LMC Bulletins 2016

Bulletin 310

GPC/BMA Survey
You will have recently received an email from the BMA/GPC outlining a GP survey that is being carried out. Please take a moment to complete this survey. The survey can be completed on a computer or mobile device and should take about 15 to 20 minutes. Some functionality may be reduced on mobile devices but your answers will be recorded once you click ‘continue’ at the end of the survey.            

At a time when general practice is facing increasing and unprecedented workload pressures, a workforce crisis and inadequate resources, the BMA GPs committee wishes to hear from all GPs in England about how you would like to see general practice develop – and how it can best support your workload and future aspirations.  It is vital to design general practice around the needs of current and future GPs if we are to make general practice an attractive, rewarding and sustainable career option. This important and comprehensive survey of GPs is aimed at all GPs in England, of all denominations including GP trainees. We know that GPs have diverse career wishes, and even more so when stratified according to contract type or career stage. For example, the wishes of a newly qualified GP may differ from those approaching retirement; the perspective of a sessional GP may not be the same as a partner – and indeed the issues affecting salaried GPs may vary from that of freelance locums. That’s why it’s important the BMA hear from all GPs – not just a sub-section. The survey results can be broken down into individual categories to help develop general practice to accommodate this range of views.

The survey asks searching and challenging questions, and importantly it asks what sort of environment GPs want to work in, as well as their personal career intentions.     

It is therefore very important that GPs think carefully before they answer the questions.     

The survey will ask GPs in England about:             

GPC England will use the survey results to help inform our negotiations with the Government and NHS England as we aim to turn around the parlous state of the profession into one that is sustainable, offering hope to existing and future GPs.

That is why, as a GP working in England, it is so important that you fill in the survey to play a part in empowering GPC England to help develop a model of general practice that is crucially based on your views and wishes.
Make sure your voice is heard!

GP Induction & Refresher Scheme
Getting back into general practice? Find out the key changes to the national induction and refresher scheme following the 2016 review. Find out more in GPC updated guidance.

Christmas and New Year Opening
It is coming to that time of year again and NHS England (national) have recently circulated a letter to commissioners for practices about guidance for the Christmas and New Year period. We would like to take this opportunity to draw your attention to the guidance with which you may wish to refresh yourself ensure that patients are adequately provided for over this period.

RMBF Occupational Health Guidance – Vital Signs of Primary Care, seeking advice and support
The Vital Signs in Primary Care: A guide for GPs seeking help and advice” written for the RMBF by Dr Richard Stevens sets out the key stress and pressure points for GPS and GP Trainees, seeks to provide practical advice, and signposts support and resources for those experiencing stress and difficulty.

Sessional GP Newsletter & Update
This latest GPC Sessional GP Newsletter includes articles covering the indicative locum rate that was recently announced, pension advice and information on tax relief for locum doctors.

GPC letter to Simon Stephens re Vulnerable Practices
You can view the letter sent by Chaand Nagpaul, Charim of GPC, to Simon Stephens here.

NHS England Data Collection
Reminder The first return of the biannual extended access survey is open for submission until 31 October 2016 inclusive.

The Government’s mandate to NHS England has a commitment to ensure everyone has easier and more convenient access to GP services, including appointments at evening and weekends. From October 2016, as set out in regulations, every GP practice in England will be required to submit an online return twice a year through the Primary Care Web Tool: www.primarycare.nhs.uk within a new module titled “Biannual Extended Access”. This will set out what access to appointments the practice offers to patients either itself or through other arrangements, seven days a week.  This module is automatically available to GP practice staff who currently have ability to submit mandatory data returns to NHS England.

GP Registrars and the Performers List
We have received the following message from PCSE:

I can confirm that the lists of GPRs in the August 2016 cohort have been received from HEE.  All of these GPRs (except those with an FTP concern) are being accepted onto the performers list as per the national agreement between NHS England and HEE, which you considered and supported.  Each GPR will receive an email in the next few days confirming their acceptance on to the MPL.  This will be followed up by a letter once the notifications and updates to the PL website have all been completed (this may take a little longer hence the early email). The small number of GPRs with a fitness to practice concern are being reviewed by the national team, with a view to inclusion  with a condition if necessary.  The same communication process will follow once this decision has been made.

We are also in receipt of the February 2016 cohort details.  These are being checked to ensure they are all included on MPL and follow up action will occur if this is not the case. We will follow a similar process for the Feb 2017 cohort as set out above for August, once all the current trainees, from all primary care services, are included in the relevant PL.

Thank you for your continued support – I would be grateful if you can reassure any GPRs that raise concern that this is being addressed to prevent wide spread emails into PCSE which will distract from the urgent actions in hand for all current new applicants to PL.

Community Pharmacy and Pharmacy Integration Fund
Following the announcement from the Department of Health about the Community Pharmacy Contractual Framework (CPCF) 20th October 2016, this briefing provides further information about the NHS England response to the announcement and the launch of the Pharmacy Integration Fund. Further information will be coming about the urgent medicines supply pilot by December 2016.

Bulletin 309

Workload Demands, NHS Standard Contract Changes for Trusts and Template Letters for Practices
A number of changes were made to the NHS Standard Contract for hospitals in England from April 2016, to reduce inappropriate workload shift onto GP practices. Many of these changes have been brought about as a result of ongoing negotiations between GPC and NHS England. At the specific request of GPC, a letter reiterating these new requirements was sent by NHS England to CCGs and NHS Trusts. To help practices push back on inappropriate demands, GPC has developed new standard hospital contract template letters as part of the Quality First web resource. This is a ‘cut and paste’ document of the appropriate element of the latest newsletter from Chaand Nagpaul, chair of GPC England.

Fast Track of Patient Notes for Safeguarding
PCSE have advised us of a contact email address to use where you may be trying to fast track patient notes in cases relating to any safeguarding matters. Any record requests relating to safeguarding should be sent to pcse.safeguarding@nhs.net.

GP Trainees and Medical Performers List
The BMA is aware that there have been delays in processing GP trainee applications for the performers list beyond the three month window for applications to be processed. We understand that this has serious implications for both trainees and practices and we have sought legal advice on this issue. Whatever the reason, GP trainees are not lawfully allowed to perform primary medical services past the three month mark (i.e. three months after the start of their GP specialty training programme, not three months after the start of the first GP placement), if the trainee has not been added to the medical performers list. Trainees should inform their employer in a timely manner if there is a delay in an application being progressed. If the application is approaching 3 months after the start of the GP specialty training programme, the trainee should contact their NHS England local area team personally to ask for their intervention. They could intervene urgently to consider the application, irrespective of whether Capita considers it to be complete, and to see whether it can be progressed to allow you to continue working. In the event that the necessary documentation has not been provided by the deadline, the NHS England local area team will be notified and will decide if the application should progress or further information is required.  Instructions for applications are outlined by HEE on the PCSE website. All documentation should be sent together with the application in order to be processed. If members have any concerns about how this will affect them or their practice and would like further advice, please call our BMA employment advisors on 0300 123 1233 (between 08.30 to 18.00 Monday to Friday, excluding UK Bank Holidays).

