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Somerset LMC Weekly Update Friday 8th December 2023

Date sent: Friday 8 December 2023

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

Clinical News/Updates

Licensing of Anastrozole for Primary Prevention of Breast Cancer: We would like to highlight that with the changes explained below, anastrozole remains an amber drug and any prescribing needs to be initiated from the family history service to discuss options. 

The national multi-agency Medicines Repurposing Programme secured a MHRA licence variation for anastrozole on 6 November (news). Anastrozole’s marketing authorisation now includes a new indication of primary prevention of breast cancer in postmenopausal women at moderate or high risk. The new indication mirrors the pre-existing NICE guideline recommendation from 2017 familial breast cancer guideline CG164, whereby the uptake for its off-label use has been low.

The NICE guideline has been updated to reflect that anastrozole is now licensed for prevention. Recommendations | Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer | Guidance | NICE. Additional resources that maybe useful for assessing risk until local/ national guidance is established include: Family history: Assessing your breast cancer risk | Breast Cancer Now and CG164 Familial breast cancer: Patient decision aid user guide for healthcare professionals 16/11/2023 (

Important Information for Action Fluenz® Tetra - Vaccine Update: Astra Zeneca have reduced the shelf life of 6 batches of Fluenz Tetra issued between 30 August and 13 October 2023 by 5days as a precautionary measure due to the result of routine stability testing. They have updated expiry dates for specific batches of Fluenz Tetra® and issued a product recall. Please follow this link to the full details on our website.

National Medical Examiner System Roll out in Primary Care Somerset: The Medical Examiner System is a national pathway to ensure all deaths not under coronial jurisdiction, are reviewed by an independent Medical Examiner. The system will become statutory in April 2024. If your practice is not yet referring deaths via the service, please contact Helen Waldon (formerly Gilliland) for more information on the processes by emailing
The Somerset Medical Examiner Service (SMES) have produced some useful slides on Certification of death along with the ‘Workflow for referral to Somerset Medical Examiner Service’ and a summary of the information that is sent to relatives, see below.
Certification of death poster 1
Certification of death poster 2
Workflow for GP referrals
ME letter for relatives

The LMC will help by sharing relevant information about the service in 2024.

Information for GP Partners/Salaried/Locums/Practice Managers

Partnership Agreements: We are aware that many practices struggle with partnership agreements with many complaining that they are difficult to navigate and often impossible to understand, whilst also being very expensive. As an LMC we have commissioned a template partnership agreement from Adrian Poole which will be in plain English and will be available early in the New Year. It will come with the general disclaimer that specific advice should be obtained on its use, but the aim is to have something which is readily available and which will avoid unnecessary expense for all.

Minor Improvement Grant Expressions of Interest for 2024/25 Being Accepted Now:  Practices will have seen in a recent ICB update that they are now accepting expressions of interest for commissioners application for capital in 2024/25. The EOI must only include projects/works that have not already been contracted or undertaken, and must be submitted by the 10th January 2024. We are aware many of our practices are tight on space and several have contacted the LMC in the past about accessing funding for improvements so please do submit a proposal after reading the eligibility criteria documents.

Locum GPs Reporting Reduced Opportunities: In Katie Bramwell-Stainer's (GPC Chairman) key note speech at the LMCs conference she drew attention to where funding is landing, and where investment is being focused, almost every practice is experiencing a cashflow crisis. The GPC concern is that this represents the perfect storm leaving Locum GPs with reduced opportunities for work. Are you a GP Locum who is worried for their future? Tell us in our survey today, and please share among your Locum networks to provide the BMA with evidence to take forward.

BMA GP Committee England's Finance Survey: We are at a critical point in 2024/25 negotiations – we need all practice managers in England to complete the BMA GP committee England’s finance survey. You will have seen last week’s full GP profession survey; now this is your opportunity to demonstrate the increasing impact of inflation and rising costs on English GP practices over the past 12 months.
You will need the practice’s set of GP accounts for 2021/22 and 2022/23, as well as expenditure data for October 2022 and October 2023 together with information on how many staff the practice employs. The survey should take between 20-30 minutes to complete - survey link here
The closing time/date is midnight on 3rd January 2024. Should you wish to follow up with any further feedback, please share it via


IR (ME)R Training: The LMC has received some queries on how often non-medical referrers should update their training, there is a requirement for all NMRs to update their IR(ME)R training every 3 years by completing Radiation Regulations updates through E learning for health. SFT are also checking for compliance with this, please could all NMRs check their compliance as this is a legal requirement under IRMER and failure to update may result in removal from the NMR register. Any queries please do contact Full detail was shared in our update in June please see here.

Safe Working - Online Discussion Group with GPC Representative Dr Paul Hynam: Following recent updates to the BMA’s Safe Working Guidance, we have been running a series of online update sessions to explore the practical implications of delivering a safe service. These one hour sessions are fully interactive and provide a safe space to discuss the pros and cons of the various measures being proposed. They are not being recorded. There will be a maximum of 20 participants per session and are for Somerset GPs and practice managers only.
The last session is next week via MS Teams on Thursday 14th December 19.00-20.00 (book online).

As you will see above we are trialling a new layout for the weekly update this week, please let us know your thoughts by emailing

Kind regards


Jill Hellens

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

Tel: (01823) 331 428            
Fax: (01823) 338 561
eneral Practice in Somerset Great Place Great Potential

We have updated our privacy policies on both the Somerset LMC and Somerset GP Education Trust websites.

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