Cornwall & Isles of Scilly LMC

Meetings

No. 286
July 2015

Here at the LMC Office, we are aware that whilst most GPs are
aware of the existence of the LMC, many are unaware of the work
the LMC Committee does on your behalf, and to many it may seem
like a closed shop.

Cornwall & Isles of Scilly

LMC Newsletter

The Cabinet, at the last meeting, decided they would like to change
this and would like to encourage any GP, whether they be a
Partner, Salaried or Locum to attend an LMC meeting as an
observer.
A locum fee will be paid along with mileage costs.
The remaining meetings for this year will be held on Tuesday 15th
September and Tuesday 17th November.
The meetings
commence at 2.30pm and usually finish around 5pm. The venue is
Victoria Business Centre, which is a couple of minutes off the A30,
so convenient and accessible for most of the county.
If you would be interested in attending, please contact the LMC
Office for further details.

Inside this issue:

Psychiatric Services provided by
CFT.
Pharmacists delivering flu
vaccines,

Cremation Forms.
Updated PGD and PSD Guidance.
Psychological Services for GPs.

Induction and Refresher Scheme

Transgender Guidance

Men C Vaccinations for University

Freshers.
Workforce Minimum Data Set.

Disabled Patients.
Out of Area Registrations.
FGM Prevention Programme

Duty of Care and Investigation

Results

Vacancies

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Victoria Beacon Place, Room
B314, Station Approach, Victoria,
Roche, St Austell, PL26 8LG
Tel :01726 210141

Dr Basil Bile writes

10

e-mail dawn@kernowlmc.co.uk

Advance Notice Kernow Health

CICs AGM
Kernow Healths GP Shareholders Annual
General Meeting to be held on 29th September 2015, from 7pm at Kingsley Village, Fraddon (Conference Suite, 1st
Floor). Postcode for Sat Nav: TR9 6NA.

Psychiatric service provided by

Cornwall Foundation Trust
Numerous anecdotal reports have reached the LMC about the level of service that we are receiving from
the Community Mental Health Team. These often seem to stem from a divergence in expectation between
GPs and the consultants running the service. On the psychiatric side is the belief that they provide a
therapeutic advice service on a one contact basis with the understanding that we will prescribe as directed
and monitor progress. On the GP side we have usually exhausted our expertise comfort zone and want
regular specialist input; in particular with titrating unfamiliar drugs and ongoing follow up until our patient is
stabilised.
A recent agreement between the GP Committee and Consultants Committee of the BMA has produced a
pertinent statement that can be found here (http://bma.org.uk/practical-support-at-work/gp-practices/
service-provision/duty-of-care-to-patients-regarding-test-results).
To summarise:
Drugs required for urgent administration should be prescribed by the hospital doctor.
Scripts for non-urgent drugs can be delegated to the GP if that has been agreed locally but can only
happen with the explicit agreement of the GP who will sign the script and all communication with the GP in
this case should be in writing.
The doctor recommending a prescription should ensure that the prescription is appropriate, including
carrying out any tests required to ensure safety.
Phil Confue the CEO of CFT (which runs Cornwalls mental health services) has confirmed that there is no
barrier to the consultant psychiatrists prescribing for their patients. Our advice is that if you are sent a
regime instruction that you do not feel comfortable instigating and/or monitoring you send a letter back to
the clinician concerned with a copy of the LMC rebuff letter and possibly a copy of the BMA statement.
Furthermore it would continue to be helpful to report any concerns via Stream.

Pharmacists delivering Flu Vaccines

It has been announced that from September 2015, adult at-risk patients will be able to access seasonal flu
vaccinations in participating community pharmacies. Pharmacy staff will be expected to identify eligible
patients and encourage them to be vaccinated. There will be a payment of 7.64 per vaccination administered, with an additional 1.50 payment in recognition of costs incurred such as training, revalidation and
disposal of clinical waste.
The GPC will request that the fee for this service for GPs is now reviewed given that pharmacists do not
have responsibilities for record keeping or call/recall procedures that GPs have.
More information about this is available on the BMA website via the link.
The original announcement, Community pharmacy funding settlement and national flu vaccination service
for 2015/16, can be viewed here .

