SMS messages
Practices will be aware that the ICB is working to keep practice SMS (text message) bills within its budget, and has announced a cap on the annual amount of messaging per patient. We have written to the ICB to make the case for funding SMS as an efficient way to communicate with patients, promote the uptake of services and reduce unnecessary appointments and DNAs. Londonwide LMCs have also been lobbying intensively at the NEL level to get SMS better supported. The ICB has acknowledged that practices are reporting that DNAs have increased and vaccinations decreased as practices send fewer prompts and reminders.
As it stands, practices will face some limits on the number and length of messages they can send without being charged for the excess. Following LMC pressure, the ICB should be giving communications to help practices monitor and control their texting. IT facilitators are also visiting practices.
Practices may consider increasing their use of email to contact patients. Londonwide LMCs has provided some guidance. If you are texting a patient in AccuRx, an option to send by email may appear if you click on the word Mobile at the top right.
Secondary care – referral routes
We have been working with colleagues at Whipps Cross and have understood each other on some key issues. For example, Advice & Guidance and Advice & Referral reach secondary care as two separate pathways, and A&G cannot easily be converted to a referral, which causes problems at the hospital. But GPs only have one way to request referral for some services, and cannot control which pathway the request goes down. Whipps Cross now understand this and hopefully will react with less hostility in future to referral requests that come through as A&G. There may also in due course be a more thorough review of the process.
Secondary care – fit notes
Whipps Cross have increased their ability to issue fit notes (on paper) and should do so for the whole expected recovery time. They say they will no longer decline follow-up inappropriately on the basis of catchment area.
BHRUT is also working on providing fit notes – paper fit notes are available in some wards, and the principle of providing them across the hospital is part of a policy currently being consulted with staff. There is also hope to provide online fit notes in future.
Secondary care – outsourcing
GPs have been finding patients who had been on Barts waiting lists picked up by a private provider called Holly House, who have been coming back to GPs with queries and clarifications. We raised this with Barts, who have discussed it at their Executive Board. They recognise the principle that queries should not go back to GPs unnecessarily, and are investigating the source of the issues and how to ensure their providers can have access to the information that Barts hold.
Secondary interface – general practice working
The primary-secondary dialogue is two-way, and we have heard that secondary colleagues need GPs to be selective and succinct when giving patient history in Advice & Referral – please include what is relevant to the case, and do not tick to include unnecessary chunks of information. GPs are encouraged to use the electronic Patients Know Best Channel.
Secondary care – shared care and prescribing
Several practices have stopped accepting new Shared Care agreements. Some secondary care / mental health services have now responded by not mentioning Shared Care and simply asking GPs to prescribe medication. Please be aware of this pattern, and exercise judgement when deciding whether recommendations from other providers fall within your remit and within your competence.
Another development has been that NELFT has inserted in the ADHD referral form a line that the GP making the referral commits to a shared care agreement for any resultant prescription. The LMC has written back to NELFT saying that this does not comply with GMC guidance, and to GPs suggesting that they strike out the shared care commitment from the referral and highlight that they have done so in a cover note – the LMC provided some sample text for a cover note.
Secondary care – further issues
Work at the primary-secondary interface is ongoing. Please let us know if the above issues have not improved in practice, or if there are additional issues to address. For BHRUT interface issues, contact LMC member Dr Chidi Okorie [email protected] and for Whipps Cross LMC member Dr Sarah Heyes [email protected].
Public Health – childhood obesity and physical activity
We heard from LB Redbridge public health about the national child measurement programme. A letter had gone out with incomplete information, and is to be followed up with a better communication with details of local services for children’s weight management and physical activity, and contact details for Sultana Choudhury the lead for this work in public health.
Families can be referred (or self-refer) to Active Stars, the local Tier 2 weight management service. Parent concerns may be sparked by a letter from the child measurement programme. Some interpreters and culturally appropriate information are available. There are also information sessions at schools provided by NELFT, which, as an inclusiveness and destigmatising measure, are no longer offered to specific children.
LIS contract review
The LMC is engaging with the ICB in response to their proposed review of locally commissioned services in NEL. In collaboration with other NEL LMCs, we are drafting key principles and priorities to inform the review process. We are in the process of analysing current contracts to identify priority areas for Redbridge and across NEL. Some of the areas we are focusing on are:
- Understanding historical underfunding in Redbridge and addressing disparities in investment levels.
- The lack of uplifts on service budgets for many years and the need to review tariffs in the light of cost pressures on practices (including the NI increase).
- Highlighting risks of defunding Access Enhanced Services and the need for a clear, strong narrative around the importance of this service and the impact of a reduced service.
- Demanding impact assessments on patient care for any change to current services.
If GPs feel there are specific contracts which need looking at or are not worth participating in, please let us know. Contact Daniele Serdoz ([email protected]).
Service issues
LMC staff are currently collecting anonymised examples of issues experienced by practices with the following services:
- DMC dermatology
- HealthShare – quality of diagnostic reports
- Rego – single point of access, referral rejections or inappropriate requests for further information
Please send anonymised details to Daniele Serdoz ([email protected]). This information is crucial to enable us to feedback to the commissioners and provider and to provide strong evidence to support change and improvements in the services.
London Ambulance Service procedures
LAS have developed a decision-making tool for LAS staff to observe which clearly articulates the circumstances when crews should contact GP practices. These are agreed for the following situations:
- End of life care.
- Information sharing regarding/surrounding a safeguarding referral.
- Expected death
- GP admission request where on arrival of the LAS crew the patient is refusing conveyance which the patient’s GP has arranged.
For all other situations there are other processes for ambulance crews to follow including accessing internal LAS clinical support and advice. Incidental findings will be shared with details of the London Care Record or via an electronic form – patients will be advised by the LAS crew to contact the GP for a routine follow up.
LMC/constituent engagement
LMC members have begun providing quarterly updates at the Redbridge PLE event. Also LMC member Dr Dania Shoeb and LMC Practice Manager Representative Susan Byrne presented to the PMs Forum about the work of the LMC, and engaged with contacts following. We hope that these events were useful and helped GPs and practices understand our role representing you. Please let us know (contact [email protected]) if you have any queries or would like to know more.
Yours faithfully,
Dr Najib Seedat
Chair, Redbridge LMC