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Somerset LMC Weekly Update Friday 4th September 2020

Date sent: Friday 4 September 2020

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

SGPET weekly update with all online education can be found here

Practice Rag Rating/Secondary Care Interface: The LMC notes how many practices always report “green” in the SitRep. Top marks for fortitude but things don’t feel too “green” as patients become less forgiving, more frightened and less inclined (often rightly) to put up with delayed appointments, investigations and operations. And of course many struggle with the idea of triage before a face-to-face appointment. Staff have been abused in shops: “The pubs are open but I can’t see my GP!” We cannot struggle into work feverish and coughing any more but have to retreat from the front line, at short notice by statute, to get a swab. And that’s before the schools start calling staff in to collect hot kids. We hear disturbing stories of practices being criticised by other HCPs for not seeing people in person despite NHS directives to the contrary “unless clinically necessary” (the definition of which can change with hindsight). Some of us too may have been free with patients about our views on e.g. “physio by telephone.” We understand that secondary care is under the cosh too - and all the above cut both ways - but beg to point out that Practices cannot send out letters putting off swathes of work indefinitely or reply to requests with “we are not taking any bookings at the moment.” Similarly Primary Care cannot accommodate each remote secondary care assessment’s list of homework. “I’d be grateful if you’d prescribe this, check that, test it again every three months, let me know the result and refer her to that other department for me.” We work best for patients when we work together and don’t stand on contractual ceremony but the LMC feels forced to remind colleagues that it is important to gently and politely push back against these endless transfers of work. We are not community F1s. Want blood testing? That’s probably OK, but send the patient a form and labels and deal with the results yourself. Refer to a colleague? You’ve been able to do it yourself under the standard NHS contract for years. Pushing back on inappropriate workload templates.
We look to the Primary Care Board and proposed Collaborative Forum to forge closer links as we head towards Integrated Care but at present it seems that the CV19 response is undoing years of progress. We are pleased that the growing frustration, disappointment and dissatisfaction across the country is continually raised by GPC. CV19 presents the NHS with unique challenges but also the chance to reset, reframe and rectify some of the long standing problems with working across the interface. BMA GPs and Consultants are writing a position paper and will meet Prof Stephen Powis, NHSEI Med. Dir., about the urgent need to address these problems. The answer is not more work dumping on practices so in the meantime please don’t sell yourselves short. For now we have tweaked the SitRep to try to reflect a truer picture of the pressures on practices. The reporting will be unchanged but please read the new criterion before completing. The next SitRep will be circulated on Monday 7th with the new criteria attached and which is also available on the website.  

From the CCG Safeguarding Lead: A reminder that safeguarding in adults needs a prompt response in the same way that we deal with children’s. In a recent case an elderly lady was being physically abused by her demented husband. Frightened to go home she apparently asked for an urgent appointment but was offered one the following week, leaving her at risk. The practice is reviewing the case. We ask that practices review procedures and brief reception teams so that adult safeguarding can get the priority it needs.

Pharmacy Flu Advanced Service SPEC - Summary of key changes 20/21:

Skin Lesion Template: ARDENS have recently adopted the Skin lesion assessment template designed by the Somerset dermatology team. This is now readily available to all clinicians in Somerset that use the ARDENS templates. It is strongly encouraged that any referrals coming into the dermatology service make use of this template and where possible includes clinical images.

Redacting GP Records: In June, GPC wrote to NHSEI to raise concerns over the redaction of records and the unintended consequences of any processes to help patient see their records. GPC asked for reassurance that
(a) patients would not be able to view incoming correspondence before a GP has had the opportunity to review it and
(b) that the workload of GPs should not increase as a result of needing to review individual records and mark consultation notes for redaction.
GPC has now had a response outlining measures taken and reassurances given that where practices feel granting access to patients’ records during the pandemic would have an impact on provision of essential services, they are not required to do so. NHSEI is now reviewing their guidance for patients to reflect these points.

Funding opportunity for Registered Nurse Degree Apprenticeship in Primary Care: Building your future workforce: Funding is available to Employers to support Registered Nurse Degree Apprenticeships (RNDA)in the form of an Employer Training Grant of £8,300 per apprentice per year. In addition, the new post Covid-19 recovery initiative of financial incentives announced by the Department of Education of £1500 for over 25s, or £2000 for under 25s, per apprentice start (only for apprentices new to workforce), can be added to the £8,300 payment for each new RNDA starter in 2020.
The Training Hub has been asked to submit a bid for a proportion of the places available across the South West. Numbers are limited so if you are interested either as a practice or PCN please email and register your interest by 17th September 2020. More info will then follow.
As you are all developing your future workforce plans and looking at your existing staff development needs have you thought about other apprenticeships? Please see Apprenticeship in Primary & Social Care Information Pack. As you identify any skills gaps it may be an apprenticeship is an option to consider not only for new posts but for existing staff as they move into a new or expanded role. Apprenticeships are wide and varied and can be for anyone. If you would like further information on apprenticeships or the Government Kick Start scheme - see - please email or

Nexplanon Fitters Forum meeting: We have been informed that places are still available on the following dates, information and booking can be found here

Zoomed Out: The thirteenth episode of the free Somerset Emotional Wellbeing podcast, a discussion about remote working and video fatigue, is available now.


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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