Tower Hamlets LMC – Newsletter October 2024
ENT referrals
LMC members raised that ENT referrals were not working with no response and long wait times. The Royal London has subsequently reviewed the ENT emergency pathway, and decided to re-open the e-rs referral service on a six month trial basis from Friday 23 August 2024.
The emergency service is under ‘Emergency ENT RAS (RLH) Barts Health Trust – R1H’, Service ID: 7244253. It accepts emergency referrals for the following conditions, which should be shown in e-rs:
- Unresolving otitis externa or otitis media
- Sudden sensorineural hearing loss
- Foreign bodies in the ear/nose
- Acute facial palsy
- Fractured nose – within 5 days (without septal haematoma)
- Recurrent epistaxis
- Acute TM injury
- Acute neck swelling
The Royal London asks that GPs only referring patients showing the above conditions via this service and continue to refer routine requests via the ENT Communitas service which is also available on via e-Rs. Barts say that any routine referrals received via the Emergency Pathway will be rejected.
Immediate ENT advice is available from the ENT on call team via the RLH switchboard: 0207 377 7000.
There was a transition period in which referrals sent to the inbox ([email protected]) were read and actioned, but it may now be closed. Use e-rs with immediate effect.
The LMC does not endorse inflexible criteria, or rejection back to the GP in the case of patients deemed not to meet them, and asks for secondary care to ENT to reroute referrals between its clinics if necessary. We are still in discussions about Barts’ internal pathways for referrals that they deem inappropriate.
Omnes
The LMC has raised with the ICB several concerns in relation to the quality of service provided by Omnes in NE London. This is specifically in relation to the poor quality of the results of the investigation, the complexity and poor design of the reports, as well as the inefficient referral system.
The commissioner of the service has requested more details on these concerns, which the LMC has collated and submitted for consideration and discussion with the provider. The provider has indicated willingness to work with the local system to improve the quality of the service provided. We are awaiting further feedback from the commissioner and an update on the steps that will be taken to address these concerns.
We will keep you informed of progress. In the meantime, if you have any concerns to report around the quality of this service, please contact [email protected].
For the future, the LMC has protested in the strongest possible terms about outsourcing a backlog (or making other service changes) without considering the adverse impact on general practice.
AccuRx SMS messaging
The LMC, along with other LMCs in NE London, has been lobbying the ICB over support for practices to text message patients, as an effective and accessible way to exchange information without taking up appointments unnecessarily. The ICB has withdrawn proposals to cut the budget this year, but to stay within its budget will insist on capping how many free text message fragments each practice can send (per weighted patient) – practices should be advised of their allocations. Any fragments over the practice allocation will be charged to the practice. The LMC, supported by Londonwide LMCs, is strongly arguing against this decision by the ICB and we have made it clear that we will not support it. We have also said there should be a live dashboard to see fragment usage to help practices understand how they are using their allocation and when they are nearing their cap.
The ICB will be approaching practices that are top users of text messages, to review their data and understand what strategies can be put into place to optimise text message utilisation, for example length of text messages. Consideration must be given to the use of the NHS app and other channels where possible or appropriate. Practices should also think carefully about any requests from other services to send SMS text messages on their behalf.
Patient deductions from lists
Practices have been reporting issues with patient list deductions, and the admin time taken to reinstate patients who are still in the area and requiring services. There is a national issue, but if there are severely affected practices, or especially patients being deducted without any FP69 process, please contact the LMC.
Advice & Guidance
Londonwide LMCs has heavily fed into a proposal by the ICB to review and evaluate A&R, including the additional work undertaken by General Practices to support the A&R implementation, which at this stage still remains unpaid. Londonwide LMCs has urged the ICB to honour the payments for the local incentive scheme and we are working with them to identify a solution.
Not engaging in Advice and Guidance is one of the BMAs suggestions for collective action. Please remember A&G significantly increases your workload and you are not being paid for it. Londonwide LMCs have written the following guidance, including a form of words that can be used in the advice box in ERS to make it clear that you are requesting an outpatient appointment, not advice.
ICB financial position
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. You will remember that the LMC could not endorse the NISs this year due to lack of uplift in funding over many years. ICB managers have acknowledged the issues and discussions continue, but due to the challenging financial position of the ICB, savings are still being sought from the General Practice budget. LLMC has asked for clarity from the ICB on how these savings will be achieved and from which budget. We are awaiting further details on this.
Other ongoing issues
The LMC is currently working on other issues including coding for ARRS roles and STI screening, the lack of a spirometry service, and some other secondary care matters such as AIRS and radiology. We will update with progress when we can.
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. Local members of the BMA’s GP Committee have been briefing meetings of Tower Hamlets GPs.
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 major 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 and the newly released safe working webinar is here.
LMC information
You can find information about LMC members, contact channels, meeting dates and so on at our web page.
If you have any feedback on the above, or anything you wish to bring to the attention of the LMC, you can contact via the Committee Liaison Executive [email protected].
Yours faithfully,
Jackie Applebee, Chair, Tower Hamlets LMC