PCIP Updates

Available pharmacist and technician resource should now be as equitably distributed as possible across practices with some challenges remaining with regard to cover during periods of staff absence. Some pharmacotherapy team members are working remotely to assist with space utilisation in practices or cross-cover for colleagues. The latest MOU document advises that Level 1 service is now the priority and that this must be universally delivered by ** for NHS Borders to avoid penalty. The Exec GP members continue to seek transparency around the allocation of resource within the pharmacotherapy team as variability from historic arrangements continues to be uncovered. Our focus is on robust, resilient Level 1 service delivery by the agreed date and as a result the Exec is not currently supporting individual practice variations.

Nationally, it appears that progress is generally very slow towards practices securing sustainability loans. SGPC colleagues report legal issues (outdated partnership agreements or title deeds) and problems with technicalities related to mortgage lenders. This is a complex area so practices are advised to seek robust financial and legal advice to proceed.

The FCP service currently has two newly appointed practitioners on maternity leave. They are due to join the service over the Summer. Interviews were held on 11^th May for the current 3.2wte vacancies. There was a good level of interest in these posts and interviews were positive so we are hopeful that we will be able to strengthen the team (possibly even complete the team) as a result. Once sufficient FCPs are inducted and in post, the workstream will be reconfigured to work from a virtual appointment system. This will provide initial remote telephone triage with necessary, face to face consultations in practices. FCPs will retain their working relationships with a small group of practices as this of value to FCPs, GPs and patients. Two FCPs have recently completed joint injection courses and there are further plans being made for future professional development.

This work stream continues to thrive and provide a Borders wide service which is readily accessible and a “one-stop” contact for patients. There is wide variation in the rate of referrals between practices so we would encourage every practice to ensure that this is offered to patients. The service has only been fully staffed since the turn of the year so it is the intention to collect data after 6 months of full service provision. Scottish Government has recently announced additional funding to support national mental health services so we are hopefully that in some form this will help to support or even expand this service. To avoid any confusion in identity with the Community Mental Health service – Renew has now been identified as the “PCIP Mental Health Hub”.

This work stream is now fully recruited with trainee ANPs now all attached to practices and working alongside GP mentors. PCIP Exec would like to express our thanks to colleagues who have volunteered to accommodate our trainee ANP colleagues as we appreciate that this requires a significant time commitment from everyone involved. The deferred university training course is due to start at the very end of this month. We are also grateful to Dr Lynn Buchan who has very kindly used her expertise in this field to formalise an in-house education programme across primary and secondary care to support the training of our nursing colleagues. This will not be successful without the contribution of our secondary care colleagues so we should acknowledge the willingness and generosity of our colleagues to participate in this work. Host practices should note that we understand that the initial university modules may not be deferred but instead compressed to catch up for the delayed start. This may mean that the trainees need additional, disproportionate study time away from clinical duties over the next few months. Practices are asked to ensure that the clinical duties and responsibilities allocated to trainee ANPs are appropriate for individual’s level of training and experience.

Delivery of this workstream is due by 1.10.21 with Transitional arrangement fines only applicable from 1.4.22. NHS Borders is currently building on the Covid and flu vaccine programme infrastructure to plan future delivery of all adult and child vaccinations. Planning for delivery of this workstream is continuing at pace with optimism that the tight time deadline can be met locally. Identification of recurrent funds to permanently resource this area of the new contract is a sticking point at the current time as the entirety of the allocated £3.2 million for PCIP has been earmarked to date. Some of the additional, non-recurrent funds can be used for short-term posts to set up and establish this service.

Much working is currently going on behind the scenes to look at an innovative model for delivery of this work stream. Whilst a service must meet the requirements of the GMS contract, discussions are underway to consider dual purpose hubs to provide services to both primary and secondary care. This has the potential to reduce administration for GP practices by providing secondary care with a direct route to request investigations in the community with results reverting back to the requesting clinician. Despite discussions over the past couple of months, there has not yet been a concrete commitment from secondary care regarding the resource that can be contributed to or mobilised into a dual purpose hub model. Therefore, it is the position of the Exec GPs that the primary focus must remain on the contractual specifications for this workstream. Progress in this area cannot be delayed for the possibility of a broader, more ambitious model even though we believe that this would be preferential for patients and GPs alike. Again, there is a lack of clarity over the funding source for this work stream which requires secure, long-term investment to honour the contractual requirements. The Exec GPs are very aware of the additional demands that remote secondary care consulting is placing on community services as requests for investigations to be performed are transferred to Treatment Room, District Nursing and practice services. GP representatives on the Clinical Interface Group (CIG), GP Sub, AMC and PCIP Exec are raising concerns about this unilateral, unauthorised workload transfer at every possible opportunity as it is unsustainable and lacking in clinical accountability.

This service has been greatly constrained by the Covid restrictions over recent months but face to face contacts should be resuming shortly. The service provision has also been reduced in some areas due to vacancies. A Service Level Agreement (SLA) is currently being drawn up between Scottish Borders Council and NHS Borders for the provision of the CLWs.