MWord Issue 101 – Dr Michelle Drage’s latest update for GPs and practice teams

  • Mword

This message covers concerns over patient access to records falling on deaf ears in Government and a surprise October PCN DES opt-out window is now open.

12 October 2022

Dear Colleague,

Two things:

  1. Patient access to records – Government deaf ears
  2. Surprise October PCN DES opt-out window now open
  1. Patient access to records – Government deaf ears
    I cannot overstate the degree of stress this is causing our practices right now. We have a national piece of legislation, due to be implemented on 1 November, which we know for certain will impact on our ability to deliver care to patients as demanded by the terms of our national contract. So yet again we have a situation where the national government is demanding something which undermines the delivery by its GP practices of its own national contract.As an elected GPC representative I know, also for certain, that the BMA has been making the strongest representations to Government who seem to see it as a simple process-driven task for practices, with no comprehension of the consequences for our already severely over-loaded and under-resourced practice teams. Yet once “switched on” it will be nigh impossible to reverse. Yet even now, at this pivotal moment with just two weeks to go, those national representations are still falling on deaf government ears.While we wait for any last minute announcements or indeed U-turns I recommend reading the thoughts of Dr Lisa Harrod-Rothwell, our Deputy Chief Executive, here:”An impending deadline is generating much discussion and concern about the implications of online access to patient medical records, that is due to start from 1 November 2022. This was initially planned to commence in December 2021 but was delayed due to safeguarding concerns and the impact on patients and doctors. There were further delays because of these unresolved concerns and, with these still unaddressed, we wait on tenterhooks to see what will happen to this fourth go live date.”Before implementation, there have been calls for:

    • Greater transparency around the risks, with publication of NHS Digital clinical safety documentation and the lessons learned from earlier adopter sites, with published recommendations;
    • Support to practices to be able to implement this appropriately, with provision of robust training to all GP staff and support to establish appropriate processes;
    • Consideration of the impact on GP workload, in the context of the significant patient demand/workforce capacity mismatch that threatens all general practice services. Even in the unlikely best-case scenario, of the provision of adequate funded third-party redaction software provided to every GP practice, there would remain significant workload concerns and justifiable debate about whether this is how clinicians should prioritise their finite time.

    “These are very significant issues which aren’t even the biggest questions for me. The biggest questions are: What is it that we want to achieve? Is this the best way to achieve it?” Read more.

  2. Surprise October PCN DES opt-out window now open
    At the end of September NHS England published a letter outlining support for practices and PCNs. These in-year changes include changes to the ARRS (including changes to reimbursement rates to reflect the Agenda for Change pay award and the introduction of ‘GP Assistants’ and ‘PCN Digital Leads’), removal/postponement of some IIF indicators, and a new PCN ‘capacity and access support payment’, funded from the reduced IIF indicators.As these changes have been introduced by NHSE in-year, an opt-out window for the PCN DES has been triggered. Within this opt-out window, practices can choose to opt-out of the DES without risking a breach of contract. BMA advice is to read this guidance and consult with your staff and fellow PCN members as to whether to utilise the window to leave your PCN by the 31 October deadline. The next op-out window is not expected before April 2023.

And as the pressure on you and your teams continues to mount, we’ve made a video and some ICS specific posters, as reported in GPOnline, to help you explain the drop in staff and the increase in appointments across the capital to staff, patients and commissioners. Please feel free to share/use as you see fit locally. As ever, I welcome your feedback at The team of experts, leaders and support staff here at Londonwide LMCs are by your side.

With best wishes




Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs