MARCH 2021
NEWSLETTER
10, Westgate House, Westgate Business Park, The island, Westgate Street, Gloucester GL1 2RU Tel: 01452 310706 Fax: 01452 386503
Our website: http://www.gloslmc.com Twitter: @Glos LMC
Dr Tom Yerburgh – LMC Chairman Dr Penelope West – Medical Secretary [email protected] [email protected] Mrs Elizabeth Barstow- Office Administrator
[email protected] Mrs Lesley Mansfield-Office Administrator
LOCKDOWN RESTRICTIONS LOOSENING (ENGLAND)
Ahead of the announcement by the Prime Minister last week of a four-step end to the lockdown in England, the BMA published a paper setting out the principles and policy ideas which it believes should inform a sensible and safety-first approach to easing the current lockdown. The BMA warned the Government to take ‘cautious approach’ to lifting lockdown restrictions as otherwise the NHS will be overwhelmed. Easing restrictions must be connected with measurable metrics and targets on virus circulation. Read more here Although England is still in a national lockdown, as of 8 March, some of the rules will be changing, such as all pupils returning to school. More details can be found in the Government’s COVID-19 Response - Spring 2021, which sets out the roadmap out of the current lockdown and explains how the restrictions will be lifted over time. Read the BMA’s response to the PM’s announcement here
CONTRACT UPDATES 2021/22 (ENGLAND)
Here are the updates to the 2021/22 contract.
COVID-19 VACCINATION PROGRAMME (ENGLAND)
NHSE/I has sent a letter setting out the additional steps being taken to support the vaccination of cohort 6 - adult carers and individuals added to the shielded patient list - as a result of the COVID-19 Population Risk Assessment tool (QCovid). The letter also includes information on the availability of the national booking system for these groups.
This follows the letters to people identified as high risk by COVID-19 Population Risk Assessment Model – under 70 years of age which was sent out last week. We have since raised concerns with the Department of Health and Social Care about the impact this letter has had on some patients who have subsequently contacted their practice seeking more information. Although the letter clearly states, on our insistence, that patients do not need to contact their GP about the letter, many anxious patients are still clearly doing so, so we have asked whether modifications can be made to any future letters sent. A- 1
COVID-19 Clinical Risk Assessment Tool (QCovid) A new online tool that can help clinicians better understand how at-risk a person may be of admission to hospital or dying as a result of being infected with coronavirus is now available. The COVID-19 Clinical Risk Assessment Tool is powered by QCovid®, a coronavirus risk prediction model created by the University of Oxford.
Clinicians can use the tool to risk assess individual patients or review those added to the Shielded Patient List (SPL) as part of the COVID-19 Population Risk Assessment. There is though no requirement or expectation for practices to validate the latest update to the shielding list following the application of the QCovid tool. There are some instructions for individuals and organisations to follow before using the tool, including the requirement for a Data Protection Impact Assessment (DPIA) and privacy notice in place that covers the tool’s use. A template DPIA and privacy notice have been provided to support you to do this. This may be creating onerous work for practices, and the LMC office would like to hear from you if that is the case. Following concerns about the inclusion of some codes relating to gestational diabetes, NHS Digital has published specific guidance on gestational diabetes on their COVID-19 Population Risk Assessment page. This page also has a lot of detail about the development of the risk assessment tool and it has information about how patients can get more information if the page does not answer their questions (email [email protected]). The RCGP has also developed a flow chart to support GPs when considering risk for patients with a history of gestational diabetes.
Vaccinating people with a learning disability As we know, multimorbidity is very common for those with a learning disability and we would therefore encourage all practices to contact all people on their learning disability practice register and offer an early appointment for vaccination.
Vaccinating people with Severe Mental Illness (SMI) As people with SMI people face reduced life expectancy of 15-20 years when compared to the general population and have also been disproportionately impacted by the coronavirus pandemic, this group is also included in cohort 6 prioritisation list. Note that the Green Book defines SMI as schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment, and also includes people with an eating disorder and those with a diagnosis of ‘personality disorder’.
