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: