Primary Care Bulletin - this week's round-up

26 August 2021

Dear colleagues,

This edition of the primary care bulletin brings details of a contract update for Primary Care Networks for 21/22 and 22/23 and an agreement for 21/22 of the Community Pharmacy Contractual Framework.

The two contracts further cement the importance of primary care in offering patients with diverse needs a wider choice of personalised, digital-first health services than ever before.

General practice teams in PCNs and Community Pharmacy will work collaboratively on key areas, including high blood pressure case finding, safer anticoagulation, supporting people to achieve a healthy weight and advice on taking new medicines. They will also work together to support clinically effective and sustainable use of inhalers. More details on both contracts is provided below.

Thank you for all you are doing across primary care.

Robert and Ursula

COVID-19 updates

Removal of patients from the Shielded Patient List (SPL)

NHS Digital has identified cases from the SPL where a high-risk flag has been deleted from a patient record but was not replaced by a moderate or low risk flag. As the flag was not replaced, the patient was not removed from the SPL and their record was left inconsistent. This applies to a very small number of patients nationally.

If a GP practice had a high proportion of affected patients, we have already asked them to review a list of these patients. Where this affected a low proportion of patients in the GP practice list, NHS Digital is automatically updating these remaining affected patient records this week with a medium or low flag based on their health records. A letter will be sent informing these patients that they are being removed from the SPL. If you think that a patient needs to remain on the SPL however, you can re-instate the high-risk flag if needed. 

Removal of Children and Young People from the Shielded Patient List (SPL)

Following an evidence review, which found the COVID-19 risk of hospital admission, critical care and death for children and young people to be very low, UK Chief Medical Officers have accepted the recommendation from the UK Clinical Review Panel to remove all remaining children and young people from the SPL. 

These individuals will receive a letter from Jenny Harries, chief executive of the UK Health Security Agency, informing them of this decision in the coming days. This letter and an FAQ document which answers the main questions that we anticipate from parents/guardians were shared on Tuesday for information via a SPOC. No action is required of you at this time.

Vaccinations for all staff entering a care home

From 11 November 2021, all staff entering a care home need to be vaccinated, unless exempt. Following the publication of DHSC operational guidance, we have written to the NHS and published FAQs on how this new regulation will be delivered operationally. All relevant providers of NHS funded services will need to:

• actively support staff to have their first COVID-19 vaccine by 16 September 2021 (as eight weeks is required between the two doses)
• carry out proactive workforce planning to ensure:
  • only staff who are vaccinated, or exempt, are deployed to a care home from 11 November
  • service provision is not disrupted once this regulation comes into force
• ensure that relevant staff can demonstrate to care home staff, via the NHS COVID Pass service, that they have either had two doses or are exempt

The FAQs will be updated on a regular basis, to support systems and providers to implement this new regulation.

Antibody testing: information for general practitioners

The Department of Health and Social Care has published guidance for general practice on antibody testing for coronavirus (COVID-19) to support with any patient queries that may arise.

New report on COVID-19 admission risk tools: the health inequalities lens

Led by the University of Birmingham, this first of its kind study of COVID-19 patients admitted to four Midland hospitals provides new and important insights into the stark contrasts for ethnic minorities. The research finds that ethnic minorities exhibit younger age structures, higher multimorbidity and disproportionate exposure to unscored risk factors, resulting in potential triage to an inappropriate level of care with clinicians left falsely reassured regarding the severity of presentation and risk of deterioration. Risk tools need to reflect risk factors predominantly affecting ethnic minorities to help healthcare workers manage patients effectively. Read the full COVID-19 admission risk tools report online.

COVID-19 Vaccination Programme – workspace

General practice

Primary Care Networks - 2021/22 and 22/23

The Covid-19 pandemic has clearly demonstrated the value and effectiveness of the PCN model as a basis for local multidisciplinary partnership working. We are pleased to be able to set out plans for the phased introduction of new service requirements for PCNs and confirm how PCNs will access the funding available for their activities through the Investment and Impact Fund (IIF) across the second half of 2021/22 and 2022/23.