Tailored invitation letters for local vaccination sites to invite these groups are available on the FutureNHS platform.
Vaccination patients who are HIV positive People living with HIV, at all stages of infection, should be offered the vaccination due to the associated immunosuppression, and are as such part of cohort 6. Most of these patients will be invited for vaccination by their GP, however, for the small proportion who has declined sharing their HIV status with their GP, HIV clinics should encourage and support these patients to share their HIV status with their GP.
Vaccinating those aged under 18 As the AstraZeneca (AZ) vaccine is not licensed for use in those under the age of 18 – if any young staff members or volunteers (aged 16-17) present to a vaccination centre for vaccination, they should be referred to their GP or local hospital hub where they can access the Pfizer vaccine which is authorised for this age group. If the Pfizer vaccine is unavailable, JCVI have recommended that the AZ vaccine can be used as an alternative in those aged 16-17 years. This is outside the license and must therefore be done under a PSD and cannot be done under a PGD or National Protocol.
Vaccination cohort 5 Patients in cohort 5 (people aged 65 and over) have received a letter from the national booking system stating that they are now eligible for vaccination, with information about A- 2
how to book into a mass vaccination site or a pharmacy. The letter also states that if the patient wishes to be vaccinated by their GP then they should wait to be contacted by their practice. Practices, however, have been told to prioritise patients in cohort 6.
To be clear, if practices vaccinate anyone in cohort 5, they will receive payment. However, the priority for practices should be those in cohort 6, which is a much bigger group, but once practices are in an appropriate position having completed cohort 6, they could contact patients in cohort 5 to invite them for their vaccination if they have not already received it. In order to manage patient expectations and to prevent additional patient enquiries, practices may wish to contact their patients in cohort 5 to inform them that they will be contacting them in the near future to give them the opportunity to receive their vaccination locally if that is their preference.
We expect people in cohort 7 to shortly receive similar letters, and the same points with respect to cohort 5 apply to 7.
NHSE/I has published a letter on Supporting CCGs to address vaccine inequalities, which describes further action to enable and locally deliver community activity and engagement to support COVID-19 vaccination access and uptake, building on the vaccine uptake strategy.
NHSE/I has also published guidance on Further opportunities for PCN and Community Pharmacy vaccination sites to partner with community venues to deliver temporary vaccination clinics.
Read the BMA guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Vaccination of frontline health and social care workers Protecting frontline health and social care workers from COVID-19 remains a priority, something that the BMA has been lobbying on, and NHSE/I has written to commissioners this week asking for reassurance that the offer of a vaccination frontline health and social care workers, as priority cohorts, has been fulfilled.
Practices are encouraged to liaise with local system partners to ensure that any staff who have not yet been offered a vaccine are offered one, including any locum GPs they are in regular contact with, as soon as practically possible.
Transport of Astra Zeneca vaccine to GP practices within the PCN Grouping The NHSE/I has confirmed that the SPS SOP (Standard Operating Procedure) has been updated to make clear that the Astra Zeneca COVID-19 vaccine does not need to be used immediately after being transported within the PCN grouping. The SOP states:
1.1.2. The vaccine should be used as soon as it is received or immediately put in a refrigerator to be administered as soon as possible thereafter. This has been defined as meaning within 24 hours or over the following days.
Freeing up practices to support COVID-19 vaccination NHSE/I has written to practices and commissioners providing further measures on freeing up practices to support COVID-19 vaccinations, following their letter of 7 January 2021. The letter sets out the arrangements for additional funding for PCN clinical directors, and income protection arrangements for the Minor Surgery DES and QOF (Quality and Outcomes Framework).
Vaccine hesitancy Surveys have shown stark differences by ethnic group in attitudes to COVID vaccines, and a quarter of younger women fear it would affect fertility. The BMA has published guidance and resources on how to communicate with different groups about the vaccine. A- 3
The British Fertility Society and Association of Reproductive and Clinical Scientists has also published some COVID-19 Vaccines FAQs to help address some of the vaccine hesitancy relating to fertility.
