MWord Issue 107 – Dr Michelle Drage’s latest update for GPs and practice teams

9 May 2023

Dear Colleague,

1. Londonwide LMC Elections
2. Retention in London General Practice
3. Managing new contractual requirements on GP Access within your permitted contractual terms

1. Londonwide LMC Elections
   Every LMC seat in the Londonwide LMCs area is up for election this year and GPs in all roles and with all levels of experience can now nominate themselves for election to their LMC; representing local general practice and learning new skills. Any GP on the performer’s list and working in one of the 27 London boroughs we represent can stand for election regardless of their contractual status. We particularly welcome nominations from those GPs who are currently under-represented on LMCs. If you would like to stand please complete the nomination form by Friday 26 May.At this time of unprecedented pressure on GPs and practice staff across London the need for a strong professional voice has never been greater. People with little understanding of general practice or the value we give to patients and the NHS are pushing changes which involve compromising our core values, sacrificing continuity of care and wringing more out of an exhausted workforce.

   Only LMCs represent local grassroots GPs and are not influenced by funding from commissioners or other arms of government, at a time when GPs and practice staff across London need a strong professional voice more than ever. Amid here today and gone tomorrow NHS bodies, LMCs offer stability, continuity and independent expertise across all aspects of general practice – by general practice, for general practice – from engaging with systems across London to supporting individual GPs, and everything in between.

   Being part of the Londonwide LMCs family means that new and existing members are supported to build expertise and experience, giving a steady path to taking on clinical leadership responsibilities such as leading local representation within your own borough and integrated care board (ICB) area, working with your area’s system, ICB, provider alliances, federations and primary care networks to help protect GP services and stabilise frontline general practice.

   With strong support from the expert teams at Londonwide LMCs, your LMC is tracking contractual funding streams and challenging where they are not reaching practices, working on local enhanced service changes, protecting and maintaining funding for IT such as Accurx, and tackling the interface between general practice and hospital trusts.

2. Retention in London General Practice
   Anyone working in London general practice right now knows all too well that retention is a major issue, maybe even “the” issue, when we talk about workforce challenges. Our new report, authored by my formidable Deputy CEO Dr Lisa Harrod-Rothwell, considers how commissioners can work with LMCs and practices to improve job satisfaction, which would in turn improve retention.This timely and well researched study reflects the recent findings of the Health and Social Care Select Committee report into the Future of General Practice, which clearly states that: “GP retention needs to be improved” adding “…GPs are facing unsustainable workloads, which increase burnout and make GPs more likely to leave the profession. This creates a vicious circle of workforce and workload pressures for the GPs who remain…”.

   Without more doctors and nurses in general practice, each providing care to fewer patients, in a system that supports safe and effective patient care, in a way that retains this valuable workforce, we can only anticipate things getting worse. We believe that ICBs can play a vital role in stemming the spiralling attrition if they are able to work and collaborate with general practice. And we put that challenge to them! You can also read an excellent piece about the report in GPOnline, or listen to the podcast!

3. Managing new contractual requirements on GP Access within your permitted contractual terms
   Notwithstanding months of negotiations, the Government has imposed new contractual patient access requirements on practices through statutory Regulations which come into force next week, on 15 May. The BMA believes that these requirements are not achievable for many practices with current resource and workforce, and that practices who attempt to achieve the requirements may do so at the expense of clinician wellbeing and patient safety. 

   As a consequence, the BMA has issued clear guidance on your contractual obligations to be accessible to patients and, crucially, what you can do if you are challenged by your commissioner. I urge all GPs and practice managers to read this guidance which includes “protecting patients and clinical staff from the risks of decision fatigue, clinical errors, patient harm and clinician burnout by limiting clinical contacts to no more than 25 per day for each GP, and any excess demand beyond this being signposted to other settings such as 111, overflow hubs or urgent treatment centres”. This list is not exhaustive.So I have written to all of our ICBs seeking confirmation that a list of all wider commissioned services will be accessible to all GPs and practice teams on the Directory of Services. And that practices are provided with the contact details to whom patients can directly complain should they experience a breach in the provision of the service to which they were referred or signposted by the practice under these new Regulations in good time before they come into effect.

   Whilst we await their replies, you might be interested in this helpful summary of the new access requirements, which was created by LMC colleagues in Berkshire, Buckinghamshire and Oxfordshire.

   Meanwhile, the Government decided to issue more propaganda about its non-recovery plan for Primary Care (note Primary Care, not General Practice) over the Coronation weekend. My hot take, following a conversation with health communications expert and fellow GP Dr Helen Salisbury, is below:

   1. Better telephones don’t create more receptionist to answer them, or appointments for patients to be allocated.
   2. Most of the other services that patients might be ‘signposted’ to have long queues… or don’t exist.
   3. Plans to dilute prescribing present a real risk to antibiotic stewardship.
   4. Pharmacies are almost keeping pace with general practice closures, chasing their tails over drug shortages, also struggling to retain staff, and can’t make ends meet on the funding formula they have.

   And if you really want to wreck your week, take a look here. But I think your time would be better spent following the advice in my recent e-alert.

As ever, I welcome your feedback at mword@lmc.org.uk.

With best wishes

Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs