Dr David Smith, Chair, Sefton LMC
1) Local Quality Contract (LQC) Hints & Tips
September is the final month of quarter 2 of the fiscal year. Please note the following LQC indicators, which should be completed by the end of quarter 2:
- Indicator 18 – review of your primary care dashboard data
- Indicator 19 – sharing your easy read invitation letter for LD health checks
- Indicator 24 – your quarter 2 MMT quarterly meeting
- Indicator 36 – Practice Manager completion of the eLFH veterans e-Learning
I have been asked to remind practices that the denominator for indicator 01 should be approximately 0.6% of your practice population this year.
Also, the patients who need contacting following a non-response to a cervical screening invitation can be found on the Exeter system.
2) Outpatient Prescribing
Further to the July bulletin, I am pleased to report that there has been tangible progress with our outpatient prescribing initiative. A pushback form has been approved by the ICB & will be circulated by the end of September 2023. Please use this form consistently to reject inappropriate prescribing requests by specialist colleagues, by emailing it to the relevant department.
In particular, the LMC advises practices to ensure that they have evidence of a patient being counselled on a medication fully before prescribing it or adding it to their repeat list. For Amber or Purple medications, we recommend that practices ensure the responsible specialist clinician has been consulted too.
3) ADHD Shared Care
In connection with the previous item, the LMC recommends that practices only accept shared care for ADHD medications using the Sefton shared care frameworks. In these, it states that the specialist must ‘provide the name and contact details of the consultant. When the request for shared care is made by a specialist nurse, it is the supervising consultant who takes medico-legal responsibility for the agreement’. Accordingly, the LMC does not recommend accepting shared care when the diagnosis & management decisions have been made without the involvement of a responsible consultant psychiatrist.
4) Rejected Referrals
In the July bulletin, I asked practices to report examples of referrals being rejected because a referral template had not been completed or a patient was ‘out of area’. Indeed, the latest guidance suggests that patients should be given a choice of 5 providers when a practice makes a referral. I understand some referrals are being rejected because departments have long waiting lists – we feel this is unacceptable so please report such examples to the LMC too.
5) Virtual Wards
There are now a number of virtual ward pilots in operation in Sefton. The LMC’s position is that practices should not be responsible for the clinical care of patients who have been admitted to a virtual ward – e.g. home visits, repeat prescribing or investigations. Notwithstanding the resource implications of practices caring for a patients who would otherwise be a hospital/hospice inpatient, we feel it is safer for just one team to provide the patient’s care.
6) Neonatal Hepatitis B Testing
Earlier this month, I met with Tricia Spedding (Head of Public Health, NHSE North West). She acknowledged that LMCs should have been consulted about this matter, we agreed on the importance of this intervention & that practices were well-placed to perform it, & we agreed that it needed to be properly commissioned with an associated item-of-service payment. Also, I advised that the governance surrounding the tests needs to be clarified; in particular, who is responsible for the results, any subsequent actions & any DNAs.
7) Targeted Lung Health Checks
These have now commenced in South Sefton, with Southport & Formby patients soon to be included too. It has been extremely concerning to hear about the experiences of some practices, where the management of incidental coronary artery calcification has caused a huge amount of additional workload. The LMC has requested a pause whilst the scale of the problem is understood properly, so the resource requirements can be reconsidered by Sefton Place. We are hopeful that a CVD risk pilot at Liverpool Heart & Chest Hospital will be able to manage these cases instead going forward.
8) Medical Examiner Rollout
Whilst there is not yet a statutory requirement for practices to agree death certificates with an independent medical examiner (& the BMA has cited this in its list of workload that should be removed from practices in order to relieve pressures), I am aware that some practices are engaging with the rollout in South Sefton. I have been asked to remind South Sefton practices that the Liverpool Medical Examiner Office are available to support practices who wish to proceed with the rollout, by emailing meservice@liverpoolft.nhs.uk
9) Patient Registration Audit
The LMC has been consulted about an audit that Sefton Place would like practices to support; to understand demand for registration within the Sefton area, in respect of new patients to the area & movement between practices.
An online form has been created for receptionists to complete & submit