Dear Colleagues,
We are pleased to present our latest newsletter, which highlights the tremendous work and collaborative efforts of Newham LMC and Londonwide LMCs along with local partners. In this edition, we share an update from a variety of meetings, keeping you informed of LMC feedback on current issues and progress to date.
Newham LMC membership and contact
LIS working group progress
The LMC has been engaging with the ICB (Integrated Care Board) reviewing LIS (Local Incentive Scheme) contracts. We have secured a deprivation payment in the Vulnerable Children and Young People LIS which can be several thousand depending on list size. It is important to engage health visitors, but this can be done by email if they do not attend. A cap has been removed in the ECG spec. Engagement on the Long-Term Conditions spec is ongoing and includes suggestions to scrap the PCN 20% target, so practices get full payment despite PCN performance. We have also asked for payment to made to practices for ELFT training not held in previous years. The LMC has also presented to CDs an overview of what the current financial model looks like for the coming year in regards to spec changes.
Targeted Lung Health Checks
Secondary care colleagues assured us that, as often as possible, they arrange treatment directly for conditions identified in these checks. However, the LMC fed back that the findings still significantly increase both GP workload and patient concern – especially as results appear in patient online records. We continue to push for funding for general practice to support the programme, and for pathways to be established to refer patients for common incidental findings without going via the GP. Patients should be advised by the programme on possible findings, and get a letter with a number to call about concerns. We were suggested to point patients at this line for reassurance.
Phlebotomy
Londonwide LMCs has advised that the current NE London offer to PCNs to carry out phlebotomy is under-resourced and should be looked at with some caution. Not all PCNs are signed up, and so there are gaps for patients in some areas. In Newham there is a supplementary service commissioned from ELFT but there have been some long waits, especially for domiciliary provision. The LMC raised this with the ICB, who are escalating it as a quality issue and asked for examples to evidence this. The LMC has emphasised that there is a need to commission a housebound phlebotomy service, which many GPs did not have the workforce or capacity to take over.
GP direct access community diagnostics
The LMC, along with neighbouring LMCs, gave feedback about recent developments in this service. Due diligence had taken much longer than expected, meaning that little engagement with grassroots GPs took place and the mobilization was greatly accelerated. GP workload is being generated around elements like onward referrals and rearranging appointments. There were initial issues with the ERS. The LMC fed back a need for more locations in south Newham. We heard that Omnes are accepting email referral as well as ERS.
Wound care
The LMC discussed wound care and identified that more complex wounds may be better directed to A&E than to the wound care centre. Also, clarification has been sought on the pathway for children presenting with complicated wound care as TVN only covers adults.
Public Health contracts
The LMC has begun to talk with Newham Council about the viability of GP work commissioned by public health, such as contraceptive fitting. Council finances are very limited and the discussions are ongoing. Public Health colleagues said that there were efforts to minimise the associated workload for GPs.
Hepatitis C memorandum of Understanding
The LMC looked at a proposed MoU for GPs delivering Hep C case finding. There are clinical benefits to getting a hidden population of patients in touch with treatment that is now available. However, it seemed that the workload could make it unviable for some practices. Practices can make their own decisions – they are advised to assess the bottom line for themselves. The LMC has fed back some specific areas where delivery might be streamlined.
Deductions
At least one practice has reported hundreds of bulk deductions from its patient list with no FP69 process. Londonwide LMCs has advised the practice on the process that PCSE should have followed, and is monitoring the situation to see if the issue is more widespread.
Text message charging
There is a national issue of limited budgets for practice texts via AccuRx. Londonwide LMCs has lobbied NHS NEL ICB about the importance of SMS communication to modern general practice, especially to save appointments just to give information, and for equitable access. NEL has withdrawn proposals to reduce its SMS budget but, even to stay within the existing budget, it will still cap the number of messages each practice can send for free, based on list size. Londonwide is still pushing for the ICB to understand that high text volumes may be effective and efficient, but also to provide help to practices about how to use fewer SMS ‘fragments’ to achieve communication aims.
Practices should meanwhile be wary of requests by other organisations to message patients on their behalf, and should consider where it might be possible to shorten long messages.
Advice & Guidance
Londonwide LMCs has produced a briefing on GPs’ responsibilities with regard to referring patients or managing them with specialist advice, and how this interacts with the Advice & Guidance model. In particular it notes that referrals can be made through the channel designed for A&G, providing all the information necessary for a referral and making it clear that an outpatient appointment is sought.
Via the Barts Health outpatient services group and other channels, the LMC is lobbying secondary care to understand the pressures and position in general practice.
Shared care
Concerns have been growing about shared care, including unresourced work transfer and the involvement of medications that are challenging for GPs to manage. Shared Care agreements require the agreement of all parties, including primary care, secondary care and the patient – this means practices can choose to decline them. Options for practices include setting policies about certain types of agreement which enable quick and consistent response to requests. There is guidance from Londonwide LMCs on shared care agreements here.
ICB lobbying
LMC members, alongside colleagues from other boroughs in NE London, have been lobbying the ICB to invest in general practice as an essential and highly cost-effective part of the NHS system, despite the budget deficits that the ICB faces. ICB managers have acknowledged the principle and discussions continue, but some savings are still being sought from the General Practice budget.
111
The LMC discussed communications that GPs have received about using 111 slots. We felt that GPs generally do not control how many of their patients call 111 or book those slots. More urgent cases may be most appropriately seen in a service like 111. Non-urgent cases may have a GP appointment on an appropriate timescale but may still go to 111 seeking earlier consultation.
There is a procurement of the 111 service coming up.
BMA actions
The GP Committee of the BMA, which is the Trade Union for the profession, is leading a call for collective action to make their case to the national NHS and the Government. A ballot in July on a menu of 10 actions that are possible within national contract requirements was overwhelmingly supported by the BMA membership. Practices can choose the actions that they may wish to undertake, as and when. There is information from the BMA here.
The LMC is not a Trade Union and is therefore legally barred from leading or co-ordinating such action.
To help GPs and our other stakeholders understand and prepare for potential impacts of the BMA action, there is a survey to gauge intentions. One lead Partner for each practice is invited to complete the survey each month, here.
Safe Working
Londonwide LMCs has produced a large resource pack for safe working, including guidelines on safe workload and on what work is and isn’t required by contract, template letters for pushing back unresourced extra-contractual work, posters and materials for communicating with patients, and guidance for dealing with abusive and violent patients. There are also pointers to other relevant LMC work and sources of support. The index page for the resource pack is here.
GP Support
Londonwide LMCs, our secretariat organization, also provides direct support to practices, GPs and others working in general practice. Information is available here.
General Practice Alert Status – anonymised GP-led pressures reporting
Over the last year Londonwide LMCs and other LMCs nationally have been rolling out GPAS on behalf of general practice. It is to identify and track the pressures area-wide in general practice and flag them to NHS partners, as hospital and ambulance trusts do with their OPEL system. It aims to change the narrative so that the challenges of general practice are recognised as system problems rather than painted as practice failings.
NHS England is requiring ICBs to have a reporting system for general practice, and we hope to establish GPAS in this role, as it is general-practice-run, confidential and anonymous, while we cannot be confident that an ICB-established system would be. In GPAS, practice-level data is not passed to the ICB, only borough-wide aggregates.
GPAS is simple to use and takes on average a couple of minutes per week in response to a data request email. Practices receive a copy of the weekly situation report with the borough- and sector-wide pressure levels. The LMC uses this report to press the NHS system for support where and when needed. Currently, the numbers of practices participating need to be higher to provide stronger evidence – Newham is a relatively new participant in GPAS and generally less than a quarter of local practices have been providing data each week.
There is more information at this article by the LMC’s Medical Director Dr Elliott Singer, and you can sign up here.
New and current GPAS practices can see updated guidance on GPAS completion and alert ratings here.
LMC information
You can find information about LMC members, contact channels, meeting dates and so on at our web page .
We look forward to your continued support and engagement in highlighting any issues that are impacting Newham practices. A unified voice is our strength.
Kind regards,
Dr Tammy Hibbert
Newham LMC Chair