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27 May 2021
Dear Colleague
Words Mean What Words Say
Picking up on the impact of the last two weeks events I hope you have had a chance to read our recent messages on 14, 17 and 20 May, regarding the NHS England letter B0497, the associated SOP Guidance, and the Response of the BMA’s GP Committee in England.
To summarise, the key messages from those e-alerts are:
- Know the key clauses in the Contract Regulations (Statutory Instruments) which govern your GMS, PMS or APMS contracts.
- Know that the Contract Regulations trump "guidance" documents.
- Practise Safely – safely for your patients; safely for you and your staff.
- Be part of your LMC. You can still self-nominate for your LMC until close this coming Tuesday.
1. Know the key clauses in the Contract Regulations (Statutory Instruments) which govern your GMS, PMS or APMS contracts.
You are not obliged to offer a face-to-face appointment solely upon request and it is well worth revisiting and thoroughly digesting the relevant parts of the Contract Regulations which are highlighted below:
Essential Services
4) The services described in this paragraph are services required for the management of a contractor’s registered patients and temporary residents who are, or believe themselves to be —
a) a ill, with conditions from which recovery is generally expected;
b) b terminally ill; or
c) c suffering from chronic disease,
which are delivered in the manner determined by the contractor’s practice in discussion with the patient.
(5) For the purposes of paragraph (4) — "disease" means a disease included in the list of three- character categories contained in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems; and "management" includes— a offering consultation and, where appropriate, physical examination for the purposes of identifying the need, if any, for treatment or further investigation; and b making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Act and liaison with other health care professionals involved in the patient’s treatment and care.
And so, If you are offering patients:
- Access to your practice via telephone/online and your reception is also open;
- Face to face appointments based upon your assessment of clinical need following a discussion between the clinician and the patient;
- On-line access for a proportion of your appointments;
- A discretionary e-consultation (or equivalent) platform, which need only be during core hours Monday-Friday 08:00-18:30, and;
- Information about your services via your practice website,
then you are complying with the terms of your contract.
2. Know that the Contract Regulations trump "guidance" documents.
The updated standard operating procedure (SOP) published last week is guidance. Where there is conflict and confusion between the guidance and the Contract Regulations, default to the Contract Regulations. In other words, stick to the terms of your contract.
Under the above Contract Regulations it is for your practice to determine how best to manage and deliver your services and the best arrangements for appointments, based on your expert knowledge of your local community, and with regard to maintaining safe infection prevention and control.
3. Practise safely – safely for your patients; safely for you and your staff.
We have far too many GPs, GPNs, PMs and pharmacists and administrative staff who are functioning at or beyond the limits of the human function curve. This is unacceptable and cannot carry on like this.
It is not possible for practices to continue to deliver all that is expected of them. It was so before the pandemic, and it most certainly is not so now. With the rapidly rising case numbers of the B1.617.2 variant now in our midst, it is important to know that under the above Contact Regulations you do have the flexibility to manage and deliver your essential services in a manner determined by your practice, taking into account your capacity and workload pressures, in order to provide a safe service to your patients that is consistent with your duty of care to your staff, yourselves and each other.
So what happens next?
With our continuing to face unprecedented patient and system demand, we anxiously await the outcome of the GPC’s recent representations to the Secretary of State for Health.
And what can you do right now?
4. Get involved in your LMC. You can still self-nominate for your LMC until close this coming Tuesday.
Get involved! This is a challenging and important time for general practice, and we need the strongest possible voice from the grassroots, as practices continue to manage their response to the Coronavirus pandemic, and prepare for the significant health needs which will follow it. If ever there was a time to think about joining your LMC, it’s now.
LMCs are not beholden to any other organisation via chain of command or funding, they represent each practice in their area equally, and recent days have shown the value in that. Only LMCs represent every GP practice in their area and every person working within each one. And being part of the Londonwide LMCs’ family gives your LMC greater influence as they feed-in to our pan-London leadership role, in turn Londonwide LMCs supports individual LMCs with advice, guidance, intelligence and development opportunities.
Nominations close at 5:00pm on Tuesday, 1 June 2021, so visit www.cesvotes.com/londonwidelmcs download your nomination form.
Finally, having missed the four months since being admitted to Northwick Park on Boxing Day ill with severe covid, pulmonary and renal emboli, I am now back and fingers crossed, mostly recovered. I want to pay tribute to all the Londonwide team who without wavering, unremittingly carried on supporting you throughout this awful period. In particular, I want to express my immense gratitude to my deputy Dr Lisa Harrod-Rothwell for her leadership while standing in for me, and to our NEL Medical Director, Dr Elliott Singer for his unwavering support. The Londonwide LMCs’ Covid Living Guide is but one of the reasons why we are all so fortunate to have such an amazing team. A team dedicated to having our backs.
As ever I welcome your feedback at mword@lmc.org.uk. Meanwhile, please do try to switch off and enjoy this warm Bank Holiday weekend.
Keep well. Stay safe.
With best wishes
Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs
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