Mword Issue 59 – Dr Michelle Drage’s latest update for GPs and practice teams
Mword
1 May 2020
Dear Colleague
I can’t believe its May already.
Whilst we (continue) to await news of the latest NHS Standard Operating Procedure (SOP), I’m pleased to share our new Londonwide Covid-19 Living Guide – Mayday edition, released today, containing updated advice and guidance on a range of operational issues. And below are a few key messages from me to take you into the weekend.
NEW – Bank Holiday working Friday 8 May (May Day Bank Holiday).
The Simon Stevens and Amanda Pritchard letter – “IMPORTANT – FOR ACTION – SECOND PHASE OF NHS RESPONSE TO COVID-19”.
1. NEW – Bank Holiday working Friday 8 May (May Day Bank Holiday).
NHSE&I has acknowledged that the imperative for practices to be all-hands on deck next Bank Holiday Friday has diminished. As a result, the expectation on an individual practice’s arrangements for the “normal working day” is much more pragmatic, enabling the requirement to be met using cross-cover such as your local access arrangements where appropriate and agreed with your CCG. In fact, on the NHS England Primary Care Webinar last night it was stated that “minimal cover is fine as long as practices agree it with their CCG”. If you need further advice on this please contact gpsupport@lmc.org.uk.
The issue of recovery of costs and time remains unchanged. In the meantime, we continue to advise you that it is important to keep a clear account of all additional costs associated with these Bank Holidays of normal opening. The BMA continues to push the powers that be for all necessary expenses to be reimbursed, and we at Londonwide LMCs will continue to lobby for the lost Bank Holidays be reinstated in due course.
2. The Simon Stevens and Amanda Pritchard letter – “IMPORTANT – FOR ACTION – SECOND PHASE OF NHS RESPONSE TO COVID-19”.
On Wednesday, right bang in the middle of what otherwise was a rather helpful letter issued to the NHS and Local Authorities by the CE and COO of NHSE&I, responding to our professional concerns about delays in referrals and in particular 2WWs, and recognising the value that small units such as GP practices bring to the whole NHS effort in terms of agility and responsiveness to local patient need, there was a clause which states:
“To further support care homes, the NHS will bring forward from October to May 2020 the national roll out of key elements of the primary and community health service-led Enhanced Health in Care Homes service.”
This was taken as meaning that the PCN DES specification on care homes – not due for implementation until October – would be brought forward to from October to May, and has caused much grass roots concern and consternation, reflected in my own message to the BMA’s GPC England Executive Team, which I will share with you one day when this is all over. As a result of urgent discussions with the GPC yesterday, it was clarified last night by NHSE&I that the PCN DES Specification for Care Homes is NOT being brought forward from October to May and that the DES provisions have not changed. Instead, NHSE&I, recognising that most care homes already have good GP arrangements in place will be issuing a letter clarifying “what good looks like” in terms of GP provision in care homes.
So, as you were Pike.
3. Reasons to be cheerful, one, two, three.
Sticking with Sir Simon’s letter for a moment, we should recognise the incredible task that general practice has achieved in ensuring that patients have clear information on how to access primary care services, resulting in:
One: Our GP-led implementation of remote, telephone, video, digital and e-consultations has been astounding, and has delivered in five weeks a bottom-up transformation of care which had not been achieved after even 10 years of centrally-driven initiatives. There is a message here about liberation from the shackles of central diktat, and enabling all to deliver good care, rather than cherry-picking a few to meet political narratives.
Two: Delivery of as much routine and preventative work as can be provided safely including immunisations and vaccinations – particularly important for vulnerable groups including the elderly and the very young, are another of our noteworthy achievements in this the WHO’s World Immunisation Week. Our guidance on routine and non-acute work can be seen here.
Three: And, in accordance with our core purpose, our practice teams have not, and will not, allow the fear of being infected by Covid-19 to get in the way of patients receiving appropriate care and onward referral for other significant conditions. Nor will we allow our pro-active care, and the relationship/relational continuity of care which is the essence of general practice, to be so disregarded as has become the political fashion over the last decade. Our publication General Practice During The Pandemic: The Role of the General Practitioner and Practice Team makes specific reference to this and many other aspects of care which will define what we will be doing in London for the foreseeable future.
