Safe Working Guidance webinars with the BMA and Practice Manager Association, 16 & 17 July

Protecting your patients, Protecting your practice

The BMA Safe Working Guidance is being refreshed. Join us to find out about the updates and how this can support GPs to manage their workload and protect their patients and practice. This is your opportunity to Protect Your Practice and Protect Your Patients.

Speakers

Dr Samira Anane, GP in Manchester, vice chair of Manchester LMC and deputy chair of GPC England

Denise Smith, practice manager at Merepark Medical Centre in Cheshire, fellow of the PMA

• 16 July 19.30 to 21.00: BMA/Practice Manager Association
• 17 July 12.30pm to 1.30pm: Practice Manage Association/ BMA Safe Working Guidance

BMA GP Practice Survival Toolkit

We will be inviting GP partners to work with their practice teams and, in liaison with their LMC, to determine the actions they will be willing to take. Each of these actions is outlined in the BMA GP Practice Survival Toolkit.

It is for each practice to pick and choose as they see fit. You may decide to add to your choices over the days, weeks and months ahead. You can read more in the guidance provided or in our FAQs.

Read our contract guidance to help you consider how best to approach the contract changes.

Other National Updates

Working with the new government to rebuild general practice in England

GPC England has written to the newly appointed Secretary of State for Health and Social Care, Wes Streeting MP, offering to work together to rebuild general practice in England. We highlighted ‘the enormous frustration at the loss of over 2,000 GP practices over the past 14 years and of over 5,000 “home-grown” GPs whose training has cost taxpayers in the region of £2–3bn. The number of registered patients in England has increased by 6.4 million in the past 5 years alone, the average number of patients per full-time equivalent fully qualified GP has risen by 18% to over 2,300.’

In the letter we suggested that the real issue over access to general practice is patients’ access to their GPs, and as such GPC England has proposed some solutions to hit the ground running when we meet with Mr Streeting:

1. Commitment towards a universal GP-led continuity of care model for NHS general practice in England with a minimal general practice investment standard.

2. Work with the BMA’s GPs committee England to agree a 2025 Family Doctor Charter.

3. Practices need safe GP to patient list size ratios to ensure manageable workloads and patient safety.

4. Build real-terms re-investment into general practice to retain and return our GPs to safe numbers to guarantee continuity of care for the population.

Read the full letter here

The GP patient survey 2024, published yesterday, also shows that there is a need to focus on general practice, something that the Nuffield Trust agrees on in their response: “Today’s results show that if the new government is truly aiming to fix a broken NHS, it must prioritise fixing general practice”.

Read also my response to news that the Government plans to divert significant amounts of funding from hospitals to general practice

 GP Connect update

Our position on GP Connect (Update Record function) remains that GPs must retain the ability to restrict access to third parties to update the GP record. It is important to say we do not wish to restrict the use of the GP record for direct patient care. GPs who wish to and have already switched off update record need not make any further changes. Any GPs wishing to turn off the functionality can do so via the steps listed here.

*Save the Date* – Practice Finance Health joint webinar 7 August 12:30-14:00

GPCE – AISMA (Association of Independent Specialist Medical Accountants)

Find out how good practice management makes a difference. Join us to hear about improving practice income and keeping on top of finances. Register here

Template letter requesting access to a patient’s record

Following some concerns raised, GPCE wrote to the OPG (Office of the Public Guardian), suggesting that under Para 5 (a) of the Mental Capacity Act, the OPG has the right of access to patients’ health records if they are investigating the actions of a deputy or an attorney. However, the OPG letter referenced card 16 of the BMA MCA Toolkit; section 4 of this card confirms the right of access and ‘if GPs can release this information promptly it can help ensure these investigations are completed as quickly as possible’.

We suggested that practices may misunderstand this issue; the BMA MCA toolkit is not saying that the OPG’s list of questions should be answered as soon as possible, but that the relevant health records should be released. Responding to the list of questions posed by the OPG is a private, non-NHS, matter for which a fee can be charged by the GP involved.

The OPG has reviewed the letter templates, which they agree could be viewed as unintentionally misrepresenting OPG’s statutory rights to medical information. As a result, the templates have been edited to clarify that the BMA’s MCA toolkit and the legislation on which this advice is based only apply to medical records and not to any of the accompanying questions. Access the templates here:

• LPAs and enduring powers of attorney
• Form concerning Lasting Powers of Attorney

IIF and GPAD

We recently wrote to NHS England about practices adversely affected by a significant flaw in the appointments mapping data processing for GP surgeries using the TPP SystmOne clinical system. It appears that although practices accurately mapped appointment slots in line with the indicator, an issue with the data collection/processing software meant that many did not achieve the necessary targets, as during processing for General Practice Appointments Data, the legacy mapping often persisted, rather than utilising the updated mapping by the practice. Some practices have lost significant sums of money; in some cases, running into thousands of pounds.

NHSE has now acknowledged that due to the issues we highlighted, GPAD will not be able to serve as a robust source of achievement data for 2023/24 and the usual route to correcting data locally through the declaration process is likely to require a disproportionate amount of local effort this year, given the unique difficulties in being able to access alternative local appointment data. For this reason, in 2023/24, all PCNs have been considered to have earned 100% of the points available for this indicator.

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:

Practice Manager update from your regional representative of the Institute of General Practice Management

IGPM statement on the initial pay proposal offer for the 2024/25 GP contract: https://igpm.org.uk/category/news/

For associate members – for just £50 a year fee the following free webinars are imminent.

Upcoming Webinars

Thursday 14th March at 1.45pm: One less task for NHS staff – Automation with Healthtech-1. There’s a growing appetite for automation and AI in primary care, but what’s the difference between these technologies? Dr Lydia van Hamel-Parsons, GP and Founding Clinician at Healthtech-1 will help explain this and where to get started with automation (within a week!) so you can join in on the time and cost savings as well as the relief in workload from using this tech. Email info@igpm.org.uk to book your place.

Thursday 21st March at 12.30pm: IGPM Finance for Practice Managers with Medics Money. We will be looking at the GMS statement breakdown, along with tips and aspects of the business to concentrate on when looking at how to help make the 2% increase in funding work as a business.

Measles outbreak – practice staff and MMR vaccinations

This is an issue we are all facing in our practices, and we have been doing searches for patients who need vaccinating. We have written to NHSE asking for funding to do this additional work and pressed for negligence scheme cover. We can now advise that cover is in place and is outlined in the message below.

On behalf of Jane Freeguard, deputy Director of vaccination – medicines & pharmacy

In light of the national measles outbreak and urgency to support rapid uptake of the MMR vaccine, we are permitting practices to administer MMR vaccines to their eligible staff who are registered with another practice under INT (immediately necessary treatment). Please note this is a time limited arrangement until 31 March 2024 in light of the on-going national incident and only applies to MMR vaccinations.

An item of service fee cannot be claimed for the administration of MMR vaccines to staff registered with another practice. However, indemnity cover will be provided through CNSGP and nationally supplied MMR stock can be used to vaccinate eligible staff. Staff must be strongly encouraged to inform their registered practice that they have received an MMR vaccine, requesting it be included in their medical record.

PC0241 | MMR Vaccination Survey Comms For Practice Staff | 11.03.24:

A reminder of the email that was sent to GP Practices yesterday following information circulated from the East of England Immunisation team and confirmation below on vaccinating their own staff:

Can GPs vaccinate their own staff, and can they get paid? (update 23rd February 2024) Practices are formally endorsed to administer MMR vaccines to their eligible staff who are registered with another practice under a temporary registration for INT (immediately necessary treatment).

• This is in light of the current high risk measles situation and whether all of these vaccines continue to qualify as ‘immediately necessary’ will be reviewed in March 2024. Clearly in certain exposure situations, vaccines may be immediately necessary and clinicians should use appropriate professional discretion.
• This arrangement does not apply to other staff
• The national NHSE team have confirmed that indemnity cover for this activity will be provided through CNSGP and nationally supplied MMR stock can be used to vaccinate eligible staff.
• Staff must be strongly encouraged to inform their registered practice that they have received an MMR vaccine, requesting it be included in their medical record.
• In the East of England, we are encouraging staff to get vaccinated in their registered practice where possible, to support accurate and timely record-keeping

For clarity, the first port of call should be for staff to attend their own GP practice or one of HCT’s walk in vaccination clinics. A list of walk-in clinics can be found on our website The Vaccinators | CPICS Website.

As a reminder, any staff member that is exposed to measles without documented evidence will need to isolate from day 5 to day 21 after exposure and should be strongly encouraged to be protected. Documented evidence includes:

• 2 x MMR vaccinations
• 2 x Separate Measles Vaccinations (updated guidance from UKHSA and NHSE)
• Positive antibodies for measles test

NATIONAL UPDATES:

2024/25 GP Contract Referendum – webinars

GPC England has rejected the 2024/25 GP contract changes. The contract has now been put to BMA GP members in a referendum. The referendum cannot prevent the Government from choosing to impose their changes to the contract, but it will send a strong signal as to how the profession feels about the contract, a potential third successive contractual imposition by Government and where we collectively go next. Find out more about the current contract changes here. You can watch Dr Katie Bramall-Stainer discussing the GP referendum here.

To ensure you can feel fully informed before you vote, BMA is holding a series of webinars and as you feedback we FAQs will be added to the BMA webpage http://www.bma.org.uk/gpcontract early next week, which you can read and reflect on with your practice colleagues.

What to expect:

• A presentation from GPC England Officers outlining the context of the 2024/25 contract and what it means both for your practice, and you as a GP.  A summary of next steps and the choice BMA GP members will need to make in the referendum.
• A roadmap of what the months ahead may look like.
• The opportunity to have your questions answered – please send your questions in advance to gpreferendum@bma.org.uk

Webinar dates, times and Microsoft Teams joining links:

These webinars will NOT be recorded, so please attend your regional slot, or a national catch-up session. The referendum opened on 7 March and closes midday Wednesday 27 March. You should have received an email with a unique voting link. How you vote will determine BMA’s next steps as a profession.

