LMC Office Relocation

No. 285
June 2015

The LMC office will be moving on 1st July and our new address is:
Cornwall & Isles Of Scilly LMC
Room B314
Victoria Beacon Place
Station Approach

Cornwall & Isles of Scilly

LMC Newsletter

Victoria, Roche
St Austell
Cornwall
PL26 8LG
Chrissy and Julies telephone number: 01726 210141
Dawns direct telephone number: 01726 210140
The email addresses will remain the same.
Because of the obvious disruption to the LMC phones and emails
for a day or two either side of 1st July, if you have an urgent issue
that needs advice and or help please ring Dawn on 07581 483437.

Inside this issue:

LMC New Offices

Your Chairman writes

BMA, Chaand Nagpaul

3-4

SMS Services

DOLS
Overseas Visitors PC
CQC Review

FGM Guidance
Meningococcal Vaccination
Extended Hours DES

Events
Jobs
Dr Basil Bile

8-11

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Room B314, Victoria Beacon
Place, Station Approach, Victoria,
Roche. PL26 8LG
Tel :01726 210140

12

e-mail dawn@kernowlmc.co.uk

Your Chairman Writes

Deal or no deal ?
If any of us finished work early enough, we might be able to catch the Noel Edmunds hosted
Deal or No Deal. Its a game show on in the early evening (remember that?). The objective is for
the contestant to obtain the highest amount of money they believe they can, whilst the Banker is
trying to minimise the amount they have to pay out. To my mind this is a bit like Mr Hunts new
deal for General Practice with Mr Hunt playing the part of the Banker. Ive read his speech a
number of times to see if I have missed something, but no I dont think I have. The word deal
can be used as a noun or verb. I think it is being used in this context as a noun but others might
feel we have been dealt something that they wouldn't recognise as a deal. A reminder of the
dictionary definition of deal is as follows: - An agreement entered into by two or more parties for
their mutual benefit, especially in a business or political context.
The new deal for General practice is slightly unusual in that I am not aware that an representative
body was involved in its construction and it can therefore hardly be called an agreement. So what
is it ? Well in short there are some promises of support (10 million) for struggling practices and
5000 more GPs - thats his side of the agreement and in turn he wants 7 day working from us.
This should not be a surprise to any readers of this column.
So, dont bother trying to ring the Banker and ask for more because it wont be forthcoming,
unless the request is tied to some aspect of seven day working. Now we have two alternatives,
we can either say it wont or cant happen or adapt ie make do and mend. Organisationally we
are building structures that can deliver the make do and mend model - it wont be GP as we or
patients know it but it could be a seven day model that ticks Mr Hunts box of political promises.
This is the only way we can attract new money into GP at present, unfortunately.
So Deal or No Deal ?

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From your BMA GPs committee

chair

Technology to ease your workload

Dear Colleague
At a time of overwhelming pressures on general practice, anything that can reduce our workload while
improving patient care should be welcome.
Our practice has recently started using mobile technology that has achieved just this, and has made a
tangible and positive difference to the way in which we care for housebound patients.
Until recently, like most GPs, I used to print out a brief two-page summary of patients records to take with
me on home visits. These visits are for patients who by definition are mostly elderly, frail, and have
multiple or complex morbidity.
This limited summary of the patients record significantly compromised my clinical management I was
unable to refer to previous consultations or results, or answer questions from patients regarding a hospital
admission or test results, and for those patients with memory impairment I could not rely on direct
questioning.
I would scribble handwritten notes and then return to the surgery and duplicate effort by typing the entry
into the patient records. If the visit took place after evening surgery, there would be a delay in the
information being entered until the next morning.
For many patients, I had to defer making a clinical decision and go back to the surgery to look at the full
clinical records, phone the patient back, and in some cases even revisit them. Multiply this rigmarole by a
number of visits, and the workload generated and time potentially wasted were significant.
Data on the move
This has all changed now, with the use of EMIS mobile. This is a software program that is loaded on to a
tablet (iPad or Android device) and wirelessly downloads the patients clinical data from the EMIS clinical
system.
Other clinical suppliers offer similar products, but only a minority of practices use this nationally. Systems
such as this provide a scaled-down but comprehensive version of patients' medical records on the tablet
during a home visit, including data on consultations spanning the past year, investigation results,
medication, details of referrals, major alerts, quality and outcomes framework reminders, and even
hospital letters.
I now record consultations on the tablet while seeing the patient, and with a keystroke this is synchronised
wirelessly into the practice clinical records in real-time. No more going back to the surgery to type up the
consultation or calling the patient back because I didnt have the vital information during the visit. The
scenario is all the more advantageous when visiting multiple patients in care homes.
Not only has this significantly saved on time and work, but has the added clinical-governance benefit of
managing patients more effectively and safely with access to their medical records. It has informationgovernance advantages of no longer carrying around pages of confidential patient data, and allows
contemporaneous remote recording of my clinical entry into the patient's records while visiting a patient.
Contd/..
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From your BMA GPs committee chairContinued

Our CCG (clinical commissioning group) funded the software and subsidised the costs of tablets. This is a
facility I believe should be fully resourced by all CCGs and equivalent bodies in the devolved nations,
and I strongly recommend that you ask your CCG to provide this.
At a time when Government emphasis is on managing patients out of hospital, this is an inexpensive
investment that can optimise our ability to care for our most vulnerable patients at home, while saving
ourselves work and time.
Principles of working together
The BMA GPs committee has just published guiding principles for GP networks, which outlines a number
of headline best-practice principles that established or emerging GP networks should use to guide their
set-up and operational activity. We are aware that GPs are increasingly working at scale, in various
collaborative forms, from loose alliances and federations to setting up formal companies.
We believe it is vital that these networks should be underpinned by sound principles. At a time when
general practice is under considerable strain, a key feature of networks should be to provide support to
overstretched member practices, rather than only focus on extended out-of-hospital care.
Networks could share staff, provide cross cover and have management functions delivered across
surgeries, with the aim of also proactively supporting vulnerable practices. Networks should also from the
outset encourage inclusivity and engagement of all local GPs, including sessionals to maximise full,
collaborative use of a limited GP workforce.
Honoured to represent you
I was genuinely taken by surprise and humbled to be awarded a CBE in the Queens 2015 birthday
honours list last Saturday.
I consider this a tribute to the more than 40,000 dedicated, hard-working GPs across the UK, who are the
true unsung heroes keeping the NHS afloat daily, and who I feel most privileged and proud to represent.
This honour equally belongs to the discipline of general practice the most treasured jewel in the NHSs
crown and the bedrock of our health service, which provides personalised and trusted care to millions of
patients every week.
It is vital in the forthcoming 'new deal' the Government delivers on its stated recognition of the value of
general practice by providing the resources to rebuild it and enable GPs to work with a manageable and
rewarding workload.
For the latest news please visit our website www.bma.org.uk/gpc
With best wishes

Chaand Nagpaul
BMA GPs committee chair
info.gpc@bma.org.uk

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SMS services for practices post 30 September 2015

As you may be aware, central funding for the provision of SMS services for practices was
withdrawn by the Department of Health in March 2015. The decision was taken in order to reduce
the overall cost of the service through local control and accountability, with responsibility
devolved to CCGs. NHS England subsequently decided to fund the SMS service for primary care
until 30 September 2015, to allow a replacement service to be procured. A replacement SMS
service has now been established through the provider EE.
GPC raised concerns with NHS England about the decision to devolve funding to CCGs for this
important service. NHS England is writing to CCGs this week (http://www.england.nhs.uk/wpcontent/uploads/2015/06/sms-ccg-assurance-letter.pdf), asking them to confirm their plans for the
continuation of SMS services for practices. They have been asked to confirm the practices they
represent, as well as the SMS service the CCG intends to provide. CCGs will have a choice of
using the replacement service provided by EE (as the default), or to procure their own alternative
service. The letter asks CCGs to seek support from their LMCs when considering any alternative
service.
The letter also asks CCGs to ensure patients and practices experience no interruption in their
NHS SMS provision, and that practices should be able to exercise individual choice in their
provider, with the EE service available to all, even where other practices within the CCG choose
an alternative.
Furthermore, the letter reminds CCGs of the additional increase to their budgets for GP IT to
assist with the financial support required to implement local SMS messaging. The core baseline
of budget distributed to CCGs was uplifted by approximately 2% above 2014/15 budgets
(142.5m in financial year 2014/15 and 146m in financial year 2015/16). Provision of messaging
capability will also be considered as a core requirement within the GPIT Operating Framework
review, currently underway.
GPC recommends that LMCs work with their CCGs to ensure appropriate plans are in place for
fully funded SMS messaging from 1 October onwards.
The letter to CCGs, a briefing on the transition arrangements, and some FAQs are available on
the following page (see underneath SMS messaging transition arrangements):
http://www.england.nhs.uk/ourwork/tsd/sst/it-pc/

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Deprivation of Liberty Safeguarding (DOLS)

The Coroners and Justice Act 2009 requires an Inquest to be held when someone dies in a
state of detention.

The Supreme Court has ruled recently that patients subject to a DOLS Order are effectively
detained for these purposes.

It is this judgement that has caused the confusion and we are not expecting national
clarification in the near future.

The clear advice must be that all GPs , including those who work Out of Hours and who
attend a death where a DOLS order is in place, should report this to the Coroner, even if the
death is from natural causes.

If an OOHs GP confirms death and it seems very likely that the patients own GP is able to
issue a death certificate then the body can be removed and the Coroner contacted by the
certifying GP. However, if the OOHs GP is uncertain that the patients GP will be in a
position to issue a death certificate, or if there are concerns relating to the death, then this
should be reported to the Police using the standard sudden death protocol.

BMA briefing paper

Overseas Visitors and Primary Care

The Department of Health has recently issued guidance on implementing the overseas visitor
hospital charging regulations 2015. The BMA guidance on this and the impact on primary care
has been updated accordingly and is available here.

Changes to CQC Inspection Regime

BMA calls on Care Quality Commission to suspend its current inspection regime
GP leaders at the BMAs Annual Representative Meeting (ARM) have called on the Care Quality
Commission (CQC) to suspend its current inspection regime after delegates overwhelmingly
passed a motion describing the CQC as unfit for purpose.
Notes to Editors
The BMAs response to the dropping of the risk banding assessments can be found here

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Female Genital Mutilation guidance - update

The BMAs Medical Ethics department are currently in the process of updating the BMAs FGM guidance
(2011) but are awaiting the secondary legislation on mandatory reporting and the FGM statutory guidance
consultation. The direct link to this guidance is available here: http://bma.org.uk//media/files/pdfs/practical%20advice%20at%20work/ethics/femalegenitalmutilation.pdf
In addition, Health Education England has just produced an e-learning tool which had RCGP input and
includes an introduction to FGM; communication skills for FGM consultations; legal and safeguarding
issues regarding FGM in the UK; issues, presentation and management in children and young women;
and issues, presentation and management in women and around pregnancy.
Some of the material from this has been packaged into a DVD for GPs and has just been sent out to all
GP practices in England in a Female Genital Mutilation Resource Pack. The pack includes:
Raising Awareness of Female Genital Mutilation a training DVD developed by Health
Education England, with materials from the existing eLearning for Healthcare elearning modules
-

Female Genital Mutilation Risk and Safeguarding Guidance for professionals

2 copies of the Patient Information Leaflet in English, available to order from DH Orderline in
other languages and English. All language versions are available to download on this page at
NHS Choices.

2 copies of A Statement Opposing Female Genital Mutilation also known as the FGM Health
passport, available to order from Home Office or to download from NHS Choices

FGM Enhanced Dataset: Implementation Summary for GP Practices for further information
please see www.hscic.gov.uk/fgm. Please note, all GP practices will be required to submit
information under the Enhanced Dataset when treating patients who have FGM from October
2015, so we now have less than 6 months to support implementation.

Any questions about the resource pack should be directed to FGM@dh.gsi.gov.uk

New and amended meningococcal vaccination programmes

for 2015-16
Further information about all these programmes is available in the attached table and on the BMA website
Vaccs and Imms pages. The service specifications are available on the NHS England website.

Extended Hours DES

It has come to the attention of the GPC secretariat that the SLA for the extended hours DES which has
been sent to practices for signature includes a clause indicating that, in respect of appointments being
offered by health care professionals other than GPs, a GP should however be onsite throughout the
extended hours period.
The Chair of the Contracts and Regulation subcommittee and the Executive Lead on C&R have both
confirmed that while it might be the case that the GP will be onsite during the extended hours period, there
is no such requirement in the DES Directions.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417192/pms-des-directions2015.pdf
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Practice Management Master Class, with Darius Ferrigno

How to Keep In Touch With, Discipline and Dismiss Sick Employees at;
The Cornwall Hotel and Spa, St Austell
Tuesday 22nd September
For further details please contact the LMC Office julie.wickett@kernowlmc.co.uk
Please note: There are only a couple of places left on this seminar.

Updates for Primary Care

The Headland Hotel, Newquay

12th - 16th October 2015
For further details please see attached flyer or contact
www.updatesforprimarycare.org.uk

Doctor needed - Portview Surgery, Saltash

We are looking for an enthusiastic GP to become part of our friendly, committed team. We are flexible in
how we fill this vacancy, Salaried or Partnership role will be considered, we need to fill 4-8 sessions a
week.
What we an offer:

A stable list of 6500

4 GP partners & 1 Salaried GP

Excellent nursing and admin support

Clinical management of 9 community hospital beds

Partner owned premises with outstanding views out to Plymouth Sound

Flexibility around session timings

Emis Web

Electronic Prescribing

Patient care remains at the centre of all we do

What we are looking for

Enthusiasm and commitment

A pro-active approach

Team orientation
Please contact Tina Seedhouse - Practice Managertina.seedhouse2@nhs.net
Tel: 01752 840115 - Website: www.portviewsurgery.co.uk

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Partner / Salaried GPs Required, Mevagissey

Due to ill health we require Enthusiastic Partners/Salaried GPs to join our friendly, dedicated
practice team.
We are looking to cover 9 sessions per week and are happy to wait for the right applicant/s. You
will be joining a GMS dispensing Practice with 2 Partners, 1 Salaried GP and 5000 patients. Our
main surgery is in the beautiful fishing village of Mevagissey with a branch surgery operating in
the nearby village of Gorran Haven.
The surgery has a high QOF, enhanced services and prescribing achievements, supported by
highly experienced nursing and administration teams.
We are actively involved in a wide range of activities including research and commissioning as
well as providing placements for medical students.
Apply in writing with CV and covering letter, marked Private and Confidential, to Nikki Deakin,
Practice Manager, Mevagissey Surgery, River Street, Mevagissey, St Austell, Cornwall, PL26
6UE. Email: n.deakin@nhs.net Tel: 01726 843701 Closing date: 23rd July 2015

Hospice DoctorLittle Harbour, St Austell

The childrens hospice is supported by both paediatricians and general practitioners who work a
variety of flexible sessions per month. We are currently looking to add a further two colleagues
to our rota. Interested candidates do not need expertise in paediatric palliative care, just a
significant interest in, and experience in working with children and their families. The sessions
covered would be either a morning or an afternoon visit to review children during their respite
stay. There is also a rota to cover for an hour visit at weekends. The only out of hours work
would be to cover end of life care which is infrequent and fully supported by experienced in
house paediatric nursing colleagues.
If you think you may be interested then please contact Dr Roger Jenkins. He would be very
happy to show you around the hospice at a convenient time and explain in more detail the
expectations and support for this post.
The job advertisement can be found on the Childrens Hospice South West website:
www.chsw.org.uk/vacancies

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Practice Nurse, Wadebridge

Practice Nurse (RGN) approximately 21.5 hours per week + cover
We are seeking a part-time Practice Nurse to join our busy friendly practice. Experience in the
management of diabetes is desirable as the post holder will be required to undertake the management of
the practice diabetes register although training will be offered to the right candidate. A range of General
Practice Nurse duties are required, these include dressings, ear syringing, ECGs, phlebotomy,
vaccinations, assisting minor operations, health checks, health promotion.
Salary is negotiable depending on qualifications and experience.
For a full job description and specification please see the practice website www.wadebridgedoctors.co.uk
or collect an application pack from the practice reception.
All applicants are required to submit an application form and covering letter to the Practice Manager, Mrs
Sonia Geach, Wadebridge & Camel Estuary Practice, Brooklyn, Wadebridge, Cornwall, PL27 7BS.

Practice Nurse Required, Penryn

Penryn Surgery have a vacancy for a practice nurse to work 25 hours per week at the equivalent of Band
5 - Dependent on experience
The role will include respiratory care and although relevant qualifications would be an advantage, this can
be a developmental role.
Members of the nursing team are required to work at local branch surgeries.
The successful applicant will be flexible and have excellent communication skills. Being able to work independently is important while also being part of a very supportive team
For further information please contact Emma Berry or Heather Pascoe on 01326 372502 or visit
www.penrynsurgery.co.uk emma.berry2@nhs.net Closing date - 14th July 2015

Practice Nurse Required, Falmouth

A permanent vacancy has arisen for a dedicated Practice Nurse to join our treatment room team. Forward
thinking and fully committed to the highest level of patient care, Trescobeas Surgery is looking to enhance
the outstanding level of service it already provides. Previous Practice Nurse experience is highly
desirable and a family planning/sexual health qualification advantageous.
Up to 24 hours available with salary negotiable dependent on qualifications and experience. Membership
of the NHS pension scheme is available.
For more information and to apply please visit
www.trescobeas-surgery.co.uk or ring the Practice Manager, Mr Yorick O'Nyons on 01326 315615.
Closing date for applications is the 21st July with interviews the following week

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Are you interested in improving Cancer Care and End of Life

Care for patients?
Why not apply to become a Macmillan GP Facilitator in Cornwall?
This interesting, stimulating and rewarding job aims to develop the quality of cancer care within Primary
Care settings.
The role provides protected time for an experienced General Practitioner to work with Primary Care contractors and community staff and others involved in cancer and end of life care.
This involves working in a leadership and educational capacity, to facilitate change through formal and
informal routes to enable learning, development and action in Primary Care settings.
We already have an established team of six Devon-based GPs and there are now 2 Macmillan GP Facilitator posts available in Cornwall for up to 2 sessions per week each for a period of up to 3 years.
We are also recruiting a Primary Care Nurse Facilitator (part time contract for 2 years) to support Practice
Nurses in their work with cancer patients and to complete this new team for Cornwall.
For further information/to discuss this further, please contact:
Dr Susanna Hill, Macmillan GP Advisor - Devon, Cornwall and Isles of Scilly
E mail: drsrhill0@btinternet.com or
Dr Bryson Pottinger, Director of Cancer Services - Royal Cornwall Hospitals Trust
E mail: Bryson.Pottinger@rcht.cornwall.nhs.uk
The GP posts are being advertised on the NHS Jobs website in the Medical Staffing section
Ref: 156150552
Closing date for all posts will be mid-June and interviews will be held in early July.

Part-Time Practice Manager - Harris Memorial Surgery

Part-time Practice Manager required for a friendly, semi-rural dispensing practice due to retirement of present
manager.
Enthusiastic, dedicated team player with business management experience (NHS experience not essential)
Competitive salary negotiable
Start date: 1st October 2015
Email: Karen.beswetherick@nhs.net for application pack
Closing date: 12 July 2015

Middleway Surgery, St Blazey - Nurse Practitioner

Part-time Nurse Practitioner required. This is a new post and the post-holder will have the opportunity to
develop the role to compliment the existing clinical provision. The idea candidate will have attained the MSc
Advanced Nurse Practitioner qualification and be able to work autonomously running their own clinics and
providing telephone triage and have previous experience in a similar role.
This post will initially be for 20 hours per week, with the possibility of more hours as the role expands.
Job Description and application form are available by contacting Mrs Katrina Clemes, Practice Manager,
Middleway Surgery, St Blazey 01726 812019 or email k.clemes@nhs.net
Closing Date: Friday, June 12, 2015
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DR BASIL BILE WRITES POLITICALLY INCORRECT POETRY

Ive Come About My Friend
Ive come about my friend she mouthed

My attitude is proper

Her eyes all glazed and red,

There isnt any lust

Shes worried that theres something wrong

But I can count, and bloody hell

And taken to her bed

She has an extra bust

I gaze at her with sympathy

I truly am astonished at

I havent any choice

What lurks beneath her vest

Theres something really woeful

I could make a fortune here

With the tone thats in her voice

With this sweet treasure chest

Im as certain as a Doc could be

And has your friend got three of those,

Its not her friend who ails

When ladies should have two?

Its her whos got a problem

Oh yes, she cried, How did you guess?

My instinct never fails

The extra one just grew

So whats the matter with your friend?

The Guinness Book of Records,

I ask and play her game

The Sun, and Panorama,

She doesnt answer but just frowns,

Ill invent the triple bra

Well get there all the same

To culminate this drama

Perhaps shes got the flu? I prompt

I guess therell be a hoo-ha

Or maybe found a mass,

Im bound to have my mockers

A cough, a pain, a throat that hurts,

But fate decrees I cant ignore

A rash in a crevasse?

These opportunity knockers

Suddenly she lifts her blouse

Theres just one thing that bothers me

To show what lies beneath

It causes me some trouble,

I stare and blush with open mouth

Does she really have a friend?

In staggered disbelief

If so, I could earn double.

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