Mword Issue 64 - Dr Michelle Drage's latest update for GPs and practice teams

This page was updated on 12.06.2020 to clarify that TFL guidance does not currenly include exemptions to wearing face masks, but Department for Transport guidance does.

Mword Heading - Issue 64

12 June 2020

Dear Colleague

Thanks to all who have shared your concerns and stories regarding the management of referrals for ultrasounds and other investigations, and the asks made of practices in some areas. We are urgently raising these concerns on your behalf and working with STP clinical leads to try to find a safe and appropriate way forward. We are not alone in this and GPC England has asked us to send them examples (not individual case details obviously – just the type) of all unfunded transfers of work from secondary care. To help with that I’d be really grateful if you could find the time as soon as possible to email your examples to me at If you could also let me know your PCN and borough that would be great. If you could do it today, it would be amazing.

In addition to the above, today I bring you:
  1. Our latest Londonwide Covid-19 Living Guide version 11 - updated today.
  2. Cervical screening - update.
  3. Our latest comment on the PHE BAME health disparities report.
  4. CQC "Support Framework" - update.
  5. GANFYD - Asthma and face coverings.
  6. And finally, PPE (again).
1. Our latest Londonwide Covid-19 Living Guide version 11 - updated today.

With talk of resets and bounce-backs abounding, the latest Londonwide LMCs Covid-19 Living Guide, version 11 updates practices regarding long term condition management, whilst still managing strict infection control procedures, in our new guide. We have also produced a template letter which practices can adapt for patients requesting/receiving an antibody test, after the Government announced the start of a major new national antibody testing programme last week, and updated the dental care pathway flowchart.

2. Cervical screening - update

NHSE&I London have circulated an update on cervical screening, advising of the plans to restore the cervical screening programme, please see the letter and the IPC SOP document that is embedded within it.

3. Our latest comment on the PHE BAME health disparities report

Last week the Government released the long awaited PHE London "Fenton Review" considering the relationship between ethnicity and risks/outcomes of Covid-19 earlier this week. I included headlines in MWord 63.

The PHE report concluded that the death rate from Covid-19 was highest among BAME groups and identified, unsurprisingly, that London is significantly more impacted than other parts of the country on most of the metrics used to measure this.

Beyond the obvious risk to frontline healthcare staff, this a story of social inequality, with people working in hospitality, retail, construction and transport disproportionately exposed. The risk of death among working age people in the most deprived areas is double that of the least deprived.

Our message to our practices is to remain cautious and keep abreast of the regularly updated guidance we are providing, we know that the risk to healthcare staff, Londoners and people of BAME backgrounds remains substantial even as lockdown is eased.

We are aware of reports that stakeholder comments regarding inequity and inequality experienced by BAME staff and patients were removed from the report prior to publication and concerned at both that, and the absence of specific actions and recommendations to better protect BAME individuals and communities identified as particularly vulnerable during the current pandemic. We will continue to provide practices with support and guidance on safe practise for their staff and patients.

For practices seeking to assess the risk to BAME staff, and to take appropriate action, in the absence of any firm detailed guidance from NHSE&I or PHE, we are sharing three tools which may be of help. The ALAMA tool offers an occupational health evidence-based risk-assessment tool, and the SAAD and BAPIO tools provide some advice on what to do in practical terms. The Risk Reduction Framework circulated by NHSE&I is of more limited practical use. Please note that whilst I am sharing these tools today, do bear in mind that nobody has the answers to the primary care BAME risk assessment practicalities at this time. Please see also our Londonwide LMCs Covid-19 Living Guide which contains up to date guidance on wider HR issues.

4. CQC "Support Framework" - update.

Yesterday Dr Jackie Applebee (Chair, Tower Hamlets LMC) and Dr Elliott Singer (Medical Director, Londonwide LMCs) met informally with Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care for CQC to share our concerns about the new CQC approach, and are now putting our views in writing along with LMCs from other regions.

5. GANFYD – Asthma and face

We are aware that patients are approaching practices to write notes for people who feel they should be exempt from the requirement to wear face coverings on public transport, on account of being asthmatic or for other reasons, ahead of this rule coming into effect on Monday. There are currently no exceptions in the TFL guidance, while the Department of Transport guidance gives exceptions for "very young children, disabled people and those with breathing difficulties." There is no requirement or point in practices providing such doctor's letters.

6. And finally, PPE (again).

If you are concerned about supply, our Londonwide Buying Group partner MidMeds may be able to assist. Find out more here.

As ever I welcome your feedback at, and know that my team of experts and leaders here at Londonwide LMCs will always be by your side.

Keep well. Stay safe.

With best wishes

Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs


Last updated : 16 Jun 2020


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