Long thread, apologies.

Increasingly concerned at the direction of primary care policy in England.
Also, the lack of clear representation and apparent push-back.

This isn’t aimed at clinicians. We know where the gaps are in leadership.

First flu vaccines.

Every practice (or PCN if you’re all friendly) will be trying to plan the ‘biggest flu vaccination ever’

In a pandemic.

There’s lots of evidence re the importance of flu vaccination and Covid. Primary Care bears a huge responsibility. Fail and the economy/lives/schools lost

So it’s clear that, this year, this is a national priority?

Not really.

Despite a reduction in GP numbers and a workforce that is tired, stressed and often hasn’t taken leave - we are asked to ‘open the doors’ to routine work.

So with the same workforce Practices are asked to cope with winter, staff hot clinics, take a bit of leave and keep themselves well and safe.
And deliver high satisfaction figures in a patient survey.

(And we were always open)

Surely there’ll be Comms to guide us?

The primary care bulletins are a mix of managerial wish lists, merged into paragraphs with no connection to reality, national rules or actual priorities.

We can’t tell patients to wear masks? We can, and the PM said they should indoors.

But don’t worry, there’s a reduction in bureaucracy and more support.

In the form of appraisal which will be starting as the flu season does, and CCG inspections to make sure we aren’t napping or ignoring staff wellbeing.

Feeling supported now?

QOF is surely suspended? ‘We will let you know’

Incentive schemes? - they can restart. As can minor surgery.

And keep the extended hours going.

And could you do some extra work for secondary care as well please (they are financially ok, block contracts and no debt now)

While delivering winter access, vaccinations (no Covid vaccine yet...) and enhanced services at least the mode of delivery is clear.

Everything must be remote.
We must offer face to face consultations.

There must be significant noise from our representatives?

I’ll paste it here....

I’m lucky. I’m in a large and stable practice and have multiple good premises. Many aren’t.

I’ll also get my flu jab. At work.

My worry is that the time needed to deliver a flu campaign safely THIS winter is being underestimated. It matters.

Commission. Properly.

My plea?

Focus is needed. What is important for primary care to deliver Over the next year.

Scrap the rest. Put funding into core, I promise we will be busy enough.

Focus on the imperatives, support with guidance (not about masks), give us the PPE and more staff for 6 months

We need to collectively be clear on this. It is our professional responsibility.

Fail and we all fail is often said about the NHS.

Never more so than this year.

@BMA_GP @pulsetoday

Next:

Prescribing.

Would it be too much to ask @MHRAgovuk and @NICEComms to talk to each other before producing new guidance in the same week?

I understand the concerns about opiates. I’m a low prescriber.

But pain is real.

Imagine a 70 year old with severe knee osteoarthritis. On otc co-codamol.

He can’t take NSAIDs. They are bad for you. Read that paracetamol doesn’t work.

He buys OTC because the CCG issued something in the paper advising him to go the chemist not the doctor.
He can’t mobilise much as been in lockdown. He’s in more pain.

Can’t have an injection as guidance is not to during Covid.
Can’t get an appointment for surgery.
Or physio.

The pain clinic is only doing phone calls and they really like patches anyway.

If there was a knee surgeon appointment the local threshold suggests he has to have tried analgesia before surgery. For 6 months minimum.

Now co-codamol isn’t available At the chemist. Doesn’t really want to bother the GP but then finds they can’t prescribe it either.
(Or they can but the CCG rule is that he has to attend rehab and see a practice pharmacist daily)

Stay at home
Be in pain
Save the NHS.

My plea:

Opiates are important. They are a drug of addiction and over-prescribed generally.

Let’s produce a co-ordinated effort and a plan including access to services.

This needs to be post-Covid or design services in a different way. First.