Focus On... Partnership Agreements
In the first of a new series of articles to showcase how the LMC can help your practice, Dr Zoe Norris, Chief Executive Medical Director explains how to avoid some common difficulties with partnership agreements.

You may have seen adverts for recent free webinars taking place on partnership agreements coming from the LMC. These have now concluded, and the legal firm who delivered them – DR Solicitors – also presented at our recent practice managers conference.

The webinars were funded by the ICB, after they came to us concerned about a number of practices they had been in touch with who didn’t have up to date partnership agreements. This is an area the LMC often deals with and one it’s well worth being aware of. Despite our excellent local practices, reviewing and updating partnership agreements is something that tends to get lost in delivering patient care and trying to hit the latest DES or QoF targets.

The LMC are always clear with constituents that we aren’t legally trained, but we have seen lots of partnership agreements and can give you some advice about where you might want to start. The commonest problems we see are where a partner has left and the agreement hasn’t been updated, where there is no partnership agreement at all, or where an issue arises and there is no “green socks” clause.

The green socks clause will sound bizarre unless you’re familiar with it, and is based on the fact that it’s always helpful if any partnership agreement has in it the ability to remove a partner for no other reason than the fact they wear green socks. In other words, if the partnership wants to expel an individual, they can do so without citing any particular reason and avoid a complicated situation and lots of legal bills. Partnership dynamics often change, and removing a partner without giving a clear reason opens up a potential claim against the remaining partners.

Understanding what the legal situation is and seeking early advice before getting to that stage is a way to reduce risk and financial liability. If you’re reading this and are unsure, I’d really encourage you to get in touch with us for a conversation. We can look at your current agreement and point out areas that might need to be updated or amended and recommend some legal firms with the necessary expertise to support you. If you are heading towards a partnership dispute and haven’t yet got in touch with us, again please do as early as possible.

As well as confidential advice on your situation or the partnership agreement, we can help with facilitated discussions or formal mediation – all free of charge to the practice as part of your LMC Levy. It’s often reassuring for partnerships to know that it’s common to need help with their agreements, and with partnership dynamics – we deal with it frequently and are happy to advise you either individually or collectively. We can also speak to practice managers who might have questions too.

You can sign up to receive a free guide from DR Solicitors on “8 signs your GP partnership deed needs an update” here, and if you’d like more information from the LMC please email us at humberside.lmcgroup@nhs.net. 

Interface Update
Interface Officer Simon Nichols continues to assist practices with interface issues. Click below for the latest interface update, which this month includes:

• Interface website
• Interface data and themes
• Diabetic eye screening
• Maternity services
• Tier 3 Weight Management

Contact us with your interface queries via humberside.lmcgroup@nhs.net. 

BMA Contract Imposition Roadshow
Wednesday 19 June 2024, 14:00-16:00
Estuary Room, The Ropewalk, Barton upon Humber DN18 5JT

The GPCE officer team will be presenting at this event for the Humber and Lincolnshire regions. They will be presenting the GPC England manifesto and sharing the BMA GP Practice Survival Toolkit to Protect your Practice, Protect your Patients. The event provides an  opportunity to hear about the menu of actions, understand the ballot, and give you an opportunity to ask any questions. You can also take campaign resources and goodies back to your practice. This events is free and open to:

• All holders of a GP contract
• Every GP and GP Registrar
• Practice Managers and Practice Nurses

You do NOT need to be a BMA member to attend.

Hot Topics GP Update Course
Saturday 15 June 2024, 09:30-17:00 (Registration from 08:30)
Tranby School, Tranby Croft, Anlaby, Hull HU10 7EH

This course is open to GPs in any role – partners, salaried or locums, GP ST3s and ANPs working in the Humberside region. The Hot Topics GP Update course will provide you with an overall update of all the latest developments in the literature and to serve as a platform for CPD and help to deliver better patient care. The course revolves around short, engaging presentations using clinical cases and problems to illustrate recent learning points from the literature, followed by Q&A sessions. 

Course fee of £55 includes course reference book, NB Medical app, and lunch and refreshments. Full course details and booking link​. 

