Welcome to this week's primary care bulletin

Key points this week include:

• Commencement date for the statutory medical examiner system - 9 September 2024
• Congratulations to Mando Watson!
• Spring 24 Covid-19 vaccination of immunosuppressed individuals (6 months and over)
• Draft Joint Forward Plan for 2024/25
• NW London Children and Young People bulletin 
• Views sought on working with CNWL NHS Foundation Trust's Adult community mental health hubs (applicable to practices in Westminster, K&C, Brent, Harrow, Hillingdon)
• ERS changes
• Two week wait changes to urgent suspected cancer (USC)
• NW London cervical screening survey
• Hepatitis C GP Champions
• Stress awareness month - Keeping Well NWL
• Training, webinars and more

Commencement date for the statutory medical examiner system – 9 September 2024

We now have a date!

The legislation will come into force on Monday 9 September 2024 meaning independent scrutiny by a medical examiner will become a statutory requirement prior to the registration of all non-coronial deaths in England and Wales from this date.

Please find the announcement by the Department of Health and Social Care here. 

Most practices in are now set up on the new IT system and are using it. But in some cases only one or two members of practice staff are trained.

Please use this time to ensure your practice is ready for the commencement of the system and ensure that several members of practice staff can use the new online system.

SystmOne and EMIS guides and information for staff can be found on the ICS website here:

NEW: Medical examiner process :: North West London ICS (nwlondonicb.nhs.uk)

The NW London IT team can support practices with the set-up please contact:  tsmith8@nhs.net

In addition to the ME service – here is a summary of the other changes that will also come into place.

Changes to the Medical Certificate of Cause of Death (MCCD)

1. A revised version of the MCCD is imminent.  New MCCD books will be issued nationally -  the new medical certificates of cause of death must be used from the date of statute – old ones will be rejected from the date of statute.

a. New certificate books will be ordered for GP practices and distributed by the Department of Health.

2.  The requirements for issuing a MCCD will also change from this date.  There will no longer need to be a medical practitioner who has seen the patient alive in the last 28 days of life, any practitioner who has seen the patient in life. They will need to be able to formulate cause of death “to the best of their knowledge and belief”.

3. New fields will also be added to the MCCD:

Ethnicity
Presence/absence of a medical device
Additional line 1d - The cause of death is currently expressed as immediate, direct cause of death and its underlying causes (1a, 1b and 1c) and any contributory causes of death (II). With the new legislation, and to bring us in line with other countries, section 1 will be expanded to have 1d as well as 1a-c.

Changes to the process

4. From the date of statute, the MCCD must be sent to the Registrar office by the Medical Examiner’s office.  The completed MCCD must therefore be sent to the ME office by the GP, and not direct to the Registrar office

5. The MCCD will be signed by the Medical Examiner before it is then sent to the Registrar.  

6. The crematorium form 4 is being abolished as this new process will be in place.

Congratulations to Mando Watson!

Mando Watson who has recently been appointed as an Honorary fellow of the RCPCH. 

The work of Dr Watson has empowered the sector to think differently about child health, and she has been a trailblazer for integrated child health. Mando is responsible for setting up Connecting Care for Children (CC4C) which is the national gold standard of how to integrate primary and secondary care. 
Dr Watson’s is a busy general paediatrician with a subspecialty interest in diabetes at St Mary's Hospital in North West London, she is also the clinical lead for the CYP Programme in the North West London Integrated Care System as well as the clinical lead for child health in the North Kensington (Grenfell) Recovery team.

Mando’s involvement in both undergraduate and postgraduate medical education throughout her professional career; she has been a training programme director in the London School of Paediatrics, a RCPCH Regional Advisor for North Thames West and also President of Paediatrics and Child Health Council of the Royal Society of Medicine.

Her contribution to the College has been over many years, and she is the lead author for the 'Paediatrician of the Future: Delivering really good training'. This sizeable document lays out the principles for our new postgraduate training programme and underpins the design of Progress+.

Spring 24 Covid-19 vaccination of immunosuppressed individuals (6 months and over

 
Download the update here. 

Draft Joint Forward Plan for 2024/25

North West London Integrated Care Board and our partner NHS trusts are developing our Joint Forward Plan for 2024/25 to 2028/29. We are today publishing an initial draft for discussion with residents, our local authority colleagues and other partners.

North West London Integrated Care System published its Health and Care Strategy in November 2023. We are required to publish a Joint Forward Plan (JFP) each year which covers the services we commission or those delivered by our NHS partners. The JFP builds on the strategy and sets out how the NHS will implement the parts of the strategy within its remit.

The Health and Wellbeing Boards in each of our boroughs is being asked whether the JFP is sufficient to meet the needs of the residents of their area. The ICB is arranging to attend Health and Wellbeing Boards to discuss the draft plan with them.

NW London children and young people bulletin

Click here to read the bulletin.

