National Insurance Increase
The autumn budget announcement has created huge concern in general practice about the impact of the significant rise in employment costs from April 2025. 

For many the cost of these changes to National Insurance contributions and the lowering of the threshold will be devastating. Previously, cost increases have been fully compensated, but Treasury officials have said there will no reimbursement this time. 

The BMA is putting pressure on the Government to guarantee these cost pressures be fully resourced, and has launched an online calculator (BMA member login required) to estimate the impact on your practice. Please sit down and login with your practice manager and click submit to share your figures anonymously to help build a picture of the reality facing practices.

More information, including a tool to write to your local MP, can be found on the BMA National Insurance campaign page. 

Collective Action
Thank you to every practice now taking part in collective action to protect our patients and practices. These actions have already, and will continue to make a difference: they are safe, sustainable, and do not breach your contract. This month we are focusing on Advice and Guidance.

In this two-minute video Dr Clare Bannon discusses how advice and guidance has been used when a referral would have been appropriate and that this has increased both work and risk for GPs. Using advice and guidance is not a contractual obligation, so as part of collective action, her practice is pushing back making it clear in referral letters that a patient should be provided with a consultation.

Physician Associates in General Practice
The LMC has received queries from practices who currently employ physician associates in our region. The national stance and guidance on this has changed significantly since practices first employed PAs locally. 

The BMA’s General Practitioners Committee for the UK (GPC UK) has voted in favour of stopping hiring physician associates in general practice, and for existing roles to be phased out. The RCGP's governing UK Council has also voted to oppose a role for physician associates working in general practice.

The European Union of General Practitioners (UEMO) has expressed its concern with the deployment of MAPs (medical associate professionals) and called on governments across Europe to legislate prohibiting the unsupervised initial assessment, unverified diagnosis, treatment, and discharge of the undifferentiated patient by MAPs. 

We recognise this makes things very challenging for practices and especially partners as employers. We have asked the BMA for legal advice on where GP partners will stand if they continue to employ PAs working outside the scope recommended by both the BMA and RCGP guidance. The informal feedback we have had so far is that, while this guidance is not mandatory, partners would need to have clear reasons for not following this and be able to demonstrate what systems they have in place to address the concerns raised by both the BMA and RCGP. 

The decision about the ongoing role of PAs will be very individual for each practice and PCN and depend significantly on their roles and supervision within each setting. You may find the BMA guidance on Physician Associates in general practice and also the RCGP guidance useful. Please get in touch if you would like further support and advice on your practice’s particular situation.

Focus On... The Role of the LMC part 3
Dr Zoe Norris, Chief Executive Medical Director, concludes a series of posts on the LMC. 

A lot of the work we do at the LMC used to be done by local GPs in the CCGs, either via council of members or GPs in leadership positions. The move away from GP led commissioning has meant the loss of that clinical voice in many key decision-making meetings, and we’ve needed to step up and step in to provide this. We try to juggle managing this workload with still being available for practice or individual concerns, and are constantly reviewing the contact we have with our practices. 

Four large maps on the wall of the LMC have colour coded pins, to identify those practices we haven’t had contact with for several months, so we can proactively reach out and make sure they know we are here for them. Looking at our website metrics helps us know what content is being accessed most often and informs our focus. Once a year we review all the constituent feedback from different events, and update our rolling strategy for the coming 12 months to best meet the need. 

We link in with other LMCs, both YORLMC who share our ICS footprint with us, and other regional and national LMCs to share ideas and good practice. Our links with the national GP Committees at the BMA are strong, meaning we have a good feel for national politics and changes that might appear. Attendance at LMC conferences by us and committee members helps cement this, and we have a good reputation amongst our wider LMC colleagues. 

We are always reflecting, sense-checking and trying to do our best within the constraints of a small team, but hope that practices are increasingly aware of how to access our help. If you have any queries and want to get in touch, or are interested in knowing more about how the LMC committee works, do email us at humberside.lmcgroup@nhs.net. Our website and newsletter contain a huge amount of information and are well worth a read if you haven’t had a look recently. We hope to keep working hard for general practice in the Humber area – keep in touch and please do say hello at any upcoming events or meetings. 

Death Certification – Further Guidance for GP Practices
We have updated our further guidance for GP practices on the Death Certification Reforms which came into force on September 9, 2024. Since September we have been engaging with practices and system partners to gather feedback and monitor how the changes are working. This new guidance follows a number of issues raised with us by practices and our discussions with the Medical Examiner Office. It includes:

Download Death Certification – Further Guidance for GP Practices.

Macmillan GP Education Offer
The Macmillan GP team are offering free palliative care training to clinicians in Hull and the East Riding. They have created a short survey to gauge interest and learning needs - take the survey. 

The Cameron Fund 
The winter newsletter from the Cameron Fund, the charity that supports GPs and their dependants, is now available. It includes information on how they have supported recipients this year and how to support their Christmas appeal. 

Spire General Practice Events
Spire have a number of upcoming events for general practitioners, practice nurses and other allied health professionals. All sessions are free and will be hosted on MS Teams. Click on the links to reserve places on Eventbrite. 

Tuesday 3 December 2024, 13:00-14:00 

Wednesday 4 December, 2024 13:00-14:00

Monday 9 December 2024, 13:00-14:00

Tuesday 10 December, 17:00-18:00

Partnership Disputes
BMA Law have published a new article exploring key questions including:

Read the article and equip yourself with knowledge to protect your business interests and make informed decisions.

