Thursday, July 25, 2019

Report of GPC England 18 July 2019

GPC England Report
For East and West Sussex LMCs
Dr Russell Brown
18 July 2019

The GPC met this week. I was unable to attend in person as we were short-staffed and so Skyped in.  This was a novel experience for me but enabled me to contribute to the meeting while also managing work flows such as phone calls, visit requests and clinical admin in the practice.  I even saw a couple of patients during the day...

A variety of matters were discussed and I will ask the office to send out the “official” news with this report.

Capita have made known yet another error on their part, having discovered over four thousand unactioned emails in an inbox somewhere, though presumably not in the same draw as the previously reported missing notes.  These date back to 2017 and 71 practices are affected, predominantly in Leicestershire and Lincolnshire.

There are widespread CCG Merger plans going on across the country.  I am aware of it happening in East Sussex.  Please remember that CCGs are membership organisations and that CCG executive bodies should be ASKING you for your views, rather than telling you what they want you to do.  This doesn’t stop them suggesting a course of action but do not feel forced into anything you don’t feel comfortable with.

There were updates on sessional matters from the new Chair of the committee, Ben Molyneaux.   I have known Ben for several years through GPC and he is excellent at making sure GPC does not simply take the contractor view all the time.  I think his election, after his predecessor stood down to concentrate on her role as an LMC secretary, is a very positive thing for our craft generally and sessional colleagues in particular.

There was a Contract item, in which we discussed the implementation of the current year’s contract (essentially confirmation that the necessary changes to Regulations are being placed before Parliament so that they can come into effect from October).

PCNs are now with us and apparently 99.7% of practices are signed up to the DES, with about 25 practices throughout England electing not to sign up.  There have been some concerns aired about the long term affordability of the 30% staff costs which practices will be responsible for going forward, though of course there is much new money coming into the pot to support this new contract over the next five years.  The BMA hosted a PCN Directors’ Conference, which was apparently well-received by attendees.  There are more supportive events planned for the future, though details are currently lacking.  There is a webcast of the plenary talk and summaries available here.  The five service specifications detailed in the contract documents previously circulated are being developed by NHSE and the GPC Exec team over the summer and will be looked at by GPC in the Autumn, I understand.   Additionally, the Investment and Impact fund is in the process of being designed.  Separately, there have been reports from around the country of various management structures viewing PCNs as the answer to a wide variety of system issues.  It is very important that expectations are managed: the new staff in PCNs are to support and address CURRENT pressures IN PRACTICES, not necessarily to be a repository of new work.  That may come in time but we must build capacity and sustainability first.  Once PCNs are properly established and are confident that they are both willing and able to take on new work, negotiations could begin to discuss that.  The LMC is of course able to assist all parties in discussions of that nature.

The OOA (out of area) regulations are being looked at by NHSE.  GPC remains concerned about the effect of cherry-picking and disruption caused by providers such as GP@Hand and Babylon.  That said, the technology of Digital first itself and the issues it may raise, positive and negative, are recognised as something we must get to grips with for the benefit of our constituents, who of course include those GPs who choose to work in and for companies such as Babylon.  In my view, their products are a potential solution to a poorly defined question.  I think NHSE would do well to define the question they are trying to answer then resource practices, or perhaps PCNS, properly to come up with innovative solutions.  Those may include companies such as Babylon.  Many of us in GP would welcome the ability to utilise tools like these, provided they are properly resourced, both financially and in terms of time. But there must be a level playing field.  Digital first providers should be obliged to register ANYONE who presents to them, as we are.

QOF and QI work has begun, with the models in the seven areas being developed with a view to being negotiated on and agreed in the autumn.  The areas are replacing the current two modules from April 2020 and practices will be expected to work on two of them.  They are:
  • early cancer diagnosis
  • CVD prevention and detection
  • supporting people with learning disabilities
  • shared decision making
  • anxiety and depression
  • anti-microbial resistance including antibiotic prescribing
  • wider primary healthcare prevention

The promised Vaccinations and immunisation review has started.  I won’t bore you with details of it yet but this is a Good Thing™ for general practice.  The review should conclude in the Autumn and the results of the review should feed in to the negotiation process in due course.