Views sought on working with CNWL NHS Foundation Trust’s adult community mental health hubs (applicable to practices in Westminster, K&C, Brent, Harrow, Hillingdon)

CNWL NHS Foundation Trust are seeking feedback from GPs on their experience working with CNWL’s Adult Community Mental Health Hubs. The purpose of the survey is to gather an understanding of GPs views on their relationships with Community Hubs, what is working well and areas for development. 

This will not take any longer than 5 minutes to complete, and is accessible via the link: GP survey

Please could you complete the survey by close of play Friday 19 April. If you have any questions, please contact Julia.prudhoe@nhs.net 

ERS changes 

In March 2024 there was an update to e-RS to enable Referral Assessment Services to be shortlisted. Due to this change, we have been informed by the NHS England’s e-RS National Team that all practices should be monitoring their e-RS worklists on a regular basis. In particular the Urgent Suspected Cancer services (2WW) which have not yet had an appointment booked by either the patient themselves or by the practice on behalf of the patient. 

Please see the attached support manual for more information and how to deal with this.

Two week wait changes to urgent suspected cancer (USC)

The name of the address entries for Two Week Waits AKA 2WW will be changing imminently to Urgent Suspected Cancer in both SystmOne and EMIS. 

This is inline with national guidance. 

Should you have any problems with the above, please log a call via the Service Desk via one of the following routes below, and one of the team will call you back.

Log a call via:

🖥️ Self Service Portal, 

⌨️ nhsnwl.servicedesk@nhs.net, 

📞 telephone 020 3350 4050 

NWL cervical screening survey 

NWL are committed to ensuring excellent clinical effectiveness and working with Primary Care to increase cervical screening uptake within our population.

The Cervical Screening Task and Finish Group have been working with RM Partners, Cancer Screening Leads and Primary Care colleagues to learn what the challenges and possible solutions are around cervical screening uptake. 

The group are asking for your help to gather detailed information about cervical screening processes at practice level, especially in terms of what is working well and where further support maybe required. 

This data will support the group to gain a greater understanding of the current processes and what General Practice requires to manage and deliver the demands of the National Cervical Screening Programme.

The team would be grateful if you could take some time to complete the short survey. Only one response per Practice is required.

If you have any questions, please email the Borough Professional Leads at: nhsnwl.pcquality@nhs.net

Hepatitis C GP Champions 

NWL has 4 GP Hep C champions working with the West London Hepatitis C ODN (all acute trusts in NWL led by Professor Ashley Brown)

• Dr Lyndsey Williams linked to LNWHT working within Harrow, Ealing (excluding Acton PCN) and North Brent PCN’s (Harness North, K+W Central, West, North) lyndseywilliams@nhs.net
• Dr Sam Gheiace linked to ICHT working with South Brent PCN’s (Harness South, Kilburn Partnership and K+W South), Acton PCN, Westminster PCN (except south Westminster PCN) sam.gheiace@nhs.net
• Dr Pritti Vaghani linked to Hillingdon hospital trust and working with all Hillingdon PCN’s p.vaghani@nhs.net
• Dr Paul O’reilly linked to Chelsea and Westminster hospital trust working with Brompton Health PCN, Brentworth, Feltham & Bedfont, Great West Road, Hounslow Health, Kensington & Chelsea South, South Fulham PCN, South Westminster PCN Pauloreilly@nhs.net

Over the past decade, the development of direct-acting antiviral treatments (DAAs) has revolutionised care in hepatitis C. It is now curable in >95% of people, usually with a single course of safe and well-tolerated oral treatment, given for as little as 8 weeks. The use of these treatments in the UK, alongside other successful strategies, means that England is on track to eliminate the virus by 2025.

Acute infection is usually asymptomatic, and people can be well with chronic infection for many years. It’s estimated that in the UK, about three-quarters of people with active hep C infection are undiagnosed. Primary care has been identified as a priority where a large number of people with unidentified HCV may be identified. The advice nationally is HAVE A LOW THRESHOLD TO OFFER TESTING, AND NORMALISE TESTING AS A ROUTINE PART OF HEALTHCARE.

Free NHS home-testing kits 

Anyone in England can request a free, self-sampled finger-prick bloodspot test kit for hep C to use at home and return by post. Order online at hepctest.nhs.uk. People with a negative result are informed via text, and those with a positive result are linked directly to their local viral hepatitis team.

Free posters and videos for GP practices

• An A4 Poster highlighting risk, symptoms and the National Testing Portal, primarily for GP/Primary Care settings -HCUL-GP-Poster-V4.pdf (hepculater.com)
• A wallet sized card advertising the National Testing Portal
• TV screens educating on risks/symptoms HCUL EP TV Screens (hepculater.com)

The team have lots of posters available to post direct to your practice. They are also available in Urdu, Bengali and Punjabi – please email w.odili@nhs.net

Hepatitis C search tool in EMIS/S1

Thank you to all PCN’s and federations who have run the search tool called PSIT (patient search identification tool) within S1 and EMIS. This searches for two groups of patients.

