Somerset LMC Weekly Update Friday 13th January 2023
Date sent: Friday 13 January 2023
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- MD Soundbites!
- Primary Care Improvement Scheme (PCIS) Amendments – Childhood Immunisations and Vaccinations
- Microalbumin Samples (plea from the Lab)
- Somerset End Stage Heart Failure Guideline
- Anaemia in Pregnancy
- LARC Contract
- Occupational Health Assessments
- Preparing for Upcoming Funding for Advanced Practice
- Job Vacancies
Almost the middle of Jan and if you are feeling a little jaded already you are not alone! Early starts, late finish, dark mornings and rain, forget the work load pressure and the usual complexities of working in general practice I think we can all recognise difficulties. The weather may improve but the workload abating is some way off which is why I wrote this week to all the Somerset Practice Managers and Senior Partners asking for their support in collating data! If your eyes are rolling thinking data, how boring, please bear with me and read on ….
We are brilliant at ‘getting on with it’ but there is only so much we can do. This is why it is critically important that we capture what we are actually doing. Without data that evidences the activity in our general practices it is very difficult for our ICB leaders and ultimately the GPC and central government to be truly aware of the scale of the challenges we face. The LMC has been running a pilot involving seven practices in several PCNs since the 1st November 2022 to show our Opel status. From the 17th Jan we will be inviting all practices to contribute. The individual Opel status of each practice is NOT released to the ICB but it allows the LMC to start to understand with greater detail the activity and be better armed to negotiate for you. I very much hope I can give you further details next week. Nationally, the BMA are reporting that practices have never been so busy, the national data for December 2022 is published later this month – for more details on this here is a link to the e-mail from Kieran Sharrock – GPC England acting chair – worth a read.
With such pressure some practices are more than struggling as is almost every other aspect of health care. This is why we also need to be aware of other developments in our system. We all have clinical encounters when we wish that the support was more resilient. Just last week I spent 2 hours of my day visiting and co-ordinating care for a frail patient, only to find that a well meaning neighbour called 999 and he was admitted. Only yesterday I visited a lady who desperately needs care but there is no capacity for that to be delivered. None of these scenarios are new to you, but more of the same will I fear just give us the same outcomes. We therefore have to think differently about community care. There is some very exciting work being delivered in our complex care and H@H teams, aiming to deliver care for our patients as close to home as possible to lead to better outcomes. As specialist generalists we are very good at this which is why some of you may want to have a greater role. Some of my clinical colleagues have expressed an interest in working with frailty and H@H teams – if this is you and you want to know more please just e-mail me firstname.lastname@example.org.
We had a productive meeting with the ICB on Thursday and a confirmed agreement on the practice winter resilience funding will be with us by the close of play next week if not before, more news very soon.
What you are doing is not easy, especially at this time. Everyone at the LMC recognises that. If you can help us capture the data we can do better in facilitating change and if you have an interest in knowing more about H@H and the role you can play just get in touch. Until next time.
Primary Care Improvement Scheme (PCIS) Amendments – Childhood Immunisations and Vaccinations: National changes have had a significant negative impact on funding for some practices. The LMC has negotiated a local change with the ICB which will help stabilise funding for all practices. This change will be in effect from 1/10/22-30/09/23 after which a further review will take place. Click here for the detail of the additions being made. This is in addition to the 3% uplift to the full contract negotiated in October.
Opiates: Somerset Drugs and Alcohol Service (SDAS) and Somerset Community Pain Management Service (SCPMS) are offering a new combined service starting in January 2023 for patients whom are wanting to reduce their opiates. The referral criteria for this service is found here.
The pathway for the service is as follows:
- Appropriate referrals are sent via e-Referrals to the Somerset Community Pain Management Service and the referral needs to specify that this combined service of SDAS/SCPMS is required.
- They will be triaged accordingly to an MDT process where the patient is discussed with SDAS and SCPMS colleagues.
- The patient is then offered a 1:1 outpatient appointment (telephone/ video/ F2F in Yeovil).
- The patient is offered a mindfulness-based programme tailored for opiate reduction and managing pain, then has a 1:1 at the end.
- There is also the opportunity to be seen in either SDAS or SCPMS as an alternative.
Microalbumin Samples (plea from the Lab): Where it is feasible, could all GP surgeries take aliquots of 50ml universal MALB urine samples. Please use the specialist MALB kits that are available to request from SPS Stores team on 01823 346734.
Somerset End Stage Heart Failure Guideline: There is now a Somerset End Stage Heart Failure guideline offering practical guidance on palliative care management of heart failure. It includes information on prognosis, medication, planning ahead and ICD deactivation. It can be accessed here.
Anaemia in Pregnancy: SFT has recently lowered the levels to start iron. It is summarised here and it is in line with UK guidelines on the management of iron deficiency in pregnancy (wiley.com). We are aware of concern from some practices that this may increase GP workload, but it continues to remain the responsibility of the midwife to order and action bloods on booking and 28 week bloods. If this is not the case, please contact the LMC.
LARC Contract: We are aware that a new contract has been sent out to practices in the past week, this was not discussed with the LMC and we are currently in contact with the council to discuss some aspects of concern and the possibility of an uplift, may we suggest that practices do not sign the contract before we have had those discussions and fed back to you all.
Occupational Health Assessments: Dr Andrew Tresidder from Practitioner Health has highlighted that GPs are returning to work after a period of absence from stress or mental health issues without an occupational health assessment. The LMC fully supports recommending that practitioners should have a full occupational health assessment of self and workplace prior to returning after a period of absence. This is best practice and is protective both to the individual and to the NHS in Somerset. Without this safeguard, issues may be perpetuated or not addressed, with subsequent problems with health and performance. Such assessments provide an objective assessment and advice can be given to ensure a successful return to work. After this, it would be about the practice and GP implementing the advice. Funded assessments are available through Heales Medical – Leading Innovation in Occupational Health Care.
Preparing for Upcoming Funding for Advanced Practice: The South West Faculty for Advancing Practice has updated their funding handbook for 2023/24, alongside a Frequently Asked Questions document. Both are now live and available on the Faculty website where additional relevant information can also be found. The handbook details the funding offer for Advanced Practice training that will be available for 2023/24, and the annual demand scoping survey (application) for this funding will open on 1 February 2023 for six weeks. The survey link will be circulated closer to this date.
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