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Cornwall & Isles of Scilly

LMC Newsletter

October 2013

Your Chairman writes...

I always knew that GPs could multitask but I never knew how much
I could do. I've always been worried by my limitations but my eyes
have been opened by the Health Secretary. In addition to the ever
expanding day job (9 to 5 three or four days a week full time
apparently) I can or should be working seven days a week 8 till 8,
reducing the mountain of A and E attendances, be single handedly
responsible for scores of the frail elderly, commissioning secondary
care, overseeing out of hours care, looking after the terminally ill.
The list is endless. I'm thinking of selling my services to the UN, we
GPs after all are super human right ?
I think it's a difficult time to be working in primary care, but we are
not alone. Colleagues in other healthcare settings are also under
the cosh. There is increasing pressure on the NHS, its services and
staff promulgated through the media. Politicians are happy for the
press to carry on giving the NHS a bashing because it avoids the
difficult question that needs answering. Which is, how can we
continue to afford the NHS that we as a nation want at the price that
we are willing to pay ?
Meanwhile let's keep fiddling, Rome's burning!

Inside this issue:

The Practice Manager
Vaccine Supply : Zostavax

LARC: Enhances Services

2013/14 Enhanced Services
guidance and audit
requirements - update

How innovative GPs are

already tackling the many
challenges that come with
the Call to Action.

Child Protection template

From the archives

How to Skype your GP:

a handy guide
If you havent already seen this,
do take a look - it makes amusing

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Sedgemoor Centre, Priory Road,
St Austell PL25 5AS
Tel :01726 627978,

When was the last time you made your

Practice Manager a cup of coffee?
It is not just GPs who are currently having a tough time.
Spare a thought for your Practice Manager; on top of their daily work many other challenges have been
thrown at them, including:
Care Quality Commission
Payments from PCTs moving to several different organisations
Data issues with QMAS moving to CQRS and the whole issue of Care.Data and information extraction
from your clinical systems.

Vaccine supply: Zostavax temporarily unavailable

Public Health England (PHE) recently published the third special issue of Vaccine Update in September,
which deals with the temporary suspension of the acceptance of orders for Zostavax following the recent
capping of orders.
National distribution of Zostavax vaccine began on 1 August 2013. However, due to an ongoing delay in
the supply of the vaccine into the UK, PHE has temporarily removed Zostavax from the ImmForm website, and it is not currently available to order.
PHE expect further limited deliveries during October, at which point ordering will be resumed, with more
substantial volumes due in November and December.
It is likely that the order level cap for England will remain in place during this period. PHE apologise for the
inconvenience caused.
Multiple ordering to circumvent the cap has presented a number of challenges both for the distributor in
distributing those orders, and for PHE in managing the remaining stock.
Further orders will be monitored.
When ordering resumes, Zostavax must only be ordered for the 70 year old and 79 year old cohorts this
PHE have asked GP practices not to stockpile the vaccine as the vaccine is expensive and it is important
to minimise wastage.
Please note that the vaccine can be administered to the two eligible cohorts at any time between 1 September 2013 and 31 August 2014.
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LARC Enhances Services

In these times of doom and gloom some good news is very welcome. Did you know that

The figures for provision of long acting reversible contraception (LARC) within primary care in Cornwall are among the highest in the country

The teenage pregnancy rate in Cornwall is now below the average for England

Cornwall has a lower rate for hysterectomy than the average for England and significantly less than
Devon I think that this is due to good primary care management and will be cost saving to the

I have been making a very strong case to the council to continue to commission coils and implants
from primary care and unlike the situation in some other areas there is no immediate threat to the
LARC enhanced services.

The LESs have an audit requirement and I will need this information in order to demonstrate the quality of
the service we provide. Please do respond when this is requested, it is in your interest.
Sarah Gray
As Clinical Lead for Contraception and Sexual Health - Cornwall
Termination of Pregnancy Notification
Practices should be aware that women attending for a termination of pregnancies are asked whether they
wish their GP to be informed. Many elect not to. The LMC has been advised that this is within their rights.
As a consequence, this information may be missing from the record. Please bear this in mind and take a
careful history in presentations where this may be relevant.

2013/14 Enhanced Services guidance and audit requirements - update

NHS Employers, NHS England and the Health and Social Care Information Centre (HSCIC) have updated their guidance and audit requirements for the 2013/14 enhanced services and the vaccination programmes supported by automated extractions.
This guidance is intended to support area teams and practices in delivering these services, and includes
the new read codes and business rules, including for childhood influenza.
Note that guidelines and a template for all the flu vaccines (including childhood nasal spray) are available
for Vision practices.
The guidance is available on the GP contract pages on the BMA website in the enhanced services section. The business rules have also been published on the HSCIC website.

