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Member Practice Update

 22 August 2018

Welcome to the member practice update

This weekly Member Practice Update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:

Find out about local and national events and training here.

  • No specific Redditch and Bromsgrove news
  • No specific South Worcestershire  news
  •  No specific Wyre Forest news


GP Patient Survey results  

Please follow this link to access a copy of the CCGs Countywide report showing the results of the GP Patient Survey.

You will see from the results, a number of our practices patients’ experiences continue to exceed national expectations – in the past this group of practices have been reported as being in the top 10% of all practices in England. This is an astonishing achievement, which may well be the case again this year. The CCGs recognise that this is a significant achievement in such a demanding environment and congratulate the practice teams involved. 

The results of the survey, impacts on a number of areas. They can demonstrate how positive access and services are when we’re planning for future developments and play a key part in discussions with other organisations and service providers, e.g. Healthwatch. As you know the CCGs and the individual practice results are monitored very closely by NHSE, CQC and of course the local press. Across Worcestershire there is a significant variation between the lowest and highest survey results. This will be an area of focus for the Primary Care Quality and Risk Sub-Committee, as those with lower patient experiences may also be placed on the NHSE Performance Management Framework, which is one of their criteria.

The survey was conducted between January 2018 and March 2018. If you need further practice details e.g. numbers of surveys issued and numbers completed, this data can be found on the GP Patient survey website - www.gp-patient.co.uk/

Governing Body Nominations 

Nominations are invited for the following roles:

1x GP Member of the Governing Body for Redditch & Bromsgrove CCG - Job description
Appointment for the period of September 2018 (Date TBC) to 31 March 2020.

1x GP Member of the Governing Body for South Worcestershire CCG - Job description
Appointment for the period of 1 October 2018 to 31 March 2020

Appointment and Election Process:

Elections are held in accordance with BMA guidance and CCG Constitutions

If you:

  • Are a medical practitioner who is either  a partner or a salaried GP of one of the CCG member practices
  • Meet the role requirements as set out in Clinical commissioning group governing body: Role outlines, attributes and skills document and summarised in the job description; and
  • Are not within the exclusions as detailed in the National Health Service (Clinical Commissioning Groups) Regulations 2012 (Schedule 5, pages 12-15). View here.
  • Have evidence of your practice’s support of the nomination


Would like to stand for election, please fill in the nomination form together with a short supporting statement and email it to hana.taylor@nhs.net no later than Wednesday 5 September.

Nominations will not be accepted after 5pm on Wednesday 5 September.

If you would like to informally discuss the positions, please contact Hana Taylor.

If more than one nomination is received, ballot papers will be sent to all partners and salaried GPs within the CCG member practices and process outlined in the CCGs’ Standing Orders will be followed.


Deadline for submitting nominations

 Wednesday 5 September, 5pm

Nominees notified of outcome of nominations

 Friday 7 September

Ballot opens (if multiple nominations are received)

 Monday 10 September

Ballot closes

 Friday 21 September

Results of ballot announced

 Tuesday 25 September

GP Forward View Update 

Simon Trickett and Lynda Dando met with Dominic Hardy who is the national NHSE Director of Primary Care Development last Wednesday when he visited the West Midlands. Dominic leads on Implementation of the GPFV and so was interested to learn of progress and challenges. The Worcestershire presentation highlighted the rewards and challenges of working in a rural practice and the feedback we had from 6 of our 11 rural practices was helpful in signalling the differences which exist between these and more urban surgeries. Dominic has contacted Simon with a view to his spending time in Worcestershire some time this year. We’ll keep you posted.

Workforce – GP Retention and Recruitment

A bid, developed in partnership with GPs from across the county and the LMC, was submitted to NHSE and we were hoping to receive between 200-300k to support four GP recruitment and retention work streams across Herefordshire and Worcestershire. £106,000 was allocated from NHSE to support the bid. This reduction in funding is disappointing and has necessitated a change in planning, a revised plan to support only one of the proposals in the original bid will be presented to NHSE on 22 August to support a single work stream within the STP. Updates on these will be published as we have more information.


