Avon LMCs Newsletter on 18-12-24

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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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As we approach the holiday season, this is to inform you that this will be the last newsletter for this year, and our next newsletter will be 8th January next year! Whether you are celebrating Christmas, Hanukkah, or just a chance to be with friends and family, we hope you manage to get some well-deserved downtime over the holiday period. Christmas can be a difficult time for some people, especially if it is a reminder of loss or isolation so here is some useful mental health support for your staff and patients over the festive season.

As Complaints Lead for my practice, I have been reflecting on the power of words without context, and the impact this may have on a patient. Many patient interactions involve health care professionals outside one’s own organisation, and the way in which we navigate these sensitive conversations can often mean the difference between patient acceptance for an adverse event, or litigation. It is for this reason that medical defence organisations deliver free courses to their members on interacting with colleagues, no doubt aware of the ease by which professionals can throw each other under a bus. As GPs we are often at the receiving end of such comments, but it is worth remembering the basic principle of “First do no Harm” and apply it to colleagues as well as patients.

“Professionalism is about having integrity, honesty, and sincere regard for the personhood of the customer, in the context of always doing what is best for the business. Those two things do not need to be in conflict.” – Eric Lippert

Dr Shaba Nabi
Chair Avon LMC

It was good to see so many of you at our virtual drop in yesterday. GP Collective Action was the main topic of conversation, and it was great to hear your feedback about this, as well as responding to your queries. Please do join us for the next one scheduled for 14/01/25.

Single, Generic Referral Form

The following providers have informed us they are unable to accept the ICB BNSSG Standard referral form:

• Everyone Active for exercise referrals to certain leisure centres in the Bristol area – > they use an on-line platform and no ability to self-refer. This has now been changed to amber on the RAG rating
• Community Dental Referral – > is a regional centre and only accepts the NHSE referral template. Like other LMCs in the Southwest, we encourage our members to signpost to the General Dental Practitioner to make the referral. It remains green on the RAG rating.

The RAG rating for referrals document has been updated on the collective action web page to reflect the above changes.

Collective Action Queries to the LMC – > all added to the FAQ section of the web page

Question: I had a request from a DHI worker for our practice to do bloods prior to specialist initiation of acamprosate. They are saying we should do it as they have no ICE access, and it speeds things up for the patient.

Answer: Substance misuse is commissioned via the local authority and is not part of the core GP contract. As such, there is no contractual obligation to provide a phlebotomy service for this. Practices can individually decide whether they choose to pushback on this work, but there is no breach of contract should they decide to decline.

Question: What is the LMC position be on patients contacting hospital advice lines (eg: gastroenterology or rheumatology) with a flare of symptoms and the hospital advising a course of treatment?  Who would do the script?

Answer: As the patient is under hospital care and has received advice through a telephone consultation, the responsibility would lie with the provider to initiate the required medication. The only possible exception may be a restart of a repeat medication, which would be less common.

Prescribing initiation and 28-day supply following specialist recommendation

Bullet point one of the prescribing workload transfer template letter pushes back on the following work:

• The medicine has not been initiated and optimised by the specialist

This would include documentation that a shared decision-making dialogue had taken place to achieve informed consent, and a 28-day supply of medication issued, before transfer of care to general practice for transcription of medication.

This has created significant challenges within the system and the LMC has been working closely with system leaders to find solutions for this. These issues will be shared with the committee this week, with a view to seeking a membership/practice steer.

Please engage with your PCN committee representative when asked about this issue as we are working at pace.

Phase 2 of GP Collective Action

The LMC has been working closely with the ICB and GPCB who have been working at pace to set up enhanced services for additional specialist medicines monitoring and eating disorders. These areas are on track for a roll-out for January 2025.

The 2021 Community Phlebotomy LES contains a SOP stating that hospital trusts will pass the responsibility of Sirona referrals to the GP for a housebound patient. This position was accepted by the LMC at the time of roll-out of this LES.

In view of GP Collective Action and the current position on unnecessary workload transfer, Avon LMC is engaged in system meetings to ensure hospital trusts are in a position to make their own referrals for domiciliary phlebotomy.

The LMC is aware of some of the challenges navigating the interface between GPs and midwifery services and is attending regular meetings to improve this. Although GP prescribing for community midwives is included in the supplementary services contract, areas to be progressed are as follows:



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

• Robust communication pathways, especially for test results and prescribing
• Onward referrals to medical obstetric clinics
• Prescribing of low molecular weight heparin for VTE prophylaxis
• Existing midwifery SOPs which impact on general practice (eg: anaemia in pregnancy)

If you have any additional areas, you would like raised, please do not hesitate to contact us on info@almc.co.uk.

Question: Parents of a neonate attended the children’s hospital emergency department and subsequently received a letter from them to state that the child had been a potential measles contact. The advice was to see their GP if the child was under one years old. Whose responsibility is this as I am concerned about patient safety?

Answer: Management of a contact of measles (especially if outside your own practice) is not part of the core GP contract and there is no enhanced service commissioned for this locally. This work should have been undertaken by BCH and we would advise submitting a datix about this to raise awareness. The document found in this Somerset LMC web page provides a summary of what is core contractual and what isn’t regarding infectious diseases within the community

This can be found here.

This can be found here.

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

Are you an HCA who is interested in progressing or a Nurse Associate who would like to become a registered nurse?

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

Student Nurse Associate (SNA) Apprenticeship:
Requirements: English and Maths at GCSE 4/C and above (or functional skills pass); Level 3 qualification (an exemption is possible in some cases if applying to Weston College), working 30 hours a week or more.

University College Weston – next cohort starts March 2025 (one day a week in college)

University of the West of England (UWE) – next cohort is 5th May 2025 (two days a week in college – Tuesday/Wednesday).

Registered Nurse Degree Apprenticeship (RNDA):
Completion of Nurse Associate or Associate Practitioner course (with passes in English and Maths as above).

University of the West of England (UWE) – next cohort is end of April 2025. 

Please contact Jonathan Hall if you are interested – jonathan6.hall@uwe.ac.uk

Best Practice London is a free-to-attend event for General Practice staff. The event is packed full of content and exhibitors for all roles. This year the IGPM are hosting the Management Theatre and will be providing talks on a range of subjects specific to Practice and PCN Managers, as well as GP and Non-GP Partners.

As Huntington’s disease is a relatively rare condition many GPs may not have come across a family where there is Huntington’s before, so when they do it can present many challenges. As Huntington’s disease is progressive, patients’ needs change over time and can be complex due to not only the impact of physical symptoms but those of a cognitive and psychiatric nature.  As it is a genetic condition family members may also approach their GP with questions about testing to see if they carry the gene or about having children. 

To try to support GPs in providing good care the Huntington’s Disease Association is organising a short lunchtime webinar at 1pm on 24 January 2025.  It is free to attend and a certificate of attendance will be available. 

Huntington’s disease – a webinar for GPs
Our speakers will be: 
Dr Nayana Lahiri, Consultant Clinical Geneticist, St Georges University Hospital, will take us through how to support Huntington’s disease family members around questions of genetic testing and having children.
Dr Marianne Novak, Consultant Neurologist, St Georges University Hospital, will talk us through supporting your Huntington’s disease patient to manage their symptoms.

Please see attached for webinar flyer.

The link for more information and to register is below:
https://www.hda.org.uk/events/supporting-people-in-huntingtons-disease-families-a-webinar-for-gps/

• Tuesday 17 December General practice bulletin (mailchi.mp)
• Thursday 12 December General practice bulletin (mailchi.mp)

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– LATEST TRAINING AND EVENTS –

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

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