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Email update November 26th 2017

Date sent: Tuesday 28 November 2017

As soon as I finish writing one email I seem to get a number of items that I think are worth sharing with you.  Some topical and some which are old issues but more information has become available.  

This email seems to have an IT flavour.

The  LMC plans to hold its 4th IT Conference in April of next year.  The previous conferences have attracted large numbers of delegates and have proved hugely popular. It is sometime since we focused on this important area and hence our decision to put on a conference covering this important area.  The dates, venue and agenda will be published in the near future.


Contents of this email

1. GP IT and NHS Digital

This section provides information about the following:

There is also general advice about switching your fax machine off!

2. GP at hand/Babylon 

You may have read about this in the GP press but what is this all about?

3. Mental Health - GPs and patients

This is an important issue and one of the reasons the LMC has a Mental Health day this week.  How can you look after after yourself?

4. Extension of the seasonal Flu programme to include social care workers

This gives details of the extension of this years Flu programme to include health and social care workers.

5. Junior Doctors Contract

The BMA has recently produced some excellent guidance for Practices and trainees relating to the new 2016 junior doctors contract.

6. Sessional GPs latest Newsletter

There is a link to the latest sessional GP newsletter.


The Vine Medical Group have kindly shared details of their multi-disciplinary Same-day Care Team (SDCT) which might be of interest to those who are struggling with on the day demand.


1. GP IT and NHS Digital

Recently the LMC had an excellent meeting with NHS Digital to discuss a number of issues that were common to both of us.

Most meetings I attend are in my capacity as an LMC Officer but I find that it is rare that the contents of the meetings does not contain some information that is of benefit to the efficient and effective working of every practice.

At our meeting with NHS Digital we discussed Electronic Referral, Electronic Prescribing and the Summary Care Record amongst other things but did you know that there was a wealth of information on NHS Digital's website that would be of interest and benefit  to your practice? Click here for more information.

Electronic Prescription Service (EPS)

The Electronic Prescription Service (EPS) allows prescribers - such as GPs and practice nurses - to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice in England.

In my practice, we use EPS for an increasing number of repeat prescriptions, most acute prescription and we are slowly moving to appropriate patients using electronic repeat dispensing. The investment in time to make this work,  brings rewards in terms of safety, quality and time saved by GPs and practice staff.

You can access the EPS dashboard by clicking here.

EPS Prescription Tracker  - Do you get frustrated when the patient goes to the Pharmacy and are told they do not have the prescription and go back to the Practice to ask for another one when you know it have been issued and collected by the Pharmacy? if you work at a prescribing or dispensing site, use this tracker to check the status of an individual  prescription (N3 connection needed). I have seen the prescribing team in my practice use this and it can be really helpful.

The latest data as of the 20th November 2017 showed:

By accessing the data about current usage, I can see for example my practice - the Arnewood Practice:

I can then look at my CCG and see that 56% of patients with a nominated pharmacy is in the top 1/3 compared to all practices. Most practices have yet to start using ERD but one local practice is now up to 11% and 73% of prescriptions being issued as EPS is one of the highest.  On one level, as the Managing Partner in my practice, this practice data compared to other local practices is good but on another level the use of EDS will save practices time and help them with sustainability and resilience and therefore will look to increase the % with a target of reaching 10% by April 2018.  I haven't told them that yet - but they will be getting an email from me shortly!

Click here to access the spreadsheet of all practices in the UK. To find your practice look at the link to usage. This will give you an Excel spreadsheet which is a bit daunting. I would suggest if you click on the tabs at the top for Area Teams and then CCGs - you can remove all the areas that are not relevant to you. I just left the practices in my CCG which provided an excellent comparison especially as I know these practices really well and the their local circumstances.

An alternative you can access the EPS Dashboard - click here - look at the bottom of the page and you will see page numbers 1-8 - go to page 4 and you can easily look at your practice, CCG or Area team data.

There are some excellent resources on the website that most practices would find useful.


Summary Care Record (SCR)

The SCR contains important information including name, address, date of birth, NHS number, current medications and allergies. The patient can also choose to provide additional information.

All practices are contractually required to provide the above information to the SCR and about 98% of practices are compliant with this but there are still a small number of practices that are not complying with their contractual obligations. It is worth checking that your practice is compliant.

There is an excellent letter that you could use for your patients - click here .

