Avon LMCs Newsletter on 06-11-24

---

The ALMC Newsletter

Welcome to our weekly newsletter, sharing the latest news and topics of interest for practices.

---

– LATEST NEWS –

---

I would like to wish colleagues a Happy belated Diwali for last week and I hope you enjoyed your celebrations.

It was lovely for me to spend a few days walking the Cami de Ronda coastal trail for the half-term break and I have included some pictures of this stunning area. Thankfully, we left just before the devastating floods hit Valencia, and my thoughts are with all those people who have lost loved ones.

Back in the Avon area, our first phase of GP Collective Action went live at the start of this week with two major changes:

• The use of a single, generic referral form for the vast majority of referrals
• The unified pushback of workload transfer from other providers

The impact of the recent budget on general practice is likely to be a key driver for implementing collective action, as there is no guarantee that the changes in the national living wage and national insurance will be reimbursed within the 2025 GP contract. Early financial modelling shows that many practices would become unviable if there are no contractual mitigations in place, so this is being pushed hard at a national level.

GPs cannot pass their increased costs to their “customers” like any other business. All we can do is provide less with the existing funding: fewer appointments, less bureaucracy, less of other people’s work. This is what collective action is all about – taking back control of our workload so it matches the level of funding offered within the contract. 

“Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent.” – Carl Sandburg

Dr Shaba Nabi
Chair Avon LMC

If you have any questions or feedback about GP Collective Action, or anything else you wish to discuss, then please do join us for an hour for this virtual lunchtime drop-in.

To register your interest and receive an invite, please complete this registration form. 

As of 4th November, we entered our first phase of collective action which includes:

• The use of a single, generic referral form for the vast majority of referrals
• The unified pushback of workload transfer from other providers

As always, please check the Avon LMC Collective Action webpage for the source of information as this is the central point for any updates. It is also beneficial to share the video embedded slide set with your entire practice team, previously emailed to practice managers.

Single, Generic Referral Form
Avon LMC encourages you to use the ICB BNSSG Standard Referral Form Template embedded in EMIS, which can be found using the keyword “standard” in the documents search. The form has been approved by the LMC and GPCB and populates key patient information.
The LMC RAG rating document (found on the webpage) highlights important inclusion/exclusion criteria for a referral, as well as situations when the specific referral should be used.
There are two reasons why your referral may be rejected by the provider:

1. It is not clear if it fulfils the criteria for referral
2. The specific provider form is not used

Avon LMC is working closely with the BNSSG Referral Support Service during this period of collective action. They will helpfully liaise with practices to ensure the smooth handover of patient referrals from general practice to other providers.

However, if a referral is rejected for no reason other than the format of the referral form, we would encourage practices to pushback on this using the template letter we have produced:
Please download here.

This template letter for referral rejections can also be found on the collective action webpage and will be embedded into EMIS in due course.

Pushback of workload transfer
There are two template letters for this in EMIS; one for prescribing and one for all other workload transfer, and they can be found by using the keyword “LMC” in the documents search.

The workload transfer letter has recently been edited within the collective action webpage to include the fact that private providers should make their own onward NHS referrals, according to the 2024 BNSSG Access policy.

If you are faced with any challenges with the pushback of workload transfer, please email us at info@almc.co.uk

Prescribing queries relating to Collective Action
We have received a number of queries around prescribing and collective action which we have responded to individually. Thanks to Dr Susie Carey, GP Partner at Pioneer Medical Group, for her input with collating these.

It is important to acknowledge and highlight some of the nuance in these decisions.

Prescribing Request	LMC Guidance
Clinic BP is high, and practice asked to consider optimising BP treatment	A high BP reading in clinic may be an isolated reading, so it seems reasonable to monitor this using home readings or repeats at the practice (encouraging self-care)
Non-prescribing clinicians asking us to start treatment. (eg: chest pain clinic, mental health, dementia services)	General Practice does not have the capacity to complete prescription requests on behalf of other providers who use non-prescribing clinicians within their pathways
Community midwives requesting aspirin or high dose folic acid	This is a contractual requirement for those practices signed up to the supplementary basket of services contract. However, it does not include provision of prescriptions for hospital midwives.
Medication advised as part of the Advice and Guidance Service	Patient remains under the care of general practice so prescribing is their responsibility. However, engagement with Advice and Guidance is not mandatory.
Sirona wound care service requesting a prescription (eg: antibiotics)	It is reasonable for general practice to complete this request as the patient remains under its care

Q: A nurse in our practice requires Cervical Smear training. Can the LMC help with this?
 
A: Avon LMC has been able to obtain funding for up to 40 places for nurses in the BNSSG area to facilitate the Cervical Smear training up to March 2025.  We will be sending out more details – so watch this space!

