GP Action

 The GPs Committee England met last week where we discussed the next steps of GP collective action as part of our ‘Protect your Patients and Protect your Practice‘ campaign and other upcoming issues affecting general practice.

We would encourage practices to continue to take action using our safe sustainable action menu. It is up to each practice to choose which actions to take, and whether to do one, or many. None of them represent a breach of your contract, but they will help you manage your workload and keep you and your patients safe. Your LMC will also provide you with additional advice, tailored to local arrangements.

Our GP practice survival toolkit provides for a menu of actions you can choose from, to support a safer delivery of services for patients and practice team:

• Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25
• Serving notice on voluntary services that plug local commissioning gaps
• Cost up the value of providing locally commissioned services and serve notice on contracts which are undermining practices’ ability to sustain a service
• Withdraw permission from secondary-use data sharing agreements
• Freeze sign-up to new data sharing platforms
• Stop engaging with the e-Referral Advice & Guidance pathway
• Stop rationing referrals, investigations, and admissions
• Switch off GP Connect Update Record Functionality
• Ignore medicine optimisation software which diminishes patient choice in return for system savings never seen by GP practices
• Defer your PCN declaration regarding online triage to 2025

We are urging the Government to engage constructively with us as soon as possible to determine short, medium, and long-term solutions to save General Practice.

Find out more here.

GP Additional Roles Reimbursement Scheme (ARRS)

The updated PCN DES bringing in the GP ARRS was released last week. Pay for these roles will be set at the lowest level of the DDRB recommended sessional pay range, with PCNs able to claim up to £92,462 (including on costs), together with London weighting if applicable. The funding available to PCNs to fund these roles will be £1,303 multiplied by the PCN Contractor Weighted Population on 1 January 2024. The GP in ARRS allocation is separate to the pre-existing ARRS allocation, and PCNs cannot cross-subsidise between the two funding streams

GPs employed via the Scheme must be within 2 years of their CCT on 1/10/24 and PCNs will be required to provide terms no less favourable than the BMA salaried GP model contract, in line with the GMS/PMS contract.  There are, however, no requirements on how these GPs should be utilised within the PCN.  GPC England and the Sessional GPs Committee will be releasing guidance for PCNs, and individuals employed under this scheme, shortly.

Whilst there is progress in acknowledging the difficulties currently faced by many GPs struggling to find jobs, we continue to stress to NHSE and the DHSC the underlying issue of GP unemployment and how this needs to be better addressed through additional support and funding at a practice level.

Safe working guidance

Last month we published a safe working guidance handbook to help GPs and practices in the delivery of safe, high-quality care for their patients and communities. The profession wants to provide care without risk to patients or ourselves. The handbook embeds and prioritises safe high-quality care for your patients by focusing on the delivery of prioritised core GP services. These actions will work, and will build growing leverage in the months ahead to support us in negotiations for you and your practice team.

Read more on Safe working, including social media graphics and a poster.

Shortages of doctors and patient increase – BBC analysis

A BBC analysis of NHS data has shown that the average GP in England has to care for 17% more patients than nine years ago. The areas struggling the most have more than 3,000 patients, nearly double those with the most doctors. The government said it was developing plans to train more doctors and relieve some of the pressure by giving pharmacists more responsibilities.

The GPCE Chair, Dr Katie Bramall-Stainer said these figures lay bare the realities of the workforce crisis in general practice and demonstrate how practices have been expected to keep doing more for less. This has led to the closure of 2,000 GP practices since 2010. General practice is collapsing. Rather than giving pharmacists more responsibility, patients want more GPs and we agree with them.

Labour party conference update

Last week GPCE Officers attended the Labour Party Conference. The NHS, and particularly general practice, was a key conference topic, alongside the Darzi Review and the NHS ten-year plan, anticipated for release next spring. Dr Katie Bramall-Stainer and Dr Samira Anane met with a number of MPs including Minister of State for Care, Stephen Kinnock, PPS to Wes Streeting, Mr Zubir Ahmed, Dr Simon Opher, Dr Beccy Cooper, Leigh Ingham, Nesil Caliskan and Josh Dean. Dr Bramall-Stainer also spoke at the BMA’s roundtable attended by a number of MPs. During these meetings GPCE outlined our upcoming strategy for the new Government; our priorities and our recommendations to urgently address the crisis in general practice and GP unemployment.

GP pressures: latest workforce and appointment data

GPs continue to treat many more patients than they have done in the past. The latest data shows a record 63.47 million patients registered with practices in England, while there are over 1,000 fewer GPs compared to 2015.

As a result, each full-time equivalent GP is now responsible for an average of 2,282 patients, 345 (or 18%) more than in 2015, and appointments level at an average of almost 1.5 million per day. All of this puts staff at your GP surgery under immense strain, with knock-on effects for patients.

Learn more about the pressures on general practice

RCGP changes position on physician associates

At its September UK Council meeting, the RCGP voted to oppose a role for physician associates in general practice, with 61% of members voting for the change of position. However, the college will still be pushing ahead with planned guidance development given the pe-existing presence of PAs in general practice. The RCGP also voted to expunge a paragraph from their draft scope of practice guidance which would have exempted PAs already working in general practice from the scope limits. The college now plan further work on this guidance before publication.

GPC UK recently published the guidance Physician associates in general practice: making it safe for patients and GPsand will be discussing the RCGP’s change in position at its next meeting on 17 October.

New dispensing feescales

The new dispensing feescales for England and Wales, effective from 1st October 2024, have been published, showing a reduction in the average dispensing fee to 218.7p per item (average), a decrease of 0.2p compared with April 2024. This reduction is based on a new methodology designed to further smooth out the fluctuations seen in the previous biannual fee adjustments.

Dispensing fees are intended to cover the costs of running a dispensary, including staff expenses. However, from April 2025, the average fee is set to reduce further by 5.37p per item (on average) to 213.3p (compared to the October 2024 rate). This continued downward trend may prove to be a tipping point for some dispensing practices, as the cumulative impact of underfunding in rural practices takes its toll. GPC England continues to work closely with the Dispensing Doctors Association; both organisations recognise and promote the value of dispensing practices to their patients and within their communities.