STUDIES ON COVID-19 VACCINE EFFICACY
Three new studies about COVID-19 vaccine efficacy have been published, as summarised below:
EAVE II Study (Pfizer and Oxford/AstraZeneca vaccines) The EAVE II study looked at the efficacy of the single dose regimen of both the Pfizer and the Oxford/AstraZeneca vaccines at reducing hospitalisations from COVID-19 over a number of timeframes, post vaccination. Hospitalisations are defined as an individual who is hospitalised with COVID-19 as the principle reason for hospitalisation within 28 days of a positive PCR test. The paper found that the vaccines have an 85% (Pfzier) and a 94% (Oxford/AZ) efficacy at reducing hospitalisations after one dose, respectively – although this varied over different time periods post-vaccination.
PHE monitoring of the early impact and effectiveness of COVID-19 vaccination (Pfizer) in England Public Health England has published their initial findings from the rollout of the Pfizer COVID-19 vaccine, assessing the impact the vaccine has had on across relevant metrics such as infection, hospitalisations and deaths. For over 80s one dose of the Pfizer vaccine is 57% effective at reducing incidence of symptomatic COVID-19, and this rises to 88% after two doses. It also showed that mortality was reduced by just over 50% if the patients became infected. When cases do occur among elderly groups, vaccinated over 80s are half as likely to die or be hospitalised from COVID-19 as their unvaccinated counterparts.
PHE SIREN study of efficacy rate of Pfizer vaccine among healthcare workers Public Health England has also published the SIREN study which looks at efficacy rate of the Pfzier vaccine at preventing both symptomatic and asymptomatic COVID-19 among healthcare workers under 65 years of age.
The study found that effectiveness against infection was 70% after one dose which rose to 85% after two doses. However, partially vaccinated patients who can still get COVID (the 30%) are more likely to produce vaccine resistant variants and there is still significant risk of nosocomial infection with the doctors acting as vectors.
These are encouraging findings as this is among the first real world data that suggests the vaccine will likely reduce onward transmission.
UPDATE BMA COVID RISK ASSESSMENT TOOL
The BMA has updated the risk assessment tool (PDF). This can help you to quantify your biological risk and should be used to facilitate your work-based risk assessment. It does not replace the need for a comprehensive risk assessment that employers must undertake in addressing the risks posed by COVID-19. Read our full guidance >
ANNUAL ALLOWANCE REPAYMENT SCHEME 2019/20 (ENGLAND AND WALES)
The annual allowance repayment scheme, which was introduced in England and Wales following BMA lobbying, guarantees that any annual allowance tax charge for eligible clinicians will be compensated for at the time of retirement. Under the scheme, if an eligible clinician who is a member of the NHS England and Wales pension scheme incurs an annual allowance tax charge, they must elect to pay this through scheme pays - and you must not pay this tax bill using cash.
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GPs retiring by 31 March 2021 who are eligible to apply for the 2019/20 Pensions Annual Allowance Charge Compensation Policy can submit their application form via PCSE until 21 March 2021. Application windows for other GPs will open after the mandatory scheme pays election deadline for 2019/20 closes on 31 July 2021. To qualify for the policy, you must first submit a scheme pays election (SPE2) form for 2019/20 to NHSBSA.
Find details about how the scheme and how to apply >
MEDICINE DELIVERY SERVICE
Following the announcement last week for Clinically Extremely Vulnerable (CEV) patients to continue to self-isolate, NHSE/I will continue to commission the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service until 31 March 2021.
NHSE/I has sent a letter to Dispensing Doctors and community pharmacies setting out the details. The Service Specification has also been updated to make it more generic so that it can be applied in other situations moving forwards e.g. if a therapeutic agent for Covid suitable for supply in Primary Care is identified. Read more on the NHSE/I webpage for community pharmacy
VACCINE DOSE DATE (UK AND ENGLAND)
Over 13,5 million people in the UK have received their first dose, and almost 525,000 have received their second dose. The latest data report show that as of 12 February a total of 12,3 million doses in total have been given in England.
