GPC Wales has been lobbying Welsh Government regarding last man standing liabilities
and written formally to Vaughan Gething regarding this.

GPC Wales highlighted the following issues:

When a partner(s) leaves the practice, business related liabilities such as lease
responsibilities, mortgage loans and employers TUPE responsibilities transfer to
the remaining partner(s). In some circumstances, we have seen a single partner
sometimes of retirement age, sometimes much younger, being left holding full
business liability.
The fear of this outcome can lead to a succession of resignations driven by both
workload pressures and fear of being left with sole responsibility for business
liabilities of a size that would be individually crippling.
A practice that was once stable can destabilise within a matter of months, or for
a small or rural practice, a matter of weeks, with for example retirements
following unexpected sickness and new recruitment to practices is frequently
unsuccessful in the current climate.
The repercussions and implications on both a personal and professional level for
GPs are potentially catastrophic with some cases experiencing severe financial
Our strong view that LHBs need to take more ownership of the strategic
decisions they make.
When strategic premises decisions are made the HBs are in effect saying that a
given set of infrastructure is needed to discharge the LHB’s responsibility to
provide universally available primary care in that area. These strategic decisions,
allowing for minor local tweaking, would also lead one to conclude that a given
level of clinical and administrative staff is needed to support that provision.
If this were accepted, we would argue that whilst nearly seventy years
experience suggests that the independent contractor model is the most efficient
way of providing that care, if the current financial, contractual and manpower
environment makes that impossible it should not alter the need for the staff and
buildings to provide it. In addition, we believe that the HB should also commit to
covering TUPE for the practice staff.
 Need for a range of solutions to be put in place to support the recovery and
stability of a practice following the loss of a partner(s) which will need to be
flexible and appropriate to the context of the practice.

These solutions could include:

1) LHBs underwriting new premises leases (or increasingly rarely GP practices
personal investment in premises) and
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2) LHBs underwrite the staff employment within those premises
3) Consideration to exploring whether solutions in other nations would work in a
Wales context e.g. the Republic of Ireland’s Department of Health acts as head
lease holder and sublets premises to general practices for a period of 5/10
years, mitigating risks for GPs. England is currently exploring Limited Liability
Partnerships, a step which provides means of legally separating the person from
the business liabilities.
These issues are having a significant negative effect on the sustainability of
General Practice in Wales and this will only worsen without effective solutions
being urgently put in place.

The response from Welsh Government:

They recognise the problem – that is a start.
There is already in place the ability within Wales for Health Boards to seek
consent to obtain a lease under the NHS Wales Act (2006) and this has already
been used in Briton Ferry and Brynmawr.
Their belief that the approach from Health Boards to premises lease issues,
whether new or historic, can include:
1. Working with practices and providing letter of comfort detailing the
approach to sustainability in the event of “last man standing”
2. Taking the head lease in the case of a managed practice
3. Taking the head lease for a period whilst practice sustainability solutions
are put in place and then the lease assigned over to the practice
4. Taking the head lease and subletting this to the practice for a term of
5/10 years or such agreed between both parties.
These options need to be considered within the premises estates strategy
including the need for robust infrastructure to deliver local primary care.

The solution needs to be dependent on the individualised circumstances,
business and GMS planning between the practices and the Health Boards -
Welsh Government would recommend early discussions where a practice is
concerned about “last man standing” liabilities.

 In addition, Welsh Government confirmed that they are committed to delivering
care closer to the patients home and prioritising further investment in primary
and community care infrastructure.

What this means:

There is the ability for Health Boards to take on and provide solutions to the
problems that are being experienced across Wales – we need to highlight these
to the profession.
GPC Wales will put this in a newsletter but it would be worth LMCs
disseminating this to practices as it will bring some assurances

More is needed – we will be pursuing this both within the contract negotiations
(e.g. additional investment directly into practices, reducing workload pressures
etc that may well help with recruitment challenges around partnership and GP
practice employed salaried GPs) and also measures to address issues that fall
outside of the parameter for contractual negotiations.

Charlotte Jones
Sept 2016

Uptake of this vaccine for teenagers and those going to higher education under the age of 25 was not good last year.

This year we have the advantage of the uprated vaccination fee at £9.80!

Children D/B 1/9/1997 – 31/8/1999 should be pursued and jabbed!

Anyone unvaccinated under the age of 25 THINKING of going to University / College should also be vaccinated.

Vaccines are available through the Paediatric Vaccine Supply Chain.

Any further queries please contact your Health Board Vaccination Co-ordinator.


GPCW is delighted to announce that after persistent lobbying of WG by the team, in particular Phil White, that the arguments for properly resourcing the complex vaccinations and immunisations programmes (as outlined in the SFe) has been recognised.

The IOS fee has increased to £9.80 / vaccine for those vaccines as above and this payment will be backdated to 1st April 2016.

In addition, GPC Wales has now agreed the specification for an adolescent NES for "mop up" or "catch up" vaccinations with each vaccine's IOS being £9.80. This is again backdated to 1st April 2016.

The revised SFe will be sent out in due course.

Warm Regards,

Charlotte & the GPC Wales negotiating team.

GPC Wales are aware of the unexpectedly low aspiration payments for 2016-17 and have been working with NHS Wales SSP branch to investigate further.

An early reply from Welsh Government has found that the SFE for 2016-17 still refers to the calculation of aspiration payments using 59% (59% was used last year because of the reduction in number of QOF points) when it should have reverted back to the usual 70% figure for 2016-17. The necessary amendment to the SFE will be applied as soon as possible and retrospectively from 1 April 2016 - a directive will be sent to all Health Boards shortly with instruction from Welsh Government.

Kind regards

GPC Wales

As part of ongoing work to identify patients at increased risk of significant liver disease, the Biochemistry Department, in conjunction with the Liver Unit will be launching a new tool to evaluate the likelihood of underlying fibrotic change in patients presenting with raised ALT. This tool will involve automatic measurement of serum AST in all primary care patients in whom ALT is raised for the first time and the calculation of an AST:ALT ratio. A comment advising the requester to refer to the liver plan pathway for guidance on further management will be appended to all results. Patients with a ratio ≥1 are considered to be at increased risk of developing significant liver disease, irrespective of the degree to which their ALT is elevated, while those with a ratio <1 are at low risk.

Dr Andrew Yeoman, Consultant Hepatologist, has devised an algorithm based on a combination of AST:ALT ratio, ALT concentration and relevant underlying diagnoses e.g. alcohol excess, obesity and the metabolic syndrome, to guide on further investigation and management (attached below). The algorithm will also be available on the Clinical Biochemistry Home Page and can be found in the ABUHB Pathology Handbook by searching for LFT, AST or ALT and following the external link.

This service will be launched on Monday the 4th of July. However, as this is a work in progress the algorithm may be adjusted following a 3 month pilot period, during which we will be evaluating how well this approach identifies the target population.