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Somerset LMC Weekly Update Friday 9th April 2021

Date sent: Friday 9 April 2021

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

AZ Oxford Vaccine: The LMC thinks you may find this link helpful in discussing the extremely rare side effects that may be linked to this safe and effective vaccine. Information for healthcare professionals on blood clotting following COVID-19 vaccination - GOV.UK ( Practices may also wish to use this text from the GPC on their websites.

Covid-19 Risk Assessment and Return to Work: The Society of Occupational Medicine has released some new guidance around return to work that managers may find useful: This is a direct link to the PDF.

BMA summary: NHS Planning Guidance 2021/22 and NHS Mandate 2021/22 (England): The BMA has produced a member summary of NHS England’s latest Planning Guidance for 2021/22, which sets out its expectations for NHS commissioners and providers in England over the coming year and for the recovery from Covid-19.
They have also responded to the publication of the planning guidance publicly here, and have welcomed the focus on staff wellbeing, recruitment and retention in the guidance, which echoes some of the priorities they set out in their recent paper Rest, recover, restore: Getting UK health services back on track.
The BMA has also called for a realistic approach to tackling the growing backlog of care given the scale of the challenge facing the NHS. Although it is positive that the planning guidance sets out relatively cautious timescales for increasing non-COVID care in the NHS over the coming six months. They have warned that offering financial incentives to raise activity levels could be counterproductive if this leads to healthcare workers being put under pressure to ramp up services too quickly.

NHS Standard Contract 2021/22 – New “interface” provision: Following reports from GPs regarding inconsistent implementation of NHS Standard Contract requirements on secondary care relationships with primary care BMA and NHSE have agreed a new contractual provision to improve collaboration. This requires that secondary care providers and commissioners assess by the end of September (and annually thereafter) their compliance with the interface requirements of the contract.  Commissioners and providers will have to agree an action plan (with LMC input) to address any deficiencies. Providers’ and commissioners’ governing bodies will have to adopt the plan publicly and progress on implementation will have to be reported to LMCs. 

DES directions and flu immunisations (England): The DES (Directed Enhanced Service). Directions have also been published. NHSE/I has decided not to include the revised Influenza Immunisation Scheme in this set of DES directions. This is due to the possibility of a COVID-19 booster programme running alongside the flu programme, and the need to look at potential operational considerations for providers. NHSE/I has made a commitment to discuss delivery of COVID-19 boosters and the impact on the flu campaign with GPC England once further information is available.
Note that practices should continue to plan to deliver the 2021/22 flu programme as per the letter from NHSE/I Medical Director Professor Steve Powis.

Educational vignettes: The Peninsula Paediatric Allergy Network covers the allergy units from Cornwall to Taunton and Dorchester. They are keen to engage with primary care and have created a series of educational vignettes for conditions often seen in their clinics. The second set covers cow’s milk protein allergy and allergic rhino-conjunctivitis (hay fever). These common conditions have an enormous impact on the lives of patients and families. Because of this it is worth investing in trials and early escalation of treatment meaning less intervention will be needed later down the line. The vignettes will also be on the SGPET website.
Allergic Rhinitis
Cow’s Milk Protein Allergy

Diabetics & Oramorph - From the PAMM: Despite flagging this back in September the number of diabetics prescribed Oramorph has risen not reduced. If Morphine is required we recommend Zomorph as the capsules can be opened and added to food etc. The sugar content of Oramorph will impact upon blood glucose and HbA1c, making control more difficult.  Similarly the alcohol content of oramorph can potentially interact with other medication. Shaun Green asked prescribers to consider these issues when reviewing Oramorph prescribing. Eclipse searches have been set up.

Updated B12 guidance - Pernicious anaemia - from the PAMM: Due to COVID there has been a significant increase in oral cyanocobalamin prescribing, particularly the 50mcg strength. Prescribers are reminded that the British Society for Haematology guidance for non-dietary vitamin B12 deficiency is that oral cyanocobalamin can be offered at a dose of 1mg per day until regular IM hydroxocobalamin can be resumed. Prescribers are asked to ensure that no patients have been moved to 50mcg inappropriately. 

Community pharmacy pandemic delivery service: There has been be a recent addition to the pharmacy pandemic delivery service which allows pharmacy contractors and dispensing doctors to support the delivery of prescriptions to people who have been told to self-isolate by NHS Test & Trace.  Pharmacists have reported that some, when told to self-isolate (particularly household contacts of positive patients), are not following the guidance and are still going to pharmacies. We suggest that all primary care providers flag the option to have medication delivered when prescribing for COVID-19 positive patients to try to ensure they and their households stay away from healthcare premises. 

Somerset Cancer Campaign: CCG Cancer Lead Angela Beattie writes: A cancer awareness campaign has been launched across Somerset because of the fall in 2 WW referrals especially for Lung, Skin, Breast and Head & Neck during the pandemic. Sadly, there have been more late stage, emergency presentations. In a BBC Points West item Dr Caroline Osborne, Breast Surgeon & Cancer Lead, YDH and Dr Beattie will encourage patients to contact their surgeries with concerns about cancer. Patients will also be encouraged to attend hospitals as many have deferred even 2 WW appointments for fear of COVID. This will lead to an unavoidable but temporary increase in work across the system.
It will be followed up with interviews on social media with HCPs including GPs and patients. The CCG will share more about public messages in coming weeks - but the key message will be that the NHS is open and to encourage people to make contact if they have symptoms which are new, worrying that could indicate cancer.

St Margaret’s virtual Tour: St Margaret’s have organised this event especially designed for GP Practices. A time for you to have a whistle stop tour of what they do & why they do it. Also,  to give the opportunity to have your say on what you think the model of future services from St Margaret’s should be looking to include. Joining details can be found here.

Coaching and mediation/Action learning sets: Somerset LMC are pleased to have engaged Yvonne Vigar from Astara coaching to offer these sessions which are fully funded and open to all Practice managers, deputies, operational managers and leads. For reasons of confidentiality we ask that members of the practice make contact with Yvonne direct to express an interest, full details can be found on the corresponding posters.
Coaching and Mentoring
Action Learning sets

Gypsy & Traveller Health – Lunch & Learn 28th April: As part of the CCG  monthly series of Lunch & Learn sessions, in April they will focus on the Gypsy, Roma and Traveller communities that either live in Somerset or travel through.
Somerset’s Gypsy Liaison Officers work closely with both nomadic communities and those who are settled on permanent sites or in “bricks and mortar”.  They will be talking about the various challenges and barriers to accessing health care within the county and offering guidance to providers and commissioners on how to better meet the needs of these communities.
The event will take place on Microsoft Teams at noon on 28 April 2021. Please Email to secure your place and gain access to the MS Teams link.

Remote surgery sessions with Veales Wasborough 11th May: Practices may remember the complimentary surgery sessions we held with Ros Lockhart from Lockharts solicitors at the LMC office that proved to be very popular. Since Lockharts merge with Veales Wasborough we have asked if these could be re- instated remotely until we can all meet again face to face, if you would like to book one of these sessions please complete the enquiry sheet and e mail direct to Sandeep Saib further detail here.


Kind Regards



Jill Hellens

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

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