13 October 2020

Dear colleagues,

The Department of Health and Social Care (DHSC) has shared new guidance for general practice on accessing their centrally supplied flu vaccines. The NHS will be running the largest flu programme ever in the 2020/21 flu season and part of this includes a drive to increase uptake in existing cohorts eligible for a free vaccine, along with the expansion to new groups.

In order to support the expanded vaccination programme, DHSC has secured an additional supply of influenza vaccines, which arrive later in the season to top up local supplies once they run low. The process by which GPs will be able to access this additional stock is explained in the guidance. GP practices will be provided the DHSC vaccines free of charge but will only be able to claim an Item of Service Fee for each DHSC supplied vaccine that is administered. A pre-set proportion of this additional stock will also be made available to Trusts and community pharmacy, and the arrangements for them to order against this stock will be confirmed shortly.

In addition, NHS England and NHS Improvement, Public Health England and DHSC have published a narrative outlining the position on vaccine supply for the national flu programme.

GP Latest Updates – new webpage

We know there has been a lot of updates and information published in the last few months. This new webpage brings together a summary of some of the key activities and resources available for general practice.

A note on Appraisals 

Whilst a restart of a new, more supportive appraisal model was described in our 3 September letter, we fully recognise the current pressures on the system and the need for a flexible and sympathetic approach - many areas will not be in a position to carry out appraisals at this time but we will maintain the ability to access support for those who need it. 

Nikki and Ed

COVID-19 guidance and updates

Local Covid Alert Level guidance and associated update to guidance for people who are Clinically Extremely Vulnerable (on the Shielded Patient List) 

The Government has issued guidance on the new approach to managing outbreaks. Every local area will be assigned a Local Covid Alert Level (medium, high, very high) determining the regulations/guidance that will apply in an area.   

Alongside this, the Government has also published updated guidance on shielding and protecting people who are Clinically Extremely Vulnerable (CEV - those on the Shielded Patients List). This provides advice on additional precautions people at highest risk may wish to take at each Local Alert Level.  

In the future, the government will only reintroduce formal shielding advice in the very worst affected local areas and for a limited period of time. This will only apply to some, but not all, Very High Alert Level areas and will be based on advice from the Chief Medical Officer.

It is essential that everyone who needs to access health services is supported to do so. Individuals who are CEV may be particularly anxious about attending health settings, and this should be taken into account in care planning and in communications about attending appointments and visiting NHS sites.    

We know that practices could be faced with the need to clinically prioritise care for those most in need of support, including those with urgent healthcare needs. We have already described (in our 9 July letter) the local flexibilities that could be made available, subject to commissioner agreement, to support practices to prioritise capacity where that is required. Those arrangements still apply and we would encourage you to have an early conversation with your commissioner if you need further support. Local commissioners will need to liaise with the NHS England and NHS Improvement national team via regions where requests for support relate to the national GP contracts.

We will write again if there is specific action for the NHS.

Review of all Children and Young People (CYP) identified as Clinically Extremely Vulnerable 

On 8 July 2020, the Chief Medical Officer for England and NHS Medical Director asked clinicians to review all CYP who had been identified as CEV to COVID-19 and included on the Shielded Patient List (SPL).  This was because only a small proportion of children should still be considered at highest risk during the pandemic and remain on the SPL.

Paediatricians have been reviewing their patients and removing them from the list as appropriate. For those which have not yet been removed, the majority were added by GPs. If they have not done so already, practices are asked to review remaining patients under the age of 18 on the SPL, make contact with the family to review whether they should still be considered clinically extremely vulnerable according to guidance from the Royal College of Paediatrics and Child Health, and adjust the flag in the patient record, marking the person as “moderate” or “low” categories for developing complication from coronavirus disease. If unsure, GPs should request advice from a specialist on whether the patient should be considered clinically extremely vulnerable, using an ‘advice and guidance’ approach where appropriate. Guidance is published here.

General practice

Primary care networks Additional Roles Reimbursement Scheme (ARRS) funding

Last week we provided an update to commissioners on the process by which they can claim centrally held additional funds for the Additional Roles Reimbursement Scheme. Primary Care Networks can recruit from the reimbursable roles as they require to support delivery of the DES, with a maximum reimbursable amount for each role.

Interruption of Roche Reagent distribution

On 7 October a CAS alert was issued in relation to an interruption in the supply chain for reagent supplied by Roche Diagnostics Ltd. The issue resulted in variable impact across the country and the response is being managed locally. GPs should ensure they are in contact with their CCG and local pathology labs, who will be helping to coordinate the response.

