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Somerset LMC Weekly Update Friday 26th October 2018

Date sent: Friday 26 October 2018

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

CHIS Requests: We have requested a meeting with NHSE and CHIS to try and resolve the lack of communications to practices on changes to their services and the random requests for information being sent to practices that would have formally been completed by child health.

News from the performance advisory group: A doctor working for OOH without being on the Medical Performers List was referred to the GMC and has been erased from the Medical Register: GMC judged that it is essential to take regulatory requirements seriously and that in this case the doctor had deliberately mislead the employer and NHSE. (Details available on GMC website). All doctors working in any role as a GP (a doctor providing GMS) must be on the MPL. Anyone who has not worked for two years must return to work via the induction and refresher scheme.
A complaint following a missed lung cancer found that patients having spirometry because of deteriorating symptoms could benefit from a chest X-ray as an opportunity to pick up a malignancy. Anyone with a cough for more than four weeks should have a CXR.
PAG recommends that Drs should familiarise themselves with NICE guidance on sedatives prescribing for patients with long term mental health problems and document medication reviews accordingly with reference to concerns of addiction, quantities of medication and support offered. Another complaint related to patient self-harming with numerous overdoses after the practice had failed to act on prescribing recommendations from a psychiatrist. PAG felt that practices should carry out a medication review following a drug overdose, considering quantities supplied.
If a GP performance concern is raised as part of a complaint this will be referred to PAG. In most cases the GP will be informed before the meeting but the complaint will be considered by the officers of the PAG ahead of the meeting and may decide not to take the concern to the formal meeting. The complaint will be logged and the GP advised that it has been closed.
A reminder about the Violent Patient Scheme: document any violent incidents, involve the police early and then contact the Special Allocation team at NHSE.

Trainee numbers exceed target: The Secretary of State for Health and Social Care gave a speech at the National Association of Primary Care (NAPC) annual conference where he reported on a 10% increase in GP trainees compared with last year, with 3,473 trainees recruited against a target of 3,250. The BMA commented that it is good to be making progress on recruitment but there is clearly much more to do on GP retention.

State backed indemnity scheme: Mr Hancock also reaffirmed his commitment to delivering a state-backed GP indemnity scheme from April, subject to negotiations on the primary care contract and “engagement with stakeholders” and that he wants to reduce indemnity costs as a barrier to doctors entering or staying in general practice. Linked to this the BMA has had a letter from the DHSC with an update outlining the scope of the scheme as part of the GMS negotiations. GPC expects DHSC to produce more public information for GPs shortly.

Primary Care same day data: Thanks are due to the 10 practices who are submitting activity data to Adam Hann and his team at the CCG. This has been extrapolated to show that in a year Somerset practices deal with 3,000,000 consultations of all types or 12,500 every working day. GPs still handle over a half of them. If one percent of those patients turned up at A&E it would increase the number seen on even their busiest ever day by 50%. Colleagues will imagine the effect this had on the representatives of the acute trusts, OOH, social and community care at the Somerset A&E Delivery Board. These organisations all know exactly how many people call them and when, ambulance dispatches and conveyance rates, A&E and MIU attendances and acute admissions. Up until now all primary care has been able to say is that “we are really busy.” After the presentation the A&EDB agreed to include this data as part of whole system reporting. This is great progress but we need your continued support. Please continue to send in data if your practice is already doing so and, if not, PLEASE consider joining in to make the data even more powerful and meaningful for both the practice and the health care system. Further information, including the early findings will be published in the coming weeks via the CCG GP bulletin. Contact the LMC Med Director for more details.

New QOF indicators for diabetes: NICE has published new diabetes indicators for consideration for inclusion in the Quality and Outcomes Framework (QOF). The GPC has been active in producing these new indicators which will now be considered as part of the current negotiations with NHS England. GPC prescribing policy lead, Dr Andrew Green, commented that the new indicators will 'encourage GPs to ensure that patients with diabetes will receive care tailored to their individual circumstances. It is vital to balance the need of younger fitter patients for good risk-factor control with the importance of avoiding overtreatment in frailer people and we are pleased that this principle has been incorporated into these indicators.'

Pregabalin and gabapentin: The Home Office announced this week that gabapentonoids are to be reclassified as class C controlled substances from April 2019 amid concerns people are becoming addicted and misusing them. The BMA has been calling for this passing a resolution to make pregabalin a controlled drug. In response to this the GPC prescribing lead, said: “While an important drug for treating several conditions, there has been an increase in the prescribing of pregabalin in the past five years… Granting pregabalin controlled status will help… but the government must also invest in specialised support services for prescription drug dependence…”

BMA ‘Let’s Talk about Brexit and the NHS’: Monday 19th November 2018 at Engineers House, The Promenade, Clifton Bristol BS8 3NB 19:00 – 21:00 (2 course hot supper from 18:45. Talk begins at 19:30) Details here

Report of the committee of enquiry into the cost of the national health service: ‘The NHS will never be financially sustainable unless the clinical decisions of General Practitioners are brought alongside the resource implications of those decisions.’ From the Guillebaud Report - 1956 - with thanks to Michael Bainbridge.

Flu: We have posted a couple of new documents to the website that practices may find useful they are also available below

And finally...

The LMC Office will be closed from 12 PM Tuesday 30th October for the team to attend Dr Roger Crabtree’s funeral, for anything that may be urgent please phone 07824 545315 and leave a message. 


Kind Regards



Jill Hellens

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

Tel: (01823) 331 428            
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