GPs can include additional information by changing the patient's consent status on the clinical system used in the practice. From 1 July 2017, the General Medical Services (GMS) contract requires GPs to identify patients with moderate or severe frailty, and promote the inclusion of additional information in the SCRs of those with severe frailty by seeking their consent to add it, but most GPs I talk to have little idea as to how to change the consent to allow this enhanced SCR.

The majority of Wessex Practices use either TPP or EMIS, if you click here, you will find the link to guidance specific for each system. The documents for TPP and EMIS are attached to this email.

Resources that are available include - look at bottom of page click here:

Electronic Referrals (eRS)

The NHS Contracts states that after October 2018 hospitals will only be paid for referrals that are received by them electronically.  This means that all GP referrals would need to be made electronically, yet currently there is nothing in the GMS or PMS contract to force this to happen.  From my previous emails you will have seen that some local hospitals are trying to increase the use of eRS (AKA Choose and Book) by "turning off" paper referrals in certain specialities.  I have been asked repeatedly to detail the LMC's position.

The LMC's view is:

  1. The ERS system must be fit for purpose
  2. An inadequate Bandwidth would be a barrier to full implementation of ERS.
  3. There must be a contingency process if the ERS is not working or there are other issues which cannot be overcome.  This means there should be a secure hospital email address where electronic referrals can be sent to as we are all aware C&B and smart cards are not 100% reliable.
  4. There must be adequate information and training for the new system and this should preferably be practice based and if possible available online.
  5. The Referral pathways as a result of ERS must be agreed with GPs and by that I mean the LMC.
  6. If a Trust receives a referral via a non ERS route then this must not be returned to the referring practice it must be processed internally by the Trust.
  7. Trusts must reply to the referring GP and not to a generic name in a practice or,  what often seems to happen a name which appeared once in the hospital records.
  8. Any eRS must have clinical input within the hospital, referrals need to be managed and it is not acceptable if the first time a referral letter is seen by a clinician is when the patient is seen in the OPD.

The LMC is engaged with a number of CCGs and hospitals that are trying to implement eRS.

I remain concerned about the whole referral process and believe greater clarity is needed for all to have a safe and effective service.

Some issues that need wider debate include:

Clinical responsibility - as a GP I see a patient whom I am concerned about and refer them to my local hospital. I write a detailed letter explaining my concerns and ask for the patient to be seen urgently.  Does this then mean I absolve my responsibilities for this patient? Clearly not, and I am sure we would all say to that patient if they have not heard within a defined period or if they are getting worse to come back to see us or contact us.  But how much responsibility does the Consultant have when he or she reads my letter and is made fully aware of my concerns and the urgency that I believe is required to help this patient?

We have clarified the responsibility for following up tests and investigations and I hope this has improved in your area.

Available services - what happens when you decide to refer a patient to the hospital and that service is not available.  Recently I had a patient with a shoulder problem and wanted to refer them, I was a good boy and tried to access the Orthopaedic Choice Clinic (essentially a triage clinic which in my locality,  which is excellent) only to find every other part of the body was available but no shoulder clinic.  This is not acceptable.

Follow-up - When the patient is seen and they are told they will be reviewed in the hospital in 3 months and the appointment comes through for 6 months or more often they receive an appointment that is then cancelled several times delaying follow up. Should they contact the GP as their advocate and coordinator of care or the hospital? Clearly they should contact the hospital.


General Practice Workload Tool: EMIS practice reporting dashboard now available

In the General Practice Forward View (published April 2016) NHS England committed to providing an automated appointment measuring interface to enable general practices to quickly view information on their appointment capacity and utilisation and how it varies over time. NHS England has announced the availability of the new practice based reporting tool – known as the General Practice Workload Tool – for users of the EMIS system.

The tool will be rolled out to all EMIS practices in the coming weeks.


The end of an era for Fax machines!

The NHS has the"dubious" title as the world’s biggest buyer of fax machines and a recent report stated that "the NHS’s obsession with fax machines is putting patient confidentiality at risk".  

The LMC's advice remains that every practice should have a generic email account, that is secure and has address. Faxes are old technology and practices should have a plan to stop using them and move to the more secure and reliable electronic form of communication.


2. GP at hand/Babylon 

If you walk around London you will see numerous adverts for GP at hand, offering a free NHS service that allows you to register with a practice in London and gain fast access to a GP via smart phones.   Click here to see the promotional adverts.

