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Somerset LMC Weekly Update Friday 1st March 2019

Date sent: Friday 1 March 2019

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

Notes from The Performance Management Group: Don't forget to consider a diagnosis of possible lung cancer in patients with persistent coughs - spirometry will not exclude a diagnosis of lung cancer so have a very low threshold for ordering a chest Xray.
When sharing public health information via the practice website or on information boards in the surgery please ensure that the origin of the information is reputable and valid - do not share information from other sources without checking them first.
Recording routine observations on all unwell patients and documenting them is essential - pulse, temperature, CRT, respiratory rate, sats - in the event of a deteriorating patient this can help recognise deterioration and in the case of a negative outcome can protect the clinician from criticism - this is especially helpful if the patient does not appear to be particularly unwell at first presentation.

From the Somerset GP Board: Update on Clinical Directors for Primary Care Networks: The 2019 GP Contract includes a requirement for the new PCNs to appoint an accountable Clinical Director who will be “responsible for delivery”. The contract does not include a person specification, but suggests the job role will include a variety of responsibilities. The GP Board has for some time been thinking about what clinical leadership is needed by clusters of practices it is working with its constituents (LMC, SGPET, the CCG, SPH) - as well as the Foundation Trusts and Social Care – to find an effective selection process that will combine our ideas with those in the contract. Network Clinical Directors are important for the future of healthcare in Somerset and the role will involve contributing to the shaping of the new Integrated Care System as well as work within individual networks. The GP Board thinks it is important that everyone is clear on the selection process and that those putting themselves forward are confident that they will get the right financial, administrative and mentoring support. A further announcement confirming the selection process, job specification and support package will be made shortly, but if you have any questions regarding the appointment of Clinical Directors please email the GP Board via

Police email address for electronic death referral form: Colleagues will recall the new e-system for informing Coroner’s Officers about a death when a Death Certificate cannot be issued straightforwardly which was introduced unilaterally recently. There was some concern about how secure the police email address provided is. We are happy to confirm that NHS Digital has confirmed that it does satisfy NHS security standards.

Firearms Licensing: The BMA have been meeting the Home Office, the Countryside Alliance and taking legal advice. All accept the principle of doctors charging a reasonable fee for completing firearms medical reports. BMA guidance is being updated. Guidance on record flagging or alerts is changing to: While the BMA supports the principle of flagging in this way and reminds doctors of their duty of care to the public to raise concerns where they are apparent, we must also make doctors aware that due to the imprecise nature of flags, the lack of clear protocols for their appropriate removal and the absence of reliable software to facilitate the surveillance and cross-referencing of flags with diagnoses of concern, that we continue to have concerns about the flagging process and will continue to work with the Home Office to resolve this pressing question. Guidance on Conscientious Objection is changing to: In our view conscientious objectors are not required to arrange for alternative provision of such a report. Where access to a firearm is a professional requirement – such as for gamekeepers and farmers – we would nonetheless encourage doctors to assist applicants in identifying a suitable colleague willing to engage in the firearms certification process.

Metoprolol 50mg & 100mg Tablets: The latest non Brexit-related shortage is of metoprolol. This has come about because some manufacturers discontinuing the products and others having supply difficulties. Supply is likely to be intermittent for a number of months. If patients are having difficulty obtaining metoprolol, they may need to be switched to an alternative. Advice on management options for patients affected with dosing information is available on the SPS website. Manufacturers of bisoprolol, atenolol and propranolol have indicated they have capacity for additional demand. We hope that pharmacists will be made aware of this information too. 

Contract funding figures 2019/20: Please see below table with updated GP contract funding figures for 2019/20 following the contract agreement a few weeks ago.




Value of QOF point



Global Sum price per weighted patient



Out of Hours adjustment




Participation payment

£105m total

Annual payment per weighted patient*


*This figure will be paid in instalments direct to practices, upon signing up the PCN DES.

These figures have been agreed between NHS England and GPC England – the BMA GP contract webpage will be updated shortly. These figures include the recycling of MPIG and Seniority into global sum, and therefore the figures represent greater than the 1.4% contact uplift noted in the contract agreement document.
In addition to the above, a one-off payment to cover indemnity inflation arising in 2018/19 is planned for March 2019 – this figure is still being calculated and information will be provided soon.
The above figures are in addition to the other financial agreements, for example uplift S7a V&I programmes, all funding via the network, and the delivery of the state-backed indemnity scheme, and do not include payments for any uplift in employer pensions contributions which will be funded separately.

Why join a Primary Care Network?: In Somerset practices are already working together informally in communities of 30-50,000 to sustain general practice and improve care. As set out in the new GP contract Primary Care Networks (PCNs) will narrow the gap between the specialist generalist GP and the super specialist consultant. PCNs will mean more services, not just community services but also traditional hospital specialities, will be locally based. Under the new contract PCNs will be the only route for the promised additional investment to support general practice, the people we serve, and to massively expand the workforce. By July we are expected to have established PCNs and signed up to the Network DES. The PCN will receive funding towards a GP to become the Clinical Director and there will be £1.50 per patient which the PCN can use to develop, transform or invest in services. Practices that sign up will receive £1.76 per patient for working in a PCN. Next year networks will have an entitlement to 70% funding for Pharmacists and 100% for Social Prescribers - part of the workforce offer which will fund an additional 220 staff working in primary care by 2024 as the scheme expands to include Paramedics, first point of contact Musculoskeletal Practitioners and Physician Associates. These posts must be additional and not simply substitute funding for existing ones. The Extended Access DES is worth £88m nationally to practices but this will be transferred to PCNs to deliver it within the same specification. The PCN could agree to continue to provide the EA DES at practice level or develop a new service, collaborated across the PCN. The Improving Access (“at scale”) DES is worth £6 per patient but partly duplicates the practice EA DES: this money could also go to PCNs to provide the services and help support practices to keep going. But the contract says all this must be GP led, by practices who will see rewards in terms of patient services, additional staffing and reimbursement through the new QOF for participating in PCNs. CCGs cannot impose Clinical Directors, for example. If a practice does not sign up there is an obligation on CCGs to make sure that their patients receive the benefits of the PCN but they will have no say about it nor receive any of the benefits. All this will be made clearer on Tuesday 9th April at the LMC/CEPN Study Day “Transformation 2- Networks ” Can you afford to miss it? Please book online here


Kind Regards



Jill Hellens

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

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