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LMC Update February 22nd 2018

Date sent: Thursday 22 February 2018

Another email for your to read, but hopefully this will be much shorted than my usual emails to you!

Although some practices are beginning to recruit again others are really struggling.  The LMC has been developing services to support individual practices and I am pleased to provide you with details of a new service we are launching this week.

Safe working, how many patients is it safe to see in a day? What do you think 20,30, 30 or 75? Remember consultations will include surgery face to face (in surgery)  home visits and also telephone consultations. Then add in the time taken to to manage your results and letters. What should you do if you believe the environment you are working in is unsafe? Report it but to where? Should you walk away and refuse to engage?

Read more about this difficult situation and what to do.

Following my last email some keen eyed GPs found that the link to excessive prescribing document were broken, I did test this link before i sent the email out to you. Attached to this document is the information I was referring to.



1. GP supporters - a Wessex LMCs initiative to help practices

The GP Forward View has invested a significant amount of funding to the Vulnerable Practice Scheme and the Resilience programme.  Many practices have benefits from this in Wessex.

For some the help and support has been hugely beneficial to support development, transformation and stabilisation.  But as an LMC we are all too aware of a number of practices who lose more than one GP, they also lose their practice leader (whether that is GP or Practice Manager) it then becomes increasingly difficult to cover the clinical sessions and at the same time look at what could be made more efficient or even transform the practice, a locum may be difficult to find and they only cover the clinical work.  This scheme will hopefully provide some clinical support but also one of our experience GPs can look at other systems in your practice and help you with a wide range of things.

2. Safe working and what this means for GPs

There is a lot of discussion following the recent GMC case.  What should you do if you are working in an unsafe environment? We are often compared in terms of safety to the Airline Industry, if a Pilot does not have a full crew and deems the flight to be unsafe, they would cancel the flight, so if you are concerned should you walk away or is there a different approach needed for doctors?

3. Education and training for Practice Staff, Nurses Managers and GPs

Wessex LeaD as part of Wessex LMCs, has been working hard to ensure there has been a comprehensive programme of education and training that is of good quality at a reasonable price, but what about GP education?

4. Focus on excessive prescribing

Sorry document now attached.


1. GP Supporters - a Wessex LMCs initiative to help practices

The  is acutely aware of the increasing number of practices that are really struggling and finding it difficult to recruit new staff and sometimes short term locums, which inevitably means that the situation they find themselves in just gets worse and becomes impossible to turn around.

For many, what is needed is an experienced GP who can come in and assist for a short period of time to help the practice get back on its feet. The help needed will vary from practice to practice - seeing patients is a must, but assistance with leadership, providing the headspace to think about different ways of working, to help explore working at scale or even merging plus the provision of advice on practice finance, governance etc are all available too.

The LMC developed a proposal to recruit a number of experienced GPs to fulfill this role and developed a proposal which was submitted to NHS England.  I am please to report that we were successful in our bid and have secured some national funding to help with the development of these proposals.

The LMC has recruited 10 experienced GPs to provide support to struggling practices both as hands on GPs and as GP leaders in order to ensure that both the clinical and managerial aspects of the practice are being fully examined prior to agreeing a plan towards sustainability.

We have a myriad of further support available to practices should this prove to be the need e.g. Practice Manager Supporters; our education and training arm; access to financial and legal advice plus our pastoral service to help GPs reach their full potential and our GP Supporters will be assisted to signpost appropriately.

Practices who wish to take advantage of a GP Supporter will be required to complete and submit a Wessex LMC diagnostic tool and each member of the practice team will be required to complete a short anonymous 360 whole practice feedback – both of these are valuable tools for the GP Supporter to use.

Once these have been analysed a GP Supporter will agree a date to attend the practice with the aim of a mutual assessment to ensure the practice and the Supporter believe they can work together to achieve a positive sustainable outcome.

The assessment day is free of charge to the practice but thereafter, the practice will be expected to part fundthe GP Supporters time, the balance being subsidised by the LMC.

The GP Supporter and the practice will agree the number and times of both clinical input and leadership/managerial input to suit the needs of the practice and it is expected that this will be up to a maximum of three months.

If you believe your practice would benefit from this type of assistance, please do not hesitate to let Wessex LMCs know by email: or if you wish to speak to someone first then please call Carole Cusack, Director of Primary Care on 023 8025 3874.

Please see attached document for more information.


2. Safe working and what this means for GPs

There is no doubt that the workload in general practice has increased significantly in the last few years and this at times makes the working day unmanageable and then contributes to the problems with recruitment and retention. 

The recent case of the Paediatrician, Dr Bawa-Garba, has raised many issues and one of which is working in a safe environment and what to do if you feel it is unsafe.

There are many comparisons made about safety with the Airline industry, they developed a lot of the thinking related to significant events and avoiding blame but learning from mistakes or near misses.  The health service has followed this culture and adapted it for the NHS, and the recent GMC cases raises the issue of responsibility of the individual, the system, accountability, responsibility and blame. Much has been written about this and I do not want to focus on this aspect.

