Avon LMCs Newsletter on 23-04-25

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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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I hope you managed to have a few days off during the recent bank holiday weekend and enjoy the sunshine.

Since covid, remote working has been both a blessing and a curse. As a GP Partner prior to covid, I would access EMIS remotely in the evenings, so I could get home in time to breastfeed my children and put them to bed. Following covid, we dispensed with the need to leave our homes for management work, as most face to face meetings defaulted to virtual ones. So, despite being on leave from the practice last week, and travelling to London with my daughter, I continued working in my other roles with the help of a laptop and Wi-Fi. And with my ‘Black Mirror’ reflections, I am unsure if this is progress or a ball and chain around my neck.

This week, we are sharing the agenda for the UK LMC Conference taking place in Glasgow on the 8th and 9th May. Avon LMC will be proposing a motion asking the BMA to adopt a firm position statement to reject shared care prescribing with a private provider, which is already our LMC position. This year, I opted for Menorca over Glasgow so your LMC Board and Committee will be representing your views.

Finally, I just want to pay my respects to the late Pope Francis. He was the first Pope of Latin American descent and more liberal than his predecessors. He campaigned for social equality, favouring a universal basic income for the poor, as well as appearing more tolerant of issues relating to contraception, abortion, and LGBTQ. Bob Dylan paid a moving tribute to him:

“Pope Francis was a voice of mercy in a time of noise. He walked with humility, spoke with fire, and dared to love the unloved. He reminded the world that compassion isn’t weakness, and faith doesn’t have to shout to be heard.” – Bob Dylan

Shaba Nabi
Chair Avon LMC

Our recent phase 3 practice survey for interface priorities received a whopping 98% response rate and the results were discussed at the virtual members’ event on 2nd April. The following areas have been agreed for the LMC to take forwards:

• Shared Care Prescribing of Medicines for Prostate Cancer
• PSA surveillance post specialist discharge
• Complex wound care beyond six weeks

Kim Ball, our LMC Director of Nursing, will be engaging with practice nurse teams to establish some baseline information on the volume of complex wound care currently taking place.

The LMC would like to highlight the capacity issues within the ICB for the next phase of commissioning action. The ICB continues to progress work relating to phase one and two of collective action, as well as being nationally mandated to cut running costs by a further 50%. This will no doubt have an impact on general practice, and we continue to work with our colleagues in a collaborative way.

The agenda for this conference in Glasgow can be found here:
UK Conf Agenda – May 2025

Question: Could you help clarify our position with shared care prescribing for ADHD with regards to certain Right to Choose providers? Some providers discharge the patient after limited post diagnostic support so it is difficult to access advice should we need it.

Answer:
Thank you for your query asking about where responsibility lies for shared care for those RTC ADHD providers who do not offer follow-up and annual review.

The wording within the ADHD annual review LES contract (which is currently being updated to make this more explicit) states the following:

Right to Choose

We are aware of a number of Right to Choose providers for adult ADHD services.
The legal rights to choose of mental health provider and team apply when:

• the patient has an elective referral for a first outpatient appointment
• the patient is referred by a GP
• the referral is clinically appropriate
• the service and team are led by a consultant or a mental healthcare professional
• the provider has a commissioning contract with any Integrated Care Board (ICB) or NHS England for the required service

For patients wishing to choose a “Right to Choose” provider it is important the patient understands that the provider may not integrate with local BNSSG pathways and/or other services as the provider does not hold a contract directly with BNSSG ICB. It is advisable for the GP and patient to agree the most suitable provider as the referral must be “clinically appropriate” for the patient under choice framework.

This last paragraph highlights that the patient can only access a RTC pathway if referred by a GP and has to be clinically appropriate. If there is no follow-up care by the specialist provider, then it is unlikely to be clinically appropriate. 

The next paragraph of the contract states:

As part of this enhanced service Primary Care providers are required to provide:

An annual review for any stable (adult) patient who has been discharged to Primary Care by AWP or a patient with a (NICE Compliant) recognised diagnosis from an alternative (NHS or non-NHS) provider.

I have emphasised the word stable in red, as it is not possible to ensure the patient is stable if they have not been followed up for a sufficient period of time by the specialist provider. 

Therefore, a GP is within their right to decline a patient’s request for a RTC provider in these circumstances, provided the patient is offered a full explanation of why this is not an acceptable referral route for their practice.

This can be found here.

• 3rd June 2025: Virtual LMC drop in, 13.00 – 14.00 (instead of 6th May as previously circulated)
• 1st July 2025: Virtual LMC drop in, 13.00 – 14.00
• 9th September 2025: Virtual LMC drop in, 13.00 – 14.00
• 4th November 2025: Virtual LMC drop in, 13.00 – 14.00

• Tuesday 22 April General practice bulletin
• Thursday 17 April General practice bulletin

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– LATEST TRAINING AND EVENTS –

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Health Academy’s ‘Introduction to Sexual Health in Primary Care & Community Pharmacy‘ training is an e-learning course for those needing to deliver core sexual health services.

Take this course and you will learn about:

• Basic anatomy and physiology
• Sexual health history-taking and risk assessment
• Providing emergency contraception
• Testing for sexually transmitted infections (STIs)
• Condom distribution schemes
• Assessing vulnerable adults, children and young people

The are videos, interactions, assessments, and reflective opportunities to keep you engaged throughout! The course provides 3 hours of CPD and can be taken online at anytime.

Find out more here.

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

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