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Your Chairman writes ……..
March 2018 All Change at the LMC
NHS GP practices are increasingly being asked to provide primary care medical services to patients residing in
institutions or care homes where the types of services expected may not fall under their contractual obligations;
accordingly the BMA is receiving increased queries from practices and LMCs as to the requirements to register
and provide services to such patients.
This guidance outlines the responsibilities of practices in deciding whether they need to register such patients,
and if so, what services they are required to provide.
When GPs provide services to patients residing in institutions and care homes, there is often confusion over
who is clinically responsible for their care, which may present a risk to patient safety. GPs must not be forced to
accept clinical responsibility for aspects of the care of patients in secondary care institutions, nor for those in
any setting where the clinical needs of the patient fall outside the normal skills and contractual requirements of
GPs.
Care for patients in intermediate care can also present problems caused by a lack of clarity about the profes-
sional responsibility of GPs. This is important in the light of the trend to discharge relatively high-dependency
patients from hospitals to other institutions, with GPs increasingly being asked to provide care which is likely to
be beyond that which most GPs are trained, or contracted, to provide.
With this in mind, and following legal advice, this guidance outlines the responsibilities of practices in deciding
whether they need to register such patients, and if so, what services they are required to provide. References
to the CQC and NHS England should be read as including the relevant bodies in the four nations (e.g. Health
Inspectorate Wales, NHS Scotland etc.) and members should also ensure they refer to the relevant regulations
for their jurisdiction.
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NHS primary care medical services in institutions and care
homes in the UK (2)
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Reminder for practices – Recruitment companies may contact
you with offers of International GP for work.
This is just a reminder that all doctors working in a practice are required to be included on the National
Performers List (PL) if they are delivering a GMS, PMS, and APMS contract.
There are a number of International recruitment companies which are contacting GP surgeries and other
NHS bodies who deliver primary care offering doctors to work in primary care.
Very often the companies will advise that these GPs are fully qualified and on the GMC register and that
their status as an EU doctor allows them to work in this country. These GPS are able to work but MUST
also be on the PL to work in practice delivering GMS/PMS/APMS contracts.
If you employ a doctor who is not on the PL then your indemnity will not cover their clinical activity leaving
you at risk of patient harm and potentially ruinous litigation costs.
If you are interested in employing an International GP then you can do so through the national IGPR
scheme which has engaged with approved recruitment companies.
For further information on the regulations please contact the performance team in the medical directorate
who are the experts in this matter england.southwestperformerslist@nhs.net .
If you are interested in the International GP recruitment scheme then you can email your interest to
liz.thomas2@nhs.net – South Lead for the IGPR.
This useful and pertinent document is attached to this newsletter, and you are encouraged to read it.
If you prefer it can be accessed here
Please see below link for the information about the contract agreement.
Link: https://www.bma.org.uk/gpcontractengland
Here is the link to the national flu immunisation programme letter for 2018/19:
.It includes detail of extension of the childhood flu immunisation programme to include children in school
year 5.
Please note, further detail around vaccination of frontline health and social care workers will follow in a
second letter due to be released in late Spring.
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Learning from incidences in Primary Care
These are a result of incidences that have occurred in primary care and the learning has come from the Primary
Care Quality & Sustainability Hub Meetings.
Lost prescriptions in the post
6 loose prescriptions were delivered to a practice with the incoming mail which had apparently been found at the
Sorting Office. These prescriptions had been posted in an A5 envelope and taped at both ends. A postage label to
the Prescriptions Pricing Authority had been secured to the package.
The practice immediately identified that 39 prescriptions were unaccounted for. Royal Mail advised that 3 working
days should be left before contacting the recipient to check the outstanding items had been delivered.
Key learning points are:
1) That all prescriptions need to be sent recorded or special delivery as loss of prescriptions has both income and
information governance implications.
Medication error into a Monitored Dosage System (MDS)
Carer returned an unused MDS for a change in medication. The pharmacy team removed the Ramipril 2.5mg and
5mg Capsules and dispensed 10mg Capsules into the MDS but failed to identified that Ticagrelor was not present in
the MDS.
Key learning points are:
1) Ensure MDS is not accepted for alterations or re-dispensing. A new prescription should be requested and any
changes should be recorded on the MDS record card.
2) The content and the dispensing label on the MDS should always be checked against the MDS record card and
prescriptions as per Standard Operating Procedures.
Patients refusing to attend hospital
Recently a number of Serious Incidents and Significant Events in Primary Care have been identified with patients
refusing to attend hospital. NHS South, Central and West Commissioning Support Unit (SCW CSU) have investigat-
ed similar issues.
Key learning points are:
1) Informed consent needs to be accepted and understood by the patient. For consent to be truly informed, the infor-
mation given needs to be fully understood by the patient.
2) Healthcare Professionals must explain all reasonably and foreseeable risks of any patient decision. SCW CSU call
this ‘informed consent - explaining the risk’.
3) This conversation needs to be documented, including the risks discussed.
4) It should be noted that this applies not just to patients refusing to attend hospital, but particular treatments also.
SCW CSU also note that:
“If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment,
their decision must be respected.” – NHS Choices.’
EPS system does NOT allow urgent prescriptions to be highlighted to the receiving pharmacy when sent
from a GP system
A recent incident has occurred whereby, following a home visit from the GP, a patient was prescribed Amoxicillin
500mg capsules for a suspected chest infection. The GP issued this prescription electronically on their return to the
surgery via EPS, which was confirmed as received and downloaded at the patients chosen pharmacy.
The EPS token was sent to print@ the visual alert on the PMR which would indicate the patient required a delivery
was not seen by staff at the pharmacy. Additionally, there was no record of any verbal request from the GP, patient
or the patients family requesting the medication be delivered urgently. Consequently, the medication was neither
dispensed nor supplied.
The patient collapsed 5 days later and was admitted to hospital. Sadly the patient died 3 days later with the cause of
death noted as sepsis.
This incident highlights the importance of reiterating to General Practice teams that the EPS system does NOT allow
urgent prescriptions to be highlighted to the receiving pharmacy when sent from a GP system.
NHS Digital are currently reviewing the options available to support the identification of clinically urgent prescriptions
however, this is likely to take time in order to follow due process therefore unlikely to happen in the foreseeable fu-
ture.
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Guidance on Responsibilities for Prescribing between Primary
and Secondary/Tertiary Care
We have been alerted to this document from NHSE concerning prescribing at the primary and secondary/
tertiary care interface, and which is the result of a year’s work arising from the GPC’s Urgent Prescription for
General Practice
I would urge you to read it carefully, as its implementation will help with many of the problems that GPs will
have been reporting to you in recent years. Patients will also benefit by no longer being caught in the middle
with regard to obtaining the drugs that they need.
Please see below link for the information about the contract agreement.
Link: https://www.bma.org.uk/gpcontractengland
How about joining Methigion cricket club? A doctors team who have been together since 1989. We are a
mixture of Hospital doctors and GPs and are always keen for new players to come and join us. We play
evening 20.20 cricket throughout the summer. We play socially and don't take it too seriously .We have
Nets booked at the Truro cricket centre on the 11th April 7.30 - 9.00 , and a fun internal indoor six a side
at the same venue a week later on the 18th April, 7.---9.00 . Further outdoor nets on the 25th venue TBA,
all before the season starts in May. Any queries please get in touch - david.farrar2@nhs.net
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Practice Managers and Admin Courses Run
2017/18
I thought it would be quite nice to give you a summary of the courses we ran and the support we had from
them.
The courses ran throughout 2017 and into 2018 starting in May 2017 with the programme ending in March
2018. The maximum number of delegates we could have for each course was 20 delegates, but the ideal
number was actually 15. Due to demand we tried to put on the same course at different times of the year
which was reasonably successful, so here is a quick summary with delegate numbers.
So, Dawn and I would like to thank everybody that has supported us by attending the courses and I am
pleased to add that our programme for 2018/19 is already booking well.
If you have any suggestions for future courses, please do not hesitate to get in contact with us and we will
investigate them.
LMC Executive
I am pleased to announce that the new LMC Executive team has been elected unopposed and will
comprise of the following.
Dawn Molenkamp
Returning Officer
Just to let you know the course title for the day will be “Legal Surgery” and the content will run as follows:
Legal Surgery
This seminar provides delegates with an opportunity to have their individual scenarios considered and, as
such, it is run with a great emphasis on the individual delegate. Very practical answers are given to direct con-
cerns and delegates learn not just from the tutor, but also from one another’s problems.
And of course, the course tutor will be the ever-popular Darius Ferrigno – early booking is recommended as the
maximum number for this day will be 16.
I now also have more details on the days content. This will be run by Lucy Mace and Joe Dowling from Francis
Clark with Luke Bennett introducing the day. Luke will also be on hand for the entire session.
Again the course tutor will be Darius Ferrigno and the subject for the day will an “Employment Law Update”.
Booking forms for the above is attached to the back of this newsletter – please email to: ad-
min@kernowlmc.co.uk
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EVENTS
LARC UPDATE
LARC UPDATE – 2nd MAY 2018 – St Erme Community Centre
There are still spaces available for this study day.
It is structured as two separate 3-hour sessions which can be used towards DFSRH reaccreditation.
The morning session covering IUD provision (3 hours CPD). This will include the very latest changes to
guidance and product range. The afternoon session (3 hours CPD) will review contraceptive implants. It
will cover the theory base for this method and set the context for making a choice between the various
hormonal methods.
Details and a booking form are available on
http://www.crescetis.co.uk/womens-health-training-sexualhealth.html#lu_0205
Sarah Gray
Just to remind you we have the following courses coming up in the next couple of months:
Signposting Level 1 and Level 2 – Weds 18th April and Weds 15th May respectively – places available
Employment Seminar, entitled “Legal Surgery” with the ever-popular Darius Ferrigno – Thursday 3rd May
– places available
Keep your eyes on the courses coming up and we have an addition to the current list, that being
“Managing Pressure At Work” – an all day course and the date being Weds 10th Oct 2018.
Anybody that needs a schedule of courses please just email me – admin@kernowlmc.co.uk and I will
send you one with the booking forms.
Office Administrator required 3 days a week (24hrs per week – Weds, Thurs & Fri) plus holiday and
sickness cover. This post is to work alongside the present administrator. The ability to run the office alone
for part of the week will be required.
Tasks to include covering Sage Payroll and Sage Accounts, Co-managing the LMC Web site, minute tak-
ing and all general office functions.
Generous pay and holiday, good working conditions.
For further information contact either Dawn or Nicky (01726 210140 or 01726 210141) or email either:
Dawn@kernowlmc.co.uk or Admin@kernowlmc.co.uk
For more details on these vacancies please see the LMC website