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26 June 2020
Dear Colleague
Thank you so much for sharing your concerns and stories about the management of referrals for phlebotomy, ultrasounds and other investigations, and the asks made of practices in some areas. We are urgently raising these concerns on your behalf and working with STP clinical leads to try to find a safe and appropriate way forwards. In the meantime please do keep sending us your examples – we’ve made this easy to do in real time with our Beam To LMC app which you can download right here:
Today I bring you:
- Our latest Londonwide Covid-19 Living Guide version 12.
- TfL and face coverings – downloadable self-exemption cards.
- CQC.
- Talk to us about dumping.
- Re referrals.
1. Our latest Londonwide Covid-19 Living Guide version 12.
We have three key updates in our latest Londonwide LMCs Covid-19 Living Guide, version 12. Monday’s shielding relaxations are covered in both the Living Guide, and the associated guidance on shielding, along with the inclusion of a new section on post Covid-19 aftercare, an update to our HR guidance, and some news about TfL and mandatory facemasks (about which, more below).
2. TfL and face coverings – downloadable self-exemption cards.
Since 15 June it has been mandatory for passengers over the age of 11 to wear face coverings on London public transport and in private hire vehicles. Listening to practice concerns about an increasing number of patients asking for doctor’s notes to exempt them from the requirement on health grounds, Londonwide LMCs’ Comms Director Sam Dowling raised this with London transport bosses and we are pleased to share that TFL have created exemption cards for passengers who believe they are exempt from wearing a face covering for a reason on the TfL exemption list. These cards can be printed or displayed on a mobile phone and passengers with neither a smartphone or printer are directed to call TFL on 0343 222 1234 and arrange to have a card printed and sent to them. Further details are available in the new Living Guide.
3. CQC.
As updated in previous Mwords, we have raised concerns about the resumption of routine CQC inspections of GP practices in the autumn, with no start date specified yet. The CQC say that inspection activity remains paused and has stated that “our emergency support framework is not an inspection, and we are not rating your performance." However, not participating in providing information to the CQC as part of the framework may increase the chance of being subject to a formal inspection once they are resumed. Reinforcing this position, our Deputy CEO Dr Lisa Harrod-Rothwell issued a statement earlier this week.
4. Talk to us about dumping.
Throughout the pandemic Londonwide LMCs have supported practices to provide safe and effective care for patients whilst looking after their own staff, including sharing best practice. Such work has been, by necessity, agile and dedicated. Following local practices concerns being raised regarding referral practices in East London, our NEL Medical Director Dr Elliott Singer has secured and shared a message sent to consultants at Barts Health NHS Trust from the Group’s Chief Medical Officer which states "consultants must request blood & diagnostic tests themselves and not ask the GP to this on their behalf" and "Hospital clinicians should not ask GPs to prescribe hospital-only medications for patients." In response to feedback from practices we have added a category for 'referral management' issues to our Beam to LMC app to allow you to report, and allow us to help you tackle, appropriate workload issues at the primary/secondary care interface. Find out more here.
5. Re referrals.
I know, too, that practices and patients have been sent messages regarding the use of NHS 111 and A&Es, and that some of the messaging has not landed well. We continue to discuss this with NHSE/I and STPs. In the meantime, you may be aware that along with over 1000 GPs and primary care staff, I have signed an open letter after an emergency medicine professor suggested in Tuesday’s Government briefing that practices have 'referred large numbers of patients to the emergency department'. Some of us think this is at best ill-informed, don’t you? If you would like to add your voice please do so!
As ever I welcome your feedback at mword@lmc.org.uk, and know that my team of experts and leaders here at Londonwide LMCs will always be by your side.
Keep well. Stay safe.
With best wishes
Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs
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