Launch of BMA GP Safe Working Guidance Handbook

Following the overwhelming YES vote in our ballot over the summer, practices are starting to take action as part of our ‘Protect your Patients and Protect your Practice‘ campaign.

GPC England have published a ‘Safe working guidance’ handbook to help GPs and practices in the delivery of safe, high-quality care for their patients and communities. The profession wants to provide care without risking harm to others or ourselves.

At a time of unprecedented pressures, we must make changes to our workload to preserve patient care in the face of a shrinking workforce and rising demand. This will help to protect the sustainability and future of general practice.

It is recommended that you do this by focusing on the delivery of General Medical Services, in line with the needs of your patients and practice, and deprioritising work and activities that fall outside of your core contractual requirements. This guidance reflects the contractual changes imposed by NHS England in April 2024. BMA offers ways of doing this that still enable you to stay within the terms of your GMS/PMS.

The guidance outlines how to manage workload effectively, setting safe limits of 25 patient consultations per day in line with UEMO recommendations, and encouraging practices to adopt systems that protect both patients and staff.

The BMA handbook can be downloaded and saved from the website:  www.bma.org.uk/GPsSafeWorking.

Further guidance and resources such webinars and FAQs can also be accessed, with patient information posters and social media graphics to download and share.

We cannot care for our patients if we do not care for ourselves and our colleagues.

Practice Finance Survey – DEADLINE MIDDAY 17 SEPTEMBER

BMA is inviting practices in England to complete a Practice Finance survey, to build evidence to support the annual contract negotiations. This is your opportunity to feed into an evidence base demonstrating the impact of inflation and rising cost over the last couple of years, on GP practices.

Please share the survey link with your practice manager colleagues so that they can complete the survey. The survey will close at 9am, Tuesday 17 September. 

It is recommended that respondents have relevant information to hand before starting the survey: they will need GP practice accounts for 2022/23 and 2023/24, expenditure data for April 2023 and April 2024, and information on staff numbers and practice list size. Take the survey

Action tracker survey

BMA is gathering data on any actions that practices across England are taking, and from 16 September, surveys will be sent monthly. BMA will share the survey with LMCs to distribute to practices and will be contacting partner members directly to ask you to input data per practice.

BMA wants to hear about the actions you are doing, or considering so please do reply when you receive the survey during the week commencing 16 September. Responses from practices helps to monitor how collective action is progressing across the country, supporting our negotiations and work towards a GP contract that is fit for purpose.  The data will not be shared outside of the BMA.

GPCE view on request for Cloud Based Telephony data

As part of the 2024/25 contract imposed on the profession in April, NHS England (NHSE) have sought directions from the Secretary of State to extract data from our clinical systems on our Cloud Based Telephony (CBT) usage. An email has been sent by NHSE outlining the instructions to comply with this data extraction under section 259 (1) (a) of the Health and Social Care Act 2012, stating:

‘All general practices are therefore mandated to comply with this invitation and approve the collection.’

The legal basis for the collection is explained in the Data Provision Notice, which will enable your call data to be extracted on a monthly basis.

The BMA has taken its own legal advice:

Practices cannot decline the instructions, as doing so will risk breaching their contract.

BMA has made it clear to NHSE that the data must not be used to performance manage practices or single them out for criticism.

The PCN DES includes three components of the Capacity and Access Improvement Payment (CAIP). This data extraction is the component pertaining to the existing use of CBT and the relevant metrics. GPCE advice is that should a practice fail to sign up ahead of the October 1^st deadline, there may be a risk of a breach notice being imposed as well as contravening the Health and Social Care Act 2012.

There is another component which relates to ask No 9 in our collective action campaign. BMA has significant concerns around online consultation software being available to patients from 08:00-18:30 given practices’ lack of capacity, and their responsibilities for ensuing patient safety.

GPCE advice continues to apply here: CDs and PCNs are advised not to sign this particular declaration presently, but to await further guidance closer to the financial year end.

Read the full update here and if you have any queries, please email us at info.gpc@bma.org.uk

Rollout of the medical examiner system in England

In England, the statutory implementation of the medical examiner system will take place on 9 September 2024. This will mean that independent scrutiny by a medical examiner will become a statutory requirement prior to the registration of all non-coronial deaths from this date. Information from the Department of Health and Social Care is here.

While many are using the medical examiner system, some are not. If you require further information on implementation in your area, please contact your LMC. For more wider information on the medical examiner system please contact the BMA.

Zero tolerance of racism: download our poster

Last month’s racist, Islamophobic and anti-migrant riots were hugely distressing with wide reaching impact felt across healthcare settings and communities. All healthcare workers have a right to work in an environment free from abuse.  Patients need to be warned that there will be zero tolerance of racist behaviour with resultant consequences, should this not be respected. BMA has produced a poster you can print and display in your premises, making it clear that racist abuse will not be tolerated.

You can also contact the BMA for wellbeing and support, and we have guidance for managing discrimination from patients, with clear steps to take when incidents of racist abuse against healthcare staff occur.

Successful RCGP legal challenge in support of disabled doctors

The BMA has won a legal challenge supporting a trainee GP who believed they had been unfairly treated by the RCGP because of its policy on the number of attempts at taking an exam. ​The BMA supported the doctor to bring judicial review proceedings challenging the lawfulness of the RCGP’s attempts policy, which only allows four attempts at the AKT/RCA exam required to complete GP training. According to the policy, no additional attempts would be granted, even in circumstances where a candidate discovered, after sitting a test, that they had a disability which would have entitled them to “reasonable adjustments”, including additional time for the taking of the test.

GP pension campaign in England

At the end of July, the BMA’s pensions committee launched a campaign to assist GPs in England to get their pension records up to date. There is a step-by-step guide for members to follow, with pre-populated email templates to assist. It is important to ensure that your record is as accurate as possible so you can make appropriate decisions about your pension and the McCloud remedy.

If you have received your 05 and AA statement from NHS Pensions, and your record is not updated to 2022-23, you can check what years are missing from your record by logging into your PCSE Pensions Online account. As the Pensions Online system is updated in sequential order, you will be able to see which type 1 or type 2 form is holding up your record from being up to date. You can then submit the required forms via your online account or through the online form.

If you have submitted all required forms and your record is still not up to date, you should raise a complaint with PCSE. If it not fully resolved within 40 days – follow the escalation process.

Practices taking action

Following the overwhelming YES vote in the BMA ballot practices are beginning to take action – the range of actions are all detailed on the toolkit menu on the BMA website. Each action is safe, effective, sustainable and clear, and it is up to each practice to choose which actions to take, and when.

Please do continue to liaise with your LMC to access additional advice, tailored to local arrangements.

BMA is continuing to collate the data in the weekly local action tracker surveys which have a deadline of 5pm each Sunday for completion.  These insights are vital to the overall campaign and securing the profession’s objectives.

Cambridgeshire & Peterborough constituent practices will receive the new survey link every Wednesday together with the GPAS submission reminder.

Read the BMA GP campaign page for more information about the actions you can take and how to order campaign materials and patient leaflet. There is also a patient-facing animation, complete with additional subtitles that can be activated for screen reading.

Read also the guidance for salaried GPs and locum GPs during collective action

Data Request for Cloud Based Telephony Statistics

You will have received in your practice a request to share telephony data due to a Data Provision Notice. This email will have been sent to the main practice contact registered with the CQC. We have received additional documentation and messaging from NHSE on this issue. David Wrigley and Mark Coley have met NHSE on the topic, having been given 24hrs notice of the data request and documentation associated with it.

BMA is analysing the information and will issue a further update with more information. At the present time practices are being asked to defer making a decision this week and await further communication from BMA.

Practice Finance Survey – Summer 2024

General Practice in England is being asked to complete the BMA Practice Finance survey. The aim is to build evidence for the GPC England team to support the annual contract negotiations.

We appreciate how hard the past few months have been for GP contractors and their managers. This is your opportunity to feed into an evidence base demonstrating the impact of inflation and rising costs, over the last couple of years, on GP practices across England.

Please send the survey link to your practice manager, so that they can complete the survey. The survey will be close at 9am, Tuesday 17 September. 

It is recommended that respondents have relevant information to hand before starting the survey: they will need GP practice accounts for 2022/23 and 2023/24, expenditure data for April 2023 and April 2024, and information on staff numbers and practice list size.

Take the survey: https://www.research.net/r/H9CYXCP

DHSC announcement to expand the ARR Scheme to include GPs

GPC England, Sessional GPs Committee and GP Registrars Committee have written a letter to the Secretary of State for Health, Wes Streeting, about our concerns over the DHSC announcement to expand the Additional Roles Reimbursement Scheme (ARRS) to include GPs, and how the expansion can be best implemented and possible long-term alternatives.

BMA has expressed concerns that providing this funding at PCN level does not provide GPs and patients with the desperately needed stability required, and instead suggested that it would be far more effective to provide this funding at a practice level, helping to address GP unemployment in the places most severely affected. In the long-term, GP contract funding must be increased so practices have full control over who they recruit to best serve their patients’ needs without the need for additional schemes like ARRS.

Other BMA Updates

GP pressures: latest workforce data

The latest workforce data showed that the NHS had the equivalent of 27,662 fully qualified full-time GPs in July 2024 – a decrease of 8 FTE GPs since the previous month, and 1,702 fewer fully qualified full-time GPs than in September 2015. The number of GP practices in England has decreased by 98 over the past year – reflecting a long-term trend of closures and mergers.

Between September 2015 and June 2023, the NHS had been losing FTE fully qualified GPs at an alarming rate. While some recent gains are positive, they have not been sufficient to make up for historical losses. During this time, there has also been a rise in the number of patients, with July 2024 seeing yet another record-breaking number. GPs are now responsible for about 18% more patients than in 2015, demonstrating ever mounting workload pressures. See more BMA infographics and data shoing the pressures in general practice here.

BMA sessional GP conference 2024: diversity, opportunity, safety

The BMA conference for sessional GPs is happening at BMA House and online on 20 September. It’s free for members, but non-members can also attend. This event will give you information and updates on topical issues including future models of general practice and establishing professional relationships with new clinical roles such as ARRS staff and PAs. Breakout groups will provide practical advice and guidance on a choice of topics in smaller groups. Check out the details of the day and register your place.

Clinical academic trainees conference 2024

The BMA’s clinical academic trainees conference is an exciting half-day event on 12 September. It aims to help you make the most of your academic training and develop your career, and provide an opportunity to share experiences with colleagues. Find out more and register >

August 2024 GMS Contract Variation Notices

ICBs will be sending out Contract Variation Notices for signature, if they have not already done so.  This is a nationally imposed change.

As you know, your Union, the BMA, has announced a period of Collective Action and the current imposed GMS contract and associated funding is widely seen as inadequate to deliver 21^st century General Practice.

Therefore, practices may (at any time, but particularly during Collective Action) opt NOT to sign the Contract Variation Notice. Signing may be seen as acceptance or even endorsement of the deal NHSE has imposed.

As always, these imposed GMS contract variations will take effect 14 days from the date they are served on the practice, regardless of whether or not the practice signs.  Not signing is a small but potentially useful message back to NHSE, and it will not harm patients or alter your services or funding in any way.

Cambs LMC supports any practice who chooses not to participate in “signing” an imposed contract.

Changes in Death certification coming into force from 9th September 2024

As you will already be aware, the definition of an attending doctor for legal purposes changes FROM “attendance during final illness and either seen within 28 days of death / after death” TO “attended at any point during the patient’s life” from 9th September 2024.

The cause of death will still be determined to “the best of knowledge and belief”.

From September 9th doctors will need to use the new attending practitioner Medical Certificate of Cause of Death (MCCD). These have already been sent to hospital sites, GP practices etc. Do not use them before then. The current MCCD will not be valid if written on or after September 9th.

From September 9th, the final wording of the cause of death will need to be agreed with the Medical Examiner. They will need access to relevant clinical records and be able to view the proposed cause of death.

A pragmatic approach will be taken but changes may be necessary if there are clear errors in formulation or an absence of supporting evidence.

If the death is referred to the coroner (Notification of Deaths Regulations 2019) and the coroner decides not to investigate, the attending doctor will complete an MCCD and Medical Examiner scrutiny will apply. Coroners have no jurisdiction over the MCCD.

The Medical Examiner will co-sign the new MCCD at the end of their scrutiny process which will include a discussion with the bereaved. The death cannot be registered without the Medical Examiner’s signature. It should be sent to the ME office (scan if remote) not the register office.

For a death certified with the new MCCD, cremation form 4 will no longer apply. There will be no fees. The Medical Examiner system is primarily about giving bereaved people an opportunity to ask questions about the death of their loved one, reviewed by an independent doctor.

If you have not engaged with your local medical examiner then now is the time to do so as the scrutiny process may differ between areas.

Your local examiner contact details can be found here: https://www.england.nhs.uk/patient-safety/patient-safety-insight/national-medical-examiner-system/contact-details-for-medical-examiner-offices-in-england/#east-of-england  

Further information can also be found here: https://www.gov.uk/government/publications/changes-to-the-death-certification-process/an-overview-of-the-death-certification-reforms

Cambs LMC GPAS Report – 30 August 2024

Please see attached this weeks report for your information

GPC Englands vision to rebuild general practice

We have published our Vision for General Practice which outlines key short, medium and longer term asks of the new Government framed around safety now, stability for next year’s contract and longer-term hope in negotiating a new substantive contract for general practice in England.

Our vision has been informed by our conversations with thousands of GPs across our roadshows in recent weeks and responding to the manifesto commitments from the new Government where we have an opportunity to repair trust and rebuild general practice.

NHSE Potential collective action by GPs:  supporting guidance

Many colleagues will have seen this guidance by NHS England on potential collective action by GPs, which is been reviewed by GPC England and an update will be circulated shortly.

Other National Updates

DDRB announcement

This year’s investment into national GP practice contract funding to support DDRB recommended pay uplifts for 2024/25 is a welcome step forward.

However, the formula that’s used allocates funding per patient for each individual practice, and is based on criteria like the age and sex of patients and where the practice is located. Instead, staff costs should reflect the diverse skill-mix needed to deliver the full range of patient care within each individual practice. Partners will want to reward all their staff for their dedication and commitment, but while some practices may receive enough to pass on a full 6% salary uplift, others won’t, forcing them to make difficult choices about what they can and can’t afford to give hardworking staff.

We have raised these issues repeatedly with DHSC and NHS England. For years, GPs have been expected to do more with less, but practices can’t make insufficient funding stretch any further and staff morale, recruitment and retention is suffering as a result. This inevitably contributes to longer patient waiting times, poorer outcomes and widening health inequalities across England; the very opposite of GPC England’s vision for the future of General Practice.

When we negotiate the new GP contract – which we have publicly stated we expect to do with the new Government in this Parliament – we will seek to devise a better mechanism for allocating annual DDRB uplifts. Investment must be distributed fairly and equitably so that every hard-working staff member gets the annual pay uplift they deserve wherever they work in England. In the meantime, we will continue to work with DHSC and NHSE to develop short, medium and long-term solutions to give patients and practices safety, stability and hope.

ARRS funding scheme expansion

Following the recent announcement from the DHSC and the secretary of state on the temporary inclusion of newly or recently qualified GPs in the ARR Scheme, GPC England provided a joint statement with the Sessional GPs Committee highlighting the potential impact of expanding funding to include GPs, and raising our concerns about the practical implementation of this:

‘There are experienced and talented GPs, ready and able to work, but practices can’t afford to hire them so expanding the funding scheme to include GPs shows the Government is keen to find solutions to stabilise general practice. However, we have concerns around how this policy will work in practice, and it’s fundamentally nowhere near enough to save general practice. Because the funding won’t be allocated at a practice level, but instead via Primary Care Networks, this means any GPs employed through this scheme could be forced to move across the country at short notice, uprooting their families in the process, and depriving their patients of continuity of care. This in itself could drive more GPs away from the NHS.

‘We’ve shared ideas with the Government for how to best get more unemployed GPs back into the workforce, because there are more flexible and effective ways that this funding could be used to ensure the maximum benefit for patients – for example reimbursing the practices themselves. In the long-term, however, we need to see the core GP contract funding increased so that practices have full control over who they recruit, without the need to go via bolt-on schemes. We will continue to share suggestions with the new government to potentially take forward in 2025/26.’

We continue to call on the new government to listen to the concerns of GPs and to act swiftly to restore and enhance the cornerstone of effective healthcare – our general practitioners.

PCN Pilots – S96 guidance

Following requests from LMCs and practices GPCE has sought advice on the Section 96 Agreement that is being sent out to practices to sign up to participation in the PCN Test Pilots.  This sets out a number of concerns with the proposed Agreement raised following legal consultation.

In line with our recommended list of collective actions, we would strongly urge practice to defer making any decisions to accept local or national NHSE Pilot programmes whilst we explore opportunities with the new Government. Read our guidance.

Crowdstrike outage

Following the events of Friday 19 July that saw critical digital services, including in general practice, across the country impacted by the outage. GPC sought and received assurances from the ICO and NHS England that GPs would not be required to report the availability breach to the ICO created by the outage on an individual basis. Instead – NHSE is providing a bulk report to the ICO, allowing them to satisfy their obligations under Article 33 (1) UK GDPR. The ICO confirmed that for those practices that have already reported, they may consider the matter closed with no further action to follow. However, any breaches unrelated to the crowdstrike outage and its impact on EMIS will still need to be reported.

New GPCE guidance on Physician Associates (PAs) working in general practice

We have published guidance to help standardise practice and reduce variation in how physician associates work within a general practice setting. It aims to provide a framework to support physician associates to work safely in general practice, for patients, their employers, and GP supervisors.  It has been designed to complement the scope of practice and supervision guidance already published by the BMA and should also be read in conjunction with GPCE’s Focus on MAPs in general practice.

Are your pension records up to date?

The BMA’s Pensions Committee have launched a campaign encouraging you to take action to make sure that your pension records are accurate and up to date, so you can make informed decisions about your pension savings, retirement plans and the McCloud remedy.  We are aware that thousands of GPs in England have “missing years” of pensions data due to PCSE’s maladministration of pension records. We have been consistently highlighting the failures of PCSE (run by Capita), and the significant importance of them fixing this issue as soon as possible. Unfortunately, there has not been sufficient progress to resolve this issue, so we are now encouraging you to take action to get your pension records in order.

To support you the Pensions Committee have created detailed guidance including template letters to help you get your records up to date, raise a complaint and escalate further where appropriate. Guidance on getting your pension record up to date, for GPs in England – YouTube

UK Visa Sponsorship Licences (formerly known as Tier 2)

Does your practice have a visa sponsorship licence? Do you what it is or why you might want one?

This podcast will persuade you to push this up your practice list of priorities as something to have in place! Listen now to find out why. Wessex LMCs joint CEO and GP Dr Laura Edwards talks with a panel around visa sponsorship and how it impacts international graduates particularly around the time of qualification and what actions practices may want to take to help with their recruitment.

Read also the BMA guidance on Visa sponsorship for GP practices

BMA GP Contract guidance

We have now published our 2024/25 contract guidance documents, to help you consider how best to approach the contract changes. These documents cover the following areas:

• Dispensing and prescribing
• GP data sharing and controllership
• Limited Liability Partnerships and the GMS contract
• Medical Associate Professions in General Practice
• 2024 Premises Cost Directions
• Use of enhanced access appointments
• Vaccinations and Immunisations
• Proformas and referral forms
• Spending and the PCN DES capacity and access payment funding

PCN DES 2024/25 GPC England Guidance on the Capacity and Access Improvement Payment (CAIP)

There are three separate and discrete elements to the CAIP within the 24/25 PCN DES:

• Faster care navigation, assessment, and response
• Better digital telephony
• Simpler online requests

GPC England guidance is that practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance in early 2025.

Read our Focus on guidance

GPC England recommends PCNs do not confirm compliance with the on-line platform CAIP element at this time, because unless the workload associated with a practice’s on-line platform can be controlled, it will not be possible for practices to effectively implement the BMA Safe Working Guidance.

GPC England recommends PCNs do not confirm compliance with better digital telephony CAIP element at this time as NHS England has signalled its intention to issue a contract variation notice from October 2024 to make the sharing of the eight call data metrics they have identified contractual.

Other National Updates

Contraceptive services

Contraceptive services, formerly an Additional Service funded by an identified 2.4% of Global Sum, have been included as an Essential Service under the Primary Medical Services (GMS/PMS) Contract, since 2020.  This includes the treatment of and prescribing for patients for contraceptive services, with the specific exclusion of the “fitting and implanting of intrauterine devices and implants”.

In addition, Para 14(2)1 of the GMS/PMS contract includes a reference to “drugs” including contraceptive as substances and “appliances” as including contraceptive appliances.

GPC England’s advice is therefore that the prescription and administration of contraceptive injections (such as Depo Provera, Sayana Press, and Noristerat) does form part of Essential Services.  Reimbursement is available through the Personally Admitted drugs provisions in the Statement of Financial Entitlements and indemnity is available via CNSGP.

Seasonal Flu Immunisation Programme QIVr vaccine

Sanofi has advised that the Recombinant Quadrivalent Influenza vaccine [QIVr] will, due to a supply issue, not be available for the flu vaccination programme for the 2024/25 season.

The original JCVI recommendation was to use QIVr for adults aged 65 years and over, and also adults aged 16 to 64 who are in eligible groups.

In the light of this change, NHS England has advised the following (see table 1 in this link).

As QIVr is only licensed for those aged 18 and over, this does not affect the immunisation programme for younger patients. For practices who have ordered QIVr, and who are participating in the 2024/25 immunisation programme, the primary alternative is QIV-HD [high dose quadrivalent influenza vaccine] which is licensed in the UK for those 60 and over.  Otherwise, practices may seek to order additional supplies of aQIV [Adjuvanted Quadrivalent Influenza Vaccine] for those aged 65 and over, and QIVc [Cell-based Quadrivalent Influenza Vaccine] for those under 65 years.

NHSE has updated the list of influenza vaccines marketed in the UK

GP Appointment data – April 2024

The latest appointment data shows that that around 30.5 million standard appointments were booked in April 2024, with an average of 1.45 million appointments per working day. Over the past year, approximately 359.6 million standard (non-Covid-19 vaccination) appointments were booked. When comparing to pre-pandemic levels, this is around 57.3 million more appointments than between May 2019 to April 2020.

In terms of access, the proportion of appointments booked to take place the same day has increased slightly from the previous month: 44.6% of appointments in April 2024 were booked to take place on the same day, compared to 43.9% in March 2024. Face-to-face appointments remained the same as the previous month, around 65%. See more data showing the pressures in general practice

NHS Education Funding Agreement 2024/27

NHSE has published a new NHS Funding Agreement. Unlike the previous education contract, this new version includes GP-specific elements in schedule 1. The contract creates a formal mechanism for training practices to receive payment from NHSE.

GPC England has had the opportunity to review and comment on the funding agreement during its development and is content with the final version.

All of the funding agreement documentation can be accessed on the NHS England website. If they haven’t already done so, NHS England commissioners will be contacting training practices shortly about bringing you onto the new agreement.

Infected blood inquiry – Hepatitis C testing

Although it is likely that the majority of people directly affected by infected blood have now been identified and started appropriate treatment, there may be people who have not yet been identified, particularly where they are living with asymptomatic Hepatitis C. People who had blood transfusions may not have considered these risks before or sought testing. Patients may decide to contact practices as they are worried following the publicity about this issue.

The Inquiry report recommends that people who received blood transfusions up until 1996 should be offered a blood test for Hepatitis C if they have not been tested before (GP practices may have noticed that previous guidance set the date as before September 1991).

Patients can be directed to the online service for at-home Hepatitis C self-testing kits, which are available via hepctest.nhs.uk for anyone over the age of 18 and living in England. Any positive results from at-home testing are dealt with by local Operational Delivery Networks and passed to specialist hepatology teams, who arrange to contact the patient, notify them of their results, manage their care and treatment, and communicate this to the patient’s registered GP.

Further resources for Hepatitis C care, including a Primary Care Toolkit are available here

Other Updates from BMA

GP contract guidance

GPC England is currently preparing contractual guidance following the imposition on 1 April and this should be available on the BMA website shortly. There is also a planned update of the safe working guidance, which it is hoped will be completed by early June.

Premises Costs Directions

After almost a decade of pressure from the BMA, the Department of Health and Social Care (DHSC) have published the long-anticipated update to the Premises Costs Directions (PCDs), which will bring changes to assist premises costs, including permission for commissioners to award improvement grants of up to 100% of the project value, (up from 66%), and new powers for commissioners to better support contractors.

These changes were initially agreed five years ago, as part of the multi-year GP contract in 2019. The full guidance will be published at a later date.

Responding to the announcement, Dr Gaurav Gupta, GPC England premises lead, said:

“We’re pleased to see positive steps to help GP premises owners, and any partners aspiring to buy into property-owning partnership in advancing their services to provide the best possible care for patients.

But we still have a very long way to go, with no additional funds going into ICB budget lines. The past decade has seen us caring for an additional eight million patients, with over a thousand practices lost, and record numbers of appointments. It’s clear to patients and GPs alike that we must push Government and NHS England for significantly greater investment into General Practice premises.”

Read the full statement here

Accelerated Access to GP-held patient records – update

Following engagement with the ICO and NHSE, BMA maintains the position outlined by the Information Commissioner. While the direction to provide prospective record access to patients is legal, mitigations outlined by practices in DPIAs submitted to the ICO should also be implemented to ensure that processing is compliant with the requirement of the Data Protection Act.

Where practices are facing pressure from ICBs to move ahead with prospective automatic access and have produced a DPIA, they should cite the ICOs response and continue in line with their DPIA.  Read more here

Cloud based telephony

Following changes that have mandated adoption of Cloud Based Telephony on NHSE’s approved procurement framework GPC England has received extensive complaints from GPs being charged excessive costs for adopting new systems.

While we remain in discussion with NHSE to seek a resolution, we have been advised that GPs can raise concerns directly with NHSE about additional costs they are experiencing using the following email commercial.procurementhub@nhs.net. Please continue to get in touch via info.lmcqueries@bma.org.uk with any concerns.

Changes to the benefits payment process

The DWP and DHSC has published a call for evidence that will inform a programme of work announced at the autumn statement in 2023, to explore reforming the fit note process to support those with long term health conditions in accessing work and health support. The evidence will help to assess the impact of the current fit note process in aiding work and health conversations, and the exploration of enhancements that GPs and other health care professionals would require for the fit note to better support people to start and stay in work. GPCE will submit its evidence in due course.

Medical Examiner System in England

The BMA continues to engage with stakeholders on the implementation of the Medical Examiner system in England which is currently scheduled for 9 September 2024. The Statutory Instruments and timeline of the ME implementation can be found here with the relevant legislation found here.

WorkWell Pilot

During the recent BMA Occupational Medicine Committee (OMC) meeting, the Government announced increased services being rolled out in occupational health. At ARM 2023, Motion 69 was passed which called on universal access to occupational health and medicine. Since the announcement, the Government has published the areas to pilot the WorkWell health and support service (all in England). Going forward, OMC will be lobbying the Government on a truly universal occupational health and occupational medicine system for all workers in the UK.  OMC also discussed recruitment and other challenges for those undertaking work in occupational medicine. For further information please contact info.omc@bma.org.uk

National updates from BMA

Contract dispute update

We are now in dispute with NHS England in relation to the imposed changes to the 2024/25 GMS Contract for General Practice. We have warned them that industrial action could follow unless urgent improvements are made to the contract. It is now vital that we reassure patients that we’re on their side by raising awareness of the issues that have brought us to this crisis point. Thank you once again to the huge number of BMA members who responded to the referendum giving a 99.2% rejection of the 24/25 contract. We are preparing for the next steps over action we can take.

We also wrote to each of the 42 ICBs asking them to add ‘general practice’ to their risk register given the ongoing crisis we face with unmanageable workloads, practices handing back contracts and many being in financial distress. This was an important step and quite rightly has raised concerns from ICB leaders and NHS England.

We will soon be sending some digital resources to use in your surgeries to explain to patients some of the problems we face. Keep an eye out for these in your inbox and via our social media channels.

Within the next two weeks we will be sharing details of roadshows taking place across the country, both face-to-face and virtually. This will be an opportunity to be part of the wider discussion around what the next steps for the profession will be.

Thank you for your support. Together we will fight for the future of our profession.

Read more about the dispute here: GPs in England go into dispute with NHS England over contract

GP pressures

The latest GP workforce figures for England show the number of patients per practice is rising. GPs are now responsible for about 18% more patients than in 2015, demonstrating ever-mounting workload pressures.

The NHS in England has lost the equivalent of 1,790 full-time fully qualified GPs since 2015. There are also fewer GP practices, with a decrease by 106 over the past year. This fall in both staff numbers and GP practice coincides with a rise in patients: as of March 2024, there was another record-high of 63.27 million patients registered with practices in England – a full time equivalent GP is now responsible for an average of 2,295 patients.

The latest appointment data shows that that around 29.9 million standard appointments were booked in March 2024, and over the past year, approximately 353.3 million standard (non-Covid-19 vaccination) appointments were booked.When comparing to pre-pandemic levels, this is 43.1 million more appointments than between April 2019 to March 2020.

See more infographics and data, showing the pressures in general practice, on the BMA website.

BMA medical attrition report

Last week, the BMA released a new report exploring medical attrition in the UK’s health services.

In 2022/23, between 15,000 and 23,000 doctors left the NHS in England before reaching retirement age. Depending on the exact number of doctors leaving, we estimate that this loss has resulted in between £1.6 to 2.4 billion in additional costs for NHS employers and the public purse, at a minimum. With increasing numbers of doctors reporting taking hard steps to leave the profession, this cost will increase without action.