In the 10 weeks since vaccinations against coronavirus began in the UK, a first dose has been given to more than 11.8 million people in England, more than 715,900 people in Wales, more than 1.1 million in Scotland and more than 373,400 in Northern Ireland. This is an incredible achievement and thank you to all those that have made this possible.
GOVERNMENT WHITE PAPER ON NHS REFORM AND INTEGRATED CARE SYSTEMS (ENGLAND)
The Government has now published ‘Integration and Innovation: working together to improve health and social care for all' – its white paper on new plans to reform the NHS, including proposals to make ICSs statutory and make major changes to way services are procured. Chaand Nagpaul, Chair of BMA council, has released a strong statement on the white paper, stressing the need for clinicians to be at the heart of any changes. The BMA will be producing a summary of the white paper for members shortly. In January, the BMA submitted a comprehensive response to NHS England’s legislative proposals, on which the Government’s plans have been based, highlighting the importance of ensuring proper clinical, GP, and LMC representation. The proposals set out that GPs will be one of the few required members of the ICS leadership, and that there will be a lot of flexibility around how place level (former CCG) working is organised and works, so there is a key role for LMCs to engage in that to help shape it.
ASSESSMENTS CARRIED OUT FOR DETENTION UNDER THE MENTAL HEALTH ACT TO TAKE PLACE IN PERSON (ENGLAND)
Following a ruling in case bought by Devon Partnership NHS Trust against the Secretary of State, NHS England has issued directions to all mental health providers not to carry out any assessments for the purposes of determining whether or not an individual should be detained under the act remotely (by any medium). This applies to all members of a medical team involved in the decision and should be considered as the overriding guidance until further notice. This was reported by the Guardian
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AMENDMENTS TO EUROPEAN HEALTH INSURANCE CARDS (EHICs) AND S1 FORMS (UK) REGULATIONS
There have been some minor amendments to the GMS and PMS regulations relating to European Health Insurance Cards (EHICs) and S1 forms, to allow for reciprocal healthcare arrangements with EU member states.
The change has been made via the Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020 which support the process of EU exit. The amendments are within the contract regulations that govern information relating to overseas visitors (GMS regulation 74F and PMS regulation 67F) – where, if patients choose to provide EHIC, S1 or PRC details on registration, then GPs must forward those details to NHS Digital or NHS BSA.
The new wording allows for the possibility that, on registration, patients may in future submit other (unnamed) documents which are equivalent to EHICs or S1s, which could be required as part of a “listed healthcare arrangement” between the UK and an EU/EEA country (or the EU). However, at present, the UK government has not agreed any listed healthcare arrangements which establish EHIC or S1 equivalent documents, so for now there is no possibility of patients submitting them.
COVID-19 MEDIA
Vaccine passports The Daily Mail reported on the suggestion that the vaccine minister Nadhim Zahawi said that GPs should provide COVID-19 vaccine certificates to travellers, to which Dr Vautrey commented: “Practices are working flat out successfully delivering the Covid vaccination programme while continuing to provide non-Covid care to many other patients. To prioritise this vital work, we need a reduction in bureaucracy and admin tasks – including writing letters, which practices can charge for as this work is not funded by the NHS. It would far better if all patients had easy access to their vaccination history electronically, so that they are able to provide evidence of this without needing to request a letter from their surgery.”
Dr Richard Vautrey told the Telegraph that the UK should set up an internationally- recognised system enabling people to have access to their own vaccination records, and told BBC Radio 4’s World at One that it was untenable for GPs to administer vaccine passports. “We need to enable people who have been vaccinated to have access to the information about that. What we don’t want is millions of people contacting their GPs for a letter outlining that. It’s so much easier if we can empower patients to do this themselves. It’s possible through apps – the NHS app can be configured to enable patients to see elements of their record including their vaccination status and that should be sufficient. What we need is a national or an international recognised system. But we need to avoid the need for large numbers of requests from letters from GPs because that simply isn’t tenable.”
