GPC Chair's News: 22 October 2021
Overwhelming rejection of government’s ‘rescue package’
As you will have seen from our message yesterday, GPC England has unanimously rejected the Government’s ‘rescue plan’ which fundamentally failed to address the ongoing crisis in general practice. The committee called for GPs and LMCs to disengage in its implementation in line with the overwhelming view that you voiced to us in a snap poll last weekend. By this we mean they should not comply with the ‘rescue plan’ – which would mean spending more time on bureaucratic process, and complying with target driven leagues tables to ‘name and shame’ GPs. We are also taking steps towards industrial action over the Government’s decision to impose plans on GP earnings declarations and forcing GPs to be involved in the Covid vaccination exemption process.
We believe that Sajid Javid, the Secretary of State for Health and Social Care, ignored GPs expertise and experience when he laid out his bully’s charter and that patient care will suffer as a result, and are now calling on the Government to withdraw their plan and work with us to introduce a new contract which ensures general practice is properly funded, with safer workload and reduced bureaucracy, and ultimately provides better care and services for patients and vastly improved working conditions for doctors and their teams.
Read more about the response of GPCE and the actions that we are taking
Read our statement here
Workload control in general practice
As it is clear neither the government nor NHSE/I show they understand the scale of the crisis impacting general practice, or have provided the necessary measures to support the profession at this critical time, we would encourage practices to look again at our Workload Control in General Practice paper.
In addition to the actions highlighted above, GPC England also resolved that practices should be encouraged to take actions to prioritise higher quality of care that delivers a safer service to our patients and protects the wellbeing of our workforce. Practices should not feel pressured to return to a traditional 10 minute treadmill of face to face consultations, that are neither good for patients nor clinicians. Instead, they should:
Offer patients consultations that are 15 minutes or more
Apply to close the practice list in order to focus on the needs of existing patients
Stop all non-GMS work to give priority to GMS care
Reject all shifted work from secondary care that has not been properly commissioned
Don't accept additional NHS 111 referrals above the contractual 1 per 3000 patients
Stop unnecessary cost based prescribing audits in order to focus on quality care
Decline to do additional extended access sessions in order to focus on the core work of the practice
We will provide more guidance in the coming days on what practices could do if NHSE/I and government fail to take the action needed to properly support general practice.
Analysis of NHSE/I ‘rescue package’
Following our initial response last week to the NHSEI/government’s ‘rescue package’ – we have done some rapid analysis of each element of the package that shows just how many sticks there are. Our analysis shows what the package really means for general practice and highlight that it consists mainly of things NHSE/I and/or government has already stated or things that are already the case, and are clear that the few positives are completely outweighed by the impact of the negatives (often packaged as positives). We hope this will help explain just how damaging the package is and dispel any suggestion that this provides the necessary support for general practice.
All health systems have been told they must develop and submit a plan, by Thursday 28 October, assured by the ICS board. We believe CCGs and ICS managers should resist this punitive and damaging approach, and we know that many want instead work to support not punish practices.
We have also updated our General Practice factsheet showing the facts and figures of the crisis.
These are also available on our Support your Surgery campaign page
GP declaration of earnings guidance
Ahead of the Government’s GP pay transparency deadline of 12 November, which were introduced on 1 October, when the GMS and PMS Regulations were amended to require some GPs to self-declare their earnings, we have now published guidance on what this means for GPs.
We have already made clear our significant concerns about the compelling GPs to publicly declare their NHS earnings over a certain threshold, especially in the current climate of threat, aggression and violence towards GPs. This will be damaging to morale among the profession, could lead to an increase in abuse targeted at individual GPs and will be wholly counterproductive in terms of the ability to recruit and retain GPs. We have received reports of GPs already reducing their hours to remain under the threshold. GPs need to consider carefully the implications before making a self declaration.
As GPC England did not agree to this amendment to the regulations, we consider these to have been imposed on the profession and in breach of the original agreement. In addition, GPCE has resolved that it will seek support from BMA council to formally ballot members for industrial action over the Government’s decision to impose this solely on GPs
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with our Support Your Surgery campaign to get the changes that are so urgently needed to support general practice teams.