GPC also continues to engage with NHSE’s Access review, in which we have expressed considerable concern about some of their suggested aims.  Essentially, they wish to reduce waiting times, develop a comprehensive offer for out-of-hospital care including times when practices are not open and look at workforce to ensure resources are used sensibly and thus reduce pressure on and improve services.  Forgive my cynicism, but the word “hospital” seems to loom large by its absence in several of those aims...

Pensions were discussed, with the current pressures being faced by a variety of GPs as well as other members of several branches of public service.  It can be summarised thusly:  the situation is absolutely ludicrous and Government thinks we should just suck it up.  If you haven’t had professional advice, can I suggest you get some sooner rather than later, as an annual additional 5-figure tax bill is rather unpleasant to receive.

Finally, there was a brief item about the NHS Campaigns that you will recall we are now contractually obliged to advertise.  They are basically mostly the patient-facing bits of the items above.  I am sure there is a notice board somewhere in your practice just begging for a new poster.  When they are sent out, obviously.

finally, a plug for the LMC’s annual conference, “General Pratcice: Powerhouse of our NHS”, to be held on Wednesday 2 October at the Aurora Hotel in Crawley.  The speaker list is impressive and you will no doubt be delighted to hear it does not include me.  To sign up, please go to the LMC website at this link.


The next meeting GPCUK in September. 

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  


Dr Russell Brown

Saturday, May 18, 2019

Report of GPC England meeting 16 May 2019

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 May 2018

The GPC met this week. This was a GPC England meeting.

I was not terribly happy with this meeting.  Though the Speaker managed our time well and kept us on track, I did not feel that we were given enough opportunity to discuss matters.  Many items were essentially “receive” items with a small opportunity to ask questions (and no chance to respond to answers).  We also spent more time on a presentation by Dr Masood Nazir of NHSE on IT aspirations and plans than we did on the executive and policy leads’ reports.  My own feeling is that should be the other way round.  On the upside though, for the first time we have been asked for feedback, almost in the style of evaluation forms after a CPD activity.  I have done so.  At considerable length.

With regard to the Independent Enquiry that the BMA has organised after the sexism/misogyny scandal, it does appear that it will be properly independent, which provides some hope.  It should be starting soon, with a plan to report back in only a few months time.

New intercollegiate Safeguarding guidance has been released and as is often the case is onerous and far too time consuming for the reality of life.  As things stand, we will be spending more time on safeguarding training and reviews/reflection than we will on PCNs...

Honoraria issues continue to grumble along.  The Meldrum reforms which changed how things work with regard to resourcing your representation have not, in my view, been helpful.  for example, I attended the LMC conference in Belfast on your behalf (rather than as an LMC rep).  I did not receive any honorarium for either of the two days I attended.  I was able to claim for a locum cost on the Tuesday.  Wednesday is my day off so I was there in my own time.  However, I was fortunate that I am a partner in a practice.  If I had been a locum, I could not have claimed any money for the Tuesday to offset earnings lost by attending.  BMA rules don’t pay any honorarium until 12 meetings in a year have been attended.  This is partly because employed members (such as consultants) are entitled to up to 12 days of trade union time.  GPs, often being self-employed, are not able to make use of this of course.  For GPC reps, the GPDF pays an honorarium for attendance at GPC meetings.  For some reason, that has not been continued for LMC Conference, which to my mind is ridiculous.  If you want decent representation, you need to resource it.  It’s not a gravy train but if I can’t fund a locum (or afford to take the hit myself) I can’t go and represent you.  I also have considerable concern that the arrangements as they stand run the risk of reducing an appropriate diversity of representation: we might end up with a larger than appropriate number or ratio of straight, white, male, semi-retired people on the committee.  Oh, wait... (I only conform to some of those categories.) In my view, the only people who can decide whether a person or body represents them is the group of people concerned.  I *think* I do a decent job of representing all of you, but please keep the feedback coming.

Anyway, moving on from my own bugbears...

EMIS Amazon Web Services is a work in progress, with EMIS intending to move patient data on to AWS.  This is something which we support for reasons of service resilience, delivery and sustainability.  There is much work ongoing to tie down the details of any Data Controller liability issues.  Practices in due course will need to update their Privacy Notices and inform their patients about changes, which will involve things such as automated text messages and emailing.  EMIS will be writing to practices at the appropriate time.  One for your radar rather than any action at the moment.

There is a review of the GP trainee contract arrangements as part of wider junior doctors’ contract negotiations.  This is currently confidential but I understand there will be more Comms very soon from the relevant committees and subcommittees of the BMA.

As I mentioned above, Dr Nazir presented on IT aspirations and plans from NHSE.  While interesting, I feel it would have been better to have that item away from the main committee meeting.  

We briefly discussed PCNs, negotiations on the details of the staff groups from year two are beginning and the support that has been put in place this year for ACDs will continue, as there is a recognition that ACDs may well change often.

There was an oral update from Dr Zoe Norris, the outgoing sessional subcommittee chair, who is also leaving the GPC.  She has been remarkable in her vigour and tenacity in her relatively brief time on the committee, representing sessionals’ interests consistently and comprehensively.  She leaves a legacy of a much more visible part of our profession, one which has historically been somewhat neglected by the GPC and BMA.  I will not be alone in missing her contributions.

There were other items in the exec team’s report that were not discussed.  A version of that report will be provided by the GPC secretariat soon (usually the Monday after the meeting) and I will ask the LMC office to forward it on when it is available.

The next meeting is Thursday 18 July, another GPC England meeting.  After that, we have GPCUK in September.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest and have suggested this is reviewed as I am concerned about the adequacy of representation at a national level.  But now I’m at risk of repeating myself.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  


Dr Russell Brown

Saturday, January 19, 2019

GPC report 17 January 2019

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
17 January 2019

The GPCE met today in London.  

It was a full day, with the majority of the time being taken up by discussions around a proposed contract deal.  Details of that are currently confidential but there will be an announcement in the next couple of weeks.  Many elements such as indemnity changes, if not details, have already been announced and I hope the package as a whole will become clear to you all soon.  The GPC will share this as soon as possible and there will be a series of contract roadshows in forthcoming months.

There were also two question and answer sessions.  

The first was with Nigel Watson, regarding his reported GP Partnership Review, which was published on 8 January and can be found here.    I think this is a good piece of work with much to commend in its pages.  However, delivery of the recommendations is a concern, given previous actions by DHSC.  That said, if the Secretary of State accepts any or all of them, the DHSC will have to find some way to implement them. There are also a number if YouTube videos on the different sections of the report:

Dovetailing nicely with that session, Nikki Kanani and Dominic Hardy of NHSE visited GPC to discuss the 10 year Long Term Plan which was recently announced.  Details of that can be found here, with a links to the full document, an on line version and a summary document.  The summary is worth looking at for all my constituents, being only a couple of pages long.

There seems to be a welcome meeting of minds and, to a degree, vision between NHSE and GPC.  Relationships this year have been more productive than of late.  There seems to be much more recognition of the vital importance of Primary care, and general practice within that, than before.  There is also a commitment to support and develop our part of the NHS after a drought of any real investment in the last decade.

The next event is the annual LMC Conference in Belfast on 19-20 March, which I shall be attending in my GPC capacity, with GPC UK meeting the following day.  The next GPC England meeting is in May.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 


Dr Russell Brown

Tuesday, November 20, 2018

GPC report for 15 Nov 2018

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 November 2018

The GPC met this week.  It was my second meeting this year after a period of absence from work for family reasons.  I am back in the saddle now and all is well.  

There was much time spent on Contract negotiations which are proceeding and I hope to be able to report more soon.  Suffice to say that there is much uncertainty as to long term planning in the NHS as a whole.

There was a lively debate about future ways of working, including Primary Care Networks and Integrated Care Systems, the latest buzz-phrases but towards which we are all moving.  My own feeling is that, essentially, this is the product the NHS wishes to purchase from us and so we should engage with LMCs central in the process so that we can help GPs develop matters to the benefit of patients.  As sure as eggs is eggs, if we leave it to others, they’ll muck it up and damage us in the process.  The fact that the benefits are nebulous and currently have no supporting evidence of benefit whatsoever seems to be an irrelevancy. For what it’s worth, we keep pointing this out, but apparently it will all be wonderful in the new systems.  Who knows?

There was an extensive update from the executive team and policy leads and I will ask the LMC office to attach those documents to this report.  GPC News is 4 pages long.  The Exec and Policy lead document is 14 but is worth at least a skim read to find info that may be relevant to you personally.

The next meeting is Friday 23 November, the LMC England Conference in London, which I shall be attending in my GPC capacity.  After that, we have GPC England in January and GPC UK in March.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.


