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Changes to the referral process for patient’s potentially eligible for Covid 19 treatment
- Triage and Prescribing of COVID treatments will change on 21st August 2023.
- Local Care Direct is commissioned to offer a community triage and prescribing service for high-risk adult patients in South Yorkshire
- Patients aged over 16 under adult services will contact their GP practice in-hours, or else NHS111 out of hours, to request a referral to the community triage and prescribing service. The contacted service (GP or 111) should refer the patient.
- Eligible patients who are unsuitable for oral treatment will be referred to their local Acute Trust by Local Care Direct.
- A record of clinical intervention will be sent to the patient’s registered GP once the triage and treatment process has been completed.
- Patients 16 or under with a paediatrician (including under 18’s still under paediatric care) will be treated by Sheffield Children’s Hospital via their paediatric specialist. They should not be referred to LCD but asked to contact their peadiatrician.
THE ROLE OF GP PRACTICES IN NEW LOCAL PATHWAYS
Eligible patients who contact your surgery with a positive Covid test result should be referred to Local Care Direct for triage and treatment by emailing CMDU@lcdwestyorks.nhs.uk containing:
- Name
- DOB
- NHS number
- Address
- Tel number (best contact)
- When the patient tested positive
- Symptoms
COVID treatments are currently classed as RED traffic light status – specialist use only in SY. GP practices should not prescribe COVID treatment to patients.
Oral COVID antivirals are now available through community pharmacy. At present seventeen community pharmacies across SY are to be commissioned to retain and provide oral COVID medication, and a list is available here on the ICB website under “Covid medicines supply service”.
CHILDREN AND YOUNG ADULTS
As oral COVID medications aren’t licensed for under 18s, treatment should be initiated by secondary care. For patients aged under 18 still under paediatric care, the patient/carer should contact their paediatric specialist for onward referral to Sheffield Children’s Hospital. All other patients (including those aged 16 and 17 without a paediatric specialist) should be referred to Local Care Direct by their GP practice or NHS 111.
ACCESS TO LATERAL FLOW TESTS
Eligible patients will continue to have free access to lateral flow tests via GOV.UK or 119. They can also now use tests purchased from a pharmacy or shop. They will not be able to report the result of privately-bought tests but this will not affect access to an assessment for treatment.
From 1 October 2023, the way patients access tests may change. Patients will be able to check www.nhs.uk/CovidTreatments for more information closer to the time.
FURTHER INFORMATION
The national webpages at https://www.nhs.uk/CovidTreatments will be kept up-to-date with new information. ICBs may also be making information available for patients on their own websites.
For more detailed information about eligibility, please refer to the NICE MTA.
An e-learning module on community-based COVID treatments is available on https://learninghub.nhs.uk/catalogue/Covidantiviraltreatment. This will provide an education and training resource to support safe and effective prescribing decisions.
Gynae fitting/refitting coils
A local practice reported instances where patients had been referred to Gynaecology for coils to be removed and new coils refitted. However, the patients concerned had the coils removed but were told to return to their GP for a new coil to be fitted. Doncaster LMC have spoken to department lead and it has been confirmed that a consultant had misinterpreted the agreement which had been put in place by the trust.
A reminder has been sent to colleagues in the department to ensure that if requested a coil is refitted at the clinic.
Relaunch of Return to Practice Programme
NHS England have relaunched the GP Return to Practice (RtP) Programme. It introduces the following improvements to the programme:
- A more flexible and streamlined programme offering personalised pathways built around the individual needs of each GP
- A less confusing programme for GPs with the closure of the multiple schemes that currently sit under the programme
- A move away from a “one size fits all” and the expectation that all domestic returners must undertake assessments and placements, particularly those GPs with breaks of less than 5 years
- Widening eligibility for the RCGP managed Portfolio Route to include some domestic returners that have been working in other clinical fields
- Offering mentorship to returning GPs either as additional support or instead of assessments/placements
- The option for GPs to access support to return under a defined scope of practice
- The option for returning GPs to undertake the programme whilst employed providing access to employment rights such as sick pay and annual leave for the first time
- Increased financial support with the monthly bursary for GPs rising to £4000 per month backdated to 1 April 2023
- A move to a self-declaration process for occupational health meaning that the majority of returners will no longer be required to arrange an occupational health check
- A reduction in bureaucracy and paperwork and a new online application system
Full details of the programme can be found on the Health Education England website Return to Practice | Medical Hub (hee.nhs.uk)
Enhancing Patient Safety Through Event-Based Learning
“Learning from patient safety events” represents a healthcare medical informatics solution designed to enhance patient safety by studying and drawing insights from previous patient safety incidents and occurrences. This system encompasses the following key elements:
1. Data Collection: The system actively gathers data concerning patient safety incidents, encompassing medication errors, surgical complications, falls, infections, and other adverse events that take place within healthcare environments.