The latest resource added to the campaign page is a zero-tolerance poster to show that assault on practice staff, threatening or abusive behaviour or damage to property will not be tolerated.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice and use our resources to explain to patients why practices need to work in the way they are doing in order to protect patients from a rising incidence of COVID-19 and to make the best use of the available but limited workforce.
You can also get involved in the #SupportYourSurgery social media discussion by sharing your support across social media.
Please do all you can to help us defend and support general practice at this critical time.
Use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
Our GP campaign factsheet can be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs.
Next steps for vaccinations of 12 to 15 year olds
NHSE/I has published a letter setting out the next steps in the deployment of COVID vaccinations for 12-15 year olds, with vaccinations now being offered via the National Booking Service and mass vaccination sites (rather than PCNs) to support the school based programme.
In a few areas where there isn’t good geographic coverage, there may be a small number of PCNs who are asked to take part. This would utilise the Enhanced Service amendment which has already been agreed and would only be on the agreement of both the commissioner and the PCN. The majority of PCNs will not be expected to be vaccinating this group but to continue to focus on boosters, the at-risk 12-15s and third doses for the severely immunosuppressed.
Government COVID antiviral strategy
On Wednesday the Government announced plans to roll out new anti-viral drugs via clinical trials over the coming winter months, with a view to deploying more widely in summer 2022. Trials have found the twice-daily tablet molnupiravir (Merck) cut the risk of hospital admission or death by about half- 480,000 courses have been secured.
A further 250,000 courses of PF-07321332/ritonavir (Pfizer) have also been secured, which is currently undergoing clinical trials with three Phase Two and Phase Three trials looking at the clinical effectiveness of the treatment currently underway.
The drugs reduce the severity of symptoms and speed up recovery time for those who test positive. The two new drugs are yet to be approved by the Medicines and Healthcare products Regulatory Agency.
COVID-19 medical exemptions
A systematic medical exemptions process was introduced on 30 September, to ensure that those who, for medical reasons, should not be vaccinated (and/or be tested) for COVID-19 are not disadvantaged across certification use cases.
Given the need for clinical judgement and access to patient records, the Department of Health and Social Care have set up a system using 119 to initially assess patients and may then ask GPs, secondary care clinicians or midwives, depending on who is involved in the person’s care, to assess applications. Steps have been taken to limit the number of applications reaching clinicians (e.g. no appointment required, pre-screening process).
Read the guidance detailing the process and clinical criteria and payment mechanisms (for GPs).
Please complete our PCN survey to tell us about the issues you are facing and how the pandemic has affected your work. Your responses will provide us with insights to share among PCNs. It is open to all clinical directors of PCNs across England and closes on 27 October. Take the survey
Management of IBS in primary care - survey
King’s College London are currently carrying out research that aims to capture how Irritable Bowel Syndrome (IBS) is diagnosed in clinical practice by GPs and the dietary advice provided to patients with IBS. If you would like to participate in this short survey (no longer than 5-8 minutes) click here
GPC UK election
Voting for a representative for Nottinghamshire and Derbyshire in the GPC UK election is now open.
To submit your vote please go to https://elections.bma.org.uk/
Voting will close on 25 October at midday.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team firstname.lastname@example.org
GP Trainee Regional Elections
Nominations for the reopened elections for GP Trainees Regional Elections 2021 opened on Wednesday 20th October at midday and remain open until 3rd November at midday. Below are the seats open for nomination.
If you would like to submit a nomination, please go to https://elections.bma.org.uk/.
If you have any questions about the elections please email email@example.com
I told Mail Online that GPs are 'deeply unhappy' about Government's plans to improve NHS access for patients and support GPs. When the 'rescue package' was announced last week, I said that the plans will not reduce the burden that practices carry and free up any more time for doctors to see more patients. I was also quoted in the Yorkshire Post where I said that preoccupation with face-to-face consultations is disappointing and that minsters should listen to GPs, adding that what was needed was "a more intelligent conversation about the variety of appointments that patients need."
Speaking on BBC Cornwall (starting at 07:13).GPC England deputy chair Dr Mark Sanford-Wood said: "There are not enough GPs, we're all working ourselves into the ground and if we have to see all patients face-to-face, the numbers of appointments will drastically reduce." He also said: "The Government has thrown GPs under the bus, diverting the blame for shortages in numbers to GPs who are burned out and exhausted as we're down by about 8,000 in total." His also featured in South West local media outlets, like the Plymouth Herald (also in print) and Western Morning News.
GPC England executive team member Dr Krishna Kasaraneni was interviewed on local BBC Radio stations, and a letter from GPC England executive member Dr Farah Jameel was also printed in the Yorkshire Post (and print).
Dr George Rae, BMA North East regional council chair, was quoted in the print edition of the Sunday Sun (Newcastle upon Tyne) saying that GPs were preparing to 'hang up their stethoscopes and leave the profession altogether'.
Dr Chaand Nagpaul, BMA council chair, was quoted in the Daily Telegraph (print) and online, saying that forcing GPs to see patients face-to-face was 'discrimination and harassment' explaining that no other parts of the NHS were blamed via league tables for workforce shortages. The story has also been covered by Eastern Eye, who quoted Dr Chaand about another element of the plans - to rank surgeries based on performance. He was also quoted in the Guardian saying that the rescue package would leave GPs open to more abuse.
Other coverage on this topic with BMA commentary includes The Chester Standard, Express explaining the shortage of GPs, Mail Online (also in print) about the crisis facing the NHS, the Times (also in print), Daily Mirror (also in print), Daily Mail (also here), Daily Telegraph (print), Daily Express (also in print), Medscape, GPOnline, Pulse (also here), GB News, over a hundred regional press, Express Digest, and on local BBC radio stations.
Vote to reject the ‘rescue package’ and BMA action
The story was featured in Sky News, Guardian (also here, and here, also print front page), Daily Mail (also here, also in print), Daily Mirror (in print), Daily Star (in print), Telegraph (also in print), Sun (also in print), Times, LBC, GPOnline, Pulse, Medscape, and hundreds of local and regional media outlets, and has been discussed in most news bulletins for TV and radio stations across the country since last night. I was interviewed on LBC and Times Radio.
The BMJ reported on England’s chief medical adviser, Chris Whitty, speaking at the RCGP conference last week, saying that the NHS will have an “exceptionally difficult” winter, whether there is another covid-19 surge or a slump. He was due to speak after the health and social care secretary for England, Sajid Javid, who pulled out of attending at the last minute. Dr Farah Jameel, GPC England executive team member, was also quoted “The fact that Sajid Javid failed to keep his promise to address doctors at the RCGP conference tells you everything we need to know about this health secretary. He is running scared of speaking to the profession face to face because he knows his plan is, in reality, no plan at all. The secretary of state had the perfect opportunity today to stand up and defend his so called ‘rescue package’ and hear at first hand what GPs thought of it. But ducking out of the conference shows he wasn’t willing or, in reality, able to defend the indefensible.”
Rejection of call for Plan B measures
The BMA's response was featured widely across the media after the Health Secretary rejected calls for plan B measures to be put in place, despite predicting that infections could reach unprecedented levels, in a press conference on Wednesday. Council chair Dr Chaand Nagpaul was interviewed on BBC News, Sky News, BBC Breakfast (clip at 1m45s in replay, highlights here and here), BBC News at 9 (at 8m54 on replay), and ITV's Good Morning Britain (first item in replay). Council deputy chair and GP, Dr David Wrigley, was interviewed on LBC and Yorkshire regional chair and GP Dr Brian McGregor was interviewed on BBC Radio Humberside (at 2h in replay) on the same topic. I was interviewed by BBC Radio Leeds.
COVID vaccine and booster roll-out
I spoke to BBC York (around 8.09am) on Tuesday about the Covid vaccine and booster rollouts. I said that practices are limited by when they are able to give the booster and flu jabs and that practices are working hard to mitigate any delays to the rollout and are trying to see as many patients as quickly as possible. I was also interviewed on the BBC Richard Stead Breakfast show about COVID vaccinations.
Access to face to face GP appointments and the UK GP recruitment crisis
Dr Iain Kennedy, GPC UK and SGPC member, appeared on Channel 4 News Wednesday at 7-8 pm to talk about access to face to face GP appointments and the UK GP recruitment crisis.
Read the GP bulletin here.