Worcestershire will be working with NHS App locally to support some initial testing within several practices across the county.  The key aims of the app are to:

  • Give access to digital services whenever, wherever and however users want to consume them
  • Make it straightforward for local /regional providers, commissioners and 3rd parties to create and iterate high quality services
  • Reduce administrative costs through increased use of digital channels
  • In time, and with appropriate permissions, use patient record information to inform digital triage and promote approved digital apps from a competitive and vibrant marketplace.

Workforce Survey

A big thank you to the 29 practices across the county who have already completed and returned the Quarterly Workforce Survey.  This information will be key in helping to make financial decisions and allocations going forward. In the long term it will also provide a detailed view on workforce changes across the county and allow us to target support where it is most needed. The deadline to complete the survey is 31 August,  if you have any questions or need to have it resent please contact Denise Horton at dhorton@nhs.net

You can find the full GP Forward View Highlight Report for August and September here.

Social Prescribing in Worcestershire

The Worcestershire social prescribing programme has launched and in just a few short months has received over 200 referrals.

Social Prescribing is a means of enabling GPs and other frontline healthcare professionals to refer patients to a social prescriber. This provides them with a face-to-face conversation during which they can learn about opportunities to improve their health and wellbeing. The social prescriber can motivate and support individuals to achieve the change(s) that they want to achieve.

The programme jointly funded by Worcestershire County Council Public Health and the Worcestershire CCGs has six pilot sites. To find out more about social prescribing, including these pilot sites, click here.

Healthcare Navigation Scheme - South Worcestershire and Wyre Forest

As part of the Healthcare Navigation Scheme, the local pharmacies are being written to with the below letter and a feedback form.

This feedback form, which has been approved by the Wyre Forest lead GP Dr Carter and the South Worcestershire GP Dr Deshpande, are to enable GPs to monitor the appropriateness of the signposting by their receptionists to the pharmacies under the Healthcare Navigation Scheme.

If you have any comments or suggestions please email amy.louvaine@nhs.net by the 24 August.

Letter - South Worcestershire
Letter - Wyre Forest
Feedback form

COPD Team/Pulmonary Rehab - New Referral Template 

The Acute Trust’s COPD Team now has an electronic referral template available here. Please load this new referral template to EMIS. This will replace the old paper version.

Referrals can be made for the following services:

  • Pulmonary Rehabilitation – for all COPD patients with MRC > 3 or with MRC 2 with a recent hospital admission
  • Top up Pulmonary Rehabilitation
  • COPD symptom management
  • Acute COPD assessment and management
  • Admission avoidance hot clinics (currently in Redditch and Bromsgrove only)
  • Fit to Breathe maintenance classes

If you would like to know more about the COPD Team, the services they provide or would like to discuss patients you may want to refer please contact the team directly on 01905 760023 or  via Email at wah-tr.COPDTeam@nhs.net.

National Diabetes Prevention Programme - Relaunch 

Following a national re-procurement exercise, we're pleased to confirm that our current provider, ICS Health & Wellbeing, has been appointed to provide the Healthier You programme across the Herefordshire and Worcestershire STP area for the next two years. 

From 1 September, the delivery of the programme will be managed by Herefordshire, with a single delivery pathway being adopted across the STP. Practices will be asked to work within their Neighbourhood Team to meet referral targets, and practices will receive a payment per referral.  Further details of the pathway, paperwork and payment will be circulated in the Member Practice Update during w/c 3 September.

Practices in south Worcestershire will be most affected by the change, with referrals going straight to ICS Health, rather than via the Clinical Contact Centre. For that reason, any practice who intends to write to patients between now and 1 September is asked to use this template.

If you have any queries, please contact Jo Hall on jo.hall@nhs.net

Drugs that are Unexpectedly Expensive                                                     

Drug Tariff price increases of licensed generic medicines have become an increasingly common phenomenon over the last few years. Frequently this is a result of a branded product being withdrawn from the market once a drug patent has expired; for some therapeutic areas where there are few or no other alternatives the price of the generic equivalent will then rise in line with increased demand. This has been seen with liquid formulations in particular.

In many cases prescribing these expensive products cannot be avoided, however in some cases other options could be considered. The table below lists some commonly prescribed examples, and details possible alternatives or suggestions to help mitigate the price increases. (Note: this list is not exhaustive.)

