Somerset LMC Weekly Update Friday 7th January 2022
Date sent: Friday 7 January 2022
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- No Jab, No Job
- Home Oximetry Referral Criteria Change
- Recording Overseas Vaccinations in the National Booking Service
- Somerset Leads the Way on Boosters
- Coronavirus Act Easements
- Death of Patients in England Who Registered for the Data Opt-Out
- Vit B12 Prescribing - from November's PAMM
- Inclisiran Position Statement
- Camp Fires & Company
- And Finally...
- Job Vacancies
‘No Jab, No Job’: There is considerable uncertainty around this issue currently, such that we have asked Adrian Poole at Porter Dodson to advise. Adrian will be providing a guidance note, template letters and updated Contagious Diseases Policy in early January. Adrian’s initial advice is for practices to be on their guard. It appears that there are a number of legal challenges to the policy which might result in requests for vaccines to be responded to by legal letters before action. If ignored or answered the wrong way, this could result in practices unwittingly opening themselves up to liability. Adrian therefore advises that legal advice should be sought if responses of this nature are received. At present, there is at least the risk of claims of constructive dismissal, breach of contract and discrimination arising from the demand that staff be vaccinated. We are also in discussions with Adrian over providing online advice to reassure and guide. Watch this space.’
Home Oximetry Referral Criteria Change: This week the Home Oximetry/Virtual Ward and Covid Antiviral Delivery Unit changed its referral criteria to make sure it can monitor the most vulnerable patients in the face of rising cases and modelling that suggests the incidence may double the present rate before the end of the month. Expansion of the team should mean a daily capacity to monitor 750 people a day. The change also takes into account growing evidence that the Omicron variant is not proving as serious a disease as Delta in the vast majority of cases. It means that only all those over 75 and over 65s who are Clinically Extremely Vulnerable will be “onboarded” automatically when a positive test is notified. This does not mean that GPs need to triage all cases under 65 who are CEV but GPs can refer any about whom there are clinical concerns. Dr Matt Hayman and the team are happy to discuss any case and no-one that might benefit from monitoring will be rejected. pulseox@somersetft.nhs.uk
Recording Overseas Vaccinations in the National Booking Service: Eligible people can now book a face-to-face appointment via the National Booking system at a selected vaccination centre to show evidence of MHRA-approved COVID-19 vaccinations administered abroad and have them recorded in the National Immunisation Management System (NIMS). Support is also provided through 119 to signpost the service, or to make bookings on behalf of users. More information is provided when the user books an appointment.
Somerset Leads the Way on Boosters: Last week we heard that Somerset had vaccinated or offered a vaccine to 75% on those eligible putting among the top five CCGs in England.
Coronavirus Act Easements: A review of the Coronavirus Act 2020 and related provisions takes place every two months with a six-monthly Parliamentary review. The second six-monthly Parliamentary review has recently taken place and concluded that the easements relating to death certification and registration are retained. This means the guidance published in March 2020 remains in place at present.
Deaths of Patients in England Who Registered for the Data Opt-Out: Where patients registered with the national data opt-out before they died, GPs will not be able to share their medical records for medical examiner scrutiny in the non-statutory system. The information available suggests numbers will not be high and it is not expected that medical examiners will scrutinise deaths of patients which registered for the national data opt-out.
Vit B12 Prescribing - from November's PAMM: Due to covid, a number of patients were switched from I.M hydroxocobalamin 1mg/1ml solution for injection ampoules to oral cyanocobalamin. Somerset currently now has >1000 patients prescribed oral cyanocobalamin at an annual cost of £130,000. We would recommend that patients prescribed oral cyanocobalamin are reviewed and considered (depending on diagnosis/indication) for switching to IM Hydroxocobalamin 1mg/1ml 2-3 monthly. If all oral cyanocobalamin patients were able to switch this would save the NHS in Somerset >£100,000 per year. If however a clinical decision is made to keep the patient on oral cyanocobalamin then we would recommend consideration of 1mg per day dose (no clinical concerns exist in moving to this higher dose) as this would rule out the possibility of sub optimal dosing – ‘care must be taken if low dose oral cyanacobalamin is used as this risks suboptimal treatment of latent and emerging pernicious anaemia with possible inadequate treatment of neurological features.’
Please can we remind prescribers that the BSH guidance for non-dietary vitamin B12 deficiency is oral cyanocobalamin can be offered at a dose of 1mg per day until regular IM hydroxocobalamin can be resumed. Based on the current mixture of doses being used, moving to oral cyanocobalamin 1mg would also be cost saving on average compared to using 50mcg or 100mcg tablets and would ensure less risk of sub optimal dosing.
Inclisiran Position Statement: we would encourage practices to refer to a position statement from the General Practitioners’ Committee (GPC) and Royal College of General Practitioners (RCGP) following concerns raised about the proposed rollout of inclisiran in primary care.
Camp Fires & Company: Do read this interesting item from Dr Andrew Tresidder who is on the Well-being Group for the county. Don’t forget that the LMC also has a wealth of support and guidance when you need it.
And finally…
Norwegian GPs Really Are Good For You: In August the BJGP published the largest ever study conducted into continuity of care. Researchers at the University of Bergen had analysed the health records of 4.5m people – virtually the entire population of Norway – and looked at what patients derive from a long-standing relationship with their GP. After adjusting for various confounding factors, what they discovered was little short of astounding. Patients who’d had the same family doctor for many years were 30% less likely to use out-of-hours services; 30% less likely to be admitted to hospital as an emergency; and 25% less likely to die than people registered with their GP for under a year. The risk of needing emergency care or dying "[at least, we assume, during the study period?]” began to decrease once patients had been with the same doctor for as little as two years…Knowing and being known by your GP really is good for your health. (New Statesman)
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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