Information on GP Collective Action
Humberside LMCs has published a new resource pack for our GP practices and PCNs. The pack consists of summaries of the BMA GP Survival toolkit which is the basis for national BMA collective action in England. This action is due to start from 1 August 2024. 

All documents referenced are hyperlinked to the relevant national guidance. Download the four documents below:

• LMC letter to GP practices
• BMA GP Practice Survival Toolkit Summary
• Enhanced Services RAG Summary
• Interface Actions

The GPC is inviting GP partners to work with their practice teams to determine the actions they will be willing to take. You can read the full BMA toolkit here: BMA GP Practice Survival Toolkit.
 
It is for each practice to pick and choose as they see fit. You may decide to add to your choices over the days, weeks and months ahead. You can read more in the guidance provided or in the GPC's FAQs. Read the GPC contract guidance to help you consider how best to approach the contract changes. 

The LMC is circulating regular updates on this issue via our GP Contract 2024/25 Updates WhatsApp group. If you're not in the group yet and you would like to be added just send a quick message to 07493 066651 and we'll add you, or you can join the group online: GP Contract 2024/25 group joining link. 

The recent LMC contract webinar is now available to watch online. The session, held on 23 July 2024, was presented by LMC team members Dr Zoe Norris and Dr Rolan Schreiber, who provided an update on the GP contract imposition.

Help Spread the Word to Patients - GPs Are On Your Side Campaign 
The BMA has produced a range of materials to help you engage patients in the campaign GPs Are On Your Side, including:

• posters to download and display in your surgery
• social graphics to save and share on social media and websites
• new patient-facing video with subtitles that can be activated for screen reading

Access the patient materials on the GPsOnYourSide Campaign page.  

GP Forum Study Days - Autumn 2024
You are invited to attend the following Primary Care programmes. Certificates of Attendance will be issued and all sessions are free to attend. Full details including how to book your place can be found on the GP Forum study days flyer. 

Dermatology - Wednesday 11 September 2024, 11:45-16:00
Mercure Grange Park Hotel, Willerby HU10 6EA
This session includes:
- Recognising, diagnosing and management of skin cancer, Professor Shernaz Walton, Ozone Health, Hull
- Dangerous and unusual rashes in the manifestations of cutaneous and systemic disease, Dr James Britton, Ozone Health, Hull

Musculoskeletal - Thursday 14 November 2024, 11:45-16:00
The Pelham Suite, Cambridge Road, Grimsby DN34 5SZ
This session includes:
- Spines: what not to miss - a surgeon's perspective, Mr Masood Hussain - Hull University Teaching Hospitals
- Rheumatology essentials for primary care, Dr Bela Szebenyi - North Lincs & Goole NHS Foundation Trust

Contraception and Sexual Health - Wednesday 4 December 2024, 11:45-16:00
Mercure Grange Park Hotel, Willerby HU10 6EA
This session includes:
- New developments in infertility - controversies and treatments, Dr Shilpa Pandey - Care Fertility
- An overview of contraception and recent advances, Dr Pushpa Ajith - City Healthcare Partnership

BMA Sessional GPs Conference 2024: Diversity, Opportunity, Safety
The next BMA sessional GPs conference will be held on Friday 20 September 2024. The conference will give you updates on topical issues and is a one-day conference specifically for sessional GPs. Full details and registration here.

Practice Finance Health Joint Webinar 
Wednesday 7 August 2024, 12:30-14:00
GPCE - AISMA (Association of Independent Specialist Medical Accountants)

Find out how good practice management makes a difference. Join the webinar to hear about improving practice income and keeping on top of finances. Register here

LMC Jobs Page
A reminder that practices in the Humber area can post their GP and practice manager vacancies free of charge on the new Humberside LMCs Jobs page. Complete the online form to submit a vacancy.

NLAG Haematology Changes
A single service managing all aspects of haematology care across the Humber region will be established from 5 August 2024.

Colleagues will likely be aware that, since 2017, Hull University Teaching Hospitals NHS Trust (HUTH) and Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) have been working together as part of a clinical network model. 

As part of this arrangement, a number of changes have taken place to ensure haematology services can continue to be delivered safely and sustainably across the entire Humber region, and the last of these will take place over the coming days. 

From Monday 5 August, the remaining outpatient haematology service provided by NLaG, along with a small number of patients who have been receiving care from the NLaG team under long term follow-up arrangements, will transfer over to HUTH. 

The move will help to maintain the safety and reliability of the haematology service, both now and in the future, and allow every patient to benefit from the expertise of the Queen’s Centre team which works at a sub-specialty level.
For your absolute assurance, the service will continue to be led by the Consultant Haematologists, with support from Clinical Nurse Specialists, Senior Pharmacists and Biomedical Scientists. 

For you as General Practitioners and primary care colleagues, there will be no change to any of the existing advice and guidance or to the referral pathways into the haematology service. Laboratory haematology services will also be unaffected.

Most patients should see little to no difference in the way they receive their care as many of the staff delivering the service will remain the same. While face-to-face medical reviews will henceforth be carried out at the Queen’s Centre in Hull, in order to minimise the need for patients to travel, virtual clinics will be used for this purpose wherever clinically appropriate to do so. 

Again, for convenience, arrangements have been made for patients to continue to have blood tests, receive treatments and collect prescriptions close to their homes, and we have taken steps to notify affected patients of the upcoming change. 

HNY Primary Care Workforce and Training Hub 
All the latest opportunities available via the hub can be viewed on their news feed. Opportunities available this month include:

• CPD Funding 24/25 - Please tell us what training is needed
• New-to-Practice Nurse & NA VTS Programme - September 2024 Registrations
• Trainee ACP Funding 2024/25 - Still open for Applications 
• Funded Cervical Screening Training - October 2024 - Applications Open
• AP Conference (University of Cumbria) - Online 6th November 2024
• Humber Generalist School Programme - Sept 2024
• Pharmacy Education Update Briefing - July 2024
• Humber & North Yorkshire Eyecare - Free online CPD - SPRINT Events 2024
• Apprenticeship and Widening Participation News - July 2024

Visit the hub website for details of all opportunities. If you would like more information on please contact the hub: hnyicb.traininghub@nhs.net (please note the new training hub team email address)

NHS Healthy Start Scheme
The NHS Healthy Start scheme helps young families and those who are pregnant to access healthy food, milk and vitamins.

People may be eligible if they have responsibility for at least one child under the age of four or are more than 10 weeks pregnant. Eligibility also depends on the benefit the person receives and what their income is.

People apply for the scheme online and get a prepaid card, which they can use to buy healthy food and milk. They can also get free Healthy Start vitamins.

The prepaid card can be used in most places that sell eligible healthy food and milk items and accept Mastercard®. The card is topped up every four weeks with their payments.

Once on the scheme, people will get:

• £4.25 each week of their pregnancy (from the 10th week of pregnancy)
• £8.50 each week for children from birth to one year old
• £4.25 each week for children between one and four years old.

The payments will stop on the child’s 4th birthday or if they no longer receive the qualifying benefits.

Full details and how to apply can be found at How to apply – Get help to buy food and milk (Healthy Start). Healthcare professionals play an important part in promoting the Healthy Start scheme. Information for professionals plus a communications toolkit can be found at Healthcare professionals – Get help to buy food and milk (Healthy Start). 

Interface Update
Interface Officer Simon Nichols continues to assist practices with interface issues. Click below for the July interface update presentation, which outlines this month's activity to support practices with their interface queries. Contact us with your interface queries via humberside.lmcgroup@nhs.net. 

Emergency Changes to Clinical Microbiology Service in North & North East Lincolnshire 
The Clinical Microbiology team is currently under extreme pressure due to significant workforce vacancies at consultant level. The team provides all of the microbiology service for patients across the ULH-NLAG Hospitals and remains committed to trying to maintain the best possible service.

In order to help maintain the service in the face of this major workforce challenge the process for seeking input from the team has changed with effect from Monday 1^st July 2024 as follows:

Urgent advice can still be sought by contacting the on-call Microbiology Consultant via switchboard. Calls will only be accepted from colleagues on Consultant rota and General Practitioners. Wherever safe and possible, please defer calls to in-hours.
 
There are no changes to the laboratory aspect of the service. Please use MicroGuide to access the antimicrobial guidelines. MicroGuide can be downloaded as an app or via intranet.

Please be assured that the team are actively trying to recruit staff and improve the resilience of the service.

This situation doesn’t impact on microbiology services north of the Humber as these are managed by a different pathology group (SHYPS).

