No.

313

October 2017 Your Chairman writes

Sometimes I feel like Bill Murrays character in Groundhog Day
(hes a weatherman who gets caught in a blizzard that he didn't
predict and finds himself trapped in a time warp. He is doomed to
relive the same day over and over again). My alarm goes at the
same time every day, I do the same things before driving to work. I
see the same people queueing outside the front door to try and get
an appointment and then see the same people I have been seeing
on a regular basis for 20 plus years (at least it sometimes feels like
that). Nothing changes. All the old hands will say, Its been like this
before and usually nothing does. Regular readers probably view
Cornwall & Isles of Scilly

me as some kind of medical Chicken Licken as I keep saying that

the GP sky is falling down. Well Ive got news for you, the sky is
falling down - it really is, a least from my perspective. Perhaps I
look through a different lens to a lot of you. However, at last some
of my colleagues are also beginning to notice and after my last
newsletter piece last month, GPs from the major Gp organisations
are getting together to discuss how we can put up some scaffolding
to stop the sky from falling down on top of us. Representatives from
the LMC, KernowHealthCIC and KCCG are meeting to discuss a
GP/primary care systems response to the evolving healthcare
landscape in Cornwall. How will this work ? Dont know yet. I have
some ideas but that is for a different audience at present. For now,
if you have strong views on the delivery Of GP within Cornwall you
need to make them know to your locality lead, LMC or CIC rep or
LMC Newsletter

even through the LMC office.

Only question is, will the groundhog see its shadow ?

Inside this issue:

GP subcommittee
NHS Whistle Blowing 2
guidance. newsletter
Snowmed
Snowmed contd/. 3 Here is the link to the session-
al GP subcommittee newslet-
State backed indemnity 4
scheme ter for October:
New PGDs 5 http://bma-mail.org.uk/t/JVX-
Flu Vaccine Offers 2018/19 57VT3-1BJCJOU46E/cr.aspx
NHS England Third Available 6
Appointment survey.
NHS Pensions Items for the Newsletter should be
sent to the Editor, Dawn Molenkamp
Events 7 at Victoria Beacon Place, Room
B314, Station Approach, Victoria,
Roche, St Austell, PL26 8LG
Vacancies 8-10 Tel :01726 210141

Dr Basil Bile 11 e-mail dawn@kernowlmc.co.uk

 NHS Whistle Blowing Guidance

The LMC is volunteering to become the independent external organisation that practices can identify to
staff to raise concerns with in confidence (freedom to speak guardian). If you wish us to perform this role
for your surgery, please contact Dawn on 00726 210140 or email dawn@kernowlmc.co.uk to let us know.

Snowmed
As you will all be aware SNOMED CT will become the default NHS coding system replacing the Read and CTV3
coding systems in all GP clinical systems. The changeover will begin in April 2018. We understand from a number of
LMCs and practices that there are questions and concerns surrounding this move and we hope that this letter will
provide some clarification on those issues and point to resources that practices can refer to in advance of the
changeover.

We can confirm that

All1 current GP Read and CTV3 Codes each have their own equivalent SNOMED CT code. Therefore, all of the
terms currently used by GPs and their staff will be identical or very similar in SNOMED CT.
All data previously coded in Read or CTV3 will be retained but beginning from April 2018 clinical systems will
move to selecting from the SNOMED CT codes as the primary entry.
In the background the systems will also automatically add the equivalent Read or CTV3 code in a process of
dual coding.
Most systems have in fact been automatically dual coding the equivalent SNOMED CT codes in the background
for some time as part of the run up to the changeover.
The mapping tables that enable this dual coding have been verified nationally with input from the Joint IT Com-
mittee of the GPC and RCGP (JGPITC).

What will happen from April 2018 is the priority for code pickers or selectors will swap from Read or CTV3 to
SNOMED CT. There will be a transition period of continued dual coding for at least 1 year. This transition period is
to ensure that reports and functionalities that rely on Read or CTV3 codes will still work after the switchover even
though the primary records are being created in SNOMED CT. All national reporting such as QUOF and DESs will
continue with the intention that they will be replaced by nationally approved and verified SNOMED CT based reports
from April 2019 onwards. Locally authored reports may need to be reviewed, as new SNOMED codes are intro-
duced, there will be no equivalent Read or CTV3 code and thus searches and reports will become less reliable over
time.

