Avon LMCs Newsletter on 04-12-24

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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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It is fantastic for Avon LMC to have a flooded inbox as it means GPs are engaging with GP Collective Action and reflecting on the grey areas. Very little in life is binary so we welcome all your questions and queries, so continue emailing them to us at info@almc.co.uk.

The assisted dying bill was passed in parliament last week, and by sheer coincidence, I completed the ReSPECT Plus process with a patient on that same day. This process reminded me of the enormous privilege it is to be a GP; to be trusted to care for someone throughout their life, and advocate for them in death. This privilege would not be possible without enduring relationships and continuity of care; two areas which seemed to have been downgraded in favour of immediate access with any clinician. We must continually fight against the perverse incentives of access over continuity, as well as resisting the fragmentation of holistic care. Above all, we need to work safely and sustainably so that there is enough left in our tank to share with our patients.

“Wherever the art of Medicine is loved, there is also a love of Humanity.” ? Hippocrates

Dr Shaba Nabi
Chair Avon LMC

Progress on Collective Action

There have been numerous collective action meetings across the system, and we are grateful to the ICB, AWP, Sirona, Referral Service and GPCB Clinical Leads for working so collaboratively to work up solutions. We are pleased to report on the following progress:

• The single generic referral form has been accepted within the system
• Regular meetings to work up solutions for providers to initiate their own medications
• A proposal to add additional medications into the specialist medicines monitoring LES
• Working towards ICE access for AWP and commissioning pathways for eating disorders

Collective Action in the News

Some of you may have seen this BBC news article posted last week, as well as viewing it on BBC Points West. It is disappointing that the BBC did not give Avon LMC a chance to respond by interview to explain the rationale for collective action. What GP Collective Action has highlighted to me is the ignorance surrounding the GP contract, not just amongst the general public, but also from our hospital colleagues. We need a massive education and PR campaign to explain the business of general practice, so we are not viewed as shirking our responsibilities when we choose to adhere to the core contract. Rebuild General Practice is a start for this campaign and contains resources for you and your patients.

Single Generic Referral Forms

Please continue to send us your examples of providers who have rejected a referral based on the referral form. Avon LMC can share that the following providers have been contacted and confirmed acceptance of the generic referral form:

• CAMHS asylum and refugee clinic: referral will not be rejected in the absence of a “CRIES 13” questionnaire

Prescribing and GP Collective Action

There are three important principles to consider with regards to prescribing and GP Collective Action:

1. Prescribing following advice and guidance remains the responsibility of general practice. Prescribing following a consultation (face to face or remote) is the responsibility of the provider delivering the consultation.
2. General practice no longer has the capacity to serve as the prescriber for providers who deliver services through non-prescribers (one exception to this is if a practice is signed up to the dementia LES)
3. If a medication is initiated by a provider, the role for general practice is one of transcription, which can be fulfilled by a trained prescribing clerk or pharmacy technician. If, instead, the provider directs the patient to the practice for initiation of medication, this requires an additional consultation with a prescriber in general practice to ensure patient informed consent has been obtained. This leads to unnecessary duplication of work within general practice.

Avon LMC is attending 2-weekly system meetings to discuss the barriers and solutions for trusts (secondary care or community) to initiate and supply medications for patients they have consulted with. We are working collaboratively to facilitate some temporary and long-term solutions for this.

Emergency Departments and GP Collective Action

The LMC has received a number of queries from both practices and consultants about the interface between the emergency department (ED) and general practice. ED is different from an out-patient setting as they do not have the infrastructure for call/recall and tend to deal with the acute presentation only. As such, we have articulated further guidance for GP Collective Action, specifically for the Emergency Department as follows:

ROLE OF EMERGENCY DEPARTMENT	ROLE OF GENERAL PRACTICE
Follow-up of results requested by ED eg: MSU/bloods	Repeat investigations eg: CXR in 6 weeks, U+Es in 2 weeks, BP
Fit note for expected duration of illness	Extension of fit note for longer recovery periods
Urgent referrals   eg: RACP clinic, two-week rule referrals (NB: exception may be straight to test referrals on ICE which need to be done by GP)	Non-urgent referrals   (NB: system is working up pathway for Eye Hospital presentations to be booked directly into clinic appointment)
Acute medications	Repeat medications

Bullet point one of the workload transfer template letter has been amended to reflect this guidance. The updated letter has been added to the Avon LMC collective action web page and will be embedded in EMIS in due course.

Population Health Management Data Sharing Agreement
The LMC has met with the ICB to discuss the pros and cons of signing up to the PHM DSA. At this stage, our steer is to not sign up to this, but as always, this is an individual practice decision.

Question: Can we get some advice on Inclisiran prescribing? The lipid clinic has advised us there is no secondary care provision for this medication

Answer: If your practice is signed up to the Inclisiran LES, this is one of the exceptions to the specialist initiating their own medications (bullet point one of the prescribing workload transfer template letter). The reason for this is because the acquisition cost is far greater in secondary care than primary care, due to an agreement between NHS England and the drug company.

If your practice is not signed up to the Inclisiran LES, you are under no obligation to prescribe this.

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. 

Read the latest GPC England bulletin here. 

• 17th December 2024: Virtual LMC drop in, 13.00 – 14.00
• 14th January 2025: Virtual LMC drop in, 13.00 – 14.00
• 11th March 2025: Virtual LMC drop in, 13.00 – 14.00

We are having National Grief Awareness Week 2024, it aimed to remind of the importance of understanding grief, acknowledging its impact, and supporting those who are going through it. This year, from 2nd December to 8th December, National Grief Awareness Week serves as a time to bring the often silent journey of grieving to light, create community support, and foster compassion for the millions affected by loss.

This year’s theme is “Shine A Light”, encouraging people to help raise awareness of the bereavement services across the country. The idea is to nominate people, places and projects in your community you feel are going above and beyond to make a difference to those who are grieving.

• Tuesday 03 December General practice bulletin (mailchi.mp)
• Thursday 28 November General practice bulletin (mailchi.mp)

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– LATEST TRAINING AND EVENTS –

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Date: Wednesday 18th December 2024

Time: 13.00 – 14.00

Online: MS Teams – please sign up via this link

Hosts: Kerri Magnus (AP & Multi-professional Lead, ALMC ) and Sally King (Superintendent Radiographer, UHBW)

Dear Practice Management Teams, Nurses, Physios, Paramedics, Clinical Pharmacists and Podiatrists

You are invited to an online webinar to discuss Imaging Requesting and associated updates for Non-Medical Referrers (NMR) in BNSSG General Practice.

Topics on the agenda:

• Updated protocol and entitlements for all roles
• Responsibilities – employers and staff
• SOP for subcontracted staff
• Relevant documents
• Onboarding process
• Audit
• FAQ
• ICE & IRMER training
• Where to access information 

Please submit any questions you have prior to the meeting to kerri@almc.co.uk

• Late Careers GP Group – Experiences of working abroad as a doctor
  4^th December from 19.00-21.00
  Signup Form
• Pharmacy Professional Networking Event
  5^th December from 9.30-13.00
  Signup Form
• Blood Interpretation in Primary Care
  5^th December from 9.15-12.30
  Signup Form
• Launch of BNSSG HRT guidance: management of postmenopausal bleeding
  10^th December from 12.00-13.00
  Signup Form
• BCYP EduForum: Cough in Children
  17^th December from 13.00-13.30
  Signup Form

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

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