Drug Presentation

Total Items 12  months to June 18 (All CCGs)

Total Spend 12 months to June 18 (All CCGs)

DT Price- Aug18

Suggested Advice

Amitriptyline HCl Oral Soln 10mg/5ml S/F




Consider use of 25mg/5ml SF solution (£18 for 150ml) & adjust dose instructions, if appropriate.

Dicycloverine HCl_Oral Soln 10mg/5ml



£178.16 (120ml)

Consider Kolanticon® Gel (£6 for 500ml) if in line with license.

Dicycloverine HCl Tab 10mg & 20mg




£259.39(84) 20mg

Consider alternative antispasmodic tablet – eg hyoscine (£3 for 56 tabs).

Ethinylestradiol_Tab 10mcg & 50mcg



£200 (21) 10mcg

£200(21) 50mcg

Prescribe on specialist advice only.

Flucloxacillin Oral Soln 125mg/5ml S/F



£24.72 (100ml)

Use non SF solution (£6.77 for 100ml).

Mebeverine HCl Oral Susp 50mg/5ml S/F



£187 (300ml)

Consider Kolanticon® Gel (£6 for 500ml) if in line with license.

Nitrofurantoin_Oral Susp 25mg/5ml S/F



£446.95 (300ml)

Check indication, dose & frequency are in line with guidance.

Oxybutynin HCl Oral Soln 2.5mg/5ml S/F & 5mg/5ml SF




£184.68(150ml) 2.5mg

£199.20 (150ml) 5mg

Only use if solid dose forms (or patches) are not appropriate.

Paracetamol_Oral Susp 500mg/5ml S/F



£18 (200ml)

£24 (150ml)

Use paracetamol oral SF suspension 250mg/5ml & adjust dose instructions. Or dispersible 500mg tablets.

Salbutamol_Tab 4mg



£102.90 (28)

Consider salbutamol 2mg/5ml  SF solution (£1.15 for 150ml).

Trifluoperazine_Oral Soln 1mg/5ml S/F



£112.25 (200ml)

Consider use of 5mg/5ml SF solution (£25.50 for 150ml) & adjust dose instructions, if appropriate.

If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

Primrose at Home Service 

A message from Primrose Hospice

Primrose Hospice has made the difficult decision to end their Primrose at Home Service. The service has been under review for the last year with a consistent reduction in referrals making it no longer viable. 

Primrose Hospice use their limited resources responsibly to provide care and support in the best way to its local community. End of Life Care is now being provided by a local Care Agency through the CCG.

Counselling Service for Children and Young People 

There is a new Counselling Service now available for Children and Young People aged 5-19 years old, providing early support to any young person who may be experiencing emotional difficulties.

The service is provided by Worcestershire Health and Care NHS Trust and is called Reach4Wellbeing.

Any health professional, parent or young person can refer/self-refer to the service.

For more information visit the service’s website here.

An information leaflet on the service is attached here.

Adult Safeguarding Concerns  

Worcestershire County Council is working towards effectively managing the response to Adult Safeguarding concerns. To assist with this the council has reviewed and updated the online safeguarding form, which went live on Monday 20 August.

Please could you use the online form at: https://ylyc.worcestershire.gov.uk/raising-an-adult-safeguarding-concern/

Please ensure that the concern being raised relates to the section 42 safeguarding criteria as detailed in the Care Act 2014 and is not used to refer in requests for assessments of care and support needs. These need to be requested via:
www.worcestershire.gov.uk/info/20500/adult_social_care/1227/request_an_assessment_for_your_care_needs - 18 years and above only.

The Access Service will continue to support agencies if there is an issue with the online form.

Any questions, please contact Jeremy Newell at jeremynewell@nhs.net

Worcestershire Forum against Domestic Abuse and Sexual Violence update 

Here is an update from the Worcestershire Forum against Domestic Abuse and Sexual Violence. It is a directory of available services and resources that will support victims and their families  who are subject to domestic abuse and violence.

Worcestershire Safeguarding Children's Board - August Newsletter

Access the latest version of the WSCB newsletter here

Articles of interest include;

  • Working Together 2018 - revised statutory guidance
  • Changes to LSCBs 
  • Information Sharing advice for practitioners 
  • Neglect in Older Children 
  • Obtaining service user feedback 
  • Signs of Safety Update 
  • Mind Of My Own App