The actual cost of replacing an individual doctor will vary, however, and can easily cost over £250,000. For a full-time salaried GP who decides to move abroad, leaving their post at a small rural practice after six years work, the combatively cost would be around £295,000. The practice may struggle to recruit and have to rely on locum cover for 3 months – resulting in an addition £86,000 cost. Eventually, a newly qualified GP is hired, and they take around 25 days to find their feet – resulting in £1000 of productivity losses over that period. One less doctor in the workforce results in the need to train a new doctor to keep workforce numbers up – training a GP to the same level would cost at least £260,000.

The good news is that there is plenty that governments, UK health services and employers can do to hold on to staff and curb preventable costs in the process, many of which would result in immediate benefits. We pinpoint four key areas where urgent action is needed to retain doctors in the UK’s health services, and save public money: pay and debt; working conditions; diversity and inclusion; and development and support.  Read the report.

Covid therapeutics guidance

Further to the guidance sent out last week about COVID therapeutics, we have had multiple reports of ICBs trying to push this prescribing to General Practice, with minimal funding and support. It is very important to be clear that prescribing of the first and second line agents Paxlovid (Nirmatrelvir plus ritonavir) and Sotrovimab (an IV medication) are not suitable for prescribing routinely through General Practice.

Clinicians running Covid Medicines Delivery Units (CMDUs) are clear the assessment of these patients is time consuming due to the large number of interactions and contraindications, and often requires input from specialist colleagues before prescribing. The first line drug (Paxlovid) is very difficult to prescribe, as it has interactions with many common and specialist medications that many in these patient groups will be taking (e.g. Amlodipine). Even with increased eligibility, GPs would not see sufficient numbers to prescribe this drug safely, and doing so would be contrary to the GMC’s good medical practice guidance.

We therefore recommend that GPs do not agree to prescribe Paxlovid unless as part of an appropriately commissioned specialised service. We would recommend you contact your LMC if you feel pressured to prescribe or feel unhappy at how this is being dealt with by your local system.

Where traffic light systems are in place maintaining as a ‘red’ classification supports the need for a separately commissioned service.  We are clear that governance of ICB Medicines committees must allow GPs to refuse such prescribing in line with GMC guidance. Read our guidance.

Medical Examiner arrangements

The National Medical Examiner (ME), Dr Alan Fletcher, has confirmed the deferment of the statutory introduction of the Medical Examiner (ME) until 9 September 2024; this delay offers a further opportunity for local ME Units to “on-board” GP practices. Practices should start to trial their links with ME Units in terms of IT connections, and when providing a draft MCCD for ME comment. This will help local ME Units plan their capacity and responsiveness both in terms of the numbers involved when all community deaths are reviewed, once this a statutory process, and the need to provide “fast-track” arrangements, for example, for certain faith groups. Finally, the digital MCCD is planned to be available by September.

GPC England will continue to liaise with the National Medical Examiner and provide updates as they become available, and practices are encouraged to contact their LMCs with any queries. Many LMCs already have good links with their local ME Units which is very helpful.

RCGP consultation on Physician Associates

The RCGP is undertaking a consultation on the role of PAs (Physician Associates) in general practice. A survey of all current RCGP members is running from 22 April to 10 May 2024. We would encourage all RCGP members to respond. To help inform your response the BMA position on PAs in general practice, including on scope of practice and seeing undifferentiated patients, is available here.

If you are an RCGP member and you have not received an email with the survey link and believe that you should have, please contact policy@rcgp.org.uk

National Visa support service for GPs

As part of the closure of NHSE’s Primary Care Workforce Team, the national Visa Support Service for GPs and GP practices currently provided by the team will also be closing. National support for practices, ICBs, regional teams and GPs with visa queries will end on 31 May 2024 and other responsibilities such as funding visas and providing practice matching are moving to ICBs under the new NHS England operating model. Individual GPs with immigration concerns can get free advice from our Immigration Advice Service, and the following contacts will apply after the 31 May 2024:

• Visa related queries and issues should be raised directly with the dedicated NHS Visa Team at the Home Office via UKVINHSTeam@homeoffice.gov.uk.
• Queries relating to the 4-month visa extension for newly qualified GPs should be raised with NHS England’s Overseas Sponsorship Team via sponsorship@nhs.net.

Please note that existing NHS England visa support for sponsored GP trainees, and GP and practices participating in the International Induction Programme will continue to be provided.

BMA members with concerns about this can contact the BMA’s International Team info.international@bma.org.uk

Participants needed for new autism research

Autistic Doctors International, in partnership with Brighton and Sussex Medical Schools, are conducting a new survey which aims to assess the prevalence of autism and autistic traits in doctors within the UK. The research is intended to help to improve understanding of autism within the medical profession on a national scale, which will help impact future support and policy. The survey is anonymous and takes around 7 minutes to complete. If you are interested in taking part and/or sharing with your networks, the link is here

Wellbeing resources

We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services,NHS practitioner health service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and support wellbeing.

GPC England committee pages and guidance for practices

Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk

Read the latest GPC England bulletin

CAMBS LMC EVENT:  Thursday 18 April 2024 – 12:30 – 2:00pm via Zoom

Directors duties and responsibilities, corporate governance and running your company

Cambs LMC is hosting an online training session for those that have, or are considering, setting up a limited liability, incorporated structure for your PCN, we are pleased to invite you to attend the following Cambs LMC hosted online training session:

LMC Law offers a practical seminar for incorporated organisations which includes general corporate governance and director’ duties and responsibilities, directors’ liabilities, decision making, difficult directors, conflicts of interest and company housekeeping.

If this is of interest, please email office@cambslmc.org with details of those who would like to attend from your PCN. 

