Somerset LMC Weekly Update Friday 26th April 2019
Date sent: Friday 26 April 2019
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- An Inspector Calls the latest blog from LMC Chairman Dr Nick Bray
- Somerset policy for the management of the downgrading of 2-week wait referrals
- Indemnity for GPs doing Hospice work
- State backed indemnity & travel vaccinations
- New claim form for reimbursement of NHS Pension Scheme contributions - 2015/16 and 2016/17
- Helping establish Primary Care Networks
- New end of life QOF domain
- Diploma in Advanced Primary Care Management – June intake
- Thank you for voting TECTONA!
Somerset policy for the management of the downgrading of 2-week wait referrals. The latest Cancer Waiting Times guidance published 1st April 2019 states that “incorrect or inappropriate” referrals should be discussed with the GP, (GDP or Optometrist) and that only the referrer can downgrade or withdraw a two-week wait referral. In practice, with ever increasing 2ww referrals and more part time working, there are often difficulties tracking down individual clinicians. This results in some referrals being managed through the fast track despite the referral information suggesting cancer is unlikely. In consultation with the LMC it has been agreed that consultants will manage the redirection or downgrading of referrals on behalf of the referrer as part of an advice and guidance style approach. If at triage the consultant judges a referral not to meet the national NICE Guidance 2ww criteria or where referral information suggests it is highly unlikely the patient has cancer, the consultant will write within two working days to the referrer. The letter will explain the consultant’s rationale for the change in managing the referral and the actions being taken by the trust e.g. redirected to urgent gynaecology service, WITHOUT the GP having to re-refer the patient, along with any suggested action for the GP to take. It has been agreed that only a consultant can decide to downgrade or re-direct a 2ww referral and will take clinical responsibility for the decision. When a GP thinks the revised approach is wrong s/he should contact the consultant by phone or letter as soon as possible. In these instances the patient will be reinstated on the GP cancer pathway from the original date of referral and managed accordingly.
Indemnity for GPs doing Hospice work: This is a hot topic at the moment as it appears that nobody thought about these colleagues when the state-backed indemnity scheme (CNSGP) was devised. Only if the hospice holds an NHS contract or is part of an organisation that does then these (effectively) employed doctors should be covered by Clinical Negligence Scheme for Trusts for that organisation. However if a hospice does not hold an NHS contract and that does present a problem. CNSGP covers GPs delivering care where they are working for an organisation whose primary function is delivering primary medical services under a “Part 4 contract.” The GPC has suggested that one solution would be for the hospice to subcontract the medical care to each practice who then “released” their GP to do the work then they WOULD be covered by CNSGP. But this would expose the practice to employer liabilities. However those GPs employed/engaged directly by the hospice will NOT be covered by CNSGP. GPC has made DHSC very aware of this problem and the potentially catastrophic effect it could have on the hospice movement. All agree that this is care that we would like to be covered but which falls outside of the current statutory instrument as passed by Parliament. GPC is working to try to address the core problem but in the meantime it is important that people understand that directly engaged GPs are not currently covered by CNSGP.
State backed indemnity & travel vaccinations: Following further negotiations with DHSC GPC confirmed on 17th April that travel vaccinations WILL be covered under the scope of the Clinical Negligence Scheme for GPs. The rationale that has now been accepted is that travel vaccines are part of GMS contracts even though charges may apply. This good news take time to percolate to the Medical Defence Organisations so anyone asking them is likely to get a different response for the time being!
New claim form for reimbursement of NHS Pension Scheme contributions - 2015/16 and 2016/17. NHS Pensions has published a new claim form for reimbursement of NHS Pension Scheme contributions - 2015/16 and 2016/17. This will be of interest to salaried GPs who are seeking reimbursement of some of their 2015 NHS Pension Scheme contributions paid in years 2015/16 and/or 2016/17 because their tiered employee contribution rate was set using the ‘annualise then add’ instead of the ‘add then annualise’ method, should complete and submit this form to PCSE via the online enquiries form . Forms completed incorrectly will be returned for resubmission. All forms, including those that need to be re-submitted must be received by PCSE no later than 14 June 2019.
Helping establish Primary Care Networks: With three weeks to go until PCNs are to submit their first paperwork, BMA is adding further support for establishing PCNs. Last week they added a ‘top tips’ document which highlights what groups should be thinking about now. One on decision making was elaborated on this week in specific guidance. BMA is liaising with VAT specialists and aiming to release specific guidance. Read the latest blog by Krishna Kasaraneni, GPC England, which goes into detail about the support provided and in preparation, but if you’re responsible for establishing a PCN, or just interested, then join our PCN forum . There will be a PCN Clinical Directors conference on 5 June to hear from experts in the field and to share experiences and knowledge.
New end of life QOF domain: You may be interested to see the toolkit and network support document which MacMillan has made available for all to use freely which may be of use to practices tackling the EOL domain in QOF this year.
Diploma in Advanced Primary Care Management – June intake Are you interested in developing the expertise needed to manage primary care networks? If so, there are still some places available on the next Diploma in Advanced Primary Care Management course starting in June. The one-year course - which is mainly online – run by the National Association of Primary Care and is designed for people who are managing primary care and becoming responsible for creating and running primary care at scale.
It's ideal for emerging primary care networks as well as more established networks such as primary care homes. It offers a practical ‘how to’ curriculum and incorporates learning from the new care models and primary care home programmes. For more information click here.
Thank you for voting TECTONA! Dr Barbara Crabtree reports that the Tectona Trust has won £50,000 of National Lottery Funding. The prize opening occasion was shown on ITV which was amazingly moving for all who knew her late husband, Somerset GP, educator and trust founder, Dr Roger Crabtree. Sail training is using the experience of sailing to provide people from all walks of life the opportunity to develop character, build self-esteem and an awareness of the needs of others through teamwork and the shared adventure. Encouraged to work as part of a team, setting sails, steering, preparing meals and participating generally in life on board all help people, including those recovering from drug and alcohol addiction and with mental health problems, to get a new focus in life based on sailing and the sea. The prize will help more disadvantaged people of all ages with no experience of the sea to widen their horizons. http://www.sailingtectona.co.uk/about-us
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