Avon LMCs Newsletter on 08-01-25

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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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A New Year is always a time for new intentions, and I’ve been reflecting on the fact that it’s been a quarter of a decade since we welcomed the millennium. Like any major world event, people will recall exactly what they were doing at the time. I was halfway through my final GP Training year and preparing for my first GP job as a Cruise Ship Doctor, which offered the enormous privilege of travelling the world for eighteen months.

Looking ahead, it’s likely to be another eventful year for general practice. There’s been a promise of an Advice and Guidance DES, but as always, the devil is in the detail. How much additional responsibility will GPs have, and will it just become a vehicle for unfettered secondary to primary care workload transfer?

Other “reforms” for tackling NHS waiting lists are direct access to tests for GPs and I’ve been surprised at the divide this has created amongst my national GPC colleagues. Within the BNSSG area we have had good access to radiological imaging for some years which most of us welcome. However, there are concerns around competencies to interpret results and the additional workload which may arise. Again, we will need the specification details before forming any firm opinions.

Whatever a new GP contract brings, we need to be ready for change and agile in our approach.

“When we are no longer able to change a situation – we are challenged to change ourselves” – Viktor E Frankl

Dr Shaba Nabi
Chair Avon LMC

Come and join us at our next virtual drop in to ask about all things collective action related, as well as any other local and national issues you would like to discuss. It would be lovely to see some new faces, as well as offer a warm welcome to our regulars.

To register, please sign up here.

The following information was shared within an extraordinary newsletter on 06/01/25:

Avon LMC would like to update you on the progress made regarding Phase 2 of GP Collective Action, which goes live today. As of 6th January 2025, the LMC served notice on the following non-commissioned interface areas:

• New initiation of shared care prescribing for three medications
• New patients requiring Bariatric Surgery Monitoring
• Physical monitoring for AWP and CAMHS including for eating disorders

Shared Care Prescribing

We are pleased to inform you that specialist medicines monitoring LES has been updated to include three additional medications:

• ADHD medications: Shared Care Protocol being signed off by AWP
• Lithium: Shared Care Protocol in place
• Mesalazine: Prescribing Monitoring Guide being signed off. Further work includes:
  • agreement for its traffic light status
  • agree funding arrangements for monitoring after a year of treatment, when requirement is reduced to just annual monitoring

Details for coding this activity are being finalised but these will be applied retrospectively.

We would like to thank the ICB Medicines Optimisation Team, led by Debbie Campbell, for all their hard work facilitating this.

Avon LMC recommends you continue sharing care for the above medications (and accept new patients) if you wish to participate in the specialist medicines monitoring LES.

Bariatric Surgery Monitoring

A commissioned pathway for monitoring has not yet been agreed within the system.

Avon LMC recommends you decline any new requests for Bariatric Surgery monitoring and refer the patient back to specialist care.

Physical Monitoring for AWP/CAMHS

As per the extraordinary newsletter dated 23/12/24, both child and adult eating disorders pathways require an additional few weeks until completion.

Avon LMC has agreed to extend the notice period for this activity from 6th January to 27th January.

This has been amended to clarify the requirement for providers to initiate all medications they recommend, regardless of traffic light status. The updated template letter can be found here as well as on the collective action webpage:

Pease click here for the Template Letter.

and this will be amended in EMIS in due course.

Question: We receive letters requesting titration of medication which is often longer than a 4-week period. Should we expect the specialist clinic to take responsible for the entirety of this titration?

Answer: This will depend on the medication and the complexity of the medical condition. It is reasonable for a GP to titrate blood pressure medication, but titration of specialist medication is likely to require a hospital specialist.

An email was sent to all Practice Managers on 30/12/24 to share information about practice levies to Avon LMC for the next financial year: 2025/26.

If your practice has not received this, please contact us on info@almc.co.uk

What GP Collective Action has put under the spotlight is the vast amount of unfunded workload taking place within general practice which sits outside the core contract or an enhanced service. Practices have been empowered to question all work they have been asked to undertake on behalf of secondary care and this is the wake-up call which has been required to effect change.

