How to survive 2023 (and beyond)
Patient Lists
NHSE/I has asked PCSE to recommence data quality checks on GP practice patients lists, this includes a reconciliation of practice patients lists. This work was paused during the COVID-19 pandemic but started again on Monday 1 August 2022. Although some targeted list reconciliation activity continued during the pandemic as essential groundwork for the decommissioning NHAIS, it has now been un-paused as a 3-year rolling cycle for all GP practices. The reconciliation checks the practice-held list with the NHAIS list held by PCSE. PCSE plan to start a new 12-month cycle, meaning a third of practice will be contacted over the next 12 months that have not previously had a reconciliation request. BMA raised their concern with NHSE/I that this is a bureaucratic burden for practices which will detract from practices’ capacity to provide patient care. They asked that the process be delayed until practices had their full complement of clinical and administrative workforce. Whilst NHSE/I have acknowledged and considered the points raised, they have declined the request, stating that the process will only affect a small proportion of practices nationally and that there will never be an ideal time to restart the process.
GP Pay transparency Update
In April 2022, amendments to the GP contract regulations were made that removed the requirement for individuals within scope of the general practice pay transparency provisions to make a self-declaration of their 2020/21 NHS earnings by 30 April 2022. Individuals within scope of the pay transparency provisions are not required to take any action in relation to their 2020/21 NHS earnings at this stage. Pay transparency remains part of the current regulations, however DHSC has confirmed that commissioners should not enforce the requirement at this time. Currently the individuals in scope of the regulations introduced in October 2021 will need to make a declaration of their 2021/2022 earnings in April 2023 as the provision remains in the GP contract.
The latest position on Pay Transparency is available on the NHSE website: NHS England » General Practice pay transparency
GPC are continuing to request further suspension of the requirement to declare earnings as they believe this is harmful to morale of the profession and could lead colleagues to reduce their working commitments or to retire.
GP workload and workforce
GP practices across the country continue to experience significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and has knock-on effects for patients. GP numbers are falling, with little increase in the overall number of GPs since 2015, and a significant decline in the number of GP partners over that time.
As shown by the latest GP practice workforce data, as of July 2022 there are now the equivalent of 1,857 fewer fully qualified full-time GPs compared to September 2015. This means that NHS has lost the equivalent of 51 full-time fully qualified GPs compared to the previous month (June 2022). This is despite the promises by the Government of an additional 6,000 GPs by 2024.
At the same time, the number of GP appointments remains high, with the July total of 26 million, of which 44.3% were same day appointments. Read more about the pressures in general practice here
General practice is under considerable strain and due to these pressures, GPs continue to leave the profession in larger numbers than ever before.
BMA are encouraging practices to control their workload to mitigate the impact of unsustainable demand and overworking. The Safe working in general practice guidance enables practices to prioritise safe patient care within the present bounds of their contract with the NHS. The BMA encourage practices to consider these suggestions for controlling their workload to ensure safe patient care, and better staff wellbeing could make a significant difference in the coming weeks and months. Please also take a moment to check in on your colleagues’ wellbeing and look out for each other.
The BMA is here for you and offers a range of wellbeing and support services for doctors, and we encourage anybody who is feeling under strain to seek support. You can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions. Call 0330 123 1245 today or visit the website for more information.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk
Contractual Status of Salaried GP Pay Uplift Recommendations
Following queries from practices regarding the contractual status of the latest Salaried GP pay uplift recommendation from the Doctors’ and Dentists’ Review Body (DDRB), the General Practitioners Committee (GPC) has issued guidance as follows:
- It is not the DDRB recommendations that are contractual, it is what the government of the day does with those recommendations. On this occasion they have adopted the 4.5% recommendation.
- From a General Medical Services (GMS) and Personal Medical Services (PMS) contractual perspective, independent contractors are obliged to provide the 4.5% uplift. This is set out in the regulations for both contracts, this being the GMS version:
- The contractor may only offer employment to a general medical practitioner on terms which are no less favourable than those contained in the document entitled “Model terms and conditions of service for a salaried general practitioner employed by a GMS practice” published by the British Medical Association and the NHS Confederation as item 1.2 of the supplementary documents to the GMS contract 2003.
The Salaried GP contract states:
- Your starting salary will be [£xx] per annum paid monthly in arrears by credit transfer, normally on the last day of each month. Your salary will be increased [insert 1 below].
Insert 1: ‘by annual increments on [incremental date] each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the Doctors’ and Dentists’ Review Body.’
School absence
In 2012, Doncaster LMC and the Doncaster Local Authority came to an agreement that a letter from a GP would not be classed as medical evidence to validate absence from school.
As such, Doncaster practices have been advised to decline to provide evidence for attendance at an appointment or for periods of illness.
This helps to free up vital capacity for patients who are ill and need appointments for assessment and treatment.
We remain grateful to the Doncaster Local Authority for understanding and appreciating the value of the NHS.
RCGP Faculty and Northern Region FREE events local to you
Please find below the latest events that the RCGP SYNT Faculty and the Northern region currently have organised in your area. These events are organised by your local RCGP and are there to support you with your continued personal/professional development and wellbeing.
