Primary Care Bulletin - today's round-up

20 May 2021

Dear colleagues,

Supporting people to access the care they need

It’s been more than a year since the NHS introduced remote triage as the default for accessing general practice, in response to the pandemic, to keep patients and staff safe. We are very grateful to everyone who adapted rapidly to new ways of working, and your continued delivery of the largest vaccination programme we have ever carried out.

Your dedication and hard work has not gone unnoticed, and we are now managing higher levels of demand than ever before. As we ease out of the pandemic we must build on the innovation and achievements, focussing on a primary care service which is right for patients and staff both now and in the future. It is a key ambition of the NHS Long Term Plan that we provide a digital option for every patient, improving fast access to convenient primary care, navigating people to the most appropriate member of the general practice team. 14 new roles have been introduced into PCNs and utilising this expansion of the workforce is critical to the sustainability of primary care. For many of you, this blended approach has been part of your patient offering for a long time.

However, we need to bring patients with us, and although we know over 50% of appointments are now face-to-face, and as GP teams you have been working constantly throughout, some patients have still struggled to get access to their GP. Both Healthwatch and the Patients Association have reported challenges which we cannot ignore.

The message that primary care continues to be open is an important one, because we know that many people over the course of the pandemic have put off seeking medical attention, including for symptoms which could be cancer or other serious conditions. But this message can only be effective if it is matched by people’s experience when they do then try to come forward, or the experience of their family and friends.

With restrictions across wider society easing, we need to keep in step and be accessible, while adhering to IPC guidelines, ensuring the remote triage offer facilitates a balance of online and face to face care. We know that this for some means more change, but this is important for ensuring that patients who do not have easy access to phones or other devices are not disadvantaged in their ability to access care.

Both the BMA and the RCGP have recently called for clarity on next steps in terms of access, and our latest GP Standard Operating Procedure (SOP) provides that, making clear that practices should continue to engage with local populations regarding access models and you should actively adapt your processes as appropriate, in response to feedback. We know that many practices are already providing an excellent balance, offering face to face services and making best use of remote working for those patients for whom this works well, and keeping people safe. This update to the Standard Operating Procedure has been welcomed by patient groups including the Patients Association.

We know this is a complex issue and one size does not fit all, as we discussed in a recent article for Pulse. We hear you when you describe the changing and increasing workload and we want to work with you as the General Practice operating model evolves, to ensure we are supporting our patients and staff in the best possible way, making the best possible use of the skills and expertise of the wider primary care workforce.  

As GP teams, working with patients, you are best placed to ensure the best balance for the communities you serve, and we will do all we can to support you through the most difficult time you have experienced.

GPs and every part of the primary care team have responded amazingly to be there for patients during the greatest challenge the NHS has ever faced. Our challenge now is to build on all of that good work and together continue improving primary care for the future, with the mix of remote and face to face appointments we know our patients want and need.

Funding for primary care

We have written to CCGs and ICSs outlining all the funds available to primary care via regions, systems and CCGs. It covers areas including workforce growth and development, technology and practice and PCN resilience and development. This large and vital investment in primary care will help to support general practice both now and in the future. With the onus shifting to recovery, it is now even more important to deliver these transformation programmes, we must all make full use of the funding available. Further guidance on the support on offer is here.

Nikki and Ed

COVID-19 updates

Vaccination programme updates

We are now beginning to accelerate second doses for priority cohorts 1-9 as outlined in our letter published 15 May.

Following advice from the Joint Committee on Vaccination and Immunisation (JVCI), second dose appointments will be brought forward from 12 to 8 weeks for the remaining people in the top nine priority groups who have yet to receive their second dose. This is to ensure people across the UK have the strongest possible protection from the virus at an earlier opportunity.

This week, 34 to 37 year olds have been invited to book their COVID-19 vaccination through the National Booking Service (online at nhs.uk or by calling 119). People will be contacted by text and will receive a letter later in the week. This phased approach is being taken in line with available supply.

Hospital hubs and PCN vaccination sites should continue to work through vaccination of cohort 11. This is alongside continued action to increase uptake across all eligible cohorts and action set out last week to ensure there is sufficient capacity for those in cohorts 1-9 who need to bring forward their second dose appointment.

Second dose FAQs

The updated set of FAQs on COVID-19 vaccine second doses have been published. Changes reflect recent JCVI and MHRA advice and include:

• the newly recommended second dose interval of 8 weeks (56-63 days) for people in priority cohorts 1-9;
• updated situations where it may be appropriate to give a different vaccine for the second dose than was given for the first.

