It’s all about strong, safe and sustainable general practice. There have been many discussions about why this is so important, but I would also urge you to consider how we make this a reality for our staff and patients within Newham. We need a coherent, unified voice to escalate issues to the system, highlighting our local needs and transparency around decision making. I would like to thank everyone who contributes to these discussions and encourage others to participate. The Newham LMC committee nominations are now complete and we are planning our next steps for the year ahead. We have invaluable support from Londonwide LMCs, but the local intelligence our Newham GP teams provide is essential for us to be an effective committee. It’s vital that we work together.
Primary Care Access plans
There have been recent national contract changes, and guidance on how GPs handle patient contacts and provide access to their services. It is important for practices to know which of the asks coming from local commissioners are contractual requirements. Londonwide LMCs have given a video presentation on the subject.
There is BMA guidance on safe capacity and the LMC is asking for a directory of services that practices can signpost to when they have reached this capacity and contacts are still coming.
Supplementary Network Services (SNSs)
The LMC, supported by Londonwide LMCs, is engaging intensively with commissioners about a range of SNS specs that are being consulted on. On the wound care spec, there are cases being sent that are too complex to be handled in general practice, and general practice does not have the capacity to act as an open-access on-the-day clinic as requested. On childhood immunisations, payment is sought for catch-up jabs given by practices. In general, the LMC is giving a strong message about safe, sustainable general practice, and that it is not compatible with continuing to transfer additional work, especially if unfunded.
Enhanced access and other providers of additional appointments such as NHS 111 and urgent care often direct patients to GPs for a more thorough consultation and it is not always clear that this is appropriate. The LMC asked that it be made clearer to GPs which service has sent them a patient and why. It is hoped that letters will now include this information and GPs are advised to look for it if they have concerns. If there are ongoing problems, anonymised details can be provided via the LMC – contact email@example.com.
It is also hoped in the longer term to get services like NHS 111 to complete more cases themselves and to focus as much on keeping inappropriate cases out of GP surgeries as they do on keeping them out of hospitals.
The LMC supports the local authority and NHS commissioners in pushing back against plans to accommodate large numbers of migrants in ships moored to Newham water frontage, at a time when local services are already saturated.
Public Health and partners are launching a Well Newham project to help the public access services and understand where to go for different needs. There is a website: https://www.wellnewham.org.uk/ and a number of other activities. Feedback is invited on the website, and reports of any patterns of patients contacting GPs for inappropriate reasons. The LMC welcomed the project, and encouraged patient-facing work to reduce unnecessary GP contacts.
A Unified Voice for Newham general practice
The LMC and partners including Newham Health Collaborative, Newham GP Co-operative and PCNs have for some time been working together to reach united positions on issues facing general practice in the borough. There are monthly virtual meetings which are now open to all GPs – please contact us if you would like to participate (Shimi.Loo@lmc.org.uk) or use the joining link if forwarded by a colleague.
The LMC has been pursuing issues with screening for latent TB, principally arising from a shortage of medication which meant patients were receiving news that they carried the infection but were not eligible for immediate treatment. The evidence base still supports screening, which is therefore still recommended. Awareness of latent cases enables earliest response if the illness becomes active.
There is a payment available, on the completion of an examination and counselling appointment. It can be difficult to get patients to attend face to face, but this is important because lymph node and chest exams are required to identify or exclude active TB. The EMIS treatment template shows the examinations to conduct and record.
The LMC has secured that pharmacists take over after a latent case is identified, advising patients about the treatment shortage, holding responsibility for the case and providing treatment when there is a complete course available for the specific patient. The protocol is to be updated to reflect this and commissioners were asked to clarify in the contract. A list of accredited pharmacies is below:
- Akro Pharmacy
- Beckton Pharmacy
- Church Rd Pharmacy
- Day Lewis
- Duncans Pharmacy
- Frank Mays Pharmacy
- Jetsol Pharmacy
- Kalhan Ltd
- Mansons Chemist
- Sai Pharmacy
- Vicarage Lane Pharmacy
Mental health Crisis Line and café
The LMC raised with East London Foundation Trust (EFLT) difficulties that GPs had had getting access to these services for their patients. Crisis Line should take calls from a full range of clinicians, and talk to the patient directly if the clinician hands the call over. Training will now emphasise this, and if problems continue the LMC (via firstname.lastname@example.org) can pass them to ELFT. The LMC asked for a separate line for GPs to use, and this is to be considered. A new promoter is expected to promote the café service with GPs, as it is under-utilised.
Mental health referrals to other secondary services
Mental health services have been asking GPs to refer patients to other specialists, such as for cardiology opinions. ELFT agreed that referrals should be made directly, but there is currently no system for doing so. ELFT is exploring what system can be put in place. ELFT is actively working on a robust IT system for blood test ordering which should be in place in months. Doctors were asked to copy Dr Dominic Dougall of ELFT if raising patient safety concerns on this issue.
Dr Tammy Hibbert