Focus on DDRB Pay Award
The BMA have published a Focus on document on the 6% DDRB pay award and how it is applied to the national practice contract baseline funding (‘Global Sum’) and allocated to practices.

General Practice Annual Electronic Self-Declaration (eDEC)
The electronic practice self-declaration (eDEC) is a mandatory collection which all GP practices in England must complete every year. The revised version was published on 11 October – read more. 

N3i Selected as Primary Care Digital/IT Partner for HNY ICB
Following a procurement process, Humber and North Yorkshire Integrated Care Board (ICB) has selected N3i as their new Primary Care Digital/IT Partner with new service delivery effective April 1 2025.

N3i already provide Primary Care Digital/IT provision across the Humber area  but from April will take on this provision across the entire HNY geography. A transition process for practices in North Yorkshire and York will include the ICB, N3i and current provider NECS. Humberside LMCs does not anticipate any impact on practices in the Humber area but we will monitor developments. 

Read a letter to practices from Humber and North Yorkshire Integrated Care Board announcing the change.

This online workshop is delivered by ISM Pension Services.

Pensions Online is an integral part of the Pension Scheme Administrators toolbox providing a broad range of functionality. The E-Form Suite has unexplored assets and attributes that support employers sustain compliance with the employer obligations. Attendance at the session will ensure that your will be aware of where, how and when to access and respond to these important communications. Visit Eventbrite for further information and online booking. 

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

YAS Diaries
Yorkshire Ambulance Service have shared the first in a series of reflective articles on the interface with primary care. This article focuses on the use of the YAS HCP line in preference to dialling 999 based on a patient story. Dr Martin Sutcliffe, YAS Associate Medical Director - Primary and Urgent Care, invites feedback and his contact details are included.  

Upcoming Health and Wellbeing Staff Events
HNY ICB have a programme of health and wellbeing sessions over winter and spring for healthcare staff working in the region. Visit the booking page to view the programme and book on to sessions.   

NHS England 10 Year Health Plan
DHSC and NHS England have launched a consultation – Change NHS – to help inform the development of a new 10 Year Health Plan. The consultation is looking for ideas on how the NHS can improve, as well as views on these three proposed ‘shifts’; moving more care from hospitals into the community; going from analogue to digital; and moving toward prevention and away from sickness. Submit responses via the survey. 

Do You Look After Asylum Seekers or Refugees?
This group of patients continue to face significant barriers accessing appropriate and timely healthcare. The BMA has launched a survey to capture your experiences so they can update their Refugee and Asylum Patient Health Toolkit and influence government policy to better support you in enhancing healthcare services for asylum seekers and refugees. Share your views and complete this ten-minute survey by Saturday 14 December 2024. 

You will be shown tools to help bring about both team and individual change, and you will also also be given tools to measure the effectiveness of the changes that you implement. Suitable for all staff working within General Practice. Fully funded. More details and online booking. 

Thursday 12 December, 9.30am-1.30pm. Via Zoom.  

Discover tools and techniques to aid your practice/organisation become more resilient. Access resources and a community which will provide ongoing support. Suitable for GP partners, GPs, practice managers and other senior managers. Fully Funded. More details and online booking. 

As in previous years, under the terms of the flu enhanced service, practices are able to provide flu vaccination to their patient-facing staff. Unfortunately, while these will not be eligible for an item of service payment due to an NHSE decision, such vaccinations will be covered under CNSGP.

Locum GPs are also eligible to receive free flu vaccination under the flu enhanced service. While this may be received from their registered practice, under the terms of the ES they do not need to be a registered patient in order to receive the vaccination, and so may receive it from their substantive workplace, if applicable, and vaccinations provided to locum GPs are eligible for an item of service payment, as with other patient cohorts. Further guidance on this, including how such vaccinations should be recorded, is available on the NHS England website.

Opportunity: Health Equity Fellowship
Applications for the 2025/26 HNY Health Equity Fellowship Programme are now open. The ICB is seeking 50 passionate individuals who are eager to drive change and address health inequalities in our region.

This fellowship provides participants with advanced skills to enhance population health and tackle disparities within their organisations and communities. The programme is open to everyone working in health, social care, local government and the voluntary and community (VCSE) sectors in Humber and North Yorkshire – irrespective of their current role, grade or profession. 

Further information on the programme and how to apply can be found on the Health Equity Fellowship website page.

Haxby's new training diary includes a range of primary care courses such as:

View full details including prices and booking information on the Haxby Training Diary. 

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. 

Bleeding and Haemorrhage in Advanced Cancer
Significant bleeding may occur in 10–20% of people with advanced cancer. This Red Whale article looks at causes, treatment, discussion with patients, and preparation to deal with bleeding. 

Menopause Management
New draft NICE menopause guidelines caused considerable disquiet when they were published last year. After a consultation process, the guideline is now out in its final format. This NB Medical article suggests there is plenty to celebrate, but also some disappointing missed opportunities. 

Tobacco Cessation
This concise guidelines summary from Medscape covers World Health Organization (WHO) evidence-based recommendations for clinicians treating adult tobacco users, including behavioural and pharmacological interventions.