BEST Events – Held @ Shaw Lane Sports Club, Barnsley
For further information the BEST Portal Website can be accessed at http://best.barnsleyccg.nhs.uk/
Medicines Management
Shared care and Amber-G guidelines can be found at the following link: http://best.barnsleyccg.nhs.uk/clinical-support/medicines/shared-care-guidelines/ An overview of Shared Care guidelines, including the Principles of Shared Care is available to read here.
Prescribers (including secondary care clinicians) are encouraged to report any problems they experience with shared care or other medicines related issue, particularly where guidelines are not being complied with, to the following email address: BarnsleyAPCReport@nhs.net.
With secondary care opening up activity and undertaking remote consultations, it has been reported that there has been increased pressure in primary care to undertake things they wouldn’t normally. Due to this, the APC reporting has been temporarily expanded to capture any issues and these can be fed into the APC. The hospitals need this information so that issues can be addressed.
Practices can now report any interface issues they have, as much as possible, via Barnsley LMC, which will then be submitted to the hospitals.
A list of Prescribing Guidelines is available to view here.
The Barnsley Area Joint Formulary is available to view here.
Medicines Management monthly Newsletters are available to view here.
Workload Shift
Barnsley LMC would like to remind all practices it is important that we receive examples of any workload shift. Please provide examples of workload shift to barnsley.lmc@nhs.net in order that these can be taken to the meeting with Secondary Care.
Barnsley LMC would like to inform practices that if there are any examples of workload shift from Sheffield Hospitals they can now be emailed to Sth.Impagsheffield@nhs.net.
Safe working in general practice
The BMA’s England GP committee (GPCE) has generated the following guide to enable practices to prioritise safe patient care, within the present bounds of the GMS contract.
Shared Care Requests For Post-natal Dalteparin
It has now been agreed that all women requiring the standard 6 weeks of Dalteparin treatment prophylaxis in the post-natal period will receive the full supply from Barnsley Hospital.
The Medical Examiner System
Ali Morrell from the Medical Examiners office met with Barnsley LMC at the meeting held on 12th September 2023 regarding the changes happening to death certification. Please see the information below giving background and an update on what is happening in the future. Barnsley LMC members agreed that this is a very good idea moving forward. The Medical Examiners Service is encouraging GP practices in Barnsley to join them in this new process.
Introduction
The medical examiner system is the biggest change to death certification in 150 years, and has come about as a result of the public enquiries which followed several high-profile healthcare stories. Initially, acute trusts were asked to set up medical examiner offices to focus on certification of all deaths that occurred within their own organisation on a non-statutory basis. A white paper was published in February 2021 (Working together to improve health and social care) which includes provision for MEs to be put on a statutory footing. The role of these offices is being extended incrementally during 2023 to include all non-coronial deaths wherever they occur.
The purpose of the medical examiner system is to Improve care for future patients by informing learning, or, in fewer cases, being referred for further review. By putting the bereaved at the centre of the process and giving them the opportunity to ask questions or raise concerns, they feel involved and this provides reassurance.
There are three questions the ME seeks to answer:
- What caused the death of the deceased?
- Does the coroner need to be informed?
- Was the care before death appropriate?
Independent scrutiny by MEs with the following three elements provides the answers:
- A proportionate review of medical records.
- Interaction with the doctor completing the MCCD.
- Discussion with the bereaved.
Medical examiner office
Medical Examiners are senior medical doctors from a diverse range of backgrounds and specialities. They are contracted for a number of sessions per week as Medical Examiners, outside of their normal clinical duties.
Medical examiner officers are either Band 5 (non-clinical) or Band 6 (usually clinical, e.g. from a nursing or Paramedic background). They are the constant in the ME office and are there to facilitate the gathering of information for the MEs, and to act under delegated authority with various activities such as discussions with the bereaved.
Moving forward
The ME service is now working with the majority of GP practices in Barnsley, with most of the rest starting to refer to us by the end of October 2024. This will enable us to ensure that the system is running smoothly by April 2024, when the system becomes statutory. By working collaboratively in this way, we can ensure that disruption to the certification process, and causing distress to the bereaved, is kept to an absolute minimum. We are working hard to engage with the practices who are more reluctant to work with us before the service becomes statutory. We are always available to answer questions, and will visit practices and talk to teams to allay any concerns.
How the ME system can benefit primary care.
Supporting the bereaved: This will not replace GPs providing contact and support to bereaved families, but may lessen the workload by dealing with enquiries.
Support with MCCD completion: Medical examiners can use their experience and specialist training to support GPs, particularly in complex cases and decisions on coroner referrals.
Supporting local coroners’ offices: MEs can be used as a source of medical advice, which should lessen the need for GP discussions with coroners.
Clinical governance: The aim of medical examiners is not to find fault or investigate in any way, however when issues are detected, they will offer non-judgmental feedback.
Learning and concerns: Constructive learning to improve patient care is one of the key objectives of the medical examiner system.
Feedback so far:
Reports back from the Coroner and Registrar have been positive, with the Coroner stating that referrals have been appropriate and more accurate, and Registrars reporting that far fewer MCCDs are rejected since the introduction of the ME service in Barnsley.
The GP practices who work with us so far have found the service helpful, with no noticeable increase in workload.
If you have any further comments or questions, please don’t hesitate to contact us at: Barnsley.medicalexaminersservice@nhs.net
NHS Flu and Covid Vaccine Programmes Brought Forward Due To Risk Of New Covid Variant
Millions of eligible people will now be offered a covid vaccine from 11 September, in line with the latest expert guidance on the new covid variant.
This change follows an announcement by the Department of Health and Social Care (DHSC) and the UK Health Security Agency (UKHSA) on the risks presented by the new BA.2.86 variant and pre-emptive measures the NHS has been asked to take.
The adult covid and flu vaccination programmes had been due to start in October to maximise protection over the winter months, but now those most at risk including adult care home residents will be vaccinated from 11 September.
The NHS has been asked to bring the programme forward and will be working quickly to ensure as many eligible people as possible are vaccinated by the end of October.
Residents of older adult care homes and those most at risk including those who are immunosuppressed will receive their covid vaccine first.
Carers, pregnant women, and health and social care staff will all be among the groups to be offered a covid jab this winter, as well as adults aged 65 and over.
Eligible people should wait to receive an invite from their local provider.
From 18 September, the NHS will start to invite people in priority order of risk and those eligible will be able to book an appointment on the National Booking Service.
The NHS winter flu and COVID-19 vaccination programme provides vital protection to those eligible and their families over winter, keeping people from developing serious illnesses, and helping to minimise hospitalisations during busy winter months.
Following the JCVI’s recommendation that adults over the age of 65 and those with underlying health conditions would be eligible for a flu and COVID-19 vaccination this year, the offer was due to start from early October to maximise protection for patients right across the winter months.
Now with the increased risks presented by the COVID-19 variant BA.2.86, vaccine sites can vaccinate those eligible for both flu and covid from 11 September.
Accelerated Access to Records Programme Update
GPC England continues to support patients taking a proactive role in the management of their own health. This could be facilitated through access to a patient’s own electronic health records.
Following the imposition of the 2023/24 GMS contract, the Accelerated Access to Records Programme is currently scheduled to go live for all patients on 1 November 2023. From that date, patients in England will be given prospective access to information entered into their GP record.
However, GPC England believe there are patient safety and information governance concerns that remain outstanding, and which need to be addressed. For this programme to be successful and fulfil its potential we believe it should not be rolled out in a ‘big bang’ style on 1 November. Practices need to be given the appropriate time and resources to safely plan this in each practice across England, and we continue to press for this as well as further modifications.
Rollout dates
We are aware that EMIS have shared training dates to facilitate their ‘bulk upload’ and they are encouraging EMIS practices to use the new functionality which has been paid for by NHS England. Earlier this year, many practices wrote to system suppliers to turn this functionality off.
We will publish comprehensive advice and guidance for all practices and will continue to set out concerns and solutions to Government ministers. We will also be engaging with EMIS and TPP to ascertain how they can best support GPs with respect to bulk uploads in the lead up to and after the proposed switch on date.
We would therefore reassure practices that they have time to consider matters, and contractors do not need to make any quick decisions before our guidance has been published.
GP Pressures
GP practices in England are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.
The latest GP workforce data showed that the number of fully qualified GPs has dropped since September 2015. In July 2023, the NHS in England had the equivalent of 27,177 fully qualified full-time GPs, which is 2,187 fewer than in September 2015.
The longer-term trend shows that the NHS is losing GPs at an alarming rate: over the past year (between July 2022 and July 2023) it lost the equivalent of 330 fully qualified full-time GPs and the equivalent of 358 full-time partners. This means that, on average, the NHS lost 28 fully qualified FTE GPs per month over the past year.
The number of GP practices in England has decreased by 102 over the past year – reflecting a long-term trend of closures as well as mergers primarily due to a lack of workforce. This coincides with a rise in patients. As of July 2023, there was another average of 9,834 patients registered per practice, and as a result, the average number of patients each full-time equivalent GP is responsible for continues to rise, and now stands at 2,305. This is an increase of 367 patients per GP, or 19%, since 2015, demonstrating the ever-mounting workload in general practice. Read more about the pressures in general practice here
Wes Streeting proposal to pay GPs more to allow patients to see the doctor of their choice
Responding to shadow health secretary Wes Streeting’s proposal to pay GPs more to allow patients to see the doctor of their choice, Dr Katie Bramall-Stainer, chair of GPC England, said:
“Mr Streeting was correct to say fewer patients were now able to see a doctor of their choice, but
argued it was vital to see this in the context of 2,200 full-time GP posts being lost since 2015.
Combine this workforce exodus where GPs at breaking point are retraining, taking on other roles or leaving entirely with millions of patients on NHS waiting lists and we have the perfect storm.
Every GP strives to deliver the best care to our patients in the most appropriate way we can based on patient choice, but the reality of the chronic workforce shortage makes this an impossible ask against the backdrop of increasing demand from a growing – and ageing – population.”
Every day over a million appointments are delivered across England, way more than even before the Pandemic – with less staff. GPs regularly see more patients than our safe working guidance recommends. And yet, we still cannot keep pace with demand.
We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract.
LMC Buying Group
A Reminder about LMC Buying Group Membership
The LMC Buying Group helps GP practices save money on products and services they regularly buy. The Buying Group have negotiated excellent discounts on a wide range of products and services from their approved suppliers.
Buying Group membership is completely free and there is no compulsion to use all the suppliers. They do the hard work associated with finding the most competitive suppliers in cost and customer service, so they save you time as well as money on your purchasing!
Although the Buying Group was originally set up to help GP practices save money on the products and services they regularly buy, membership is now also open to GP Federations and Primary Care Networks.
Why use the Buying Group?
- No membership fees
- Excellent negotiated discounts from a range of suppliers
- Quality products and services
- Free cost analysis for members
- No need to ‘shop around’ anymore – we’ve done the hard work already!
- Access to a recruitment platform to advertise your clinical and non-clinical roles for free and a premium ‘Featured Job’ package for a small fee.
- Access to a community resource hub
If you’re not sure whether you’re a member and/or have access to the Buying Group website (this is where you can view the pricing/discounts and get quotes) then contact the Buying Group team on 0115 979 6910 or info@lmcbuyinggroups.co.uk . They can also help you with any questions you might have about your membership or the suppliers.