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Somerset weekly Update friday 19th June 2015

Date sent: Friday 19 June 2015

Sent to all Somerset GPs and Practice Managers

Health & Safety session on 1st July, spaces are still available please book your place at

Follow up after Bariatric Surgery.  Below is an email the LMC have sent to the CCG regarding the new suggested protocol for these patient’s.  The LMC do not consider this core work for the reasons stated in the email and we have requested that this be looked and resolved as soon as possible. In the meantime we suggest that you write back to the service who have requested such follow up and advise that they will need to arrange the tests themselves.

We note that these are guidelines produced by the Trust, so far as we can tell without any involvement of  primary care, but directed at “clinical staff in Somerset and the Southwest”.  Clearly it will up to the CCG (in discussion with Specialist Commissioning if they are still responsible for the service) to decide whether and how they wish to commission follow up care for these patients. 

The LMC believes that the vitamins and mineral recommended should probably be regarded as food supplements and therefore not be prescribed by the NHS.  The recommendation for intramuscular Vitamin B12 may complicate this, though it is possible to take this orally, albeit in large doses. However, because these supplements are prophylactic and not for the treatment of an established disease, we believe providing them does not fall within the core GMS contract.

Follow up blood testing for bariatric patients is more complicated than simply arranging blood samples on behalf of the responsible  secondary care provider, and the additional tests suggested, including  blood zinc, selenium and copper levels are certainly not investigations that are normally initiated in primary care. GPs do not have sufficient knowledge in this specialist field to safely interpret the results and, where required, arrange corrective treatment.

We are not sure if anyone has considered the long term cost implications of this lifelong testing regime or whether it is included in the health economic analysis of the value of bariatric surgery procedures.

Dispensing and nursing homes Residents of a nursing home, who are patients of a dispensing practice, have the choice to be dispensing patients and receive their medication from their practice or be registered as non-dispensing patients and have their medication dispensed by a pharmacy. It is the patients’ choice and not the nursing home’s decision or right to change patients’ status.

 There are clinical implications and consequences if such a change is made. Recently there was a safeguarding issue of a patient in a nursing home who had been converted to non-dispensing without her consent or knowledge. Medication issued by her GP was delayed in being dispensed to her by a pharmacy. If she had been a dispensing patient, there would not have been any delay in her receiving her medication as part of her end-of-life care.

Dispensing practices should also be mindful that they should not be dispensing to these non-dispensing patients for the convenience of the nursing homes and sometimes even for the patient’s convenience.  Antibiotics needing to be dispensed at the end of the day do not meet requirements to breach the regulations.

Further discussion with the CCG and safeguarding leads shall be taking place to discuss patients in nursing homes having their choice removed, but in the meantime dispensing practices - please do not dispense to non-dispensing patients.

Dr Nick Chapman Dispensing lead Somerset LMC

PMS reviews PMS Practices will be aware that it is a National requirement with plans to be in place by 1st April 2016.  Somerset is fortunate in that the PCT undertook these reviews in their final days so much of the work that other areas will need to do will not be required. However one the biggest problems last time the review happened was the disparity between PCT and Practice figures and we expect this to happen again,  those figures are  currently awaited. It is planned that it will be a graduated change (if any) once again over 5 years. The Area Team is not aiming to necessarily remove payments from Practices but would want to see ‘added value’ for any extra monies received over and above GMS. We are currently talking to the Area Team and the CCG, the LMC still hold all the detail from previous negotiations.

If you do have any queries please send these to  the GPC have also just realised a guidance note on PMS reviews and a transition to GMS which can be found here

FOI Request Care.Data Update The CCG have advised that further information will be available on this request early next week, still well within the 20 day deadline for practices to reply.