Avon LMCs Newsletter on 13-11-24

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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 a quiet weekend of sewing and ironing in preparation for my daughter to attend Remembrance Sunday parades, and it was a good opportunity for mindfulness and reflection. All the sewing (which I’m not bad at) made me think about how different my life would be if I had chosen a surgical or medical speciality. I love the variety of General Practice, but I’ve always been intrigued by the concept of a Sliding Doors moment, whereby your entire life course could change depending on one act of fate.

In today’s newsletter, we’ve included information about the BMA budget calculator, to assess the impact of the budget on your practice. You need to be a BMA member to access this tool, so please consider joining to access this.

This week I will be going to London to attend a GPC England Meeting and the week after Avon LMC will be attending the England LMC Conference. I would encourage you to take a look at the summarised document for conference (of prioritised motions only) and make your Board representatives aware of your views, so these can be reflected at conference. We cannot claim to be representing you if we are not engaging with you.

“Speak your mind, even if your voice shakes” – Maggie Kuhn

Dr Shaba Nabi
Chair Avon LMC

It was good to see so many of you at the LMC drop-in yesterday. GP Collective Action was the main topic of conversation, and it was helpful to hear your feedback about this. As it is early days after the phase one “go live” date, we will be hosting an additional virtual drop-in on 17th December at 1pm. More details on registration to follow in due course.

Standard ICB Generic Referral
Dr Elaine Lunts, an LMC Committee member, has very kindly facilitated additional wording at the foot of this referral letter (thanks to One Care for their timely help) as follows:

As part of the BMA “Collective Action” this referral is on a standard referral form. The BMA advises that the completion of a local referral form or proforma is neither a contractual nor a professional obligation. A referral letter providing relevant information to ensure a safe transfer of care is required for an appropriate request for a secondary care service to act on it.

We have updated the RAG rating for referrals to include the following, which are all rated ‘Green’ for use of the generic referral form:

• GP Care Urology referral
• Smoking Cessation referral
• Exercise on referral
• Diabetes Prevention Programme

As always, please refer to the Avon LMC Collective Action web page for your information, as this is where it will be updated. Get into the habit of having two web browsers open for your clinical care: this one on collective action and Remedy.
The template letter for referral rejection, shared last week, has now been embedded into EMIS, and can be found using the keyword “LMC” in a document search.

Workload Transfer
Dr Pete Edwards, an LMC Committee member, has very kindly shared a patient text template used by his practice for hospital fit note requests. Feel free to adapt this for your practice:

You can self-certify for the first 7 days. If you need more time, please request the note from the hospital that treated you.  This is in line with government guidance that the healthcare professional treating you is responsible for providing a statement on your fitness to work. 
The patient liaison service can usually help: 
BRI: Call 0117 342 1050 or https://www.uhbristol.nhs.uk/patients-and-visitors/support-for-patients/patient-support-and-complaints/
Southmead: Call 0117 414 4569 or https://www.nbt.nhs.uk/patients-carers/feedback/how-raise-a-concern-or-a-complaint

This will also be added the collective action webpage very soon.
(Download here)

DSA for Bristol Drugs Project
The LMC and One Care are working in the background to review data sharing agreements (DSAs) and ensuring that they are consistent with Avon LMC’s approach to Collective Action.
This week we were approached by Public Health at Bristol City Council regarding a data sharing agreement for physical health checks for individuals with addiction problems.
The LMC supported the DSA for the following reasons:

• The principles for this project have already been discussed with- and supported by- practice addiction leads
• Physical health considerations already form part of the shared-care contract
• None of the data will be used for performance management
• Individual practice data will only be accessible by the practice. Aggregated Bristol-wide data will be shared with Public Health to aid service design.

Shared Care Prescribing and managing patient expectations
As we have served notice for new unfunded shared care prescribing from 06/01/24, it would be sensible to highlight this to patients at the point of referral, as you may not be able to enter into a shared care prescribing arrangement with the specialist. Avon LMC is highlighting the importance of funded commissioned pathways within the system, as the alternative would be much costlier to the system.

Collective Action Questions
Question: How do we manage blood test requests from private providers that cannot be delegated on ICE?

Answer: There is no contractual obligation to provide blood test monitoring for any provider who cannot delegate bloods on ICE, especially private providers. It is an individual practice decision if you choose to do this (most practices will decline private providers and make decisions about an out of area NHS provider on a case-by-case basis)

You have to be a BMA member to access this tool:
https://www.bma.org.uk/BudgetNIblow

Using this tool will not only help you with financial modelling, but completion of the survey it will also collect anonymous aggregated data to assist the BMA with lobbying the government.

Please encourage all colleagues in your networks to use the calculator, complete the survey, and send a letter to their local MP citing the financial impact these changes will have and the mitigatory measures their practices will take, if this is not resolved. This will put the pressure on the government to immediately resolve this issue.

The full agenda can be found here.
A summary document (of prioritised motions only) can be found here:

Please click here.

Question: How do we approach the prescribing and monitoring for a new transgender patient who has been discharged from a tertiary Gender Clinic? The original clinic refuses to see them as the are stable on treatment.

Answer:
This is a very challenging area. The reason it is challenging is because:

1. NHS Transgender shared care prescribing is not funded (both the ICB and NHSE hold the position it is not their responsibility)
2. The gender clinics don’t hold on to people indefinitely and often discharge back to the GP
3. This is not part of the GP core contract

Owing to point 3, practices are within their rights to decline this prescribing. However, there is a mixed response to this, with many practices choosing to continue NHS shared care without the funding, owing to the systemic funding and commissioning gaps. 
Needless to say, there are ongoing discussions at a national level to find a solution for this issue.

In line with the DBS fees increase that is taking place from December 2024, Avon LMC needs to increase the tariff to ensure we can still provide the service.

Standard checks have marginally increased however the enhanced checks have increased by 30% due to the operational costs of delivering DBS’ safeguarding service.

We are still a cost-effective option compared with other providers.

The new tariff can be found below:

Check	Old tariff	New tariff
Standard	£34.00	£38.50
Enhanced	£54.00	£66.50
Volunteer	£16.00	£17.00

This is the link to the DBS announcement:
https://www.gov.uk/government/news/dbs-fees-are-changing-in-december

November is Men’s health Awareness Month on promoting physical and mental well-being among men, addressing issues such as prostate cancer, testicular cancer, mental health challenges, and suicide prevention.

Men have higher rates of heart disease, cancer, and mental health challenges, and tend to ignore or “tough out” their symptoms more than women do.

It’s crucial for men to remember that taking care of their own health is just as important as taking care of others. Whether it’s mental health check-ins or getting those yearly screenings, a little effort now can make a huge difference.

• 22nd November 2024: England LMC Conference – London, all day
• 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

• Tuesday  12 November General practice bulletin (mailchi.mp)
• Thursday 07 November General practice bulletin (mailchi.mp)

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– LATEST TRAINING AND EVENTS –

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• 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, 28th 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

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