There are a couple of other companies who are starting to offer similar products.

There are two separate issues here, the first is the potential for a group of practices based in London to register patients using the regulations that were implemented a couple of years ago to allow patients to register with a practice and not live in that catchment area.  The potential here is for a significant number of patients to de-register from their existing practices and register in London, largely using the smart phone online consultations. The reality is those who would want these services are the younger, fitter patients who are mobile, leaving the chronically ill, housebound to their usual practice. You then also have the problem for CCGs in terms of providing a visiting service for these patients.  Potential for chaos especially in the areas where there are a large number of commuters. 

The second issue is the technology - this is apparently a simple development from a stable platform and available for Android and iPhones.  I am sure we will see  more of this opportunity but I would hope the wider application will come from practices and GP Federations supporting local practices.

Innovation is important and we need to embrace this for the future but this must not be done at the cost of de-stabilising general practice, this technology if effective should be made available to all.


3. Mental Health - GPs and patients

Mental health is such an important issue and one that holds many taboos. With the pressure on general practice the LMC is seeing more GPs and Practice Managers who are affected by mental health issues. This is probably a combination of people being more open about mental health issues that affect themselves and also the result of the pressures we face in our practices on a daily basis.

This week we are holding the first LMC Conference dedicated to mental health.  The day will start off exploring how to maintain our mental wellbeing, then explore the services to help and support GPs and then in the afternoon look at common clinical problems faced by GPs like personality disorders, depression and anxiety, perinatal mental health and adult ADHD. It is great to see that this is fully booked with over 140 delegates.

I was pleased to see a BMA campaign called  ‘Give the gift of 5 minutes’.

 The BMA is running a campaign aimed at encouraging doctors to take 5 minutes during their day , to focus on their mental health.

Phase one of the campaign is called ‘give the gift of 5 minutes’ and runs through to the end of December. Phase two – ‘take 5’ will then run until the end of January. To support doctors in taking 5 minutes to unwind and focus on their mental health, the BMA is  giving two months’ free trial of Headspace – the mindfulness and mediation app. 

To support the campaign, the BMA  are also running a twitter competition. They are calling for members to post photos of how they look after their well-being, using the hashtag #thegiftof5 and @thebma. The winners will receive a hamper for their practice or hospital team – the BMA are  doing 10 hamper giveaways each week. You can see some of the great entries they have had so far. 

Please do help spread the word by making sure a poster is up in an appropriate space in your practice, retweeting the BMA and taking part in the social media competition. If you would like to request a poster, please email (please ignore the auto-response).


4. Extension of the seasonal Flu programme to include social care workers

NHS England has announced that for the 2017/18 flu season, the delivery of flu immunisation will be extended to include social care workers that offer direct patient care. 

The influenza vaccine PGD template has been amended to include the vaccination of health and social care staff, employed by a registered residential care/nursing home or registered domiciliary care provider, who are directly involved in the care of Page 3 of 4 

vulnerable patients/clients who are at increased risk from exposure to influenza, meaning those patients/clients in a clinical risk group (see Appendix A) or aged 65 years and over. 

Note that the previous version (v04.00) is not being formally withdrawn in order to ensure continuity of service and may still be used this season (until 31 March 2018). However, this new version of the PGD will be needed to vaccinate health and social care staff in line with the NHS commissioned service when it is commenced. 

A GP enhanced service specification has been published on the NHS England website

The GPC’s vaccinations and immunisation's page will be updated with links to the PGD and enhanced service.


5. Junior Doctors Contract

The BMA has recently produced some excellent guidance for Practices and trainees relating to the new 2016 junior doctors contract - click here for more information.


6. Sessional GPs latest Newsletter

Please click here to access the latest newsletter.



Sometime ago I asked all practices to share their successes with the LMC, we are looking for good ideas and innovations that has benefited your practice and that you are prepared to share so that others could learn from this and use this in their own practice.

I would like to thank Lisa Sheppard, Lead Clinical Practitioner for the Vine Medical Group for sharing this with me.


"We are a large practice based in East Hampshire, providing patient care across four sites. We currently have 27,500 patients, with a high daily demand for same day care appointments.

Early last year we recognised that we were struggling to keep pace with the ever increasing demand from patients requiring same day care, so set about streamlining our system to provide timely access for our patients.