Faculty Events
- Thursday 29 September – An introduction to greener, more sustainable primary care – For more information and to book online here
Northern Region Events
September
- Tuesday 20 September – Mindfulness & how to apply it as a GP – For more information and to book online here
- Wednesday 21 September – Resilient Practice – For more information and to book online here
October
- Wednesday 5 October – How to Manage Conflict – For more information and to book online here
- Wednesday 12 October – 10 ways to boost your mental health – For more information and to book online here
- Tuesday 18 October – Finance – Savings and Investments for GPs – For more information and to book online here
November
GP premises update
Two key policy developments – the Premises Cost Directions and the NHS England Ownership Review – have been due ‘any week now’ for some months. Either could have seismic implications for how the primary care estate is managed and funded, immediately and in the future. The BMA are monitoring developments closely and will communicate them widely.
While they await the arrival of these strategic-level publications, they have been resolving operational issues. They have been meeting regularly with NHS Property Services and Community Health Partnerships to resolve ongoing issues.
The BMA continue to engage with NHSE/I, most recently on the Housing Building Note 11-01 Facilities for primary and community care services, to be published shortly, and conveying their concerns about the 3 Facet Survey, emphasising the need to ensure a ‘light touch’ approach to gathering information about the primary care estate, and that practices should not have to submit any information that has already been collected.
The NHS PS case (Valley View v NHS Property Services Ltd [2022] EWHC 1393) is ongoing. In the meantime the BMA have produced FAQs outlining the key issues, and their relevance to practices, which will also be available on the BMA website shortly.
Inflation and your practice
GPs across England are grappling with increasing levels of inflation, sky-high fuel costs and the impact it is having on practice costs. The BMA are interested in learning more about how individual practices are experiencing inflationary cost pressures (eg gas and other utilities, staffing costs), so would value the opportunity to hear from you about this. Your contributions will better enable them, on behalf of the profession, to advocate and pressure NHSE/I, DHSC and the Government to seek solutions.
To share your experiences and help bolster the BMA’s evidence-based lobbying and influencing case for urgent general practice support, please get in touch with our independent contractor doctors team.
Cremetion Regulations - seeing the body after death
Please be reminded of the the following, associated with cremation
- The completion of Form ‘Cremation 4’ is a private service.
- GPs are not contractually obligated to complete “Form Cremation 4” if they do not wish to.
- Examination of the body is not required for completion of form ‘Cremation 4’ if the deceased was seen by a medical practitioner (including audiovisual/video consultation) in the 28 days before death.
- If the GP chooses to see the body after death, they may request for the body to moved to a more convenient location to reduce the time burden associated with this task.
Access to plain film imaging
This is a reminder that from 1st September 2022, open access for plain film imaging from primary care has returned. Patients can attend any of the three main sites (DRI, Mexborough and Bassetlaw) to have plain film x-rays undertaken as they did prior to the pandemic.
The opening times for this walk-in service are Monday to Sunday, 8.30am until 7pm. Waiting times for imaging will fluctuate depending on the number of patients using this walk-in service.
All referrals must be electronic via the ICE system. If patients fail to attend within six weeks of the referral, then it will be returned to the referrer as a DNA.
Any patients on the system up to 1st September 2022 will still be invited via appointment to attend the department to ensure that everyone is captured.
Edoxaban switch workstream
NHS England and NHS Improvement (NHSE&I) recommends LIXIANA® (edoxaban) as the first choice DOAC for patients with NVAF where clinically appropriate. The commissioning recommendations intend that any cost reductions released would allow more patients with AF and other CVDs to be diagnosed and treated.
The planned edoxaban workstream which included switching clinically appropriate patients diagnosed with Atrial Fibrillation (AF) in line with the Doncaster and Bassetlaw Area Formulary Guidance-Anticoagulation for stroke prevention in AF and the DOAC Review Pharmacist Protocol was put on hold in June 2022 due to two generic suppliers who have challenged the UK patents currently in place for the direct oral anticoagulant (DOAC), apixaban. These court proceedings resulted in one of the apixaban patents and SPC, that was held by patent holder, Bristol Myers Squibb (BMS), being declared invalid. However, implementation of the court decision is stayed (postponed) until either; a) BMS have not appealed prior to the deadline or b) the outcome of any appeal is determined. BMS has filed its application to seek permission to appeal to the Court of Appeal. There are no set timelines for the Court of Appeal to issue a decision and currently an appeal hearing has not been set. Typically, these processes take months to conclude, even if an expedited trial is requested and therefore, do not currently expect this to be resolved before mid-2023.
A generic version of apixaban has been made available to wholesalers from the end of May. However, it is important to note:
a. the generic version of apixaban has been made available at a small discount against the originator list price (i.e. nowhere near a typical generic discount of 80+%).
b. the generic version of apixaban has been launched within Category C of the Drug Tariff.
c. there is limited supply.
d. the above are not expected to change in the short term.
e. edoxaban remains the best value DOAC by a considerable margin.
A communication from Mark Perkins in June 2022 who is the Head of Strategic Category Management/Medicines Value Team stated that:
Neither the price at which the generic version of apixaban has been made available nor its limited supply justifies the NHS to change the existing commissioning recommendations that were issued in January 2022 and therefore, consistent with NICE guidance, we continue to recommend clinicians use edoxaban for new patients, where clinically appropriate. There are still as many as 600,000 extra patients across the country who could benefit from effective anticoagulation. This creates an opportunity to prevent thousands of potentially fatal stroke events over the next three years and therefore our commissioning recommendations for DOACs should continue to be implemented without delay