Extra support for PCN-led sites

We have issued a letter to all PCNs and General Practices today setting out the support available to PCN groupings following the change in advice on the second dose interval for people in priority cohorts 1-9.  This includes:

• an additional payment of £1,000 for each PCN grouping for rescheduling second dose appointments on or after 25 May in line with the revised guidance;
• signposting to a template patient letter, script, text message and website copy to help with rescheduling appointments;
• asking CCGs and ICSs to offer all possible support, including for Lead Employers to work with PCN groupings to help them drawdown additional workforce capacity from national supply routes.

Updated Enhanced Service Specification

We have updated the General Practice COVID-19 vaccination programme 2020/21 Enhanced Service Specification to reflect the revised JCVI guidance on second dose appointments. The changes have been agreed with the British Medical Association.

Vaccinations for eligible frontline social care workers
All eligible frontline social care workers who have not already had their COVID-19 vaccine can book a vaccination online through the National Booking Service, or by contacting their GP. When you book your vaccine, you will only be offered appointments for vaccines that are recommended for you based on your age, any underlying health conditions, and whether you are pregnant. If anyone has any problems in obtaining a vaccination, they should contact their employer and/or their local authority vaccination lead.

National protocol for COVID-19 Vaccine AstraZeneca (ChAdOx1-S [recombinant]) - updated

Public Health England has published its updated protocol for the administration of COVID-19 Vaccine AstraZeneca (ChAdOx1-S [recombinant]) to individuals in accordance with the national COVID-19 vaccination programme. Version 4 includes amends to:

• identify in the Criteria for inclusion and Cautions sections the preference for an alternative COVID-19 Vaccine for healthy individuals under 40 years of age
• identify in the Cautions section COVID-19 mRNA vaccine BNT162b2 (Pfizer BioNTech) or COVID-19 Vaccine Moderna as the preferred vaccines to offer to pregnant women
• minor rewording of breastfeeding paragraph.

Vaccinating unpaid carers – communications toolkit

DHSC has published an updated communications toolkit to be used by local authorities and carers’ organisations to provide information and advice to unpaid carers in England about the COVID-19 vaccines and how those caring for people vulnerable to COVID-19 can be vaccinated. Links to resources on the COVID-19 vaccines are included.

All eligible unpaid carers who are known to health and care services have now been contacted by the NHS and given information about how they should book their appointment. Unpaid carers who have not already made themselves known to their local health and care services should contact their GP practice to be assessed and registered as a carer so they can receive their COVID-19 vaccination.

COVID-19 Vaccination Programme – workspace

General practice

RCGP Quality and Outcomes Framework (QOF) QI project

In 2019 the RCGP, in collaboration with NICE and the Health Foundation, were commissioned by NHS England and NHS Improvement to develop a series of quality improvement (QI) modules and guidance to form part of QOF. Ten modules were produced in this phase of work.

In 2021 the RCGP has continued to support general practice carry out this QOF activity by producing learning material for the QOF QI module topics supporting people with learning disability and early diagnosis of cancer. Additionally, guidance has been produced to support effective and sustainable QI within a primary care network (PCN). These resources are available on RCGP’s website.

This project is clinically led and draws upon expertise from across the system, and from the established evidence base for specific module topics and for QI more broadly.

Exploring the role of Partner within General Practice podcast

In our latest Primary Care podcast, a GP, Paramedic and Advanced Nurse Practitioner come together to discuss their journeys’ towards becoming a Partner in General Practice and why they would recommend others consider taking up a partnership opportunity.

The podcast is chaired by Dr Mike Holmes, GP Partner at the Haxby Group Practice in York who is joined by a recent new partner in his practice, Paramedic Mark Coultate, as well as Advanced Nurse Practitioner Heather Rodgers, who recently became a Partner at Brook Lane Surgery in Southampton.

The group talk about why they became partners, any challenges they faced, as well as the benefits they have felt from being able to bring new ideas and experiences to their practice. They also touch on the support available to new partners through schemes like the New to Partnerships Payment Scheme which has provided a brilliant incentive and opened doors for them.

Accessing the GP career support hub

The GP career support hub has been created to help our doctors identify the best options available to them in terms of career development, funding and support. The hub is available on the FutureNHS platform and if you haven’t signed up already, joining is easy. Simply enter some registration details, which takes less than a couple of minutes, and you should be able to access it straightaway.

We are really keen to hear from you about the Hub. We want it to be a useful source of information about the options available to our GPs right from training to those who are planning their retirement. There is a feedback function on the hub so do let us know what you think or what else you would like to see featured.

GPs needed to market-test new social care website

Researchers at the University of York have created a website featuring older people’s experiences of self-funding social care. GPs are often the first point of contact for information about social care. The University would like this website to be somewhere GPs and other primary care staff can suggest people go to for peer experience information. 

