Primary Care Bulletin - this week's round-up

19 May 2022

Dear colleagues,

Latest figures out today (19 May) show that PCNs have made excellent progress in recruiting additional roles as part of expanded community multidisciplinary teams. Over 18,000 FTE additional staff have been recruited into PCNs since March 2019 and we are on track to achieving the government target of 26,000 FTE additional staff by March 2024. The vast majority of these roles have been recruited via the Additional Roles Reimbursement Scheme (ARRS).

The data brings together workforce statistics for staff working in general practice and PCNs using data from the National Workforce Reporting Service (NWRS) and additional sources. Our aspiration is for NWRS to represent a single source of information for the primary care workforce and we continue to encourage GP teams and PCNs to complete NWRS returns as accurately as possible. 

Embedding new roles into general practice teams means that people have greater access to a range of professionals to meet their needs within their practice. These expanded multidisciplinary teams have already made a significant contribution to primary care delivery across the country – delivering new services and supporting vulnerable populations, including through the pandemic response.  

Our latest case study explores how West Leeds PCN have used the ARRS to introduce new roles into their PCN, pooling capacity, experience, knowledge and skills to deliver care to their patients. Resources to support the recruitment and retention of the primary care team, including those roles hired through the ARRS, are available on FutureNHS.  

Nikki and Ursula

COVID-19 updates

Research into Long COVID

The National Institute for Health and Care Research (NIHR) has launched new content to outline the wide range of research studies on understanding, diagnosing and treating long COVID. This research is examining the causes of long COVID, investigating symptoms such as ‘brain fog’ and breathlessness, and finding drugs to tackle the condition. NIHR’s latest themed review Researching long COVID: addressing a new global health challenge rounds up this long COVID research and summarises the research findings to date.

COVID-19 Vaccination Programme – workspace

General practice

New digital GP Contract requirements and guidance to support GP practices 

In October 2021 new requirements for general practice came into effect in the GP Contract relating to digital services. To help explain what these requirements are and to support the implementation of them we have published new guidance for GP practices. The requirements state practices must offer and promote to their patients (and those acting on their behalf): 

• An online consultation tool 
• A video consultation tool  
• A secure electronic communication method 
• An online facility to provide and update personal/contact information. 

Practices must also signpost patients towards their online consultation tool and the NHS Symptom Checker from their website and other online presence. For any questions please contact england.digitalfirstprimarycare@nhs.net

Annual health checks to patients aged 14 years or over on the learning disabilities registe

Under the Learning Disability Health Check Scheme (LDHC) Directed Enhanced Service (DES), GP practices are required to offer an annual health check to each patient aged 14 years or over on the learning disabilities register. The requirements are set out in the DES Directions 2022. During the pandemic, we advised GP practices that the LDHC could be undertaken with a blend of remote and in person appointments.

However, recent feedback of patient experience has indicated a preference to return to face to face checks and GP practices should now ensure that at least part of the check is face to face unless there is a strong clinical and / or patient preference for not doing so. Where the LDHC has already been delivered virtually this financial year, this will still be counted. More information can be found here.

The GP Learning Disability Register (GPLDR)

A person does not need a formal learning disability diagnosis in order to access the GPLDR. Guidance, including a checklist, is available to support Primary Care where they believe someone meets the criteria and would benefit from an Annual Health Check (AHC), with the option of using a non-diagnostic SNOMED code to support this process.

It's important to ensure you capture Children and Young People (CYP) in the GLDPR, so that eligible people aren't missed. GPLDR should be reviewed and updated at least annually. New additions to the GPLDR are supported via QOF with four points allocated for new additions.

Improvements to benefit eligibility at the end of life

On Monday 4 April 2022, the eligibility criteria for the Special Rules changed for two benefits, namely Universal Credit (UC) and Employment and Support Allowance (ESA). Clinicians can be asked to provide medical evidence (a DS1500 or the new SR1 form) for a benefit claim under the Special Rules process. To support people accessing these benefits and to find out more about the new process and medical evidence form, DWP have published guidance.

Eighty GP practice staff improve own lifestyles with PHM approach

Staff at two GP practices applied a Population Health Management (PHM) approach to improve their lifestyles after being inspired by the National PHM Development Programme. 

The practices in Wantage Primary Care Network, Oxfordshire, surveyed over 80 members of staff anonymously, including thoughts on what the staff would like more input and help with throughout their working day and re-surveyed at the end of each phase to check it was having a positive effect. The practice is continuing as an Royal College of GPs Active Practice with ongoing emphasis on staff wellbeing. Read the full story at the PHM Academy.

Shape the future of GP data sharing  

NHS Digital want your views on the access to and use of data to help them to shape their thinking and to drive change - please complete this five minute survey. We want to hear from all members of staff, so please do share with your team team. The survey will close on Friday 10 June 2022. 

General practice - latest updates

Dentistry

Reminder: Looking After Your Dental Team webinar

We know it continues to be an incredibly busy time for dental teams, which is why we want to invite you to find out more about how you can look after yourself and your colleagues at a webinar on 26 May 2022 from 6.30pm. Sara Hurley, Chief Dental Officer for England, will be in attendance to introduce this important topic.

‘Looking After You’ coaching is free and available to primary care dental teams across England; our coaches can help support your individual wellbeing, your team, or career conversations. We're encouraging dental colleagues to come forward and benefit from this HSJ award-winning programme.

Community pharmacy

Supporting May Measurement Month

This month we are supporting the International Society for Hypertension’s May Measurement Month campaign, which raises awareness of the risks of high blood pressure and encourages people to get their blood pressure checked regularly. We are encouraging people to ‘know their numbers’ and get their blood pressure checked at their local community pharmacy, to prevent heart attacks and stroke.

Please watch our video on the NHS blood pressure check service in community pharmacy and read and share our blog by Dr Shahed Ahmad and David Webb. We have also enlisted the help of regional radio channels to urge listeners over 40 to get their blood pressure checked as a way of preventing and diagnosing hypertension or a related condition.

Primary care

Monkeypox CAS alert

UKHSA has been notified of a number of confirmed cases of monkeypox virus, including five in London, one in the South East and one in the North East. Some of the cases do not have any identified travel links with West Africa.

A CAS alert has been issued with the following immediate actions:

• providers to ensure that they have appropriate PPE for the assessment and treatment of patients presenting with possible monkeypox virus
• services should consider a differential diagnosis of monkeypox virus in any patient who meets the case definitions in the CAS alert
• inform local IPC teams and infectious disease/microbiology/virology consultants if a diagnosis of monkeypox virus is being considered so that appropriate testing and infection control measures can be implemented.

Management of hormone replacement therapy (HRT) supply

DHSC has issued serious shortage protocols (SSPs) for three products: Oestrogel pump-pack 750mcg/actuation gel, Ovestin 1mg cream and Premique low dose 0.3mg/1.5mg modified release tablets. “Pharmacists therefore only dispense three months’ supply, irrespective of whether the prescription is for longer provided the patient gives their consent”. To support the management of HRT supply, prescribers are encouraged to limit prescriptions for all HRT products to 3 months’ supply.

Prescribers in primary care are guided by local formularies but this does not prevent prescribing of a wider range of products (listed in the BNF) if, for example, the formulary products are in short supply. The British Menopause Society resource on HRT supply provides information on choosing alternative HRT products. Furthermore, information on which formulations are most appropriate for different populations and comorbidities can be found on the NICE website.

We encourage prescribers to check the availability of HRT products before prescribing, by reviewing the NHS England Specialist Pharmacy Service website, liaising with local pharmacies to identify available stocks and agreeing clinically suitable alternatives where necessary.

Wider work on menopause

DHSC plans to introduce an HRT-specific pre-payment certificate (PPC) by April 2023, meaning women can pay a one-off charge (currently £18.70), which is equivalent to two single prescription charges, for all their HRT prescriptions for a year. The PPC will mean women can access HRT on a month-by-month basis, easing pressure on supply while keeping the costs low.

This forms part of the wider DHSC priority to increase support for menopausal and peri-menopausal women. As set out in the Vision for the Women’s Health Strategy, the menopause will be a key priority in the first government-led Women’s Health Strategy for England. In addition, the RCGP, RCOG and BMS have recently issued a joint position statement on menopause, which brings together advice and resources for healthcare professionals.

Managing inappropriate and unacceptable patient behaviours

In response to feedback from our primary care colleagues, The Primary Medical Care Policy and Guidance Manual has been updated with a new chapter on managing inappropriate and unacceptable patient behaviours, including protecting against discrimination, harassment or victimisation (chapter 6). This includes information on contract regulations on managing these behaviours including racial abuse and microaggression and considerations for ensuring ongoing access for patients removed from a practice patient list. 

Share your views to help shape future veterans mental and physical health services in England

As part of this engagement exercise, we would like to hear people’s views and experiences of Op COURAGE: The Veterans Mental Health and Wellbeing Service, as well as the Veterans Trauma Network, which is for Service-related physical health conditions. The information gathered in this survey will be used to help inform the development and provision of veterans mental and physical health services in the future. We are particularly keen to hear from veterans and their families and carers, whether they have used these services or not, as well as from individuals and organisations providing care and support to them. The deadline for responding is 22 May 2022.

Confed Expo – sessions of interest

We are pleased to confirm some sessions that are taking place that might be of interest to you at the upcoming NHS Confed Expo from the 15 – 16 June. Sessions include:

• First impressions matter: improving the digital journey for patients in general practice
• Looking after you: mental health and well-being for primary care
• GP referral pathway to the NHS Community Pharmacist Consultation Service: integrating community pharmacy into urgent care
• Embedding MDT working in Primary Care
• NHS Supply Chain: supporting primary care clinicians with delivering excellent front line care

Free delegate places are available for all NHS and public sector staff, and there are reduced rates for the voluntary sector. Register now to secure your place.

Upcoming events and webinars

April – May. Core20PLUS5 - reducing healthcare inequalities series covering the five clinical priority areas outlined within the Core20PLUS5 approach.

May – June. Community Pharmacist Consultation Service training for practices - Leading change - CPPE

May – June. NHS staff pension seminars

April – June. Community Pharmacist Consultation Service training for practices - PCC

April – June. Demand and Capacity series designed to help gain a deeper and practical understanding of what demand and capacity are and the consequent issues that occur.

April – July. Public Participation online learning sessions about working with people and communities.

19 May, 1pm. Primary Care Discussions: the role of pharmacy technicians

19 May, 6pm – 9pm. Welcome to General Practice – event for GP trainees

23 May, 6pm – 7pm. Becoming a UK visa sponsoring practice

25 May, 1pm – 2.30pm. Social Prescribing National webinar series: Working together to support mental health in communities

26 May, 6.30pm – 7pm. Looking After Your Dental Team

30 May, 3pm – 4pm. Partnerships with people and communities in primary care: The art of the possible

1 June, 3pm – 4pm. Working with health inclusion groups in primary care: What to consider

8 June, 9am – 1pm. Personalised Care at Scale - Working with Multi-disciplinary teams

8 June, 1pm – 2.30pm. Social Prescribing National webinar series. Expanding your SPLW worker workforce, targeted roles and impact

14 June, 1.00pm - 2.30pm. Wessex AHSN - FeNO Learning Collaborative 3

15 June, 2pm - 4pm. Super Skills: Involving Children and Young People - an open space discussion workshop

Link of the week

Link workers for population health: it's time to get with the (social prescribing) programme