Primary Care Bulletin - today's round-up

15 June 2021

Dear colleagues,

You will have seen the announcement that Step 4 of the Government’s Roadmap has been paused. This comes alongside an acceleration of the vaccine programme to ensure that by 19 July, all adults will have been offered a first dose and around two thirds of all adults will have been offered two doses. Ongoing support of up to £20m of additional staff resources is available to all PCN and community pharmacy local vaccination services, in recognition of your huge ongoing role in the programme for which we are grateful.

As we approached the original date for Step 4, we were asked regularly for how long we intend to keep standard operating procedures in place. This week’s announcement demonstrates that to reflect a changing situation. We need to continue to keep reviewing the need for SOPs as well as their content. Whilst current SOPs remain as guidance, we want to reassure you all that the SOP approach is still a temporary one - useful during the pandemic to help adapt service delivery, not a permanent fixture. We anticipate that Step 4 of the Roadmap may be the right time to review what, if any, elements of an SOP may need to remain and how we then best signpost people to relevant guidance. This may well differ depending on the extent of ongoing disruption to the usual business model for each professional group.

At the NHS Confederation conference today, Sir Simon Stevens announced that the NHS is setting up specialist long COVID services for children and young people as part of a £100 million expansion of care for those suffering from long COVID (post COVID syndrome). Up to £30 million will also be made available to GPs to support around long COVID through a new enhanced service. Further details of this enhanced service will be made available shortly.

Nikki and Ed

COVID-19 updates

Acceleration of second doses for cohort 10 (40 to 49 year olds) and further opening of cohort 12 to 23 and 24 year olds

In response to advice from the independent JCVI, the Government has set out that appointments for a second dose of the COVID-19 vaccine will be brought forward from 12 to 8 weeks for the remaining people in cohort 10 (people in their 40s) who have yet to receive their second dose. This is to ensure priority groups have the strongest possible protection from the Delta variant of the virus at the earliest opportunity possible.

This announcement builds on the previous advice that second doses for cohorts 1-9 should be brought forward from 12 weeks to 8 weeks. All providers are asked to continue to vaccinate priority groups as soon as possible and not to hold on to vaccine supply. Second dose vaccinations should not be offered earlier than 8 weeks except in accordance with the guidance by JCVI and the Green Book.

From today, we are sending text messages to people aged 23 and 24 inviting them to book their vaccination appointments through the National Booking Service (on the NHS website or by calling 119). We expect to then invite the remainder of cohort 12 to book their appointments later this week and will send further communications on timings as soon as possible.

Read our letter which provides more detail and actions for all vaccination sites to take.

Shielded Patient List improvements

Working together with DHSC and NHS Digital we have continued to make improvements to the Shielded Patient List (SPL) to inform shielding advice in the future should that be needed and/or for future vaccination prioritisation.

It’s quicker and easier to access the COVID-19 Clinical Risk Assessment Tool from a wider range of devices and locations. Using your NHSmail email address, you can now generate a unique sign-in link which is sent directly to your inbox. This link is valid for 24 hours, and once activated you will be able to access the tool for six months.

We are continuing to assess the impacts of vaccination on risks for people with different health conditions and we will provide updates in the coming months.

Identifying people with cerebral palsy, inflammatory bowel disease and chronic liver disease at risk

The initial COVID-19 Population Risk Assessment used hospital records to identify people at greater risk due to cerebral palsy (alongside other factors). Work is now underway to extend this analysis by drawing on cerebral palsy data from GP records. Further information is available on the NHS Digital website.

We are also looking to improve the identification of people with inflammatory bowel disease and chronic liver disease and COVID-19 risks. The British Society of Gastroenterology has produced guidance for clinicians regarding COVID-19 risks for people with inflammatory bowel disease or chronic liver disease. Guidance and decision-support tools produced by other specialty organisations are available on the NHS Digital Risk Criteria page.

This guidance represents professional consensus and can be used to support conversations between individual patients and their GPs or specialist clinicians about the risk from COVID-19 infection. It can also be used to inform decisions about whether individual patients should be classified as clinically extremely vulnerable (CEV).

COVID-19 Vaccination Programme – workspace

General practice

Support for complaints resolution

We heard through the GP bureaucracy review that complaints resolution is an important administrative task but it can sometimes be resource intensive and time consuming. When complaints resolution is done effectively, it can help reduce the overall burden felt by general practice and give patients a better experience. A new and free training programme has been launched for 2021. If you are a practice manager or senior responsible person and are interested in attending a facilitated workshop, email england.complaints-training@nhs.net. Booking will commence from Friday, 18 June 2021.

Sodium valproate

The National Director for Patient Safety is writing to women and girls aged 12-55 who are currently prescribed sodium valproate to advise them to contact their clinician for a review. We know that some women, who are currently prescribed sodium valproate, may not be aware of the risks of taking it during pregnancy or of the need to use effective female contraception such as a coil or an implant. Good communication between the specialist prescriber and the health professional is essential to ensure the safe prescribing of valproate in primary care and a shared care protocol is being developed to support this and will be available later this year. Please visit our website for more information.

