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General Practice Alert State – Pilot sites needed

For many years we have been notified of the alert statuses for hospital trusts & asked to divert patients away, while at the same time being inundated with patients in General Practice. Having no alert state has made it difficult to report this into the system. However, we are now able to roll out an alerting system for General Practice in Lincolnshire.

The General Practice Alert State (GPAS) is a simple system that collects a small amount of anonymised data so that it can be indicated to the broader system the strain that General Practice is under. It presents data in a simple to understand format which can compete with OPEL data collected on various system dash boards. The anonymised data will be collated by LMC & distributed the wider system

GPAS is being introduced to all Lincolnshire Practices from March 2022. Data collection takes place on a Tuesday each week & should take no more than a couple of minutes.

We are currently looking for pilot sites to trial GPAS with. If you are interested in piloting GPAS please email laura.dexter1@nhs.net for further details.

Temporary GP contract changes to support COVID-19 vaccination programme

Last Friday, following discussion with GPC, NHSE/I published a letter announcing changes to QOF and IIF and changes to the COVID vaccination DES.

It has now provided further guidance on these changes.  NB. These changes apply to practices that are actively taking part in the booster campaign.

We will send out an update to our FAQs early next week which will go through these changes in detail.

Inclisiran added to Lincolnshire Formulary

Inclisiran is an injectable drug which is used for patients with hyperlipidaemia. Lincolnshire PACEF has classed Inclisiran as “Green” on the Lincolnshire Joint Formulary. This means it can be initiated by general practice clinicians.

Inclisiran is recommended as an option for patients with a history of a cardiovascular event PLUS low-density lipoprotein cholesterol (LDL-C) concentrations are persistently 2.6 mmol/l or more, despite maximum tolerated lipid-lowering therapy, defined as:

    • maximum tolerated statins with or without other lipid-lowering therapies or
    • other lipid-lowering therapies when statins are not tolerated or are contraindicated.

General practice clinicians can initiate Inclisiran if they are confident to do so and can also seek Advice and Guidance from cardiology if they are not. A Lipidology A&G service is starting at ULHT in January 2022.

For more information on administration of Inclisiran please go to: www.lincslmc.co.uk/inclisiranaddedtolincolnshireformulary

General Practice Annual Electronic Self-Declaration

The collection window for the 2021 General Practice Annual Electronic Self-Declaration (eDec) will open to receive submissions from Monday 18th October 2021.

All practices are required to submit their practice eDec through SDCS, the link to login is here: https://datacollection.sdcs.digital.nhs.uk/


Deadline for eDec submission: Friday 26th November 2021

Further information can be found on the NHS digital website. The guidance outlines registration, accessibility, the type of information required for practice eDec and how that data is used.

Full article: https://www.lincslmc.co.uk/generalpractice_edec

Veterans Support Service

VSS is a local charity based in Spalding which provides expert advice and guidance to veterans and their families on issues that affects their lives. They support the mental health and wellbeing of veterans, empower veterans to acknowledge, talk about, and address their health issues, including signposting them to support services. They provide support to individuals to overcome personal barriers. Any of your patients who are military veterans can get support from VSS by contacting info@vsscic.org.uk or ringing 07434 827372

Practices should ask all patients “are you a military veteran?” so that veterans can be easily identified when they do present.

Full article: www.lincslmc.co.uk/veteranssupportservice

Parliamentary Enquiry - The Future of General Practice

The Health and Social Care Committee of the House of Commons has started an enquiry into “The future of General Practice”. 

The LMC will respond to this enquiry and encourages as many individuals and practices as possible to do so too.   It would also help to engage with your PPGs so that you can support them to respond to the enquiry.

We ask that any responses to the enquiry also be copied to the LMC so that we can shape our response based upon your views.

The enquiry can be accessed via parliament.uk website and responses must be submitted before 14th December 2021.

Full article can be found here:  www.lincslmc.co.uk/parliamentaryenquiry_thefutureofgeneralpractice

Lincolnshire Integrated Medicines and Prescribing Service (LIMPS)

LIMPS are a small team of Pharmacists, Pharmacy Technicians,  Programme Manager, and Prescribing Project Manager based within Lincolnshire CCG.  LIMPS is the replacement for the previous Optum Medicines Management Team.

