Frequently asked questions
There is a recent Welsh Health Circular "The safe and responsible adoption of ambient voice technologies (‘AI Scribes’) in clinical and practice settings". The BMA also have guidance below which is worth reading before starting to use an AI medical scribe. NHS England also have a comprehensive document "Guidance on the use of AI-enabled ambient scribing products in health and care settings" which is recommended. An overview of this document is available below, courtesy of Gill Farmer from GPC/LMC Interface:
Overview
This document, published by NHS England on 27th April, provides guidance on the deployment of AI-enabled ambient scribing products including advanced ambient voice technologies (AVTs) used for clinical or patient documentation and workflow support in health and care settings. It is of relevance to GPs aiming to implement a specific product. This is the first in a series of documents to be published over the next six months. An AI Ambassadors network will be established to support best practice and sharing of insights.
What are AI-enabled Ambient Scribing Products?
These are speech recognition and natural language processing (NLP) systems that:
Record and transcribe conversations between clinicians and patients during consultations.
Use AI algorithms to generate structured clinical notes, such as SNOMED-coded entries.
Can auto-populate sections of the patient record, with clinician approval.
· Can generate outputs in the form of medical letters or other documentation.
Can recommend actions such as onward referral.
Some tools include features such as:
Automatic summarisation of discussions based on text transcripts.
Intelligent prompts for missing clinical information.
Real-time transcription during the consultation.
Information from Morgannwg LMC regarding responding to Private Healthcare requests for Bariatric Care follow up can be downloaded here
BMA advice regarding private healthcare requests can be found here:
Unfortunately, there is no useful local guidance.
This issue has been raised in the past by the LMC with GPC Wales at national meetings and also locally with Mr Beamish (SBUHB's Clinical Lead). The discussions are ongoing, and a national solution is required. The LMC have recently approached SBUHB regarding this problem and highlighted the unhelpful response from the bariatric surgery department in that if they took this on they do not have the capacity.
At recent meetings with MLMC, SBUHB and Tertiary departments the key message to GPs was that patients should be referred to secondary care and they should not be refused. They will be added to the waiting list so that referrals can be catalogued and the patient will be written to and given a leaflet on what to look for re complications. Patients will be advised by the service that there is “No prospect of them being seen within 2 years” due to current waiting lists. The department have reassured that for any complications patients will be seen.
It is the view of GPC Wales and the LMC that post-bariatric surgery is not considered a general medical service. The primary responsibility that GPs have is to ensure that patients receive the appropriate follow-up that a GP decides is indicated. This includes referral to secondary care even where a specific service has not been commissioned by the Health Board. We note that you are having referrals rejected and whilst there is no other alternative patients will unfortunately have to continue within private healthcare until the secondary care infrastructure is resolved. Obviously, this is very difficult with the issue of private providers abroad.
The LMC believes that an MDT approach is required and completely agree specialist input is required. The patient can and should be referred to NHS services even if the surgery was undertaken privately whether in the UK or abroad.
Post-operative tests are required to ensure adequate nutrition is maintained. These tests are part of the patient’s follow-up which the surgical provider should provide, however, for pragmatic reasons practices can perform the phlebotomy and send the results to the surgical provider.
If the patient chooses to have surgery privately, the practice’s responsibility is the same, as patients have the right to move between private and NHS at any time. It remains the responsibility of the private provider to advise the patient and practice of management of any abnormalities found. If the private provider is outside the UK the practice can seek Advice and Guidance from local gastroenterologists/bariatric surgery or dietician. Patients need to be aware that follow up is part of the procedure for 2 years following surgery and should have been organised by their private provider.
If a patient did undergo surgery privately in the UK you can consider writing to the service provider stating that you consider it is their responsibility to undertake any specialist follow up which should be included in the contract that they have agreed with the patient.
The LMC are aware that BOMSS provide specific guidance for GPs but the LMC feel that this level of monitoring should only be considered GPs with a special interest who are able to take on the legal risk. As GPs we are driven to try and do the best for our patients but in this instance the LMC would suggest that the practice reconsider the benefit of partially accepting the monitoring and therefore the legal responsibility.
GPC Wales, and the LMC will continue to raise the requirement for the establishment and commissioning of an appropriate service.
The bottom line is if you do not feel you have the experience to manage post operative bloods then you should refer into the bariatric service. If you have referred it will not be your responsibility if SBUHB do not have a service, but if you take on the bloods the responsibility will be yours to manage appropriately.
For reference:
NICE Quality Standard QS127:
People who have had bariatric surgery have a postoperative follow-up care package within the bariatric surgery service for a minimum of 2 years.
Follow-up care package
This should be for a minimum of 2 years and include:
· monitoring nutritional intake (including protein and vitamins) and mineral deficiencies
· monitoring for comorbidities
· medication review
· dietary and nutritional assessment, advice and support
· physical activity advice and support
· psychological support tailored to the individual
· information about professionally-led or peer-support groups.
[NICE's guideline on obesity: identification, assessment and management, recommendation 1.12.1]
For the first 2 years after surgery, follow-up appointments are likely to be with a dietitian or a bariatric physician. It is assumed that in the first year the person has 3 follow-up appointments, with annual follow-up thereafter. After the first 2 years, follow-up appointments are likely to be with either a dietitian or a GP within a locally agreed shared-care protocol.
[NICE's full guideline on obesity: identification, assessment and management, section 8.1.3.2]
Writing to the HB and also Llais would help increase the pressure on the HB.
A recent Welsh Health Circular has been released which states that secondary care should be accepting patients onto waiting list and not referring back to the GP. The LMC are therefore advising GPs to refer into secondary care if your patient requires assistance with post bariatric care in the first two years.
Included below a link to the WHC relating to post private Bariatric Surgery follow-up:
It states that if a post-op bariatric patient cannot, or chooses not to access private sector follow up, the GP may refer into secondary care, for specialist level 3/4 post-operative follow-up as per NICE guidance. Patients should be accepted onto waiting lists according to clinical priorities identified by the referrer and receiving health board. In line with NICE guidance, and once identified as clinically fit for discharge, the patient will be discharged in accordance with the local pathways (WHC/2024/005).
Firstly – thank you for coming to the LMC about this issue! There is a very robust document outlining responsibilities in communications between primary care and secondary care. It can be accessed here. We have also created a template letter which can be used to reply to the inappropriate request (available to download here), please remember to copy us into correspondence (removing any patient identifiable data) so that we can identify trends and take appropriate action!
Dear Doctor,
I note your recent request for investigations to be done in general practice which is attached to this letter. Upon discussion with Morgannwg LMC, We remind you of your professional responsibilities as agreed by Welsh Government, NHS Wales and BMA Cymru Wales:
· If Secondary Care require investigations to be done then it is the responsibility of the requesting Secondary Care department to arrange the investigations to be carried out.
· If Secondary Care organise investigations, then it is the responsibility of the requesting Secondary Care department to review the results and action them appropriately.
· Handing over of responsibility for patient care from secondary care doctors to General Practitioners should only be done when the General Practitioners agrees to accept responsibility.
This position is not intended to be obstructive, but to simply adhere to our duty to provide safe, consistent, and appropriate care for our patients. We are also supported by our statutory representative body Morgannwg LMC.I have copied this email to Morgannwg LMC at office@morgannwglmc.org.uk.
Yours sincerely
[name of practice]
PCIC team in Cardiff & Vale Health Board have jointly created a template letter for responding to requests from Private Healthcare providers:
There is an All Wales Information Leaflet which provides guide for clinicians in managing diagnostic requesting for patients receiving private healthcare treatment which is attached below:
The leaflet is summarised here:
Responsibilities for Testing:
Private consultants are responsible for arranging and managing all aspects of their private patients' healthcare, including diagnostic tests. Patients pay for these services as part of their private care.
NHS General Practitioners (GPs) and clinicians should not be arranging tests for private consultants or their patients unless those tests are part of the patient's NHS care.
Transition Between Private and NHS Care:
Patients who begin private care can transfer back to NHS care if their treatment is available on the NHS. However, they must:
Undergo reassessment by an NHS clinician.
Adhere to normal NHS waiting times.
GPs are not obligated to arrange or prescribe treatments privately recommended if they go against normal NHS practices.
Prohibition of Mixing Private and NHS Care:
Private consultants cannot use NHS resources for private patients unless those services are explicitly identified as private and invoiced accordingly.
GPs should avoid requesting tests through the NHS system for private care to prevent potential legal or ethical violations.
Criteria for NHS Test Requests:
Any tests sent to NHS services for private patients must be labeled as private.
Private consultants are required to inform patients of the costs involved and ensure their consent before referring them for NHS tests.
Examples of Scenarios:
Patients transferring from private to NHS care must follow the standard NHS process, including reassessment and waiting times.
Private consultants recommending tests must arrange them if they manage the patient’s care. NHS GPs are only responsible if they assume full clinical responsibility for the patient’s ongoing care.
Additionally GPC England has written guidance to help practices reduce extra workload generated by requests from private providers which is an excellent resource in responding to requests from private healthcare which can be found here.
AWTTC also have a document "Prescribing dilemmas: A guide for prescribers" which contains information regarding this query, as well as many other prescribing issues.
Note that private provider requests for information regarding GLPI-1 agonists are addressed in the BMA guidance here, which includes a template letter.
The LMC is not aware that it is National or SBUHB policy to refuse a referral if a template is not completed. The GMC also specifies that relevant information should be included, and this is considered sufficient for appropriate referral. GPC Wales policy is for a universal referral form via WCCG, and not for individual templates. A template does not need to be used if all the information requested on the template is on a referral via WCCG.
The LMC therefore advocate for a WCCG referral in the free text box, with the correct referral information. However, if referrals are missing essential information ( which should be made clear on the health pathway), this can be sent back to the practice to be amended and in the future ensure that this information is included.
Please do let the LMC know if you have been asked to complete a template, as we can support you in reminding the department of the local & national policies.
If your query is regarding clinical responsibility, prescribing duration, foodstuffs, complementary medicines and alternative therapies, common ailments, fertility treatment, erectile dysfunction, prescribing for self and family, visitors from overseas, travel and occupational health vaccines, prescribing situations not covered by the NHS including private care and private prescriptions, unlicensed medicines, or prescribing outside national guidance then please review the AWTTC document "Prescribing dilemmas: A guide for prescribers" attached below.
There is no GMS obligation to request this Xray and you may reply declining to undertake this unfunded additional work.
RCEM guidance states that "in general, for patients the ED discharges the ED must take responsibility for the checking of reports and acting on any abnormal or missed findings" and that "Emergency Departments should try to avoid requesting primary care teams to ‘follow-up’ or ‘chase’ the results of tests requested by the ED team."
Unfortunately the LMC have established that the CMO breach forms that practices have been using to report breaches of the All Wales Communications Standards were not being collated by the HB. Practices should therefore cease to use this reporting tool and log ALL breaches on the All Wales General Practitioners Datix page.
General Practitioners - NHS Wales Shared Services Partnership
To ensure that SBUHB Primary Care colleagues have access to these it is necessary to use the “Logged Out datix form”. If the logged-in form is used this goes straight to the department being reported, and this is not being affectively governed. By sending all datix reports via primary care it will be possible for the HB to monitor trends which will be extremely beneficial as these will be shared with the LMC.
You need to use a NHS email and also need to use the link above and not save the link to SB logged out form directly as the link changes every few months .
Could the LMC ask that you remove and delete any saved links to the previous datix or CMO Reporting tool. We recognise the effort that reporting takes but feel that this is a significant step towards greater transparency and appreciate your support.
Any specific concerns or questions about Datix submitted, please contact Amanda Reece- Quality and Governance IT lead for primary, community of therapies group.
Use of the Welsh Clinical Communications Gateway for all clinical correspondence has been agreed by the Local Health Board and the Local Medical Committee. This process has been agreed as there have been instances where email and other, non-WCCG, forms of communication have not been promptly actioned due to the inherent lack of robustness in the process (staff being on annual leave etc).
This is to ensure adherence to the “All Wales Communication Standards between General Medical Practitioners and Secondary care” (available here).
A sample letter for you to use when replying to such requests is available here.
The Clinical Online Information Network (COIN) houses local clinical guidelines and protocols from across the entire Health Board ensuring high quality consistent cost-effective practice. Library Services play an integral part in maintaining the quality assurance of COIN, in addition to linking to electronic resources such as Full-text Finder and UpToDate.
(Please note that this link is to a Swansea Bay Intranet only site and is therefore accessible to Health Board employees only)
Enhanced services vary across Wales, and there is no single resource describing them. Morgannwg LMC has created a summary spreadsheet (in both excel and pdf format) describing the services available in every Healthboard in Wales. The information was obtained by making freedom of information requests to each Healthboard and also to Welsh government. All information in the spreadsheet comes directly from these public sources.
Please use it to support your business planning and negotiations.
This project was made possible through a generous grant from GPDF. If you have any questions or suggestions please contact Morgannwg LMC.
The information is available as an Excel spreadsheet or PDF and the source information is available here.
Budgeting and forecasting
To help practices to calculate costs incurred in providing supplementary services, Gwent LMC have developed a useful calculator which has been included below. It is necessary to factor in human resource expenses (salary, oncosts and mandatory training) , building expenses (including insurance) and materials and fixed costs. This means including proportionally the number of clinical and admin staff involved and all the running costs such as fridges, beds, lights in minor surgery room, extra cleaning etc.
Enhanced Service Financial Calculator
Gwent LMC have developed a calculator to aid business decisions about the viability of enhanced services for practices. It will allow additional costs such as pension, NI contributions etc to be automatically included. Just input hourly staff rates and time spent by differing members of the practice team to get an overall estimate of practice costs to complete an activity.
Gwent LMC Enhanced Service Calculator
Recent Uplift from SBUHB
Please note that MLMC were unable to reach a mutually agreeable position regarding an uplift with SBUHB. SBUHB felt that their offer of a 5% uplift was reasonable considering their financial position, but MLMC did not feel that they could endorse the offer based upon the information contained in the comparative spreadsheet.
If practices would like a further discussion about supplementary services please do not hesitate to get in touch with MLMC.
The letter from SBUHB can be downloaded for reference here.
The Welsh Clinical Portal (WCP) (please note that this link is to a Swansea Bay Intranet only site and is therefore accessible to Health Board employees only) is a patient record across hospitals and health boards in Wales which is available to doctors and health professionals through a single application.
The Welsh Clinical Portal makes it easier for health professionals to collaborate and access vital information about the patient.
It shares, delivers and displays patient information from a number of sources with a single log-on, even if that information is spread across health boards. With information in one place it means clinicians always have access to up to date and accurate patient records.
The main features include:
Requesting tests
Electronic test requesting allows clinicians to create test sets, bulk order tests for multiple patients and request tests for a patient on selected days.
Prioritising referrals
Helps clinicians sort and display electronic referrals into levels of urgency, place them on hold, or request more information from the GP.
Creating patient ‘watch’ lists
Allows clinicians to keep track of patients more closely by organising patient care in a way similar to how shoppers sort their lists on consumer websites.
Viewing your patient’s GP record
Clinicians can access a summary of important information held on a patient’s GP record, such as current medication, recent test and allergies.
Accessing results
Diagnostic test results and reports for are available to view in the portal, regardless of where they are produced in Wales.
Accessing radiology images
Patients’ x-rays, ultrasound, CT and MRI scans taken anywhere in Wales are available to view in the portal. There is a new National Imaging Viewing User Guide available.
Viewing your patient’s medical history
Patients’ referrals, discharges, letters, outpatient assessments, clinical notes, care plans, contact lists, and much more are available for clinicians to view at any point in a patient’s journey.
Listing medication and prescriptions
A pre-populated list of medicines can be important from a patient’s GP record.
What is the problem? HMRC has recently taken a keen interest in the employment status of many independent contractors which includes GPs working in a sessional capacity. In essence, if it determines that you are employed, as opposed to being self-employed, then your tax and national insurance contributions will be removed by the organisation which pays you. In addition, if the organisation has, in HMRC’s opinion, wrongly treated you as self-employed then the organisation can face a significant fine and interest which can potentially go back as far as 20 years. Therefore, this is causing much angst amongst employers. In particular, Health Boards have become very concerned about their potential liabilities and have commissioned specific advice from Deloitte. The Health Board interpretation of this advice has concluded that GPs working for the Health Board but not in a salaried position (e.g. in out of hours centres; in prisons; doing shifts in a minor injuries unit; working in directly managed practices) should be classed as employed for taxation purposes but not for employment purposes. Thus, you would be unable to access employment rights, which includes annual leave / sick leave / maternity leave / and other parental rights. Their assertion applies to all sessional GPs whether working through an intermediary (where IR35 applies) or not. Please note, for avoidance of doubt, this guidance applies also to GP principals or salaried GPs offering services and directly contracting with the Health Board on a sessional basis for the types of work as outlined above.
Does GPC Wales believe that the Health Board interpretation of the taxation status is correct for GPs working in above settings?
Sadly, it appears that the HMRC toolkit to determine whether an individual is employed or self-employed isn’t always that clear-cut, and thus there are risks to any organisation in getting it wrong. However, we support the guidance in other parts of the UK; namely that blanket application of the ruling is wrong as it doesn’t allow for differences in an individual’s circumstances.
Does GPC Wales believe that the Health Board interpretation is correct for the employment status / ability to access employment rights of GPs working in above settings?
We do not feel this interpretation is correct. The tests to determine whether an individual is employed for taxation purposes and for access to employment rights are very similar, and it seems nonsensical to say they apply to one section and not to the other. We believe this could be open to challenge by GPs who contract directly with the Health Board. However, if you are working through an intermediary/ personal service company (see below) then it is unlikely that you could argue you are employed for employment benefits.
Isn’t this just about the HMRC IR35 regulation?
This is wider than the application of IR35 regulations. IR35 solely applies to GPs working through an intermediary such as limited liability companies. These are often described as a personal service company which individuals have set up so that they avoid paying tax and are liable to a lower rate of tax via corporation tax (which currently stands at 19% rather than the tax levels for higher earners) and this is why HMRC at trying to close the loophole. The approach from the Welsh Health Boards applies to all sessional GPs working as above. Matt Mayer from the BMA sessional GPs committee has written an excellent blog on this issue which can be accessed here.
Should I just accept the HB advice?
We would say no. There are a few issues to consider
Lack of consultation: is this fair or right given the significant change to your terms and conditions of service?
The assertion that employment status does not confer employment rights Do your own HMRC toolkit assessment and take individual accountant advice
Talk to your LMC or contact the BMA if you are a member (unfortunately neither are in a position to offer individual legal or financial advice).
WHAT ACTIONS ARE POSSIBLE?
1. What can I do?
Consider the BMA website advice, complete the HMRC toolkit and discuss the results with your accountant. You could use it to challenge the Health Board to apply non-employed status to you. However, it is unlikely the Health Board will change its stance and the toolkit isn’t quite clear cut.
Consider whether you want to continue working for an organisation that has taken this unilateral action. Your accountant may be able to help guide this with respect to impact on tax brackets etc.
Consider whether to ask your LMC to act on your behalf and outline what course of action you wish them to take. You should do this whether you continue working or not.
Consider whether you are willing to withdraw services or not? The BMAs sessional GP subcommittee states that you can consider the following:
If you are willing to withdraw services, then further think about whether you would add your name to signatures to be gathered by LMCs threatening to withdraw services OR write to the Health Board declaring a termination of service in accordance with the contractual obligations to which you are subject.
If you are not willing to withdraw services, then (if you are a GP who contracts directly rather than via an intermediary) consider writing to the Health Board telling them that you believe you are entitled to statutory employment protection and reserve the right to take them to an employment tribunal, and advise them, if employment tribunal found in your favour that you would be chasing historic holiday pay / sick pay / pension etc. back to your start date. This latter needs to be done by an individual GP.
2. What can your LMC do?
LMCs do have the responsibility of acting on behalf of all GPs in their area in all their working roles. To do so effectively they need a clear mandate from the workforce affected – therefore you have to play your role in making your feelings known. The LMC can:
liaise with Health Board to ask further questions as to validity of this change to terms and conditions of service through seeking to see evidence, challenging lack of consultation, highlighting potential adverse impact on sustainability of workforce and service provision (including whether this is on the Health Board’s risk register)
work with the Health Board to find possible solutions e.g. deferred implementation date of changes to enable consultation, devising a zero-hours contract for local GPs to work under which could confer some employment rights etc.
keep local GPs up to date with likely impact of these decisions and progress on solutions
work on your behalf without you having to raise your head above the parapet e.g. gather signatures from affected GPs threatening to withdraw services; OR collate responses from GPs to the Health Boards declaring a termination of services in accordance with the contractual obligations to which they are subject.
3. What is GPC Wales doing?
GPC Wales is:
working closely with LMCs to support them in progressing local discussions and solutions on behalf of GPs in their area (that’s why it is important to make your views and situation known to LMCs)
in our regular meetings with the Welsh Government, highlighting risks to service provision and workforce sustainability in an already creaking service area, requesting that it seeks assurance from Health Boards on how these risks have been considered, including in respect of winter pressure plans
considering what other national solutions may need to be implemented after listening to the profession and seeing how the Health Boards respond e.g. a national zero-hours contract for GPs working in settings as above What already happened in Wales and elsewhere?
Betsi Cadwaladr UHB did not use Deloitte to determine its stance but instead worked directly with HMRC. This has already been put in place and GPs have made individual decisions whether or not to accept changes, and this has resulted in less GPs working in directly managed practices.
In Dorset, a blanket policy was applied early in 2017 which was challenged by GPs, LMC and GPC. A new deal was offered to GPs with better pay and employment rights and a catastrophe was averted.
In Swindon, the OOH trust applied a blanket policy but despite pressure did not back down and this resulted in great difficulty in sourcing doctors.
What should I do next?
It comes down to whether you as an individual want to take action on this. Please review this guidance carefully and consider all the available options before deciding on your response. The Local Medical Committees and GPC Wales are here to help. We need to know your views to inform our next steps in discussions with Health Boards at a local level, and the Welsh Government on a national basis. Please inform your LMC about what you want to see happen.
Azathioprine/Mercaptopurine
Rheumatoid arthritis
Inflammatory bowel disease
Diffuse Interstitial lung Disease
Misc Inflammatory diseases
Ciclosporin
Rheumatoid arthritis
Psoriasis/atopic dermatitis
Denosumab (Prolia)
Osteoporosis
Bone loss
Leflunomide
Rheumatoid arthritis
Psoriatic arthritis
Amiodarone
Ventricular arrhythmia
Paroxysmal atrial fibrillation
Wolff-Parkinson- White syndrome
Lithium
Treatment and prophylaxis of mania, bipolar
disorder, and recurrent depression, aggressive or
self-mutilating behaviour
Sulfasalazine
Rheumatoid arthritis
Inflammatory Bowel Disease
Methotrexate oral and subcutaneous
Rheumatoid arthritis and psoriasis
Psoriasis/psoriatic arthritis
Neurology indications (MS, MND)
Mycophenolate Mofetil
Rheumatoid arthritis
Penicillamine
Rheumatoid arthritis
Auranofin
Rheumatoid arthritis
Sodium Aurothiomalate
Rheumatoid arthritis
Any other medications prescribed under a shared care arrangement are not funded under an Enhanced Service. For information on how to withdraw from an enhanced service please see this FAQ.
GPs are not contracted or have any other requirement to provide support or advice to the ambulance service. Practices should aim to support their patients by cooperating with other organisations who may also provide care to their patients. However, there is no contractual obligation for practices to give clinical advice to ambulance crews.
There are senior clinicians in the ambulance control centre available when crews have a clinical query. Sometimes, crews may need to contact the GP practice to gain medical history, which your administrative team may be able to provide from the patient medical summary. It is the choice of the practice if their team give advice to ambulance crews but is not contractual and practices are under no obligation to respond in certain timeframes.
Practices may wish to consider developing their own policy which may cover:
- Ascertaining the reason for the ambulance contact to the practice.
- Provide medical history relevant to support ambulance assessment of the patient.
- Escalate the contact to appropriate clinician if the practice has chosen to do so.
- Informed the ambulance crew of possible timeframes of any response.
- Practice may offer advice if they choose but may also redirect ambulance colleagues to their own clinical supervision and advice pathway.
If offering clinical advice to an ambulance colleague, do consider that you are advising based on a clinical assessment you did not perform and so you must be confident in that assessment. If you do provide advice to ambulance crews that you keep very clear contemporaneous records as there has been later differences of account between ambulances and the practice.
If the ambulance service inappropriately request your practice to provide help outside of your contractual obligations or reasonable practice policy, then let us know so we can raise directly with WAST.
After discussing directly with the HB we would like to ask that practices attempt to datix all concerns related to the DN service staff shortages. The LMC are aware that there are delays accessing the SPOA phone line, waiting lists for Wound Clinics, and an inability to request bloods for housebound patients. We appreciate the time that it takes to report but this will illustrate the importance of the service and the levels of concern that practices have about how this is affecting patient care.
The inappropriate commissioning and expanding of the DN workload, without adequate staffing, has created an overstretched service that is not working for patients nor for the DN team. We have made it clear that this is not a complaint regarding any one individual but rather a way to report that the service is not adequately equipped to deliver the volume of work.
We have raised our concerns with the HB and they agree re shortfall in service but have advised that it will help to escalate if practices datix.
The BMA have produced guidance as GLP-1 analogues, including Tirzepatide (Mounjaro), have recently been licensed for weight management in adults with obesity or overweight with comorbidities. While NICE has approved Tirzepatide for use under specific criteria, they have not been commissioned for prescribing or monitoring in Welsh General Practice.
Until a national or local supplementary service is negotiated, GPs should not initiate or monitor GLP-1 analogues for weight loss. Prescribing for weight management remains the remit of specialist services only.
Private prescribing of GLP-1 analogues is becoming increasingly commonplace and generates requests to practices for access to patient medical information. This guidance seeks to assist practices in appropriately managing these requests, taking account of professional guidance and patient safety considerations. The guidance also includes a template letter for practices to respond to requests for medical information following a private consultation.
Ty Elli Surgery have created leaflets to clearly lay out eligibility which they are happy for other Practices to use. There is a patient information leaflet and a structured eligibility‑criteria form tailored for Type 2 diabetes patients in Wales who may be considered for prescription of tirzepatide (Mounjaro®), based on the final NICE Technology Appraisal TA924, as implemented via Welsh policy.
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Following a "discussion" on MRIs being requested by audiology in the GP's name at PLTS on 16/10/25, Morgannwg LMC has written a formal complaint on behalf of the constituents regarding the conduct of a recent presentation concerning MRI scans being requested in the name of General Practitioners.
Several constituents attempted to submit legitimate questions and concerns via the moderated discussion platform. We are profoundly disappointed to report that these attempts at open discussion were actively censored. Numerous submissions from our members, including key questions highlighting that this requesting pathway appears to contravene established General Medical Council (GMC) guidance that clinicians should not request investigations using another clinicians name, were neither published for general viewing nor put to the presenters for a response. If a similar request was made of secondary care consultants to authorise other persons to request investigations in their name, we would expect them to have similar concerns. Several constituents also felt that it was incorrect to suggest that mastoid abnormalities and vascular abnormalities impinging on the 8th nerve are "incidental" findings in a scan requested for a patient with ear symptoms to regard them as such raises concerns regarding the capabilities of those reporting the scans, concerns which, again, they were unable to raise for discussion.
Morgannwg LMC had previously encouraged its constituent GPs to ensure that all outstanding professional concerns regarding this pathway were robustly discussed at this forum and discussions with the Health Board led us to believe that there would be the opportunity to do so on 16/10/25. The failure of the moderator to allow any opportunity for these critical points to be addressed is unacceptable and undermines the spirit of collaboration and transparency required between primary and secondary care services.
Our concerns which remain outstanding and are summised on our website at: https://www.morgannwglmc.org.uk/post/mri-scans-being-requested-in-gp-s-name .We strongly urge practices to consider these ethical and professional matters when engaging with the pathway as it has been described. It is the view of Morgannwg LMC that the pathway is unlikely to be withdrawn completely as it is regarded as a success by the Health Board, despite the gap in commissioning this service which has resulted in this demand for MRI scans to be requested by audiology in the name of the GP, and reduces the workload for the ENT department.
We have requested a formal explanation from the Health Board as to why legitimate questions relating to professional guidance were censored, and what steps will be taken to ensure open and honest dialogue on contentious clinical pathways moving forward.
We would very much welcome feedback regarding this issue so please do not hesitate to contact us with any questions or queries.