13 November 2020

Dear colleagues,

Yesterday marked the beginning of Diwali, a five-day festival of lights. It symbolises "victory of light over darkness, good over evil, and knowledge over ignorance" which is an incredibly powerful and important message. We’d like to wish the millions of Hindus, Sikhs and Jains around the world who celebrate this festival a happy Diwali filled with love, hope and happiness.

Prioritisation and resourcing in general practice

We want to remind practices of the position around prioritisation and resourcing at this difficult time and to facilitate delivery of COVID-19 vaccination. General clinical prioritisation is something that practices are used to managing. In these particular circumstances additional steps have been taken as below:

1. We announced on Monday the availability of £150m of re-prioritised capacity funding ring-fenced to support general practice to deliver at this time. This is not to be diverted by systems for wider purposes.

2. Local enhanced services should where possible be re-purposed by agreement with CCGs to make funded capacity available for COVID 19 vaccination.

3. Extended Access and hours capacity should similarly be reprioritised to provide additional capacity [as above].

4. QOF has been significantly income protected around long term condition management activity. Practices should approach the management of long term conditions on the basis of clinical prioritisation and should continue to record patient contact but this will not impact payment.

5. QI modules in QOF have been significantly revised, supporting essential activity.

6. Additional Roles Reimbursement Scheme (ARRS) staff can be deployed as required to vaccination as integral members of PCN teams. ARRS recruitment should continue with full funding entitlements remaining in place to continue to support practice teams.

7. PCNs should note that the Structured Medication Review and Medicines Optimisation service requirements in the Network Contract DES are very clear that the number of SMRs to be delivered will be determined and limited by PCN clinical pharmacist capacity. Depending on local clinical prioritisation it is likely to be the case that COVID vaccination is considered a priority for deploying available clinical pharmacists in the short term.

8. A PCN may use its Additional Roles Reimbursement Sum to reimburse extra hours worked by PCN staff, at plain time rates only, as long as the increase in WTE hours worked is clearly recorded on the PCN’s claim form and National Workforce Reporting System.

9. Further information will follow in due course about how PCNs can access further support from local systems to bring in additional workforce to support the Covid-19 vaccination programme.

10. Whilst a restart of a new, more supportive appraisal model was described in a letter from Stephen Powis earlier this year, 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.

11. CQC have separately communicated about their approach to ease burden on providers in this period.

Nikki and Ed

COVID-19 updates and guidance

The Chief Medical Officers, the General Medical Council and Academy of Medical Royal Colleges and ourselves, have written to doctors including general practice providing a COVID-19 wave two update and collective support to the profession. Similarly, the Chief Dental Officers have written to the dental profession with a similar message and a letter from the Chief Pharmaceutical Officer will be sent to community pharmacy colleagues.

COVID-19 Vaccination Programme 2020/21

Due to an error, the site designation form has been updated and is now available on our website. PCN groupings will need to submit this form to the CCG no later than Tuesday 17 November with the details of the site (or sites) initially being nominated for designation and the names and contact details of all of the practices collaborating within the PCN (and with other local non-PCN member practices or PCNs as Classification: Official Publication approval reference: 001559 appropriate) who have agreed that the nominated site will be used to administer COVID-19 vaccinations to their patient population under the Enhanced Service.

Reminder of dates

• PCN groupings to advise CCGs of nominated site for designation Tuesday 17 November
• CCGs complete designation assessment process for nominated sites and submit recommendations to NHS England and NHS Improvement regional teams Thursday 19 November
• NHS England and NHS Improvement decision communicated to PCN groupings along with formal commissioner offer to practices with access to an approved designated site to sign up to deliver the Enhanced Service Monday 23 November

All the documents associated with the above can be found on our website.

The CQC have also published some advice on registration requirements for those delivering the flu and COVID-19 vaccination programmes.

We will be hosting a webinar for primary care networks, general practice, CCGs and community pharmacy on Wednesday 18 November at 1pm to talk in more detail about the COVID-19 vaccination programme. If you have previously signed up to our general practice webinars, there is no need to sign up again but for those who have not joined us before, please register for this event.

Further information on the COVID-19 Vaccination Programme

This workspace provides a community for colleagues across the country who are working to deliver the COVID-19 vaccination in primary care. We will be regularly updating the space with resources, webinars, links to key policy document and for you to ask questions, learn and share from others using the discussion forum. If you are not already a member, please register to join the platform using an NHS or similar professional email address by emailing: P_C_N-manager@future.nhs.uk.

COVID Oximetry @home standard operating procedure published

We published the COVID Oximetry @home standard operating procedure on 12 November 2020. It is recommended that all clinical commissioning groups (CCGs) should put in place a “COVID Oximetry @home” model as rapidly as possible during November 2020, further to guidance on the use of pulse oximetry first published in June 2020.

Supporting the NHS during resurge phases of COVID-19 and the ongoing pandemic: managing the training workforce

Health Education England (HEE) has published guidance that outlines the process for governing HEE’s decisions, operational activity and management of general practice students and trainees during a resurgence of COVID-19 and expected winter pressures over the first quarter of the academic year. The guidance draws on HEE’s experience and lessons learned from the first wave of the pandemic in March to July 2020.

General practice 

QOF income protection

As practices will be aware, Quality and Outcomes Framework (QOF)  2020/21 has been revised to reflect the impact of COVID-19 on general practice. We recognise that practices need to reprioritise aspects of care not related to COVID-19 and the QOF requirements have been modified for 2020/21 to support this and to help release capacity in general practice. Practices and commissioners have been asked to work together to confirm that any population stratification is clinically appropriate for their local population.

Clinical system suppliers have recently updated QOF indicators and prompts. In some instances, this may have impacted on practices’ records of progress to date. Practices should be reassured that the indicators affected by this update are those that are subject to income protection as outlined in 2020/21 QOF guidance. Practices are not expected to re-code or re-review patients for indicators affected by this system update, unless there is a clinical need to do so.

Primary Care Network (PCN) Development Support Guidance 2020/21

We have published updated 2020/21 PCN Development Support Guidance building upon the guidance published in 2019/20. It sets out the PCN development priorities for 2020/21 and guidance about utilisation of national £43.7m funding for 2020/21. Funding was made available to integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) in August 2020. It is imperative that this funding is used to support PCN development, and that PCN clinical directors are key parties in discussions about how funding is deployed, alongside their CCG and system.

Flu vaccines for general practice staff

When arranging flu vaccines for general practice staff, please remember to include all the primary care network (PCN) DES-funded additional roles, including social prescribing link workers. It is the PCN’s responsibility to ensure that this happens whether or not they are directly employed or hosted by an external organisation.

General practice - latest updates

Community pharmacy

World Antibiotic Awareness Week: 18 – 24 November 2020

World Antibiotic Awareness Week (WAAW) aims to avoid the further emergence and spread of antibiotic resistance by improving awareness and understanding of antimicrobial resistance through effective communication, education and training.

Community pharmacies can make a big difference to antimicrobial stewardship. Public Health England has produced a campaign pack for community pharmacies as part of the ‘Keep Antibiotics Working’ campaign. Further resources can be accessed on the World Health Organisation website.

COVID-19 messaging resources available for community pharmacies

Community pharmacies are being encouraged to use the NHS patient-facing communications assets which have been produced to support pharmacy teams during the COVID-19 pandemic. The resources include images for use on in-pharmacy digital screens, websites and social media channels, and some key messages. These include: ‘safe distancing’, ‘please treat staff with respect’ and ‘order your usual quantities’ messages.

Primary care

Flu vaccination messaging resources available

To help answer questions you may be getting on flu vaccine availability, Public Health England has created a new two page leaflet. It explains there is enough vaccine available for all eligible groups and why, if a person is eligible, they may be asked to wait for their vaccine. Assets to support the flu vaccination campaign are still available to download on the Campaign Resource Centre.

Video consultations – translated resources now available

Translated versions of ‘Video consulting with your NHS’, a quick guide to video consultations for patients, have been added to our website. This is a visual resource intended to support patients use video technology for their appointments, the guide is relevant to any technology and any clinical setting and is now also available to download in Arabic, Bengali, Bulgarian, Italian, Polish, Punjabi, Romanian and Urdu.

Abdominal Cancers’ ‘Help Us, Help You’ campaign resource materials

On Monday 9 November, together with Public Health England, we launched the ‘Abdominal Cancers’ phase of the ‘Help Us, Help You’ campaign. This follows the general cancer symptoms campaign that launched on Friday 9 October.

The campaign focuses on abdominal symptoms of cancer (persistent bloating, diarrhoea or discomfort in the tummy area for three weeks or more). These symptoms can be signs of a number of cancers, including oesophageal, stomach, pancreatic, ovarian, colorectal, kidney and uterine. This campaign will encourage anyone who has had any of these symptoms to speak to their GP. The campaign messages will be seen across a full range of communication channels such as TV advertising, social media and regional press. You can access resources for promoting the campaign on the Public Health England Campaign Resource Centre.

Financial wellbeing support offer

Don’t forget that we  are working with the Money Advice Service to provide all health and social care staff with free and independent financial support. We have a variety of offers that you are able to access or signpost colleagues to who may need this support:

1. Support line: Free and impartial money advice
2. Online support: Hub of Resources
3. Virtual interactive events: Managing Your Money

If you need support now, you can contact the Money Advice Service for free, confidential and impartial money advice by telephone on 0800 448 0826, via WhatsApp to +44 7701 342 744 and via web chat.

Dates for your diary

Implementation support for COVID-19 remote pulse oximetry services. CCG colleagues are invited to attend one of two national webinars:

• Monday 16 November, 11am -12pm
• Wednesday 18 November, 3pm - 4pm

Wednesday 18 November, 1pm - 2.30pm. COVID-19 vaccination programme 

Thursday 19 November, 10am - 12pm. NHSX Innovation Collaborative virtual event

NHS and care staff with an interest in rapidly deploying and scaling digital technologies in response to COVID-19 are invited to attend our virtual event to mark the formation of the NHSX national Innovation Collaboratives. Health and care staff will be at the forefront of accelerating digital technology within health and social care and this event will provide an overview of the Innovation Collaborative and the national support available to you and how to get involved.

Monday 23 November, 1pm - 2pm. Antimicrobial Stewardship in Primary Care webinar

Wednesday 25 November, 2pm - 3pm. Harnessing health and housing support to improve population health

NHS Volunteer Responder programme update webinars. 

• Thursday 26 November, 10.30 - 11.30am - Join Microsoft Teams Meeting
• Thursday 10 December, 10.30 - 11.30am - Join Microsoft Teams Meeting

Various dates - REACT Mental Health Conversation training

Link of the day

An introduction to population health management