LIMPS aim is to ensure that the local formulary, medicines optimisation work, and commissioning decisions around prescribing, reflect the needs of the Lincolnshire population, and to facilitate the uptake of safe, cost effective, evidence based medicines and treatments.


  • Provide dedicated clinical support, giving unbiased information to clinicians and assisting with medicine queries in a timely manner
  • Keep up to date with new drugs and research, national guidance and legislation changes, presenting findings to support local decision-making through the Prescribing and Clinical Effectiveness Forum (PACEF)
  • Carry out data analysis on prescribing patterns across the county, ensuring the best use of medicines and identifying areas where quality prescribing could be improved
  • Work with service providers and stakeholders to support the development and implementation of treatment pathways, policies, and guidance to help get the best out of medicines and resources for our population
  • Manage and maintain the OptimiseRx Lincolnshire profiles, which support cost effective prescribing in line with statutory guidance, and support and improve medicines use
  • Deliver IMPACT education session to our clinicians on priority areas of prescribing, such as antimicrobials and high dose opioids.

For the full article please go to: www.lincslmc.co.uk/limps

Lincoln Medical School Research Projects

Lincoln Medical School students are currently developing research projects for their BMedSci qualifications.  Lincolnshire LMC is working with some of these students to perform research in general practice.    Please help these students by completing their research surveys when you receive them, and by sharing your experiences through these surveys.

The projects which are currently being developed focus on “The impact of Total Triage” and “The impact on patient care of Primary Care Networks”.

The students are seeking for views from practice staff of all clinical and non-clinical professions.  Please ensure that your whole team have access to the surveys.

Discharge Medicines Service

The Discharge Medicines Service (DMS) is an essential service provided by community pharmacies to support patients discharged from hospital with medication changes made in hospital.  The service aims to improve outcomes, prevent harm, and reduce readmissions.

Currently the interface between Lincolnshire’s hospitals and pharmacies has prevented any patients being referred in to DMS.  However, from 15th November 2021 patients discharged from NWAFT may be referred into DMS, so practices in South Lincolnshire may start receiving queries from pharmacies about patients’ medications post-discharge. 


To view the full article, please go to: www.lincslmc.co.uk/dischargemedicinesservice

Access and Support for General Practice - LMC Response 

Lincolnshire LMC met on Thursday 14th October and we discussed the recently published guidance from NHSEI “ Our plan for improving access for patients and supporting general practice ” . LMC are angry that NHSEI have produced this guidance whilst practices are working hard to best manage their patients, in an environment of spiraling workload and staff shortages, whilst also providing flu and Covid vaccinations.

Fortunately, John Turner, CEO of NHS Lincolnshire CCG, was also in attendance at the Committee meeting. Mr Turner emphasised both his and the CCG’s Board’s appreciation for the outstanding work of GP Practices and their teams across Lincolnshire throughout the pandemic, particularly in recent months in terms of responding to exceptional levels of patient demand and consistently going the ‘extra mile’ to meet it, and he thanked all practices for this.

Mr Turner acknowledged that we do need to remove unwarranted variation and that the CCG wants to work with practices who are finding it difficult to provide face-to-face appointments. Mr Turner committed to working with practices, PCNs, the LMC, and his colleagues in the CCG to deliver the guidance about access in a way which supports practices rather than is punitive. The Committee welcomed these sentiments, and the LMC secretariat will work with the CCG team to develop a sensible, sensitive, and proportionate approach.

ICON- “Babies cry, you can cope”

ICON ‘Babies Cry, You Can Cope’, is an evidenced-based programme designed to help parents and carers understand the normal crying pattern of young infants and to help them develop successful coping mechanisms. ICON stands for:

I   – Infant crying is normal;

C – Comforting methods can help;

O – It’s OK to walk away;

N – Never, ever shake a baby.

Lincolnshire CCG safeguarding team is leading on the Lincolnshire roll-out of ICON, an initiative to help prevent abusive head trauma (also known as shaken baby syndrome). Research suggests that some people lose control when a baby’s crying becomes too much. Sadly, some go on to shake a baby with devastating consequences.


