GP Contract Changes 2024/25 and BMA Ballot
GPCE has announced a non-statutory ballot, which opened on 17 June and closes on 29 July 2024 ahead of action commencing from Thursday 1 August.

The ballot question:
 
‘Are you prepared to undertake one or more examples of collective action as outlined in the BMA campaign to Protect Your Patients, Protect Your Practice?’

The ballot is open to GP contractors/partners, and the BMA is urging members to vote YES to send a message to Government that we are ready to stand up for a better service for our patients, and to protect our practices.

Non-members still have time to join in the ballot. Any new member joining the BMA from 17 June will get their first 3 months of membership for free. The latest date to join for the vote to be counted is 22 July. Join via bma.org.uk/join.

Members are urged to check their details are up to date to ensure their vote will count. Login to www.bma.org.uk and check your details are current and correct. If you have any issues updating your details, please email gpcontract@bma.org.uk for further assistance. Please look out for an email from bma@cesvotes.com which will allow you to vote.  

GP contract roadshow events are taking place across England in June and July. Thanks to all who attended our region's event in Barton on 19 June. The full list of events, including a number of virtual events still to take place, can be found here. You don't need to be a BMA member to attend.

The BMA's page with further details of the contract changes can be found here. GPC England has now drafted contractual guidance on the 2024/25 contract following the imposition. These documents cover the following areas:

• Dispensing and prescribing 
• GP data sharing and controllership 
• Limited Liability Partnerships and the GMS contract
• Medical Associate Professions in General Practice
• 2024 Premises Cost Directions
• Use of enhanced access appointments
• Vaccinations and Immunisations
• Proformas and referral forms
• Spending and the PCN DES capacity and access payment funding

Documents can be found on our website here - under the Resources heading.

What will the menu of actions look like?
GP partners are urged to work with their practice management team and, working in liaison with their LMC, determine the actions they will be willing to take. Each of these actions is outlined in the 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. This is a marathon, not a sprint. 
 
PCN DES 2024/25 GPC England Guidance on the Capacity and Access Improvement Payment (CAIP)

There are three separate and discrete elements to the CAIP within the 24/25 PCN DES: 

• Faster care navigation, assessment, and response 
• Better digital telephony 
• Simpler online requests 

GPC England guidance is that practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance in early 2025.

Read the BMA Focus on guidance
 
GPC England recommends PCNs do not confirm compliance with the on-line platform CAIP element at this time, because unless the workload associated with a practice’s on-line platform can be controlled, it will not be possible for practices to effectively implement the BMA Safe Working Guidance. 
 
GPC England recommends PCNs do not confirm compliance with better digital telephony CAIP element at this time as NHS England has signalled its intention to issue a contract variation notice from October 2024 to make the sharing of the eight call data metrics they have identified contractual. 

Continuing Health Care Assessment Forms – An Update
The LMC has been approached by colleagues who are being asked to complete forms relating to Continuing Health Care assessments. Having discussed this with the CHC team at the ICB, they are clear that GPs should NOT be asked to complete these.

Most forms are completed by social workers (either in the community or occasionally hospital), or community nurses. The only forms GPs may be asked to complete are Fast Track forms for those patients who are approaching end of life care.

If you are asked to complete other CHC forms, please decline citing the above information and send details of who has made the request to the LMC humberside.lmcgroup@nhs.net and CHC team hnyicb-ery.continuingcare@nhs.net . Both local authority and community nursing colleagues have had the correct arrangements reiterated to them. 

Interface Update
Click below for the latest interface update, which this month includes:

• Consensus document – Northern Lincolnshire
• Digital communications
• Interface Data and Themes
• Diabetic Eye Screening
• Maternity Services – HUTH
• Memory Services – Humber NHS Foundation Trust

Visit our interface web pages for more on this topic. Contact us with your interface queries via humberside.lmcgroup@nhs.net. 

Empowering Sessional GPs Week
‘Empowering sessional GPs’ week was held from 10 to 16 June, dedicated to celebrating and empowering sessional GPs. GP partners also benefitted from content promoting the advantages of offering the model contract to their employees, alongside guidance on ensuring good working practices. The goals were to promote professionalism, fairness and wellbeing within the sessional GP workforce. During the week, the new GP Diary app, which helps GPs understand their working patterns, and the annual leave calculator that simplifies leave entitlement calculations, were highlighted. Read more. 

GP Workforce Data
The latest workforce data showed that the NHS had the equivalent of 27,606 fully qualified full-time GPs in April 2024. We have the equivalent of 1,759 fewer fully qualified full time GPs than we did in September 2015. During this time, there has been a rise in the number of patients, with April 2024 seeing yet another record-breaking number. GPs are now responsible for almost 20% more patients than in 2015, demonstrating ever mounting workload pressures.  

