Chairman's Newsletter - May 2018
Kent and Medway Medical School bid successful
I am delighted to start with some very positive news. The joint bid by the University of Kent and Canterbury Christ Church University to develop Kent and Medway’s first medical school has been successful. The new medical school in Canterbury will be instrumental in achieving sustainable medical services in the future by helping with recruitment and retention of medical professionals.
Workload Control in General Practice
Increasing Primary Care workload remains the biggest issue facing our profession. Rising consultation rates, falling GP numbers and inadequate funding are making the workload unsafe for patients and General Practice workforce.
BBC Radio Kent recently covered the problems patients face in getting appointments with the same GP. Both I (at 25:30) and Dr Mark Ironmonger from LMC (at 1:06:30) spoke on the program regarding the reasons for this and the challenges faced by practices. You can listen to the program here .
BMA’s General Practitioners Committee (GPC) has produced guidance on ensuring patient safety through demand management which looks at safe workload limits and Operational Pressures Escalation Levels (OPEL) alert system to trigger urgent actions when workload reaches critical levels. Between 25-35 appointments per day have been suggested as safe limits for a GP in a day, depending on the complexity of consultations. This requires local discussion and the LMC will be working with CCGs and other NHS bodies to look into this as a matter of priority. You can find the guidance here .
e-Referral Service (e-RS) concerns
As you will be aware eRS is now part of the GMS contract. The target is to have all CCGs and Trusts using e-RS for all their practice to first outpatient appointments from October 2018. Some Trusts are moving forward with this ahead of the October timeline. We have a number of concerns that need to be addressed to make sure this process is safe. The full committee passed a resolution raising these concerns and we wrote with this to all stakeholders. You can read the letter here .
We want to ensure that the e-RS roll out does not compromise patient safety. We are working with NHS England to ensure that the system is safe for patients and does not shift unnecessary medico-legal risk and work to practices already under pressure. We believe that paper referrals should not be 'switched off' until all these concerns have been addressed. If you have any concerns regarding the e-RS roll out please share these with the LMC.
Spirometry in Primary Care
GPC has published a statement clarifying that spirometry is not part of the core GMS contract. There are no mandatory requirements for practices to perform spirometry. The LMC would like this work to be adequately resourced if it is being provided in General Practice. Read the GPC statement here .
Guidance on Shared Care and responsibility for prescribing between Primary & Secondary/Tertiary Care
NHS England has produced very useful guidance on Shared Care. GPs should only prescribe within their level of competence and any shared care arrangements need formal agreement with GPs. The resources and capacity to ensure consistent delivery need to be determined before any shared care prescribing is implemented. You can find the guidance here .
The LMC wants to ensure that this work is not passed to GPs without specific agreements and adequate resources. If you have any queries or are being asked to prescribe these drugs without adequate arrangements please get in touch with the LMC office.
NHS Winter Pressures
GP practices, like the rest of NHS, have been under unprecedented pressure during the winter months. Worryingly the pressure on the NHS does not seem to have eased and BMA’s analysis shows that that so-called “winter pressures” will extend right through the year with increasing levels of demand and activity this summer predicted to mirror winters of just two or three years ago. The government needs to urgently find adequate resources if General Practice and NHS are to pull through this crisis.
Kent LMC wrote to the CCGs and STP to suspend QoF for 2017/18 and give practices some breathing space but, while many CCGs were supportive, disappointingly this was not approved by NHS England. There has been a lot of attention on the A&E crisis but the plight of practices seems to have gone unnoticed. The LMC continues to highlight the pressures on primary care and we’re lobbying CCGs and NHS England to ensure that any measures to ease pressures on the NHS work to help General Practice as well.
NHS Property Services (NHSPS) update
Practices in NHSPS premises have been struggling due to NHSPS trying to increase service charges. This is an unacceptable situation that can potentially destabilise General Practice. I have been working closely with BMA’s General Practitioners Committee (GPC) to try and get this matter resolved.
BMA GPC advice is that practices ‘…do not sign any lease or Heads of Terms (including those purporting to be based on the national template GP lease negotiated between the BMA and NHSPS) unless and until you fully understand and are comfortable with your potential liabilities.’ and that ‘…practices should only make payments to both the extent that they are both satisfied as to the legal basis upon which they are payable and their accuracy.’
BMA’s advice can be found here . If your practice is facing any pressure or has received any threatening letters from NHSPS please contact the LMC immediately.
Kent LMC works closely with other NHS organisations to represent the interests of GP practices. We are working with Kent and Medway STP to represent the issues faced by General Practice. It is vital that any future models of care do not increase workload on GPs and any new work comes with adequate resources and funding.
We recently started liaison meetings with IC24 who provide OOH GP and 111 services in parts of Kent. They have agreed to set up a dedicated email for GPs to report any concerns. You can find the details of this in the newsletter here . You can also find newsletters from the various liaison meetings with other providers, CCGs and LMC meetings here .
Sessional GPs Conference
Kent LMC Sessional Conference will be held on 24th May 2018. Our keynote speaker is Zoe Norris, Sessional Chair of the GPC, and we will be covering topics such as starting out as a locum, pros and cons of partnerships, sessional working, portfolio careers and pensions.
This conference is open to all sessional GPs and trainees There are very few spaces now left for this FREE conference and registration is open on Kent LMC website .
Kent LMC is here to work for General Practice but to do this effectively we need your help. Please let us know if you have any concerns or queries and give us feedback on what we do well and what we can do better.
If you are a Kent GP and would like to attend a LMC meeting as an observer, please contact us at firstname.lastname@example.org and we would be happy to arrange this.
Dr G Gupta