All GPSoC clinical system suppliers have been involved since 2014 in the work leading up to this changeover and
more recently have been working with their relevant user groups to develop code selectors or picking lists that act as
seamlessly as possible. NHS Digital have been assuring any technical changes to GPSoC systems.

The intention is to minimise any additional workload on practices as a result of the move, in most cases the change-
over for end users should be almost unnoticeable. More detailed information on deployments will be available once
the first roll-outs have begun in early 2018.

There are a variety of on-line tools that have been set up to assist LMCs, Practices, GPs and their staff 2. A web site
has been set up to demonstrate SNOMED CT equivalent codes 3 where codes can be searched for you can enter
a Read or CTV3 code and it will provide you with the SNOMED CT equivalent 4. NHS Digital have also produced an
overview webex5 which has run every week since January and will be continue to run once a month; there is also a
recorded version. More information and resources can also be found here 6. The JGPITC also recommends these
two quick videos 7, 8

NHS Digital has already begun to communicate these messages to CCGs who in turn should pass this information
onto general practices as part of their responsibilities for the delivery of GP IT, as outlined in the GP IT Operating
Model9. NHS England have informed CCGs of the need to appoint a named SNOMED CT lead and 99% of CCGs
now have one. Some CCGs have already planned SNOMED CT training for later this year and will have more de-
tails from the suppliers regarding the switch over. NHS Digital have run face-to-face workshops for CCGs, CSUs
and IT service providers.

NO . 3 1 3 Page 2
 Snowmed

Supplier roadmaps and implementation plans, where available, are provided by NHS Digital. These will be updated
as plans progress.

Microtest are advertising training for later this year and there are extensive SNOMED resources, PowerPoint
Presentations, screenshots and training information for practice staff and clinicians at www.microtest.co.uk/snomed-
ct-resources/. The company have written to practices offering a number of SNOMED training courses at various lo-
cations.
EMIS have made available their current proposed code picker to download via the EMIS support centre; they are
asking for feedback and have plans to make further updates before they go live.
TPP are currently in the process of developing and assuring the new SystmOne SNOMED functionality in co-
operation with NHS Digital and will release detailed documentation on how SystmOne will interact with SNOMED
within the next month.
In Practice Systems will soon be releasing a customer-facing FAQ document, as well as continuing to engage with
the user group on the interface designs for code selection in Vision.

We would recommend that practices work with their CCG SNOMED leads and look at the educational material from
NHS Digital and their clinical system suppliers.

Yours sincerely
Dr Paul CundyGPC Co-Chair of the Joint GP IT Committee
Dr Manpreet PujaraRCGP Co-Chair of the Joint GP IT Committee
References

1. While every Read code maps to an appropriate SNOMED CT concept, and the original text is visible when
viewing a record, some Read codes are unsuitable for future use and will therefore be retired and no longer
available. These differences are captured in a Data Quality Guidance document; this has been widely com-
municated to all CCGs, trainers and data quality leads, download in Word from
https://hscic.kahootz.com/gf2.ti/f/762498/30503621.1/DOCX/-
/Data_Quality_Guidance_for_Primary_Care.docx

2. Snowmed implementation in Primary Care

3. Browsers and mapping lookups

4. Snowmed Browser CT

5, Snowmed webinars

6. Snowmed implimentation

7. A quick guide to SNOMED CT

8. Searching for symptoms

https://www.england.nhs.uk/digitaltechnology/wp-content/uploads/sites/31/2015/04/gp-it-
operating-model-16-18.pdf

NO . 3 1 3 Page 3
Announcement of state backed indemnity scheme

As you will be aware, following the DH announcement of a state backed indemnity scheme, MDU advised that its
membership benefits for GPs working under an NHS England contract who renew/join after 1 st Nov will change to
Transitional Benefits intended to provide the indemnity until a state-backed scheme is introduced.