Partnership Deeds – Your Key Questions Answered
An up-to-date partnership deed is crucial for the smooth operation of practices. Without it, partners may be left vulnerable under the outdated Partnership Act 1890, leading to unstable and risky business arrangements.
 
This article from BMA Law will help you understand:

• the key provisions that every partnership deed should include
• the significant risks of neglecting updates
• how an effective deed can prevent and resolve disputes.

Read the full article. 

As we develop our offer under the People Promise, we would love to hear how your practice nurses are supported.

The People Promise is an NHS England initiative to improve the experience of working in the NHS for everyone. You can find a brief overview of The People Promise at the following link Read more about the People Promise.

Humberside LMCs and Yorkshire Health Partners are working together on the People Promise and are planning to raise the profile of practice nursing and provide enhanced support for practice nurses across the Humber region. 

We’re keen to hear what support your practice nurses currently receive and what support they would like to receive in the future.  Please complete this short survey to tell us about what’s available currently and what support practice nurses would like in the future.

Working with YHP, we will use the information gathered to inform a range of offers of support for practice nurses to begin later this year.

If you have any questions about the People Promise work or have a practice nurse or lead PCN nurse who would be keen to be involved, please share our contact details and ask them to get in touch humberside.lmcgroup@nhs.net 

Haxby Training Dates September-December 2024
Haxby have a number of courses available in the coming months, both in person and virtual. Courses include Basic Life Support; Flu update; Imms updates; and Venepuncture. Full details including dates/times, locations and prices can be found here. 

Working with the New Government to Rebuild General Practice 
GPC England has written to the newly appointed Secretary of State for Health and Social Care, Wes Streeting MP, offering to work together to rebuild general practice in England. The letter highlights ‘the enormous frustration at the loss of over 2,000 GP practices over the past 14 years and of over 5,000 “home-grown” GPs whose training has cost taxpayers in the region of £2–3bn. The number of registered patients in England has increased by 6.4 million in the past 5 years alone, the average number of patients per full-time equivalent fully qualified GP has risen by 18% to over 2,300.’ Read the full letter here

GP Connect Update
The GPCE position on GP Connect (Update Record function) remains that GPs must retain the ability to restrict access to third parties to update the GP record. GPs who wish to and have already switched off update record need not make any further changes. Any GPs wishing to turn off the functionality can do so via the steps listed here.

GP Pressures: Workforce and Appointment Data
The latest workforce data showed that the NHS had the equivalent of 27,649 fully qualified full-time GPs. Although this is an increase of 43 FTE GPs since the previous month, we still have 1,715 fewer fully qualified full-time GPs than in September 2015. The number of GP practices in England has decreased by 89 over the past year – reflecting a long-term trend of closures and mergers. 
 
This fall in both staff numbers and GP practices coincides with a rise in patients: as of May 2024, there was another record high of 63.37m patients registered with practices in England – an average of 10,079 patients registered per practice, and each full-time equivalent GP is now responsible for an average of 2,292 patients. This is an increase of 354 patients per GP, or about 18%, since 2015, demonstrating the ever-mounting workload in general practice.  
 
The latest appointment data show that over 30.5m (non-COVID vaccination) appointments were booked in May 2024. The number of COVID-19 vaccination appointments increased from around 247,000 in April to over 285,000 in May. On average there were 1.47m appointments (estimated total count of appointments, including COVID vaccination appointments) per working day in May 2024.
See more BMA infographics and data, showing the pressures in general practice >

Best Practice Birmingham 2024
Wednesday 9 & Thursday 10 October 2024
NEC Birmingham, Pendigo Way, Marston Green, Birmingham B40 1NT

Best Practice Birmingham is one of the largest gatherings of general practice health care professionals from across England, and is free to attend.  

• Accredited CPD Content – 12 different theatres of educational sessions to choose from with over 200 individual talks. Earn up to 12 hours of accredited CPD content. 
• Clinical Education – over 100 different clinical updates covering diabetes, respiratory, cardiovascular, women’s health and many more…
• Multi-disciplinary Appeal – different yet specific programmes for PCN leaders, practice managers, GP Partners and all clinical staff.
• Business Advice – develop your non-clinical skill set 

For full information and to register please click here:
https://www.bestpracticeshow.co.uk

Covid and Flu Vaccination Programme
In June, GPC England wrote to practices to highlight their position on both the COVID vaccination programme, and the seasonal flu programme for 2024/25. Since then, NHS England has also announced a new RSV vaccination schedule from Autumn 2024, which is discussed below.
 