The University is looking for GPs who can spare some of their time to explore and give feedback on the pre-launch version of the website. The research has been funded by the NIHR Research for Patient Benefit funding stream. Please email Lyndsay.Lindley@york.ac.uk for information. 

General practice - latest updates

Dentistry

NHS dentistry and oral health bulletin

The latest edition of the NHS dentistry and oral health bulletin has been published, with an update from Sara Hurley and Roger Banks. This issue includes lots of useful resources, advice and patient facing materials in better supporting our patients with a learning disability and/or autism.

Primary care

New network for GP Federations launched in England

The NHS Confederation has expanded its support and representation of primary care providers by launching a new national network for GP Federations.

Chairs, chief executives, chief operating officers and other senior managers of federations will be able to sign up to access and receive a range of benefits from the NHS Confederation, which already represents NHS trusts, integrated care systems, clinical commissioning groups and primary care networks across England. This includes tailored member products such as bulletins, briefings and events, as well as opportunities to influence and inform national guidance and forthcoming legislation.

New fellowship seeks aspiring clinical leaders with a passion for the environment

Pharmacists, doctors in training, dentists, nurses, Allied Health Professionals, midwives, public health specialist registrar trainees and healthcare scientists are invited to apply for the new Chief Sustainability Officer’s Clinical Fellow Scheme to identify and support the next clinical and sustainability leaders and help the NHS to reach its net zero ambitions.

Clinical fellows will be given the unique chance to work on the new Greener NHS National Programme with a broad remit of delivering a net zero health service and learn how sustainability and carbon reduction principles align with delivering high quality care and protecting wellbeing. Applications close on 24 May 21.

Self Care survey

The Self Care Forum and Imperial College London’s Self Care Academic Research Unit (SCARU) are inviting all professionals involved in the delivery of care, across all sectors, to participate and complete a short online questionnaire.

COVID-19 has fundamentally changed the delivery of health and care services. Supported self care has revealed itself as the critical answer to tackling the pandemic. Professionals and the population alike have successfully adapted their expectations and practice to support this way of working, yet little is known about this quantum change in professional attitudes and practice and its likely impact.

The Self Care Forum and SCARU are undertaking qualitative research to explore this further. If you have any questions about the study please contact selfcare@selfcareforum.org.  

Dates for your diary

Friday 21 May, 11am – 11.45am. Your questions answered – the COVID19 vaccine. While the majority of social care workers have taken up the COVID-19 vaccine, some may still have questions or concerns about getting vaccinated. The Minister for COVID Vaccine Deployment, Nadhim Zahawi, is hosting an interactive webinar with Professor Jonathan Van-Tam, Deputy Chief Medical Officer, and Dr Nikita Kanani, Director of Primary Care at NHS England and NHS Improvement, to give social care workers the opportunity to have their questions answered about the safety and effectiveness of the vaccines.

Monday 24 May, 2pm – 3pm. Lipid Management-Delivering on National CVD priorities using a population health management approach

Tuesday 25 May, 1pm – 1.30pm. Faecal Immunochemical Test (FIT) in suspected bowel cancer

Thursday 27 May, 7pm – 8.30pm. GP CPCS – next steps in promoting the service. As part of our ongoing comms activity to support the implementation of the GP referral pathway to the Community Pharmacist Consultation Service, we are hosting a webinar with the RCGP.

GP Appointment Data: GP practice briefing. These sessions hosted by NHS Digital will introduce recently issued national categorisation guidance and show practices how to carry out mapping to the new national standard categories. There are several dates available:

• Thursday 27 May, 4pm – 5pm
• Wednesday 9 June, 11.30am – 12.30pm
• Tuesday 15 June, 5pm – 6pm

Anticipatory Care: Clinical and Professional Reference Group. These webinars are aimed at any colleagues working in health and care, who are looking to either start delivering Anticipatory Care or would like to enhance their existing models.

• 20 May 11am – 12.30pm. An Introduction to Anticipatory Care: Insights into proactive, personalised care
• 26 May 11am – 12.30pm. Anticipatory Care-Population Health Management and Risk Stratification
• 2 June 11am – 12.30pm. Anticipatory Care-Data Sharing and Digital Tools for MDTs

Webinars from the COVID Vaccine Equalities team:

• Thursday 20 May, 1.30pm – 2.30pm. Vaccination Equalities Tool
• Thursday 27 May, 1.30pm – 2.30pm. The business of boosting vaccine uptake - how we can work with businesses
• Thursday 3 June, 1.30pm – 2.30pm. Boosting vaccine confidence within African and Caribbean communities

Link of the day

Keeping young people healthy: health and wellbeing leaflets for young refugees and asylum seekers