All Somerset GP's & Practice Managers
Date sent: Friday 10 July 2020
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
SGPET Covid weekly update with all online education can be found here
- Staff CV19 Antibody Test Results - Please tell people not to ring the laboratory
- COVID & Fitness to fly Certificates
- Vacancies on the LMC
- Death Certificates - tell relatives the cause of death but don't hand over the certificate
- Remote Consultations beware of intimate images - please read this guide
- GP Recruitment event 15th July
- LD and SMI Physical Health Checks; We Need Your Opinions
- Top Tips...
Staff CV19 Antibody Test Results - Please tell people not to ring the laboratory: SPS has told us that it is receiving calls from staff members wanting to know their test results. Results are conveyed by text message. The laboratory is too busy to deal with extra incoming calls.
COVID & Fitness to fly Certificates: Some patients may ask for a “free from COVID-19 certificate.” We advise against supplying these. It is not GMS work. Antigen testing is not normally available in primary care for the asymptomatic. A negative test does not guarantee freedom from future infection. Antibody testing is focused on those having blood taken for some other reason and we have no idea what a positive test means for immunity. In any event there are medical legal implications for such private work (see below).
Fitness to fly certificates are not GMS work: if you do decide to supply one you can charge a fee. Fitness to fly assessments can be complex especially for those with LTCs. Specialist private clinics are available. Furthermore the BMA advises caution when considering undertaking this sort of work: ‘We discourage doctors from signing certificates which indicate that the patient will, for example, be fit for the duration of the holiday, as current fitness is not a guide to future fitness. Doctors can only report on what is written in the patient notes, and reporting on future fitness could have medico-legal consequences for you.’
And just in case you are still tempted do not forget that, being private work, the CNSGP will not cover any liabilities arising so consult your MDO.
Vacancies on the LMC: There are vacancies on the LMC for representatives for the Bridgwater and Yeovil constituencies. The LMC is the only statutory body to negotiate for all practices on contracts but has a wider range of responsibilities from representing individual practices in dispute to pastoral care. The LMC is active in promoting recruitment to GP in Somerset and has an educational arm the SGPET. It represents all GPs whether partners, salaried, sessional or working for a Trust or OOH and also GPs in training. It has participation from practice managers and specialists like dispensing doctors. Anyone working in the Bridgwater or Yeovil area in any capacity as a GP who is interested in applying can find a wealth of information on our website and is welcome to contact the Medical Director directly on b.moyse@nhs.net
Death Certificates - tell relatives the cause of death but don't hand over the certificate: The County Registrar has asked us to remind you not to forget to tell next-of-kin the cause of death. Whilst the scanning of documents seems to work well there have been examples unnecessary distress when the registration is taking place especially with unexpected CV19 related deaths. In some cases this has even led to a referral to the Coroner.
Some relatives have also been given the MCCD rather than the surgery retaining it. Practices keeping the certificates remains the current procedure until we get further central guidance.
Remote Consultations beware of intimate images - please read this guide: Practices are still directed to reduce footfall by consulting remotely wherever possible. It seems likely this will continue and we have learned how much good work can be done like this. Patients or carers providing images can often be helpful. However colleagues must be careful. A GP in another part of the UK was sent a photograph to help a referral for precocious puberty. The GP and the mother of the patient found themselves under Police investigation for exchanging indecent images of a child after a hospital safeguarding team felt obliged to report them. Technically they had broken the law but the police decided not to prosecute. A new, useful guide has come from NHSE to which the excellent Dr Shaba Nabi of the GPC contributed - see here. We urge you to read it.
GP Recruitment event 15th July: We are going online Our popular GP recruitment events of the past four years gave GPs and GP Trainees the chance to meet up and talk to a wide variety of Somerset practices all in one session. We have re-designed the format so this year you are able to do this online. Registration and participation is free. There will be two sessions available to book on the day which hopefully will fit within any work commitments, they will run from 14.30-17.00 and 18.30-21.00 you can book either or both, the full detail on the event and how to book can be found here.
Practices that would like to take part in this event the full detail of how the evening will run, booking details and what we are asking you to prepare can be found here.
LD and SMI Physical Health Checks; We Need Your Opinions: Somerset CCG would love to hear what you think about delivering LD and SMI physical health checks to people across the county. We have developed a short, anonymous survey; we would like to know what has had to change in response to the pandemic and how you think processes could be improved.Please click on the link before the 19th of July to have your say and help shape services for the future.