2. Data Analysis: The collected data undergoes rigorous analysis to pinpoint recurring patterns, emerging trends, and underlying factors contributing to patient safety incidents.
3. Reporting and Feedback: The system generates comprehensive reports and provides constructive feedback to healthcare providers and institutions. These reports not only spotlight areas of concern but also offer recommendations for best practices and propose interventions to prevent future patient safety issues.
4. Continuous Enhancement: To underscore the “learning” component, the system facilitates an ongoing improvement process, ensuring that insights gained are implemented to enhance patient safety continuously.
5. Knowledge Sharing: Furthermore, the system serves as a collaborative platform for disseminating lessons learned and promoting best practices across various healthcare institutions, fostering a safety-oriented culture throughout the healthcare industry.
Homeless healthcare mythbusters
- You need an address to register with a GP
There has never been a requirement to have an address to register with a GP. There are lots of ways around this. For example, we use our practice address for many of our patients but you can also use the postcode ZZ99 3VZ “No fixed abode” – however, using the practice address is preferred.
- You need ID to register with a GP
You don’t need ID, an NHS number, or proof of address to register. Practices can ask for supporting documentation but can’t insist on it. If you don’t have a permanent address, you can still register using a temporary address or the address of the GP surgery.
- Homeless patients are hard to contact
Many homeless patients actually have temporary accommodation, jobs and live a “normal life” so are only as hard to contact as anyone else. Rough sleepers often have mobile phones, use community charging points and are happy to accept calls and messages. However, their lives are sometimes complex so it does take some effort to contact them. Telephone contact and keeping updated with phone numbers from hospital letters and other contacts, is often the best way to keep in touch.
- People experiencing homelessness create additional work
People experiencing homelessness have a significantly reduced life expectancy, they may have mental health and substance misuse issues, as well as long-term conditions. These are the people to whom we should give proportionately more of our time, as their health outcomes are worse.
Whether you know it or not, you’ll have people on your patient list who are homeless. That might be through a relationship break-up, it may be because of a cost-of-living increase, they may be sleeping on a friend’s couch, have moved back to their parents or are sleeping in their car. Being in a similar situation, where we might need additional help from healthcare services, is only a payday away for many of us.
- They need specialist care
The CQC suggest that good practice includes the following.
“When caring for patients who are homeless or are at risk of becoming homeless, you could consider:
- introducing double appointments
- keeping prescriptions for as short a duration as possible
- ensuring clear boundaries for consultations are in place
- giving fast access to a named GP
- waiving any charges for housing letters or medical reports.”
Tier 2 Dementia Awareness Training
Starting early September, project ECHO Team are offering 5 separate programmes each of 5 sessions covering essential skills for those caring for people living with dementia.
The programmes run weekly for 5 weeks, the same time and day each week:
You only need to sign up to one of the five programmes – booking link and QR Code for programme 1 can be found below. Or contact echo@hospicesheffield.co.uk
Programme 1 of 5
session dates and subjects all from 14:00-15:30
– Tuesday 5th Sep – Dementia identification, assessment, diagnosis & risk management
– Tuesday 12th Sep – Person-centred dementia care & the importance of families and carers
– Tuesday 19th Sep – Communication, interaction & behaviour in dementia care
– Tuesday 26th Sep – Living well including promoting health, independence and well-being in dementia care
– Tuesday 10th Oct – Equality, diversity & inclusion in dementia care- sexuality/Learning disabilities/cultural diversity
For more information or if you have any questions, please contact the Project ECHO team echo@hospicesheffield.co.uk
Partial Retirement
Following the Government’s consultation on retirement flexibilities earlier this year, partial retirement will be implemented from October 2023.
