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DDLMC WEEKLY UPDATE 17th SEPTEMBER 2020

NATIONAL UPDATES

Pulse Magazine Top 50 GPs. I’m sure you will join us in congratulating Dr Pauline Love for her inclusion in this year’s Top 50 GPs in Pulse magazine. The article read “Macmillan GP Dr Love has supported Derbyshire care homes and developed comprehensive palliative care, ‘selflessly committing countless hours to our most vulnerable’ says Dr Susie Bayley”.

Dr Susie Bayley was also included in the “Honourable mentions High Profile GPs nominated by peers and patients” as “Medical Director of Derbyshire’s GP Task Force, for ‘effective, clear, well received’ communications.

done Pauline and Susie for this well-deserved national recognition.

Flu. There have been a number of updates this week:

  • Flu vaccinations for maternity patients. It has been confirmed that midwives may only administer flu vaccinations to antenatal patients at acute trust sites since they are not indemnified to vaccinate in community clinics. Practices may therefore wish to invite their antenatal patients for a vaccination at the surgery if they have not already done so. (We are also investigating reports that even these flu vaccinations in the acute trusts may not be happening and will report back).
  • PHE - Flu vaccination orders for 2021. JCVI advice on the recommended flu vaccines for 2021 is awaited. PHE advice is to delay ordering flu for 2021 until that advice is available, to prevent ordering inappropriate vaccines.
  • DES Contractual Requirements. The requirement in the DES specification “Practices must include within at least one written communication (including letters and SMS text messages) offering vaccination to eligible patients, a request that the patient advises the practice of their ethnicity status if they have not previously provided this information to the practice and where provided by the patient or their carer, the practice must record the ethnicity information in the patient record.” is NOT retrospective. If you have already sent out your initial communications, you do not need to write/text the entire patient cohort again just to obtain this information. However, if you send any follow up chasers this request should be included at that stage.
  • Barcoding. We understand that EMIS have contacted practices directly with a barcoding system for flu vaccinations, but no central system exists for TPP. Ruth Cater at Staffa Health has shared (Attachment A) a guide for SystmOne practices. This was instigated by Will (on a TPP Facebook page) and Grace Kirkwood at Staffa developed the version you see here. Thank you to Staffa for sharing this, which may ease the administrative burden of delivering flu vaccines.

COVID-19 Testing. The issue of access to COVID-19 testing for GPs and practice staff has been the highest priority following the well-publicised problems with testing capacity. The CCG are resurrecting the previous healthcare worker testing at Toyota in Derby and the Proact Stadium Chesterfield. Further details on how to access this testing are expected tomorrow and we will ensure everyone is made aware.

Schools. The usual September upsurge in coughs and colds in schools is in full swing. It is important to get the message out that these are different from the specific symptoms of COVID-19 and a schematic (Attachment B) may help. In short, a cold or a cough (unless accompanied by a temperature greater than 37.8C or a persistent new cough) are not in themselves a reason to keep children off school.

LOCAL UPDATES

Letter to GPs. The letter from E has been well publicised and hopefully you will have seen the LMC response from Dr Kath Markus (Attachment C). We’d also like to thank Clive Newman and the Primary Care Team at the CCG for their support and for writing to the NHSE Regional Team expressing their displeasure at the way general practice was vilified in the letter and the national press. This is also being pursued nationally and the GPC Chair, Dr Richard Vautrey, has written to Sir Simon Stevens (Attachment D). It is worth noting that we have confirmed EVERY PRACTICE in Derbyshire has been and remains open for F2F appointments where clinically appropriate.

Christmas Eve and New Year’s Eve. You will hopefully have seen that DHU have offered to subcontract essential services and take over the phones from 4pm on both Christmas Eve and New Year’s Eve 2020. If you wish to take advantage of this (and you haven’t already done so) you need to contact DHU to confirm the arrangements/payments and contact the CCG (preferably by 22nd September) to inform them that you are subcontracting essential services from 4pm to 6:30 pm on these days. I’ve chatted with DHU and thanked them for arranging this as I know it was not easy finding staff. They’ve also confirmed that they will not be able to offer any earlier handovers so if practices were hoping to subcontract from 1pm they will need to make those arrangements individually, with other practices or through PCNs. Any such arrangements would need to satisfy the usual criteria for subcontracting and of course all these arrangements could be subject to short notice changes imposed by NHSE depending on the COVID-19 situation that prevails at the time. And no we don’t have any intelligence to suggest this might happen!

Lithium – Priadel. Kate Needham, Meds Management, has asked us to share: As you will be aware from the Supply Disruption Alert, Priadel is being discontinued. September JAPC agreed the attached guideline (Attachment E), which has been agreed for use across Derbyshire.

Recommendation is to aim to move approximately 25% patients across per month, to help manage workload and supply of products

Those patients actively under the care of DHcFT will be switched by DHcFT, remainder will need to be switched in primary care

Derbyshire GPs can access specialist medication advice from the Derbyshire Healthcare NHS FT mental health pharmacists through Consultant Connect, where advice is needed on individual patients

DHcFT could arrange virtual education/refresher sessions on lithium with practices/groups of clinicians if this would be useful please contact Stephen.jones35@nhs.net

The local guideline includes lots of useful information to support practices with this switch, including guidance on dose and formulation choice for the initial switch, quick reference guide, guidance on target levels etc.

Due to the specialist nature of this medication, the LMC has raised concerns with DHcFT about the potential implications of this policy, as no GP should feel pressured to prescribe anything which is beyond their experience/competency.

Community Pharmacy Update. The weekly LPC update is at Attachment F.

JUCD Cancer Resources. Jo Rhodes CCG Commissioning Manager has asked us to share: You are probably aware of the work we have been doing to develop the Cancer Resources system. The document (Attachment G) will give you much more detail but, in brief, this system is to support GPs when considering making 2ww referrals by providing NG12 guidance, useful information, potential alternative pathways and tumour site specific 2ww referral templates all in one place. The system also provides prompts to GPs where specific test are required to support a referral and to provide the patient information leaflet.

Following a big push last year to get this in place we entered the Covid 19 pandemic which paused our work, but I am now pleased to share with you the comms that went out to all Derbyshire GP practices last week to launch the system. EMIS practices across Derbyshire will not be able to access the full dashboard, but all the information and templates are available to them. Please feel free to share amongst any forums you think appropriate to ensure maximum coverage.

We had significant clinical input in reviewing the Front page and 2ww templates, some of which have been changed to accommodate individual Trust requirements. Trusts will begin to see the Joined Up Care Derbyshire (JUCD) referral templates (Attachment H) coming through and, whilst use of this system is not mandatory, we hope practices will access it and use it. We will monitor and work with practices to increase usage of the referral templates. I would encourage specialties to let us know if there are ongoing issues/concerns around the templates so we can support a resolution.

Where possible the system accommodates referral templates for bordering counties, however development of this is part of the next steps plan.

I would like to pass on thanks to everyone that has been involved in developing this system and your ongoing support as we continue to develop it. Please feel free to send your comments and any suggestions to me so we can improve the system as it becomes embedded.

Safety Netting in Primary Care Webinar Wednesday 30th September, 1-2pm.

Overview: Dr Sarah Taylor and Dr Pawan Randev will explore safety netting patients with suspected cancer and the particular challenges posed by COVID-19.

Audience: This webinar is suitable for primary care professionals across NHS England.

Key speakers:

  • Dr Sarah Taylor, Cancer Research UK GP and GatewayC GP Lead
  • Dr Pawan Randev, Cancer Research UK GP East Midlands Cancer Alliance and GP Trainer

Register here: https://bit.ly/3ayD8BO

GatewayC’s webinar page: https://www.gatewayc.org.uk/free-webinars/

OTHER UPDATES

Questions from NHSE Primary Care Team Dementia/QOF/Restoration Planning. Dr Bola Olowabi from DCHS has asked us to share: “I’ll really value your views please. The national dementia team are pondering some questions which relate to Primary Care and more broadly to systems. I have captured these below and will be grateful for your time in considering them and offering some thoughts. Thanks:

Any suggestions and comments about what would be useful to include in the NHSD QOF/DDR report and how it might be used by you or colleagues focussing on dementia would be welcomed.

Advise the national team views on whether it is possible to integrate delivery of rehabilitation support for people with dementia with other services? What does rehabilitation specifically mean for people living with dementia? What would be helpful? Are there any service already in place at a local level?

Kind Regards, Bola. Contact bola.owolabi@nhs.net

RCGP Vale of Trent Faculty AGM. The Faculty Provost, Dr Nick Humphry, Faculty Chair, Dr Richard Churchill, and members of the Faculty Board, would like to invite you to attend the 38th Annual General Meeting of the Faculty on 8 October 2020 at 1900. The full details are here .

GMC Fitness to Practice. The GMC have published guidance (Attachment I) COVID-19: assessing the risk to public protection posed by a doctor as a result of concerns about their practice during the pandemic.

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