Patient Participation Group

Introduction

It was great to see not only our regular members but also some new members and some who have not been able to attend previously.

Update on Collective action

Dr Wyer recapped about collective action and the reason for it. He explained that there had been some promising movement and a good start on addressing the points raised.

GP collective action in Somerset

GP collective action in Somerset has highlighted several gaps in services, leading to an additional £2m investment from the local ICB, the LMC has said.

Somerset LMC told GP practices in its area that it has finalised a funding agreement for 2025/26 with the ICB, with new arrangements around GPs providing funded services for ADHD, minor surgery and bariatric surgery monitoring.

This will ‘address gaps in service’ that have been ‘highlighted through collective action’, the LMC added.

The ICB has agreed to £2m extra funding and said that this includes uncapped funding for inclisiran, denosumab, and pessary fittings.

ICB funding and service adjustments

In a joint letter to practices, Somerset ICB director of primary care Sukeina Kassam and LMC chair Dr Tim Horlock said: ‘The ICB invested £1.5 million in 2024/25 and will add another £2 million in 2025/26.

‘The additional investment has enabled gaps in service to be appropriately resourced. These include, ADHD (children and adults), MGUS, CLL, polycythaemia, coeliac disease, NAFLD, and bariatric surgery follow-up after two years.’

As part of its guidance for GP practices, the LMC said: ‘Somerset LMC and ICB have now finalised the agreement for New Funding Framework (NFF) for 2025/26. This will address gaps in service that have been highlighted through collective action.’

The ICB told Pulse that it is adding uncapped funding into the minor surgery DES to ‘support additional locally agreed elements’ – including inclisiran, denosumab, and pessary fittings. While the DES is nationally directed, ICBs have the flexibility to determine which procedures are delivered locally.

‘These additions have been identified through local discussions with our GPs, as necessary to address local commissioning gaps and are therefore being funded through the NFF or local arrangements within the national DES scope,’ an ICB spokesperson said.

The ICB has also committed to reviewing the locally commissioned elements of the minor surgery DES.

National and regional developments

As part of the new arrangement, GPs will only be expected to prescribe ADHD medication for patients on an agreed shared care agreement with Somerset Foundation Trust.

The letter added: ‘ADHD will follow a shared care agreement with Somerset Foundation Trust (SFT) but will not include prescribing under “right to choose” or from a private provider. If medication becomes unavailable, patients will be referred to secondary care for review.’

The ICB also acknowledged that:

• GPs should not be responsible for health monitoring of all patients with eating disorders ‘on grounds of safety’;
• Prescribing for patients with gender dysphoria is a specialist service.
• Bariatric surgery follow-up in the first two years after surgery should be a secondary care responsibility.

The letter also pointed out that last year ICB funding targeted health inequalities using a deprivation factor, moving away from the Carr-Hill formula which ‘does not reflect deprivation’ or ‘compensate enough towards the additional costs’ that practices serving a deprived population incur.

It added: ‘This additional funding will continue. The national funding framework also contains a small practice premium for practices with fewer than 5,000 patients, recognising the vital role of small rural practices in serving our dispersed population.

‘The 2025/26 contract will continue hypertension optimisation, particularly for those not covered by the QOF and will also prioritise dementia and frailty coding.’

Pulse has previously reported on GPs in several areas coming together to serve notice to their ICBs on unfunded work as part of collective action, including various services and shared care arrangements, such as PSA monitoring, phlebotomy, ring pessaries and ECGs.

In Cambridgeshire, the action has led to the introduction of a new commissioned service for PSA monitoring after the ICB acknowledged the service gap.

In an update to practices, Cambridgeshire LMC said: ‘There is no doubt that your collective withdrawal from PSA monitoring has had an impact. It directly led to the introduction of the new PSA LES, with our ICB acknowledging the commissioning gap and properly contracting for this work.

‘The LES wording is clear in defining why this work sits outside GMS, ensuring appropriate recognition and funding.

‘The committee also reviewed progress on other locally commissioned services and was encouraged to see that the ICB has listened to LMC feedback. Changes are being made, including a shift towards tariff-based funding, which better reflects the true costs of providing these services.’

Practices have taken action serving notice on any underfunded services, which has produced a financial impact in some areas, including Humber and Yorkshire, where both local ICBs said they had to provide an extra £1.6m to mitigate against practices servicing notice on locally commissioned services.

The BMA has most recently advised GP practices to continue refusing unresourced work from local commissioners. Following the 2025/26 GP contract deal, collective action is still in place but aimed at ICBs rather than the Government.

Last month, GP collective action in Kent led to an agreement from the ICB to fund new locally commissioned services, including for CVD and ADHD.

News from our surgery team

Our new triaging system

CB explained what we have been working on over the past couple of months. In order to meet the increasing demand, we have overhauled how we currently manage our appointments. Moving away from surgeries where the GP would be juggling askmyGP requests, telephone calls and face to face appointments within surgery. We have streamlined our surgeries allowing the GP to focus on face-to-face appointments or telephone calls and avoid multi-tasking.

All incoming requests and enquiries are added on to Askmygp by the Care Navigator team. This enables the GP to work through the list alongside the Care Navigators who are positioned upstairs. The Askmygp sorting is rota’d so that face to face appointment capacity is not lost. The GP working on Askmygp is sat with the Care Navigator team advising them on the appropriate appointment and the appropriate timeframe in which the appointments should be booked. If there are things that can be resolved without becoming an appointment it is at this point it can be actioned preventing an additional appointment.

For patients who do not have access to IT or are unable to use Askmygp this does not change anything for them as our team create it on their behalf.

The receptionist on main reception can concentrate on meeting and greeting patients and answering the telephone.

Dispensary

The group was asked for feedback on the closure. The group had no issues with the closure and appreciated the need for it for safety. There was feedback that there is still some inconsistency in the texting when medication is ready for collection.

Nursing team

Covid clinics now completed 590 vaccinations was given. Home visits will be happening shortly. Currently recruiting for another phlebotomist.

Health coaches

As Health Coaches, we are often engaging with patients who are lonely or have no family friends in the area. This can sometimes take a toll on their health – they could be unable to get to a support group which may help, unable to get to an appointment at GP surgery, unable to collect prescriptions…..etc

Sue Crisfield (RPN Social Prescribing Link Worker) and I had a meeting with the Fiona Miller Chair of Sherborne Good Neighbour Scheme. We are hoping to have something like this in Milborne Port for patients of the surgery. This would be essentially for patients who need a bit of friendly assistance and do not have family/friends who can help.

I have printed the objective and operational procedures they use for information.

Once you’ve looked at the paperwork, if anyone would like to be involved with this project, or know anyone, please let me know. We may not be able to cover all the areas Sherborne have; we are looking to start small.

We are currently looking at ways this can work as I am unable to head it. I am happy to be the surgery support for it. Once we have more information how we will move forward with this, I will be in contact with those interested in helping.

We have attached a copy of the Sherborne good neighbours’ objectives and operational procedures.

Property update

The area outside the waiting room at Milborne Port has now been completed and looks much nicer and safer underfoot in bad weather.

New blinds have been fitted to the waiting area at Milborne Port.

Flooring is due to be replaced at Templecombe. Kate is still in discussions with this and funding for surgery improvements.

Gardener has been employed to help improve and maintain the outside area of Templecombe.

The Templecombe Surgery discussions are still ongoing……………..

Next meeting

TBC in September