Collective Action Update
Declining un-resourced work is a core element of the BMA’s GP collective action plan. By declining to undertake unfunded work, you are preserving ‘core’ GP services. You are also demonstrating to providers, the ICB, NHSE, and government, the significant volume of work GPs do for free and how much work is inappropriately transferred into general practice.

During August, we’ve supported practices with a significant number of queries about collective action. We’ve already responded to twice as many queries as we would have in a typical month. We’ve been providing advice about the types of interface activity you can decline, how to decline it, and have helped safety net your patients where there has been incorrect pushback from other providers.

You have identified a significant number of inappropriate requests, and the majority have been declined, outright. Many of you are choosing to use our new workload rejection letter template for all interface issues. If you would like any advice or help rejecting inappropriate work, we would be happy to support you.

There are signs that by rejecting unfunded activity and inappropriate requests, action is starting to be taken by the system. This is great news. Collective action has the potential to advance the interface agenda, significantly. This is unfunded, non-core work that general practice should not be undertaking, and often is contracted to another provider organisation. A non-exhaustive list of activities you may wish to reject can be found here.

Examples of confirmed workload rejections during the first two weeks of August are:

• A & E – GP to finish hepatitis B vaccination
• Community Nursing – GP to onward referral
• Community Nursing – GP to complete MAR chart
• Community Nursing – GP to change nephrostomy bag
• Gastroenterology – GP to onward refer
• Frailty service – GP to action A & G response. A & G not requested by GP.
• Midwifery – GP to report results to patients
• Midwifery – GP to action results ordered by other providers
• Midwifery – GP to prescribe
• Podiatry – GP to prescribe
• Pre-op – GP to arrange bridging script
• Pre-op – GP to prescribe MRSA eradication treatment
• Pre-op – GP to provide fragmin injections

Other actions that practices in our area are undertaking include:

• No longer using A&G when there are delays or workload shift coming via that route
• No longer using referral forms and instead sending traditional letters to save the practice time.
• Issuing notice on LES that are costing the practice money to deliver due to inadequate funding
• Stopping delivery of unfunded work e.g. wound care, spirometry, phlebotomy.

Practices can find advice on these actions on our website resources section, and in the BMA ‘focus on’ document.

Collective action can be taken with ANY provider, not just acute trusts. The ICB now has systems in place to report declined activity/collective action. If you wish, you can report any instances of declined activity to primary care contracts at hnyicb-ny.primarycarecontracts@nhs.net.

If you have any questions, please don’t hesitate to get in touch with the LMC via humberside.lmcgroup@nhs.net . A reminder to please anonymise any patient identifiers to only include the NHS number. If you need to send full patient identifiers, please only do this to our GPs – zoe.norris1@nhs.net and rolan.schreiber1@nhs.net

GP Local Action Tracker Survey 
We have started to share a weekly BMA local action tracker survey to find out what action practices are taking. The survey asks: which ICB and LMC the respondent is part of; whether their practice is undertaking each type of action; and provides a space for further comment.  

The data collected will be used to monitor participation with the different types of action across the country, and as a lobbying tool to demonstrate the level of participation in collective action. 

The survey link will be sent at the start of the week, with a deadline of 5pm on Sunday for practices to complete. These surveys should be completed by only one member of staff per practice.  

DDRB Update 
The GPC England dispute with NHS England, including collective action, is unaffected by the recent global sum uplift.

The government has announced an uplift to the global sum to cover the pay increase recommended by the Review Body on Doctors' and Dentists' Remuneration (DDRB). This uplift of 6% does not represent a negotiated settlement over the imposed 2024/25 contract. It doesn’t even see general practice standing still financially compared to 2019 practice income (if it had been uplifted for inflation).
 
We know we need 10.7% just to restore our contract real terms funding back to 2019 levels. This offer is nowhere near sufficient to save general practice and pull us back from the brink. 

GPC England are continuing to negotiate for a settlement that restores the funding eroded by the below inflation increases over recent years. They are asking practices to participate in collective action to strengthen their hand in achieving this, to stop the attrition of GPs and practice staff, and to restore safe services for patients. 