CAMBS LMC EVENT: Tuesday 23 April 2024 – 7:30pm-9:00pm via MS Teams

GP Contract Imposition, GP Referendum, local commissioning and impact on constituents

Reminder to register!  We are delighted to invite all GPs (including partners, salaried, locum and registrar colleagues) and Practice Business Managers to attend our online webinar, via Zoom on Tuesday 23 April 2024, 7:30pm – 9:00pm with our chief executive, Dr Katie Bramall-Stainer, to discuss the recent GP Contract Imposition and GP Referendum, including:

• What this means for Cambridgeshire & Peterborough constituents
• Local commissioning plans
• Q&A session

There will be the opportunity for questions and answers at the event, however should you have any questions you’d like to share with us ahead of time, please email them to office@cambslmc.org and we will look to include these at the session.

The Cambridgeshire & Peterborough Training Hub are kindly managing the bookings for this event on our behalf, registration link here: https://cptraininghub.nhs.uk/event/cambs-lmc-webinar/

We look forward to seeing you on 23 April 2024.

GP Referendum BMA voting review

We wish to thank the profession for their support and engagement with the GP Referendum.  We are aware of some database issues identified within the BMA which meant that, despite everyone’s best efforts, some GPs who wanted to vote weren’t able to.

In order to better understand why GP colleagues couldn’t vote, we are collating information to make sure that no GP is disenfranchised in any future votes.  We are asking our local GP colleagues who were entitled to vote but didn’t manage to, to complete this form: https://forms.office.com/e/Wk3P4PjzPE

Any information you share will be used strictly for the purposes of working with the BMA membership department to amend these issues.

GPAS Report – 12 April 2024

Last weeks GPAS report can be found below:

CAMBS LMC EVENT:  Thursday 18 April 2024 – 12:30 – 2:00pm via Zoom

Directors duties and responsibilities, corporate governance and running your company

Cambs LMC is hosting an online training session for those that have, or are considering, setting up a limited liability, incorporated structure for your PCN, we are pleased to invite you to attend the following Cambs LMC hosted online training session:

LMC Law offers a practical seminar for incorporated organisations which includes general corporate governance and director’ duties and responsibilities, directors’ liabilities, decision making, difficult directors, conflicts of interest and company housekeeping.

If this is of interest, please email office@cambslmc.org with details of those who would like to attend from your PCN.

Cambs LMC Communications

Further to our email last week around the changes to the LINK, we would like to issue a correction to the information given around the available local WhatsApp groups.

The Cambridgeshire GP WhatsApp group is for GPs only and independent of the LMC.  We apologise for any confusion around this or upset caused.

The Cambs and Peterborough GP SOS WhatsApp group was set up to inform GPs predominantly of national communications and is hosted by the LMC.  As your GPCE representative,  Dr Diana Hunter, Chair of Cambs LMC receives information from central communications that require cascading out locally.  It is mostly broadcast only although we have opened the chat up around webinars.

The membership of this WhatsApp is for GPs initially, however this may be open to change and we will inform you accordingly.

With the changes to the LINK mailing list , our next planned step is to add all those who are current members of the SOS group to a new LINK equivalent WhatsApp group for local communications and discussion.  This membership will be for GPs and PMs, in the same way that the link always has been.

We will let you know when that group is up and running and we are planning to add numbers across.

You will have the option to opt out, either by emailing us at office@cambslmc.org or removing yourself from the group at any time.

GP Referendum BMA voting review

We wish to thank the profession for their support and engagement with the GP Referendum.  We are aware of some database issues identified within the BMA which meant that, despite everyone’s best efforts, some GPs who wanted to vote weren’t able to.

In order to better understand why GP colleagues couldn’t vote, we are collating information to make sure that no GP is disenfranchised in any future votes.  We are asking our local GP colleagues who were entitled to vote but didn’t manage to, to complete this form: https://forms.office.com/e/Wk3P4PjzPE

Any information you share will be used strictly for the purposes of working with the BMA membership department to amend these issues.

National update from BMA

On behalf of GPC England, I want to thank every single GP and GP registrar across the country who took part in our referendum. Let us not forget, this referendum wasn’t even a ballot, it was merely a dress rehearsal for what’s around the corner. Either way, had it been a ballot, it would have comfortably passed the required thresholds.

This referendum was a temperature check of the profession – and make no mistake – in the week where we have a third consecutive contract imposition, we are at boiling point. I’m overwhelmed to share the result that more than 99.2% of you have voted firmly against this contract. This is an unequivocal result that will demand NHS England, the Department of Health and Social Care, Government, and other parties now sit up and take notice.

It is now clear that we are one profession, which has spoken with one voice and said enough – time’s up. This contract imposition does not give practices stability. It does not give us hope. This contract, which NHSE are choosing to impose upon us, is not safe.

The contract changes, which will be imposed by the Government and NHS England from 1 April 2024, include a national practice contract baseline funding uplift of just £179m for England’s general practices, way below inflation in recent years, meaning many practices will struggle to stay financially viable over the next six to 12 months and risk closure.

The day after the referendum closed, GPC England met to decide and determine the next steps we’ll be taking as a profession knowing you’re standing right behind us. We are now starting to receive the full dataset and results breakdown from Civica, and we’ll share that with you in due course too.

When I qualified as a GP in 2008, we were called the ‘jewel in the crown of the NHS’. General practice has been demeaned, diminished, diluted, bullied and gaslit long enough. We now start the fight back, bringing our patients with us. Patients want access to their family doctor in a surgery that feels safe, with a well-resourced team ready to meet the needs of our communities, and that’s what we want too.

We are the bedrock upon which the rest of the NHS stands, with 400 million patient contacts a year. Almost 1.4 million every single day. That’s a lot of voters.

So congratulations, ‘team GP’. The battle to save general practice has begun. I’m proud to represent you, and I know that your BMA committee, GPC England, is proud to serve you.

We will be in touch soon with more information, guidance on the 2024/25 contract and next steps for us all.  Watch my video about the GP contract referendum results: GPCE contract referendum results.  Find out about the contract changes and read our FAQs to learn what this means for you.  Link to press release: GPs vote overwhelmingly to reject contract changes in BMA referendum

Dr Katie Bramall-Stainer, GPC England chair

GPAS reports for 05 April 2024 & monthly highlight report for March 2024

Please see most recent GPAS reports below: