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