The LMC will be sharing guidance from GPCE as soon as it becomes available as we are conscious many practices are already receiving queries from staff.  

Are Your Pension Records Up to Date?
The BMA’s Pensions Committee have launched a campaign encouraging you to take action to make sure that your pension records are accurate and up to date, so you can make informed decisions about your pension savings, retirement plans and the McCloud remedy.  

Thousands of GPs in England have “missing years” of pensions data due to PCSE’s maladministration of pension records. The BMA has been consistently highlighting the failures of PCSE (run by Capita), and the significant importance of them fixing this issue as soon as possible. Unfortunately, there has not been sufficient progress to resolve this issue, so GPs are now encouraging you to take action to get your pension records in order.
 
To support you the Pensions Committee have created detailed guidance including template letters to help you get your records up to date, raise a complaint and escalate further where appropriate. 
 
Guidance on getting your pension record up to date, for GPs in England - YouTube

GP Forum Study Days 
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
  
Musculoskeletal - Thursday 14 November 2024, 11:45-16:00
The Pelham Suite, Cambridge Road, Grimsby DN34 5SZ
  
Contraception and Sexual Health - Wednesday 4 December 2024, 11:45-16:00
Mercure Grange Park Hotel, Willerby HU10 6EA 

Endoscopy Feedback Questionnaire 
The Hull Endoscopy Services at NHS Humber Health Partnership (Castle Hill Hospital and Hull Royal Infirmary) would greatly appreciate it if you could take a few moments to complete a brief feedback survey. They  are interested in learning how they can improve services and build on strengths.
 
Your feedback will be reviewed by the Endoscopy Governance Group and inform future services improvements where necessary.

Download the questionnaire. Please return by 30 August 2024.  

BMA Sessional GP Conference 
The BMA conference for sessional GPs is happening at BMA House and online on 20 September 2024. It's free for members, but non-members can also attend. This event will give you information and updates on topical issues including future models of general practice and establishing professional relationships with new clinical roles such as ARRS staff and PAs. Breakout groups will provide practical advice and guidance on a choice of topics in smaller groups. Check out the details of the day and register your place  

Crowdstrike Outage
Following the events of Friday 19 July that saw critical digital services, including in general practice, across the country impacted by the outage, GPC sought and received assurances from the ICO and NHS England that GPs would not be required to report the availability breach to the ICO created by the outage on an individual basis.

Instead, NHSE is providing a bulk report to the ICO, allowing them to satisfy their obligations under Article 33 (1) UK GDPR. The ICO confirmed that for those practices that have already reported, they may consider the matter closed with no further action to follow. However, any breaches unrelated to the crowdstrike outage and its impact on EMIS will still need to be reported.

UK Visa Sponsorship Licences (Formerly Known as Tier 2)
Does your practice have a visa sponsorship licence? In this podcast Wessex LMCs joint CEO and GP Dr Laura Edwards talks with a panel around visa sponsorship and how it impacts international graduates, particularly around the time of qualification and what actions practices may want to take to help with their recruitment.
 
Read also the BMA guidance on Visa sponsorship for GP practices

General Practice Staff Survey 2024 *Closes Soon*
HNY ICB are participating in the roll out of the General Practice Staff Survey (GPSS). This provides those working in general practice, PCNs and federations equal opportunity to participate in a tailored version of the NHS Staff Survey. 

This survey is one of the world’s largest and well-respected workforce surveys, gathering data to inform understanding of staff experience with the ambition of driving improvements for staff with further benefits for both organisations and patients.
 
Participation is voluntary, but if you would like your organisation to participate in the survey, please complete the Staff List Template, and return, as an attachment, to hnyicb-ny.primarycarecontracts@nhs.net by close of play Friday 30 August 2024.
 