Electronic Palliative Care Co-ordination System (EPaCCS) Webinar

The EPaCCS webinar on Tuesday 19th October will help practices to:

  • Save time and improve efficiencies with the updated Gold Standards Framework (GSF) Meeting Tools.
  • Streamline communication using the GSF Report and new EPaCCS
  • Automate administration for your GSF/MDT Meetings
  • Automate your Quality Outcomes Framework (QOF) After Death Audit.

For the full article and webinar flyer please go to:  https://www.lincslmc.co.uk/epaccswebinar

Pension deductions by PCSE

We are aware that around 2,000 practices did not have pension deductions taken for one or more GPs from June through August. PCSE inform us that the majority will have the deductions in total taken from payments to practices during this month’s payment runs. The deductions will be taken from the first payment processed by PCSE during the month, be that global sum or any other payment.

Full article -  Lincolnshire LMC: Pension deductions by PCSE (lincslmc.co.uk)

Item of Service for giving flu vaccine to practice staff

BMA have informed LMCs that this year practices will receive an IoS fee for providing a flu vaccine to their own practice staff.  The Enhanced Service specification will be updated to reflect this shortly.

#Support your Surgery

At a time when so many are criticising general practice, we would encourage you to continue to use the resources and tools available on the Support Your Surgery campaign page to get the support of our patients to make the changes we urgently need to see.

This is one of the ways to address the concerns we share with our patients and to reduce the workload pressures we currently experience – and more than 10,000 people have now signed our petition - please show your support and sign it here

For more information, please see our full article at:  www.lincslmc.co.uk/supportyoursurgerycampaign

Racism and Discrimination- Your role in tackling this every day

It is every member of society’s responsibility to tackle behaviours which are discriminatory. If we stand by and allow discriminatory behaviour to go unchallenged, we are as guilty as the perpetrator. It may not be comfortable to challenge those around us, but it our responsibility to do so. You can learn the skills required by attending our Active Bystander training on 7th September or 19th October.



New CQC Mythbuster – 105 DNACPR


The DNACPR mythbuster from the CQC aims to reduce confusion, clarify, signpost and share guidance for providers.


Appraisal Payments


Following the submission to the DDRB, and the recommendation of a 3% uplift for GP appraiser pay and trainers grants being accepted by government, NHSE/I has confirmed the standard appraisal fee will be uplifted by 3% and applied from 1 April 2021. It is anticipated that the September 2021 payment will reflect the new recalculated fee and include back payments for appraisals undertaken and paid.


Help Us, Help You – next phase of campaign


The latest iteration of the ‘Help Us, Help You’ campaign is due to go live on 16 August 2021. Its aim is to ensure people know how and when to access services and reassure them that the NHS wants to see them.

This next phase will focus on cancer symptoms, including activity for cancers in the abdominal area, urological cancers, and lung cancer, due to these cancer types being among those most significantly impacted by the pandemic in terms of numbers of patients having come forward.

We will be sharing assets highlighting specific cancer symptoms and will encourage people experiencing them to contact to their GP practice.


Endorsing correctly for Serious Shortage Protocols

Dispensing practices are being encouraged make sure they are correctly using the new endorsement Serious Shortage Protocols (SSPs) to avoid invalid claims.

In February 2019, the government amended the Human Medicines Regulations 2012 to introduce SSPs. The Department of Health and Social Care (DHSC) can issue an SSP if they decide there is a serious shortage of a specific medicine or appliance. In line with the changes, the NHSBSA introduced a new SSP endorsement, to replace the No Cheaper Stock Obtainable (NCSO) endorsement.

How to claim for an SSP:

 When claiming for an SSP product on a non-electronic prescription:

• endorse SSP and the 3-digit reference number

• endorse the SSP product dispensed including strength, pharmaceutical form, and quantity

You can still use the ‘NCSO’ endorsement option if SSP endorsement functionality is not yet available on your dispensing system. However, NHSBA will be unable to accept NCSO endorsements from October 2021.


Further guidance is available at  Serious shortage protocols (SSPs) | NHSBSA

Claim back your Immigration Health Surcharge

Do you work in a healthcare role for an average of 16 hours per week and have paid the Immigration Health Surcharge?

You can claim back your Immigration Health Surcharge fee, even if your employer paid the surcharge and you are reimbursing your employer through salary deductions.