1. Those known to be Hepatitis C in the GP practices, and for these patients to be cross checked with national data base systems to either record them as HEP C eliminated or offer additional testing and treatment.

2. Help identify those who may be at risk of Hep C. The at risk patient list requires further discussion with Practices, PCN’s and Federations. The team will be focusing on specific areas of NWL where the at risk population is largest.  

For those who have not yet run the search you will find this below. Do not hesitate to contact Lyndseywilliams@nhs.net.

EMIS practices – In the Population Reporting module, EMIS Library;- SNOMED Searches >EMIS Clinical Utilities > Third Sector Partnerships > HEP C Elimination Programme.

SystmOne practices – email hepcsearches@vipc.co.uk to request the searches.

Education for Healthcare professionals

- The CPD Accredited Training Module gives an overview of testing, treatment and risks for all healthcare professionals and can be accessed here PageTiger Reader Login

- Hepatitis C GP Toolkit - The toolkit is an ‘all in one’ document covering an introduction to the virus, testing, NICE Guidelines, treatment, the National Testing Portal and more.  

- The team are in the process of setting a date for a webinar for Hepatitis C elimination.

Community Liver Health Checks pilot 

The West London Hepatitis C ODN is introducing pilot FibroScan clinics within primary care and community outreach settings in NWL. Primary liver cancer incidence has increased by 50% over the last decade. We are working to identify people with advanced liver fibrosis, with the aim to identify and treat liver cancer at an earlier stage. Please contact sam.gheiace@nhs.net for further information.

Stress awareness month – Keeping Well NWL

April marks Stress Awareness Month.  

This year’s theme for Stress Awareness Month is “little by little”, highlighting the transformative impact consistent, small positive actions can have over time on our wellbeing.

Find more on the Keeping Well NWL dedicated stress & burnout page and information for NHS employers about supporting our NHS people. 

The Keeping Well NWL website has short, quick self-assessment questionnaires that can be helpful if you are unsure about whether to seek support for low mood or anxiety.

All scores are anonymous and no data is saved.  

We are here to support you. Get in touch with us by:     
Telephone: 0300 123 1705  
Email: keepingwell.nwl@nhs.net     
Complete a self-referral form 

NHS England Webinar: Improving the physical health of those living with severe mental illness

The webinar is scheduled for Tuesday 30 April 2024 from 12:30 – 14:00 and is aimed at all colleagues working within physical health for SMI, including clinicians, ICBs, local authorities, VCSE and experts by experience. 

In January, NHS England published new guidance: 'Improving the physical health of people living with Severe Mental Illness: Guidance for Integrated Care Systems'.

NHS England is hosting a webinar to outline best practice for improving the physical health of those living with severe mental illness, who experience a persistent health inequality of dying 15-20 years younger than the general population, drawing on the expertise of those with lived experience of mental illness, carers, primary care and secondary care:

Mark Farmer: Co-Lead Adult Mental Health Advisory Network, NHS England
Dr David Shiers: Retired GP and carer to his daughter with schizophrenia
Dr Emma Tiffin: National GP Advisor, Community and Primary Care Adult Mental Health, NHS England
Dr Ed Beveridge: Presidential Lead for Physical Health, Royal College of Psychiatrists

There will also be time for Q&A.

For more information on improving the physical health of people living with severe mental illness, visit the NHS Futures platform.  

Click here to join the webinar. 

Polypharmacy: Prescribing safely in older people lunchtime masterclass

13 May 2024, 12pm to 1.30pm

Join the webinar to find out why we need to be more careful about prescribing for older people, understand more about the drug metabolism in older people and some of the common safety issues.

Dr Lauren Walker Senior Clinical Lecturer in Clinical Pharmacology & Therapeutics and Internal Medicine, University of Liverpool is a Guest Speaker. The session will include therapeutics, evidence base summary and patient case study for discussion and learning, followed by a Q&A session.

Book now.

Polypharmacy: Stopping antidepressants safely lunchtime masterclass

21 May 2024, 12pm to 2pm

Join Dr Mark Horowitz, author of The Maudsley Deprescribing Guidelines, Clinical Research Fellow and Training Psychiatrist on stopping antidepressants safely and managing withdrawal symptoms, an essential masterclass for clinicians who prescribe these medicines.

The session will include a summary of the evidence base and patient case study for discussion and learning, followed by a Q&A session.

Book now

NIHR ARC NWL Spring collaborative learning event 

Building capacity for integration engaging local workforces  

Date: Thursday 9th May 2024
Times: 10am – 4pm
Venue: St Paul’s Centre, Queen Caroline Street, Hammersmith, London, W6 9PJ 

The event will explore the development of integrated care from the perspective of the workforce. 

Nigel Edwards, Health and healthcare policy expert, will present a keynote talk titled: “Lessons from integration: implications for building local teams.” 

This event has as been approved by the Federation of the Royal Colleges of Physicians of the United Kingdom for 3 category 1 (external) CPD credit(s). Activity Code: 148176

 Click here to register your attendance.