• The GP Partner workforce in particular has been shrinking since 2015. There were 16,534 FTE GP partners in April 2023 but 16,091 in April 2024: a total loss of 404 FTE GP partners in the past 12 months alone. 
• We have lost a further 101 GP practices in England over the past year – reflecting a long-term trend of closures and mergers. 
• This fall in both GP partner numbers and GP practices coincides with a rise in patients: as of April 2024, there was another record-high of 63.32 million patients registered with practices in England – an average of 10,065 patients registered per practice. 

See more infographics and data, collated by our BMA teams, showing the pressures in general practice

GP Update Course
Thanks to all who attended the GP Update Course on Saturday 15 June at Tranby School. This course, delivered by NB Medical, was arranged by the LMC for our constituents at a reduced rate. We've had some excellent feedback from the training which provided an overall update of all the latest developments  to serve as a platform for CPD and help to deliver better patient care.

Focus On... the LMC's Practice Managers Reference Group
LMC Operations Manager Maddie Clifford-Roper outlines this useful group for Practice Manager colleagues:

It is probably not going to win any prizes for having the snappiest meeting title out there, but we like to think of it as real winner in the monthly calendar of any Practice Manager working across our patch. So, if you don’t already attend, this is your opportunity to discover a little more about what it could offer you. 
 
Casually termed PMRG for short, this meeting aims to provide a quick, concise update from the Secretariat and serve as a touch point for all our PMs to come together, catch up with each other and several members of our LMC team. The meeting is just for an hour, over Teams, and takes place at 9:30am on the second Wednesday of every month. An opportunity to shut your office door, sit down with a hot beverage and tune in! 
 
Facilitated by myself, one half of the LMCs’ Operations Manager duo, Dr Rolan Schreiber, our Medical Secretary and Simon Nichols, our Interface Officer, we have been running this meeting for around 5 years now. In that time, it has become one of our most useful vehicles for linking in with the managers of our practices, PCNs and their deputies. We have also used it as a launchpad for several focus groups, such as those to help design our Practice Managers’ Conference and Practice Manager Connect Programme and the recent work around reducing DNA rates to name just a few. It is just as valuable to us as we hope it is for you. 
 
Since the meeting has grown both in size and profile over the years, we have noted an increase in how many other system stakeholders request the opportunity to dial in, liaise with attendees, obtain early feedback, and request valuable PM input. Just this year we’ve hosted N3i to discuss Multi-Factor Authentication, the ICB to discuss Pharmacy First and reducing DNAs across practices, the Breast Screening Team and we’ll be welcoming a representative from CQC to June’s meeting. 
 
Upcoming dates can be found here. If you’d like to dial in, please don’t hesitate to contact us for more info. Particularly if you’re new to your role, it could be extremely helpful for you and would act as a gateway to so many other forms of support you can access from the LMC. We hope to see you there!

NHS Premises Costs Directions 2024 – What You Need to Know
As we covered in last month's newsletters, the Department of Health and Social Care (DHSC) have published the long-anticipated update to the Premises Costs Directions (PCDs). DR Solicitors have published an article covering the main points of the new directions - read it 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.

GPMplus Education Brochure July-September 2024 
The GPMplus range of fully funded courses are now available for July, August and September. The course brochure can be downloaded here, or you can click here to access their website directly for more information and booking.

All courses are presented, live, by very experienced practice managers or GPs. They are presented via Zoom and there is no cost thanks to funding from NHSE. In lieu of a course fee,  attendee are invited to make a donation of £10.00 to the Cameron Fund Charity, but this is voluntary.

If you need any assistance or further information, please do not hesitate to contact Tim Bennett at GPMplus on 01423 879922 or email tim.bennett@yorlmcltd.co.uk

HNY Primary Care Workforce and Training Hub 
All the latest opportunities available via the hub can be viewed on their news feed. Recent additions and updates on the newsfeed:

• Funded CPD Courses and Webinars for HNY Nurses, NAs and AHPs - Still Available
• Legacy Nurse Mentor - Role Opportunity - Open for Applications
• HNY Nursing, Midwifery & AHP conference - 3rd July 2024
• Education and training funding offers 2024/25 - North East and Yorkshire School of Pharmacy
• Pharmacy Education Update - Supplement May 2024
• Bursaries available for Certificate/Diploma/Master's Courses in Clinical Research
• Upcoming HNY Wellbeing Events
• Funded QoF Training for General Practice

Humber Generalist School Applications Open
Applications are open for the next cohort of the Humber Generalist School programme based in the Humber region, which starts in September 2024.
 
