Special Newsletter on 07-06-24

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The ALMC Newsletter

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

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– LATEST NEWS –

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Avon LMC is keen to tackle interface issues within general practice, as we know this creates huge workload for practices. Many of the activities carried out in general practice fall within a commissioning gap and are not mandated in either a specialist or GP contract. Everyday examples are PSA surveillance, post bariatric surgery monitoring, ADHD care and transgender care, to name a few. As a result, the fallback position tends to lie with the GP, unless we take a stand and decline. Avon LMC wishes to negotiate funded, commissioned pathways within general practice, but this change will not happen overnight.

The two areas the LMC will focus on at present are:

• Sharing care with private providers
• AWP bloods not falling within the scope of the Community Phlebotomy LES

Sharing Care with Private Providers
As waiting times for specialist assessments are so long, patients often seek a private, specialist opinion, and then request that GPs maintain any medications which have been initiated. It is reasonable to continue these if they are “green” on the formulary traffic light status and a GP is competent to initiate. However, if these are specialist medications requiring shared care (amber on formulary), there are a number of challenges with sharing care with a private provider which include:

• Ensuring quality assurance and governance of the private provider
• The lack of enduring care by the private provider which depends on patients self-funding
• Creating a two-tiered system if patients with the resources to fund private referrals can access maintenance medication faster than via the NHS route
• The capacity issues within general practice which is not resourced to meet the additional demand from the private sector

As such, the position of Avon LMC would be to decline any private requests for shared care of medications. It is up to each practice to create their own policy about both new and existing patients who receive shared care medications from the private sector.

To empower practices who wish to decline this work, we have created a template letter for practices to embed into EMIS, via resource publisher. Avon LMC would like to thank One Care for facilitating this and the letter can be accessed through:

Resource Publisher > BNSSG Referral Forms > Adults > Prescribing > Template Letter for Declining Private Monitoring and Prescribing.

Alternatively, you can download it from here:

AWP Bloods and the Community Phlebotomy LES
Avon LMC has received multiple concerns from its members about the increased workload of monitoring bloods and ECGs for patients within AWP, STEPS and CAMHS. When the community phlebotomy LES was established some years ago, these providers were not included, and we are starting the process of ensuring that this work is transferred into the community phlebotomy LES. (for over 12 years old only, as under 12s are no longer in scope for the supplementary services basket)

This will require both the ICE infrastructure to be set up, as well as the AWP workforce to monitor these bloods. As such, we are planning to negotiate a timeline with commissioners and AWP, to serve notice on general practice undertaking this activity.

Of course, any practices already declining this activity should continue to do so, as it is non-contractual and unfunded work.

Any questions about any of the above, please feel free to email us at info@almc.co.uk

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