Dr Russell Brown

Tuesday, March 20, 2018

GPC report 15 March 2018

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 March 2018

Since my last report in January I am delighted to report you have re-elected me for another three years. I was unopposed, so no actual election took place.  That either means you are in the main happy with how I represent you or that you don't think there's anyone else you'd rather represent you. At least, that's the two options I prefer to consider. Nevertheless, I take the representative role seriously and so would encourage anyone interested to speak to me or Julius about either the GPC visitor scheme or other routes to election. And of course in three years, if you think you could do the job, I would encourage you to stand.

The GPC met on Thursday in Edinburgh.  This was a GPCUK meeting but the day began with an extraordinary GPC England meeting to discuss the progress of contract negotiations. I have delayed my report until details were published.  These can now be found via the Bma website.

Update from the exec team and policy leads:
In the same new format as January, we were provided with a written update from the executive team and policy leads.  A slightly edited version will be published early next week for LMCs. I will ask the LMC office to forward it on when it is released.  It is fairly long but provides much more information that such reports did previously. I find it very helpful but please feedback if you have any comments on it.

Dr Bawa-Garba and the GMC: there have been several meeting between the BMA (led by the Junior Doctors' Committee) and the GMC.  The GMC have made several pledges which can be found on the BMA website here.

Model locum T&Cs are being developed to assist both locums and practices in avoiding and resolving any problems and will provide equal protection for both parties.

We received updates from Wales, Scotland and Northern Ireland.  The situations are very different but just as challenging as in England. The Secretary of State wishes to undertake a Partnership model review, and the BMA will be one of the main contributors.

GDPR  
The Information commissioners in all four counties are working on final guidance.  The GPC will shortly be publishing adaptable templates for practices' policy posters.  I understand that GPs will be able to act as Data Processing Officers.

Following on from the themed debate at LMC Conference in Liverpool the week before, GPC discussed the Workload recommendations.  Hubs are still a popular model but are not without their issues.  Given the shortage of GPs generally and the often skeleton staff employed out of hours, it is difficult to see where clinicians manning the hubs are going to be found. Additionally, all these pathways of care are often confusing enough for us, never mind our patients.  As I may have mentioned before, we need demand management as otherwise workload management is going to fail. Compared to elsewhere in Europe, we see patients far more often per year for similar health outcomes.

We also had policy group meetings in the afternoon, essentially the old subcommittee meetings. In the Working at Scale Policy group that I work in, we discussed the STP agenda and our concerns with it as well as discussing pharmacists, allied professionals and the difficulty of making a success of things when agendas of different parties fail to mesh.

Separately to GPC I have been working within the BMA on a work stream called "Living our values", a response to some historical concerns about the way in which relationships within the BMA are managed.  In particular, trying to assist committee members to see that their behaviour may cause difficulties for others, given that there are often unconscious biases which may disadvantage certain groups such as women. This is a work in progress.  I am hoping it will lead to better, more inclusive and representatives policies within the Association.

The next GPC meeting is in May, a GPC England meeting being held in London.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 
Dr Russell Brown

Tuesday, November 21, 2017

GPC report 16 November 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 November 2017

The GPC met on Thursday.  This was my first meeting for some time, having missed the last one for family reasons. GPC meets less frequently now, a fact I am still not convinced is sensible.  This time was a GPC England meeting, held at BMA House in London.

Much of the subject matter is confidential but hopefully only until Monday when the official GPC News comes out.  My plan (and you will be able to judge how effective it has been) is to send this report out with the official news. That way you'll get my impressions and the official bits side by side.

Negotiations for 2018/19: 
Negotiations are progressing but are currently strictly confidential.  As previously, this annual round of agreements is not going to solve the problems we face.  We were given much detail to allow us to decide whether to approve of the executive team's direction of travel. Broadly, we do.  More details when I am allowed to.