The BMA have queried the practical application of partial retirement for GPs with NHS BSA and they have replied: In respect of GPs and partial retirement, they must drop their commitment by at least 10% to meet the requirements. If they are a partner (type 1 GP) in a practice this can be achieved by adjusting their partnership share ratio, or for a single-handed GP they may take on a partner. As alluded to, this may be easier for a salaried GP (type 2 GP) as they just need to demonstrate a drop in their commitment, for example the number of appointments they do. For a salaried GP this could be reflected in a change in their contract with the practice. It is a little harder for Locums to demonstrate the 10% drop in commitment as they can choose whether to pension their GP Locum work and are effectively as and when. However, if they are able to demonstrate this then it may be possible for them to meet the requirements for partial retirement.
Further information on partial retirement can be found on the NHS BSA website Partial retirement | NHSBSA and they have also published an employer fact sheet and slide deck from a recent event held with pension administrators. Further NHS Employers guidance is still awaited, so it can be better understood exactly how partial retirement will be administered.
Accelerated Access to GP Held Patient Records
The GMS contract 2023-24 included an imposition of the roll out of prospective access to records. The regulations were amended by the government to make it more favourable to them and they removed clauses that helped opt out if the software was not adequate or workload too significant. The British Medical Association (BMA) looked at making a legal challenge to this imposition and certain aspects that caused concern around data governance, patient safety and the GP role as data controller. After external senior legal opinions were sought the BMA decided that the chances of success in such a legal action were low and did not justify the costs involved in such a case.
The BMA will be engaging with the government over improvements that could occur in the coming months before the intended rollout date of the end of October 2023. BMA guidance is available here Updated guidance on accelerated access to GP-held patient records (bma.org.uk) on next steps practices can take, and the BMA will be issuing more guidance around how to approach this programme and the perceived risks and wider concerns.
Access to healthcare for people seeking asylum in initial and contingency accommodation toolkit.
Doctors of the World have produced a toolkit Toolkit-for-ICBs-and-PC-commissioners-access-to-healthcare-for-asylum-accommodation-DOTW-2023.pdf (doctorsoftheworld.org.uk), which highlights key recommendations for Integrated Care Board (ICBs), primary care commissioners and providers in supporting access to initial health assessment and ongoing primary care services for people seeking asylum residing in Home Office initial and contingency accommodation.
The toolkit also provides:
- Links to useful resources, including a patient health questionnaire for people seeking asylum.
- Translated resources on navigating the NHS.
- Information on supporting GP practices to become Safe Surgeries to minimise barriers to accessing primary care and GP registration.
- A checklist for ICBs and GP practices.
- Case studies highlighting good practice from services meeting the needs of asylum seekers in England.
Process for registering a patient gender re-assignment
Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so. When a patient changes gender, the current process on NHS systems requires that they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to register their new gender on the clinical system, the practice must inform the patient that this will involve a new NHS number being issued for them. Subsequent changes to gender would involve a new NHS number. Please confirm this has been discussed with the patient when notifying PCSE.
LMC Buying Group
Doncaster LMC is been a member of the LMC Buying Groups Federation. This means that practices can access the discounts the Buying Group has negotiated on a wide range of products and services. If you’re not sure what the Buying Group is all about then this short video explains what they do: https://www.youtube.com/watch?v=FekMwFI5ILg.
By registering with the Buying Group: www.lmcbuyinggroups.co.uk/members/, you can view all the suppliers’ pricing, contact details and request quotes. The Buying Group also offers any member practice a free cost analysis which demonstrates how much money your practice could save just by swapping to buying group suppliers. Tel: 0115 979 6910 Email: info@lmcbuyinggroups.co.uk Website: www.lmcbuyinggroups.co.uk