CANCARD
Some concerns have been raised by practices about the Cancard UK website and its proposed ‘GP endorsed’ ID card. The website offers the ability to apply for: ‘‘A holographic photo ID card. Designed in collaboration with GPs and verified at the patient’s surgery. The card is for people who qualify for a legal prescription but are unable to afford one.”
Applications are said to have opened on 1 November 2020. The Medicinal Cannabis holographic photo ID card is being offered by Cancard UK to patients who meet the following criteria: Have a diagnosis (confirmed by their GP) that is currently being prescribed for privately.
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Have tried two types of prescription medication or have discussed and discounted these options based on side effect profile or dependence concerns. Are unable to afford a private prescription. Are required to be in possession of a small amount of Cannabis in order to manage their symptoms. Are at risk of criminalisation.
The BMA and RCGP supports the use of ‘cannabis-based products for medicinal use in humans’ under the supervision of specialist clinicians or prescription of MHRA authorised licenced products by doctors who have the necessary clinical experience and competences. These products must have been produced in accordance with the necessary standards for the production of medicinal products in the UK in order to ensure their safety and authenticity. We also support the call for further research into the safety and potential indications for use of these medical products. The BMA and RCGP cannot however support the use of the Cancard, nor the suggestion that UK registered GPs sign a declaration confirming a diagnosis in order for the card to be issued. The Cancard UK website states that the Cancard has been designed in collaboration with GPs, but neither the RCGP nor BMA were formally consulted or gave endorsement. The BMA and RCGP cannot support the use of Cancard, nor the suggestion that UK registered GPs sign a declaration confirming a diagnosis in order for the card to be issued. Read the BMA guidance on cannabis-based medicinal products here
INAPPROPRIATE WORKLOAD
Covid has changed how everyone works, with primary care and secondary care doing more virtual work. Whilst we sympathise with the pressures of our colleagues in secondary care, it is not possible or appropriate simply to transfer administrative tasks to GPs. General practice is working at 150% capacity compared to last year. It may help practices to know that the BMA has produced a pack of template letters to use when you wish to push back on inappropriate workload. You do not have to be a BMA member to access the resource, and can find it here
PENSIONS NEWSLETTER
The BMA’s pension committee has been at the forefront of fighting to maximise your pension benefits. Please see the first quarterly newsletter here. The newsletter provides an update you on what actions the committee is taking on a range of issues, and also provides access to educational resources, blogs and information on how to access BMA support regarding your pension.
SESSIONAL GP ISSUES
NHS mail for sessional GPs has been rolled out, recognising the important contribution of locum GPs to the workforce. GP locums can apply here.
Doctors who move from partnership/salaried roles to locum sometimes have difficulty transferring their NHS e mail address to locum status. If you are stuck with this, contact [email protected] and [email protected] who will help you sort it out.
The NHS pension scheme as a sessional GP Dr Krishan Aggarwal, a GPC England and Sessional GPs Committee member, and deputy chair of the BMA Pensions Committee, has written a webpage for sessional and locum GPs on the NHS pension scheme, which replaces
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his previous blogs on this issue. The webpage is going to be a live document and if there is anything you would like to be covered please email the BMA at [email protected] The guidance sets out which pension tier to use, submitting the right forms, annualisation, the total rewards statement (TRS), the upcoming PCSE portal and how to escalate complaints to PCSE. The webpage is here
SAFE HOUSE
GP Safe House (GPSH) is a virtual safe house providing a refuge and support for practitioners experiencing professional challenges. It guarantees anonymity, security and confidentiality and understands that these are essential. GPSH has five virtual rooms which offer support, information and resources. Each room corresponds to a different potential problem area. It has recently received a makeover/update from Somerset LMC who devised it. Services available are: Consulting Room - Personal Health Information for the Gloucestershire Area Burnout Recovery Suite - Burnout and Stress Professional Relationships Bureau - Working Relationship Problems Library of Solutions - Non-clinical Aspects of Patient Care Career Development Office - Professional Development Contacts for Support and Advice - This is a link to the Gloucestershire LMC Advocate Area which offers the possibility of a personal, completely anonymous, one-to-one, online consultation with a professional advisor as well as more everyday modes of communication! If you have misplaced or never received a password and would like one, please contact the office. The LMC pastoral care support continues. If any GP would like LMC support, but would prefer to ask someone other than their area Rep, please contact the office. Also, please find below a link to the ‘Supporting GPs Mental Health and Well-Being’ page on the Training Hub Primary Care Workforce Centre website which has been set up to provide GPs with information and links to the resources currently available to provide support. Read it here. Dr Ansell Consultant Psychiatrist recommends the covid resilience hub.