GP Workforce – January 2024

There are 48 more fully qualified, full-time equivalent GPs in January 2024 than in December 2023, marking seven months of sustained increases. However, we have the equivalent of 1,830 fewer fully qualified full time GPs than we did in September 2015. During this time, there has been a rise in the number of patients registered at practices, with January 2024 seeing another record-breaking rise. GPs are now responsible for 18% more patients than in 2015, creating ever mounting workload pressures.

• In January 2024, the NHS had the equivalent of 27,534 fully qualified full-time GPs. This is an increase (48 FTE) from the previous January 2024 marks seven months of, albeit small, increases in full-time equivalent fully qualified GPs, with an additional 382 fully qualified GPs joining the workforce during this time.
• However, the NHS been losing fully qualified GPs at an alarming rate since 2015, with GP partners making up a substantial part of this shortfall (when this data set began). We now have the equivalent of 1,830 fewer fully qualified full time GPs than we did in September.
• The GP Partner workforce in particular has been shrinking since 2015. There were 16,579 FTE GP partners in January 2023 but 16,176 in January 2024: a total loss of 403 FTE GP partners in the past 12 months alone.
• The number of GP practices in England has decreased by 106 over the past year – reflecting a long-term trend of closures and mergers.
• This fall in both staff numbers and GP practice coincides with a rise in patients: as of January 2024, there was another record-high of 63.15 million patients registered with practices in England – an average of 10,005 patients registered per practice.
• As a result, each full-time equivalent GP is now responsible for an average of 2,294 This is an increase of 356 patients per GP, or 18%, since 2015, creating an ever-mounting workload in general practice.

Read more on our analysis – “Pressures in General Practice”

HRT guidance updates

An updated HRT PPC guidance document has been published by DHSC. This is to reflect changes to the definition of products in scope of the HRT PPC, following the launch of new products onto the market, and an agreed process for managing discontinuations. The latest version can be found here: HRT PPC guidance | NHSBSA.

Preparing for the Spring 2024 COVID-19 vaccination campaign

Preparations are underway for the Spring 2024 COVID-19 vaccination campaign, following the achievements of the 2023 Autumn campaigns. The NHS is focusing on delivering a seasonal COVID-19 vaccine dose, aligning with government recommendations. Eligible cohorts include adults aged 75 and over, care home residents, and immunosuppressed individuals. Efforts are being made to ensure equity in access and address variations in uptake. Funding and contract arrangements are extended to support vaccination activities, with plans for supply and delivery to be finalised soon. The commitment of healthcare professionals is crucial for the campaign’s success. Read more here.

PRSB survey – GP activity data

The Professional Records & Standards Body (PRSB) are surveying GPs as part of a set of proposals to implement a standard set of SNOMED codes to capture consultation mode and GP activity data. The surveycloses on 15^th March and seeks to garner views from practices on how day-to-day activity that takes place can best be defined and recorded.

 NIHR in-Practice Fellowship

The NIHR in-Practice Fellowship (IPF) initially offered academic training to fully qualified general practitioners, general dental practitioners, and community dentists, who are in NHS practice in England. The eligibility for this scheme has been broadened in 2024 to cover all other health and care professionals working in a primary care setting, including (but not restricted to) nurses, midwives, pharmacists and health visitors. This enhanced offer will enable a larger cohort of health and care professionals to access research training and development, to advance their academic research careers In-Practice Fellowship (IPF) Round 18 | NIHR

Professional Record Standards Body

The PRSB is aligning its standards to the new Pathology standard (DAPB4101) going through approval at the DAPB in March. The current components used in PRSB standards were developed before the recent pathology standards. The PRSB need to ensure that test results and reports that clinicians receive can be shared digitally with their colleagues and can be incorporated into shared care records. The PRSB are asking clinical informaticians with an interest in pathology to review PRSB standards in light of the new standards to ensure that they align. To support this work, the PRSB are holding a webinar on Thursday 21 March, 11am – 1pm, to register click here.

Cloud based telephony

GPCE has written to NHSE to raise concerns over the rollout of CBT (cloud-based telephony) and the financial and workload impact this is having on practices along with pressure to sign complex contracts on very short deadlines. NHSE advised last year that there would be no increased costs to practices for their monthly contracts. We have relayed concerns raised about these issues and are seeking an urgent meeting with NHSE while calling for a pause of the roll-out of this contract mandated procurement exercise.

We want to hear if you are seeing increased costs and please do email info.gpc@bma.org.uk

with details of what you pay now and what you are being asked to pay going forward with the telephony provider.

GPs have been pressured at the last minute to sign up to new telephony systems at huge extra cost – despite reassurances from NHS England this would not be the case. Deputy chair Dr David Wrigley thinks this is a huge mistake and has called for an immediate pause, read more here.