Gender Incongruence, GPC Focus On
The GPC has provided this information regarding the management of patients who present at their general practice with gender identity problems; including questions relating to patient records and confidentiality and, in particular, regarding prescribing and monitoring responsibilities in relation to the gender reassignment process. The guidance aims to explain what should be provided in primary care, signposts to further sources of guidance and highlights some of the underpinning ethical and legal considerations.

GP Access Survey
The letter and guide for completing the general practice access survey are both available here. The revised amendments to the GMS Contract Regulations which contain the provisions for the survey among other changes can be found here.

Sessional GP Newsletter & Update
Paula Wright has been re-elected for another 3 year term (July 2016-July 2019) as the northern region sessional GP representative. You can email Paula at Pwright@doctors.org.uk or follow her on twitter @PaulaFwright.

Additionally, this latest edition of the sessional GPs e-newsletter includes a message from the Chair, Zoe Norris, setting out what she’s working on, from pension payments and indemnity, to General Practice Forward View practicalities. There is also a blog post from Rebecca Jones, newly elected member of the committee, about embracing Facebook.

Workforce Minimum Data Set
This guidance on the Workforce Minimum Data Set (WMDS) provides useful information about the scheme and contains links to further information relating to the WMDS. WMDS is a national twice-yearly collection of data from NHS organisations in England on current workforce figures. Practices are legally required under the Health and Social Care Act (HSCA) to provide the information requested for the WMDS. The collection is intended to allow the Department of Health (DH), NHS England (NHSE) and Health Education England (HEE) to understand the current NHS workforce picture and plan for future needs. The data collection replaces the annual GP census and is submitted through the Primary Care Web Tool (PCWT).

GPC Exec Team and Mini Guide to the GPDF
A new GPC England Executive Team has been appointed. Joining Chaand Nagpaul, chair of the BMA GPs Committee, will be Richard Vautrey, who has been reappointed as the committee’s deputy chair, as well as Mark Sanford-Wood and Gavin Ralston. Additionally, the General Practitioners Defence Fund have produced this brief guide to the GPDF for practices.

Austerity is Damaging Health Report
What effect have the Government's austerity measures had on people's health? This is a critical question for doctors who are increasingly seeing patients struggling on low incomes and unable to live a healthy lifestyle. This briefing from the BMA board of science sets out the evidence for the ways in which austerity and associated welfare reforms can impact on health and wellbeing. This includes increasing child poverty and rates of material deprivation, as well as more tangible effects such as a higher prevalence of mental illness and suicides. The briefing looks at what action can be taken to reduce the impact on health and wellbeing, and suggests some practical ways doctors can be advocates for their patients.

GP Earnings & Expenses Report
The GP Earnings and Expenses Report 2013/14 has been published by the Health and Social Care Information Centre this morning and can be found here.

Dementia Nursing Strategy
The Northern England Clinical Network have produced this  strategy which sets out how nurses can provide high quality compassionate care and support for people with dementia, so they can live well with dementia within all care settings, including a person’s own home. It aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise, and achieve the best outcomes for people with dementia, their carers and families. This refreshed strategy builds on the original strategy, published in March 2013.

Data Guardian Review Consultation
The Department of Health, supported by NHS England, are running a series of events in relation to the National Data Guardian Review on data security, consent model and opt outs. The events will be split into public/patients and professionals and they are hoping to get as wide a range of views as possible.  There is an invitation for professionals and patients.

Bulletin 308

Undated Resignations & Industrial Action, GPC Guidance
We are pleased that discussions between the GPC and NHS England have progressed to such a place as to no longer require the balloting of GPs on their willingness for industrial action and undated resignations. That said, should it be required in the future, the GPC has compiled this Focus on Undated Resignations and Industrial Action providing useful explanation of the logistic and financial consequences, which would need to be fully understood should such action ever be considered.

With regards to industrial action, it is important to recognise the differences between independent contractor GPs and employees, such as hospital doctors:

The GPC guidance also outlines action that can be taken which would not breach contracts and as constructive measures to help you manage your workload to ensure safe patient care. Broadly speaking, the types of action you could take include the withdrawal of services that are over and above contractual obligations. Such options may include:

Mefloquine for Military Veterans Guidance
Mefloquine, an anti-malarial was prescribed to military personnel who were operating or training in Sub-Saharan Africa (not in Iraq or Afghanistan, with few exceptions) over the past 20 years. This NHS England document provides information on what steps should be taken by practices if a patient presents with symptoms relating to the side-effects of Mefloquine. This accompanying MOD letter and algorithm may also prove useful.

NHS England/GPC Funding Formula Statement
NHS England has published this statement regarding the review of the Carr Hill funding formula.

PCSE Contacts
All practices should have received this information to inform them of their new contact details for Primary Care Support services.

Prevention of Telephone Fraud Advice
The GPC has provided this advice on preventing telephone fraud.

Sessional GP Newsletter
You can view the latest Sessional GP newsletter here.

Bulletin 307

GP Retainer Scheme
The 2016 Retainer scheme has now been launched. Further details are available here
. In terms of the salient points:

These payments will be available to current GPs on the scheme as well as for new GPs.  The increased funding is available up till 30 June 2019. During this time a review of the retained doctors scheme will take place to, hopefully, make improvements on the 2016 scheme.

GP Indemnity Cost Support
NHS England has announced a new GP indemnity support scheme starting in 2016/17, to provide a payment to practices to offset average indemnity inflation. The scheme will initially run for two years before being reviewed.

GP Resilience Programme
NHS England has now published their guidance on the £40m Practice Resilience Programme. The guidance states that funding allocations for the programme in 2016/17 will be made to local teams by the end of July 2016. Annex A provides details of the allocations for each local team. GPC and the GPFV LMC reference group have emphasised to NHS England the vital role of LMCs in this programme, working with practices and local teams to ensure support is delivered where needed. The guidance commits local teams to working with LMCs in tailoring and delivering the support. The key forthcoming milestones for the programme are in section 8.

Focus on MCP Emerging Care Model and Contract Framework
The GPC has provided this Focus on the MCP emerging care model and contract framework which NHS England published yesterday.

Revised Guidance on Firearms
The GPC has provided this revised position and guidance on the firearms licensing process developed in light of the new policy passed at the Local Medical Committee’s Conference and ARM seeking further action and change. The Home Office has also been kept informed and GPC will continue to engage with them on seeking improvements to the current process.

Safeguarding Guidance
AS you are aware, since the loss of the PCTs there has been some difficulties in obtaining collaborative arrangement payments for safeguarding with our commissioners maintaining the position that GPs would need to justify non-compliance with regard to their statutory safeguarding duties if a report was not submitted and that non-compliance could justify a referral to the GMC with the implication that disciplinary action could be taken against defaulting GPs. It has always been our view that GPs should provide safeguarding services but that there should be payment as the provision by GPs of the relevant safeguarding services falls outside the scope of the range of essential, additional or enhanced services provided for in parts 8 – 12 of the standard GMS contract. Clause 19.1.2 (a) of the GMS contract specifically permits the contractor to demand or accept a fee or other remuneration ‘from any statutory body for services rendered for the purposes of that body’s statutory functions’. However, Tees practices are no longer being paid for this work.