Applications are being processed for the period 1 October 2020 to 31 March 2021. You can backdate your claim to 31 March 2020 if you haven’t already applied. You must have worked for at least 16 hours per week during that period, but this can be in more than one eligible job. Reimbursement payments are processed in six-month installments in arrears.

Eligible applicants can now apply online or by telephone. Find out more about the scheme.

Step by step guide on visa sponsorship

Gaining the right to be a UK visa sponsoring practice has many advantages and could form an important part of your general practice workforce planning. A step by step guide to applying for a visa sponsorship licence is now available. The guide has been tailored to primary care needs. It does not replace official Home Office sponsor guidance but should help you work through the registration process.

Making Referral to Crisis Team

It is best practice when making referrals to another service for the clinician who has seen the patient to make the referral.   Crisis Team have emphasised the importance of the clinician to clinician discussion to help understanding.  GPs are thus asked to contact the crisis team direct rather than asking the patient to self-refer.

When other clinicians ask a patient to contact their practice this frustrates us, because the patient may not have the level of understanding or information required for us to make an appropriate response.  This is the same when we make outward referrals.

If we ask a patient to self-refer, we also have no guarantee that they will do this, it is much safer to make the referral ourselves.

You can contact the crisis team by calling LPFT SPA on 0303 123 4000.  Crisis team should be able to access the patient’s details through the Lincolnshire Care Portal, but you may be asked to email a patient summary to the SPA as well.

Vaccines and undocumented migrants

Recent research conducted by the Bureau of Investigative Journalism about access to Covid vaccines for those who are not registered with a GP practice. Their findings showed that many practices refuse to register patients that have no fixed address, no documents or an unclear immigration status. GP surgeries are required to register all patients (if their list is open to new patients) and should not turn patients away because they are lacking an address, proof of ID, or immigration status.

There is a useful resource called the Safe Surgeries toolkit which was developed by Doctors of the World, (DOTW) which aims to help practices understand all the relevant guidance and sets out recommendations that practices can adopt to reassure patients that they will not be turned away and that the practice is inclusive.

It is now more important than ever that patients are registered with a GP. By improving access to care, we can help to ensure that marginalised and excluded communities are not missed in the COVID-19 vaccine roll-out.

DOTW also offer FREE training to clinical and non-clinical NHS staff that aims to improve awareness and enables staff to better advocate for their patients.

Introduction of WebV for radiology requests

Lincolnshire CCG will soon be introducing a new software application for GP practices to request radiology tests. Practices need to sign up all their clinicians to be able to use this software application.


This software application, WebV, is currently used by both ULHT and NLAG to request radiology tests, blood tests, and record physiological readings when patients are in hospital.

WebV will soon be rolled out to GP practices so that clinicians can request radiology tests without generating a paper form or email form. The request will be transmitted automatically to the radiology department. WebV will be integrated with both EMIS and SystmOne to enable ease of access.

By using WebV practices will also have access to radiology results and other diagnostics which have been carried out at the hospital.

WebV will in future replace LabelTrace as the system used to request blood tests.

Further details will follow regarding timeframes for the switch to this new system. The CCG will also provide guidance how to use WebV.


Please ensure that your practice signs up all clinicians and administrators to be able to access WebV.

Enhanced Services for Long-Covid and Weight Management

Practices will have received the specifications for the new Long-Covid and Weight Management enhanced services. These enhanced services were not agreed by BMA GPC and have been published despite BMA GPC view that they will not best support patients and are not advantageous to practices.

Lincolnshire LMC debated these enhanced services and concluded that the workload involved with the services is not excessive and should benefit patients, and thus recommends cautiously that practices sign up to the enhanced services.

The Weight Management enhanced service encourages practices to identify patients who are over-weight or obese and to make referrals to a weight management service such as One You Lincolnshire. BMA concerns were due to the potential negative effect on the doctor-patient relationship of having these discussions. Furthermore, some parts of England do not have properly commissioned weight management services to which clinicians could refer.

The Long-Covid enhanced service requires practices to train staff regarding Long-Covid, and to understand local Long-Covid resources. LMC is discussing with Lincolnshire CCG establishing a training programme for practices about Long-Covid, and there is already a local Long-Covid service provided by LCHS.

Medical Examiner role in the community

Medical examiners are senior doctors who scrutinise the cause of death of individuals to support learning and improve registration of death processes. MEs also liaise with families of the deceased and provide them with support and feedback.

Many hospital trusts, including ULHT, have utilised MEs to scrutinise in-hospital deaths for some time, and this has led to improvements in care and support for bereaved families. This role is now being rolled out to deaths in the community.

When a patient dies GPs will have to provide information to the community ME before completing the MCCD so that the ME can scrutinise the circumstances of the death. This will be a similar process to the current coroner referral process, though the exact details are still to be agreed.

In most cases the ME will authorise completion of the MCCD, but sometimes the ME will want to discuss the case to get more information, and in other cases the ME may ask the GP to refer the case to the coroner. In exceptional circumstances the ME can also complete the MCCD, which may help where the GP is unavailable to do this.


More information will come to practices when the community ME process is due to start in Lincolnshire.

Extension to appointment mapping deadline (GPAD)

Some GP system suppliers have experienced unforeseen problems and delays in rollout of functionality to map slot types to the new national categories. To give all practices sufficient time to map all active slot types, NHS England & NHS Improvement (NHSEI) has decided to extend the deadline for confirmation of compliance with the requirements set out in ACC-01 by one calendar month, from 30 June to 31 July 2021.

New PCSE GP pay and pensions portalThis new online service to help administer practice payments and GP Pensions is now live.What’s new:

Statements: Practice statements are now accessed via PCSE Online, and will no longer be available via Open Exeter from 1 June 2021. Practices can access their statements data from the 2014/15 financial year to present day.

New pensions services: Practices will also be able to access a range of related pension services, such as completing the annual estimate of pensionable profit, notifying PCSE of new joiners and leavers to the NHS Pensions Scheme and approving Locum A forms.

Premises and locum cover claims: The new online GP Payments service also enables Practices to submit premises claims and locum cover claims online (Note: please check with your CCG when they are ready to start accepting claims submitted via PCSE online).

For more detail on all of these services, as well as information on how to request access to the new services, click on the following  link  Practices - Primary Care Support England

Deadline approaching for EU settlement scheme

The deadline of 30 June for applications to be made to the EUSS (EU settlement scheme) is rapidly approaching. If you are an EU national currently in the UK and arrived before 31 December 2020, you must apply before that date.


It is free of charge and by applying and being granted pre-settled or settled status, you will secure your rights to continue living and working in the UK. In addition, an application must be made for every eligible child within your family. If you and your family members have lived in the UK for many years, have a permanent residence document or EEA biometric residence card, you still need to apply to the EUSS (or apply for British citizenship) by 30 June to secure your existing rights in the UK.


More information is available at   Apply to the EU Settlement Scheme (settled and pre-settled status): Apply to the EU Settlement Scheme - GOV.UK (www.gov.uk)


Contract Compliance Week


Contract compliance week.pdf


Lincolnshire LMC are running a second “Contract Compliance Week” to gather data about inappropriate workload transfer. During the week of 21st-25th June please record all incidences of inappropriate workload transfer.


We all get fed up when we are asked to do a task which we should not be doing, but we usually do it because it helps the patient. Now is your opportunity to change this. The data you provide can be used as evidence of this inappropriate workload transfer.


We want to know how many times you are asked to organise a test for a patient, do an onward referral, write a Med3, prescribe a medication and explain it to the patient, and various other things which you should not have to do.


We will soon send out more detail of the things we would like you to record so that we can improve the patient pathway.

GP referral to Community Pharmacy Consultation Service (GPCPCS) Roll Out

At the LMC, we have been working with Community Pharmacy Lincolnshire to roll out the GPCPCS service across the county, starting with early adopter practices to ensure that the approach we have collectively proposed is functioning well prior to a wider rollout. The two early-adopter practices are now online and it’s our ambition to work with you to rollout this out fully across the county by the end of summer. We have an ambition the following roll out dates across the county:

w/c Monday 14th June: Boston PCN and the Lincoln ‘group’ Early individual PCN roll outs:



w/c Monday 28th June, wider roll-out remaining PCNs



Your PCN Clinical Director has today been sent a toolkit to share with GP practices in their area. Each kit contains the following:

With the above in mind, if there are any additional queries not covered by the toolkit, Community Pharmacy Lincolnshire, the representative body for Community Pharmacists in the county, are holding two zoom events at lunch time on Wednesday 9th June and Thursday 17th June. A recording will be made and circulated to all PCN clinical directors for them to share with their GP practices so anyone who cannot attend is able to access the recording.

The links to the zoom events are below. You will need to register to attend so Community Pharmacy Lincolnshire know there is enough capacity. There are 100 spaces available for attendees at each online event and we look forward to seeing many GPs and their colleagues, such as Practice Managers and their administrative support colleagues, in June.


Wednesday Jun 9, 2021 01:00 PM. Register in advance for this meeting:



Thursday Jun 17, 2021 01:00 PM. Register in advance for this meeting:



After registering, you will receive a confirmation email containing information about joining the meeting.

We’re confident that this positive change to an established service will be beneficial for General Practitioners and their primary care colleagues in practice, as well as to patients and pharmacies. It will illustrate how we can all work efficiently and effectively together for the benefit of the population of Lincolnshire as part of an integrated care system within the county.


Parkrun Relaunch

Lincolnshire Parkrun List.pdf

We are delighted that, parkrun is planning to relaunch across the country soon with a proposed relaunch date of 26th June 2021. This will be an exciting opportunity for all practices/ PCNs across Lincolnshire to engage with over the summer months going forward!


Due to the pandemic, parkrun https://www.parkrun.org.uk/ which has been in the community since 2004, was temporarily halted. Parkrun is a free, weekly, community-led event for everyone to engage in where people can walk, jog, run, pushchair, take dogs (subject to events) and wheelchair 5km and volunteer.


Parkrun is an excellent initiative which you can all engage in for free, with free resources to use, and is free for your patients and staff to engage in. The ‘parkrun practice initiative’ was launched in June 2018 in partnership with parkrun UK and the Royal College of General Practitioners (RCGP) which seeks to encourage GP practices across the country to register and promote physical activity and volunteering. To date there are over 1500+ practices in the UK signed up.


Resources can be found here https://r1.dotdigital-pages.com/p/49LX-52M/parkrunpractice and a case study https://www.gov.uk/government/case-studies/the-parkrun-practice-initiative; where there is growing academic evidence to support patient and service outcomes for this initiative.


Sign up or register as a parkrun practice https://r1.dotdigital-pages.com/p/49LX-532/parkrun-practice-registration


See further information attached which includes a list of all Lincolnshire parkruns.

For any further advice please contact Tom George tgeorge@lincoln.ac.uk

Marie Stopes International  offering Termination of Pregnancy advice and support

Patients do not need a GP referral to access our treatment: Patients can call us directly on 0345 300 8090. Our telephone line is open 24/7 and is free to use. Patients can call our telephone line for clinical advice, support, and information about the choices available to them, we also have interpreters available.

We are currently offering a telemedicine service for early medical abortions: the Government recently issued temporary approval of home use for both stages of early medical abortion. Our patients will now be screened via telephone and, if they are eligible (i.e. no risks are identified), we will prescribe medication for home use. The patient will have 24/7 access to our free telephone line, where they can request specialist nurse advice where needed. Any at-risk patient with safeguarding needs will continue to be seen face-to-face in clinic with a nurse or midwife.  If you would like some more information on our telemedicine service you can take a look at our webpage.  https://www.mariestopes.org.uk/abortion-services/online-medical-abortion/

We are CCG funded, so patients registered at your practice can access our treatment for free at any of our clinics across the UK. A full list of our clinic locations can be found here: https://www.mariestopes.org.uk/find-us/

CQC seeks views on next phase of regulation

The Care Quality Commission (CQC) is consulting on a further set of proposals which will help shape the next phase of regulation for health and social care across the country.

The proposals include:

Changes to the regulation of primary medical services and adult social care services, including the frequency and intensity of its inspections and how CQC monitors providers and gathers its intelligence

Improvements to the structure of registration and CQC’s definition of ‘registered providers’.

How CQC will monitor, inspect and rate new models of care and large or complex providers.

Updated approach to the ‘fit and proper persons’ requirement.

More information – and to provide feedback – on the set of next phase consultation proposals: www.cqc.org.uk/nextphase

Free Confidential Mentoring and Signposting Service for GPs 

GP-S is a service run for GPs by GPs. Offering mentoring, peer support, resilience training, careers advice, signposting and wellbeing resources. Read more...