19/08/2020
Clustering
The Area Team/LDN are continuing to develop the concept of clustering of practices around a hub which would provide specialist level 2 services of MOS, perio, endo and restorative which the 'spoke' practices would refer into. These would be situated near enough to the referring practices to make travel for patients convenient. Originally this model was created for AGPs as the hub with the spoke practices acting as non AGPs in many instances and referring AGPs to the hubs but as most practices now can undertake AGPs it has become more of a referral/peer review arrangement. The clusters are concentrated around towns and it will be more challenging to create them in the more rural areas. Additional funding for these clusters will be sourced via flexible commissioning
PPE.
This has been a famine or feast. There seem to be sufficient fit testers now across the region and an abundance of kits - when masks are in good supply then practices report shortages of gowns. Whether the portal will improve this situation remains to be seen. Norfolk were given 15,000 FFP2 Aura masks which have helped practices in the county but there have been a number of problems in accessing FFP3s. Many practices are using reusable half masks but eye wear can be an issue with those.
LDNs
There are three LDNs across the East of England. Essex chaired by Nick Barker, East Anglia by Tom Norfolk and Herts, Beds and Milton Keynes (Herts BLMK) until recently by Jason Wong as a caretaker chair. This LDN has never had a substantive chair but following intervention by the LDCs, work is now underway to identify a chair. Due to the lack of a consistent chair who understands the region there has been something of a dislocation in that area and tensions have been apparent between the profession and the NHSE, particularly since the start of the pandemic .
Associates
Much of the work of the LDCs since the last RLG in June has been advising associates. Many were threatened with significant ‘lab fee’ charges for any NHS AGP they undertook to offset the cost of PPE. Anything from £7.50 to £20 were reported for each visit requiring AGP. Not surprisingly these patients were referred to UDCs for their AGP. This was reasonably straightforward to resolve after NHSE were informed of the, mostly corporate, decisions and the potential for huge increases in the waiting times at UDCs as a result. NHSE had a quiet word and the threat of these charges were retracted.
The other reasons for associates contacting LDCs has been because of ‘additional charges’ to offset the abatement. Advice has been given and on some occasions direct intervention by the LDCs has been beneficial. When intervention has not been successful then a recommendation to the BDA arbitration service or private legal advice has been the only way forward. Most of those seeking advice are from the medium to large corporate and are overseas graduates, mostly European who are bewildered by circumstances they find themselves in.
Communications.
Most providers in the region are beginning to come to terms with the new way of working, recording and providing clinical care. But there is still a lack of understanding of the detail – where to access the 20% figure, what constitutes a patient contact, 19/20 year end etc. LDCs represent all GDS colleagues and a large number of PDS. Is there a role for this group to act as a conduit to disseminate a consistent message via our LDCs which doesn’t seem to be getting through to all NHS performers and providers in a way that they understand?
Nick Stolls 19.08.20