Avon LMCs Newsletter on 11-12-24

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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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I had the misfortune of requiring emergency dental care last week. It was my own fault – I diligently ignored a fluctuating gum swelling which was obviously harbouring a myriad of microbes, which culminated into a fractured molar whilst chomping a breadstick. But I have the great fortune of being registered with an NHS dentist who saw me for an emergency appointment the following morning. Her clinical skills and compassion were exemplary and it’s a travesty that this NHS privilege isn’t afforded to everyone. I couldn’t help but reflect on the comparisons between dentistry and general practice and we are heading fast towards their destination. I’m extremely grateful for my timely treatment but will have to part company with £1,800 for the complex root canal treatment required in the long run – so you know what’s on my Christmas list this year!

I continue to be heartened by the level of engagement shown by GP practices in the area, especially as Avon LMC was given a special mention by the Chair of GPC England, in her recent speech at England LMC Conference. Effecting change is never easy, but the level of commitment and solidarity shown by entire practice teams has shown to me what can be achieved if we all stand together with one voice. Keep those queries coming!

“Collective action remains the best way of renewing the march towards the great trinity of liberty, equality, and solidarity” – Guy Standing

Dr Shaba Nabi
Chair Avon LMC

This is your last chance to register for this regular drop-in. Come along armed with your collective action questions, along with all your other moans. We’re in the business of trying to find solutions to those annoying irritants within our workplace so we can just focus on offering the best care to our patients.

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

Media response to Collective Action

As expected, practices are receiving media requests for comments on GP collective action. Avon LMC will support your practice if you wish to engage with any media requests, but we have also compiled a media statement for you to share which can be found here:
<<Avon LMC Media Statement about Collective Acton>>
This can also be found on our collective action web page.

GP Collective Action Frequently Asked Questions

We have developed web pages for collective action FAQs which we will add to in an iterative manner. These can be found here.

Template letter to decline shared care prescribing with private prescribers

This template letter has now been embedded in EMIS and can be found by using the keyword search “LMC” in documents.

Referral Forms

This is a reminder to check the Avon LMC collective action web page referral RAG rating prior to sending a referral and to highlight that community DVT referrals should continue to be sent on the specific form, as they form part of an enhanced service.

Phase 3 of GP Collective Action in the BNSSG area

Avon LMC is aware of the multiple commissioning gaps that still exist, but it is important to prioritise this work, so that the entire system has the capacity to collaborate to develop solutions.

We are pleased with the success of phase one of collective action and are confident about the outcomes for phase two in early January. Once we have established success for phase two, we will move forward to assess the appetite for phase three of action next year. This will involve sharing another practice membership survey and meeting to develop a consensus plan for next steps of action. I hope this reassures those members who have contacted the LMC to highlight existing interface commissioning gaps.

Question: I wonder if there is an update on the GP Connect issue? We turned off GP Connect in July to maintain control of our records. However, we are now seeing an increase in Pharmacy First outcomes which have to be manually uploaded, rather than automatically being downloaded in EMIS. Is there an alternative position we can adopt so that we can decide on which connections we adopt individually?

Answer: The majority of practices switched off the GP Connect function in the summer of 2024 as there was a risk of losing the ability to switch off if it was not done at that time.

BMA guidance outlines some of the reasons for switch off which includes concerns about 3rd party providers adding diagnoses, results and medications, which could potentially become the legal responsibility of general practice. Unfortunately, there is not a way of selectively switching on Pharmacy First, whilst excluding other EMIS input, and the additional work this generates is acknowledged.

The LMC and BMA feels that this additional workload from importing Pharmacy First documents from NHS mail to EMIS is offset by the advantages of not introducing the risk of other 3rd party providers inputting into the medical records. Ultimately, it is an individual practice decision if they wish to switch GP Connect back on.

We are pleased to announce that guidance on prescribing processes for non-prescribers in practice has been ratified by Avon LMC, Area Prescribing and Medicines Optimisation Committee, and Primary Care Operational Group. This guidance is available here.

The aim of this guidance is to assist practices in establishing safe and effective prescribing processes. While practices are encouraged to consider this guidance, the adoption of its recommendations is entirely optional, and each practice remains responsible for determining its own prescribing procedures.

We hope you find this resource valuable and welcome any feedback you may have. For any questions, please reach out to us at nursing@almc.co.uk

As well as collating the collective action FAQs, we are keen to develop a user-friendly website which is able to search for clinical guidance that has been shared within newsletters. Unfortunately, this is not possible with the current website, so we have developed a short-term solution whilst we embark on a website improvement programme.

We are grateful to our newest member of staff, Marcus Lee, for manually converting the newsletter into a searchable format. This means that a keyword can be used in a search (eg: GANFYD) and the relevant newsletters containing this key word will be retrieved.