Update from the exec team and policy leads:
In a new format, we were provided with a written update from the executive team and policy leads.    This is confidential until Monday but is going to form the basis of the official GPC News.  There has been much work (as always) and I hope the new format will be more informative.  Suffice to say here that Julius and I are on different policy groups which we think will be complimentary to each other for Surrey and Sussex.  The subcommittees no longer meet, much of the work is undertaken electronically.  Whether this will continue I don't know but from a workflow point of view it seems to be working. That said, many of us feel disconnected from the work, with the lack of face to face meetings making discussion perhaps less productive. Nevertheless, I understand there will soon be policy group specific pages on the BMA website, if you feel the need to see how the work is divvied up.
Letter to Simon Stevens: Richard Vautrey has written to Mr Stevens to highlight the continuing farce that is Primary Care Support provided (using the word loosely) by Capita. Did I spell that correctly? Yes, good.  There are multiple issues which I suspect will be included in GPC news. Mr Stevens recent speech was both unprecedented and welcome in its criticism of NHS funding.
Practice closures: There has been much work by the BMA Comms team resulting in much media coverage.
Indemnity: there has been a high level meeting with various stakeholders to try and thrash out requirements going forward. It is recognised by DH that something must be done and soon. More meetings are planned.

As I think the policy area reports will be in GPC news, I won't cover them here but may comment depending on what ends up being published. Questions from you are as ever welcomed.

Saving General Practice
Following the publication at LMC Conference of the document of the above name, we discussed next steps. If you haven't seen it, it is available on the BMA website here. Comments welcome.

Scotland contract update
Although an England meeting, we were treated to a 45 minute update on the Scotland contract negotiations, details of which are on the BMA website. It was interesting but given the differences between the NHS in the two countries I am not sure some or indeed much of it could be applied in England. It seemed to me to be a step closer to a salaried service, albeit that it was emphasised that the independent contractor model was being promoted.

Accountable care models
We received and briefly discussed the BMA response to a consultation about proposed changes to the regulations to allow their development. The consultation was actually quite limited in scope but taking into account the views of various branch of practice committees including GPC the response was focussed and constructively critical. In particular the point was made that service integration does not actually require a new contractual model.  Again. The BMA response can be found at here.

LMC England Conference
As usual, a paper had been prepared for GPC outlining the motions passed and what effect these have on workflows and policy. Of course, most of us where there anyway as voting members of LMCs.... The BMA has published news from Conference here. There is also a webcast if you missed Conference and want to watch some or all of it. Yes, I know, but I felt I should tell you it's there. You know, in case you have a spare few hours.

NHS England review of urgent care
A large document entitled "Integrated Urgent Care Service Specification" was provided to us. It is only 148 pages if you fancy going to look for it. As ever with NHS England work of this nature, it makes enormous assumptions about General practice and it won't work without huge investment of resources, which ain't going to happen. Plus ├ža change.

The next GPC meeting is in January, a GPCUK meeting being held in Edinburgh.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

Friday, June 16, 2017

GPC report 15 June 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 June 2017

The GPC met today.  This was a GPC England meeting, the last of the current Bma year, with the Annual Representatives meeting later this month. Our current chair of GPC, Chaand Nagpaul, will be moving to take up the position of BMA Chair of Council.  This means that both GPCE and GPCUK will need new chair electing in July at the next GPCUK meeting.  At the moment I am unable to tell you who the candidates actually are as they can't technically throw their hats into the ring until nearer the time.  I have a couple of ideas who might though. I suspect we will end up with at least one new member of the executive team.

Much of the subject matter today is confidential but as usual I will tell you what I can. For a change I am going to try writing my report in real time, during the meeting.  Apologies in advance for any spelling or grammatical errors.

Chairman's report
Chaand gave a summary of events during his tenure, in particular the changes from last year and in particular the success of not allowing changes to our core hours. He also outlined the difficulties we are facing.  Quality First has been a success, with an emphasis on supporting Gps in resisting inappropriate demands on their time.

Indemnity
With recent changes in the law about the discount rate applied to compensation awards, it is likely that there will be a significant change in MDO subscription costs for GPs. Discussions regarding solutions are ongoing with the MDOs and representatives of the Department of Health who are well aware of the potentially destabilising and even catastrophic effects this issue may have on general practice in England.

UEMO
There was a recent conference held at BMA House which was a great success.  Details at the website.

Resolutions from the 2017 Conference of LMCs
Colleagues will have seen the Conference News published by the BMA, some may even have read it if unable to sleep. There was lengthy discussion about several of the resolutions with breakout groups to look at the best way to implement them.  It is conceivable that the views may change depending on the election on a new chairperson for GPC.   Effort is being put into having a proactive narrative, telling others what we think is needed rather than simply delineating the problems.

The official GPC news can be found soon at the usual bit of the BMA website.  This often includes information that is said to be confidential in the meetings but nevertheless works its way into the documents!

The next GPC meeting is in July, a GPCUK meeting.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown