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Somerset LMC weekly Update Friday 18th November 2016

Date sent: Friday 18 November 2016

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

                                                                                    General Practice in Somerset Great Place great potential

Flu Immunisation Update We’ve had encouraging provisional figures for flu immunisation uptake in the county that suggest an improvement of coverage in all target groups compared with this time last year.   As of 9th November Somerset community pharmacies had immunised  a little over 8,000 patients, up on last year’s number but still likely to be in single figures as a percentage of the total. So, if practices maintain their current performance  we anticipate many will undertake more immunisations this year than last, despite the competition, and both numerical and percentage protection of vulnerable groups will improve.   Across the Region as a whole  coverage is relatively less good for  under 65s at risk and  children aged 2-4  so these cohorts may merit particular attention.    Thank you all for your efforts.

There has been some concern that young carers are  not coming forward for immunisation or may not be identified by practices as eligible, so those that are willing to have  a flu jab may present to the practice with a letter identifying the bearer  as a  carer and asking for her or him to be offered flu immunisation, Please ask you reception staff to keep a look out for these  and to offer a convenient appointment wherever possible – ideally before the young person leaves the premises!

The LMC and LPC are particularly interested to hear about any patients who are inadvertently immunised twice.  Although  both the number and risk of harm are likely to be small, it would be helpful to know if we need to modify publicity material or patient information for next year.

The supplementary “alliance “ contract devised by the two committees  and supported by NHS England locally is probably too late for implementation this year, but we hope something along these lines will be available next immunisation season.

Finally, please can practice managers make sure that  their practice return on the immunisation of  front line healthcare  workers is submitted in the next reporting window (1st to 9th December)  The Flu  Immunisation Planning Group  only has information from a small percentage so far, which make the data difficult to interpret.

Amended BMA Guidance on Firearms  Notifications from the Police Following some  comments made by a coroner about the previous  BMA advice, the Association has  obtained a legal opinion which  suggested that the   guidance could have left the BMA and GPs vulnerable legally.  New  interim guidance  has now been  posted that  concludes by saying:

"GPs must engage in the process of firearms licensing when requested to do so. Failure to do so could place them at professional risk. In terms of their contractual obligations, GPs must cooperate with and facilitate statutory functions relating to the process. The contract also sets out that a reasonable fee may be demanded for the services provided as part of that process. The demand for a reasonable fee may form a condition, which if not fulfilled, means the GP can refuse to engage further in the firearms certification process. A GP may have a genuine conscientious objection, in which case and subject to GMC guidance they should refer the patient appropriately."

To put this in plain language, it means that the GP must engage with the process and must reply to the police.

The LMC suggests that in all cases this reply should  state that you are not an expert in the diagnosis of mental  illness  or personality disorder, and cannot offer any firm  assurance that the person is not a risk to themselves or others.  There may be circumstances under which you may then wish to provide further information from the medical record or your knowledge of the patient   without a charge, but equally you may offer to provide a report for a fee. The GPC Executive member responsible for this area has said of the new guidance

“If the police refuse to pay that fee then the GP may withhold his/her report. (The new guidance) does not therefore equate to providing the police with free reports.  We will now work on a clear FAQs sheet to explain in simple terms the practical advice that doctors should follow when they receive a firearms communication from the police.

The GPC Exec team are also conscious that there are other questions regarding competence, and also the slightly paradoxical outcomes of the advice relating to conscientious objection, that require further legal opinion. We shall therefore be writing to the Home Office to express our concerns regarding the safety and robustness of this process and to explore “non fee” issues.”

Note that If a practitioner declines to provide information on the grounds if conscience, it is still  his or her responsibility to refer the applicant to someone else who is willing and able to do so. Full BMA Guidance

Ambulance Response to  "Red Flag" Sepsis Admission Request Some GPs have expressed a concern that the Ambulance Service is not giving a high enough priority to  admission requests for patients with red flags for acute sepsis. We  presume that this is because of the piloting  of their new dispatch priority system  and it is likely to be corrected, but should you feel that an urgent sepsis admission has been delayed for this reason, please let the CCG know using the reporting button on your desktop.

PSU Update As you will be aware, the LMC operates a Practice Support Unit (PSU) which aims to provide access to specialist advisors (including legal and accountancy) in respect of the challenge associated with new methods of working. The PSU section of the website has a number of template documents for use by members, together with guidance notes to assist practices make sense of their options.You do need to be a member of the PSU and be logged onto the website to view these

Such documents come with the disclaimer however that they are templates only and are therefore drafted generally. Neither the LMC nor the professional authors of those documents can accept liability for their use without professional advice specific to the circumstances in question being sought. Every situation is different and likely to evolve over time.

Recent PSU activities include discussions with a variety of stakeholders over alternative ways of working and contract-holding. These conversations will be continuing in order to hopefully get to a position where individual or groups of practices are not in the position of doing the same things, and grappling with the same issues, in isolation.

There have also been attendances and presentations by Adrian Poole of Porter Dodson at events aimed at looking at the options open to practices, including the opportunities and threats presented by the various horizontal and vertical integration models.

The PSU is currently looking at developing a template contract for employed pharmacists as well as answering questions posed by practices relevant to the sector as a whole. Those questions are being collated and will be added to a Frequently Asked Questions section to the website in due course.

If you have any questions for the PSU, or feel that it would be relevant to have any other PSU input, then please raise that request or query with us at the LMC by email. A simple question will in all likelihood be answered by return of email, but a more substantial request will need to be assessed. This will involve deciding whether the enquiry has countywide relevance to general practice so to determine whether it is eligible for PSU support/funding. This should not however deter you making a request – the PSU is there to support you!

Kind Regards


Jill Hellens

Executive Director

Somerset LMC

TEL: 01823 331428

Fax:01823 338561

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General Practice In Somerset Great Place Great Potential


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