Somerset LMC Weekly Update Friday 5th March 2021
Date sent: Friday 5 March 2021
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- GP contract agreement 2021/22
- Single point of access for Trust Safeguarding Teams
- GP Retention webinar
- COVID-19 & Racism in Medicine webinar 5 March 5.30-8.30PM
- Verification of death by Community Nurses
- Freestyle Libre 2
- Prescribing & Medicines Management Prescribing Indicators 2021/22
- Ta-Da! (-lafil)
- Transgender shared care letter of assurance
- TEP/ACP and Bad News
- Looking after you
- PAUSE- creating space for change
- And Finally...
Single point of access for Trust Safeguarding Teams: An SEA revealed a problem between primary and secondary care. The case involved a lady suffering domestic abuse who was too unwell to come to the surgery. The GP could not phone or visit because the perpetrator would be there and so decided to admit the patient for her medical problem but also to discuss the abuse. Unfortunately due to CV19 pressures to discharge quickly the lady was sent home before any discussion. To prevent similar situations CCG Safeguarding has agreed what it hopes will be a simple solution: single points of access in the acute trusts. If you are sending a patient in to YDH or MPH with safeguarding concerns you can also alert the safeguarding teams as below. They will do their best to ensure that any safeguarding issues are addressed before the patient is discharged and that any actions or plans are clearly documented especially if you feel it would not be safe to send the patient home. Please bear in mind that the work office hours so you should still highlight the concerns in your admission letter.
For Yeovil ring 01935 384256, or email safeguardingadults@YDH.uk for adults and safechildren@YDH.uk for children and unborn babies. For Musgrove Park email email@example.com for all safeguarding
GP Retention webinar: A recording of the event held last week can be found here.
COVID-19 & Racism in Medicine webinar 5 March 5.30-8.30PM: If any colleagues are free this evening this may be of interest, organised by the Cross Specialty Research Team regarding what COVID19 has shown us about Racism in Medicine and its impact on BAME communities. Speakers include BMA Chair Dr Chaand Nagpaul, Professor Mala Rao OBE Medical Adviser for (NHSE) , Professor Dr Anton Emmanuel (FRCP), Mr Nitin Shrotri, among others Last time the same team organised a similar event it was quite interactive which led to a very interesting discussion. Cisco Webex link Meeting number 174 186 9281 Password VbMYdDZQ382
Verification of death by Community Nurses: Truly ‘unexpected’ natural deaths should be verified by a GP as this is outside the remit of community nursing (CN) teams. In a recent review of an OOH clinical case, a GP appeared to coerce a CN into verifying an unexpected death and making the referral to the Coroner (via 101) when it was outside her sphere of competency to do so. Please do remember that community nurses cannot verify unexpected death and GPs place them in a vulnerable position, (and risk the wrath of the Coroner), by asking them to do so. Expected deaths can be verified by CNs of course, although in some cases only when the patient was already on their caseload and exclusions, (such as recent falls or invasive procedures) will apply. These exclusions can feel somewhat exasperating as they often have no direct bearing on the patient’s death and the CN is only being asked to verify death, not comment on the cause –but the CN is following rules laid down by her/his own organisation so any refusal needs to be seen in that context and should be respected.
Freestyle Libre 2: More from the PAMM. Somerset CCG was one of the first CCGs to approve Freestyle Libre (FL) and has some of the highest prescribing in the country, >1:5 of Type 1 diabetics. Funding by NHSEI (aka the Theresa May legacy) ends in April but SCCG remains committed to FL prescribing. FL 2 is now available with added alarm function and is now on EMIS. Patients will need to request a new reader or update the App on their phone. Before practices switching from FL to FL2 the MM team strongly recommend that practices ensure that patients have been using it appropriately with improvements in “time in range” and HbA1c. PAMM also recommend that requests for blood glucose testing strips from FL patients are reviewed at the same time and excessive quantities queried.
Prescribing & Medicines Management Prescribing Indicators 2021/22:
In come :
- Gliflozins as a % of gliflozins+gliptins – target 50%
- Solifenacin /oxybutynin 2.5mg/5mg tablets as % of all Anticholinergic incontinence drugs – target 65%
- Sip feed spend per 1000 patients – target to remain below £513/1000 patients (CCG average), or if above £513 at baseline then to reduce spend by at least 10%
- Inhixa as a % of all Enoxaparin prescriptions – target 50% (practices served by RUH will automatically be green as RUH does not discharge patients on this most economic brand… yet)
Out go :
- Alogliptin as % of all gliptins
- Generic alendronate as % bisphosphonate
- Reduction in Vitamin B compound prescribing
- Preferred sip feeds as % all sip feeds
Ta-Da! (-lafil): Tadalafil 5mg tablets once daily for lower urinary tract symptoms (LUTS)/Benign Prostatic Hyperplasia (BPH). This formulary application was a recommendation from the Urology team and has been approved at Somerset NHS Foundation Trust D&TC. PAMM added it to the formulary as a GREEN drug in February.
Transgender shared care letter of assurance: Patients with gender identity questions have to wait for years to be seen at a Gender Identity Clinic on the NHS and so often resorting to private providers. Colleagues of course wish to help their patients but often feel that doing so would mean practising outside their area of competence and so feel the need for assurance from any provider before agreeing to share care. We are grateful to Devon LMC and BMA GPC Gender Representative Dr Rachel Ali for this letter which has been shared through the SW Regional LMC which you may choose to use to the benefit of all parties in such cases.
TEP/ACP and Bad News: Jo Lutyens, Lucy Pollock, Rob Lutyens, Kate Shorthose, Janet Gillett, John Spearman, Tom MacConnell and Ed Hayes are the excellent teachers involved in two SGPET events on March 17th that will help you improve your skills in having difficult TEP, advance planning and bad news conversations with patients and families. You can book your place here
Looking after you: NHSEi have developed a new communications toolkit and resources to help promote these offers to the workforce. The toolkit has an overview of each offer, including bulletin, email and social media copy, and links to some case studies and posters. You can also follow this link Primary Care Coaching – Link to Assets to a range of resources, including social media assets, a video, PDF case studies and posters, website and email banners.
PAUSE- creating space for change: PAUSE helps women in Somerset who have had, or are at risk of having, repeated pregnancies that result in children having to be looked after. PAUSE tried to give women the opportunity to take back control of their lives by using a LARC (through SWISH) to break a destructive cycle that can cause them and their children deep trauma. The Nelson Trust is a voluntary service supporting women to take a break from pregnancy for 18 months. Please contact PAUSE if you remove a LARC from a woman under its care or if you have a patient who might benefit from this service.
Call 01278 557 730 / 07935 060 660
Address: The Nelson Trust Women’s Centre, 14 King Square, Bridgwater, TA6 3DG
Leaflet for Professionals
Practices may be interested in this offer via the LMCs buying group for Vaccine stamps.
Crown Medical Centre, Venture Way, Taunton, TA2 8QY
Tel: (01823) 331 428
Fax: (01823) 338 561
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