Fully Funded Offer for PMs - Level 5 Leadership and Management Apprenticeships 
We are delighted to be able to offer government-funded degree level apprenticeship in Leadership & Management aimed at aspiring and experienced Departmental and Operational Managers, including Practice Managers. 

The programme is not age or length of service limited and will be delivered by live, tutor-led monthly virtual classrooms over 18 months. It is being delivered by Cherith Simmons Learning and Development, who have over 30 years’ experience in this field - much of it with the NHS. This ILM Level 5 programme is designed for those who need to develop or benchmark their existing skills in order to take on new responsibilities or advance their careers.

The programme has been designed as a result of extensive research and 30 years’ experience in the field of Leadership and Management training.
Further details of the programme content, assessments and how to enrol are included on the course information flyer. 

With Cherith Simmons, we are holding a virtual, no-obligation Q&A session on Thursday 6 June at 12:00 – 13:00. If you wish to attend, the meeting link is embedded within the course information flyer. If you are interesting in finding out more but are unable to attend on the 6 June then please do get in touch and we can arrange an alternative date for a discussion. 

This is a fantastic opportunity and we sincerely hope this will be popular amongst our local PMs and/or their deputies – please do not hesitate to get in touch if you would like to know more! 

Practice Managers' Reference Group
The LMC brings together local practice managers for a monthly virtual Practice Managers’ Reference Group meeting. Acting as a two-way reference group, this gives Practice Managers the opportunity to bring issues to the LMC for discussion, and also allows the LMC to bring items for consultation that have arisen from their other areas of involvement.

All Practice Managers (and assistant or deputy managers) in the Humber region are welcome to attend. If you would like more information on the group or would like to attend the next meeting please contact us. The next meeting is on Wednesday 12 June, 09:30-10:30 via MS Teams. 

The LMC also hosts a podcast to update Practice Managers covering news, updates and training – find out more.

Humber and North Yorkshire Health and Wellbeing Events 2024/25 
Humber and North Yorkshire’s Health and Wellbeing calendar for 2024/25 is now live. Take advantage of these FREE virtual sessions available to all volunteers and staff working within Humber and North Yorkshire in health and social care including NHS, non-NHS, community care, social care, local authority and VCSE.
 
What’s coming up..
 
13 June - Stop reacting and start responding: Stress and Self Care 
26 June - Menopause Awareness for colleagues and Line managers
2 July - Hand reflexology for MSK
12 July - Understand and managing your periods 
17 July - Imposter Syndrome 
23 July - Menopause Awareness for colleagues and Line managers
 
You can download an events poster to share. For the full list of descriptions and more dates for these virtual sessions please visit Humber and North Yorkshire Health and Care Partnership - Booking by Bookwhen

HNY Nursing, Midwifery and AHP Conference
Wednesday 3 July, 09:15-16:15
Mercure Hull Grange Park Hotel, Grange Park Lane, Willerby HU10 6EB

Whether you are a nurse, midwife or allied health professional, or simply interested in attending, this conference is designed to inspire and educate. Don't miss out on this fantastic opportunity to connect with colleagues, hear from Mark Radford, Deputy Chief Nursing Officer for England; Steve Tolan, Interim Deputy Chief Allied Health Professions Officer for England; Steve Head, inspirational speaker and performance coach to the England wheelchair rugby league world champions; and much more, as well as marketplace stands.

Online Level 3 Adult Safeguarding Training
Dates are available for Online Level 3 Adult Safeguarding Training for Primary Care from the Adult Safeguarding Named GP Humber Alliance. These bitesize sessions run via MS Teams from 12:00-12:45. Download the programme of events 2024. Booking onto these training events is done via Sue Major - sue.major@nhs.net. 

GP Forum Study Day - Management of Diabetes in General Practice
Thursday 20 June 2024, 11:45-16:00
The Pelham Suite, Cambridge Road, Grimsby DN34 5SZ

This free session has 3 hours CPD approval. It will include presentations and Q&A sessions on:

• Management of CKD in Diabetes - Dr Muhammad Imran, HUTH
• Diabetes and Your Eyesight - Miss Helen Cook, HUTH

Light lunch included. For full details and how to book download the event flyer. 

