Dr David Smith, Chair, Sefton LMC
1) QOF Achievement Search Issues
We have received a number of queries relating to the QOF achievement searches in EMIS. Some of these should have been resolved via a recent EMIS update. However, we understand that patients prescribed warfarin for AF will only appear in a practice’s AF008 achievement if they have a metallic heart valve code, a DOAC declined/ contraindicated code, or a DOAC not indicated code alongside a warfarin time-in-range code. The exclusion codes for CHOL001 are being on the palliative care register, maximum tolerated lipid-lowering therapy, a qualifying exception for all lipid-lowering drugs, adverse reaction to lipid-lowering drugs, or lipid-lowering therapy declined/ contra-indicated/ not indicated. For CHOL002, the only exception codes are patients declining a cholesterol test; instead, the achievement target is relatively low.
2) Outpatient Prescribing Initiative
We have received feedback from the ICB that they have not received very many redacted Outpatient Prescribing Optimisation Feedback forms to their QI email address since this initiative started. We really need all practices to use
the form consistently to reject inappropriate prescribing requests by specialist colleagues, & to forward redacted versions to the dedicated ICB email address if we want to put an end to this unresourced & potentially unsafe activity. To recognise the workload impact of this on practices, Sefton Place have agreed (provisionally) to resource this via one of the indicators in the 2024-25 LQC. We will discuss this further at our annual LQC workshop in April (date TBC).
3) Overseas/ Private Bariatric Surgery
Attached to this bulletin is a template letter, which practices can provide to patients who have had or are considering bariatric surgery abroad or in the private sector. It explains that the aftercare for this surgery is of a specialist nature so for NHS patients, it is provided by our local bariatric surgery service for the first two years. Our ICB does not fund a specialist service to provide aftercare for patients who have had bariatric surgery in the private sector or abroad. Therefore, GP practices should not be asked to provide aftercare for bariatric surgery & they are unable to refer patients for this. Instead, patients are advised to arrange any aftercare themselves in the private sector & if they wish to discuss the matter further, they should contact the ICB.
4) Clinical Advice to Paramedics
We have received some enquiries about the advice in our last bulletin. To re-iterate, NWAS has its own internal clinical support hub where paramedics can seek advice. If the paramedic feels they need additional advice from a GP, PC24 is commissioned to provide this so should be their second port of call. However, we feel that it would be reasonable for a paramedic to contact a GP practice to request/ share information, request non-urgent follow-up, or request support with a palliative care case. We are working with NWAS to try to firm up these pathways & in the meantime, it would be helpful if practices could share examples of any problematic interactions with paramedics with us.
5) Teledermatology Pilot
We remain keen to receive feedback from practices about this pilot, which has replaced the previous 2WW dermatology process at Ormskirk Hospital. In particular, we are keen to hear from those practices who are piloting taking the photographs themselves, regarding any procedural or clinical issues you have encountered. Even if a patient has one of the exclusion criteria for a photograph (e.g. lesions on the hands/feet) they should still be referred via the eRS process & the service will triage them to an appointment at Ormskirk. The same should apply to any patients where, in your referral letter, you state that teledermatology is not appropriate. Please tell us if this is not happening.
6) Outbreaks in Care Homes
We have confirmed with Sefton Place that PC24 is commissioned to manage outbreaks of infections in care homes. This includes scabies, which has been on the rise recently. Practices should only be prescribing anti-infective therapy for patients who they have assessed, not for wider public health interventions. Care homes should be directed to contact PC24 in such circumstances & if you encounter any difficulties with this, please contact Sefton Place.
5) Teledermatology Pilot
We remain keen to receive feedback from practices about this pilot, which has replaced the previous 2WW dermatology process at Ormskirk Hospital. In particular, we are keen to hear from those practices who are piloting taking the photographs themselves, regarding any procedural or clinical issues you have encountered. Even if a patient has one of the exclusion criteria for a photograph (e.g. lesions on the hands/feet) they should still be referred via the eRS process & the service will triage them to an appointment at Ormskirk. The same should apply to any patients where, in your referral letter, you state that teledermatology is not appropriate. Please tell us if this is not happening.
7) Joint Health Self-Referrals
Joint Health (the musculoskeletal service at Southport & Ormskirk Hospitals) has confirmed that they now accept patient self-referrals without prior clinical triage, for patients who have had musculoskeletal symptoms for >6 weeks. They are piloting a new Digital Assessment Routing Tool (DART) on the trust’s website, which can be used in place of the current self-referral process & practices should have received information about it this week. We have sought assurances that this process screens for red flag symptoms & directs such patients to seek urgent medical advice instead. We were not consulted about the new process beforehand so we are keen to receive feedback from practices, either positive or negative, so we can report this into the pilot.
8) Medical Examiner Rollout
The Medical Examiner (ME) process for non-coronial patient deaths becomes statutory from April 2024. We would recommend getting used to using this before the statutory date. South Sefton practices should contact the Liverpool ME & Southport/Formby practices should contact the Southport ME for further details. There are significant differences between how each of these services are operating & whilst practices will only need to become familiar with one of them, colleagues who work in both North & South Sefton will need to become familiar with both.
9) Ambulatory Medicine at Southport
We have significant concerns about how ambulatory medicine referrals at Southport Hospital are being processed. When a referral is sent via the eRS, it is supposed to be triaged the same day & the patient offered an assessment within the next few days. If they feel a patient is more appropriate for A&E, the agreement was that they would direct patients to A&E themselves. This does not appear to be happening & indeed, practices have received responses to referrals advising them to send patients to A&E because the ambulatory medicine service is short of capacity. This flies in the face of requests from the trust to use alternatives to A&E, & we feel the current process is unsatisfactory for patients & potentially unsafe. Unfortunately, the trust has not responded to our concerns yet so for practices who wish to continue these referrals, we would recommend monitoring the eRS closely after making them.
10) New Clinical Pathways
We are aware that a number of new clinical pathways have been circulated in recent months where activity appears to be being moved from secondary care to general practice. Please assume that none of these have been approved by the LMC unless we have confirmed so via this bulletin. We are challenging these robustly along with the other LMCs in Cheshire & Merseyside.