We are working towards a position where a keyword search will direct members straight to the guidance, rather than the newsletter, but this is an important early step. Please do try it out for yourself!

Some of you may be familiar with the expression GANFYD which stands for “Get A Note From Your Doctor” which ranges for anything from getting laser hair removal to doing a parachute jump.

Firstly, this is non-NHS work, and it is up to the discretion of the practice whether they wish to provide these. If they do wish to support a patient with a letter, they are entitled to charge for it as private work.

Secondly, Avon LMC would like to urge caution for any letter or certificate requiring a declaration of fitness, such as fitness to fly or to run a triathlon. GPs are neither indemnified by the clinical negligence scheme for general practice nor occupational health trained to undertake this work. The BMA has produced guidance on this and this Pulse article shares the risk of vicarious liability for this type of work.

Avon LMC would encourage you to develop a consistent practice policy for these requests and you may wish to consider the following principles:

• There is no contractual obligation to undertake non-NHS work
• Non-NHS work can be charged on a private basis
• The Clinical Negligence Scheme for General Practice does not cover this work
• Ensure liabilities are covered by your medical defence organisation
• Encourage patients to sign up for the NHS app so they can share their medical records with external organisations
• If you do write a letter for any activity, ensure you are making a statement of fact, rather than declaring fitness. Eg: this woman is 32 weeks pregnant and has had an uneventful pregnancy
• Seek engagement with the entire practice team so that everyone adopts the same policy consistently

The recent proliferation of private on-line providers prescribing treatments for weight loss and hormonal conditions, has led to a number of practices contacting Avon LMC for advice. Many providers are requesting that practices undertake a review of a patient’s notes to check there are no contraindications to their prescribing. This, by default, means that a practice takes responsibility for prescribing initiated by other organisations.

GMC regulations state that medicines must only be prescribed if there is sufficient knowledge to prescribe safely, which includes access to a patient’s medical records and verification of information through examination.

Avon LMC supports practices to pushback requests for medical information from private providers, which is non-contractual work a GP could be liable for. We recommend that private providers encourage patients to share their on-line records with them to obtain a full medical history, including observations. A template letter for providers has been developed for this purpose. We will add this template letter to EMIS in due course.

We also advise that any medications prescribed outside the practice are added to a patient’s medication screen as an external prescription, so that drug interactions and safety alerts can be triggered.

All the outcomes of the 2024 England Conference can be found here:
Please find the attachment.

• 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

National Workplace Day of Remembrance, observed on the 12th of December, honours workers who have lost their lives or suffered serious injuries in the workplace. This day encourages organisations, colleagues, and families to pause, remember, and reflect on the importance of safety in the workplace. It serves as a powerful reminder of the need to prioritise safe working conditions, uphold protective measures, and support workers’ well-being.

By commemorating those affected, National Workplace Day of Remembrance aims to inspire companies to reinforce safety protocols, create safer environments, and honour the contributions of workers everywhere. 

As the Event Director for the Best Practice Show, I wanted to personally invite you to join us at Best Practice London & Women’s Health Professional Care, taking place on 26th–27th February 2025 at Olympia London.

If this isn’t relevant to you, or if I should reach out to another member from Avon LMC Ltd, please let me know, and I’ll update my distribution list accordingly.

This event is an unparalleled opportunity for primary care professionals to connect, learn, and advance their practice. Here’s what makes it a must-attend:

• Empowering Education for General Practice Teams: Sessions designed to support the development and education of the whole general practice team.
• Women’s Health in Focus: Bridging the knowledge gap with comprehensive coverage of women’s health topics, from basic HRT prescribing to complex management, ethnicity considerations, and the impact of comorbidities.
• CPD-Accredited Learning: Stay updated on essential clinical topics, including dermatology, respiratory and cardiovascular diseases, lifestyle medicine, mental health, and more.
• Practical Business Advice: A one-stop shop for GP Partners and Practice Managers to explore services, technology, and solutions for greater practice efficiency and improved patient outcomes.
• Extensive Networking & Innovations: Meet over 170 exhibitors showcasing cutting-edge products and services to enhance your practice.

This conference is not just an event; it’s an opportunity to inspire, empower, and innovate in primary care.

For full details and to register for FREE, please visit: https://www.bestpracticelondon.co.uk/ian

Please contact me at i.reynolds@closerstillmedia.com if you’d like further details or additional resources to share. I hope to see you and your colleagues at the event!

Kind regards,
Ian Reynolds
Group Event Director

• Tuesday 10 December General practice bulletin (mailchi.mp)
• Thursday 06 December General practice bulletin (mailchi.mp)

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– LATEST TRAINING AND EVENTS –

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• 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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