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:

• BiteSize CPD Webinars, free for Nurses, NAs and AHPs - Book Now - Limited places remaining, and new topics added
• Funded CPD Courses for Humber and North Yorkshire Nurses, NAs and AHPs - Still Available
• Invitation to attend the CATALYST GP Fellowship Celebration Day
• Supervision courses for primary care in Yorkshire and Humber - 13th June - Book Now

L3 Safeguarding Adults Training - Humberside Fire and Rescue
A free online safeguarding L3 training session is being delivered by Humberside Fire and Rescue and looks at the risk of emollients, medical oxygen and hoarding. Fire deaths have risen in our vulnerable population recently and some have been due to the use of emollients. 

This training is suitable for L3 practitioners, particularly those doing home visits or prescribing emollients to vulnerable adults. Several dates for the 90 minute session are available in June and July 2024 and can be found on the training poster. Follow the link for your chosen date to book online via Eventbrite.  

GPMPlus Courses 
During June, GPMPlus are offering two fully funded courses to help practice partners, managers and team leaders build and develop their teams more effectively. These are followed by two further courses looking at reviewing practice systems and practical ways to make improvements and, most importantly, having a “plan B” in place when things go wrong. 

Team Leadership and Engagement
Tuesday 11 June – 09.30am- 11.30. Fully Funded. Via Zoom.
The course objectives are:

• To define good and bad leadership and explain why we are all leaders.
• Share ways to evaluate the leadership and culture of an organisation.
• Share important tools to take back to your organisation to develop leadership skills.
• To formulate your own leadership action plan.

Suitable for GPs, partners, practice managers / senior managers, team leaders. 
For more information and/or to book – click HERE. 
 
Team Resilience – What you need for a flourishing team
Wednesday 12 June – 09.30-12.30. Fully Funded. Via Zoom.
This programme will provide practical tools and techniques to build team resilience, including the following:

• Appreciate where gaps may exist in the resilience of your own team and organisation.
• Understanding where best to deploy limited practice resources for maximum benefit.
• How to streamline and automate management processes to enhance job satisfaction for team members.

Suitable for GPs, partners, practice managers / senior managers, team leaders. 
For more information and/or to book – click HERE. 

Contingency Planning for Crisis Aversion
Wednesday 19 June – 09.30-11.00. Fully Funded. Via Zoom.
A crisis, large and small, can happen at any time and have a significant impact on the practice - from a pandemic to staff shortages to a leaking roof.
Although the nature of events is extremely varied and predicting them nearly impossible, we can classify them and ensure simple contingencies are in place that will significantly improve our chances of business continuity and even thriving despite an event taking place. 

We will discuss the steps in formulating a business continuity plan (a CQC requirement) and share ideas and best practice in facilitated group discussions.
Suitable for GPs, partners, practice managers / senior managers. For more information and/or to book – click HERE
 
Practice Systems Resilience
Thursday 20 June - 09.30-13.30. Fully Funded. Via Zoom.
A full morning of looking at the practice as a whole and “pressing the reset button”. The practice systems covered within this course will include:

• Effectiveness of clinical systems.
• Effectiveness of practice management systems.
• Patient experience.

Come away with tools and techniques to take back to your organisation to enable more systems resilience. Access resources to provide ongoing support.  Suitable for GP partners, practice managers and other senior managers. For more information and/or to book – click HERE
 
The GPMPlus full course timetable for June is available – HERE. Courses can be accessed free of charge, thanks to funding from NHSE (there is an optional charitable donation of £10). They are delivered by experienced GPs and practice managers and they give you the tools, methods and ideas to help build the individual, the team and the practice.

Premises Costs Directions 
After almost a decade of pressure, the Department of Health and Social Care (DHSC) have published the long-anticipated update to the Premises Costs Directions (PCDs), which will bring changes to assist premises costs, including permission for commissioners to award improvement grants of up to 100% of the project value, (up from 66%), and new powers for commissioners to better support contractors. 
 
These changes were initially agreed five years ago, as part of the multi-year GP contract in 2019. The full guidance will be published at a later date.
 
Responding to the announcement, Dr Gaurav Gupta, GPC England premises lead, said: 
 
“We’re pleased to see positive steps to help GP premises owners, and any partners aspiring to buy into property-owning partnership in advancing their services to provide the best possible care for patients. 
 
But we still have a very long way to go, with no additional funds going into ICB budget lines. The past decade has seen us caring for an additional eight million patients, with over a thousand practices lost, and record numbers of appointments. It’s clear to patients and GPs alike that we must push Government and NHS England for significantly greater investment into General Practice premises.”

Read the full statement here

Cloud Based Telephony
Following changes that have mandated adoption of Cloud Based Telephony on NHSE’s approved procurement framework GPC England has received extensive complaints from GPs being charged excessive costs for adopting new systems.
 
While GPCE remains in discussion with NHSE to seek a resolution, they have been advised that GPs can raise concerns directly with NHSE about additional costs they are experiencing using the following email commercial.procurementhub@nhs.net.

Introducing the NHS People Promise 
The People Promise is a new NHS England initiative to improve the experience of working in the NHS for everyone. NHSE have awarded funding to primary care organisations for the first time this year to help implement aspects of the People Promise – these are known as People Promise Exemplar sites.

Humberside LMCs and Yorkshire Health Partners have received funding for the current financial year and will be using this to raise the profile of practice nursing and provide enhanced support for practice nurses across the Humber region. We will work together to achieve this.

The People Promise is based on seven themes: 

• We are compassionate and inclusive
• We are recognised and rewarded
• We each have a voice that counts
• We are safe and healthy
• We are always learning
• We work flexibly
• We are a team

We’ll be providing regular updates to practices on how to get involved. Look out for more news on the People Promise coming soon. Read more about the People Promise from NHS England. 

GPMplus Mentoring for Practice Managers - Sessions Available Now
GPMplus mentoring is available for GPs, Practice Managers, Practice Nurses and other staff in leadership roles. You can access up to 8 hours of mentoring – and thanks to funding from NHSE, this is available free of charge.

Recently four new Practice Manager mentors have been welcomed to the mentoring team, making a total of nine Practice Manager mentors available. All Practice Manager mentors are experienced Practice Managers themselves as well as being trained mentors. Please have a look at the GPMplus website to see biographies and photos of all mentors.

More than 50 Practice Managers and other members of practice teams have already accessed GPMplus mentoring. Please do share this email with other non-clinical staff in leadership roles at your practice as well as your Practice Nurses. Mentoring is also available for GPs. There are nurse and GP mentors available too.

Mentors can help you to:

• Move forward with personal and career goals
• Work through a problem
• Consider opportunities
• Manage transitions positively
• Build confidence
• Improve your work life balance
• Build your resilience
• Achieve your aspirations

You can request mentoring by completing this form on the GPMplus website. You can let GPMplus know your preferred mentors and they will do their best to accommodate this.

Hexavalent Vaccine - Information Update
UKHSA have update the Hexavalent combination vaccine: information for healthcare practitioners document. This link will take you to this as well as a training slide set which can be downloaded.
 
Hexavalent DTaP/IPV/Hib/HepB combination vaccine: information for healthcare practitioners - GOV.UK (www.gov.uk)

Identifying Adults Approaching End of Life
The Gold Standards Framework (GSF), NICE and the GMC all agree that we should aim, where possible, to identify people in the last 12 months of life to be able to address their beliefs and preferences about end-of-life care. There is increasing evidence that, by doing this and offering additional supportive care in this context, we can improve patients’ quality of life. This Red Whale article summarises key parts of the Gold Standards Framework ‘Proactive identification guidance’. 

Statins and Diabetes
We’ve known for years that statins are associated with an increased risk of developing diabetes, even if reported risks show wide variation. This NB Medical Education article looks at the most up to date data on this, recently published in The Lancet Diabetes and Endocrinology Journal, and the clinical implications . 

Guidelines on Urological Infections
This Medscape UK Guidelines summary includes evidence-based information and recommendations for the prevention and treatment of urinary tract infections (UTIs) and male accessory gland infections from the European Association of Urology (EAU) guideline on urological infections.

GP Contract Guidance
GPC England is currently preparing contractual guidance following the imposition on 1 April and this should be available on the BMA website shortly. There is also a planned update of the safe working guidance, which it is hoped will be completed by early June. We will share these resources when available. 

Psychological Trauma Resource
The Resilience Hub have shared a useful resource around Psychological Trauma. Please feel to distribute to teams/networks or anyone who you may feel would benefit from this handout. 

Medical Associate Professions (MAPs) - BMA Guidance
This content covers the increasing presence of MAPs (medical associate professions) in the NHS, their regulation, prescribing rights and the BMA’s view on the these developments. Read the BMA guidance. 

Teenage and Young Adult Cancer Clinical Network New Website
The Yorkshire and Humber Children Teenage and Young Adult Cancer Clinical Network is launching a new website developed over the past year in collaboration with key stakeholders in the region.
 
The website is in its infancy and would welcome all feedback to develop it further. Please share this with any colleagues who may wish to find out more about the clinical network's role in providing cancer care to young people aged 0-25 and their families. Contact leedsth-tr.yhctyacodn@nhs.net if you’d like to find out more about their work.
 
Home | Yorkshire and Humber Children, Teenage and Young Adult Cancer Clinical Network (yorksctyacancer.nhs.uk)

Primary and Secondary Care Interface Consensus Statement - Northern Lincolnshire 
This new publication was produced to summarise the consensus of key stakeholders on the responsibilities of clinicians in both secondary and primary care in relation to interface issues. It includes principles to follow for both primary and secondary care. Download the document.  

Changes to the Benefits Process
The DWP and DHSC has published a call for evidence that will inform a programme of work announced at the autumn statement in 2023, to explore reforming the fit note process to support those with long term health conditions in accessing work and health support. The evidence will help to assess the impact of the current fit note process in aiding work and health conversations, and the exploration of enhancements that GPs and other health care professionals would require for the fit note to better support people to start and stay in work. GPCE will submit its evidence in due course.

GP Pressures
The latest GP workforce figures for England show the number of patients per practice is rising. GPs are now responsible for about 18% more patients than in 2015, demonstrating ever-mounting workload pressures.
 
The NHS in England has lost the equivalent of 1,790 full-time fully qualified GPs since 2015. There are also fewer GP practices, with a decrease by 106 over the past year. This fall in both staff numbers and GP practice coincides with a rise in patients: as of March 2024, there was another record-high of 63.27 million patients registered with practices in England – a full time equivalent GP is now responsible for an average of 2,295 patients.
 
The latest appointment data shows that that around 29.9 million standard appointments were booked in March 2024, and over the past year, approximately 353.3 million standard (non-Covid-19 vaccination) appointments were booked. When comparing to pre-pandemic levels, this is 43.1 million more appointments than between April 2019 to March 2020.
 
See more infographics and data, showing the pressures in general practice, on the BMA website.

National Visa Support Service for GPs
As part of the closure of NHSE’s Primary Care Workforce Team, the national Visa Support Service for GPs and GP practices currently provided by the team will also be closing. National support for practices, ICBs, regional teams and GPs with visa queries will end on 31 May 2024 and other responsibilities such as funding visas and providing practice matching are moving to ICBs under the new NHS England operating model. Individual GPs with immigration concerns can get free advice from the BMA's Immigration Advice Service, and the following contacts will apply after the 31 May 2024:

• Visa related queries and issues should be raised directly with the dedicated NHS Visa Team at the Home Office via UKVINHSTeam@homeoffice.gov.uk. 
• Queries relating to the 4-month visa extension for newly qualified GPs should be raised with NHS England’s Overseas Sponsorship Team via england.sponsorship@nhs.net. 

Please note that existing NHS England visa support for sponsored GP trainees, and GP and practices participating in the International Induction Programme will continue to be provided. 

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.