The programme is place-based, and delivered by NHSE (formerly HEE) for all health and social care professionals in primary, secondary and community care, including non-clinical staff, with the intention of improving generalist skills through modules such as systems working, population health, environmental sustainability, person centred care etc., and applied modules such as oral health and independence in ageing.

The programme is FREE, and lasts 12 months with an indicative time commitment of 4 hours per week, worked flexibly. Unfortunately, there is no backfill funding for staff. All modules have CPD accreditation with the RCP and there is the option for participants to undertake a PGCert using their learning from the programme.
 
All are welcome; doctors (qualified GPs, GP trainees and Foundation trainees), nurses, ACPs, PAs, ARRS roles, practice staff and system managers. Applications for the next cohort close on 30 June 2024. Full details, including application forms, FAQs and video, are on the webpage.

Wellbeing Resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing.

A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services, NHS practitioner health service, Samaritans and Doctors in Distress. See also the poster with 10 tips to help maintain and support wellbeing. In our area, the Humber and North Yorkshire Staff Resilience Hub is available to all health and care workers who work in the region. The LMC's support pages include a broad range of resources and services available to staff. 

Safeguarding Primary Care Team Training
NHS Humber and North Yorkshire Integrated Care Board (ICB) have shared details of upcoming safeguarding training. Click on the links below to download full details. 

Safeguarding Adults Level 3 Initial Training for Primary Care
Safeguarding Child Protection Level 3 Initial Training for Primary Care  
General Practice Nurse Safeguarding Training 
Administration Staff Managing Safeguarding Information in Practice 

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. 

Contraceptive Services
Contraceptive services, formerly an Additional Service funded by an identified 2.4% of Global Sum, have been included as an Essential Service under the Primary Medical Services (GMS/PMS) Contract, since 2020. This includes the treatment of and prescribing for patients for contraceptive services, with the specific exclusion of the “fitting and implanting of intrauterine devices and implants”.
 
In addition, Para 14(2)1 of the GMS/PMS contract includes a reference to “drugs” including contraceptive as substances and “appliances” as including contraceptive appliances.
 
GPC England’s advice is therefore that the prescription and administration of contraceptive infections (such as Depo Provera, Sayana Press, and Noristerat) does form part of Essential Services.   Reimbursement is available through the Personally Admitted drugs provisions in the Statement of Financial Entitlements and indemnity is available via CNSGP.

NHS Education Funding Agreement 2024/27
NHSE has published a new NHS Funding Agreement. Unlike the previous education contract, this new version includes GP-specific elements in schedule 1. The contract creates a formal mechanism for training practices to receive payment from NHSE. 
 
GPC England has had the opportunity to review and comment on the funding agreement during its development and is content with the final version. 
 
All of the funding agreement documentation can be accessed on the NHS England website. If they haven’t already done so, NHS England commissioners will be contacting training practices shortly about bringing you onto the new agreement. 

GP Appointment Data – April 2024
The latest appointment data shows that that around 30.5 million standard appointments were booked in April 2024, with an average of 1.45 million appointments per working day. Over the past year, approximately 359.6 million standard (non-Covid-19 vaccination) appointments were booked. When comparing to pre-pandemic levels, this is around 57.3 million more appointments than between May 2019 to April 2020.
 
In terms of access, the proportion of appointments booked to take place the same day has increased slightly from the previous month: 44.6% of appointments in April 2024 were booked to take place on the same day, compared to 43.9% in March 2024. Face-to-face appointments remained the same as the previous month, around 65%. See more data showing the pressures in general practice >

Virtual ‘Ask Me Anything’ Session for Pride Month
Friday 28 June 2024, 12:00-13:00

Have a burning question this Pride month but not sure who to ask? Join LGBTQIA+ staff network chairs from across the country for a virtual question and answer (Q&A) session about all things sexual orientation, gender identity and beyond.

The event is taking place on Friday 28 June 2024 from 12-1pm via MS Teams and will provide a safe and inclusive space for compassionate conversations around reducing inequalities for LGBTQIA+ colleagues and communities.

From understanding the importance of pronouns to ‘coming out’, finding the right support or being an active ally, the group will answer all questions shared in good faith using their lived experience, knowledge and expertise as staff network chairs.

Questions can be asked in the session or submitted beforehand, anonymously if you’d prefer, using this online question form. There’s no need to book to attend, you can join the session on the day using this joining link.

Cancer and the LGBTQIA+ Community Event 
Tuesday 16 July 2024, 12.30-13.30

Humber and North Yorkshire Cancer Alliance is kicking off a series of virtual lunch and learn events looking at health inequalities around cancer with a session focusing on the LGBTQIA+ community.

The session is being held in partnership with OUTpatients – the UK’s LGBTIQ+ cancer charity and is taking place via MS Teams on Tuesday 16 July 2024 from 12.30-1.30pm.

It will be followed up later in the year with a second session looking at screening. The lunch and learn is open to all colleagues working in health and care across Humber and North Yorkshire and a recording will be shared after the event. You can book your place on the HNY Cancer Alliance EventBrite page.

Best Practice Guide and Toolkit - Recruitment and Retention of Disabled People
This new guide and toolkit was developed by the National Disabled NHS Directors (DNDN) Network with funding and support from the national NHS Workforce Disability Equality Standard (WDES) team.

It aims to provide actionable strategies and comprehensive information for NHS organisations to create a more inclusive, accessible and supportive workplace for disabled employees. 

It covers all aspects from recruitment to retention and is informed by the lived experiences of DNDN members. The actions outlined aim to improve the employment experience for disabled people.

Download the guide. 

New Restrictions on Use of Puberty Suppressing Hormones
The Government has introduced emergency restrictions on the use of gonadotrophin releasing hormone (GnRH) analogues used to suppress puberty as part of treating gender incongruence or gender dysphoria in children and young people who are under 18 years of age. Some of these restrictions, the ones for private prescriptions, took effect from 3 June 2024. Download the ops note for further details. 

Infected Blood Inquiry - Hepatitis C Testing
Although it is likely that the majority of people directly affected by infected blood have now been identified and started appropriate treatment, there may be people who have not yet been identified, particularly where they are living with asymptomatic Hepatitis C. People who had blood transfusions may not have considered these risks before or sought testing. Patients may decide to contact practices as they are worried following the publicity about this issue. 
 
The Inquiry report recommends that people who received blood transfusions up until 1996 should be offered a blood test for Hepatitis C if they have not been tested before (GP practices may have noticed that previous guidance set the date as before September 1991).
 
Patients can be directed to the online service for at-home Hepatitis C self-testing kits, which are available via hepctest.nhs.uk for anyone over the age of 18 and living in England. Any positive results from at-home testing are dealt with by local Operational Delivery Networks and passed to specialist hepatology teams, who arrange to contact the patient, notify them of their results, manage their care and treatment, and communicate this to the patient’s registered GP.
 
Further resources for Hepatitis C care, including a Primary Care Toolkit are available here 

Trigger Warning – Patterns Before Suicide
This article from NB Medical looks at research into primary care consultations before suicide, which found that escalating or more than monthly consultations are associated with increased suicide risk. It also outlines steps which can be taken in primary care to narrow down who is at risk. 

Allergic Rhinitis and Hay Fever
This Red Whale article considers all types of allergic rhinitis, including hay fever. There is growing prevalence of hay fever in adults and children, thought to be due, in part, to climate change and longer pollen seasons. We may see it as something trivial – but, in fact, it has a significant impact on quality of life and sleep, and can impact exam results.

Seasonal Flu Immunisation Programme QIVr Vaccine
Sanofi has advised that the Recombinant Quadrivalent Influenza vaccine [QIVr] will, due to a supply issue, not be available for the flu vaccination programme for the 2024/25 season.
 
The original JCVI recommendation was to use QIVr for adults aged 65 years and over, and also adults aged 16 to 64 who are in eligible groups.
 
In the light of this change, NHS England has advised the following:

Aged 65 years and over

Aged 18 to 64 years in risk groups

adjuvanted quadrivalent influenza vaccine (aQIV)   high-dose quadrivalent influenza vaccine (QIV-HD) The cell-based quadrivalent influenza vaccine (QIVc) can also be considered only when every attempt to use aQIV or QIV-HD has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.

Aged 18 to 59 years cell-based quadrivalent influenza vaccine (QIVc)  Aged 60 to 64 years cell-based quadrivalent influenza vaccine (QIVc)  high-dose quadrivalent influenza vaccine (QIV-HD) The egg-grown quadrivalent influenza vaccine (QIVe) can also be considered only when every attempt to use QIVc, or in the case of those aged 60 -64 years also QIV-HD, has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.

 
As QIVr is only licensed for those aged 18 and over, this does not affect the immunisation programme for younger patients. For practices who have ordered QIVr, and who are participating in the 2024/25 immunisation programme, the primary alternative is QIV-HD [high dose quadrivalent influenza vaccine] which is licensed in the UK for those 60 and over.  Otherwise, practices may seek to order additional supplies of aQIV [Adjuvanted Quadrivalent Influenza Vaccine] for those aged 65 and over, and QIVc [Cell-based Quadrivalent Influenza Vaccine] for those under 65 years. 
 
NHSE has updated the list of influenza vaccines marketed in the UK