• From April 2025, the rate of Employer National Insurance contribution will increase by 1.2% to 15%
• Employer secondary threshold has been reduced (level at which employers become liable to pay national insurance on each employee salary) from £9,100 to £5,000 per annum
• The National Living wage will rise to £12.21 for those over the age of 21 and to £10 for those aged 18 – 20

The above changes will have a huge impact on practices, depending on their staffing demographics. BBO LMCs have produced some helpful information for their membership, they are willing to share, as follows:

There is no quick way of working out your liability from this issue, as it depends on a lot of variables. Please consider the following:

– The number one exacerbating factor is *Minimum Wage* – The more staff you have on the current minimum wage or below the proposed new minimum wage, the worse you will be hit

– Also, the drop of Employer NIC threshold from £9.1k to £5k is a significant factor. Ergo, if you have a lot of part-time low earning staff, you will be harder hit.

– For example, a FTE staff member on minimum wage will cost a practice an extra £2.5k per year which is a >10% increase, not including pension

– A part-time staff member on 15hrs a week on minimum wage will cost an extra £1.3k a year, which is an increase of >14% not including pension

Bottom line = Please carefully calculate your liability by looking at all your staff costs collectively, rather than relying on any simple calculations.

The BMA are creating a validated detailed calculator which will be out hopefully this coming week.

The BMA briefing document on the budget can be found here:
Autumn Budget 2024: BMA member briefing

The BMA has also shared a statement specific to general practice: https://www.bma.org.uk/bma-media-centre/we-could-see-gp-practices-closing-if-they-are-made-to-pay-higher-ni-contributions-bma-warns-government

>We need action from the profession **today** on NICs
>GPCE writing formally to SoS & Ministers
>YOU need to back this up & write to your MP too – mount the pressure!
>Copy and paste the below
>Find their email here: https://members.parliament.uk/members/Commons
 
(obviously amend wording if Darren Jones is your MP for Bristol North and West)
Dear <insert MP>_

 
I am writing to flag a profound concern around NHS GP Practices and the Autumn Statement announcements on Employers’ NICs.

We have lost over 1000 NHS GP practices in the past decade. If Darren Jones’ comments on BBC Question Time are correct, we shall see many more hand back their contracts overnight.

NHS GP Practices are excluded from employer support for small businesses – and previous Conservative governments have offered full recovery for NICs rises. GPs are very clearly defined in the past 25 years of law as “public authorities”. The assertion by Darren Jones above flies in the face of various legislation, including:

– Freedom of Information Act
– The Equalities Act
– GDPR
– IR35
 
Presumably Treasury do not intend to amend hundreds of pieces of major legislation in order to claim an extra 1.2%? Such poorly thought through comments are sending us into a tailspin. This needs absolute clarity as soon as possible.

Likewise, the methodology for recent uplifts is out of date and has failed to deliver. Any repeat of a Global Sum % uplift will not work with the NICs change proposed, because of the ‘fixed per employee’ element. The Association of Specialist Medical Accountants has flagged this concern too.

Treasury and DHSC need to take immediate steps to correct Mr Jones’ comments and assure the profession that they have no intention of threatening the viability of thousands of NHS GP Practices, lest Labour kills the family doctor.

Yours
<Insert name>

Read the latest GPC England bulletin here.

Looking for a professional, convenient, and fully-equipped meeting space for your next gathering? ALMC is thrilled to offer our meeting and small conference rooms for your booking needs.

What we provide:

• Spacious and comfortable meeting rooms
• Audio-visual equipment
• Internet connection provided
• Welcoming, professional atmosphere
• Convenient location
• Refreshments available upon request
• Lunch can be provided at an additional cost

Please visit here to find out more.

• 12th November 2024: Virtual LMC drop in, 13.00 – 14.00
• 22nd November 2024: England LMC Conference – London, all day
• 14th January 2025: Virtual LMC drop in, 13.00 – 14.00
• 11th March 2025: Virtual LMC drop in, 13.00 – 14.00

• Tuesday  05 November General practice bulletin (mailchi.mp)
• Thursday 31 October General practice bulletin (mailchi.mp)

---

– LATEST TRAINING AND EVENTS –

---

• Women’s Health Event: Contraception Councelling
  Thursday, 7th November from 13.00-14.00
  Sign-up Form
• From Insomnia to Apnea: A Primary Care Guide to Sleep
  Wednesday, 13th November from 13.00-14.40
  Sign-up Form
• BCYP EduForum: UTIs and other Paediatric Nephrology
  Tuesday,19th November from 13.00-13.30
  Sign-up Form
• Menopause Learning Event for Clinical Pharmacists and Pharmacy Technicians
  Thursday, 21st November from 13.00-14.00
  Sign-up Form
• BNSSG Cancer Lead GP Forum
  Thursday, 21st November from 12.45-14.00
  Sign-up Form
• Dermoscopy Training – Part 3
  Thursday, 21st November from 13.00-17.00
  Sign-up Form
• Breast Awareness session for Primary Care Clinicians
  Tuesday, 26th November from 13.00-14.00
  Sign-up Form
• Prosthetic Joint Infection – IFORM Study
  Wednesday, 27th November from 12.30-13.00
  Sign-up Form
• Antimicrobial Stewardship in BNSSG
  Wednesday, 27th November from 13.00-14.00
  Sign-up Form
• General Practice & Community Pharmacy Independent Prescribers Forum
  Thursday, 18th November from 13.00-13.30
  Sign-up Form

Please see here for full event details.
For further information please contact Bnssg.training.hub@nhs.net

---

---