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Somerset LMC Weekly Update Friday 6th November 2020

Date sent: Friday 6 November 2020

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

Clinically vulnerable patients list ( previously shielding): The CCG Communications team have helpfully put together the following which practices may wish to post to their websites.
People who have been identified as clinically extremely vulnerable do not have to shield, but are advised to stay at home as much as possible, except to go outdoors for exercise or to attend essential health appointments. Read the full government guidance here
As part of the second lockdown, patients who have been identified as at high risk (clinically extremely vulnerable) from coronavirus (Covid-19), have been sent letters this week. The letters contain advice on how to take extra steps to protect yourself. There is no need to obtain a FIT note for your employer if you are unable to go to work the letter you will have received from the Government will suffice.
The clinically vulnerable list has been increased to cover new conditions, so some patients will be receiving letters for the first time.
If you have a booked appointment or flu vaccination please attend as normal – if anything changes we will contact you directly. Please do not worry if you need medical help - please contact us, by phone or online as usual
More information and advice for people who are at high risk can be found on the NHS website

Flu Vaccinations of 50-64 Year Cohort - wait for it!: NHSEI SW Public Health has noticed that some practices have already starting making claims for flu vaccinations for 50-64s not in any of the at-risk groups. The programme does not yet recognise these patients who will be vaccinated only “in due course.” Practices that have not yet declared September achievement should check CQRS against clinical system data and if needed submit a manual data amendment request form with supporting information. Practices that have already declared September data and incorrectly claimed for the 50-64s will have their payments placed on hold until a correction has been submitted. If you have vaccinated in error you will not receive payment and will need to complete a manual data amendment request form requesting that those vaccinations are removed from your September claim. If you have not delivered to this group and you believe this error is due to a coding issue, please complete a manual data amendment request form with supporting information. The LMC thinks it’s a shame that this group were ever told they’d get a flu jab before stocks were available but that’s another matter. 

Chronic Liver Disease (CLD) & Flu: CLD patients are nearly 50 times more likely to die from flu, the highest age-adjusted relative risk of flu-related death. Despite this CLD is consistently in the lowest uptake groups: only 39% of the 4000 patients had a jab in Somerset last season. By 23rd October only 1:4 people with CLD have had flu vaccine. The target is 75%. A patient information leaflet is available here.

CQC Transitional Regulatory Approach (TRA) Transitional Monitoring approach (TMA): The LMC met CQC managers this week about their proposed new approach during CV19. They are adapting their methods using a transitional approach to monitoring services. This focuses on safety, how effectively a service is led and how easily people can access the service. They assured us they will take a pragmatic approach being aware of the pressure that practices are under. This will include a strengthened approach to monitoring, based on specific existing key lines of enquiry (KLOEs): they can continually monitor risk in a service using technology (Including online comments) and local relationships including with inspectors to have better direct contact with service users, families and staff in services to target inspection where there may be concerns. After reviewing information about the service they will speak to practices (usually with one person) online or by telephone at a mutually agreed time. This is will not be an inspection and there will be no rating afterwards. This will help establish if a further regulatory action is needed at that time, for example an inspection. The list of Somerset inspectors and the practices they cover can be found here.

Pre-Operative Pre-Hab: The LMC was part of the Elective Care Board that approved a peri-operative medicine scheme in Somerset to make sure that those needing surgery would benefit from better pre- and post-operative care. Anaesthetist Thomas Teare said c40% on lists were 70 or older with comorbidities. The traditional model of care was based on anatomy rather than the patient. What was done outside the operating theatre made the biggest differences to outcomes including those set by the patient. Waiting lists would be replaced with “preparation lists.” Anaemia, alcohol, frailty, obesity, smoking, malnutrition, memory problems, diabetes and so could all be at least partially addressed before admission reducing cancellations and improving outcomes. Individualised risk scores are recommended by NICE so the “dead time” of the traditional waiting list could be better used optimising patients in the “amber” category. “Red “ patients would probably not benefit from surgery at all. Rather than commissioners insisting on reducing operations this could be done with better patient involvement and improve the care of those that did go forward at the same time. Evidence from Teeside showed long term benefits with more patients having pre-habilitation taking less alcohol, smoking less and taking more exercise after procedures than beforehand. Patients whose symptoms deteriorate during pre-hab could be expedited. Some might not even need orthopaedic surgery with enough weight loss for example. With more long waiters owing to CV19 it was agreed that these could be a good place for the peri-operative work to start. Little acorns but it clearly makes sense.

General practice workforce initiatives: GPC have published a guide to inform GPs, PCNs and LMCs about the range of workforce initiatives and schemes in England. The guide includes helpful information about what is on offer in each of the scheme and how to apply for them.
They have also published a new guide to applying for the GP partnership scheme, which will help you navigate what can be a complicated application process. The scheme was launched on 1 July and supports clinicians who are interested in becoming a practice partner. You can read more in this blog by Krishna Kasaraneni, member of GPC England’s Executive team and workforce lead.

Parental leave webinars with BMA: 2 December (12.30 – 2.00pm) – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. The session will also touch on local maternity workshops and there will be a Q&A session. Register here.
9 December (12.30 – 2.30pm) – Workshop - ‘GP maternity’. An in depth run through everything you need to consider before, during and after maternity leave, including advice on leave and pay entitlements, notifying your practice, appraisals, CPD and returning to work. Register here.

Non-Medical Prescribers: Dr Bridget Carne writes - There are increasing numbers of Non-Medical Prescribers (NMPs) working in general practice. While there is considerable experience of nurse prescribing, with paramedics, physios and pharmacists coming on stream there is concern about the demonstration of competence. NMPs are advised to keep ongoing evidence of competency using the Royal Pharmaceutical Society’s 'A Competency Framework for All Prescribers' and practices are advised to check that NMPs are doing this and are reviewing it at appraisals. CQC advises that practices ‘make sure NMPs are, and continue to be competent, have systems in place to audit all prescribing, including NMPs, support NMPs continuing professional development’, and ‘should …to make sure NMPs are working within their competence’. For further information please see the NMP section on the website this includes a document produced by Wessex LMC which links to the different professional bodies’ guidance documents.

Message from Carol Hobbs Somerset Training Hub - UWE Courses - A plea to those who have been offered places: As you know I have been managing the UWE CPD Contract for 2020-2021 and have recently also been in contact with you regarding this year's additional PCN CPD Funding(for all Nurses and AHPs).

Thank you to those that have responded.

I am in the process of commissioning more courses from UWE BUT our records show only 36 out of the 63 available funded places have been filled so far partly due to the course being full and partly due to lack of demand or uptake. If I have emailed you with the offer of a place and you have not yet applied PLEASE can you do so by 12th November.
If you have applied and been advised the course is full and have been placed on a UWE WAITING LIST please could you let me know so I don't chase.
I have to confirm to UWE our potential demand for courses for next year from your CPD returns so I have to validate this year's uptake first and commit to a minimum number for next year or they may not run the course, so your help is much appreciated
Any queries please email

Top Tips...

Can be found here. New item this week is:

And Finally...

Some good news! No change to CQC fees For most providers fees in 2021/22 will remain the same as in 2019/20 and 2020/21 unless registration or size has changed. As the fees for General Practice remain fully reimbursable we can all agree this represents jolly good value for money.


Kind Regards



Jill Hellens

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

Tel: (01823) 331 428            
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