This list will be provided to Picker, the independent survey provider, to enable individual survey invitations to be sent to staff. Individual invitations ensure all staff are given the opportunity to have their voice heard and enables the same robust methodology as used in the NHS Staff Survey for secondary care. If a member of your team does not have an individual email address, provision has been made to send a unique link to them on paper and you can indicate this on the list. Survey responses are anonymised and subject to the highest standards of confidentiality protocols so what respondents say is kept anonymous.
 
To see who should be included in your list, please see the guidance for employer organisations. The main principle guiding the list collation is to include all people employed by your practice, PCN or federation. For staff with more complex employment arrangements i.e., ARRS staff, please see the specific guidance.
 
Further guidance, comms materials and Data Protection information can be found here. If you have any queries or questions, please read the FAQs on the Participating Organisations tab. If your answer cannot be found, please email hnyicb-ny.primarycarecontracts@nhs.net

Practice Finance Survey Summer 2024
The BMA are inviting practices to complete their Practice Finance survey. The aim is to build evidence for the GPC England team to support the annual contract negotiations.

This is your opportunity to feed into an evidence base demonstrating the impact of inflation and rising costs, over the last couple of years, on GP practices across England.
 
Practice managers are asked to complete the survey by 09:00 on Tuesday 17 September. We recommend that respondents have relevant information to hand before starting the survey: they will need GP practice accounts for 2022/23 and 2023/24, expenditure data for April 2023 and April 2024, and information on staff numbers and practice list size. 
 
Take the survey: https://www.research.net/r/H9CYXCP

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.

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:

• Reminder - Trainee ACP Funding 2024/25 - Still open for Applications
• Reminder - Funded Cervical Screening Training - October 2024 Applications Open
• NEY Apprenticeship & Widening Participation Community Of Practice
• Return to Practice Opportunities
• Expression of Interest: NHS England Teach and Treat Programme 2024
• New CPPE e-learning programme - Pharmacy technicians: using patient group directions in practice
• GP Forum CPD Events - Sept-Dec 2024
• Best Practice Show 2024 - 9th/10th October - Free event

Free Cancer Champion Awareness Sessions 
Would you recognise the signs and symptoms of cancer? 1 in 2 people will develop cancer at some point in their life. Being aware of the signs and symptoms of cancer and detecting it early can save lives.
 
The Humber and North Yorkshire Cancer Alliance’s free cancer awareness sessions can teach you about what to look for, cancer prevention, the national cancer screening programmes, and much, much more.
 
Join over 6,300 others and sign up for a free face-to-face or virtual awareness session. Alternatively, you can request a bespoke session for your team, group or organisation. Please visit www.hnycanceralliance.org.uk/cancerchampions for further information. 
 
If you have any queries, please email the team at hny.cancerchampions@nhs.net or call 07519 120809. 
 
Dates for sessions – virtual part one (one and a half hours)

• Friday 6^th September, 11:30-13:00
• Wednesday 11^th September, 18:30-20:00
• Thursday 12^th September, 14:00-15:30
• Wednesday 18^th September, 10:00-11:30
• Tuesday 24^th September, 15:00-16:30
• Monday 30^th September, 09:30-11:00

Support for Victims - Legacy Funeral Directors
Communications materials have been shared to support those who have  been affected by the recent Legacy Independent Funeral Directors incident and would like further support and information.

Visit the joint Hull City Council and East Riding of Yorkshire Council website: www.hulleryc.uk/legacy for signposting to relevant information regarding the investigation and support services. Please note, for anyone directly experiencing distress or concern about this incident there is a dedicated helpline and support service available, call 0808 281 1136 or visit: Victim Support — Legacy Independent Funeral Directors investigation. 

A Legacy community support communications toolkit has further information and links to services. To help raise awareness of support available from Victim Support you can download a newly published dedicated poster and a leaflet.  

ARRS Funding Scheme Expansion
Following the recent announcement from the DHSC and the secretary of state on the temporary inclusion of newly or recently qualified GPs in the ARR Scheme, GPC England provided a joint statement with the Sessional GPs Committee highlighting the potential impact of expanding funding to include GPs, and raising concerns about the practical implementation of this: 
 
'There are experienced and talented GPs, ready and able to work, but practices can’t afford to hire them so expanding the funding scheme to include GPs shows the Government is keen to find solutions to stabilise general practice. However, we have concerns around how this policy will work in practice, and it’s fundamentally nowhere near enough to save general practice.

'Because the funding won’t be allocated at a practice level, but instead via Primary Care Networks, this means any GPs employed through this scheme could be forced to move across the country at short notice, uprooting their families in the process, and depriving their patients of continuity of care. This in itself could drive more GPs away from the NHS. 
 
'We’ve shared ideas with the Government for how to best get more unemployed GPs back into the workforce, because there are more flexible and effective ways that this funding could be used to ensure the maximum benefit for patients – for example reimbursing the practices themselves. In the long-term, however, we need to see the core GP contract funding increased so that practices have full control over who they recruit, without the need to go via bolt-on schemes. We will continue to share suggestions with the new government to potentially take forward in 2025/26.' 

GP Contract Roadshows - Slides and Videos
If you weren't able to get to any of the BMA's roadshow events you can now download the presentation slides or watch a recording. 

New GPCE Guidance on Physician Associates (PAs) Working in General Practice
GPCE has published guidance to help standardise practice and reduce variation in how physician associates work within a general practice setting. It aims to provide a framework to support physician associates to work safely in general practice, for patients, their employers, and GP supervisors.  It has been designed to complement the scope of practice and supervision guidance already published by the BMA and should also be read in conjunction with GPCE’s Focus on MAPs in general practice. 

GP Pressures - Workforce and Appointment Data
The latest workforce data showed that the NHS had the equivalent of 27,670 fully qualified full-time GPs in June 2024. We have the equivalent of 1,694 fewer fully qualified full time GPs than in September 2015, and the number of GP practices in England has decreased by 90 over the past year.  
 
This fall in both staff numbers and GP practices coincides with a rise in patients: as of June 2024, there was another record-high of 63.40 million patients registered in England – an average of 10,101 patients registered per practice. As a result, each full-time equivalent GP is now responsible for an average of 2,291 patients, which is an increase of 354 patients per GP, or about 18%, since 2015.   
 
The latest appointment data shows that that over 28.6 million standard appointments were booked in June 2024, with an average of 1.43 million appointments per working day. Over the past year, approximately 367.1 million appointments were booked in England. 
 
In terms of access, 44% of appointments in June 2024 were booked to take place on the same day. 44.6% of appointments were delivered by a GP in June 2024, and almost 65% of appointments were booked face to face. See more infographics and data, showing the pressures in general practice >

Free Virtual Session - Understanding Islamophobia 
Wednesday 25 September 2024, 11:00-12:00. MS Teams. 

The national NHS England team are holding a free virtual session around understanding Islamophobia and it is open to all NHS staff. The event aims to provide valuable insights into the nature of Islamophobia, its impacts on individuals and communities and effective strategies for creating an inclusive and supportive working environment.
 
There will be time within the session for colleagues to share their own experiences, ask questions and engage in meaningful dialogue. It is an important opportunity for allies to enhance our cultural competence and awareness - an especially important focus for us after the racist and Islamophobic violence seen on our streets and across the country.
 
You can find out more on the NHS England events page. There's no need to book a place, you can join the Understanding Islamophobia event using this MS Teams link on the day.

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. You can also still watch a recording of the LMC's contract imposition webinar. 

Anaemia Guidelines and Evidence Made Simple
This Red Whale guidance contains everything you need to know about how to approach all types of anaemia in primary care. Read more at Red Whale. 

Avoidant Restrictive Food Intake Disorder (ARFID)
This NB Medical Education article discusses the spectrum that exists between normal childhood “picky eating”, and the severe, clinically diagnosable ARFID which has a significant detrimental impact on quality of life of affected children and families. Read more at NB Medical Education.     

Understand the Clinician’s Role in Reporting Female Genital Mutilation
This Medscape article explains the role of clinicians in preventing, identifying, and treating complications of female genital mutilation, covering both legal and clinical concerns. Read more at Medscape.