Sent to all Lincolnshire GPs, Nurses, and Practice Managers
Dear %recipient.firstname%,
In the past when we requested a community nurse to administer medication to a patient, the community nurse would request that we document this request on an Authority to Administer (A2A) form. The LMC and...
Dear %recipient.firstname%,
For many years GPs and the LMC have requested that hospital specialist provide legible and comprehensive information when making requests for GPs to prescribe following outpatient attendances. Unfortunately, hospital specialists have continued to provide inadequate...
Dear %recipient.firstname%,
End of Life Care- updated guidelines and paperwork
Identifying patients who are End of Life, and providing anticipatory medications for symptom management, are important roles for general practice. The LMC has been working with St Barnabas Hospice, MacMillan...
This newsletter includes articles on;
General Practice Forward View
Performance Matters - Prescribing to Vulnerable Adults
PCSE Contact Details
Out of Area Registrations
Global Sum Funding & Uplift
Revalidation Guidance for GPs
Electronic Discharge Summaries - ULHT Backlog
Learning Disabilities...
Back pain is a very common problem for general practice patients, and most of the time it does not have a sinister cause. However, at recent serious case reviews there have been a number of cases where back pain in older patients has been the first presentation of more sinister diagnoses.
When...
Practices will have received notice that they can resume blood tests, however there is still a shortage of blood bottles. NHSEI have requested that practices continue to be cautious with their blood bottle usage.
Lincolnshire CCG has asked that practices inform them of any shortages by...
We all receive, deal with, and file, hundreds of blood test results every week. In the vast majority of cases this is a seamless and uncomplicated process. However, over recent months a number of cases have been discussed at performance panels where the main concern has been due to incorrectly...
Please see below our 'Cancer Care' Webinars. If you would like a copy of the slides from this session please email: info@lincslmc.co.uk. Don't forget to check out our other Educational Webinars and Podcast Episodes.
One of our Macmillan GPs Dr James Howarth has produced a short video on how to...
Please see below our 'Cardiology' Webinars. If you would like a copy of the slides from this session please email: info@lincslmc.co.uk. Don't forget to check out our other Educational Webinars and Podcast Episodes.
Our first episode in our Cardiology Series is presented by Dr James Howarth,...
This newsletter includes articles on;
Practice Manager's conference
Recent LMC work
Requests from schools
Mental capacity assessments
Transitional care / Home First
Flu vaccinations
Firearms update
Dental problems
Safeguarding guidance
Requests for branded drugs
Winter indemnity schemes for...
We all know that we make mistakes, and we learn from these mistakes. We also know that we are likely to miss certain diagnoses. The Practitioner Performance Team is, thankfully, realistic about this, and supports GPs who miss uncommon diagnoses. However, when doctors miss common diagnoses they...
Completing Fit Notes/Med 3
The LMC has recently received several enquiries regarding when Fit Notes can be completed, especially whether a Fit note can or should be completed before another Fit Note has expired.
Government guidance on completing Fit Notes explains that the fit note is...
When a patient dies it is expected by relatives and carers that a doctor or other health professional will attend the deceased to confirm that the patient has died.
BMA guidance states that English law:
does not require a doctor to confirm death has occurred or that 'life is extinct'
does not...
Not getting adequate consent is the fourth most common cause for medical indemnity claims[1]. It also accounts for high proportion of the cases which are taken to the GMC and local Performance Groups.
When consent is not adequately obtained, and a claim arises, 75% of claims are settled...
Contract changes made in April 2021 have reformed the way practices are reimbursed for immunisations and vaccinations. As part of these changes, practices must have a nominated Practice Immunisation Lead (PIL).
Practice Immunisation Leads are responsible for ensuring contractual requirements...
Contract changes made in April 2021 have reformed the way practices are reimbursed for immunisations and vaccinations. As part of these changes, practices must have a nominated Practice Immunisation Lead (PIL).
Practice Immunisation Leads are responsible for ensuring contractual requirements...
Lincolnshire LMC has met with representatives of ULHT, NWAFT, and CCG to review the outcomes of the Contract Compliance Week data collection. We plan to also discuss this with LPFT, LCHS, and NLAG.
The main findings of the data collection were that compliance with the NHS Standard Contract...
A new dementia pathway has been developed by Primary Care in conjunction with the LMC, Lincolnshire Partnership Foundation Trust (LPFT) and other care providers. It is for over 65yr olds presenting with symptoms suggestive of dementia and is intended to act as a guide to navigate the...
Articles in this newsletter include;
International Recruitment
Call for Special Conference
Improving Communication between General Practice & ULHT
Performance Matters - Firearms held ny patients
Safeguarding Children Conference
Government e-petition to save general practice
BMA Survey of GP...
The duty of candour came into effect for GP practices on 1 April 2015. This is Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which sets out fundamental standards.
It aims to ensure that providers are open and transparent with people who use...
The Lincolnshire LMC run short educational webinars aimed at GPs and other practice staff who find it a challenge to take time away from their practice to travel to training.
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End of Life Care- updated guidelines and paperwork
Identifying patients who are End of Life, and providing anticipatory medications for symptom management, are important roles for general practice. The LMC has been working with St Barnabas Hospice, MacMillan nursing, Marie curie, and other...
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...
From April 17 the Standard NHS contract for hospital explicitly requires hospital clinicians to provide fit notes for patients who are; admitted to hospital, discharged from hospital, or seen in outpatients.
Clause 11.11 of the contact states:
'The Provider must, where appropriate under and in...
Flu and Pneumococcal Vaccination by LCHS staff- it is time to sign the Vaccination Agency Agreement (VAA)
As in previous years, we want to ensure that there is maximum uptake of flu and pneumococcal vaccination. To facilitate this LCHS staff will be able to administer the vaccines on behalf of...
GPs frequently see patients who are aged under 18 years of age without the parents being present. If the GP decides to treat these patients without parental knowledge or consent parents may complain about the doctor's actions. It is thus essential that all GPs understand the rules and guidelines...
GPs are increasingly being asked to act as occupation health physicians (OHP). Patients attend the surgery with a request from and employer to complete paperwork relating to the patient's ability to per-form various duties. Similarly, other organisations request that GPs complete forms or write...
This guidance came into force on the 1 June 2016 and applies to all doctors who carry out both surgical and non-surgical cosmetic procedures including those who may be responsible for supervising others.
The GMC defines a cosmetic procedure as ''any intervention, procedure or treatment carried...
Patients frequently attend practices with hand written prescription requests which were issued to them in outpatient clinics. These requests are often illegible, and rarely have enough information for us to safely prescribe. To this end practices have to delay prescribing to get clarity.
The...
GPs are often requested to give hepatitis B immunisation covering three broad areas;
for travel
for occupational health
lifestyle risk or medical conditions
Travel
Hepatitis B immunisation for travel is not remunerated by the NHS as part of additional services. However, the regulations do not...
Visiting patients at home is a part of the GMS contract.
The GMS contract states;
7.6.1 In the case of a patient whose medical condition is such that in the reasonable opinion of the Contractor attendance on the patient is required and it would be inappropriate for the patient to attend at a...
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...
Improving 2-week-wait referrals
During the pandemic the way in which 2-week-wait (2WW) referrals have been managed by secondary care providers has had to change, as many diagnostic procedures could not be carried out due to infection risk. 2WW referrals which previously may have gone direct to...
It is well documented that interruptions during consultations are upsetting to both doctors and patients. About 10% of GP consultations are interrupted for one reason or another. When surveyed, patients felt that over 50% of these interruptions were unnecessary, and 20% felt that the...
This year practices will receive an IoS fee for providing a flu vaccine to their own practice staff in patient-facing roles. The Enhanced Service specification has been updated to reflect this change.
The LMC have been asked to share some lessons learnt from recent Serious Incidents which have affected Lincolnshire patients.
Missed diabetes in a child
A parent contacted a surgery using an online consultation platform advising that her child had started to wet the bed after having been 'dry'...
NOTE: We are not the 0-19 Service, please see attachments for contact information regarding referrals.
The LMC has heard many concerns from practices that the level of service for children has significantly reduced since the development of the 0-19 Service. We have been working with the County...
Lincolnshire's Managed Care Network for mental health aims to help people who have already experienced mental health problems, or who are having their first experience of mental ill health.