NOTES FROM THE PAG
When a complaint about a GP is made to NHS England, a referral is automatically triggered to the Performance Advisory Group (PAG.) We sometimes glean learning points to share. 1. Doctors are advised not to order investigations, interpret results, or prescribe for themselves or family members. Initial good intentions can lead to a dangerous place. The GMC has recently updated their ethical guidance on good prescribing, which comes into effect on 5th April 2021.
OTHER COVID 19 RESOURCES
BMJ – news and resources
RCGP COVID-19 information
NHSE/I daily primary care bulletins on COVID-19
COVID-19 Google Drive resource
NICE resources on COVID-19
A PENNY FOR YOUR THOUGHTS
A hundred years ago, on March 3 1921, a doctor and his student assistant announced the discovery of insulin. However, both were under the directorship of a third party at the A- 8
University of Toronto. Two of the three shared the Nobel Prize for medicine in 1923. Clinicians and scientists have been squabbling ever since, and let’s not even start on the subject of QOF.
Send the name of the pair who shared the Nobel Prize to [email protected] by 20th March 2021 to be entered into the draw. The prize will be a £10 donation to a charity chosen by the winner, who will retain the bragging rights.
Congratulations to Dr Nicola Pockett, winner of the February competition. A donation was made to the charity ‘Steps Worldwide’
The answer was, I believe, Dr Edward Jenner, who formed the breakaway ‘Fleece Society’ when he found himself ostracised by another organisation due to his barmy enthusiasm for vaccination. Thanks to Jasmine Dargan, who pointed out that Dr John Heathfield Hicks of Gloucester is listed first on the records of one of the meetings of ‘The Fleece Society’. For that reason, anyone who answered ‘Jenner’ or ‘Heathfield Hicks’ was included in the draw.
The LMC will continue to run with a mixture of office and home working. Some of our meetings will be by skype, Zoom or telephone. Dr Penelope West’s mobile number is 07415290140 if that is useful.
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JOB OPPORTUNITIES A full list of current job adverts is at http://www.gloslmc.com/blog-job- vacancies.asp and available below.
GLOUCESTERSHIRE Date posted Closing Date Partners in Health Gloucester Salaried GP Partner 30 Sept 20 Open with view to extend Acorn Practice Durlsey GP Partner 11 Dec 20 Open
Phoenix Health Group Tetbury Salaried GP (Part Time 16 Dec 20 Open or Job Share) Cleevelands Medical Centre Cheltenham Salaried GP (with a 16 Dec 20 Open view to Partnership) Beeches Green Surgery Gloucester GP Partner 22 Jan 21 05 March 21
The Brunston Coleford Salaried GP 10 Feb 21 Open and Lydbrook Practice The Lydney Practice Gloucestershire Practice Manager 17 Feb 21 11 Mar 21
ELSEWHERE Newbury Street Practice Wantage Salaried GP 27 Jan 21 08 Mar 21 Vauxhall Surgery Chepstow Salaried GP (Maternity 12 Feb 21 31 Mar 21 Cover) Ledbury Health Partnership Herefordshire Salaried GP 12 Feb 21 Open
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