No.

267

Cornwall & Isles of Scilly

LMC Newsletter

December 2013

The LMC and CCG will be holding evening meetings in January

to discuss the Future of General Practice. The national
consultation exercise 'Improving General Practice: A Call to
Action' highlighted a number of issues with the current service
model for general practice including the mismatch between
increasing demand and available capacity. The Government is
signalling that general practice will be given an even greater
role in future in leading the delivery of 'out of hospital care'
starting with the coordination role for vulnerable patients from
April 2014 (through a new Directed Enhanced Service).
Nationally and locally there have also been lots of
conversations about the pros and cons of practices Federating,
the options for county-wide or smaller groupings. These issues
and more will be discussed at these evening events at:
Kingsley Village, Fraddon on 21 January at 7pm
Penventon Park Hotel, Redruth on 23 January at 7pm

Please RSVP to Dawn or Susan at the LMC so that we

know how many people to provide a buffet for.
dawn@kernowlmc.org.uk or susan@kernowlmc.org.uk

Inside this issue:

Your Chairman Writes

Letter from the Chair of the

GPC - Dr Chaand Nagpaul

HPV Immunisation

Saliva Testing Kits

GP Trainees Newsletter
QOF Business Rules

Vacancies

Vacancies
Events

From the Archives

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Sedgemoor Centre, Priory Road,
St Austell PL25 5AS
Tel :01726 627978,
e-mail dawn@kernowlmc.org.uk

Your Chairman Writes..

Of minor interest in the news recently was the news that the surviving members of the Monty Python team
are reforming - some of you will be immediately lost at this point but bear with me. The Python team produced satirical comedy which was often a bit hit and miss and is probably best left in the 70s rather than
resurrecting it now. However, one of the more memorable pieces of dialogue for me was in the film Life of
Brian.
The film is set around the time of 32 AD and was infamous when it was released and caused great outrage among some Christian groups. Anyway there is a scene which involves a dialogue around the question What did the Romans ever do for us and ends with Ok, but apart from the sanitation, the medicine,
education, wine, public order, irrigation, roads, the fresh-water system, and public health. I am often
reminded of this dialogue when I hear people moan about the LMC and question its relevance in relation
to their working lives. Well, part from but apart from the sanitation, the medicine, education, wine, public
order, irrigation, roads, the fresh-water system, and public health - actually we cannot lay claim to all of
that although we do have an input into certain aspects as they pertain to General Practice.
A lot of what LMCs do is for the most part invisible. If I could show you a parallel universe without LMCs it
would look very different to the one in which you work. Ill give you a clue, it wouldnt be better. You would
have worse working conditions, less money, less job satisfaction, no occupational health service and no
support. In short we would all be very miserable (at this point you might be thinking its not possible to feel
more miserable than you do at the moment, in which case you need to contact the office for our pastoral
support team !).
It would not be possible to do this invisible work without our office which is run by Dawn Molenkamp and
her assistant Susan Hayes. Its a small but very able team with huge responsibility and at the same time
great flexibility and knowledge. Personally I would be lost without them. However, I would also be lost
without the support of my Vice Chair, Jon Katz, our cabinet group and our committee members.
Your LMC is so much more than the Chair and all of these people represent you in many different fora. It
can be difficult to marry up the interests of a diverse workforce but the LMC exists to represent all GPs be
they partners, salaried, OOH, locums, portfolio etc. Indeed LMCs came into existence many years before
the inception of the NHS and have adapted to changes in workforce and statute. We need to be anticipatory, responsive and reflective. I hope that we can strive in the next year to be all things to all of those differing constituents we represent.
Meanwhile, thanks to my office staff, cabinet and committee and on behalf of them, may I wish you all a
Merry Christmas and peaceful New Year
Peter Merrin
Perranporth Surgery

NO . 26 7

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Dr Chaand Nagpaul is Chair of the General Practitioners Committee

of the British Medical Association
I am writing to let you know that we have concluded negotiations on changes to the GP contract for 2014/15.
The BMAs General Practitioners Committee (GPC) has voted overwhelmingly to accept this negotiated agreement, and believes that this package as a whole puts general practice and all GPs in a better position to
deliver improvements to patient care.
Our aims in these negotiations were:

to reverse the adverse impact on all GPs and practices of imposed changes from last years contract

to reduce bureaucracy, box ticking and chasing of targets, which has added to excessive workload, widespread demotivation and has taken GPs away from attending to patients needs

to provide stability with increased resources in core GP budgets, enabling clinical judgment and flexibility
in providing care.

We believe that we have succeeded in achieving all of these. You will nevertheless appreciate that as with any
negotiated agreement, there has had to be give and take and compromise on elements of the agreement from
both sides. I would like to assure you that I and the GPCs negotiating team could not have made a stronger
case for GPs and general practice in this round of negotiations, and we fought your corner robustly.
The greatest benefit to GPs and their patients is that 238 QOF points have been removed and transferred into
core GP budgets. Most of the imposed changes to the QOF from last year have been reversed. This will significantly reduce the daily box ticking that has forced GPs to spend time looking at their computer screens rather
than the patient in front of them and will make a tangible difference to the daily lives of GPs and practice staff.
These changes allow all GPs to be freer to be doctors, exercising clinical judgment caring for patients, and resurrecting a sense of professionalism.
Three of last years imposed Directed Enhanced Services have ended, with resources reinvested into core GP
budgets. Together with the transferred QOF points, this significant transfer of money into core GP funds provides practices with stability and flexibility to deliver care based on the needs of their patients, and also protects
these funds from annual unpicking and renegotiation.
The QP points in QOF have also been removed, and together with the current risk profiling DES will fund a new
'avoiding unplanned admissions' enhanced service. This new enhanced service will resource practices to provide coordinated planned care to their most vulnerable patients.
We have ensured that requirements for a named GP for patients over 75 and the monitoring of the quality of
out of hours care are manageable for GPs. There are other contractual changes for IT that include building on
last years online access for appointments and prescriptions.
There are also important changes with the gradual phasing out of seniority payments. Faced with a government commitment to end age related pay progression across the public sector, we have negotiated for seniority
payments to remain in place for the next six years for those currently receiving them and a commitment that all
the savings made will be reinvested back into core GP budgets and therefore not be lost to the profession.
However, we remain concerned at the impact this could have on GP retention. I believe that through constructive talks we have reached an acceptable deal that is an important step forward for general practice and will
help relieve workload pressures on all GPs. This now must be followed with a planned strategy for investment
and development in general practice to meet the future challenges that it faces in the coming years.
I am sure that you will have questions and comments for us and these would be very welcome.
You can find out more from our website and you can contact me directly at info.gpc@bma.org.uk

NO . 26 7

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HPV Immunisation
Cornwall is one of only a handful of area where HPV immunisation is delivered in primary care. School
based delivery is the general model used. The national programme data monitoring looks at immunisation
completion within school years. I have argued strenuously that this is inappropriate and coverage is a
more relevant measure. The latest data from the Open Exeter system indicates that this is case. Cornwall
does achieve population coverage at a satisfactory level though a little short of the 80% target in the
younger cohorts. The measure may underestimate as it requires uploading of all data but it does indicate
that by age 17 the target level coverage has been reached. Well done.
The LMC will be pressing the case to retain this service and income stream within primary care. We believe that it encourages effective engagement with young people and may be one of the factors resulting
in our reduced teenage pregnancy figures.

Heavy Menstrual Bleeding NICE Quality Standard 47

I have been involved in the process of refining elements of the clinical guideline (CG44) into a quality
standard. This has very simple messages for primary care and may provide suggestions for audit if you
have an appraisal looming and are stuck for ideas.
Womens Health Education
For further information about the education and updating I have so far planned for the spring please look
at www.crescetis.co.uk. I am more than prepared to develop other sessions if these would meet a need.
Sarah Gray

NO . 26 7

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Saliva testing kits

For the three viral illnesses of measles, mumps and rubella, your local Public Health England Centre can
supply, either direct to the patient or to their GP, a saliva testing kit together with a prepaid addressed envelope so that salivary IgM levels can be checked.
All child cases should be excluded from school for 5 days from the onset of the rash or in the case of
mumps from the onset of parotid swelling. Since there is very little measles, mumps or rubella activity locally a clinical case remains a possible case unless there is an epidemiological link to a laboratory confirmed measles case. Other risk factors include the case belonging to a particularly vulnerable population
e.g. attends a Steiner school or the case has not been vaccinated with at least one dose of MMR. For
probable or confirmed cases, consideration should be given to providing HNIG within 6 days of exposure
to immunosuppressed or pregnant contacts; your local Public Health England Centre can advise you and
help with the risk assessment. Since the MMR will immunise close contacts of measles before the wild
virus will cause infection, it is worth immunising non immune close contacts of measles within 3 days of
exposure. Dont forget it is always worth promoting the MMR and the routine immunisation schedule to
patients.
Your local Public Health England Centres contact details:
Devon and Cornwall and Somerset PHEC
Richmond Court
Emperor Way
Exeter Business Park
Exeter
EX1 3QS
Telephone: 0844 225 3557
Fax: 01392 367356
For urgent calls outside of the hours of 9 to 5 Monday to Friday please contact your nearest acute hospital
switchboard and ask for public health on-call.

GP Trainees Newsletter
The latest edition of the GP Trainees Newsletter is now available at the address below.
http://bma.org.uk/working-for-change/negotiating-for-the-profession/bma-general-practitioners-committee/
committee/gp-trainees-subcommittee

QOF Business Rules

Version 27 of the QOF Business Rules have now been published on the PCC website:
http://www.pcc-cic.org.uk/article/qof-business-rules-v27

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C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

Meneage Street Surgery, Helston

We are seeking a salaried GP with view to partnership:

4-6 sessions per week

to include pro-rata duty doctor & extended hours cover

first offer of locum cover for partner leave

Our practice:

currently 3 partners

plus a nurse practitioner

nurse led chronic disease clinics

an enthusiastic & cohesive team

a high achieving GMS practice

clinical system: Microtest/evolution

small surgical unit plus refurbished treatment & phlebotomy rooms

medical student (year 3)

member of South Kerrier locality

Applications to/further information/informal discussion

please contact:

Linda Granger, Practice Manager

Tel: 01326 555285 e-mail: Linda.Granger@meneage.cornwall.nhs.uk

Veor Surgery
South Terrace, Camborne.
An opportunity has arisen to start March 2014 for a GP Partner , to join our friendly and progressive PMS
training practice with 8,700 patients, 8 sessions per week. We are looking for flexibility, enthusiasm and
commitment to providing high standards of clinical excellence.

Modern purpose built premises.

Consistently high QOF Achievement

Emis Web Clinical Systems

Nurse Led Chronic Disease Management clinics

GPs and nurses with special interests

Active members of our local commissioning group

NHS Pension Scheme

Please send expressions of interest and a copy of your current CV to our Practice Manager:
Teresa Kemp, Veor Surgery, South Terrace, Camborne, Cornwall. TR14 8SN 01209 611171 or e-mail to
Teresa.kemp@ veor.cornwall.nhs.uk

NO . 26 7

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NURSE PRACTITIONER VACANCY

THE STENNACK SURGERY, ST IVES
The Stennack Surgery is currently recruiting and we are looking for an experienced and enthusiastic Nurse Practitioner to join our busy and professional General Practice and Urgent Care team.
If you interested in applying please send me a CV with a covering letter highlighting how you feel you
meet the essential and desirable criteria.
Mr Chris Gendall, Strategic Business Manager
Stennack Surgery, St Ives, Cornwall
TR26 1RU
chris.gendall@stennack.cornwall.nhs.uk
The closing date for applications is the 10th January 2014, 5 pm. To allow us to invite you for interview or to let you
know that you have not been successful, please supply us with an email address.

FRIARY HOUSE SURGERY - PLYMOUTH

2 Partners Sought Friary House Surgery, Beaumont Road, Plymouth PL4 9BH
Well-established PMS Practice seeks 1 Part-time Partner (approx 4 6 sessions per week) to part replace hours of
existing Senior Partner reducing from full-time as from 1/4/2014, and 1 Full-time Partner (6 8 sessions per week)
to replace retiring second Partner as from 1/10/2014. Stable, progressive, democratic Partnership, happy to be flexible. Earlier starting dates are possible.
Contact: For further information please contact any of the Partners, Dr Tristan Bertie, Dr David Fisher, Dr Howard
Ackford, Dr Tracey OLeary, Dr Jon Tuckley, Dr Will Reader, Dr Ed Doyle (Tel: 01752 517124) or Practice Manager,
Mr Anderson Smith (Direct Tel: 01752 517122, Email: practicemanager.fhs@nhs.net. Closing date: 16/01/2014

Innovation in Community Healthcare

Health & Wellbeing Innovation Centre, Treliske, Truro TR1 3FF
Tuesday 11th February 2014, 3.00pm 6.30pm
This FREE event shows how your great ideas can become successful new healthcare products or solutions and introduce you to the people in Cornwall who can help you.
Who is this event for ? GP, Practice Manager , Practice Nurse, Pharmacist,
in fact anyone in Community Healthcare, - because we can all have good ideas
To register please email zoe.prosser@plymouth.ac.uk or call 01872 330030
Or go to http://www.cornwallinnovation.co.uk/health-wellbeing-centre/events

RCGP Tamar Faculty Minor Surgery Course

Name of event and date: RCGP Tamar Faculty Minor Surgery Course, 27 & 28 March 2014
Details: 2 Day Course covering all aspects of minor surgery skills
Venue: Buckfast Conference Centre TQ11 OEE
Cost: GP trainees: 400; RCGP member GPs: 450; Non member GPs: 490
Full details: http://www.rcgp.org.uk/courses-and-events/sw-england-and-wales/tamar-faculty/rcgp-tamar-facultyminor-surgery-course-2014.aspx
Contact:
NO . 26 7

Liz Bell E.A.Bell@exeter.ac.uk 01392 722744

Page 7

From the Archives.

An article from 1998 to show that little changes..
Dr Basil Bile Writes..
Cash starved NHS still has money to pay its doctors 135,000 a year
That headline in The Independent assaulted my senses as I groped for the alka-seltzer and Losec the
morning after a particularly ghastly night before. Momentarily my hopes foolishly rallied. Had the Review
Body deliberated upon our most recent pay-award whilst its members were deliriously high on cocaine?
Tragically not. The item referred to a certain highly appropriately named consultant in sexually transmitted
diseases, one Dr Willie Harris. Dr Willie had a consultants basic salary of 53,000, with a distinction
award taking his clinical earnings up to 88,000. Add in 43,000 as medical director of St Marys NHS
Trust, and you can forget that he also has a lucrative private practice in Harley Street. Maybe General
Practice was not such a brilliant career choice after all.
It most certainly wont be if we are forced to work in the new Primary Care Groups with the assorted oiks,
hangers-on and Community Nurses proposed within the copious glossy pages of New Labours first, but
doubles not last, White Paper on the NHS. Being told what to do by women in uniform is all very well if
you are paying for the pleasure, but not when you are being coerced by T. Blair, F. Dobson et al. Mind
you, according to my younger brother Spiggot, some of the Community Nurses on his patch in Balham
look like real goers. This could just explain why he is suddenly such a great supporter of the White Paper
Proposals, and is embracing enthusiastically the switch from Fundholding to Fondholding.
Just when a chap thought that things couldnt possibly get any worse, the very next bally page in the paper depresses me even further.
Breath test ploy to trap the doctors who drink
The blasted Nanny State has gone over the flipping top with this crassly half-baked notion. Those sanctimonious twerps at the Academy of the Medical Royal Colleges agreed that doctors suspected of having a
drink problem should be subject to random breath tests! You can imagine the palaver as a policeman
bursts into my consulting room just as I am conducting a intimate examination on an unsuspecting patient
and sticks a breathalyser in my mouth. I can hear my receptionist now That Dr Bile, hes a one isnt
he? Thats the third time this week!
And just think of the embarrassment for the policeman and the patient Gladys, what you are you doing
in here having a coil fitted when I had a vasectomy two years ago?
Still, its not all bad news. In an effort to save yet further money, and having listened very carefully to Joe
Public during their recent scrupulously genuine (honestly) consultation exercise, the Health Authority have
decided to reprieve the four threatened cottage hospitals and close Treliske down instead, proving the
same secondary care services from a portakabin sited in the adjacent Sainsburys Homebase car park

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C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R