MWord Issue 100 – Dr Michelle Drage’s latest update for GPs and practice teams

  • Mword

12 August 2022

Dear Colleague,

Welcome to MWord 100, which sadly at the moment can’t really be the celebration of general practice that I would like my 100th edition to be, because the pressure on practice teams at the coal face is just so great. But we carry on, and I have two items for you:

  1. London polio booster
  2. Stress, mental health and Dr Gail Milligan
  1. London polio booster
    On Wednesday we received news that a campaign driven by UKHSA to provide a polio booster dose to 905,000 children in London was going to start, with general practice expected to identify and offer an appointment to the vast majority of them in under seven weeks.

    This plan was published only on Tuesday, the same day it was broadcast to the public in the media, as a fait accomplis with only passing LMC involvement, which is remarkable given it’s a London region plan and will be delivered mostly by general practices, in particular our overstretched practice nurses and admin staff. (Your practice nurse colleagues should be receiving this message and other relevant communications from us, pretty much everything I write is just as relevant to them as well, if they’re not they can update or register their details here).Whenever this approach of railroading something through occurs we always say the same thing: just because we’re not in the room pointing out the practical and resourcing issues that need to be overcome, doesn’t mean that those issues magically go away.

    Beware, information is coming out haphazardly and can vary across local boundaries. Much as I wish everything was joined up, my recommendation is to follow your local Borough (transl. Place) and ICB (prev CCG, ICS) procedures as they start to trickle out. Meanwhile, from UKHSA amazingly, here is a really simple flow chart explaining who should receive which vaccine.

    Of course, all GPs recognise the importance of vaccination and do not want to see a return of polio, but we have substantial concerns over the scale and timing of this plan as expressed in our e-alert yesterday, and also in Pulse and GPOnline. The relevant wording from the e-alert is:

    We have been informed that the UK Health Security Agency (UKHSA) and NHS England are tasking London GP practices with identifying, contacting and delivering a polio booster vaccination to eligible children and those who have not had a primary course. NHS England’s timeline sets out that identifying and contacting patients should start immediately with the 160,000 children in North and East London being the priority, before moving on to offer appointments to all 905,000 eligible children in London by 26 September.

    All GPs recognise the importance of vaccination and do not want to see a return of polio. However, we do have substantial concerns about the details of this plan as it stands and have made the strongest of representations to both the national and London systems:

    • London general practice is already providing record numbers of routine appointments, with the Covid and flu vaccination season also getting into full swing. Any redirection of the workforce away from routine care would impact the work being done to reduce the NHS backlog and alleviate public concerns about GP access.
    • There is no central resourcing available at practice level beyond the standard £10.06 IoS fee, despite significant additional time being required to identify and potentially contact patients, and additional clinical staff and premises capacity being required to administer the jabs.
    • Even if there was additional workforce funding there is insufficient qualified workforce to deliver the vaccinations in the time frame, with only 1,262 WTE practice nurses in London, including advanced nurse practitioners.
      • Providing the initial 160,000 children with a 15 minute appointment would require 40,000 hours or 180 nurses working 37.5 hours solidly over a six-week period.
      • The total of 905,000 appointments would take 226,250 hours, so even if extended beyond the envisioned timeframe to allow 10 weeks, it would still take 600 nurses working solely on the campaign to provide the necessary appointments.
    • There have been suggestions that practices could involve federations or other parties to aid with delivery. Firstly, they would still be trying to staff the campaign from the same limited workforce pool as practices and secondly, only practices can order stock and the regulations around transferring it to a federation are complex.
    • We have not seen the information that will be given to parents explaining the rationale for giving children a stand-alone polio vaccine. We are concerned this may affect the informed consent process meaning appointments take longer, it could also increase health anxieties meaning more general practice and NHS capacity being taken up with counselling, consenting and reassuring patients.

    We have also escalated these issues to the BMA GPC to take forward at a national level and it may help practices to make reference to them when taking part in local discussions around the implementation of this campaign.

    Currently London general practice is providing record numbers of appointments as teams who are already under extreme strain continue to try to offer safe access for patients and handle the impact of the backlog of care, while in the midst of a workforce crisis. More than a decade of under-resourcing needs to be addressed if there is to be capacity for general practice to take on such additional large scale campaigns, against such tight deadlines, without having an impact on the delivery of the Government’s own access and backlog priorities.

  2. Stress, mental health and Dr Gail MilliganLast week all of general practice was rocked by the news that Dr Gail Milligan, a Surrey GP, had taken her own life with colleagues saying she had become overwhelmed by work. The pressures on everyone working in general practice have been steadily rising for decades and shot up at an unprecedented rate in recent years, no one should have to go to work and feel overwhelmed, let alone struggle to the degree Dr Milligan must have.

    We are all working in a broken system, if you’re struggling and feel you cannot cope it is the system that is not up to the job and you should never feel it’s you who is somehow failing.We offer a range of help through our own Londonwide LMCs GP Professional Support Network, including peer support, coaching, talking therapies and assistance through regulatory and performance processes. The vast majority of this is provided at no cost to our constituent GPs. Other sources of help include:

    We also continue to push for greater resourcing for core general practice and for an easing of many of the unnecessary demands placed on practices and teams.

As ever, I welcome your feedback at The team of experts, leaders and support staff here at Londonwide LMCs are by your side.

Keep well. Stay safe.

With best wishes




Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs