Here is the news from the most recent Redbridge LMC meeting
Primary Care Networks (PCNs) are to be required to offer (themselves or by sub-contracting) 60 minutes per 1000 patients per week of additional appointments in specified hours on weekday evenings and Saturdays. Redbridge Local Medical Committee (LMC) is involved in discussions on GPs’ behalf about how to deliver this. Issues being discussed include model of delivery, delivery sites, processes for recording notes, degree of standardization between practices (including points of access, IT interoperability etc.), equity between small and large providers, and use of any surplus by sub-contractors.
NHS England London region has produced a template for PCNs to complete, outlining their plans for extended and enhanced access: please see Londonwide LMCs’ annotated version of this which includes the areas that have to be completed according to the PCN DES specification and which areas are not essential to complete. NHS England national team have also produced a template for this; the LMC is currently discussing with the CCG how they would like to receive this information.
Dr Siva Ramakrishnan, an LMC member and GP federation representative to the ICS finance discussion, has been pursuing questions of ICS financing. There is a proposal that the block grants, the great bulk of funding in the system, will be passed directly to trusts but that other, discretionary elements will be open to allocation by boroughs.
All of the money in the borough pot is currently primary care funding, and could potentially be allocated away from primary care, while there is no other money in the pot that could be allocated into primary. The LMC, and Londonwide LMCs, are making the case for funding to be shifted by the system from secondary to primary care where it can be efficiently used. We are also lobbying for proposals and funding to be communicated early so that practices can make decisions like staff investment.
The LMC has found that this is resulting in additional unfunded work, and in the transfer to general practice of work that may be inappropriate for generalist expertise. The LMC is pushing to ensure that safe and appropriate principles are embedded like informed consent by the GP, patient stability at the outset and clear pathways for escalating problems.
There are also specific issues to tackle like long-acting anti-psychotics. Redbridge LMC and Londonwide LMCs are also emphasizing that GPs are not obliged to take on cases under shared care guidelines, and that that secondary care should not give patients this expectation. Practices may be able to facilitate responses to shared care requests by establishing a standard approach and standardized response letters to certain kinds of request.
Barking, Havering and Redbridge University Hospitals University Trust
BHRUT updated the LMC on their high patient numbers and challenges in dealing with them. The hospital is clearing a backlog in radiology which may come through in responses to GPs. The LMC raised issues for general practice such as GPs being requested to follow up results on tests ordered by hospitals, and letters arriving without contact details like email addresses and phone numbers – BHRUT committed to tackle these.
The Healthy Start service issues a prepaid card to buy items like fruit, vegetables and milk. Redbridge Public Health has made changes to reduce stigma for eligible users. The Council have produced information on how to apply and find support.
Two practices are to open sites in the Ilford Exchange site while keeping their existing premises. Members raised questions including car parking for disabled and other patients and leasehold charges, which the CCG is addressing with the practices and other parties involved.
The CCG are keen to ensure that post-operative simple wound care is done in general practice rather than the Urgent Treatment Centre. There is a pilot proposed for PCNs to deliver, supported by the Healthbridge Direct and Newcross Alliance, with out of hours work by NELFT. An increased tariff has been agreed. The LMC will be involved in discussions about next steps. Initial questions raised at the LMC meeting included the hours involved: PCNs will be asked to deliver appointments, within five day core hours as they determine.
There is to be a pilot project digitising records for selected practices, funded to create and upload digital versions of existing paper records. However, there is no funding for further rollout of this. When practices are required to provide online access for current records (currently timetabled for April 2023), practice staff will need to be aware of how to redact information that is not for online access.
Dr Najid Seedat