Safe working pack

This page is intended as an easy to refer to resource pack for use during clinical sessions, allowing practitioners to:

• easily understand what activity they are required to undertake and what they can push back against,
• explain to patients, trusts, commissioners and other bodies why a piece of activity should be provided elsewhere in the system, and
• seek help from their local medical committee or the Londonwide LMCs team where your ability to deliver safe care is compromised by an issue outside the gift of the practice to resolve.

It also draws together other resources to help you to design and make changes that support safe effective working.

Londonwide LMCs exists to care for, value and protect everyone working in London general practice ​so that you can care for, value and protect your patients. It is the role of LMCs and Londonwide LMCs to raise requests for inappropriate workload transfers into general practice with the organisations who make them and seek to change behaviours so such requests stop.
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Easy reference resources to help you work safely

• BMA safe working guidance 
  Covers how practices can prioritise safe working and patient care, including a collection of template letters for pushing back against requests for un-resourced work.
• Template letters
  Quickly explain that a request should not be actioned in general practice and detail where is the appropriate setting for the request to be made, if there is one.
  • Template letter for referral rejection due to lack of proforma
    Template letter: trust request for non-contractual task(s) (prescription of medications, arranging investigations, following up results, undertake monitoring, issuing MED3s, refer patient back, postoperative checks)
  • Automatic discharge of patient following DNA
  • Housing applications
  • DWP appeals
  • Flying when pregnant
  • Letter to schools regarding administering medications to children
  • Requests for sick notes for illness lasting fewer than seven days
  • Letter to schools regarding requests for verification for school children absence
  • Letter to patients regarding accessing new entries made in their GP record
• Posters
  Help explain to patients what services are covered by the NHS, what are available for a fee and what are not the job of a GP.
  • Fit notes/ MED3s
  • Dental care
  • Provision of OTC medication in nursery/ school settings
  • Housing applications
  • DWP appeals
  • Flying when pregnant
  • Blue badge applications
• Guidance
  These documents set out what GP practices are required to do, where such activity is resourced and where there is no resourcing or obligation for practices to take on activity.
  • Shared care pathways
  • The enforced use of advice and guidance (A&G) for specialist referrals
  • Core hours contractual requirements
  • Patients presenting with dental issues
  • Automatic access to patient records
  • Disclosure of records after death
  • Completion of medical reports for deprivation of liberty safeguards (DoLS)
  • Police requests for information from medical records
  • Application for a firearm and/ or shotgun certificate

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Resources to help design and make changes in your practice to enable safe care

• London General Practice Access Guide
  A series of webinars are the latest materials produced as part of this work with Healthy London Partnership, following on from the guide and manual created in 2021. These resources look at equitable access, and the balances between reactive vs planned care, convenience vs need, self care vs practice delivered care, and established good practice vs innovation when demand is too high.
• Patient participation pack
  We have worked with experts in this field to produce a patient participation support pack to help you co-design changes with your patients that will enable the delivery of safe care. If practices make changes to ensure safe working, the GMS contract allows you to utilise patient engagement as evidence to support the service change should there be challenge by commissioners.
  • Resource to help you consider whether undertaking a patient participation exercise is right for you
  • Guidance for setting up a safe care workshop
  • Co-create guide to session invitations
  • Safe care workshop plan and facilitators notes
  • Safe care workshop workbook
  • Guidance following the safe care workshop
  • Co-create advice on keeping people in the loop

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Londonwide LMCs support for addressing safety issues that are outside the gift of the practice to resolve

• General Practice Alert State (GPAS)
  Allows practices to submit a short, weekly data return which provides real-time data for us to advocate on your behalf, in a similar way to the OPEL system used by hospitals. The GPAS levels are also a good reference point for assessing the pressure a practice is under on any given day.
• Raising local issues
  Constituents can find their area’s LMC, each LMC page has details of a committee liaison executive who is the contact point for raising issues at a borough or ICB level.

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Our offers to individual practices and clinicians

• GP support team
  Our GP support team provides expert, confidential and bespoke advice and support to individual constituent GPs and practices in difficulty.
• GP Professional Support Network (GPPSN)
  Our single point of online access to match GPs with the most appropriate form of professional support you need for a range of challenges. This blog gives some examples of how peer supporters can help.
• Engage with us on social media
  We regularly share updates via X (Twitter), Facebook and LinkedIn, we also use these platforms to share resources such as videos that help to explain the pressures on practices to patients.

We also expect to have a practice meeting webinar ready later in the summer, which will be added to this list.