Primary care resources

Meeting the initial health needs of people arriving in the UK from Ukraine

This letter sets out expectations and support for GP registration and the management of the initial health needs for individuals and families coming to England fleeing the conflict in Ukraine.

Primary care commissioning

Primary Medical Care Commissioning Internal Audit Ratings for Delegated Clinical Commissioning Groups

NHS England has today published the second  cohort of ratings on delegated CCGs, highlighting where internal audits are finding CCGs are performing delegated primary medical care commissioning to a high standard, but also helping to identify where improvements can be made. As part of the Internal Audit Framework introduced for delegated CCGs last year, NHS England committed to collate and publish these assurance ratings to support its oversight of delegated functions

The 2018/19 summary has been updated to reflect any new approved returns received from CCGs as of 31 October 2019, for audits undertaken last year.

For clarity, any returns for audits already undertaken in the 2019/20 reporting year (including cases where audit plans were already committed prior to the introduction of the framework and therefore could not begin in 2018/19) are presented in a separate table, which will also be updated and published periodically. At point of publication returns have been received by 66% of Delegated CCG’s and based on these current returns, 98.34% of delegated CCGs are reporting acceptable levels of assurance. The internal audits help provide CCGs with feedback on aspects which need improvement, and helps NHS England target support to those in most need of support.


Controlled drugs use regulations

Health and Social Care Network (HSCN)

 The HSCN is the new network which replaces the national N3 network.  HSCN is a data network that will enable health and social care providers to access and exchange information reliably, efficiently and conveniently.  CCGs will be responsible for the local commissioning of HSCN arrangements for GPs within their area.  Each CCG have been notified of timescales and funding allocations for existing N3 connectivity and commissioning of HSCN connectivity services.

If you would like further information regarding HSCN news and webinars, please visit the HSCN section of NHS Digital website.

For any specific queries regarding HSCN please contact:

Occupational Health – National Primary Care Service Specification

Occupational Health is important in assessing the impact of work on someone’s health, their health on their ability to work and in providing advice on possible support that might be needed. Working with our partners, we have developed a single national Occupational Health (OH) specification to ensure greater consistency in the OH support for staff working in primary care across the country.

The risks of Valproate medicines in female patients

There is a 30% to 40% risk of developmental disorders in children born to mothers who take Valproate during pregnancy. GPs should identify female patients on Valproate and arrange discussions with healthcare professionals on the benefits and risks for them. A checklist for prescribers is now available. Data on CCG prescribing of valproate in ‘at risk’ women and girls is also available.  This CCG data will form part of a monitoring dashboard being constructed in partnership with MHRA which is due for release in the coming months

Individual GP metrics

To support the Government’s mandate to NHS England, the Department of Health has asked NHS Digital to extract data for a set of metrics at individual GP level and provide these data to individual GPs and their practices only. These data will not be published. The expectation is that these data will enable individual GPs and practices to review quality of care and outcomes, to stimulate peer-to-peer conversations and support continuous improvement. The first data packages will be provided in January 2017. These data will be experimental and feedback will be sought from GPs to consider how to improve the data over time. The Data Provision Notice will be sent to practices at least six weeks ahead of the first data extraction.


What metrics are you extracting and why?

We intend to use a set of metrics similar to those published at practice level on My NHS. These are based on metrics that currently exist, and follow a report by the Health Foundation last autumn which made recommendations to the Department of Health on quality indicators within general practice. NHS Digital’s General Practice Extraction Service (GPES) will extract the necessary primary care data for the 12 agreed metrics, one of which will require data from secondary care. A list is provided below. The metrics, where possible, focus on patients for whom the most impact could be achieved in terms of GPs assessing the way in which care is planned and provided.

How will the metrics be extracted and linked to an individual GP?

The majority of the metrics will be extracted from GP systems using the ‘usual GP’ data field and data will be reported back to practices. The data will not be published, but made available only to individual GPs and their practices. Each practice will be provided with their own data; they will not be provided with any patient level data or data from other practices.

When will we get the first data packages and how will I be able to access these data?

The information will be extracted from GP systems in December 2016 and shared with practices in January 2017 in the first instance.

Are these data being shared with organisations outside of the practice and isn’t this just performance management of GPs?

No, data will only be available to practices and individual GPs. The intention is for these metrics to be used by practices to review the quality of care that they are providing to a given set of patients. This is not a method of performance management and data will not be shared with any other organisation. These metrics are similar to the practice level metrics that are published on My NHS. In addition an emergency admissions metric extracted from HES data will be used.

Reporting metrics for individual GPs does not take account of the multidisciplinary nature of primary care.

Each patient should have an accountable GP. We recognise that a patient may choose to see different professionals and patients may be often seen by more than one GP and/or practice nurse for multiple conditions. Practices are in the best place to understand how they provide care to their patients. These metrics are intended to aid discussions, stimulate peer-to-peer conversations and support continuous improvement. This is why these data will not be published. These data are likely to be experimental in the first instance and we will be reviewing the quality of the data to make improvements over time to make these as useful as possible. We will seek feedback from GPs, and consider how data collections can be improved in future extractions to make it as useful and beneficial as possible for GPs and their patients.

Won’t this add to GPs workload?

We want this to be a helpful tool for GPs and their practices to consider and use to support continuous improvement. It is intended that practices use these data as part of their day-to-day assessments that they make on the quality of care that they provide to their patients.

List of metrics

  • The percentage of patients aged 65 and over, who have a record of influenza immunisation during the winter flu season per usual GP.
  • The percentage of at risk patients under 65, who have a record of influenza immunisation during the winter flu season per usual GP.
  • The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the 5 years up to and including 31 March 2017 per usual GP.
  • The percentage of children aged up to the age of 2 with record of childhood immunisations (composite) per usual GP.*
  • The percentage of patients with hypertension in whom the last blood pressure reading (measured in the reporting period) is 150/90 mmHg or less per usual GP.
  • The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHA2DS2-VASc score risk stratification scoring system in the reporting period (excluding those patients with a previous CHADS2 or CHA2DS2-VASc score of 2 or more) per usual GP.
  • The percentage of patients with diabetes, on the practice’s register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the reporting period per usual GP.
  • The percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register per usual GP.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychosis who have a comprehensive care plan documented in the record, in the reporting period, agreed between individuals, their family and/or carers as appropriate per usual GP.
  • The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the reporting period per usual GP.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses aged 25-84 (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) who have had a CVD risk assessment performed in the reporting period (using an assessment tool agreed with NHS England) per usual GP.*
  • Emergency Admissions for 19 Ambulatory Care Sensitive Conditions per usual GP.

*These metrics were in the original request from the Department of Health but have been put on hold and will not be included in the first data extractions.

Localised community outbreaks of influenza in the out of season period

NHS Clinical Commissioners and its members have worked with NHS England and Public Health England to develop an approach whereby Clinical Commissioning Groups facilitate the NHS response to localised community outbreaks of influenza in the out of season period. Following the CAS alert that GPs and other primary care prescribers should no longer prescribe antiviral medicines for influenza on FP10 prescription forms, CCGs should ensure that arrangements are commissioned for assessment of exposed persons and completion of patient specific directions (PSD) to rapidly supply antiviral medicines. CCGs should notify their local PHE Centre flu lead as to how these arrangements are activated, including out of hours.  For more information see our frequently asked questions.

GP services

Safeguarding Children and Vulnerable adults: general practice reporting

For action and onward dissemination by System Transformation Partnerships – effectively Clinical Commissioning Groups working together in this collaboration along with local GP provider representatives. Action is to review local arrangements for general practice reporting in response to local authority requests and where necessary implement changes in 2019/20 . The outcome we want to achieve is to assure safeguarding activity in general practice is supported to contribute efficiently and effectively to local decision making on ensuring the safety of children and vulnerable adults.

  • Cover letter – letter requesting action from STP areas to review support in place to support general practice reporting in response to safeguarding requests for children and vulnerable adults.
  • Annex 1 – Briefing paper providing further context, key considerations for GP providers and local commissioners and highlighting examples of good practice.
  • Annex 2 – Overview of statutory, professional and contractual duties that apply on GP practices.
  • Annex 3 – List of local systems prototyping new ways of working together to safeguard children.
  • Appendix 1 – Example Safeguarding Local Enhanced Service (Generic).
  • Appendix 2 – Example Safeguarding Local Enhanced Service – Child Protection Case Conference – Parents Report.
  • Appendix 3  – Example Safeguarding Local Enhanced Service – Child Protection Summary Report.
  • Appendix 4 – Example Safeguarding Local Enhanced Service – Claim form.
  • Appendix 5 – Example Local Enhanced Service – Claim form (completed).

Publications Approval Reference 000565.