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Cremation Forms
In collaboration with Jamie Hawke, the local Chair of the Funeral Director Association we have put
together the following information for GPs and Funeral Directors, in relation to GPs attending to issue
cremation forms.
The patients usual GP must see the body before signing part I of the cremation form. A second doctor
(who can be any doctor) also has to sign part II of the cremation form after seeing the body and after
having a conversation with the GP who signed part 1. Both doctors have to sign to say that they have
seen the body.
The family of the deceased may wish for the body to be moved nearer to where the family lives in order to
make funeral arrangements. Please remind them that if the relevant paperwork has not been completed
before the body is moved, and the body is taken outside of the GPs usual practice area then the GP will
not be able to travel to see the body. The GP has an obligation to prioritise his or her living patients and so
is unable to spend time travelling further afield than a distance of 10 miles from his practice. If the body
has been moved, the GP would ask the funeral director to bring the deceased back to a local funeral
parlour so the GP is able to complete the formalities. This usually causes distress to the family,
unnecessary delays (resulting in delays in registering the death and making the funeral arrangements)
and extra expense to the family as the funeral directors may charge for this.
It is therefore far preferable that the family understands this and has the option of making arrangements
with the funeral director to take the body to a local funeral parlour to be held there until the paperwork can
be completed, which under these circumstances can be done at relatively short notice. Most funeral
directors will have some sort of reciprocal arrangements with colleagues to do this.
We have also produced a template letter, (attached to this newsletter) which practices may find helpful to
send to their local care homes.

Updated PGD and PSD guidance

The GPCs guidance on Patient Group Directions (PGD) and Patient Specific Directions (PSD) in General
Practice has been updated to clarify the rules surrounding private PGDs.
The guidance is available on the Drugs and Prescribing page on the BMA website.

Psychological Services for GPs

If you find yourself in a position where you think you might require SPS services then we would ask that
in the first instance you contact the team by e-mail on bencharnaud@btconnect.com, or by phone on
07875 917397 (Linda Barry) or 01752 674348 (Anne Read). The e-mail address is monitored constantly,
and one of either Dr Ben Charnaud, Dr Anne Read or Dr Linda Barry will contact you back. We aim to
reply within 24 hours, but guarantee a response within 48 hours. We are not an emergency service and if
your condition is a cause for immediate concern then you should see your GP urgently or, in extremis,
dial 999.
Please note: non-members will receive a free triage phone discussion. Any further assessment or
treatment would have to be self-funded.

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Are you considering a return to NHS General Practice after a

break of 2+ years? Or is your practice interested in employing
a GP without prior NHS experience?
If so you may have noticed recent media coverage regarding the new National Induction and Refresher
(I&R) scheme. The I&R scheme provides an opportunity for GPs to safely return to general practice
following a career break or time spent working abroad or in another sector of the health service. The
scheme also supports the safe introduction of overseas GPs who have qualified outside the UK and have
no previous NHS GP experience.
The I&R scheme is tailored to the needs of each GP by them undertaking an individual learning needs
assessment (including an interview, multiple choice questionnaire (MCQ) and, in many cases, a Simulated
Surgery assessment). The results of the assessments determine the content of the scheme, and will
usually lead to a recommendation for a clinical placement that may be a minimum of a few weeks up to a
maximum of six months (or full time equivalent).
The national I&R scheme replaces the local arrangements that were previously in place within each
Deanery area. The advantages of the new scheme include:
A reduction in local variation, ensuring that GPs in England receive the same support and funding
to return to NHS General Practice, regardless of location.
Provision of a single entry point to the scheme, through the GP National Recruitment Office
(GPNRO). This provides candidates with a clear pathway through the scheme, providing a
constant point of contact and reducing the length of time it will take to progress through the
scheme.
A bursary of 2,300 (full time equivalent) on a monthly pro rata basis, for any clinical placement
lasting over two weeks, and reimbursement for the cost of one Multiple Choice Questionnaire and
one Simulated Surgery assessment (subject to the GP successfully completing the scheme, and
taking up employment in the NHS).
The scheme launched at the end of March 2015, and will initially run for three years.
Any GP who is interested in returning to NHS General Practice after a break of two or more years should
contact the GPNRO in the first instance, by emailing iandr@wm.hee.nhs.uk
Further details of the scheme can be found on the GP NRO website
In addition to applying to the I&R scheme, any doctor wishing to work as a GP in the UK is required to:
be on the GMCs GP Register
hold a GMC license to practice
be on the National Medical Performers List
Applications to the GMC Register can be made via the GMC website .
Applications to the National Medical Performers List can be made via the NHS England Performers List
website
Given that the prospect of returning to General Practice can seem a little daunting, and that the three
separate application processes may at first appear complex, NHS England South Region (South West)
has nominated a local lead to assist GPs wishing to apply to the I&R scheme. Emily Eason (Programme
Manager for Performance) is happy to speak to any GP who is considering applying to the I&R scheme, or
any practice that requires further information. Emily can act as a single point of contact within NHS
England for GPs undertaking the scheme in South West England, and can also guide GPs through the
National Medical Performers List application process.
Emily can be contacted by email at emily.eason@nhs.net or phone 0113 825 3575

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Transgender Guidance
There are a lot of issues to consider with transgender patients and I will try to give you a quick run down.
The bit below from the HSCIC website is particularly helpful and is something that could be shared with
the patient when discussing what can and cannot be done with their medical record.
First of all, becoming known by whatever name and title the patient wants is fine. This document tell you
more

Always use the name and title

(e.g. Mr, Mrs, Ms, Mx etc.) that the trans person wants to be called. If you are unsure about a
persons gender identity, or how they wish to be addressed, ask for clarification. Doing this shows
a level of understanding of trans issues.
But one of the problems with stating that the patient is male when they are female is the risk of missing the
screenings they still need for their actual biological state. MDU says:
Practices will need to ensure that patients are not sent inappropriate requests for screening e.g. invitations
to the cervical screening programme for patients who have become male, and that patients are addressed
by the correct name and title (Mr, Mrs, Ms). Patients may need to live in the acquired gender for some
time before surgery and their wishes to be addressed in their new gender should be respected.
The HSCIC website also has advice:
Patient is staying with the same GP
The Medical Record should remain with the GP.
A new Medical Record envelope should be provided with the patients new name, gender and NHS
number.
The GP must not make any changes that conceal or alter the patients clinical history.
All references to the previous name, gender and NHS number should be removed, or anything from which
this might be derived. The old notes can then be placed in the new envelope.
The previous identity and gender should be regarded as confidential disclosure of this information to any
person, even to other clinicians involved in the healthcare of the patient, without explicit patient consent is
a criminal offence. The GP Practice must ensure that they have robust systems in place to avoid
disclosure and/or access to historical information from which this may be implied due to the presence of
certain treatments or conditions.
It is good practice for the GP to place a label on the front of the new Medical Record stating Confidential
Patient Data take care on disclosure of information or some other such message, not immediately
visible to the patient.
If possible, electronic Medical Records should be merged on the GP Practice system under the new NHS
number showing the new name and gender identity details and all data relating to the previous identity not
included in the new record. GP Practice staff should seek guidance from their system supplier on how to
manage this.

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Meningococcal vaccination for University freshers

The Men C University freshers programme, which was due to start on 1 April 2015, has been on hold until
the MenACWY vaccine becomes available. The MenACWY vaccination programme will now commence
on 1 August 2015, which is when the vaccination programme for freshers will also commence.
Men ACWY vaccination will be offered to freshers (first time university or further education students who
have received notification via UCAS to obtain the vaccine aged 19-25) not previously vaccinated with
MenC since reaching age 10 who self-present at their practice for vaccination. There is a flat fee of 7.64
for one dose.
This is a single dose programme for patients aged 19 years and over and will run from 1 August 2015 to
31 March 2016.
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.