GPC has taken up this issue and is continuing to discuss with NHS England how this situation can be best resolved; it forms part of the ‘Urgent prescription for General Practice’ published earlier this year. They have emphasised that a fee is needed to cover the costs of the workload done and to ensure the practice has the capacity to do this work properly. Failing to fund this area of work leads to poorer quality services and local authorities should not be making cost cutting efficiencies in an important area such as the safeguarding of children and vulnerable adults. GPC has obtained external legal advice on the issue, in which they asked for a view on the best way forward if it was not possible to reach a resolution through negotiation with NHS England. GPC’s position, having taken such advice, is that GPs do have an obligation to comply with their statutory safeguarding duties, but equally that they are entitled to a fee. GPC’s advice is, therefore, to provide the relevant services, but on the basis that a fee will be sought for the same, indicating the rate of charge ahead of the provision of the report or attendance at the case conference as the case maybe. The commissioner of the service would be notified that acceptance of such services will be treated as signifying a willingness to engage the GP on the stipulated terms. In the event of non-payment a claim for the fee could then be pursued.

Specialist Prescribing for Gender Dysphoria
GPC wrote to the GMC challenging their guidance on specialist prescribing for gender dysphoria and are pursuing this further. Additionally, they have written to NHS England, since ultimately, this reflects a failure of commissioning adequate local specialist services for this group of patients, and which NHS England should take responsibility to correct. GPC are also contesting NHS England’s own recommendations on GP prescribing for gender dysphoria and which has been used as a basis for the GMC guidance. GPC has also written to the three main MDOs, for their advice on any indemnity implications for GPs prescribing such specialist prescriptions which falls outside their competence.

Arrangements Childhoods Flu Immunisations
This letter outlines the arrangements for childhood flu vaccination across Cumbria and the North East for 2016/17.

Sessional GP Newsletter
The July edition of the sessional GPs e-newsletter includes a message from the new Chair, Zoe Norris, introducing herself and setting out what matters to her and the emphasis she places on effective two way communication. There is also a message from Vicky Weeks, the outgoing Chair, about the subcommittee’s achievements and biggest challenges. Faisel Baig writes about salaried GPs contracts and Paula Wright sets out how locums can offer hope to general practice. The e-newsletter also covers new FAQs on locum chambers.

PCSE Relocation
PCSE are relocating all the services currently delivered by our Darlington PCSE office. Our Darlington office delivers:

From 18 August 2016, service users who currently use the Darlington office should contact us using the following details:

Generic email: PCSE.enquiries@nhs.net
Screening email:
0333 014 2884
PO Box:
Primary Care Support England, PO Box 350, Darlington, DL1 9QN

Any post, including applications, claim forms, returns or cheques posted to PCSE, should be sent to the Darlington address above, which is a secure storage and distribution facility.  If practices would like to courier any documents to us, they should email PCSE.enquiries@nhs.net for the details, as there’s a separate address for courier firms to use. There are no changes to payment dates.

Bulletin 306

Measures to Control Workload/GPC Quality Hub
As part of the GPC’s workforce engagement work, this  "Quality first" resource is a single portal for the range of practical ways in which general practice can manage workload to deliver safe care, with “how to”, and with real case examples of positive change. Areas covered includes:

This is by no means a final product, and GPC hope to keep adding on and evolving the portal as feedback and new examples are received from around the country. The original template pack (included in the workload document) has been updated and also converted to Word documents for easier editing. SystmOne, EMIS and Vision web templates have also been sourced ready to be exported into practice systems with ease. This should enable automated letters to push back on inappropriate workload. In time GPC hope that this can also become a dynamic noticeboard of LMC and practice views and ideas - it would be part of creating a sense of empowerment and resilience for GPs and practices at a local and national level. GPC would, therefore, appreciate any examples of effective workload management you can share by emailing GPworkload@bma.org.uk, so that they can add to the resources available. Please also copy janice.foster@nhs.net into this email so we can also build a local resource. Some of these initiatives can link into the General Practice Forward View’s “releasing time for patients” programme, which looks at ideas, support and funding to release time for care and to lessen workload. GPC are also inviting members to share their experience via Connecting Doctors (formerly ‘BMA Communities’) and you can join the conversation on twitter via #GPworkload which is the hashtag GPC will be using to promote this work and engage GPs around the country.

This note seeks to clarify the position about the use of private prescriptions alongside FP10s following legal advice. The question raised relates specifically to whether GPs can issue private prescription forms at the same time as FP10s, in circumstances where this is a cheaper option for the patient than paying the NHS prescription charge. GPC was asked to consider whether this could be either a breach of the Regulations or collusion to defraud the NHS, who would otherwise recoup the prescription charge.  The legal advice received is clear that in cases of treatment under the primary care contract, GPs may not issue private prescriptions alongside and as an alternative to FP10s. In any case where a GP is obliged to issue an FP10, the concurrent issue of a private prescription will be a breach of obligation. In any case where a GP is obliged or entitled to issue an FP10 the concurrent issue of a private prescription will be conduct calculated to deprive the NHS of a small amount of money and will on that account also be wrongful. The advice is therefore that GPs do not issue private prescriptions under these circumstances.

Understanding Changes to Your Practice Funding
The 2016/17 general medical services contract agreement saw significant investment in general practice. Taken together with the ongoing recycling of seniority and correction factor payments, as well as recent funding commitments and developments, there are significant changes, now and in the near future, to how general practice is funded. GPC have published a ‘focus on practice funding’ guide, which provides a summary of the funding changes and highlights some further developments that will impact on general practice funding.

Responding to LMC Conference Resolutions
There were a couple of resolutions passed at both the Special LMC and Annual LMC conferences in relation to calling for action from the government in negotiating a rescue package for general practice and taking further the General Practice Forward View as it does not go far enough in responding to the GPC Urgent Prescription for General Practice document. Both resolutions gave timescales for action (6 and 3 months respectively) and the Annual LMC Conference (resolution S20) called for the GPC to ask the BMA to ballot the profession on its willingness to sign undated resignations and take industrial action (IA) if the deadline put to the government of 20 August 2016 was not met. GPC has formally written to NHS England, pressing for their acceptance of the Urgent Prescription. GPC has also commenced dialogue with NHS England regarding identifying those proposals in the Urgent Prescription ‘Responsive, safe and sustainable’ that are not covered in the GP Forward View, and which will form the basis of further negotiation. There is recognition by NHS England of the timescale required by the resolution. Work is also underway in responding to resolution S12 on the General Practice Forward View, instructing GPC to continue to press for further dedicated resources to support GPs. GPC is working to influence the detail and implementation of the GPFV, and to hold the government to account to deliver on the positive elements. It is vital that resources and schemes within the GPFV are developed and delivered to the frontline as quickly as possible to address core pressures in general practice. GPC is represented on the GPFV oversight board, is contributing to a workstream on the practice resilience programme, and the reference group of regional LMCs is being developed to feed into GPC’s national work. GPC is additionally setting up a roundtable with the LMC reference group and NHS England to discuss implementation of the GPFV, and the key role of LMCs in monitoring and supporting delivery.

DWP Guidance on Providing Medical Reports
The DWP has updated the guidance for Healthcare professionals on providing medical reports to DWP and is available online here.

GP Trainees Subcommittee Elections
The GP trainees subcommittee is holding elections for 14 regional constituencies this summer, including the North East. Posts are held for two years, unless the representative qualifies as a GP during the first year, in which case they will only serve for one year. Nominations close at 5pm, Friday 15 July 2016. Nomination forms and further information about the elections are available here.

Anyone can stand who is either:

  1. on a GP training programme that will not finish before 21 September 2016;
  2. starting a training programme between 24 June 2016 and 30 June 2017.

Candidates do not have to be BMA members.

Please spread the word to any GP trainees you know that may be interested. If you have any queries, please contact Jonathan Longley (elections@bma.org.uk).

Bulletin 305

Back Pain Pathway App
We have been made aware of an app (provided by Inhealthcare) for the evaluation of the Regional Back Pain Pathway for new acute low back and radicular pain which can be downloaded onto PCs. To run the evaluation via the app, GPs are advised they only need to click once for those patients who provide consent and this will pull through patient contact details (name and contact number). Inhealthcare will then provide the patient with a link to an outcomes based questionnaire. Practices are not obliged to use this app. LMC worries sit around:

SystmOne practices should have received a number of emails and letters with regard to code mapping issues with the QRISK2 Calculator in SystmOne.If you have not received these and require further details places contact janice.foster@nhs.net. We understand that the expectation is that the average SystmOne practice will have approximately 100 patients affected by errors in the QRISK2 scores. NHS England have been made aware of the workload implications for practices as a result of this incident, which will vary (potentially significantly) from practice to practice. GPC are clear this must be recognised. NHS England will be carrying out an audit, using a number of practices, to assess the workload impact. The issue of how practices will be compensated for this additional work has not yet been resolved but this is something which GPC are insisting NHS England addresses to ensure that practices are resourced appropriately.

Prescribing with Confidence
GPC has raised concerns about GPs being pressurised to prescribe specialist medication outside their competences, with particular reference to gender dysphoria. The GMC has proposed that GPs should consider prescribing 'bridging medication', where the local NHS has insufficient access to provide specialist treatment. GPC believe that GPs prescribing in this way would be breaching the principles of good medical practice, and it should be a responsibility for NHS commissioners to ensure patients have access to appropriate specialist services. GPC also object to GPs coming under pressure to prescribe under shared care arrangements. This should always be voluntary, and based upon the GP having the requisite competence and ability to provide ongoing monitoring.  GPC believe that this should be under a formal locally commissioned arrangement, and have highlighted that the GMC guidance places a worrying expectation on any GP, regardless of their knowledge and competence, to continue prescribing specialist medication in this instance.

CQC Ratings Related to Practice Funding
An analysis from the BMA has revealed that there is a relationship between CQC (Care Quality Commission) ratings and the level of funding of a GP practice; the more funding the practice has, the higher their CQC rating is likely to be. The research also demonstrated wide disparities in funding for practices. This all comes as no surprise, in that we know that CQC inspections incur considerable time for GP managers and staff in preparation for inspection as well as on the day – not to mention the significant expense. It is grossly unfair that practices with lower resources are disadvantaged and put in a situation where they have to focus more on box-ticking preparation for inspections, rather than being supported to prioritise patient care. GP practices must not be unfairly judged when they are not being given the tools they need to run their practices effectively. This further highlights fundamental flaws in the CQC inspection process, and which is why GPC is calling for it to be replaced with a fit for purpose system.

ICAS Small Companies Guidance
The Institute of Chartered Accountants of Scotland have kindly shared this article which may be of interest to you.

Sessional GP Bulletin
The latest Sessional GP newsletter can be viewed here.

LMC Annual Conference Resolutions 2016
The 2016 Annual Conference Resolutions have now been published.

Bulletin 304

PCSE have sent a number of updates with regard to their services and developments going forward all of which are listed with links below:

The GPC have written to NHS England with regard to the problems practices are experiencing and we await a response. If you are still continuing to struggle to get supplies or records please forward the details to janice.foster@nhs.net and we will endeavour to assist – or at the very least use evidence to push for NHS England for a response. Supplies can be ordered through the LMC Buying Group if you are unable to obtain them elsewhere. MidMeds (the LMC Buying Group approved supplier for medical consumables) and have said they can get these items to practices who are in urgent need in the short term whilst Capita attempt to resolve the issues they’ve been having. MidMeds’ contact details are: 0845 0034 212 or email sales@midmeds.co.uk. Practices  can then invoice NHS England for sterile products (needles, syringes & Vacutainers) up until 31 May now by sending the details to: Paul.anderson12@nhs.net or X24PANDERSON, NHS England, X24 Payables K005, Phoenix House, Topcliffe Lane, Wakefield, WF3 1WE.

General Practice Forward View
The GPC have produced this Focus on the General Practice Forward View complete with annexes covering funding and the outstanding recommendations from the safe and responsive document.

Bulletin 303

There have been a vast amount of emails and calls with regard to PCSE and serious issues since Capita took over the contract with regard to supply deliveries and movement of patient records. PCSE are now providing weekly updates (the latest with regard to medical record movement available here) to practice managers to ensure everyone is up to date. CLMC have escalated the issues at the highest level and on every forum – locally, regionally and nationally. We are inundated with queries but please do continue to get in touch as we will do everything possible to assist and any evidence practices can provide of issues helps us shout louder. We are particularly working on the patient record issue at the moment. If you have not received any of the update emails from PCSE/Capita or NHS England please email janice.foster@nhs.net for an update.

Please be aware SIRMS is now linked directly to NRLS and so incidents are uploaded directly, meaning practices only need to report once. Contractually practices are obliged to report serious incidents to us (according to the NHS England Serious Incident Framework) and they are automatically uploaded to NRLS. If you have any issues with SIRMS you wish us to address with NHS E, please email janice.foster@nhs.net.

Election for GPC
Following the 2015 LMC Conference, the elections process for the seven members of GPC has changed.
Candidates do not have to be a representative of a Local Medical Committee (LMC) at conference. Full details are available in this letter and this additional explanation with regard to the seventh seat which you may find helpful. You can apply by completing this nomination form.  Please notify janice.foster@nhs.net if you choose to apply so we can ensure that CLMC records are up to date and please note that any nominations for these seats must now be received by 5:00pm on Monday 9 May 2016. Any nominations received after this time will not be accepted.

Cameron Fund Spring Newsletter
The Cameron Fund, which remains the only charity solely for use by GPs, has published this Spring Newsletter.

Bulletin 302

General Practice Forward View
You cannot fail to have heard the latest announcement from NHS England which looks to invest £2.4bn into general practice over the next 5 years. The General Practice Forward View is certainly a welcome recognition support required to ensure that general practice continues to be fit for purpose central plank to the NHS. Chaand Nagpaul has helpfully provided this summary of the document, within his latest newsletter, together with a letter to practices. Whilst the Forward View represents a comprehensive package of support to general practice, both in the immediate and longer term, there are equally clear there are a number of areas requiring more clarity and work on the detail of implementation highlighting the need for further information and analysis of the proposals before we can fully understand their significance. GPC will continue to push NHS England to respond to the remaining areas outlined in their Urgent Prescription which they have yet to address, as we believe implementation of these are vital to help resolve both the current crisis facing general practice and to provide sustainability for the future. In terms of next steps, the LMC Conference in May will provide an important opportunity for grass roots GPs to consider and debate the Forward View. GPC will sit on the Advisory Oversight Group which will steer and drive implementation of the measures; it is vital that this programme of support is delivered rapidly so that practices receive the support so urgently needed. CLMC will be debating this document and proposals at length within the LMC and with commissioners and will keep practices up to date with developments as we learn of how the proposals will be turned into action.