Top Tips...
QOF New COPD Indicators: EMIS are currently working with V44 of the business ruleset but Ardens templates are built to V45. The SNOMED codes below have come from the QOF cluster set version 300 for V45 of the Business Ruleset and are still undergoing testing so the codes below are for guidance only.
COPD009 - Patients with a clinical diagnosis of COPD on or after 1 April 2020 and whose diagnosis has been confirmed by a quality assured post-bronchodilator spirometry FEV1/FVC ratio below 0.7 between 3 months before or 6 months after diagnosis (or if newly registered in the preceding 12 months without a record of spirometry having been performed, a record of an FEV1/FVC ratio below 0.7 recorded within 6 months of registration); and patients with a clinical diagnosis of COPD on or after 1 April 2020 who are unable to undertake spirometry.
You will need to record either of these two codes for Post bronchodilator spirometry 767906009 or 7745951000000101 or Referral for Spirometry reversibility testing 702540003.
There are a number of codes for spirometry that you could use if there is a reason for not performing spirometry, they are;
- Spirometry Declined – 415572005
- Spirometry Unsuitable – 279261000000103
- Spirometry Contraindicated – 285671000000103
- Spirometry not indicated – 415571003
- Unable to perform Spirometry - 71182009
Will also need to record the FEV1/FVC ratio please take note of the timeframe above, there are a two codes for FEV1/FVC ratio they are 407603001 or 314472003.
COPD010 - The percentage of patients with COPD, on the register, who have had a review in the preceding 12 months which includes a record of the number of COPD exacerbations (723245007) and An assessment of breathlessness using the Medical Research Council dyspnoea scale, the codes are as follows;
- Medical Research Council Breathlessness Scale grade 1 - 391120009
- Medical Research Council Breathlessness Scale grade 2 - 391123006
- Medical Research Council Breathlessness Scale: grade 3 - 391124000
- Medical Research Council Breathlessness Scale grade 4 - 391125004
- Medical Research Council Breathlessness Scale grade 5 - 391126003
- Medical Research Council Breathlessness Scale: grade 3 - 391124000
- Medical Research Council Breathlessness Scale grade 4 - 391125004
- Medical Research Council Breathlessness Scale grade 5 - 391126003
The Ardens Remote Review System will identify stable patients that are suitable to have a remote annual review. This will be of particular benefit to practices with unbooked routine appointments. Completing these reviews now should reduce the volume of routine work that will be arriving in General Practice once COVID19 has resolved.
COPD patients MRC 1-3 with no review this year and COPD patients with MRC score 4-5 with no review this year are in the Ardens searches.
Heart Failure new indicator: EMIS are currently working with V44 of the business ruleset but Ardens templates are built to V45. The SNOMED codes below have come from the QOF cluster set version 300 for V45 of the Business Ruleset and are still undergoing testing so the codes below are for guidance only.
We are expecting this to occur when V45 is released. Please note: to support GP practices in enabling them to carry out QOF care reviews after two invitations for care have been coded, clinical system prompts should not remove a patient from the indicator.
HF005 - The percentage of patients with a diagnosis of heart failure on or after 1 April 2020 which:1 - Has been confirmed by an echocardiogram or by specialist assessment between 3 months before or 6 months after entering on to the register; or 2 - If newly registered in the preceding 12 months, with no record of the diagnosis originally being confirmed by echocardiogram or specialist assessment, a record of an echocardiogram or a specialist assessment within 6 months of the date of registration.
Codes indicating the patient wishes not to have an echocardiogram are:
- Echocardiogram declined – 408566000
- Angiocardiography declined - 408549002
HF006 - The percentage of patients with a diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with a beta-blocker licensed for heart failure.
HF007 - The percentage of patients with a diagnosis of heart failure on or after 1 April 2020 which:1- Has been confirmed by an echocardiogram or by specialist assessment between 3 months before or 6 months after entering on to the register; or 2 - If newly registered in the preceding 12 months, with no record of the diagnosis originally being confirmed by echocardiogram or specialist assessment, a record of an echocardiogram or a specialist assessment within 6 months of the date of registration.
Kind Regards
Jill
Jill Hellens
Executive Director
Somerset LMC
Crown Medical Centre, Venture Way, Taunton, TA2 8QY
Tel: (01823) 331 428
Fax: (01823) 338 561
www.somersetlmc.co.uk
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