover and is expected to more than double the cost of the cover.

The Government has recognised that if these issues are not addressed the impact on general practice would be devastating.

Last year an additional £30m was part of the annual negotiations with the profession to recognise the 10% increase in annual costs of indemnity for GPs.

At the recent RCGP Annual Conference the Secretary of State for Health announced the introduction of a state backed Indemnity Scheme for all GPs and practice staff to be introduced by April 2019.

This is clearly welcomed but there has been significant confusion by the MDU announcing that they would immediately reduce the cost of indemnity by 50% for all those who renewed their cover after 1st November but that this was on a claims-paid coverage which is an alternative form of indemnity which requires policy holders to obtain run-off cover at the end of any period of coverage, since it only covers claims which are reported and settled during the period of the cover. This means that claims made and settled in the period up to the introduction of a state backed scheme while the policy remains in force should be honoured. Claims made after the cover has expired, or made before the expiry of the cover but not yet settled, will not be honored, unless run-off cover is purchased at the end of the period.

This reduction in coverage will apply to any GP taking up the MDU’s offer of membership at the reduced subscription cost (whether as a renewal or new membership taken out from 1 November 2017) or with any other organisation that offers indemnity for clinical negligence on a claims-paid basis.

The Government does not currently plan to include this run-off cover in a state-backed scheme. GPs with claims-paid or claims-made indemnity policies would therefore be required to purchase such cover separately themselves at the point they move to a state-backed scheme.

Any GP purchasing an indemnity product on a reduced cover basis should make themselves fully aware of the terms under which it is being offered, taking into consideration how they will cover themselves after the period of cover has expired and the cost of run-off cover.

GPs should also continue to ensure they have appropriate cover in line with the GMC professional regulatory requirements to enable them to practice.’

Please see a Q & A by Dr Krishan Aggarwal ’s article on indemnity on behalf of the sessional GP subcommittee - click here.

Key Message: This is complex area ensure you understand all the issues before you make any decision in terms of a change to your indemnity. Run off cover is is an essential part of the calculation.


2. New patient leaflet - Primary to Secondary Care leaflet

In 2016, NHS England accepted taking forward GPC’s urgent prescription for general practice. This was followed by setting up a dedicated primary/secondary care interface group to develop our proposals, and reduce the bureaucracy and continued shift of inappropriate workload onto GP practices.

Building on past work that the GPC has delivered – securing important changes to the hospital contract in 16-17 and 17-19 –  through this national interface group the GPC have recently co-produced with NHS England and the National Association for Patient Participation, a patient information leaflet.

The leaflet explains to patients what they can expect to happen if they are referred by their GP to see a specialist or consultant at a hospital or a community health centre.

You can access this leaflet from the BMA patient information page . A copy is attached to this email. This is a significant step in supporting patients to navigate the interface between primary and secondary care.

This follows on from a recently published guidance document , jointly produced by GPC England, NHS England, NHS Improvement, NHS Clinical Commissioners, Royal College of General Practitioners, Royal College of Nursing and the Academy of Royal Medical Colleges, which describes key national requirements that clinicians and managers across the NHS need to be aware of in order to work toward improving the interface between primary and secondary care.

Each of these documents have been developed following significant work by GPC. Improving patient care has been the primary driver behind this work with patients getting what they need where they receive care, rather than being referred unnecessarily back to their GP. This positive change in national policy to start to address the impact of unnecessary workload shift onto GPs is something we will need to build on further.

Many practices have used the document produced by Kent LMC and shared by your LMC which has been helpful but at times caused a negative reaction from some hospitals as it was seen as GPs being "difficult".  The new leaflet builds on this as it is produced by NHS England working with patients should be more widely accepted.

I have printed a pile of these leaflets and have started to give them out to each patient I refer.


3. Next Generation of GP Leaders

Leadership is a topic which generates very mixed reactions. No one can deny that to be successful and organisation or professional grouping needs good leadership.  This will interest some but not others. The NHS can often be accused of short term strategies looking no further than 12 to 18 months ahead, whereas most successful organisations are looking much further ahead in terms of development and vision.