Fees for Responding to the Police Letter Regarding Firearms
The response to the police’s letter indicating whether there are any concerns and that a code on the patient’s medical record has been added is not part of a GP’s contract. It is therefore up to the GP to assess how best to proceed, taking on board the following factors and guidance:

  1. The work involved in responding to the letter is minimal and therefore can be undertaken easily without delay and without a fee.
  2. The work involved in responding to the letter requires time and resources from the practice that necessitate a fee to be charged to the patient (the police should not be charged). We would advise GPs to seek confirmation from the patient that they are in agreement to pay a fee before undertaking the work so not to cause additional confusion or delay. If there is a delay owing to this and you are unable to respond to the letter within the 21 days, please notify the police of this.
  3. No one in the practice is available (e.g. on holiday or off sick) to complete the work within 21 days. Please notify the police without delay.
  4. The practice does not have the capacity to undertake the work within the 21 days. Please notify the police without delay.
  5. That the GP has a conscientious objection to gun ownership and no other GP in the practice is available or able to undertake the work. Please notify the police without delay.

Prison GP Network
We have been contacted by Alex Bunn, the BMA representative for prison GPs. Alex would create a network of support for prison GPs who do a 'punishing job', often in a very isolated and potentially risky environment. If you would like to connect with prison colleagues, share policies, discuss best practice, and hear about educational events, contact Alex to join the network. You do NOT need to be a BMA member. Please pass on Alex’s details to any colleagues who might benefit, as this is a hard to reach specialty, even when unlocked! Contact Alex Bunn on alexbunn@btinternet.com or mobile 0780 313 0203.

Bulletin 301

Sessional GP Newsletter
The latest sessional GP bulletin is now available here.

Responsive, Safe & Sustainable: Our Urgent prescription for General Practice
Responsive, safe and sustainable: our urgent prescription for general practice’, puts forward GPC’s proposed list of required actions, both immediate as part of a “rescue package” and longer term, to provide general practice with a sustainable and viable future. GPC will use this as a basis of dialogue with NHS England, over and above the government’s forthcoming support package for general practice that was announced earlier this year. Some of the recommendations will require local implementation via CCGs, and with representative support from LMCs.

Bulletin 300

QOF Guidance 2016/17
The 2016-17 QOF guidance has been published on the NHS Employers webpage. The BMA webpage has been updated to reflect the minor amendments made to QOF for 2016-17, which are: You will also be aware that as part of the negotiations for the 2017-18 contract, NHS Employers and GPC have agreed to explore ending QOF in its entirety.

New Firearms Licensing Process
Following the recent message update regarding the introduction of a new firearms licensing process, the GPC are now able to provide the details of the new process. Complete links to more detailed Home Office guidance for GPs and all the relevant forms are here. The GPC are aware that many GPs will have concerns over the new process and those who have been involved in discussions with the Home Office share these frustrations. They will continue to raise concerns with the Home Office on the new process and seek solutions where possible. We therefore encourage you to give the GPC and LMC feedback as you go through the new process – please direct any comments or questions to info.lmcqueries@bma.org.uk

Accessible Information Standard, BMA Guidance
The Accessible Information Standard aims to ensure that disabled people have access to information they can understand and the communication support they may need. Practices in England are expected to follow the Standard by 31 July 2016. Please see this Focus On guide for further information.

Bulletin 299

NEW BMA Template, Standards for Communication Patient Diagnostic Test Results on Discharge from Hospital
Last week we shared the new guidance
from NHS England setting out Standards for the communication of patient diagnostic test results on discharge from hospital. The document proposes clearer lines of responsibility and accountability for investigations requested in hospital settings, one of the many areas in which we as GPs routinely find ourselves the recipients of inappropriate and unresourced work. The crucial explicit principle in the guidance is that 'the clinician who orders the test is responsible for reviewing, acting and communicating the result and actions taken to the general practitioner and patient even if the patient has been discharged'. The guidance is clear that reviewing a hospital-initiated investigation can only be delegated to the GP if s/he has agreed to it and if reached by consensual agreement by the GP and the hospital team. This principle is vital for clinical governance standards and patient safety. The GPC have developed this new template.

That practices can use to send copies of test results back to hospitals to ensure/confirm they have been actioned by the requesting clinician. This additional template can be used to let the CCG know if the above principles are being breached, so that appropriate commissioning levers can be applied.

DWP General Practice Bulletin
DWP have provided this update for GPs.

Bulletin 298

Revalidation Guidance, RCGP
The RCGP has approved a new Guide to Supporting Information for Appraisal and Revalidation (March 2016) that aims to reduce inconsistencies in interpretation and simplify and streamline the recommendations. It is designed to ensure that any areas where there has been a lack of clarity are better understood. The guide confirms that:

Standards for Communication Patient Diagnostic Test Results on Discharge from Hospital
NHS England has developed a set of standards for the communication of patient diagnostic test results when they are discharged from hospital. The standards describe acceptable safe practice around how diagnostic test results should be communicated between secondary, primary and social care and also with patients. The intention is to ensure that hospitals take responsibility for their own tests, and this is specified in the first key principle, which states ‘the clinician who orders the test is responsible for reviewing, acting and communicating the result and actions taken to the General Practitioner and patient even if the patient has been discharged’.

Following concerns raised about other statements within the guidance, please see the following clarification.

The standard stating that ‘Where a consultant delegates responsibility for any tasks around the communication of diagnostic test results to general practitioners, they should ensure clinicians given the task understand and fulfill that responsibility’ raised concerns from LMCs that this might refer to the inappropriate delegation of tasks to GPs.

NHS England has agreed to amend the statement to 'Where a consultant delegates responsibility to another team member for any tasks around the communication of diagnostic test results to general practitioners, they should ensure that person understands and fulfils the responsibility'. For clarity, the statement was never intended to suggest consultants can ‘delegate’ these tasks to GPs.

The stated principle that ‘every test result received by a GP practice for a patient should be reviewed and where necessary acted on by a responsible clinician even if this clinician did not order the test’ is not a new obligation. Please note that ‘acted on’ in many cases will mean ensuring the responsible secondary care clinician who ordered the test has taken, or will take, the appropriate action, in cases where patient care will be affected. If safe systems are in place to enforce the first principle, even this action should rarely be required. The BMA previously issued its own statement regarding the duty of care regarding communication of investigation results, which also confirms ultimate responsibility for ensuring that results are acted upon rests with the person requesting the test. GPC will be writing to CCGs proposing that this principle is written into local service specifications with Trusts, as well as ending any unnecessary copying of hospital initiated test results to practices.

