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Category: Procedural changes



Practice nurse support

You will recall that the practice nurse facilitator programme has been stopped.  We have spoken with the CCG and they assure us that the funding is not being reduced but is being used to fund GDoc to: provide training and mentoring for new practice nurses; facilitate practice nurse meetings and maintain a database of available practice nurses and their skill sets.  The aim is to be able to 'parachute' staff into a practice where that support is needed.

Death Certification - the Medical Examiner (ME)

From April 2019 a new medical examiner-led system will begin to be rolled out within hospitals in England and Wales. The non-statutory system will introduce a new level of scrutiny whereby all deaths will be subject to either a medical examiner's scrutiny or a coroner's investigation.  For GPs, the current arrangements for certifying death will continue for at least 2 years until the ME system is set up and fully functioning within secondary care. The ME system housed in the Trust will then look to expand its remit into the community. GPs are therefore not precluded from applying for an ME role for a Trust; experience working within primary care will no doubt be welcome for when the system moves into the community.  All Medical Examiners must be fully registered for at least five years as a medical practitioner, hold a licence to practice and have received special training in the role. The Royal College of Pathologists as lead college has developed the compulsory online training and is in the process of drafting standards to support the revalidation process.

Further news about the Falsified Medicines Directive

As part of the government's preparations to leave the EU, all eventualities are being considered, including leaving without an agreement. In a 'no-deal' scenario, we expect the UK would not have access to the EU central data hub, and therefore stakeholders would be unable to upload, verify and decommission the unique identifier on packs of medicines in the UK. In that case, it is unlikely that the Directive would come into effect in its current form.

Therefore, the legal obligation related to this would be removed for practices in the UK supply chain. Packs containing the FMD safety features would still be accepted in the UK, provided that they are in line with other UK packaging requirements.

Nevertheless, the government has been clear that it wants to retain a close working partnership with the EU to ensure patients have access to a safe medicine supply. This means that the MHRA regulations will need to be modified to achieve this.

PCSE procedures

As earnest of their good intentions the Engagement Manager in the GP Team for the South West, Tracey Bird, came to the LMC.  She had several key points to put across:

  • PCSE Website has two sides to it. The public unrestricted access part of the PCSE website ( should be the first point of contact.  It is designed in sections to help you to access guidance which will take you quickly to the help or forms you need.  The critical thing is that you should not at that stage Login, as this will only display your private practice related information, as this is a locked-down, secure part of the site.
  • How to contact PCSE. Where possible, communicate with the PCSE using the online forms, here is the link for ease of access:  Alternatively, please call the Customer Support Centre (CSC) Phone: 0333 014 2884.
  • The Online Contact Us Form.  Completing the online form helps to ensure that your query is dealt with by the correct team and assists with providing an accurate audit trail.  Lack of an audit trail can cause problems and loss of time.  If paper must be sent, then please keep copies in case of the post going astray and ensure that the information is clearly labelled. Post: Primary Care Support England, PO Box 350, Darlington, DL1 9QN
  • Pension Payments.  When sending money for pensions contributions please use BACS to provide an audit trail.  Above all, please do not send cheques unless accompanied by adequate details about who it is for. When making a BACS/online banking pension payment, please enter the reference in the following format:

Practice code - year ending - GP's full name

For example:           L84640-YEND2018-Dr John Smith

PCSE's customer support centre can provide NHS England's bank details over the phone.

  • Forthcoming changes - The Performer List.  The performers list will be undergoing changes in 2019.  See: 

When the Performer List process is transformed it will help to modernise the steps, as the practice will receive a notification of any Performer List change requests within their practice. PCSE will share more information on this nearer the time. The PCSE website gives current information. (From an LMC viewpoint we would hope that this notification would trigger the practice manager to tell us of any significant change e.g. GPs arriving, GPs leaving, salaried GPs becoming partners, etc). 

For individual GPs: When making changes to your Performers List record it is very important that you put in the Subject Heading, as appropriate:

  • 'NPL1' - for first arriving on the performers list
  • 'NPL3' - for changes in status, location etc.
  • 'NPL2' - for when you move to another NHS England area.

This then sends your form directly to the correct office for recording the change and is then sent on to the Payments and Pensions office for action.  Here is the guidance link for ease of access:         

  • Outstanding Medical Records (OSMR),

PCSE are trying to get all medical records traced and they have sent practices notifications/ reports to practices based on the last known OSMR location. PCSE plan to conclude this project by the summer of this year.  If you have any OSMRs lurking in a cupboard somewhere (e.g. because they were delivered to you in error) then get on to PCSE at their 'Contact Us': Phone: 0333 014 2884.  

For those medical records which you need then the stop-gap is a GP2GP transfer of the electronic record, with the Lloyd George folder to follow in due course.

For Urgent Medical Records PCSE have provided the latest guidance:

Confidential patient information

  • PCSE Help.  If you need to raise a query, then please first use the 'Help' tab ( to access the FAQs before taking it further. The answer may well be there.  If that draws a blank then use the 'Contact Us' page (  Be aware that the first question you will be asked will be, 'Have you tried our FAQ page?'.  PCSE will log your query and you should receive a CAS number that should be quoted in all future correspondence. 

PCSE would really appreciate it if the Contact Us process could be followed to help PCSE to assist you with your query. We (the LMC) are working closely with the PCSE Engagement Manager, so if all else fails do let us know, together with the evidence of the steps that you have taken prior to contacting us, and we will work with her to get things moving.

STI testing

The Specialist Sexual Health Service

During 2017 the Specialist Sexual Health Service underwent redevelopment to focus the Service on patients with complex GUM or contraceptive needs; and those who might be more vulnerable to poor sexual health (including those under the age of 25).

All access to the Specialist Service (including district clinics) is via the central telephone booking line (0300 421 6500).

The Service now operates a telephone triage system. This helps ensure that patients are booked into routine or emergency appointments; or signposted to alternative points of care, based on need.

The Service also provides postal self-testing for asymptomatic patients who contact the Service for STI testing.

If anyone presents in Primary Care with an STI concern or a risk factor (such as unprotected sex) you should always engage the patient and test while with them. A missed opportunity can be costly for the individual and the wider health of the public.

District Clinics

The Specialist Service runs a number of district clinics. These are all bookable appointments (not walk in) and access is via the central telephone booking line (0300 421 6500).


Clinic location



The Milsom Centre, Milsom Street

Three times a week


Quern Suite, Cirencester Hospital



Coleford Health Centre



Hope House, Gloucester Royal Hospital site

Daily weekdays


Stroud (Beeches Green)



Tewkesbury Hospital



Hartpury College


Royal Agricultural University


For up-to-date opening times, please visit the Hope House website

What should I do if someone presents for STI testing?

When a patient presents with an STI concern or has identified a risk factor (such as unprotected sex), the opportunity should always be taken to test while they are in front of the practitioner. Delaying the test can lead to poor outcomes for the individual and the health of the public in cases where they are positive.

BASHH and RCGP guidance on STI testing in primary care can be found here.

What should I do if a patient presents with a STI positive result?

If the patient has been diagnosed as positive for a STI from the postal self-testing service they will always be invited into the Specialist Sexual Health Service for treatment. If this is unacceptable to the patient, they may opt to seek treatment from their GP. This happens very rarely. However, if a patient presents in Primary Care with a STI positive result, the patient should be treated following local treatment guidelines. In these circumstances the Specialist Service will always endeavour to contact the GP Practice to confirm the result and offer support if required.

If a patient has self selected to order a dual test (Chlamydia and Gonorrhoea) via postal self-testing and has received a positive result, the practice should offer the patient a full STI screen and additional swab sites (where appropriate).

Partner notification

Where GPs are managing a patient who is positive for an STI (the Service will initiate partner notification for patients they are managing), they are encouraged to initiate partner notification (PN). This involves having a conversation with the patient to explain the importance of partner notification and (if acceptable to the patient) provide the patient with a letter they can provide to contacts.

Guidance on PN in Primary Care, including a sample letter for patients to provide to contacts, produced by the British Association for Sexual Health and HIV (BASHH) and the Royal College of General Practitioners (RCGP) can be found at Appendix 1 of 'Sexually Transmitted Infections in Primary Care', which can be found here.

For more complex cases or where support is needed, consent should be obtained from the patient and PN can be referred to the Specialist Sexual Health Service via 0300 421 6500.

New 2ww referral forms

Remember that the new forms to be used for 2ww referrals can be found in G-Care at:

Access to Medical Records


An example has been shown to us of a lengthy form which an insurance company is asking GPs to fill in for a set fee of £30.  This is not an agreed fee by GPC.  The usual rules apply: if it is work outside your contract then you are entitled to charge a reasonable fee to cover the work involved.  As usual it is best to let them know what fee you will demand in advance and get their agreement before doing the work.  In the same vein, you should look at the latest GPC guidance at:  This confirms that agreement has been reached with the Association of British Insurers that the use of SARS is inappropriate – they are now using the Access to Medical Reports Act 1988 process.  Note that electronic consent is acceptable (for details follow this link.) Guidance on setting fees for insurance reports is here.




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