This new contract package recognises the current pressures on general practice while acknowledging the work that needs to be achieved on recovery and the renewed urgency of tackling health inequalities. Two services are commencing in October 2021 with an initial set of focussed requirements; two further services will now be introduced in April 2022.

Additionally, the Investment and Impact Fund will be significantly expanded. Full details of the IIF indicator set for 2022/23, worth £225m, have been published to provide maximum preparatory time for PCNs, alongside a ‘lead in’ indicator set for 2021/22 worth £150m. Many of the IIF indicators are linked directly to delivery of the PCN services and will also reinforce connections with community pharmacy via shared objectives on GP referrals to the Community Pharmacist Consultation Service for minor illness and on safter anticoagulation. 

We are also providing new funding to support PCN leadership and management, of £43m in 2021/22, supporting Clinical Directors to work with local partners, such as community pharmacy and community services, and to play a key role in making a success of ICSs.

Shingles (herpes zoster) Green Book chapter updated

We previously shared with you details of the introduction of a new Shingles vaccine, Shingrix, from 1 September 2021, for those who are eligible for shingles vaccination but are clinically contraindicated to receive the live vaccine Zostavax due to their immunocompromised status.

Please be aware that the Shingles (herpes zoster) Green Book Chapter has now been amended in line with this change. This includes further detail on the definitions of immunosuppression to support the appropriate administration of the Shingrix vaccine.

General practice - latest updates

Community pharmacy

Year 3 of the Community Pharmacy Contractual Framework

We are delighted to have reached agreement for Year 3 of the Community Pharmacy Contractual Framework. We remain committed to the vision in the 5-year deal for pharmacy to be more integrated in the NHS, provide more clinical services, be the first port of call for healthy living support as well as minor illnesses and to support managing demand in general practice and urgent care settings. The agreement, which will come into effect from September 2021, was published on Monday by DHSC jointly with PSNC and NHSE&I.

• England’s community pharmacy teams have the opportunity to provide a new, proactive blood pressure check service to thousands of people as part of an integrated PCN approach, making the NHS’s commitment to prevent cardiovascular disease a reality across the country. Read more in our press release.
• Pharmacies have also been given an expanded role in supporting people diagnosed with heart failure, high cholesterol, Parkinson’s disease, epilepsy, gout and osteoporosis, who will now be able to access a New Medicines Service conversation with their local pharmacist about how to get the most from their newly prescribed medication.
• A new smoking cessation service will continue the NHS’ action to prevent ill-health by supporting patients who have agreed to quit while in hospital – they will have the choice to continue their treatment with support from a community pharmacy.
• The majority of pharmacies will also start to provide assistance to people who would like support with their weight, including advice and referral to support/exercise groups, local authority funded weight management services and the NHS Digital Weight Management Programme as they step up to help tackle the country’s obesity challenges.
• Ensuring patients have personalised asthma action plans, including the use of spacers for children, checking inhaler technique, and encouraging return of unwanted and used inhalers for disposal to protect the environment provide a real community pharmacy focus for patients with respiratory illnesses and demonstrate an active approach to the sustainability agenda.
• A new three-year programme of education and training for community pharmacists and pharmacy technicians will be introduced this Autumn to enhance their clinical and patient consultation skills further – including training some community pharmacists as independent prescribers with more training courses offered as capacity builds.
• Work will continue to embed GP referrals to the Community Pharmacist Consultation Service for minor illness and we are also focusing efforts on implementing the Discharge Medicines Service, to provide integrated care for patients and better communication between secondary care and primary care, so reducing harm from medicines at discharge.
• Pharmacies will receive a transition payment to support with PCN and ICS engagement to encourage further local integration of services and strengthening relationships with PCNs with the aim of increasing uptake of clinical services, digital transformation and preparing for dispensing efficiencies. Changes to the Pharmacy Access Scheme will take effect from January 2022.

Read more in this blog from Dr Bruce Warner, Deputy Chief Pharmaceutical Officer for England.

