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Somerset LMC Weekly update Friday 14th October 2016

Date sent: Friday 14 October 2016

All Somerset GPs and Practice Managers                            This and previous updates can be found here

Apologies for war and peace this week!

PMS Contract  following on from recent discussions regarding the Primary Care Incentive Scheme which we have written separately about we feel PMS practices should be in a position now to consider signing their PMS contracts. As you will be remember this model contract was nationally negotiated between the GPC and NHSE.

From our own discussions including across LMC's in our region it is felt that clause 20.17 as it is worded is fairly ambiguous to allow practices flexibility in offering terms and conditions no less favourable based on the overall package to salaried GP's. Practices need to read and understand this contract as it is worded before signing and the LMC is happy to discuss any concerns.

Focus on funding and support for general practice this focus on document builds on the Humberside Group of Local Medical Committees Ltd document released in September

Administration of Methotrexate and other Immunomodifiers by Primary Care Staff A significant number of patients now self-administer injections of methotrexate and other immunomodifiers, such as certolizumab (Cimzia). Occasionally a specialist may ask that the GP arranges for a practice or community nurse to see a patient and administer the treatment  to him or her at home or in the surgery.  Please note that the CCG has confirmed that these agents are RED drugs (unless specifically rated differently in the Somerset Formulary) and that such requests should be politely declined.  There are a number or training , patient and staff  safety, disposal and clinical concerns about asking primary care nurses to undertake these injections, and if patients cannot self-administer it is up to the specialist department concerned either to arrange administration themselves, of move the patient to a suitable non-injected  therapy.

Post Exposure Prophylaxis for HIV in Somerset I am writing as we have become aware of some gaps in service provision and confusion around access for post exposure prophylaxis (PEP) for HIV (both sexual and occupational exposure) which we believe could negatively impact on health and wellbeing.   

We are working with clinicians within the HIV treatment service (commissioned by NHS England), the Somerset-wide Integrated Sexual Health (SWISH) service (commissioned by Somerset County Council), and NHS England to provide clarity regarding this at the earliest possible time and will be in touch as soon as we have a clearer pathway.

In the interim:

SWISH is commissioned by Somerset County Council to provide clinical support for PEP for sexual exposure (PEPSE); associated drug costs are the responsibility of NHS England (although this service is not currently being reimbursed for drug costs by NHS England in accordance with Specialist services circular 1622 dated April 2016).

The HIV treatment service does not currently stock PEP packs and we are keen to resolve this situation urgently. This is the responsibility of NHS England who commission HIV treatment services and drugs for PEP.

General practitioners are not trained in the initiation of PEP and are not able to access  the required drugs; therefore patients should not be referred to their GP for PEP.

SWISH are not commissioned to provide PEP for occupational health or community exposure (non-sexual health), and are not trained to administer for occupational health reasons. PEP for occupational health and community exposures should be risk assessed by an appropriately trained clinician and then PEP initiated. Occupational Health and/or A&E should complete the assessment, initiation and monitoring and are responsible for ensuring that staff are trained, and drug costs met by NHS England. It is not clear from national guidance whose responsibility this is, we would encourage all employers of staff at potential risk to seek assurance from their occupational health advisor of a robust pathway for their employees.

We are waiting for clarification from NHS England on access to PEP drugs for SWISH, the HIV treatment services and how services providing PEP for occupational health and community exposure can access support for administration. In the meantime if you have questions regarding this please can you contact NHS England direct:

Rod Walsh -

Nigel Andrews –

For enquiries regarding access to PEP for sexual exposure please contact SWISH on 0300 1245010.

This issue is not unique to Somerset, so please bear with us whilst we try to find a safe, accessible solution for patients

Trudi Grant Director of Public Health

PCSE Performance Monitoring May we remind practices that the GPC have asked for weekly reporting from LMCs, if you are able to complete the pro forma please return to the by Friday 14 Oct, Friday 21 Oct, and Friday 28 Oct.

LMC Buying Group New Suppliers

1.AKM Music - Royalty Free Music (thanks to LMC colleagues in Cornwall and Devon for the suggestion!)

2.GP Online – Vacancy Advertising and Medeconomics/MIMS Subscriptions

Full details


Kind Regards


Jill Hellens

Executive Director

Somerset LMC

TEL: 01823 331428

Fax:01823 338561

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