However, it is also important to reflect on what activities constitute Good Medical Practice for the patient in front of you. This is a grey area, and the threshold is likely to differ between clinicians, just as our consulting style does. For referrals, it is important to include information vital for provider triage, such as risk of self-harm, or undertake pre-referral investigations in the normal work-up of a patient (eg: a CXR request prior to a respiratory referral)

As always, if there is any uncertainty about whether an activity should be declined as part of GP Collective Action, please email info@almc.co.uk as we usually respond in a timely manner.

This is to reiterate previous communication within the GP Bulletin that the Sirona incontinence service is a nurse-led primary care service and not a medical one and serves to support general practice with their patients’ continence needs. As such, they may recommend medications a GP should consider prescribing, and the LMC supports this.

You can read this here.

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

I am pleased to open the annual expression of interest in BNSSG General Practice for an application to the South West Regional Advanced Practice faculty for a £6000 Training grant and £2,600 supervision funding to support an individual to complete their NHSE Accredited MSc Advanced Practice.  Closing date Thursday 13th March 2025

There are several courses being run next year within BNSSG.  If this is you, please discuss this with your manager referring to the details below.  If you would like support or to discuss this further, please contact Jenny Bowen and Helen Russell – Legacy.nurses@almc.co.uk

AP EOI FORM

Prior to application, please ensure you have completed the following:

• Discussed and confirmed the application between the individual trainee, their employer and their educational supervisor.
• All parties have read in full the NHS England South West Advanced Practice Faculty Handbook for 2025/2026
• The AP trainee has contacted their education provider of choice and confirmed outstanding modules – see the handbook for more information on accredited programmes

As well as reading the handbook it is advised that all parties complete the following checklists found here (at the bottom of the page) to ensure they are aware of all of the supervision requirements and readiness to become and advanced practitioner:

Individual: Readiness to become and Advanced Practitioner

Supervisor: Supervisor Readiness Checklist

Employer: Employers Advanced Practice Supervision Plan

Please email bnssg.thadvancedpractice@nhs.net with any queries.

From Kerri Magnus
Advanced Practice and Multiprofessional Lead

• Tuesday 7 January General practice bulletin (mailchi.mp)
• Thursday 2 January General practice bulletin (mailchi.mp)

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– LATEST TRAINING AND EVENTS –

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• General Practice & Community Pharmacy Independent Prescribers Forum
  9^th January from 13.00-13.30
  Signup Form
• Advanced Practice Event #1 (Weston)
  15^th January from 9.00-12.00
  Signup Form
• BNSSG Cancer Lead GP Forum
  16^th January from 12.45-14.00
  Signup Form
• BCYP EduForum – Abnormal Blood Tests
  21^st January from 13.00-13.30
  Signup Form
• Consent to medical treatment: what the laws required
  22^nd January from 13.00-14.00
  Signup Form
• Blood Interpretation in Primary Care (Day 3 of 4)
  23^rd January from 9.15-12.30
  Signup Form
• Launch of BNSSG HRT guidance: Management of Postmenopausal bleeding
  24^th January from 13.00-14.00
  Signup Form
• Debunking diastasis – the facts and myths of this postnatal problem
  29^th January from 12.30-13.30
  Signup Form
• Frailty and Type 2 Diabetes – Practical Tips for Management
  4^th February from 13.00-14.00
  Signup Form
• Raring to Return – GP Refresher
  5^th February from 9.00-17.00
  Signup Form
• General Practice & Community Pharmacy Independent Prescribers Forum
  5^th February from 13.00-13.30
  Signup Form
• Getting the Best out of your Laboratory Tests: Blood and Science Session
  6^th February from 12.30-13.30
  Signup Form
• Late Career GP Group: Inspirations from Literature
  11^th February 19.00-21.00
  Signup Form
• Advanced Practice Event – The Greenway Centre
  12^th February from 9.00-12.00
  Signup Form
• The 6-8 week GP check – what to consider from a pelvic health perspective
  19^th February from 12.30-13.30
  Signup Form
• BCYP EduForum: Paediatric Cardiology
  15^th February 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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