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Somerset LMC Weekly Update Friday 21st September

Date sent: Friday 21 September 2018

Sent to all Somerset GPs and Practice Managers          This and previous updates are available here

Influenza Vaccine Payment Clawback: In letters from NHSE in Oct 17 and Feb this year we were told that the Joint Committee on Vaccinations & Immunisation (JCVI) had judged that adjuvanted trivalent inactivated flu vaccine (aTIV, Fluad®: Seqirus) to be the only licensed cost-effective option for 65s and over and that the quadrivalent inactivated vaccine (QIV) was the best option for 18-65s in at-risk groups. NHSE said “use of these most effective vaccines in the 2018/19 season was clearly in the best interests of patients” and reflected this in the National Directed Enhanced Service specification. We know of concerns about the supply of aTIV but BMA GPC chair Dr Richard Vautrey told Pulse: “Provision of QIV to over-65s is an option of last resort and should only be offered…when aTIV is not available and is highly unlikely to become available locally…[H]e warned that practices ‘found to have inappropriately provided the incorrect vaccine’ will have their payments recovered…” NHS England confirmed that GP practices can be reimbursed for administering QIV after first making attempts to direct patients over 65 to other providers. But it added that practices seeking reimbursement for the use of vaccines other than according to the NES specification will be asked to prove that their decision ‘was an exercise of reasonable care and skill as required by the GMS/PMS contracts.’ The LMC recognises that those turned away because the right vaccine is not available may not come back when it is. We therefore strongly advise practices to follow these directions and to explain to patients and carefully record any “last resort” variation that may be necessary.

Primary Care Support England (PCSE) Pensions Review: NHS England have sent the attached letter to practices regarding their sample review of pension scheme records, which has shown discrepancies between some of the pensionable earnings and contributions data which has been provided to NHS BSA. They are now going to carry out a larger review, focusing on those nearing retirement age, to identify and resolve these issues. Richard Vautrey chairman of GPC said that GPs, who pay their contributions into the NHS Pensions Scheme in good faith and use these to plan for the future, will understandably be very concerned to learn that they may have been affected by this administration error. Although NHS England have reassured the GPC that they will deal with this problem, this is yet another issue that GPs and practices have to contend with and we have insisted that NHS England needs to ensure that hard-working family doctors are not negatively affected by what appears to be a longstanding error. If, as part of this review, GPs are asked for additional financial advice the GPC have said that it is imperative that they are reimbursed for any expenses incurred through no fault of their own.

Supply of Adrenaline Auto-injectors: The Department of Health & Social Care has been in urgent discussions with the supplier but, despite this, Epipen Junior is now out of stock. The MHRA is being consulted to see if the expiry dates can be extended. We have been asked to share this message widely to ensure that available supplies are prioritised for those who need them most. “To support patient access to the product during this supply constraint, healthcare professionals are encouraged to manage prescription renewals diligently. It is important to note that when validating the expiry date of an adrenaline auto-injector, the product expires on the last day of the month indicated.” Shaun Green (Associate Director Head of Medicines Management and Clinical Effectiveness) adds, “We are aware that many patients have prescriptions for multiple pens to keep in different locations, we would advise that wherever possible the numbers of pens is reduced and patients are advised to carry the pen with them.”

Transformation: making quality care easier: The one constant in the NHS is change. You may have noticed this and so be inclined to shrug, think, “So what? Not another once-in-a-lifetime chance to save the NHS. Nothing ever happens. This job will see me out.” Neighbourhoods of 30-50,000 are being formed with primary care at their hearts. Practices are working together, practices are merging, introducing new models of care, or working with hospital trusts as never before. We think that things really are different this time and so urge you to attend. The plan is to make doing the right thing for our patients easier and make our working lives as GPs and those of our teams better at the same time.

Impossible? Come on Tuesday 13th November and find out. Book Online

Update on VAT Query from NHSE: we have now received further correspondence from the GPC on the query that NHSE have been asking practices regarding VAT, It is their view under the Premises Cost Directions, the information practices are only required to provide :

• Are you registered for VAT? If so, what is the VAT registration number?
• Do you intend to claim a refund or allowance in respect of any element of the costs that you received financial assistance from NHS England/CCG?

They are working with NHSE to ensure they capture the right information from practices. If you are being asked to provide any other information, please do let us know.

PAs (Physician Associates) in General Practice (England) - call for case studies: HEE (Health Education England) is in the process of ensuring at least 1000 new PAs are trained and recruited into General Practice by 2020/21. This is one of the English GP Forward View workforce commitments . In parallel to the aforementioned activity, HEE is working with the GMC and the Department for Health and Social Care to prepare for formal regulation of PAs in 2018/19.

The BMA is also represented on the HEE-led national working group that is developing the career framework and quality standards / scope of practice for Medical Associate Professions, e.g. PAs, Surgical Care Practitioners, Advanced Critical Care Practitioners and Physician Assistants (Anaesthesia).

In order to assist us in making sure practice experiences and feedback, both positive and negative, can inform and shape these developments in the best way possible, we are keen to hear from GPs and General Practice staff who have worked or are already working with PAs. We would be grateful if you could share case studies with us using the attached case study template.

We will use the case studies to ensure that PAs are introduced into the extended General Practice and primary care team in a way that works for GP practices and their existing staff.

Once you have completed the template, please send it to Sumayya Allam ( ) in the BMA’s Workforce and Innovation team.

Document flow In Practice: we asked two of our practices to submit a report of how they implemented document flow in their practices and what benefits it has shown for the workload of the GPs and also any challenges in the implementation. Both reports can be found in the bright ideas area of the website at the bottom of the page. If any GPs have not yet attended this training we do have further dates available to book online 25th September and 21st November

Long Term Condition (LTC) Activity Searches - Request for help: The care of people with LTCs and frailty is a priority area of the Clinical Service Review. Clinical lead GP Dr Ian Wyer has created a set of searches to show how much general practice helps LTC patients. Too often our work is invisible to everyone outside, including commissioners, since general practice is funded by capitation not activity. It is time that we started to demonstrate our value with numbers to back up our claims. The process of setting up and running the searches should take about 30-60 seconds per clinical staff member to check and amend their role title as necessary, followed by about 20-30 minutes to run the searches. These will be sent out with the next CCG GP Bulletin. No patient identifiable information is included in the exports. This is a voluntary activity which Dr Wyer believes is in the interest of general practice. The LMC supports this work.

Principles of Data Sharing for GPs: In light of GDPR / DP 2018 we are aware that many practices are asked to review Data Sharing Agreements, to this end the following document provides practices with an updated guide reflecting current legislation (and we thank Londonwide LMCs and Wessex LMCs for sharing this document): Principles of Data Sharing for GPs

NEW - LMC Respiratory Nurse Adviser

  1. New Resource -  Cost Effective Inhaler Prescribing of Inhaled Treatments for Asthma and COPD, a new document developed by David Long to assist Practices.
  2. Monthly Respiratory Telephone Contact - David Long will now be coming into the LMC Office one day per month and will be available for telephone conversations regarding any Respiratory queries you have. The upcoming dates are 23 Oct, 20 Nov and 18 Dec, between 12 and 2pm, the telephone number to use is 01823 331428.
  3. For more urgent queries or to arrange for David to visit your practice you can now contact David directly on


Kind Regards



Jill Hellens

Executive Director
Somerset LMC
Crown Medical Centre, Venture Way, Taunton, TA2 8QY

Tel: (01823) 331 428            
Fax: (01823) 338 561
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We have updated our privacy policies on both the Somerset LMC and Somerset GP Education trust websites.

Attached file: 21.9 Message-to-GPs-September-2018.pdf

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