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Somerset LMC Weekly Update Friday July 20th July 2018

Date sent: Friday 20 July 2018

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

Think Measles! Public Health consultant Alison Bell tells us that since January there have been 104 confirmed and 38 probable cases in the South West North area (Gloucestershire, Bristol, South Gloucestershire, North Somerset and BANES.) We are also aware of a confirmed case in Minehead. Eight have been admitted to hospital and four have required critical care following complications including measles pneumonitis and encephalitis. Many more have attended practices and A&Es for acute treatment and unfortunately measles cannot always be recognised promptly. This has resulted in secondary transmission to other patients and staff, with consequent risks to those affected and extra work for practitioners in following up and managing the treatment and care of vulnerable and susceptible individuals (including urgent provision of immunoglobulin and vaccination). The advice is to:

Maximise all opportunities to ensure children and young adults (especially 16-29) are fully immunised with two doses of MMR.

Ensure isolation of any possible cases - those reporting a rash and a fever should be isolated away from communal waiting areas to protect other patients and staff and seen promptly as possible – transmission only requires 15 minutes contact.

Consider all potential diagnoses – there is currently an increase in scarlet fever, measles and parvovirus within this area so consider appropriate investigations to enable differential diagnosis but don’t assume it isn’t measles.

Protect yourself and your staff – please make sure all healthcare and receptionist staff are protected against measles with two doses of MMR vaccine and ensure they are revaccinated if there is uncertainty. Unvaccinated staff (or those without proof of vaccination/immunity) will be prevented from working by PHE for three weeks after a confirmed contact. The so-called “over 50 rule” which used to assume all older people would have had wild measles as child no longer applies. Exposures in healthcare settings have led to measles in HCPs with proven transmission to vulnerable contacts.

Display and use the leaflets and posters (below) to promote MMR vaccination and to raise awareness of measles.

Notify all cases of suspected measles, including out of hours, to Public Health England South West, call 0300 303 8162 (select option 1, followed by option 1).

Exclusion – please ensure that all suspected cases of measles are given advice (as soon as suspected symptoms start) to exclude themselves from school, nursery, or work, or any activities which bring them into contact with large groups of people or susceptible individuals, for at least five days after the onset of rash.

Vaccination of patients aged 16 and over is claimable under the enhanced primary care service for MMR. The LMC (with the CCG) believes that, with best practice in mind, practices should review SOPs and record what training they have given staff to deal with a potential measles case making contact or attending the practice. Practices will have existing policies which can be adapted to include measles if not already covered so this need not be onerous. NHS Choices has useful “revision” guidance   to which patients and carers can be directed. The Care Quality Commission has published a helpful guide on immunisation of healthcare staff for primary care: 

General Leaflet

Leaflet for young People

Poster Young People

Don't let your child catch it flyer

Somerset GP Board Fit for my future: The Board discussed this document produced by the CCG which has been presented by them at the two recent member’s meetings, and which asks specific questions about how services should be delivered in the future (link). It is important that as many practices and individuals complete the survey as possible so their views can be reflected. The SGPB will also be sending a formal response.

We discussed our proposals for the allocation of Transformation Funding across the county. We have been in discussion with the CCG who have indicated broad support for our approach. After further discussion we altered some aspects slightly to further strengthen the proposals. The funding does not flow directly to practices, and there is a national mandate as to how the money can be spent, but very broadly our proposals fall into six ‘transformative’ sections (with an additional clinical component that could be discussed at neighbourhood level). These are: 1. Create New Working Arrangements, possibly using the Primary Care Home (PCH) model and develop local clinical leadership, 2. Implementation of the Ten High Impact actions, 3. Support for the further development of Somerset Primary Healthcare Ltd. (we are proposing that funding could flow through SPH), 4. Funding for a ‘Service Improvement Function’ to support supportive practice visits by a GP/practice manager, 5. Support for GPs to work in new multidisciplinary teams, and 6. Creating a strong GP Provider voice. The clinical component we feel would be helpful in seeding the collaborative work, and would suggest that localities/neighbourhoods pick from a list of effective/achievable schemes. The funding would be to set these up, rather than to pay clinical staff.

We also discussed the future funding arrangements for the Board, along with the necessary secretarial and administrative support, and how the function of the board might develop in the future.

We also heard from one of our acute trust representatives about plans to place medical students in practices in the next few years when there is expected to be a considerable expansion in medical student numbers. The intention is for them to experience Primary Care from the start of the course, and it is hoped that a wide variety of practices will wish to host students. More details will be distributed when we have them. The next SGPB meeting will be held on August 15th.

Low dose Aspirin for pregnant women ar high risk of Pre-Eclampsia You will have seen the reminder that came from the CCG Medicines Management Directorate about NICE guidance after a Child Death Overview Panel reported on a premature infant’s death that had been “possibly preventable” if the mother had been prescribed aspirin 75mg from 12 weeks as her midwife requested. This led to debate at the LMC and comment from practices. Discussions with the CCG, a member of the Panel and the BMA GPC have led to the following conclusions: despite the use of the phrase “refused to prescribe” in the report there was no intention of it being pejorative (official reports use official language) nor should there be any inference of simple cause and effect; low dose aspirin can be purchased OTC but pharmacists are not allowed to sell it if the patient is pregnant; reducing the risk of pre-eclampsia is not a “minor, self-limiting condition” and so does not come under the CCG’s policy on not prescribing drugs that can be purchased OTC (interestingly, neither is IHD); the use of low dose aspirin in this situation may be unlicensed but it is now recognised by a body of clinical opinion including, as we have seen, NICE; although some areas are advanced in allowing midwifery teams to prescribe under PGDs (Greater Manchester) in others attempts have not been successful (Bristol). Finally, although the proper commissioning of a specialist service would be ideal, senior GPC advice (Clinical & Prescribing Policy Lead) is that providing such prescriptions is probably expected under the terms of GP Medical Maternity Services.

Yeovil Hospital urgent ophthalmology referrals From Wednesday 1 August they will no longer be using the fax within the department and would request that the following email address is used


The telephone triage number will stay the same – this is just replacing the facilities of the Fax as in line with national requirements from NHS England.

The Potentially Avoidable Appointment Audit tool NHS England has launched the new fully automated Potentially Avoidable Appointment Audit tool, which is free for all practices in England. The audit is a simple tool for reviewing workload within practices and exploring how things might be managed differently in the future. So far, more than 1,000 GPs across 400 practices have audited their appointments. All practices can register for the audit by going to . To find out more about why practices are using the audit, results so far, changes they have made, and case studies, see here.


Kind Regards


Jill Hellens

Executive Director

Somerset LMC

TEL: 01823 331428

Fax:01823 338561

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