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Member Practice Update

24 October 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


Safe transfer of information about diagnostic results and tests

Sent on behalf of Worcestershire Acute Hospitals NHS Trust

In March 2016 NHS England, the Academy of Royal Colleges, and the BMA produced “Standards for the communication of patient diagnostic test results on discharge from hospital”. This document sets out the standards and principles by which test results should be communicated between secondary and primary care. This document, and previous discussions between GPs and hospital clinicians, has prompted Worcestershire Acute Hospitals NHS Trust (WAHT) and the Worcestershire Local Medical Committee (LMC) to develop local policies and principles for the safe transfer of information about diagnostic results and tests between primary and secondary care.

Find out more about what the Acute Trust and the LMC has agreed here.

Winter Indemnity Scheme

NHS England is currently undertaking a programme of activities designed to support general practice in managing winter pressures. One recognised pressure has been the rising costs of clinical negligence which may particularly affect GPs who wish to increase their sessional commitments working in out of hours or extended access services, for example over winter. Whilst work with the Department of health and Social Care (DHSC) continues to implement a state backed indemnity scheme, we are running again this year a winter indemnity scheme to support GPs who wish to offer additional extended access and/or out of hours sessions over the winter season.
The scheme started on 1 October 2018 and will run until 31 March 2019 and will cover additional extended hours, out-of-hours and unscheduled care sessions.
Any GP interested in joining the scheme should contact their MDO to express interest. We would stress that this scheme is designed to meet the costs of indemnifying additional extended and out-of-hours work this winter; GPs should not amend their previous levels of indemnity.
Further details can be found within this letter.
If you have any queries regarding this please direct them to our shared inbox england.integratedurgentcare@nhs.net.

PCE Event with Clinical Leads for Referrals - Feedback from 27 September

Thank you to the PCE Group Clinical Leads who met with the CCG leads on 27 September and discussed how their group works, the challenges they face and what would be helpful. Feedback showed that the majority of the leads found the event useful.

Key points of learning and reflection from the afternoon:

  • All groups operate very differently in how they review their referrals
  • Time is required to ensure adequate reviews but some groups felt they had got much slicker as their process has evolved
  • Patient expectations need careful management with some useful examples of language used and approach of ‘see what else can be done in primary care, otherwise unfortunately we may have to refer you’
  • Refer when the question to be answered is clear. If you don’t know what to do – ask before referral

Through the workshop the CCG has identified a number of areas where further work is needed to support practices in accessing alternative options for managing patients without the need for an Acute referral. This includes audit of Advice and Guidance and Consultant Connect, development of guidelines, easy access to these ideally integrated with Emis clinical systems, consideration of alternative referral pathways or commissioning new community services. The Primary Care team will ensure intelligence provided by practices and PCE groups is considered by the relevant CCG leads and details of actions planned and taken will be fed back.

There is a second workshop on 20 November for PCE Referral and Prescribing Leads which will be a horizon scanning for 19/20 to help identify what changes are needed to ensure the PCE contract delivers the best value in the most efficient way.

Enhanced Services – Sustainability Programme

The CCG has agreed with the LMC that the Primary Care Team will provide information to practices to ensure understanding of whether enhanced service claims are being made accurately. This follows a few cases where the CCG has contacted practices to advise them of apparent under claims, and is timely given the number of recently appointed Practice Managers.

As a first step we will analyse claims by each practice for Quarters 1&2 this year and share this with practice managers – with the agreement of all practices. The CCG’s data sharing agreement is being reviewed and will be updated if necessary to facilitate work on Enhanced Services in the future. It is hoped that for 2019/20 there will be a more automated process for claims based on establishing EMIS templates for practices to code work undertaken.

If you have any comments on this work programme please email carolinesalmon@nhs.net

Prescribing Top Tip

Patient Specific Directions

The Human Medicines Regulations 2012 do not permit nurses or other registered practitioners, who are not qualified prescribers, to administer or supply prescription only medicines (POMs) unless one of three types of instruction is in place: An FP10 prescription, a signed Patient Specific Direction (PSD) or a Patient Group Direction (PGD). This communication will focus on the use of PSDs.

A PSD is a documented instruction from a doctor, dentist or non-medical prescriber for medicines to be supplied or administered to a named patient, after the prescriber has assessed the patient on an individual basis. The prescriber must have adequate knowledge of the patient's health, and be satisfied that the medicine serves the individual needs of the patient.

In law, anyone whom the prescriber has assessed as competent, has the necessary knowledge and skills, and has been delegated the task, may follow a PSD. This can include healthcare assistants.

A PSD can be written, and signed by the prescriber, or it can be via an electronic instruction. For electronic instruction the entry must be identifiable to the authorising prescriber, and uniquely linked to the patient. As long as there is an entry in the EMIS patient notes that includes the correct details, then the drug can be administered via a PSD.

The entry would need to include:

  • Name and strength of medication
  • Route of administration
  • Dose
  • Frequency
  • Start/finish date.

A READ code 9NgM:- "Has authorisation for medication under PSD" can also be used which will ensure that a clear, identifiable electronic audit trail is generated. The READ code and details of the medication authorised for administration via PSD can be added in bulk once a cohort of patients has been identified via an EMIS search via the “batch data manager” function. 

Note that a verbal instruction is not acceptable. A generic instruction covering any patient who may be seen by a healthcare professional on any given day, who may satisfy a given inclusion criteria, is also not considered an acceptable PSD by CQC.
If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

Your views on urgent dental care services

NHS England would like to understand your views on urgent dental care services provided across the West Midlands area.

To capture your views around current and future provision of urgent dental care services a short online survey has been created which you can access through the link below.


The survey will only take 10 minutes to complete and it will help NHS England understand how you feel urgent dental care should be provided across the West Midlands, this will feed into proposals around future provision of the service.

Anyone can complete the survey so please forward it to others.

Your response to the survey will be anonymous and your responses will remain confidential as the information you provide will not be shared with anyone outside the organisation, except in reports which will show aggregate data (charts/ tables).

The survey will remain open until 1pm Sunday 4 November. if you have any queries or issues please contact Tracy Harvey at NHS England (Tracy.harvey1@nhs.net) or Asad Khaliq (asad.khaliq@nhs.net).

Health event at Tallow Hill Mosque

Public Health has asked us to make you aware that a health day at the Tallow Hill Mosque will take place on Friday the 26 October from 2pm onwards.

As part of this event ,they will be offering people at the mosque an opportunity to check their BMI, blood pressure and blood glucose levels. They will be signposting people to their local GP Practice for further information, support and guidance.

GP Online Toolkit

The latest edition of the GP Online Toolkit is now available to support GP practices in promoting GP online services to patients and encouraging them to register for this service.

Keep Antibiotics Working campaign

Public Health England has launched an eight week campaign today to alert the public to the risks of antibiotic resistance, urging them to always take their doctor, nurse or healthcare professional’s advice on antibiotics.

More information can be found here.

Resources to help you promote the campaign within your practice are available here.

GP IT Newsletter

The latest GP IT newsletter is now available to read.

Access it here.

Decision Making and Mental Capacity - Updated Guidance

An updated Decision Making and Mental Capacity NICE Guidance is now available.

Access it here.