Workforce Minimum Data Set

GPC has advised LMCs on the Workforce Minimum Data Set (WMDS), and the actions practices were
asked to undertake by the Health and Social Care Information Centre (HSCIC) in submitting this
workforce data. For reference, the current GPC guidance is attached.
We are aware that alternative guidance was provided to some practices. This guidance stated that
although practices were required to submit the data, pressure could be exerted on NHS England and the
HSCIC to prevent them from processing the data. It was recommended that practices encourage their
staff to submit a notification under Section 10 of the Data Protection Act (DPA) to the HSCIC, lodging their
objection to the use of their information, and asking the HSCIC to confirm they would comply with this
objection and not process the data. This advice had been provided following communication with the
Information Commissioners Office (ICO).
The legal department has sought to clarify the position for practices, through further independent legal
advice (attached) and correspondence with the ICO and HSCIC. Each has confirmed that data subjects
do not have the right to issue a Section 10 notice under the DPA when the processing of data is being
conducted pursuant to a legal obligation, as is the case with the WMDS. The legal advice also confirmed
that practices could be in breach of their contractual obligations if they fail to comply with a legal
requirement to provide data under direction of the Health and Social Care Act.
We therefore recommend that practices continue to follow the guidance issued by GPC. The deadline for
the initial data collection was 7 June and we understand the next collection of data will take place in
November 2015. As mentioned in the GPC guidance, we remain concerned about the burden placed on
practices in completing this collection and will continue to take up feedback from practices with the
HSCIC.
Please note that the HSCIC confirmed that they received a large number of Section 10 notices following
the alternative advice provided to practices. They are in the process of responding to these applications to
clarify the situation.
Where LMCs and practices have queries or concerns they can contact the GPC Secretariat at
(info.gpc@bma.org.uk).
See attached files: Opinion in the Matter of the WMDS Guidance - 2 July 2015.pdf & Workforce Minimum
Data Set - GPC position - 2 July 2015.pdf

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New framework set to simplify care information for disabled

patients and their carers.
Disabled patients are set to benefit from improved healthcare after a new law comes into force to ensure information
they receive is clear, consistent and easy to understand.
The Accessible Information Standard will be implemented on 31 July 2016 and aims to provide people who have a
disability, impairment or sensory loss with information that they can easily read or understand. This means informing
organisations how to make sure people get information in different formats, for example in large print, braille or via a
British Sign Language (BSL) interpreter.
All organisations that provide NHS or adult social care are required to follow the new standard, including NHS Trusts
and Foundation Trusts, and GP practices. As part of the accessible information standard, these organisations must
do five things:

Ask people if they have any information or communication needs, and find out how to meet their needs. Record
those needs clearly and in a set way.

Highlight or flag the persons file or notes so it is clear that they have information or communication needs and
how those needs should be met.

Share information about peoples information and communication needs with other providers of NHS and adult
social care, when they have consent or permission to do so.
Take steps to ensure that people receive information which they can access and understand, and receive
communication support if they need it.
Further details are available here: http://www.england.nhs.uk/ourwork/patients/accessibleinfo-2/

Out of Area Registrations

The advice of the GPC is that a practice should only register out of area patients after they have sought and obtained
assurances from area teams that arrangements for urgent GP services including home visits are in place for
individual patients at their place of residence.
Without that assurance practices are strongly advised that they should not currently register any patients under the
new regulation.
Further guidance is available on the BMA website:

FGM Prevention Programme

Please see attached a letter from Jane Ellison, Minister for Public Health, which has been sent to NHS Trust Chief
Executives, Directors of Public Health and Chairs of CCGs across England. You can also see the letter at this link:
Within the letter, the Minister highlights the need for extra vigilance across the NHS as we approach the school
summer holidays, a time when female genital mutilation is often performed on young girls who are taken abroad for
this purpose. She outlines the main warning signs for NHS staff to look out for, and the range of support and
training materials available. The letter reiterates that FGM is illegal, and that safeguarding procedures must be
followed every time there are concerns.
Please also see an article for The Guardian Health Professionals Network which highlights this letter:

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Duty of Care Regarding Communication of

Investigation Results
The joint GPC and Consultant Committee statement on hospital test results has been updated and a statement on
Duty of care regarding drugs recommended from out-patient clinics has also been published as per below and on
the BMA website.
Duty of care regarding communication of investigation results
We are aware that in some areas, some hospital doctors have been instructing GPs to find out the test results which
the hospital had ordered.
Both the General Practitioner Committee and the Consultants Committee of the BMA agree this practice is
potentially unsafe, and that the ultimate responsibility for ensuring that results are acted upon, rests with the person
requesting the test.
That responsibility can only be delegated to someone else if they accept by prior agreement.
Handover of responsibility has to be a joint consensual decision between hospital team and GP. If the GP hasn't
accepted that role, the person requesting the test must retain responsibility.
This advice is in line with both National Patient Safety Agency guidance and the Ionising Radiation (Medical
Exposure) Regulations
Duty of care regarding drugs recommended from outpatients
Communication of prescribing recommendations from out-patient clinics to patients and their GPs is a complex area
where patient safety can be compromised. We would strongly recommend that LMCs and Hospital Trusts agree
policies that are publicised and adhered to by all parties. These policies should include the following general
principles:

Drugs required for urgent administration should be prescribed by the hospital doctor, and if appropriate
dispensed by the hospital.

Responsibility for the provision of a prescription for non-urgent medications should be determined and
agreed locally, but must recognise that delegation of responsibility for prescribing from hospital to GP can only
take place with the explicit agreement of the GP concerned.

Where communications are sent via the patient, there should be clear instructions to the patient
regarding the time scale for completion of the prescription, and this should be in addition to and not instead of
a formal communication.

The doctor recommending a prescription should ensure that the prescription is appropriate, including
carrying out any tests required to ensure safety.

The doctor recommending a prescription should provide counselling for the patient about important side
effects and precautions, including any need for ongoing monitoring, which if needed should be agreed
between primary and secondary care clinicians.

Recommendations should be in line with any agreed local formularies. Individual judgements should be
made about the desirability of recommending a particular drug as opposed to a therapeutic class.

Where a GP feels that a prescription recommendation is inappropriate, the secondary care clinician
should be informed.

Notwithstanding any of the above, all prescribers must be aware that the ultimate responsibility for the
prescription lies with the prescribing doctor and cannot be delegated.

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All communications should be in writing with the responsible doctor identified.

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Partnership Opening
Quay Lane Surgery, St Germans
Due to a reduction in Partners hours there is a rare opportunity to join Quay Lane Surgery. We are seeking a highly
motivated Partner to join our friendly cohesive team from July 2016. The number of sessions will be flexible for the
right candidate.
Quay Lane Surgery is a rural dispensing practice with a stable list size of 4,500 patients. Nestled in the heart of East
Cornwall we dispense to approximately 95% of our patients and have a branch surgery in the beautiful seaside
village of Downderry. Whilst having easy access to Cornwalls stunning coastline and its amazing array of outdoor
activities, we also maintain close links with the city of Plymouth which is easily accessible by rail and road and
situated about 12 miles away.
We are a forward thinking practice with our main focus being on high quality, holistic patient-centred care.
About the Practice:
3 Partner GMS practice
Microtest Evolution IT system
Partner owned, modern, purpose-built premises with Dispensary
Consistently high QOF achievement & a range of Enhanced Services
Branch Surgery open five days per week in Downderry
Active involvement in Kernow Clinical Commissioning Group
Active Patient Participation Group
Apply with a covering letter and CV to: Mrs Debbie Todd, Practice Manager. Quay Lane Surgery, Old Quay Lane, St.
Germans, Cornwall, PL12 5LH.
For more information or to arrange an informal visit please contact Mrs Debbie Todd:
Telephone: 01503 230088
E-mail: debbietodd@nhs.net
Website: www.quaylanesurgery.co.uk
Closing date: 30th September 2015