When I started in general practice leadership positions were the preserve of the older male GPs who were seen to have "served their time" in a practice and was often an inherited position rather than one given on merit.   Much has changed in my 30 years as a GP and approach to leadership is one of those. We now have a much broader range of leaders and the LMC is proud to have played a part in that in terms of encouraging younger GP and achieving a much better gender balance in terms of representation.  But can we do more?

I am delighted that a programme to support an nurture the next generation of leaders is coming to Wessex shortly. The LMC is not only sponsoring this programme but is actively involved in the development and delivery of this.   We have currently filled about 2/3rds of the available places so if you are interest please apply as soon as possible and the closing date fast approaches.

Dear GPs and GP trainees,

We are writing to invite you to apply for a fully-funded place on this year’s ‘Next Generation GP’ in Wessex, a programme seeking to inspire emerging leaders in General Practice.

Next Generation GP aims to:

· ENERGISE: through access to the stories, perspectives and expertise of inspiring leaders at the forefront of primary care.

· ENGAGE: through a supportive network of like-minded local trainees and early career GPs

· EMPOWER: through a series of workshops designed to increase your ability to shape care within and beyond your organisation.

The core of the programme will consist of 5 evening events held in Winchester once a month, starting in December 2017.


In the face of unprecedented pressures the landscape of the NHS is changing rapidly, and the centre of gravity is moving rapidly towards primary care. This represents an exciting opportunity for new GPs to be involved in improving frontline services for patients.

That said, with the largest curriculum and the shortest time to learn it all, many of us start out without a clear understanding of the system we'll be working in, the changes being planned around us, or the tools to lead change effectively.

This programme seeks to engage the next generation of leaders in primary care, equip them with networks and an awareness of the skills required to succeed, and empower them with the belief that they can transform their ideas into impact.


The events will consists of workshop on the wider system, followed by an interview with a primary care leader to learn about their leadership journey. These will be held in Winchester, on:

Tues 12th December

Tues 16th January

Tues 20th February

Tues 27th March

April -TBC

Our speakers will include:

Prof Nick Harding-Chair of Sandwell and West Birmingham CC, founder of the Modality partnership?

Dr Nigel Watson- Chief Executive of Wessex LMCs

Prof Clare Gerada-Previous RCGP Chair, Director of the Practitioner Health Programme

Fiona Dalton- CEO for University Hospital Southampton NHS Trust

Dr Karen Kirkham -Assistant Clinical Chair, NHS Dorset Clinical Commissioning Group

The workshops will cover areas such as:

The structure of the NHS

How can we influence with impact?

Transforming primary care for the future


Next Generation GP is for GP trainees and early career GPs (first 5-7 years) with an interest in health policy and the wider NHS.

How to apply?

Applicants are invited to submit a brief expression of interest outlining their motivation for applying to the programme, which will be used to allocate places. For more information about the programme, a link to the brief application form, and to see feedback from last year’s cohort, please visit our website at:

Please note, as the programme is fully funded, applicants must be able to commit to attending 4 of the 5 events (see attachment or website for timings).

Applications open from Monday October 2nd until Friday October 27th at 5pm. We will inform applicants of the outcome by November 10th.

If you have any questions, please email us at:

Best wishes,

The Next Generation GP Wessex team



4. Sessional GPs - some useful information

Click here to access the latest newsletter produced by the Sessional GP Committee of the GPC.


5. New Models of Care

We are all trying to find solutions to the major challenges for general practice which includes excessive workload, increasing demands, an ageing population, a recruitment and retention crisis at a time when additional resources are promised to primary care and community services but all too often we seem to be placed at the back of the queue and the priority is the hospitals.  You will have heard me say numerous times, so sorry to repeat the message but we will not solve the problems face by hospital by giving them all the resources and allow primary and community care to fall apart , the NHS needs to invest heavily in the out of hospital model.

The reason I got involved in the Vanguard, MCP, New Models of Care (all the same thing) was to find solutions for our practices. Recognising that the essential building block of the NHS was and remains the registered list held by a practice but also realising that by itself that is not enough, we need more services available that are working with us in a neigbourhood and embedded in our practices rather than provided at a distance in a fragmented service.

There is great interest in the work that is being done locally, recently I have been to talk to the GPs of Leicestershire and Yorkshire who were keen to hear about what has been happening in Wessex and also understand the benefits and threats to general practice.

GP participation in a multispecialty community provider (MCP)

The new business models team in NHS England have  produced a  series of videos  which seek to portray what it’s like to be a GP in a multispecialty community provider (MCP) and to support GPs to learn more about MCPs, linking to themes identified in the GP participation document.

The videos are based on the GPs’ own views. They are site specific and aim to demonstrate the experience each area has had.  In the videos, the GPs reflect on the circumstances which led their practice to consider a new model of care and why they believe that making these changes will help to sustain general practice for the future.

There are six videos in total: five covering individual themes and one looking at the national picture .

Clearly the most important video is the one with Donal Collins, a GP from Gosport in Hampshire talking about his view of the MCP and a team approach to care - click here to view the short video.


6. Cervical Screening Incentive Scheme - Educational Practice Visits

You will be aware that NHS England have recently launched an incentive scheme to all practices in Wessex, with the aim of boosting cervical screening rates. 

Cervical screening coverage is falling year on year, to a current level of 73.6% in Wessex.  The target is 80%. 

Practices identified as having the greatest need for support - whether or not they have signed up for the scheme - will be contacted over the coming weeks by your local Macmillan GP, to offer an educational visit. 

If you are not offered a visit but would like one - for further support, information, education and training, please email 

There is a team of eight Macmillan GPs and two CRUK facilitators who cover the whole of Wessex and will be delighted to come to your practice at a mutually convenient time.  The CRUK facilitators are offering cancer workshops for non-clinical staff; see attached flyer. Please note that although the deadline has passed, you can still sign up for this incentive scheme.


7. National recognition for the work undertaken by a local GP

I was delighted to see that Dr Karen Kirkham has recently be named as the "Clinician of the Year" in the 2017 National Association of Primary Care (NAPC) annual awards.

Karen is a GP at the Bridges Medical Practice in Weymouth, Dorset, and Assistant Clinical Chair of Dorset Clinical Commissioning Group. 

The reason for this award as detailed by the NAPC was:

"Karen has been instrumental in delivering a new model of care which has brought together people from health and care teams to support people with complex needs in an integrated way. This has resulted in better quality services for patients and carers while at the same time reducing reliance on hospital services. Karen is described by colleagues as “passionate, thoughtful and caring, driven not by self-interest but by the belief that people’s experience of health care can be improved – an inspirational leader who makes personal sacrifices for the greater good”.


8. Childhood Infectious Diseases - update

A couple of months ago I included in one of my emails some details about childhood infections and who can and cannot attend school.  I have had some helpful feedback from our Public Health Colleagues with some updates on previously issued guidance - I suppose at least it shows someone is reading them!

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 for the lasted guidance.

There is a new “poster” on exclusions - click here.

Public Health England have issued some excellent "Winter Readiness Packs".

Info for schools on infectious diseases, infection control and recognition and management of outbreaks - click here .

Info for care homes on infectious diseases, infection control and recognition and management of outbreaks as well as a toolkit for improving vaccination uptake in care homes - click here .

I always think it odd when someone comes to the surgery with an attack of acute diarrhoea and vomiting - especially if this may be Norovirus thus potentially spreading this to those who are in the waiting room as well as the clinician seeing them.  Attached is a poster about Norovirus which might be helpful for your staff and patients. 

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: Cancer awareness and screening workshop flyer[1].pdf

Attached file: Next Generation GP information for participants Wessex1.pdf

Attached file: Stop_norovirus_spreading_this_winter_leaflet.pdf

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Updated on 24 October 2017 1163 views