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Somerset LMC weekly Update Friday 18th May 2018

Date sent: Friday 18 May 2018

All Somerset GPs and Practice Managers  This and previous updates can be found here

A cup of tea and biscuit needed, its a long one this week, we have tried to reduce and include as many links as possible

Somerset GP Board met at Summervale Surgery in Ilminster on Wednesday, 16th May. Devon Doctors, who are the interim Out of Hours provider met with the board at the start of the meeting to discuss engagement with local practices. In the meeting itself we discussed the need for wider representation on the board, especially with the demands for GP representation on multiple workstreams arising from the Clinical Strategy Review. In light of this we asked the new LMC Committee yesterday how we can strengthen links with constituencies and engage in “locality development”. We heard reports from board members who had attended meetings looking to support community services (rapid response service, complex care, and better support for nursing homes, amongst others). We discussed papers summarising the SGPB views on use of the transformation funding, and also GP working at scale, including possible options that might work in Somerset. The papers, tweaked following the board discussion, will be forwarded to the CCG as the SGPB position, and will be shared with practices next week

The Early Help Form again - after last week’s bulletin we have been contacted by the CCG Safeguarding Team to remind colleagues of the need to escalate to children’s social care when use of the EHA form as a child protection / Tier 4 referral form has impacted on attempts to safeguard a child in a timely way. Here is the link to the resolving professional differences (RPD) protocol which is owned by the Safeguarding Children Board: The RPD form should be sent direct to Claire Winter as the lead for the agency being challenged. It must also be copied into the Safeguarding Children Board as they then request feedback from the challenged agency on how they have addressed the concerns. Please copy in the CCG’s Safeguarding Children Team as they can then take evidence of the impact to the Safeguarding Children Board’s Health Advisory Group.

The CCG’s safeguarding children team is always happy to talk through any early help or safeguarding concerns with primary care staff. The website and most up to date contact list is here : Finally a reminder of the GP consultation line run by children’s social care: 0300 123 3078.

Revised MenB PGD Template - this is an early revision in order to align with the recommendations for the prevention of secondary cases of MenB disease in the Guidance for public health management of meningococcal disease.  This and other PGDs are available on the SGPET PGD notice board

Transgender Flow chart we receive many queries regarding the process of medical records for Transgender patients, our thanks to the County Practice manager groups, Millbrook surgery, and Dr Barry Moyse for designing this flowchart which we hope will clarify the process, please also find a Transgender cross programme screening leaflet, both are available on the LMC website 

GPDR Updates further documents have been added to Paul Cundy's GDPR Blog dropbox ,  a new blog on SARs, a Mythbusters blog and a SARs form, we are awaiting the GP pack from the GPC as soon as we receive this we will circulate.

Somerset Treatment Escalation Plan (STEP) – you will have seen this mentioned in the CCG bulletin earlier this week. The LMC supports the STEP as a useful step forward towards something which will actually be useful for patient care, especially when it is shared with other agencies including OOH. It is flexible offering stages of intervention rather than an all or nothing approach, considers mental capacity (with guidance provided) and also incorporates a DNAR. It is important to realise that this does not mean that other TEPs or DNAR forms are suddenly redundant: it is clear that these should be replaced by natural wastage so resist any calls to go to your local care home to complete 17 new ones. We are also grateful to the CCG for stating that “[although discharge from hospital can be a useful point for further thought on what is suitable…reviewing the TEP does not necessarily mean visiting the patient or being obliged to revise it. It may well be that all is required is to see what has been decided previously and if all seems appropriate, recording it in the notes and communicating that to carers.” The CCG is also interested in hearing about suggestions for further improvements with a link on the form for this purpose.

Somerset Coroner Part A Letter Somerset coroners office has asked the LMC to circulate a Part A letter    which they would like practices to use with immediate effect, we would  advise practices that it is acceptable to include a summary print out for the brief summary request in the letter , although you may wish to add a sentence to the record for this purpose.

Working at scale webinar for those who could not join the live GPC webinar the recording is now available here

and finally!

Top Tips...

Frequently asked questions for SPQS

Do patients under 16 need to be checked for orthostatic hypotension if they have had falls?

This needs to be largely influenced by clinical judgement, as encouraged in the specification. Whilst under 16s are not excluded, there is no expectation to check a child/young person’s BP every time a fall has occurred. If there has been or was a series of recurrent falls or abnormality we would encourage the discretion of clinical judgement to determine whether the individual requires further investigation.

Can we only look back 2 years for falls codes not forever?

As long as ‘falls’ codes entered prior to 2 years ago and are still coded as ‘active’ problems are picked up along with any new codes (active or inactive) entered in the last 2 years then ‘looking back over 2 years’ is considered to be reasonable.

Can the practice use Qfracture rather than Frax or Frat as stated in the Spec?

It is acknowledged that QFracture is an accurate and well validated clinical risk assessment tool and is of comparable quality to FRAX (

There is however concern that QFracture auto-populates data from EMIS which may lead to calculation of a patient’s fracture risk based on incomplete/out of date clinical information if this has either not been coded, has been coded inaccurately, or has not been reviewed for some time.

The use of QFracture is acceptable on the basis that robust controls are in place to validate the EMIS data automatically extracted.

This has been confirmed by the CCG.


Kind Regards


Jill Hellens

Executive Director

Somerset LMC

TEL: 01823 331428

Fax:01823 338561

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