COVID-19 Lateral Flow Device Distribution Service (Pharmacy Collect)

Following discussions with NHS Test and Trace we can confirm that we will extend the Community Pharmacy COVID-19 Lateral Flow Device Distribution Service (Pharmacy Collect) until 30 September 2021. Thank you to community pharmacy for your continued support in providing these vital services to your communities and keeping patients safe. NHS Test and Trace are working with NHS England and NHS Improvement and PSNC to develop a revised service. More details will be released in due course.

Optometry

Optometry PPE Engagement Panel

The Department of Health & Social Care is recruiting panel members for Optometry PPE engagement panels to gather feedback on the quality and quantity of PPE provided to meet service needs.

The purpose of the panels is to provide end-user customers the opportunity to discuss their (COVID) PPE provision experiences, in order to improve the service of the DHSC PPE cell. The meeting will take place for one hour on a monthly basis.

If you would like to express an interest in joining, please email the DHSC Optometry team with your name, role and panel preference.

Primary care

Community mental health transformation

Since April 2021, all ICSs have received baseline and transformation funding to develop integrated models across primary and secondary care to support people with severe mental illness. This includes people experiencing psychosis, bipolar disorder, ‘personality disorder’ diagnosis, eating disorders, severe depression, and those with mental health rehabilitation needs, amongst others. This animation articulates the vision for community mental health transformation.

The Additional Roles Reimbursement Scheme (ARRS) Mental Health Practitioner roles should reinforce this integration and ensure support in primary care for people with complex mental health needs. PCN leads should work with mental health providers in their area to discuss potential scope for these ARRS roles and get involved in their local transformation.

A proposed 4 week wait standard for adult community mental health services is under public consultation, which could be used to track the impact of this transformation. Primary care colleagues are invited to respond to the consultation by 1 September 2021.

Staff Mental Health and Wellbeing Hubs

In response to the pandemic, mental health and wellbeing hubs have been set up to provide staff rapid access to evidence-based mental health support where needed. The hub offer is confidential and is free for all health and social care staff in England to access.

The hubs can offer a clinical assessment and referral to local services, such as talking therapy or counselling. You can self-refer or refer a colleague (with their consent).

For further details go to the NHS.UK Mental Health and Wellbeing Hubs webpage. Doctors, dentists and senior leaders can also self-refer to the Practitioner Health service.

Support for the Armed Forces community including veterans and their families

Op COURAGE provides specialist care and support for Service-leavers, Reservists, Veterans and their families. Their experts understand the Armed Forces and military life and are either from the Armed Forces community or highly experienced in working with Serving personnel, Reservists, Veterans and their families. They will work with you to make sure you get the right type of specialist care, support, and treatment.

The service can be contacted directly for self-referral, by GP referral, a charity or by someone else, such as a family member or friend.

For more information, visit the NHS website at www.nhs.uk/opcourage.

Have your say

Social Prescribing Link Workers (SPLWs) Survey

We have launched a survey for social prescribing link workers to find out more about their experiences of social prescribing and the training, supervision and support they receive. This information will help us to plan their work to support link workers over the next year. All data collected in the survey is anonymous and should take less than 10 minutes to complete.  

SPLWs must be a member of the FutureNHS social prescribing collaboration platform to complete the survey – to join, email england.socialprescribing@nhs.net.

Key dates

• 31 August: deadline to update practice workforce data on NWRS
• 31 August: workforce planning submission deadline

Upcoming events and webinars

31 August, 2pm – 3.50pm. Higher Education Institution webinar

1 September, 1.30pm – 2.30pm. Social Prescribing Link Worker Webinar Series - Carers

2 September, 4pm – 5pm. The mental health digital playbook: how digital technology can help improve and transform our service

7 September, 6.30 – 7.30pm. RCGP: Quality improvement in primary care networks

29 September, 5.30-7pm. Enhanced Health in Care Homes: primary care networks and community health

Link of the day

Nosey GP receptionist? No, they are just trying to get the best care for you!