Doctor
Rosmellyn Surgery, Penzance
Due to injury absence, we are looking for immediate cover for up to 8 sessions until November 2015.
From November 2015 we are looking for an energetic, friendly and caring doctor for 4-8 sessions per week. We will
consider salaried, partnership and job-share arrangements for the right candidate.
We are a friendly, democratic, 5 doctor, training practice (3 rd year medical students and GP Registrars) serving a
mixed, semi-rural population of 6700 patients and have a longstanding commitment to providing easily accessible,
high quality and innovative care.
We have a first class nursing team which provides acute care, chronic disease management and frail elderly home
visiting service, and also benefit from a great support team; on-site support and ancillary services are provided,
including counselling, stop-smoking, addiction, physiotherapy and ultrasound services and we are actively involved
with AgeUK in the Penwith Pioneer project.
We have excellent existing premises, and are currently working with 2 other local surgeries in a brand new, joint
branch at the local Sainsburys store. We have a current project to move to state of the art new premises in 2017
with the same 2 surgeries.
West Penwith offers a superb working environment and all the advantages of living in one of the most beautiful parts
of the UK.
This is an exciting time to join us, so please contact our Practice Manager for more details or to arrange to visit us:
Mr Jerry Betteridge, Rosmellyn Surgery, Alverton Terrace, Penzance, TR18 4JH01736 333939
Email; jbetteridge@nhs.net

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DR BASIL BILE WRITES

So its all change for the Cornwall and Ill be Silly Local Medical Committee, location wise
that is. After an audacious attempt by NHS Fruitcake to charge an arm and a leg for renewal of
the contract for the premises in the Grand Duchys largest conurbation, our LMC has upped
sticks and buggered off to an exciting new habitat. The St Austell office was never ideal. Tucked
away in the labyrinthine Drudgemore Centre, it was like getting in to Fort Knox trying to access
Ms Molestrangler and her team. The fact that I was banned from the building (with the aid of a
rather unflattering mug shot in reception) hardly helped, but even heavily disguised in a monks
cowl and using the name Abbott, it all involved passwords, secret passages, and hidden rooms
behind bookcases.
Ms Molestranglers research revealed that, for the same exorbitant sum that NHS
Fruitcake were trying to extract, an office could be rented in central London next door to the
iconic Shard. Given its position in relation to Oxford Street, this would have suited her retail
proclivities, all part of her OSPD ( Obsessive Shoe Purchasing Disorder), but as that is
confidential medical information I wont mention it here. Suffice is to say that once Lycra Pete
complained that it was a long way from Perranporth to Central London for the Chairperson to
commute, and that cycling back on a Boris Bike might constitute theft, the idea was dropped and
alternatives sought nearer to home.
It was important that wherever was chosen had a classy ring to it. Tricky times lie in wait
for us practitioners of the noble art of Family Doctory, and morale demands a GCHQ we can be
proud of. Queen Victoria was a good egg long to reign over us and a posh monarch to boot,
Victoria Sponge is one of Ms Molestranglers favourite ingestible substances (second only to
nicotine), and is indisputably a posh confection, and to top it all, Victoria Beckham is Lycra Petes
favourite Spice Girl, aka Posh Spice. All of this background data meant that when an opportunity
arose to sidle in to posh premises in Victoria, it was a no-brainer. Ms Molestrangler was
devastated when it was explained that her desk would be situated in Victoria in Cornwall, and not
Victoria in London, but hey, shes a grown girl and will eventually get over it.
Meanwhile world leaders have been much in the news of late as the subject of the Grexit
has rather dominated news coverage. Germany has Angela, and Greece had Alexis at the time of
going to press, but we cap it all with a figurehead who is a MAMIL. For the uninitiated, this stands
for Middle Aged Man In Lycra. It is true that his habit of wearing his cycling shorts to LMC
meetings has long been a bone of contention, especially since they are a size smaller than is
wise for a man of his intimate construction. However, the recent employment of two modesty
guards to accompany him to meetings has reduced the offensive visual impact somewhat.
Chrissy and Julie walk one in front and one behind to ensure that no one of a sensitive nature
need be offended. I couldnt help noticing that one of them has the slightly unusual surname of
Wickett. I wonder if she could in any way be related to my former games master, old Sticky
Wicket

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