Pharmacy Flu Vaccinations in Care/Nursing Homes
We have been made aware that some pharmacies have proactively contacted care and nursing homes and arranged to vaccinate all residents. There is nothing within the pharmacy contract which prohibits this and we strongly recommend practices contact the homes in which their patients reside to ensure this arrangement has not been put in place prior to planning/completing vaccination timetables/plans. Additionally, we have been aware that in some circumstance the pharmacies have suggested they are vaccinating on behalf of practices. We have contacted the LPC to challenge/prevent this misleading information and, if you have experienced this, please contact janice.foster@nhs.net with specific examples where this has happened – preferably with the name of the pharmacy so this can be addressed.

Tees Sexual Health Service Procurement
The integrated sexual health service in Tees is now open for tender via NEPO. Stockton BC are leading this procurement on behalf of all the LAs and they have provided this briefing for GPs. The intention is to continue with the current model of provision, as outlined in this model vision document i.e. a prime provider who will have overarching responsibility for quality and performance across all service provision and the provision of services by General Practice and Pharmacies is still considered fundamental to the delivery model and is explicit within the specification.  We remind practices that they may also wish to view these documents with the view to tender to provide this service as well as providing as a sub-contractor. Following consultation feedback there is a strengthened the requirement in relation to Primary Care Subcontracting that includes training to maintain subcontractor competencies, support to staff and a dedicated point of access for clinical advice.  Bidders will be tested on their ability to engage and work with practices and pharmacies and the transition to new subcontract arrangements is a critical phase in the mobilisation period.

GP Calls to AAU at James Cook
ST CCG has advised that GP consultant ‘triage service’ has been reinstated. Concerns from previous experiences have been taken on board and a trial period has taken place to ensure the new system works, particularly the telephony element. Conference call phones that are being utilised are with a different network to ensure no black spots within the hospital.  If for whatever reason the GP and consultant do not get to speak together the default position is that bed bureau will admit the patient. During the trial week the service demonstrated that the phone calls have worked well with no complaints or issues from GPs or consultants being raised – 80 calls were taken during this week, of which 56 patients were still admitted and 16 were referred onto and seen in the ambulatory clinic.  The remainder were a mix of referral onto other hospital services or an alternative clinical review/advice provided. The service will now run from 9am-5pm Monday to Friday and 9am-2pm on a Saturday.

Overseas Visitors & Onward Referral
There is much confusion with regard to overseas visitors given the recent media and shift in NHS agenda. Whilst there has been no change in policy for General Practice, Trusts are increasingly vigilant – including community services as well as the more traditional secondary care services. In order to assist patients, Trusts and the NHS in ensuring charges are appropriately made; GPs are recommended to advise patients who are not ordinarily resident in the UK that they may not be entitled to free NHS services by other providers e.g. Trusts. Whilst the GP should always refer as clinically appropriate, a patient can be advised to check eligibility via an NHS Choices questionnaire and it would be helpful if the GP could include a line within the ‘additional information’ section of the referral form to alert the Trust to the fact that the GP has advised the patient to check eligibility as they suspect this patient is not ordinarily resident in the UK. Ultimately, responsibility for entitlement to NHS care remains with the Trust. This patient leaflet may provide helpful.

Men ACWY for Uni Freshers, Missed Cohort
Practices are alerted to a missed cohort of Men ACWY patients – namely patients born after 1 Sept 1997 who have just started University. Those in the current year 13 (DOB 01/09/1996-31/08/1997) would be in the school catch-up cohort and for a patient to be in the University freshers cohort they must be 19 years on 31 August 2015 in order to be eligible. GPC raised this issue with NHS England who have confirmed that, as per the tri-partite letter, patients born between 01/09/1997-31/08/1998 will be eligible for vaccination from April 2016 leaving a group of patients unprotected against meningitis until then. NHS E refused to amend the service specification to ensure this group (although likely to be small) could be included in one of the cohorts and thus funded nationally. Instead the following FAQ has been provided:

Q: What about teenagers and young adults who are going to university early but do not meet the age criteria for the two MenACWY programmes?
A: As these patients fall outside of the eligible cohorts defined by the NHS England service specifications, they would not be covered by the automated data collections. As such, practices should discuss the vaccination of these patients with their commissioner on a case-by-case basis. In line with established procedures, where the practice and commissioner agree to the amendment the commissioner will adjust the practice achievement.
In the spirit of the agreement, we would expect these practices to be remunerated for vaccinating these patients.

Whilst this allows for these patients to be protected and should allow for payment to be made, this is far from ideal as the workload involved in claiming may negate any overall income received for the practices.

Men B for Infants, FAQs
NHS Employers have updated their vaccs and imms FAQs in relation to meningococcal B for infants to explain the eligible age cohort (2 – 13 months), as well as a catch-up cohort up to 2 years for children born on or after 1 May 2015. The FAQs also explain what practices can do if parents approach them about having children outside of the cohort vaccinated privately:
Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how?
A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice.
For clarity, whilst GPs can provide private prescriptions, they are not allowed to charge their own NHS patients and we, therefore, recommend that patients (outside the cohort) access a comprehensive private service provided by another practice or service provider, who would then be able to charge an appropriate fee for this private service.

Phasing Out Seniority Payments, GPC Guidance
This new GPC guidance provided details on the phasing out of seniority payments.

Indicators No Longer in QOF
The Indicators No Longer In QOF (INLIQ) Business Rules v32.0 have now been published.