The COVID-19 programme is being offered by NHSE under a new procurement process which covers the delivery of the Covid-19 vaccination over a two year period between 1 September 2024 and 31 March 2026. You should note the funding arrangements relating to this programme: 

• The IoS fee for the Covid vaccination, during the seasonal flu programme is £7.54, on the basis that when both programmes are concurrently delivered, this would allow co-administration. 
• Outside a flu campaign period, each Covid vaccination will attract an additional payment of £2.50 as well as a £10 additional payment for patients who are housebound under the Covid-19 campaign. 

These funding arrangements are being unilaterally imposed, despite the evidence and arguments that both GPC England and Community Pharmacy England have made to NHSE regarding the increased complexity, workload and related administrative burden of the Covid vaccination process in comparison to other vaccinations. GPC England has made it clear to NHS England it believes current funding for all vaccination programmes is economically not viable. 
 
Should any practice wish to take part in the programme, it is recommended that as the current offer of £7.54 does not cover the costs incurred, practices should contact their LMC before writing to their ICB to highlight the lack of financial viability to support its delivery. Read more in the GPCE guidance 

New NHS Vaccination Programme Against Respiratory Syncytial Virus (RSV)
Following recommendations by the JCVI, two new RSV vaccination programmes will begin from 1 September 2024:

• Adults aged 75 – 79 years old
• Pregnant women to protect infants

NHSE intend to commission this from General Practice as an Essential Service. This represents a single vaccination. The routine programme means adults become eligible after the age of 75 commencing 1 September 2024, but a catch-up programme will be in place until 31 August 2025.
 
The programme for pregnant women, designed to create immunity in infants, will commence on 1 September with eligibility after 28 weeks. The antenatal service can be commissioned via a variation to the Trust NHS Standard Contract.
 
GPCE have made it clear to NHSE that the current £10.06 IoS fee is not economically viable for practices and should be substantially uplifted. Whilst GPCE advise practices to deliver immunisation programmes included within Essential Services, it strongly recommends carefully reviewing the appropriateness of participating in any other non-core contract programme, if this were to be offered, where a £10.06 IoS fee [or less, such as Covid-19 concurrent with seasonal flu, when the fee is £7.54] is offered.
 
A new RGV PGD template will be developed by UKHSA, available from the PGD collection here. Detailed clinical guidance on RSV and RSV vaccination is expected imminently within Chapter 27a of the Green Book.  Both professional and public facing information materials are available here.

Cervical Screening Management System (CSMS) 
The CSMS has gone live, replacing the previous Open Exeter call/recall IT system. The CSMS is accessed via an NHS smartcard. All providers are asked to update any internal operating procedures and documentation that supports delivery of cervical screening services, to reflect access to and how CSMS should be used. GP Practices should log on and review the notification section to check: 

• that the contact email details for Prior Notification Lists (PNLs) are correct (click on ‘manage email’ within ‘notifications’). If incorrect, amend on CSMS, ensuring it’s a generic email contact address.  
• the details of any patients due to be invited and action accordingly. 

For any technical support with using or accessing CSMS please visit: CSAS 

GPC Update
The GPC publish regular updates for LMCs, covering contractual issues, policy, news updates and more. Read the latest updates, published fortnightly by the GPC. 

Identifying and Supporting Patients Experiencing Domestic Abuse
In this filmed session Dr Vasumathy Sivarajasingam covers facts about domestic abuse, the role of primary care, how to recognise and support people experiencing domestic abuse, and practical steps that primary care teams can take when responding to domestic abuse. Watch at Medscape UK. 

Sexually Transmitted Enteric Infections (STEI)
This NB Medical Education article follows the release by the British Association of Sexual Health and HIV (BASHH) of the first ever National Guideline for Management of STEI last year. This guidance was released in response to increasing rates of STEI and the emergence of multidrug resistant strains, and it includes plenty of learning points for us in primary care. Read more at NB Medical Education.  

Familial Hypercholesterolaemia
By the age of 60y, 50% of men and 30% of women with familial hypercholesterolaemia will have had an MI. Treatment returns cardiovascular risk to near-population risk, but over a third of people with the condition in the UK are under-treated, leaving them at increased risk of CV events. Read more on testing, treatment and management at Red Whale.