Significant work has been undertaken and Roche are now operating at full capacity, whilst working at pace to address any backlog. In some parts of the country GP practices may have been asked to temporarily pause requests for non-urgent bloods. Practices should however continue to make urgent blood requests where they consider this to be clinically appropriate. GP practices may also be asked to support the identification of urgent work across bloods that have been taken but not processed, or where requests have been initiated but not taken.

Community pharmacy

Service enables pharmacies to make market entry applications digitally

Primary Care Support England (PCSE) successfully launched a digital service for pharmacies to make market entry applications online earlier this year, hosted on its platform PCSE Online. It enables users to apply to open a new pharmacy, add or remove directors from their corporate structure and change ownership.

The service is available to those wishing to make an application and modernises a paper-based service, which used over 30 separate forms. It’s a one-stop online tool giving users a streamlined, faster and more efficient application process, and enables users to track the progress of their applications in real time.

The application process is simple - users register by emailing pcse.marketentry@nhs.net and the PCSE team will  contact them to guide them through setting up their profile and start making their application. Further information on the market entry process can be found on the PCSE website.

Primary care

Flu vaccination public messaging

Thank you to GP and community pharmacy teams for your work to protect the public through providing flu vaccinations to at risk groups this autumn. Thousands of people have already been vaccinated and many more booked in for their future appointments as the flu season progresses.

Public Health England published new information for the public about flu vaccination supplies and why some people may need to wait for their flu jab last week, along with a leaflet to be shared with the public. Please read and share the materials within your teams and with the public to provide reassurance that sufficient supply is available nationally to vaccinate all eligible patients and to explain the different phases of the supply of vaccine and that there are several types of vaccination.

National flu marketing campaign posters are also available to download. These, along with a briefing, are being delivered to providers. Please use these in line with the supplies of vaccine and proactively communicate to the public with the assets available. Further briefings and updates will be shared via this bulletin as they become available.

Musculoskeletal First Contact Physiotherapists: webinar and Q&A session

Over 350 participants joined the MSK FCP webinar and Q&A session across various roles and organisations. A large number of questions were received via the Q&A chat box and whilst a vast majority of the questions were picked up by the expert speakers and panellists, the team will be reviewing all the questions and identifying common themes. These will be addressed as part of a dedicated MSK FCP FAQ and launched on the FutureNHS platform. The recording and presentations of the webinar is available now.

Engagement events: introducing CQRS Local

On behalf of NHSX, the CSU Collab is developing a new nationally supplied product called CQRS Local, to support payment calculations for locally incentivised services. This new product will bring multiple benefits to commissioner and provider users including:

• an easier claims process for Locally Incentivised Services; and
• clearer payment information, making tracking easier.

To find out more about CQRS Local please attend one of the engagement events. These online events are suitable for those in roles with responsibility for Primary Care Commissioning and management of local payment schemes, as well as digital leads.

Reducing health inequalities for people living with frailty

The VCSE Health and Wellbeing Alliance have launched a new resource which sets out practical recommendations and examples of how commissioners, service providers and health, care and support staff can successfully overcome barriers to healthcare for people at greater risk of frailty as a result of health inequalities.

Dates for your diary

Wednesday 14 October, 1.30pm – 2.30pm. Webinar for GPs. Delayed diagnosis continues to be a huge problem for our patients. Children with Cancer have developed educational resources for many healthcare professionals, including GPs, in the hope of improving time to diagnosis.

Thursday 15 October, 5pm - 6pm. General Practice Webinar with Ed Waller and Nikki Kanani. To attend please ensure you register by 12pm on 14 October. If you have registered for the previous webinar on 1 October you will not need to register again as we will now use a rolling registration system.  

20 – 22 October. HETT Leading Healthcare Innovation Summit. This virtual event will consider how both patients and clinicians are adapting to innovative tools and new ways of working towards a digitally connected ecosystem.

Wednesday 11 November, 9am - 8pm. NHS Confederation: PCN Network virtual conference

NHS Volunteer Responder programme updates – new webinars

Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme.

• Thursday 15 October, 10.30 – 11.30am - Join Microsoft Teams Meeting
• Thursday 29 October, 10.30 – 11.30am - Join Microsoft Teams Meeting
• Thursday 12 November, 10.30 – 11.30am - Join Microsoft Teams Meeting
• Thursday 26 November, 10.30 – 11.30am - Join Microsoft Teams Meeting
• Thursday 10 December, 10.30 – 11.30am - Join Microsoft Teams Meeting

Link of the day

Reframing imposter phenomenon by Rageshri Dhairyawan.