General Practice Nursing (GPN) Resource
The Queen’s Nursing Institute (QNI) GPN Transition resource is for nurses new to general practice. It might also be used to support revalidation, since it has a cloud based portfolio, and student nurses in GP placements. Over 1200 people have already accessed the resource since it was launched on 18 January. The QNI is committed to updating this as required and plan a full review in two years.

Sessional GP Newsletter
The March edition of the sessional GP E-newsletter focuses on the NHS England’s proposal to introduce maximum indicative locum rate for locum doctors’ pay. It also highlights the value of sessional GPs getting involved with their Local Medical Committees, provides guidance on managing clinical risk for locum GPs, diagnosing scarlet fever and provides a useful update on the GP campaign – Urgent Prescription for General Practice, as well as personal accounts of why one medical student is considering a career in general practice and another on coming through the other side of a GMC investigation.

GP Complaint Handling Report
The Parliamentary and Health Service Ombudsman has been working in partnership with the Care Quality Commission, Healthwatch England, and NHS England to examine how well GP practices in England are handling concerns and complaints; resulting in this joint report on GP complaint-handling. The key recommendations from the report include providing training and education to GPs and staff around complaint-handling; providing help for practices so they can share learning locally from NHS England, clinical commissioning groups, and local medical committees; and clarification from medical defence unions to GPs that an apology is not an admission of liability. As a result of the positive collaboration, there are also clear commitments resulting from the project from a range of organisations; these include:

Bulletin 297

Avoiding Unplanned Admissions Data, Component 3
Practices will have received an email from NHS England (10 March) highlighting an issue on the sequential order in which practices input the necessary READ codes for unplanned admissions. This particularly seems pertinent to EMIS practices but if you have not received the email please contact janice.foster@nhs.net .Practices are strongly advised to utilise the dummy run feature on CQRS to identify and provide the opportunity amend any coding errors prior to the official collection for component 3 on 31st March 2016.If you are unsure how to do this (explained in the same 10 March email) please email janice.foster@nhs.net. NHS E have assured us that they anticipate some appeal of data on CQRS and if you believe you have achieved the 2% goal in line with the SLA but this is not reflected in the CQRS extraction, there will be an opportunity to provide evidence to support this. All evidence will be reviewed but may take a little time to work through.

Contract Requirements for 15/16 Year End
Practices are reminded of the 31 March 2016 deadline for elements of the GP contract.

Practices should, on their website and practice leaflet, make reference to the fact that all patients have been allocated a named GP, and include information about patients’ options. The mean earnings for all GPs in their practice should also be published on the website. Practices should also offer access to the detailed patient record online, where requested by the patient. Further guidance on these requirements is available in the GMS guidance and a patient online practice toolkit, including guidance on records access, is available from the Royal College of GPs.

16/17 Global Sum Figure Explanation
It has now been confirmed that the global sum figure for 2016/17 is £80.59. This works out as an increase of 5.9%, but this figure requires an explanation. In 2015/16 there were two global sum figures, to accommodate a reduction in seniority payments with simultaneous reinvestment into global sum. This was carried out mid-year in October 2015. Therefore, the value of global sum for the first half of 2015/16 was £75.77, and for the second half of 2015/16 was £76.51. In order to most accurately demonstrate the increase for the whole year 2015/16 to 2016/17, NHS England has used the mean average of those two figures, £76.14, to represent 2015/16 global sum. NHS England will be publishing an FAQ to explain the above.

Zika Guidance Update
The joint Zika guidance for primary care has been updated to reflect the new wording for travel recommendations for pregnant women and clarification of advice on sexual transmission. The changes include:

  1. Updated travel advice for pregnant women
  2. Clarification of advice on preventing sexual transmission to pregnant women and women planning pregnancy and their male partners
  3. Clarification of symptoms associated with typical Zika virus infection
  4. Further clarification on obtaining diagnostic samples and completing RIPL request forms
  5. Links to new advice on Zika and immunocompromised patients, and the Guillain-Barre syndrome
  6. New section on minor procedures in the primary care setting, including dentistry

This Public Health England News Story has further information HERE.

The guidance is also available on the BMA website.

Bulletin 296

Sessional GP Sub Committee Elections 2016 - 2019 – call for nominations
Do you want to make a difference to the lives of your fellow sessional GPs? Then stand for election to the only nationally elected body that represents the interests of all sessional (salaried and locum/freelance) GPs - the GPC Sessional GPs Subcommittee. A single UK-wide election will be held to elect sixteen members of the subcommittee for a three year term (until the end of the 2018-2019 session). Counting rules will be applied to ensure that a candidate will be elected from each of the subcommittee’s thirteen regions, and that there are at least two salaried GPs and two locum/freelance GPs on the subcommittee. The election will be conducted by Electoral Reform Services - an independent supplier of ballot and election services. To apply to stand in this election, please complete a nomination form, which can be downloaded from our website  and return it to the GPC office by 5pm on Friday 4 March 2016. To be eligible to stand for election, your must be a salaried or locum / freelance GP whose NHS general practice performer’s work is solely as a salaried and / or freelance GP (excluding work as a GP appraiser), and you must have completed an average of at least seven hours per week of NHS general practice work during the six months prior to the election. Notes:

You can also request a copy of the nomination form by emailing info.gpc@bma.org.uk.

Sessional GP Newsletter
The February edition of the sessional GPs subcommittee newsletter, has now been published, which can be accessed here.

Bulletin 295

GP Contract 16/17
The GP Contract for 16/17 has finally been announced. In what is possibly one of the latest negotiated contract  announcements it is reassuring that the changes are far fewer than in previous years and are in keeping with the key Special Conference resolutions; to minimise the disruption of annual contract changes to practices and that the reimbursement of GP expenses must be properly funded. The agreement in no way detracts from the GPC’s mandate to hold the government to account with an ultimatum to deliver a rescue package for general practice but it does provide for increased core resources and reimbursement of expenses to an extent not achieved in recent years, and should help support practice financial pressures. The headline agreed changes are:

Full details on the new contract and FAQs are available here.

VAT & Working for CCGs
We strongly recommend practices take time to consider this guidance and practices and doctors should obtain professional advice. The BMA, GPC and GPDF are unable to give individual taxation advice.

GPDF has sought advice on the VAT position of GPs working for CCGs. This guidance has been drafted by a VAT specialist at Greenback Alan LLP. In its covering letter Greenback Alan’s specialist states the following:

Disability Living Allowance
Disability Living Allowance (DLA) is ending for people who were born after 8 April 1948 and are aged 16 or over. GPs will be asked to provide further medical evidence in the normal way for DLA claimants for individuals who decide to claim PIP. GPs may receive enquiries from patients currently on DLA who have received a letter or heard that the DLA is ending.

DWP is writing to DLA claimants to ask if they wish to make a claim for Personal Independence Payment. A DLA is ending advert is being shown via screens in GP surgeries and hospitals. This advert is to raise awareness that DLA is ending and to make sure that patients in receipt of DLA know what to do next. The advert is being shown in over 1,500 sites across England, Scotland and Wales. It will run until 4 March. Further details on DLA ending and Personal Independence Payment (PIP) is available here.

Referral System of Medical Suitability of Gun Owners
A safer system for firearms licensing is being introduced from 1 April to improve information sharing between GPs and police and to reduce the risk that a medically unfit person may have a firearm or shotgun certificate.

At present, the police usually only contact an individual’s GP before the issue of the certificate if the applicant has declared a relevant medical condition. After the certificate is granted there is no reminder system to inform the GP that the patient they are seeing is a gun owner. The new system was developed after the BMA raised concerns about weaknesses in the current process with the Home Office. It has been developed by the BMA, RCGP and the police, in conjunction with shooting associations and the Information Commissioners Office.

Workforce Data Collection
All practices should now have received this letter which provides background on the role of the workforce minimum data set collection and includes details on the upcoming March 2016 collection of data by the HSCIC, including the steps that GP practices need to take now to prepare. 

CQRS Update for Friends & Family Test
All practices should have received an email regarding the Friends and Family Test submissions via CQRS. Recent changes include the addition of a cut off date so after the 12th working day practices will not be able to enter data, practices can amend data until the cut off date and the introduction of a safeguard which ensures the data cannot be submitted into an incorrect month. It is a contractual obligation to submit the Friends & Family Test data and the deadline for submissions for the next few months are as follows:

February - submission closure is 16 March
March – submission closure is 18 April
April – submission closure is 18 May

If you have any queries, please contact Jenny Long at NHS England, E-mail: jenniferlong@nhs.net or telephone: 01138 247220 or please contact england.friendsandfamilytest@nhs.net.

MenB Vaccine Guidance
The increased media activity and campaigning around the MenB vaccine, specifically around extending the eligibility criteria  is predictably leading to increased demand for the vaccine by parents of children outside the age range. Practices are coming under increasing pressure to supply the vaccine locally but the programme is set nationally and, as such, NHS E are leading communications and  are supporting practices in dealing with requests. The national line being taken is unchanged. Practices may be experiencing difficulties re private vaccination, including difficulties in vaccine supply for private practice, and if you would like further information please contact janice.foster@nhs.net.

Bulletin 294

CQC, Role of Practice Managers
CLMC previously expressed genuine concern with regard to practice managers being registered managers for CQC purposes and advised the registered manager role is better filled by a partner and practice managers may be better placed to hold the role of administration lead. This is due to the level of responsibility and repercussion involved and our view is that it is most appropriate for the registered manager role to be held by someone who has control over the running of the practice; thus the ability to change the operations accordingly. A partner may be considered a ‘controlling mind’; a practice manager without partner status may not. Ultimately it is a practice decision but we reiterate our concern with regard to practice managers being registered managers for CQC purposes. It is important you keep your registration details up to date and should your registered manager or administration lead leave the practice you do need to notify CQC.

Young People with Learning Difficulties, ‘Doctors Talk to Me’ Resource
We have received an email and letter sent on behalf of a group of young people with learning disabilities. This group is based within Leeds but they are keen to extend their message far and wide as it is not unique to them.   The group have created this short video (2 minutes long) called ‘Doctors, Talk to me’ aimed at doctors, dentists and other health professionals. One of the young people, Gurdesh (22) explains in their own words why they made the film: “The video is based on our own experiences of how we sometimes feel when we go to the doctor. We have made the video because doctors don’t always explain things to people with learning disabilities. We want to change that.”  There is also a poster to go with the film. If you would like some higher quality printed copies of the poster, please contact Harriet Wright, Community Project Worker Healthwatch Leeds,  email: harriet@healthwatchleeds.co.uk, stating how many. 

Bulletin 293

Zika Guidance for Primary Care
Zika virus guidance for primary care has now been published on the Public Health England website, as well as on the BMA website.

This is joint guidance between PHE, the BMA and RCGP and gives information and advice for practices when approached by patients who have travelled, or may be planning to travel to affected countries, and focuses on risks for pregnant women. Further information about the Zika virus and countries affected is available via the following link on the PHE website.

PCSE Records Movement Trial
Reminder, PCSE will commence the trial of the new record movement process using CitySprint this week. A letter has been sent to all practices outlining details. If you have not received this please email Janice.foster@nhs.net. Please DO NOT send any patient records during this trail process.

We have had an enquiry with regard to patients indicating to their GP that "the hospital have told me to stop my warfarin and your GP needs to sort out some injections instead". We remind practices that if warfarin is to be stopped prior to surgery it is for the Trust to monitor the patients due to clinical risk as this being beyond GP expertise. If Tinzaparin injections are required the practice would provide this as part of a shared care agreement with the consultant; the consultant should request and explain, the practice would not make that decision. We deem this beyond the PETS in terms of the stopping/monitoring due to it being beyond competency of general practice BUT the injections if requested and agreed would fall under PETS as part of the pre op category.

Urgent Prescription for General Practice
The BMA has launched a campaign, ‘Urgent Prescription for General Practice’, to highlight the pressures on general practices, drawing on local examples of vulnerable practices and this under imminent threat of closure, and the damaging impact on patient care. A resource pack will be sent to practices shortly which will include guidance on managing inappropriate workload demands, setting up GP networks to create resilience, and how to highlight local pressures to MPs, the media and public. This campaign will have both a local and national focus to press for urgent government action to stabilise practices who find themselves vulnerable to any or all of the range of destabilising factors currently threatening the profession, including shrinking financial resources, rising workload, recruitment problems and understaffing, as well as providing the support and funding needed for a sustainable general practice of the future. You can read more about the campaign here. We will be providing similar advice and updates to the tanzaparin advice above in support of this campaign to help practices identify some work which may be less appropriate / inappropriate to be managed within practice at times of under capacity/workload pressure.

LMC Special Conference Resolutions
This special GPC News shows the conference resolutions, motions not reached and motions lost.    

Bulletin 292

Data Collection, Retired QOF Indicators
Practices have been asked again to accept requests within the Calculating Quality Reporting Service (CQRS) for the extraction of indicators no longer in QOF. GPC have clarified the advice remains unchanged from 2015, this is optional and for an individual practice decision. The decision to retire and amend these indicators was intended to reduce bureaucracy and allow practices to focus on the needs of patients. These indicators were successfully removed during negotiations as being clinically inappropriate and unhelpful to practices. As such, there is no expectation that practices should continue to focus on achieving these targets, and GPs should instead continue to use professional judgment to treat patients in accordance with best clinical practice guidelines. It is for clinicians to decide how they record clinical consultations and what codes, if any, to use.  Practices should be reassured that the previous GP contract agreement still stands, and there is no contractual requirement for practices to record codes for former QOF indicators. However, practices are also asked to note the position outlined within the 2015/16 QOF guidance - that practices are encouraged to facilitate data collection of these indicators. The data is intended to inform commissioners and practices and provide statistical information. It is not intended for any performance management purposes. GPC anticipates a large fall in the recording of many of the retired codes, particularly those that were previously imposed, as practices now work more appropriately. In GPC’s view, allowing retired codes to be extracted could help to demonstrate how inappropriate it was to impose contract changes in the first place, as well as informing discussions between GPC and government on the development of more appropriate future indicators of quality care.

