No.

318 Primary Care Responsibilities In

April 2018 Regard To Requests by Private On-
Line Medical Service Providers to
Prescribe Hormone Treatments for
Transgender People

The BMA have updated their guidance, as below.

https://www.bma.org.uk/advice/employment/gp-practices/service-
provision/prescribing/gender-incongruence-in-primary-care
Cornwall & Isles of Scilly

The circular has been shared in response to an increasing number

of requests made to us by GPs and practice managers for advice
on how to respond to any on-line provider that holds itself out as
being expert in the assessment, diagnosis and care of gender
dysphoria. As NHS England is not in a position to make judgements
on the competence and experience of providers whom we do not
directly commission, our intention is to provide GPs with an
authority to refuse a request for prescribing and monitoring
responsibilities where this is appropriate due to uncertainty about
the online provider’s expertise in this field. GPs cannot implement
a blanket approach to accepting or declining responsibility for
ongoing prescriptions, we must advise GPs to consider each case
LMC Newsletter

on its own merits.

Inside this issue:

Planned Downtime for the
Your Chair Elect writes 2 Exeter System.

Medicine shortage guidance 3 Please see attached bulletin

Private On-line medical
service providers outlining the planned NHAIS
Exeter system downtime for
GDPR 4 Cornwall and the Isles of
Scilly from 23/5-25/5
Events 5
Vacancies 6
• Items for the Newsletter should be
Dr Basil Bile 7 sent to the Editor, Dawn Molenkamp
at Victoria Beacon Place, Room
B313, Station Approach, Victoria,
Roche, St Austell, PL26 8LG
Tel :01726 210141
• e-mail dawn@kernowlmc.co.uk
Your Chair Elect Writes
You know that feeling when someone asks for a volunteer and you lose concentration for a mo-
ment as you ponder the sound of retreating feet behind you? Shortly afterwards the room fills up
again and someone hands you a dusty tiara and starts slapping you on the back. Well it was like
that.

For those of you who do not know me I work on the Roseland where I have been a partner and
trainer for the last 8-10yrs. I first came to Cornwall in 2000 and worked in most practices between
St Just and Bodmin as a locum whilst my wife (Terese Tubman) completed her GP training in the
Cornwall VTS. Somewhere in between I also worked as a GP in Australia for 4 years.

Pete Merrin has gone above and beyond on behalf of the LMC and Cornwall GPs as a whole and
he has come to the end of his tenure. Likewise, Dawn Molenkamp has supported us all and is
now due for a well-earned retirement at the end of this month. The Cabinet of the time decided it
might be an opportunity to reappraise the structure of the LMC and the service offered. To this
end it was proposed to reduce the Cabinet of six down to an Executive of three (Chair - me, Vice
Chair – Nick Rogers, Treasurer – Phil Trevail) and appoint a Chief Executive Officer to oversee
both the restructuring and running of the LMC in the future. The CEO is quite a substantive post
for a lay person to represent the LMC on occasions at the burgeoning number of meetings that
we are asked to attend. This sort of structure aligns us better with LMCs in other regions and is
likely to raise our profile and offer.

We are in the process of employing an excellent CEO but there will be a 2 month hiatus whilst
notice is served. During this time we are working on some contingencies so that the office is cov-
ered and hopefully service will continue unabated.

I think it is fair to say I did not plan to be in this position but I feel it is an important role for Cornish
GPs and I am going to give it my best shot. The role of LMC Chair has become much more com-
plex with the machinations of NHSE/KCCG/KHCIC and Pete has very kindly agreed to a period
of me shadowing him before picking up the reins. To this end we are attending the many meet-
ings together and Pete will take off my stabilisers and stand back at the end of August. I promise
not to wobble…

NO . 3 1 8 Page 2
 Medicines Shortage guidance for the South
West
Dear LMC colleagues

I have been in discussion with CCGs and LPCs about pulling together some guidance for colleagues in
community pharmacy on the subject of dealing with medicines shortages (CCG guidance already exists in
Somerset but not the other areas). This is in response to continued feedback that this is a strain on rela-
tionships in primary care and something that different pharmacies are perceived to manage in different
ways.

The attached to this newsletter is the current draft and I’d like to show it to you all before we finalise and
circulate it. Let me know of any comments?

Coincidentally yesterday I was contacted by a locum GP in Torbay who was struggling to source a vial of
cefotaxime for his doctors bag. He claimed one pharmacy had told him it was unavailable, another said
that it was a ‘hospital only line’ and in the end he went to a dispensing doctors who told him that there was
no supply problem at all and supplied him with one; leaving him with a bad impression. He rang me up to
discuss this and it did drive home to me the value of something like the attached.

With best wishes

Jon

Jon Hayhurst
Head of Pharmacy & Controlled Drugs Accountable Officer
Medical Directorate, NHS England South (South West)
South Plaza | Marlborough Street | Bristol | BS1 3NX

Primary Care Responsibilities In Regard To Requests

by Private On-Line Medical Service Providers to
Prescribe Hormone Treatments for Transgender
People

https://www.bma.org.uk/advice/employment/gp-practices/service-provision/prescribing/gender-incongruence-in-primary-care

In response to our concerns, Arvind Madan replied (and is happy for us to share)

The circular has been shared in response to an increasing number of requests made to us by GPs and practice managers
for advice on how to respond to any on-line provider that holds itself out as being expert in the assessment, diagnosis and
care of gender dysphoria. As NHS England is not in a position to make judgements on the competence and experience of
providers whom we do not directly commission, our intention is to provide GPs with an authority to refuse a request for pre-
scribing and monitoring responsibilities where this is appropriate due to uncertainty about the online provider’s expertise in
this field. GPs cannot implement a blanket approach to accepting or declining responsibility for ongoing prescriptions, we
must advise GPs to consider each case on its own merits.

NO . 3 1 8 Page 3
 GDPR

The BMA have now a page on their website for GDPR information .

This provides information on the regulation and hosts a suite of resources and blogs to help guide mem-
bers. This page will be updated regularly as new guidance is published and more GP focussed information
and resources will be added to this page soon.

And the GPC has advised the following:

• Practices should already have data protection policies and procedures in place; under the GPDR they
will need to be able to show that they are written down and accessible to staff and that staff are aware
these policies are in place.

• Practices should already know what personal data they hold, who can access them (and why), with
whom the data is shared (and the legal basis for this), and what security measures are in place for
storing and sharing; under the GPDR it will be a requirement to have an audit/record to state the
above, which can be provided to the ICO upon request (e.g. if there is a complaint from a patient about
a breach or non-compliance).

• Practices should already have ‘fair processing’ or ‘privacy notices’ displayed in the practice and on the
practice website. These notices should explain to patients how their data might be used, when they
might be shared and with whom and any rights of objection.

• Practices need to be able to demonstrate their compliance with the regulations upon request – at pre-
sent they just need to be compliant; under GPDR they will need to be able to demonstrate that they
have all policies and procedures in place, as well as a record of the above. Essentially if the ICO turns
up at a practice, they need to be able to provide them with a document showing all of the above.

• Penalties for data breaches, including not being compliant and not being able to demonstrate compli-
ance are much higher under the GDPR, and have lower thresholds (i.e. you can be fined more for a
lesser offence).

• Practices will no longer be able to charge a fee for patients to access their own information.
Practices which are already compliant with the Data Protection Act 1998 will be in a strong position for the
introduction of the GDPR. The BMA has existing guidance on GPs as data controllers under the DPA:
which you can read here .

The LMC advice remains ‘don’t panic’

With thanks to Wessex LMC

Page 4 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 EVENTS
Mindfulness based stress reduction

Mindfulness based stress reduction: This eight week course is designed to improve quality of life and re-
duce stress reactivity. Following requests for a weekend course, the next course will be run 730-930pm
on a Saturday evening at Embrace studio space in Penryn. It is open to both clinical and
NHS administrative staff across Cornwall. It costs £180 which includes a pre course interview, 8 x 2h ses-
sions, course materials and an all day retreat day which is part of the programme.
Dates: Saturday May 5th, 12th, 19th, June 2nd, 9th, 16th, 23rd, 30th, with the day retreat on Sunday 17th
June.
Stephanie Jackson is a GP and Training Programme Director for the Cornwall GP Training Scheme. She
holds a MSc. in Mindfulness based approaches and is an approved teacher with the UK Network of Mind-
fulness -Based teacher training organisations. Email Stephanie to find out more or book a place
Dr. Stephanie Jackson
Training Programme Director
Cornwall VTS 01872 252605
Sessional GP 07815801234

stephanie.jackson2@nhs.net

GDPR

Please find attached a link to the official GDPR Webinar put together by the Information Governance
Alliance

https://www.youtube.com/watch?v=S7xKH8KQlqE

NO . 3 1 8 Page 5
 Vacancies
GP (Partner/Salaried), Old Bridge Surgery, Looe

Nurse Practitioner, Old Bridge Surgery, Looe, C/D Fri 18th May 2018
Practice Manager – St Agnes Surgery, C/D Friday 11th May 2018
Salaried GP, Oak Tree Surgery, Liskeard – C/D 30/06/2018
Partner or Salaried GP, Sunnyside Surgery, Penzance – C/D 31/5/18
Lead Practice Nurse, Sunnyside Surgery, Penzance – C/D 18/5/18
Salaried GP, Clinton Road Surgery, Redruth. – C/D 1/6/18
Salaried GP or Partner, Tamar Valley Health. C/D 31/5/18
Urgent Care Practitioner, Veor Surgery, Camborne.

For further details please see Cornwall LMC Website

NO . 3 1 8 Page 6
Dr Basil Bile………..

The world’s population was shaken to its roots when Donald Trump was elected President of the
United States. Had the Yanks taken complete leave of their senses? We were shocked to the core. And
yet we practitioners of the noble art of family doctory now find ourselves in exactly the same (if not a
worse) position. To the amazement and disbelief of the watching millions tuned in to Spotlight South West,
the Cornwall and Isles of Scilly Local Medical Committee has elected Willie Hynds as its new supremo.

Out goes Lycra Pete, summarily escorted off the premises by a couple of Willie’s heavies, carrying
a cardboard box of his personal belongings: cycle clips, dayglo pants, and a puncture repair outfit. We
shall miss his whimsical editorial attempts to rally the troops.

Also on her way out of the revolving door is long-time Executive Manager Ms Sunrise Molestran-
gler. It is rumoured that once Willie discovered that the tall hill-like structures behind GCHQ in Victoria
were not, as he first assumed, china clay pit waste, but in fact mammoth piles of ash from Ms Molestran-
gler’s frequent nicotine breaks out by the back door, her fate was sealed. She will be sadly missed, not
least by Cornwall’s tobacconists. Behind every successful LMC Chairperson for goodness knows how
long has been lurking the Machiavellian figure of Sunrise Molestrangler. She has furtively supported a se-
ries of LMC Worthies of varying ability, height, and width, by fixing, bribing, blackmailing and generally oil-
ing the rusty wheels of Cornish General Malpractice. We shall not see her like again.

What of the new wave of fresh incoming talent, I hear you ask? My spies tell me that the Chair
Elect is squeaky clean, and there is no gossip to be had on him at all. Don’t you believe a word of it. I have
it on good authority that he cheats at scrabble, and carries several spare ‘S’ pieces in his pockets, not to
mention a ‘Q’ in case of redundant ‘U’s. Clearly a bounder and a cad of the first water. On the plus side he
is married to a fair dinkum Aussie. I hope he is aware of the recent publicity surrounding the Australian
proclivity for ball tampering.

Willie’s running partner as Vice Chair is an ex rugger bugger and keen athlete who has changed
his name by deed poll to Nick Rogers and wears tweed waistcoats. He is an avid runner, so soggy lycra
will continue to be hung out to dry on the radiator by the drinks cabinet in the LMC Office. I understand he
is due to compete in the Hinter Island Swim on the Scillies later this year. I’m afraid that impresses me not
one jot. I once swam from one end to the other of the pool at the New Inn on Tresco, requiring only a
handful of stops along the way for beer. An unnamed source informs me reliably that his favourite film is
Save Willy. Highly appropriate given his role and the name of his superior.

Perhaps the most alarming aspect of this changing of the guard is the emergence from the murky
shadows of a certain Dr Phil Travail to ascend to the giddy heights of LMC Treasurer. Could that by any
chance be the same Phil Travail who was intimately connected with KernowQuack, the Grand Duchy’s
erstwhile and much-lamented Cornish GP out-of-hours service? If so, I feel it my duty to point out that any
treasurer should have a rudimentary grasp of maths. Dr T apparently had the greatest of difficulty working
out exactly how much he owed me after I thrashed him at the poker table at the Sticker International Casi-
no many moons ago. I only hope for the LMC’s sake that he has calculator to hand.

Hynds, Rogers and Travail. It sounds like a very dodgy firm of solicitors to me…

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