Here is the news from the July Tower Hamlets LMC meeting:
Several Primary Care Networks in the borough are working with the GP Care Group towards providing Enhanced Access (EA) appointments on a ‘hybrid model’ – some by the PCN and some by the Care Group. Other networks are planning to provide all their EA appointments themselves. Networks (or a partner on their behalf, such as the Care Group) are required to submit their proposals to the Integrated Care Board by 31 July.
Multi-Agency Safeguarding Hub (MASH) reports
The LMC asked about payment for making MASH reports and established that backdated payments would be made in July and that communications would go out following the meeting about future claims. A form will need to be filled in to claim payments from now on.
Areas like Tower Hamlets that have lower vaccine take-up because of their urban population patterns are at a disadvantage hitting national take-up targets. Londonwide LMCs has been working with the Integrated Care System on a response, and a scheme is in development to support practices to reach targets and put in place some lower intermediate targets to aim for. Londonwide has proposed there should be a pathway for the vaccine hesitant, ending with referral to a vaccine hesitancy service, and that practices should be paid for following the pathway. Lobbying is ongoing.
Currently the route for minor ailments is to the Community Pharmacy Consultation Service (CPCS). Patients can be directed there by GP reception using EMIS. The LMC has raised the fact that over-the-counter medicines are an expense that many patients need to avoid, especially in the current situation, and so patients often return to the GP to get a free prescription – this means that the overall workload is higher. Lobbying is ongoing to restore a Minor Ailments Scheme – in the meantime, using the CPCS channel contributes to practice IIF targets and identifies the demand in a way that the System can see. Using the EMIS button puts the consultation into the workflow and notes.
The LMC told Tower Hamlets public health that the multiplicity of weight management services and the frequent changes to them is confusing and leaves significant gaps in coverage, including Tier 3 services, children, and those who are very obese but not (yet) hypertensive or diabetic. Public health acknowledged these issues and were working on them as resourcing allowed, and were looking into a self-referral mechanism. In the meantime they suggested using social prescribers who are more familiar with the services. The LMC also advocated local authority work to reduce drivers of obesity in the environment and society.
Recruitment, pay, retention
LMC members raised issues with the cost of living, and GP salaries lagging behind, with a shift of GPs from salaried positions to locum or blended working. Funding for a 2% salary increase had been paid into core funding and the LMC felt that practices should pass this on. Working conditions, including patient numbers to be seen, are also a factor in recruitment and retention. The System also advocated practices working together to fill ARRS positions and get funding drawn down. They were looking into whether they could resource training to support ARRS staff.
Long-Acting Removable Contraceptives
The LMC previously helped secure an increased payment for LARC fittings, plus other improvements to the LES contract. One of the LMC’s GP registrar members is driving a scheme for GPs trained in coil fitting to train registrar GPs.
There is still very high demand for the Urgent Treatment Centre and other on-the-day services, including from out-of-borough patients. The Care Group is working on ways of managing this. The LMC suggested that A&E should rely less on diverting patients to the UTC, especially if they had already seen a GP, because a potential UTC failure would cascade to A&E.
The LMC also continues to work on other ongoing issues including: learning lessons and identifying themes from service alerts; quality of service from London Independent Hospital; and cancer patients receiving test results via app rather than from the service that conducted the test, or being downgraded from two-week wait status.
Dr Jackie Applebee
Tower Hamlets LMC