Yesterday the Department of Health directly addressed this offer by amending its indemnity factsheet:

DH Addendum - 17 October 2017

On 12 October 2017, the Secretary of State for Health announced his intention, subject to the examination of rele-
vant issues, to develop a state-backed scheme for general practice indemnity in England.
Following that announcement, the Department of Health notes the Medical Defence Unions (MDUs) intention to
change their indemnity offer to GPs to claims-paid coverage, and thus reduce the cost of their cover, from 1 Novem-
ber 2017.
Claims-paid coverage is an alternative form of indemnity which requires policy holders to obtain run-off cover at the
end of any period of coverage, since it only covers claims which are reported and settled during the period of the
cover. This means that claims made and settled in the period up to the introduction of a state backed scheme while
the policy remains in force should be honoured. Claims made after the cover has expired, or made before the expiry
of the cover but not yet settled, will not be honoured, unless run-off cover is purchased at the end of the period.
This reduction in coverage will apply to any GP taking up the MDUs offer of membership at the reduced subscription
cost (whether as a renewal or new membership taken out from 1 November 2017) or with any other organisation that
offers indemnity for clinical negligence on a claims-paid basis.
The Government does not currently plan to include this run-off cover in a state-backed scheme. GPs with claims-
paid or claims-made indemnity policies would therefore be required to purchase such cover separately themselves at
the point they move to a state-backed scheme.
Any GP purchasing an indemnity product on a reduced cover basis should make themselves fully aware of the terms
under which it is being offered, taking into consideration how they will cover themselves after the period of cover has
expired and the cost of run-off cover.
GPs should also continue to ensure they have appropriate cover in line with the GMC professional regulatory re-
quirements to enable them to practice.

For ease of reference the current views/positions of the three MDOs are available below:

Medical Defence Union

Medical Protection Society and its comment on the MDU offer

Medical and Dental Defence Union of Scotland and its comment on the MDU offer

With the above information in mind, we would be grateful if LMCs could continue to remind GPs of the requirement to
maintain full indemnity cover before any change to a state-backed scheme in the future.

Best wishes,

Daniel

Daniel McAlonan
Head of Regulation, Education and Training
Professionalism and Guidance
Policy Directorate
British Medical Association

NO . 3 1 3 Page 4
 New PGDs
Your can now download new PGDs that have been authorised for the vaccination of patients registered with practic-
es in the South West of England*.

Note that I have tidied up the website that I hope has resulted in a better layout:
https://www.england.nhs.uk/south/info-professional/pgd/south-west/downloads/

Two new PGDs authorised from national templates from Public Health England have been published:

The administration of low-dose diphtheria, tetanus and inactivated poliomyelitis vaccine (Td/IPV) by currently
registered nurses or paramedics.
Valid from 1 November

The administration of diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis vaccine (DTaP/IPV) by
currently registered nurses or paramedics.
Valid from 1 December

One local PGD has expired

Cholera vaccine

I note that the overwhelming majority of vaccine is prescribed on FP10 and dispensed by community pharma-
cies, and given that it is not a single-dose vaccine that seems sensible. This PGD will not be renewed unless there is
significant demand for it.

Please note also that there have been some minor updates to other PGDs:

The supply and administration, or supply only, of live attenuated influenza vaccine (LAIV) nasal spray suspen-
sion (Fluenz Tetra) by currently registered nurses, pharmacists or paramedics
Amended to remove requirement to use CHIS

The administration of intramuscular (or subcutaneous) inactivated influenza vaccine by currently registered nurs-
es, midwives, pharmacists or paramedics

Amended to remove requirement to use CHIS

The administration of shingles (herpes zoster, live) vaccine by currently registered nurses or paramedics.
Amended to correct date in inclusion criteria to 2012 and add DOB note

Flu Vaccines Offers 2018-19

Please see Flu Vaccine offers from the LMC Buying group attached to this newsletter

NO . 3 1 3 Page 5
 NHS England Third Available GP Appointment Survey

All English Practices will be telephoned during October

NHSE has commissioned the North of England CSU to survey all practices in England in the hope of get-
ting a snapshot view of waiting times and demand pressure in general practice. In principle this is a good
and helpful thing to do, but unfortunately NHSE have chosen to use the old question that asks about the
practices third next available routine GP appointment.

For many reasons, this is not the right thing to be asking. A growing number of practices have triage sys-
tems, nurse led assessments or team based appointments which make the question meaningless, and it
really doesn'tt work if you have a strict personal list system.

This means that many practices will just not be able to respond to the survey, and we recommend that
unless you run a traditional open booking with a GP system you should not try to answer, but instead
explain that your system is not compatible with the question. We dont know if callers will ask practices to
estimate or answer as best they can, but if you cannot give a clear answer, its better not to try. Note that
Improved Access appointments count, though you should only use these if you use the traditional system
during the day, and do qualify your reply if the appointment is in another practice, especially if it is some
distance away.

Although this is a voluntary survey we do encourage all practices to respond as they see appropriate. If
you can give the required information that is likely to be helpful in reflecting the pressure on practices,
even if the actual numbers do not mean much; and if you cant it is important that NHSE gets the feedback
that they are asking the wrong thing. We understand that the survey only takes 3-4 minutes and it is prob-
ably best answered by the practice manager or reception manager. It would be reasonable to ask the call-
er to ring again if neither are available at the time of the first call.

With thanks to Somerset LMC

NHS Pensions
GPC UK on Annualisation within the 2015 NHS pension Scheme, Jackey Brodie (BMA pensions)
and I have written the following guidance which is now available on the BMA website.

https://www.bma.org.uk/advice/employment/pensions/annualising-of-2015-scheme-contributions

Krishan Aggarwal
MB BS(Lond), DOHNS, DFSRH, DRCOG, DLM, MRCGP.
Deputy Chair, Sessional Subcommittee, GPC UK, BMA

NO . 3 1 3 Page 6
 EVENTS
Cornwall RCGP Group
Topic: Orthopaedic Update
Speaker: Mr Andrew Lee, Consultant Orthopaedic Knee Surgeon

Date: Wednesday 1st November 2017

Time: 7.00 pm for 7.30 pm start
Hot buffet and drinks from 6.30 pm

Venue: Duchy Hospital, Truro, TR1 3UP

Conference room opposite the Staff car park, please press the PUSH PAD to enter

Parking: Staff car park, behind The Duchy Hospital

GPs, GP trainees, practice nurses and staff are very welcome to attend. There is no charge to attend. No booking
required.

We look forward to seeing you there.

Jordan Wood
GP LIAISON OFFICER
Duchy hospital

Easy Cornwall Respiratory Study Day

Thursday 16th November 2017
China Fleet Club, Saltash.
Please see the flyer attached to this newsletter for more information.

Balint Events in Bristol December 1st/2nd 2017

Date: Friday 1st December 2017, 9.00am 5pm
Venue: Engineers House, The Promenade, Clifton Down, Bristol BS8 3NB
Please see the flyer attached to this newsletter for more information.

The Learning Institute

We would like to introduce ourselves and would appreciate if the attached flyer could be displayed on staff and pa-
tient notice boards in your surgeries, to introduce some Higher Education opportunities in your the local area. Here
at The Learning Institute we are delivering three exciting Foundation Degrees:
Health and Social Care
Child & Adolescent Mental Health
Teaching and Learning.
For anyone currently working with, or who aspires to work within the Health or Education sector, then we can help
with the first steps on their academic journey! The taught sessions run on one set afternoon/evening (usually 1pm -
8pm) a week during term time only. The degree programmes are classed as full-time due to the combined
work/study hours. Full time funding from Student Finance England is available to support studies, subject to eligibil-
ity.
To find out more visit The Learning Institute's website: www.learninginstitute.co.uk
or call our team at the Roche office: Tel: 01726 891807.

Page 7 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 Tamar Valley Health
48 Session Salaried GP Vacancy
Newly qualified and retainers welcomeStart date: ASAP

Tamar Valley Health is in an Area of Outstanding Natural Beauty on the Cornwall/Devon border. Close to the market
town of Tavistock and within easy reach of Plymouth. There is a good choice of local schools. Between moor, sea
and river, outdoor opportunities abound for sailing, surfing, cycling and walking.

Tamar Valley Health is an innovative forward thinking practice:

GMS 16,000+ patients with 7 GP partners, 2 Pharmacist Partners and 6 Associate GPs working over 2 health
centres at Callington and Gunnislake

Pharmacy at Gunnislake Health Centre with rising profits and Practice Dispensaries at both sites

Full QOF scores for the last 3 years and Good/Outstanding CQC ratings

Active involvement with the CCG and LMC

SystmOne and EPS

Excellent Clerical and Nursing Teams including a Prescribing Nurse Practitioner and Prescribing Nurse Team
Leader

Medical Student Training

Active in NIHR and RCGP approved research

Close links to Community teams

For further information and to arrange an informal visit please contact Natalie Wilkerson, HR Manager at
natalie.wilkerson@nhs.net or telephone 01579 382666.

Closing Date: 10th November 2017

SALARIED GP MATERNITY COVER

FULL-TIME OR PART-TIME OPTION
WESTOVER SURGERY, FALMOUTH, CORNWALL
We are looking for a committed and enthusiastic doctor to join our team in delivering high quality patient care ide-
ally able to work 4-8 sessions per week. We are a long established, friendly and well respected practice based in
the center of Falmouth, supported by excellent admin and nursing teams.

High QoF achievers

List size of 8,000 patients
EMIS Web and Electronic Prescribing
Minor Ops
Training of Medical Undergraduates
Full range of nursing services and Chronic Disease Clinics
District Nurses and Community Matron on site

Start date: February

To apply, please send letter and CV to Daisy Beckett, Westover Surgery, Western Terrace, Falmouth, Cornwall
TR11 4QJ.

Closing date: Friday 17th November

Page 8 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 Cape Cornwall Surgery
St Just, Penzance, Cornwall.
Situated at St Just in West Cornwall we are a small rural practice in close proximity to Lands End, surrounded by
spectacular beaches and stunning coastal scenery.

You would join a very friendly and supportive 3 Partner rural GMS Dispensing Practice which will provide the life/work bal-
ance sought after by many GPs. Our GPs are supported by an excellent administration and nursing team working in mod-
ernised well equipped premises.

Practice summary:

4850 patients and growing.

On-site Dispensary.
Nurse Led Chronic Disease Management Clinics.
Enhanced serves including minor surgery, minor injuries service & extended hours.
Substance misuse clinics.
100% QOF record.
GP Training Practice.
Clinical Research Practice.

The job:

4 to 8 clinical sessions, job share or flexible working considered.

Competitive Salary.
6 weeks annual leave
One week study leave.
Weekly clinical meetings, regular governance/MDT meetings.
Partnership interest welcomed.

Please apply with a CV and covering letter to: ian.cary@nhs.net or by post to:

Ian Cary FCCA.

Practice Manager
Cape Cornwall Surgery
St Just,
Penzance,
Cornwall.
TR19 7HX.

Informal contact/visits welcome - telephone Ian Cary (Practice Manager 01736 786924).

Practice website: www.capecornwallsurgery.co.uk

NO . 3 1 3 Page 9
 Tamar Valley Health - Callington & Gunnislake Surgeries
Advanced Nurse Practitioner

Tamar Valley Health is an innovative and forward thinking practice with a team providing new models of care with
clinical pharmacists and general practice paramedics working alongside experience GPs and managers. Based over
two sites, we are looking for an Advanced Nurse Practitioner / Prescriber to join our clinical team and help deliver
primary care services to our patients in our very busy, friendly surgeries.

Full time hours (37.5 per week) but would consider part time
Salary is negotiable depending on experience
Five weeks annual leave plus bank holidays
Generous occupational pension scheme

Essential skills & Experience:

Experience of delivering a high standard of patient care as Advanced Nurse Practitioner, using advanced au-
tonomous clinical skills and a broad in-depth theoretical knowledge base
Ability to manage a clinical caseload, dealing with presenting patients needs
Ability to prioritise and triage the needs of patients accordingly, making any necessary referrals to secondary
services for diagnosis and treatment
Ability to deal with confidential and sensitive information
Excellent communication skills
Ability to work independently and as part of a team
Good IT skills

Desirable Skills & Experience

Experience of working in a GP Practice
Previous SystmOne experience

Practice Information
GMS 16,000+ patients with 7 GP partners, 2 Pharmacist Partners and 6 Associate GPs working over 2 health
centres at Callington and Gunnislake
Pharmacy at Gunnislake Health Centre with rising profits and Practice Dispensaries at both sites
Full QOF scores for the last 3 years and Good/Outstanding CQC ratings
Active involvement with the CCG and LMC
SystmOne and EPS
Excellent Clerical and Nursing Teams including a Prescribing Nurse Practitioner and Prescribing Nurse Team
Leader
Medical Student Training
Active in NIHR and RCGP approved research
Close links to Community teams

Please apply with a covering letter and C.V addressed to Natalie Wilkerson, HR Manager
Closing date: Friday 17th November 2017

Page 10 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

Dr Basil Bile.

I know full well I shouldnt be doing it. Especially not in the kitchen. But I have become ra-
ther addicted to the guilty frisson. The delightful fear of being discovered. A revealment that
would almost certainly spell the end of my marriage. But I do wait until Belinda is out of the imme-
diate vicinity. I am not a complete idiot.
I carefully remove my socks, place one foot at a time on the chair, and lean forward, per-
fectly balanced. Wielding the clippers with aplomb I set about my toe nails in business-like fash-
ion, tiny grey keratin fragments flying to all four corners of the room, landing with a satisfying
ping. One piece unfortunately lands amidst Belindas bowl of muesli, a splash announcing its ar-
rival as it hits the milk. Without the ping it really isnt the same.
To my horror there is a creak on the loose floor board on the other side of the kitchen door,
heralding my spouses imminent return. She keeps nagging me to fix it, but where would I be
without my early warning system? I swiftly pocket the clippers and sit down, heart pounding. She
has just rescued what remains of the newspaper from the jaws of the Labrador, and thrusts the
tattered journal into my hand.
You should train that animal properly, she scolds me. Its her wretched dog.
I watch in an expectant haze as she sits down and tucks in to her breakfast cereal.
I do prefer this nutty muesli, she announces.
Meanwhile I am wrestling with what remains of the Daily Brexitegraph. According to the
front page Dame Sally Davies, the Chief Medical Officer, has decided the reason that morale is
so low amongst NHS doctors is not that they are underpaid and overworked, but that they are be-
ing called by the wrong titles. Consideration is apparently being seriously given to doing-away
with the discriminatory and belittling terms of Trainee and Junior doctor, and returning to the
historic Senior House Officer and Registrar monikers. If it heralds a farewell to all this F1, F2,
RSVP3 nonsense then so much the bally better. However, it is also postulated that family docs
should forthwith be dubbed GP Consultants. Hang on a mo. That sounds like a demotion. I have
always considered myself vastly superior to Hospital Consultants. And in any event, frankly they
could call me Winnie The Pooh as long as I get paid more for doing less.
Gobsmackingly amazingly, it is up to ministers to decide what we are called, as we cannot
be trusted to decide for ourselves. We all await the Department of Healths considerations on the
matter with bated breath.
Finally, an income generating wheeze has arisen as a result of recent events in the well-
known picturesque tourist trap of arty-farty St Ives. A parking space close to the harbour and
town centre, measuring a mere fourteen feet five inches by six feet eleven inches, is up for grabs.
According to auctioneers this morsel of land is expected to fetch up to forty thousand smacke-
roos. The good news it has a 999 year lease stretching from January 1988, so the successful bid-
der will have a long time to enjoy it, as long as they dont drive anything too big, like a Fiat 500 or
a Mini.
Inspired by this turn of events I have decided to put up for auction my doctors parking
space outside the Abandonhope Surgery. One careful previous owner. Would be ideal for a hy-
pochondriac

Page 11 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R