I have been asked by several GPs recently about what they should do if the feel the service they are working in is unsafe, whether this is in their practice or Out of Hours .  

Should they refuse to put themselves at risk and simply walk away?  

If an Airline Captain arrived to fly a plane and was told that half the crew had not turned up and it was thought to be a risk to fly what would they do?  The flight would be canceled of course.  For doctors it is not the same, arriving at work or even at a point during the day if you deem things to be unsafe by walking away rather than make patients safer you are going to put them at greater risk.  So the simple answer is that walking away is not acceptable and more likely to put you in trouble with the GMC.

The latest GMC advice is that if you feel the environment you are working in is unsafe in your opinion you should raise that with a senior person, discuss what can be done to address this and ensure this is recorded.

So what is being done to help you and what should you do if you face this problem?

The GPC is currently exploring what is  the safe number of patient contacts per day a GP can undertake, what should be put in place when this limit has been reached in terms of practice, locality and even CCG wide. This is where extended opening and the new initiative of extended access must help practices to deliver a safe service to their patients.

What should your practice do?

In my practice we have an urgent care team each session which includes 2-3 GPs, a Nurse Practitioner and an Admin person, so the if the demand on the day becomes excessive and unsafe someone in that team will be advised to declare a practice "Black Alert", everyone should then know that the safe limits of working have been exceeded.  This will then trigger the most senior GP Partner, Practice Manager and Receptions Manager to meet with the urgent care team.  They will then look at the extent of the problem and then decide what action is needed.  This may result in a message being sent to all GPs working in the practice to say help is needed urgently with the telephone triage screen, or with additional appointments or help with home visits. It may result in canceling some routine appointments, looking at creating additional capacity by changing tutorials etc.

If you have a Black Alert declared every day there is clearly a significant problem with the system you are working in which needs to be addressed.

I would suggest any Black Alert would need to be discussed at a significant event meeting to look at causes, action taken and outcomes.


3. Education and training for Practice Staff, Nurses Managers and GPs

Wessex LEaD has proved to be a very successful part of the LMC and has grown over the last couple of years. In the last 12 months there has been over 300 events on offer on a wide range of topics and for different groups of people.  Some meetings are small and others have quite large attendances such as our Annual Conference or our Practice Manager Conferences, in total there have been over 4,000 delegates attending the various meetings and conferences.   Many events get booked up within a few days of being advertised such as our IT Conference in April, we had 200 delegates booked within a week and currently have a waiting list of over 50 people.

The LMC wants to build on this success and is looking to develop the programme for next year.

For more information - click here .

Practice Managers

As an LMC we have worked with NHS England to develop Practice Manager Appraisals, and led a national pilot to train peer Appraisers and worked with a number of other LMCs to evaluate this.  In addition we have developed a comprehensive programme for Practice Managers.

Part of the GP Forward View there is a commitment to invest £5m in Practice Manager Development.  The LMC has been successful in securing £300,000 for the training and development of Practice Managers.

The investment will be as follows:

  1. £100,000 will fund the Leadership Academe to expand the 5 day PM Leadership Course.
  2. There will be investment in further PM Appraisals and Appraiser Training.
  3. Coaching and Mentoring is seen as being very important in many professional groups - there will be funding made available to develop this - it is very important that GPs support their Managers in making time to engage with this as not only will they gain from this but your practice will as well.
  4. Not all Practices are close to an urban conurbation and have education and training events available on their doorstep, so there will be some investment looking at the hard to reach areas.
  5. Finally there will be greater investment in the PM programme for 2018/9.  

General Practitioners

We have not forgotten you, we have always focused on PMs, Practice Nurses and Administrative staff because that was where the massive gap was in terms of the provision of cost effective education and training for them. 

There has been quite a lot of GP education available through a variety of providers ranging from online, small groups and larger events orgainsed by hospitals, the RCGP Faculty and via the network of GP Tutors and some events have been organised by the LMC such as the conferences focused on Dementia, Cancer, Cardiovascular Disease., Mental Health and IT to name but a few.

Due to financial pressures, the support that Health Education England are able to provide via the system of GP Tutors etc is changing and therefore there is a potential risk to GP education and training.

Wessex GP Education Trust is a charity that has a significant number of GP members in Wessex and they support GP education and training.  The LMC has always enjoyed a close working relationship with them.

The LMC is going to expand the work that is undertaken by Wessex LEaD and aims to ensure that there is a comprehensive programme of education available for GPs locally.  This will be achieved by working closely with existing providers and also supporting the development of other platforms to provide education that will mean that not everyone need to attend a meeting. 

The LMC is working with WGPET to develop this programme and also explore different ways of delivering education.

We will release more information about this in the near future.


4. Focus on excessive prescribing

In my last email I provided a link to the GPC's document on excessive prescribing. Although I check the links within my email before sending them several people identified the link was broken. Sorry about that and I have now attached the document to this email update.


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: Focus-on-excessive-prescribing-February-2018.pdf

Attached file: The GP Supporter Programme info leaflet.docx

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Updated on 22 February 2018 924 views