QOF 2021/22: Quality Improvement Templates

The QOF Quality Improvement reporting templates for 2021/22 have now been published and are available to download.

The RCGP have produced resources to support practices in meeting the QOF QI requirements for 2021/22 which can be found on RCGP’s website.

General practice - latest updates

Dentistry

Update on next phase of dental contract reform

As detailed in our letter to the dental profession of 29 March 2021, NHS England and NHS Improvement has been asked to take the lead on the next stage of dental system reform. We can only do this by working with our partners and key stakeholders and as a result the first Advisory Group meeting took place on Thursday 13 May 2021. Further information on the Advisory Group can be found on the NHS England website.

Primary care

Improved National Workforce Reporting System (NWRS) and monthly extractions 

With thanks to all those who have supported user testing, NWRS will move onto a new, improved platform in July. Please sign up to the webinars or visit the NHS Digital website to find out more. 

In July, we will also return to monthly data extractions for practices as set out in the 20/21 GP Contract, providing a more timely feed of data to plan essential support for the workforce. PCN data extractions remain quarterly for now.

The next data extraction for both practices and PCNs will be taken on Wednesday 30 June 2021. Please make sure you have reviewed and updated your records before then.

Annual health check delivery and launch of exemplars for people with a learning disability

Last week’s Learning Disabilities Mortality Review (LeDeR) Annual Report shows that thanks in large part to general practice, great progress is being made to ensure that people aged 14 and over on the learning disability register receive an annual health check with 74% of checks undertaken. As a result of your efforts during a very challenging year, we are on track to meet the ambitions of the Long Term Plan of 75% by 2023/24. 

Thank you for continuing to complete all parts of the health check – including the face to face physical review – over the year to improve patient outcomes. To qualify for payment under the DES the health check does not need to be in a single consultation. Input from patients, family and carers into the choice of conducting the health check face to face or conducting some elements remotely should be sought. Reasonable adjustments can be offered to support patient and carer needs. This short film can support primary care teams to consider a simple range of reasonable adjustments that may be helpful in making consultations more acceptable and accessible for people with a learning disability and autistic people.

Building on all this good work, we are looking for pilots in each of the seven NHS England regions to work together in an innovative collaboration with secondary and primary care, and local stakeholders to deliver health improvements via the annual health check process. Delivery of AHCs remains the responsibility of individual GP practices in primary care. These pilots will focus on reducing health inequalities identify those from under-represented groups, increase awareness of reasonable adjustments and improving the quality of the annual health checks.

Good communications with patients waiting for care

Clear, concise and timely communications with patients who are waiting for care is more critical than ever. Guidance, which has been developed with support from patient groups, is available for providers setting out core principles to help them deliver personalised, patient-centred communications. The guidance is primarily aimed at acute trusts but may also be of interest to the wider system.

You can view the guidance online, alongside a visual aide memoire and template letters.

Men’s Health Week

To mark #MensHealthWeek, General Practice Nurse, Caroline Lomax shares her passion for raising awareness about men’s health issues and explains why she started Young Men’s Health Clinics to support this sometimes hard to reach group to take ownership of their own health and wellbeing.

Unsung Hero Awards

Finally, do you know an outstanding nonclinical/nonmedical colleague in primary care, such as a GP receptionist or practice manager, who goes the extra mile for patients and staff? Then why not nominate them for an Unsung Hero Award? Submit a nomination online.

PODCAST: What is the role of the NHS in tackling health inequalities?

In this podcast from the Kings Fund, Helen McKenna talks with Dr Bola Owolabi, Director of Health Inequalities, about the NHS's spheres of influence, the power of gathering around a common cause, and whether the experience of the pandemic will lead to a step change in tackling health inequalities.

Dates for your diary

Thursday 17 June, 5pm - 6pm. General Practice webinar

Wednesday 23 June, 5.30pm - 7pm. Building and housing your primary care network team

Thursday 24 June. NHSX Innovation Collaborative Conference

Tuesday 29 June, 1pm - 2pm. Making Easy Read Materials

The first in a series of webinars that focus on working with people and communities and are part of the learning and development offer from the Public Participation team, aimed at colleagues working in an NHS organisation and those supporting an NHS organisation in its engagement activity.

Tuesday 29 June, 2pm – 4pm. Webinars: From Niche to necessity: genomics in routine care

Tuesday 29 June, 6.30pm – 7.30pm. Using the Year of Care approach to personalised care and support planning to support people with long term conditions in a post COVID era

Tuesday 6 July, 2pm-3pm. Making online meetings accessible for people with a learning disability and autistic people

Wednesday 7 July, 2pm – 3.30pm. Carer-friendly general practice

Link of the day

Appraisal tips for practice nurses