No.

319 So long and thanks for all

May 2018 the fish
If you are unfamiliar with the saying, it’s from Douglas Adams Hitchhiker's Guide to the
Galaxy
Its title is the message left by the dolphins when they departed Planet Earth just before it
was demolished to make way for a hyperspace bypass.
After almost 13 fun –filled years it’s time I retired from the LMC (some will say way
beyond time, but that’s another story).
My replacement, Emma Ridgewell-Howard will be taking up her post on 6th August,
until then Nicky will be holding the fort and repelling all boarders, some of you know just
how feisty she can be and has a reputation for taking no prisoners.
Emma will, I am sure, do you all proud, but best of all she will continue my tradition of
Cornwall & Isles of Scilly

wearing mad shoes, it was not a condition of the job, but certainly helps.
I will be shortly be departing for warmer, sunnier climes, where the cheese is plentiful
and the wine free flowing, even if I do have to put up with the French I think it’s still a
win-win situation.
Another newsletter stalwart, Dr Basil Bile is also abandoning the LMC, possibly not so
much abandoning more like making a quick escape before the GMC, CQC and the Inland
Revenue catch up with him. He was last see heading for Hispaniola muttering something
about rum punch and parrots. Thanks for all the laughs Basil, and we wish you a fair
wind.
My best wishes and thoughts to you all. Thank you for making the last few years
‘interesting times’.

Dawn
LMC Newsletter

Inside this issue:

GP Health Team for Cornwall 2

Capita Stationary Stock 3

Vaccs & Imms 2018/2019 4

GMC Guidance.
National Spirometry
Certification Programme.
Diamorphine supply Issue

New PGDs 5
CHIS Mobilisation Bulletin

Practice Manager & Admin 6

Staff Courses

Dr Basil Bile 7
 GP Health Team for Cornwall

http://gphealth.nhs.uk
Access to confidential mental health and addiction support for GPs and GP Trainees across England
The GP Health Service can help GPs with issues relating to a mental health concern, including stress or depression, or an
addiction problem, in particular where these might affect work. It is NOT instead of seeing your own GP, but does recog-
nise that sometimes there are barriers to seeing someone we know well, and that we may wish to see someone with spe-
cialist knowledge in the field.

Please see the leaflet for full details

http://gphealth.nhs.uk/wp-content/uploads/sites/37/2017/12/GPH-Leaflet-V3-Nov-17.pdf
GPH is not an Occupational Health Service, nor is it a service for individuals with mental health problems which require
specialist psychiatric input - though we can help provide additional support where we can. If you think that you have a men-
tal health problem that requires this level of specialist help you must contact your GP to seek help.

GPH is provided by health professionals who have additional expertise in addressing the issues concerning doctors.

How do I contact GP Health? Access the service by emailing us on gp.health@nhs.net or by calling 0300 0303 300. The
service is available 8am – 8pm Monday – Friday and 8am – 2pm Saturday.
When you contact us, you can expect a short telephone contact to obtain demographics and other brief details. You
will than be given a code for an App which allows you to book a face-to-face assessment from GPH clinicians in Cornwall
or elsewhere in the South-West. Please expect your initial assessment to last up to 90 minutes. Further management de-
pends upon result of the assessment.

The local team in place to support you consists of:

Dr Stephanie Jackson (Truro area)

I have been a GP since 2002. Currently I work as a locum / OOH GP, training programme director, appraiser and GP Sift-
er. Prior to this I was a part time salaried GP and GP trainer. I have been interested in wellbeing and how to achieve and
maintain this for many years, both personally and as part of the therapeutic relationship. I have taught yoga for 20 years,
been a trustee for Arts for Health and also helped set up a community garden which offers horticultural therapy and nature
based play. I recently completed a MSc. in Mindfulness based approaches
Dr Mark Morris
GP Partner; Trescobeas Surgery
I'm a GP partner, out-of-hours GP and training programme director. I have been a partner in more than one practice, have
worked salaried and have been a locum. I have an interest in mental health, having obtained MRCPsych on the way to
general practice. I enjoy delivering training on mental health and therapeutic approaches. My other interests include fami-
ly, friends, running (through the woods at night so nobody can see me!!), meditating, listening to music and walking Archie
(our Brittany Spaniel).

Dr Katy Briffa (based East Cornwall)

I have worked as a Psychiatrist since 2004, following qualifying from Edinburgh University, and have been a Consultant
since 2012, specialising in the assessment and treatment of adults. I am also a systemic practitioner, which means I have
a family therapy qualification, an unusual combination but one which very much informs my approach, and is often linked to
unlocking and improving stuck situations for patients. I am a specialist with immigration, asylum seeking, refugees and
transcultural issues.

I am experienced in working with the following problems, though not exhaustive and in no particular order: suicidal thinking,
self harm,
post traumatic stress disorder, personality disorders, depression, anxiety, psychotic disorders, bipolar disorder, OCD and
other stress related disorders, eating disorders, functional somatic symptoms, perinatal conditions, ADHD, autistic spec-
trum disorders.
Dr Andrew Tresidder is South West Clinical Lead, based in Somerset but consulting in East Cornwall by arrangement
Please make initial contacts with the service through GP Health 0300 0303 300 or gp.health@nhs.net
Cornwall LMC has a well-established Pastoral Support team - contact the LMC Office for this on 01726 210141
Key Message: Don’t suffer in silence – Help is at Hand – as long as we ask

NO . 3 1 9 Page 2
 Capita - Stationary stock
Important update regarding paper stock items/supplies availability
PCSE has been advised that third party suppliers currently have limited supply or are out of stock of the items listed
below. As an interim measure, NHS England advises that practices should download and print GMS1 and GMS3
forms.
Please see the table below for an update on when stock is anticipated to be available.
Up to date information on the availability of these items will be posted on the PCSE website.
Urgent queries regarding out of stock items should be emailed directly to NHS England at:
ENGLAND.SMTinfo@nhs.net.

Medical
Code Description Status
FP111 Medical Record Folder Out of stock in some areas.
GMS1 Family Doctors Services Regis- Out of stock in some areas.
tration
It is anticipated that interim
stock of the current form will be
available for PCSE to deliver in
June.
The form is available to down-
load and print. Click here to
download the form from the
NHS Choices website.
GMS3 Temporary Services form Out of stock.
It is anticipated that interim
stock of the current form will be
available for PCSE to deliver in
June.
The form is available to down-
load and print. Click here to
download the form from the
NHS Choices website.
MTB Methotrexate Treatment Book- Out of stock in most areas.
lets
OATALERTCARD OAT Alert Card - Oral Anticoag- Out of stock in some areas.
ulant Therapy - Card only
It is anticipated that interim stock of
the current form will be available for
PCSE to deliver in June.
OATBOOK OAT Record Booklet - Oral Anti- Out of stock in some areas.
coagulant Therapy - In addition
It is anticipated that interim stock of
to those in packs the current form will be available for
PCSE to deliver in June.
PPAEXENV (RE26) PPA Return Exemption manilla Out of stock in some areas.
Envelope.
It is anticipated that interim stock of
the current form will be available for
PCSE to deliver in June.

NO . 3 1 9 Page 3
 Vaccs and Imms 2018/19 GMS guidance
Here is a link to the latest guidance on NHS Employers website .

Introducing the National Spirometry Certification Pro-

gramme - GPC statement
The statement has now been published on the BMA website and is available here and attached as a PDF.

Diamorphine supply issue

The Department of Health and Social Care (DHSC) and NHS England have been made aware of a manufac-
turing issue from one of their suppliers of Diamorphine 5mg and 10mg injection. There are currently two suppli-
ers of Diamorphine injection in the UK; Accord and Wockhardt. Recently Accord’s plant in Germany has expe-
rienced quality issues and the DHSC is working closely with Accord, regulators, and others to resolve these
issues.

Based on current usage and remaining stock, there is the potential for supplies of Diamorphine 5mg to
be depleted week commencing 4 June and diamorphine 10mg injection week commencing 11 June.
Further supplies are currently expected the week commencing 28 June.

The DHSC is working closely with the remaining supplier, Wockhardt, to secure further supplies for the UK
market from July, and are continuing work with Accord to resolve the manufacturing issues.

The DHSC has been working with national clinical leads and specialists to discuss alternatives. The UKMi has
published guidance to help support this supply issue, available here:

The recommended alternative is morphine injection; the DHSC are in discussions with all the manufacturers to
ensure that any additional demand can be met.

Further information includes the Patient Safety Alert on high dose morphine and diamorphine available here.

Also attached is patient information that has been developed by NHS England to support this medicine supply
issue.

Recommended local actions:

• Please order responsibly during this time, in line with historical demand, and do not stock pile to avoid
lengthening the stock out period.
• Review and share UKMi clinical guidance and engage with clinical colleagues to review / amend clinical
guidance accordingly.
• Morphine 10mg injection will be available to cover the Diamorphine supply issue in June. Please only order
extra stock of Morphine as Diamorphine injection becomes unavailable locally and do not stock pile.

DHSC and NHSE will continue to work with all stakeholders and provide further updates as available.

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

 New PGDs authorised for practices in the South West

Your team can now download new PGDs that have been authorised for the vaccination of pa-
tients registered with practices in the South West of England*.
https://www.england.nhs.uk/south/info-professional/pgd/south-west/downloads/

Two PGDs have been updated:

Administration of meningococcal group B (MenB) vaccine by nurses, pharmacists, paramedics,

and physiotherapists
Administration of human papillomavirus (HPV) vaccine by nurses, pharmacists, paramedics, and
physiotherapists

CHIS Mobilisation Bulletin

IMPORTANT - ‘GO Live’ date changed for Cornwall

Due to unforeseen complexities in transferring data from ‘RIO’ to ‘CarePlus’, all organisations involved in
the Cornwall CHIS data migration have agreed to extend the deadline for final data transfer. The new ‘Go
Live’ date is now set for 1st August 2018, giving all parties extra time to test and format the CHIS and ref-
erence data.

Kind regards

PJ Kirby
Healthcare Development Manager
Health Intelligence

NO . 3 1 9 Page 5
 Practice Manager and Admin Staff Courses

Just to remind you of the courses coming up.

I still have a few places on the afternoon session for “Personally Administered Items Workshop” that is
being held on Thursday 21st June 2018 – if you want a place just email me (admin@kernowlmc.co.uk).

And,

Wednesday 4th July – Notes Summarising – full day

Wednesday 11th July – Accounts Update – full day
Wednesday 18th July – Whistle Blowing – Half day – Morning
Wednesday 18th July – Chaperone Training – Half day – Afternoon

Plenty of places on the July courses so let me know and I can send you a booking form if you don’t al-
ready have one – Cost £35 per delegate for a full day course (including lunch) and £20 per delegate for a
half day course (no lunch).

NO . 3 1 9 Page 6
Dr Basil Bile

The fact that our much-loved Secretary of State for Health, Social Services and Lame Ex-
cuses has admitted that Andrew Loungelizard’s NHS Reforms have been an unmitigated disaster
comes as scant consolation to those of us who pointed out years ago that his ideas had more
holes in them than a Swiss cheese. Sadly no one listened as we were ritually accused of being
self-interested Luddites. The cogs of the rusty machine were oleaginously lubricated by those of
our number who fancied chancing their hand at the dark art of commissioning, in spite of this not
being a subject that any of us were taught at medical school. Predictably it is ending in tears.

Peeceetees were brutally sacrificed on the high altar of political knee-jerk meddling by
Messrs Cameron and Clegg. We are told by Kat Lay, Health Correspondent of the Daily To-
rygraph, that HM Gov is beginning to ‘quietly unpick the legislation by the back door’, thus hoping
to avoid yet another disruptive top-down disorganised re-organisation, the last one of which Jere-
miah Stunt admits ‘balkanised’ the NHS into ‘fiefdoms’. I haven’t a clue what being balkanised
means, but it sounds jolly painful.

As for fiefdoms: NHS Fruitcake, Public Hectoring England, and Health Scare England all
spring to mind. And lest we forget, NHS Fruitcake is begatting no fewer than forty-four Sustaina-
bility and Transformation Partnerships to remove the previously much vaunted buyer-provider in-
terface. They are to be known as STPs, and are not to be confused with STDs, although they
may turn out to be just as difficult to get rid of.

Meanwhile we are told that the much-beleaguered NHS needs an extra two-thousand quid
annually from every household in order to function ‘properly’, presumably as opposed to function-
ing ‘improperly’. A joint report by the Institute for Fiscal Studies and the Health Foundation came
to the unsurprising conclusion that there was no more room for increasing health spending by
nicking it from other Government budgets, and Johnny Tax Payer will have to stump up. The re-
sponse so far from HMG has been the usual vacuous waffle about being committed to a long-
term plan. Rather like King Canute’s long-term plan, and we all know how that ended up.

At least in our little neck-of-the-woods at the Abandonhope Practice we have managed to

sidestep some of the problems others have encountered by adroitly ignoring as many of the litany
of misguided reforms as possible. I accept it has resulted in our being put under ‘Special
Measures’ for most of the last decade but, as my dear old Mum used to say, it is always a posi-
tive thing to be considered ‘special’. And as she departs for Brazil via Heathrow with a suitcase
stuffed full of used fivers, I must extend heartfelt thanks to the LMC’s fleeing Executive Director,
Ms Sunrise Molestrangler. My partners, Drs Hilda Bunnytunnel and Clint Thrust, join me in recog-
nising her unstinting support in sending monthly food parcels for our receptionists, funded out of
the LMC’s labyrinthine coffers.

When they shout at patients (who are unreasonably demanding appointments within the
next four weeks) we have the satisfaction of knowing that it isn’t because our dedicated front-of-
house team are hungry…

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