The Managed Care Network is an alliance of groups and organisations that provide a range of activities...
(written by: Dr Kieran Sharrock)
When patients present to general practices with eye problems, we may not be the best people to assess and treat their problems. Optometrists are more experienced in dealing with eye problems and are usually able to assess and treat these problems. The LMC is...
This newsletter includes articles on;
General Practice Crisis Meetings
Private Administration of Men B Vaccinations
Performance Matters - Sepsis
GMS Contract Changes 2016/17
Publication of GP Earnings
DNA-CPR Countywide Policy
Zika Guidance for Primary Care
Improving Communications between...
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...
Over recent times the LMC has worked to reduce the administrative burden for GPs and other practice staff. One of the changes which we have been able to instigate is regarding Medication Administration Forms (MAF). We had agreed with LCHS that when medication needed to be administered to a...
From 1st Oct 2017, schools can purchase their own supply of an Epi-Pen to use in an emergency when the child's own injector is not working. Schools have been able to purchase their own supply of a Salbutamol Inhaler for a couple of years now. Please click on the attachments above to view the...
Medication Reviews
Medication and prescribing errors can cause significant patient harm, and thus can lead to complaints and referral to the Practitioner Performance Team (PPT) or GMC. When these complaints are investigated, the PPT will look at the index case, and also at the records of...
What is the Mental Capacity Act 2005?
The MCA is an Act of Parliament which provides a framework by which people who may not be able to make choices about their own welfare, can be assessed, and cared for safely.
How do we decide if a patient has capacity?
If a patient is believed to not have...
Please see below our 'Mental Health' Webinars. All attachments can be found below the descriptions of each webinar. Don't forget to check out our other Educational Webinars and Podcast Episodes.
An evening with: Consultant psychiatrists, Adaeze Bradshaw & Suneetha Siddabattuni.
Managing Eating...
An easy way to access antimicrobial guidance
Have you ever wanted easy access to local antibiotic prescribing advice? This is now available from the Microguide App. This app can be downloaded from Apple and Google app stores. When you have downloaded the app, register using 'Lincolnshire STP'...
Public Health England have published a National Protocol for inactivated influenza vaccine which sets out how flu vaccines can be administered by registered and un-registered health professionals. Practices can use this protocol to enable un-registered staff to administer the flu vaccine...
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...
Practice In Touch
Practice In Touch is the Lincolnshire LMC newsletter. The newsletter is sent out on a regular basis to all GPs & practices in the county.
If you do not currently receive a copy of our newsletter & would like to subscribe, please email rosa.larner-peet@lpft.nhs.uk to be added...
A new 2-week-wait pathway has been developed for patients who present with non-specific symptoms (NSS). This NSS pathway should be used for patients with the following non-specific symptoms
Appetite loss or early satiety
Unexplained deep vein thrombosis
Diabetes with weight loss age...
Rapid Diagnostic Service Plus (RDS+) - Internal and External (CCG) Comms release - 28.06.21:
The PEDAS clinic transition period will stop with effect from 30 June 2021.
Rapid Diagnostic Service (RDS+)
NWAngliaFT is introducing a new service called the Rapid Diagnostic Service (RDS+) for...
This newsletter includes articles on;
Marketing Lincolnshire General Practice - BMJ Careers Fair
Performance Matters - Back Pain in Older Patients
Department of Works & Pensions (DWP) Consent
Patient Registration for GP Practices
CQC Registration
Doctors Health
Intranasal Influenza...
Onward referral from Emergency Departments
Emergency Departments do not have the ability to safely make or follow-up onward referrals.
It has been agreed though that patients seen in ULHT EDs who require urgent assessment, but do not require admission, will be referred on by the ED...
When you have concerns about a child and want to make an urgent referral to paediatrics, this should be done by calling switchboard and asking for the paediatric SHO on call. The paediatric SHO should then take details of the patient and what your concerns are. The SHOs fulfill this role as the...
A recent safeguarding Serious Case Review (SCR Family V, published on the Lincolnshire LSCB website) highlighted the importance of knowing who has parental responsibility for a child. In this case, a man had repeatedly taken a child to multiple medical appointments, and the child had received...
The LMC is regularly involved in representing and supporting doctors who have been identified as having 'performance' issues. The LMC has identified a number of themes which recur, and this regular feature from our newsletter will highlight these, so that our members can avoid these...
Performance Matters- palliative care and pre-emptive planning
The LMC is regularly involved in representing and supporting doctors who have been identified as having 'performance' issues. The LMC has identified themes which recur, and this regular feature from our newsletter will highlight...
Performance Matters- Patient Safety Alerts
What you need to know:
All practices must have a system in place to review, share, and act upon patient safety alerts
MHRA and other organisations send practices patient safety alerts regarding medications and devices which could cause harm to...
Personalised Asthma Action Plans
As part of QOF, patients should have a Personalised Asthma Action Plan agreed when the patient attends for their annual asthma review. The PAAP should include information about how to step-up and step-down inhalers, and how to respond to acute exacerbations....
Pharmacy Contract Changes
There have been some recent changes to the pharmacy contract which will possibly impact GP practices. These changes include
New Medicines Service
Pharmacists will offer a medication review to patients who have been started on medications for certain conditions such...
Practice Call-Back Policy
Healthwatch Lincolnshire have recently surveyed patients about their experiences when contacting GP surgeries. One of the issues raised by patients in this survey was the uncertainty about when a clinician will call the patient back when a telephone appointment...
Practices are NOT required to prescribe antivirals to patients in care homes at risk of influenza
The LMC has provided guidance regarding antivirals in care homes in the past, and we understand that some practices have again been asked by Public Health to do this. Our advice remains the same,...
The new regulations to widen the availability of cannabis-based medicinal within the NHS came into effect today, 1 November 2018. Prescribing is restricted to a doctor on the GMC specialist register prescribing within their field of expertise where the cannabis-based product is an unlicensed...
A vulnerable adult is defined in 'No Secrets‟ Governments Guidance of Adult Abuse as:
'someone who is aged 18 and over, who is or may be in need of community care services by reason of mental or other disability, age, or illness and who is or may be unable to take care of him/herself and...
NHSEI have published their expectation for PCNs for 2021/22 and 2022/23. Full details of this can be found at the NHSEI web pages. This article aims to summarise these for practices so that you know what will be expected from October 2021 onwards. LMC plan to run a webinar about this...
Prostate Specific Antigen (PSA) changes to NICE guidance
NICE have recently amended their guidance with regard to referral thresholds for abnormal PSA.
Old NICE guidance said to refer asymptomatic patients depending upon their age-related PSA (50-59 ≥ 3, 60-69 ≥ 4). The new guidance...
The Children's Rapid Response Respiratory Service launched in February 2019. It is a countywide service that provides specialist assessment, treatment and management of children with complex physical disabilities with additional respiratory problems in the community.
To refer to the...
NHSE have recently changed the focus of GP Appraisal. The new focus is aimed at being more developmental and less bureaucratic, so that less time needs to be spent preparing for appraisal.
NHSE has circulated a document which sets out the changes; this document can also be found in the...
Schools frequently request information from GPs regarding a child’s health conditions, their absence from school, or to certify that they were ill when sitting an exam. Parents often are put under pressure from schools to get this information from practices, even though they themselves would be...
Collaborative arrangements
The NHS Act obliges NHS bodies to provide advice to statutory bodies in relation to social services, education and public health functions. Thus NHS England and CCGs, as NHS bodies, have to enable the Local Authority to carry out is safeguarding duties. This is...
All staff who come into contact with children and young people have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding issues, including child protection.
The intercollegiate document 'Safeguarding children and young...
The temporary emergency registration provided by the GMC to doctors, as part of the response to the COVID-19 pandemic, will remain until the Secretary of State for Health and Social Care declares the emergency over.
The GMC is currently contacting doctors on the temporary register to ask...
Patients presenting with possible dental problems
This guidance informs GPs of their obligations to patients either requesting emergency dental treatment or asking for an NHS prescription for drugs recommended by private or NHS dentists. It is aimed at all GP’s including out of hours...
NHS England is offering practices the voluntary opportunity to participate in two new enhanced services from 1 July 2021. These focus on two areas which are a priority to support recovery from the pandemic: long COVID and weight management.
Long COVID is an increasingly widespread condition,...