We developed the multi-disciplinary Same-day Care Team (SDCT) to ensure our patients’ are assessed by the right clinician at the right time. The SDCT compromises of General Practitioners (GP), Nurse Practitioners (NP), Paramedic Practitioners (PP), Practice Nurses with advanced skills and a Health Care Assistant (HCA). We also have a large team of call handlers supported by a call handler mentor and GP. The SDC appointments are offered at one site ensuring the SDCT practitioners can be supported by the GP’s working in SDC. There are however a small number of emergency appointments available at other sites for those frail patients who are unable to travel to our SDC clinic.

We invite our patients to call the practice between 8.00-9.30am if they require an urgent appointment that morning. Or between 2.00-3.00pm if they require an afternoon appointment. The patients are initially triaged by the call handlers who use a suite of detailed protocols, developed by the SDCT, thus ensuring consistent safe decisions are made. Patients are directed according to their clinical need. Call Handlers can book into a face-to-face appointment if required, or allocate a slot on the telephone triage list, for a clinician to call the patient back. On average 70% of the telephone triage contacts complete the episode of care without further face to face appointments.

The practice telephone message asks patients requiring a routine appointment to call back after the SDC times have finished. This maximises the number of call handlers completing the SDC requests, increasing turnover of patients on the telephone. Once clinically triaged patients are identified to need a routine appointment they are given an appropriate slot.

Each session has three GP’s, four or five SDC clinicians (a combination of NP’s & PP’s) and one HCA. The exception being a Monday when the team is bolstered by an extra GP as demand can easily reach above 600 patients contacts throughout the day.

All clinicians complete telephone triage between 8.00 – 9.45am, and 2.00-3.15pm. Face to face appointments begin at 9.45am and 3.45pm for the SDCT clinicians. The GP’s start slightly later as they continue to triage any remaining patients from the telephone triage list.

One GP works in our ‘Hub’ alongside our call handlers, offering support and advice to the clinical and non-clinical team. The Hub GP will triage any calls made after the SDC hours ensuring patients are offered clinical advice or a face to face appointment if necessary, this ensures the process is safe. The other GP’s have a clinic each with a small number of patients. The GP’s see the very complex patients and support the multi-disciplinary team.

The SDCT clinicians see the majority of the patients requiring face-to-face appointments for acute illness or injury. Many episodes of care are completed by the SDCT, however the GP’s are available to discuss or assess complicated or complex patients. The SDCT support each other throughout the clinics ensuring patients are seen in a timely manner. The HCA is available to complete observations or urinalysis prior to the appointment then any further investigations after assessment including phlebotomy and ECG’s.

Each session, there is one PP per clinic allocated to ‘roam’. The roaming PP is available to complete any appropriate urgent home visits. These are allocated via the Hub GP as they arrive via the telephone triage list. Once the home visits have been completed the roaming PP will report back to the Hub GP.

The system has been in place since June 2016. It has not only improved access to urgent care appointments for the patients but has also allowed more routine appointments to be made available with the routine GP’s, as less are now required to staff the acute team. We believe our system is safe and robust, ensuring call handlers are guided to make decisions with the use of protocols and the Hub GP. Patients are seen by the right clinician at the right time, with the multi-disciplinary team supported by GP’s.

We have further increased the multi-disciplinary team this year with the addition of a triage physiotherapy service. Patient’s calling with joint or lower back pain are triaged by the clinician and allocated a face to face short triage appointment with the physiotherapist for further advice.

Recently we have also introduced a MIND well-being practitioner into the team. They work a day and a half alongside the SDCT providing telephone assessment, one to one appointments and group therapy to those patients requiring their support. This service has already proved invaluable to those patients with mental health needs who are ready to start a recovery programme.

We are constantly improving our service and searching for new ideas to provide patients with safe, timely and efficient care."


Tax Penalties

I have attached  an Info-graphic that may be of interest to GPs. It has been prepared by the Institute of Charted Accountants of Scotland.  We have their permission to share this with GPs. I would like to add that the LMC does not provide taxation or other financial advice but is making this available for the general benefit of GPs.

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: tpps1ug.pdf

Attached file: Infographic-Tax-Penalties.pdf

Attached file: emisweb.pdf

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Updated on 28 November 2017 1139 views