Publishing GP Earnings
As you will be aware, practices are required to publish mean net earnings of GPs (including salaried and locum GPs who have worked in the practice for over six months) and the number of full time and part time GPs in the practice by 31 March 2016. This includes

This does not include:

Publication should be made on the practice website and on a poster at the practice for those patients who do not have internet access to advise it is available on request. NHS England has published guidance as to how to calculate earnings for publications – you will find this on page 10. You can find further information on the GPC website.

Bulletin 291

Sessional GP Newsletter
The GPC sessional GPs subcommittee newsletter is published here.

Bulletin 290

GPC CQC Survey
The GPC are conducting an important survey of practices about their experiences and the impact of CQC (Care Quality Commission) inspections. This comes at a time when the CQC has announced proposals for an unjustified, illogical and punitive seven-fold increase in GP fees. In 2015 the Local Medical Committees Conference and BMA Annual Representative Meeting voted to end the current inspection process on the basis of it being unfit for purpose. Furthermore, the BMA’s biggest-ever GP survey last year revealed that over-regulation is in the top four negative factors impacting on GPs. The results of this new survey will help GPC argue the case from the first-hand experience of GP practices. The survey covers the impact on practices in preparing for and coping with a CQC inspection. It will strengthen the GPC position to hear from as many practices as possible, including those yet to receive CQC inspections. Please complete the short survey. GPC are requesting one response per GP practice, which may be completed by a lead GP or practice manager. The survey should take no more than five to 10 minutes to complete. Your views will help inform discussions at the LMC special conference on 30 January, towards developing practical solutions to address the crisis in general practice.  

Changes to Medical Records Movement & Supplies Management
Over the next few months, Primary Care Support England (PCSE) is changing how medical records are moved for all practices in England. Please see this flyer
for further details They will introduce a standard process and practices will be able to check where any record for any of their registered patients is at any time, whether it be in storage or in movement across the country. At the same time, they will introduce a new, national supplies management service which will provide a quick and easy online way of ordering and tracking supplies. Both services will be accessed through the new PCSE portal, and practices will receive details on how to register on the portal in the next few weeks. The changes will be introduced in stages with a national record movement trial using a blank document in place of a medical record commencing 8 February 2016. During the first week of February, each practice will receive a Medical Record Envelope (MRE), a transit label for a single record movement and a shipping bag. Inside the MRE will be further instructions on what to do next. Shortly after the record movement trial, they will roll out the new process to practices in West Yorkshire using live medical records, and then nationally to all other practices in spring 2016. The record movement trial and the subsequent new process will apply to all practices in England. All practices will receive this communication over the next week. If you have any queries, please email PCSEngland@capita.co.uk.

Avoiding Unplanned Admissions Payments
Update with regard to the GPC/NHS E discussions around non-payment due to contract wording ambiguity. GPC have successfully negotiated agreement with NHS England that full payment will be made to all practices that have completed a review on their patients on the register by 31 March 2016, on the condition that they also fulfil the other requirements of the enhanced service. If your practice has been affected, please contact your area team. If you still have difficulties, please contact janice.foster@nhs.net or email gpc@bma.org.uk.

The specification requires practices to conduct a single annual review during 2015/16 on patients who were previously on the register as of 1 April 2015. However, the payment in the September claim was based on whether a review on existing patients occurred in the immediate 12 months prior. This meant that practices planning to complete their annual reviews throughout 2015/16 may have missed out if these were carried out after September thus failing to receive full payment for their September 2015 claims of the avoiding unplanned admissions enhanced service, owing to ambiguity in wording in the specification.

Last Order & Expiry Date of FluMist Nasal Vaccine
The latest special edition of the PHE vaccine update includes information relating to:

In particular, please note the following in relation to expiry date of FluMist:
“To ensure timely supply, changes in the supply schedule were required. This has resulted in a mismatch between the actual expiry date and that printed on the packaging and labelling. The two batches of FluMist quadrivalent being supplied (FL2113 & FL2118) must not be used after the 24 February 2016. This does not affect the safety, quality or efficacy of the batches. In agreement with the MHRA, a pre-planned withdrawal of any unused stock of FluMist quadrivalent will begin on the 25 January 2016. This will help ensure that no time-expired vaccine remains in circulation. AstraZeneca’s logistics provider, Movianto, will contact you to arrange collection. Please quarantine any unused FluMist quadrivalent ahead of 24 February 2016. This should avoid accidental administration prior to collection’.Batches of UK labelled Fluenz Tetra will not be subject to the withdrawal and may be used up to the expiry date stated on the carton and nasal applicator.”

and that of Fluenz Tetra:
Fluenz Tetra®
for 2015/16 has been supplied with expiry dates ranging from 28 December 2015 and 18 January 2016. The list below shows the batch numbers and their expiry dates. Practices should always check the expiry date before administering, dispose of expired vaccines in line with local policies and record any stock disposed of due to expiry on ImmForm.
Batch Expiry date
FJ2021 28 Dec 2015
FJ2022 29 Dec 2015
FJ2023 30 Dec 2015
FJ2072 31 Dec 2015
FJ2098 05 Jan 2016
FJ2188 18 Jan 2016

Cessation of National Supply of Paracetamol Sachets for the MenB Immunisation Programme
Public Health England (PHE) informed that as the temporary supplies of paracetamol sachets, to be given after the doses of the Men B vaccinations for infants have been given, have been fully distributed, the central supply of paracetamol sachets is being phased out. The updated patient leaflets make it clear that parents will need to make arrangements to have infant paracetamol at home in time for their baby’s first immunisation appointment, and practices will be able to  order these leaflets in paper copy, to be handed out at the time of the vaccination, from late December through the DH Orderline.

MDU Medico Legal Advice
The MDU has advised GPC that it wishes to dispel the myth that MDU members could be disadvantaged if they contact their 24 hour medico-legal advice service. One of the MDU’s core services is to provide expert medico-legal advice to members and they positively encourage members to call for advice at any time; whether pre-emptively when they need guidance on how to approach a potential matter, or when something has gone wrong. The MDU receive over 30,000 calls from members to its advice-line every year helping members to avoid potential problems and to mitigate the position if a problem has arisen. The MDU very positively encourages members to contact it whenever they need it’s input.

Contact details are:
UK 0800 716 646
Ireland – 1800 535 935
Fax (UK) 020 7202 1662
Email: advistory@themdu.com
Website: http://www.themdu.com/about-mdu/contact-us

Updated PGD & PSD Guidance
The GPC guidance Patient Group Directions and Patient Specific Directions in General Practice has been redrafted to clarify the position of PSDs, confirming that they do not necessarily have to be in written form, but can also be a verbal instruction.

QoF Business Rules V 33.0 and FAQs
Version 33.0 of the Business Rules
have been published and these FAQs may prove helpful. In addition to the usual changes where new codes have been added to clusters, some codes have also been removed from some QOF register clusters. This does not usually happen in-year but there were clinical reasons for doing so. The changes affected heart failure, the asthma register and CKD register. Note that these changes are effective from 1 October 2015.

CQC Registration for Federations Webinar
CQC held a webinar in relation to GP Federations on Tuesday 12 January with CQC Registration Advisor Andy Brown presenting. Unfortunately we have just been made aware of this webinar but a video recording will be made available via CQC’s monthly briefing for Providers. You can sign up to receive these here: http://www.cqc.org.uk/content/get-our-newsletter.