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NHS Englands Deputy Medical Director, Mike

Bewick, explains how innovative GPs are already
tackling the many challenges that come with the
Call To Action.
We are now developing an even greater understanding of the challenges that face Primary Care and how
we must work differently to achieve sustainable change.
Thanks to your feedback to my two earlier blogs which has from across the health and social care system.
The Improving General Practice Call to Action has started off your responses on both what needs done and
As a GP I understand the call for some space or headroom to think about change; how do we describe what
we need to do and how do we then go about trying to deliver it? How do we prioritise the hundred things on the
to do list and focus on the top three that will really improve the experience of our patients? The day job sometimes just doesnt give us time to think about innovation.
That said, going on last weeks special learning event in London, primary care colleagues are doing just that.
The nine work-stream leads set out the vision for each of their areas and updated peers and other stakeholders on progress from patient empowerment to premises and from workforce to information and transparency.
The room was full of enthusiasm, innovative ideas and an appetite to affect real change.
It was clear from listening to colleagues that many have already seized the opportunity to do things differently.
There are a number of emerging new models of general practice provision, such as mergers and federations,
and utilising the full opportunities of APMS/PMS contract but were really keen to explore new ideas.
In the Improving General Practice Call to Action, NHS England makes clear it doesnt want to tell GPs what
to do, rather it wants to give them the support and tools that will help secure the future of primary care.
I am absolutely clear that we will not meet the challenges of limited resources, a changing workforce and rising
patient expectation unless GPs and commissioners are given the support and legitimacy to change and innovate even if it doesnt work out.
A surgery I visited recently is doing just that. Last week on a visit to St Levan Surgery in Plymouth I was introduced to the system of doctor first to address long waits for appointments and dissatisfaction among patients
and staff. Sick of queues out of the front door every morning, GPs decided to introduce the telephone-based
access system at no additional cost, with the only funding implication being the cost of extra doctors for a two
week period to cover training for the practice.
The system is simple and effective. Patients call the GP surgery and give their basic details to the receptionist.
Administrative issues get dealt with immediately, but the majority of patients receive a call back from a doctor
within one hour, with most within 30 minutes.
During the telephone consultation, the GP determines whether the issue can be dealt with by phone, by face to
face consultation or whether ordering investigations or sign-posting to other services is most appropriate.
The practice estimates only 30 per cent of calls result in a face-to-face appointment, and, as a result, the majority of patients around 90 per cent find it easy to get an appointment at a convenient time. The St Levant
practice is one of 31 utilising this system.
This type of innovation improves outcomes and patient experience and manages the increasing demands on
GPs. While it may not be for everyone, it will work in other situations, alongside IT solutions such as email consultation.
These together with the many examples showcased at the Improving General Practice A Call to Action event
last week, show just what can be done. Giving those at the coalface the freedom to take a chance, do things
differently, to innovate and do something new can lead to dramatic improvements in patient care and the job
satisfaction of GPs.
We need to hear more of your ideas how can we support innovation and achieve it at scale for the benefit of
all patients across the country? We need you to get involved in your call to action.
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Salaried GP Post Praze-an-Beeble Surgery/Connor Downs Surgery

An opportunity has arisen for a 4 session Salaried GP to join this friendly, rural practice. We are looking
for flexibility, enthusiasm and commitment to providing high standards of clinical excellence.
GMS practice with 5,400 patients covering a wide rural area.
Dispensing Practice
Modern purpose built premises, with dispensaries at both sites.
Consistently high QOF Achievement
Microtest Clinical Systems
Nurse Led Chronic Disease Management clinics
Primary Care Research Network Members
Please send expressions of interest and a copy of your current CV to:
Anne Craig, Practice Manager, Praze Surgery, School Road, Praze-an-Beeble, Camborne, Cornwall,
TR14 0LB.
Tel:01209 831386

For further information/to arrange an informal visit contact Anne Craig or Dr Hugh Fairlie.
Closing Date: 21st November 2013

Ilchester Surgery, Nr Yeovil, Somerset.

Ilchester Surgery, Nr Yeovil, Somerset, looking for a replacement doctor/s from 01.04.14. Approx time.
Small, semi-rural, GMS practice. We like our patients and we have the best staff. If interested, please
contact Jane Burrell, Practice Manager at or on 01935 840207.
Closing date: 25.11.13

Child Protection Template

This can be accessed on the LMC website.

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From the Archives.

Truro Sept 11th 1918
The eleventh meeting of the Cornwall Panel Committee was held at the Cornwall Insurance Offices at
Truro on Wednesday September 11th at 3pm
Panel Conference London May 11th 1918
The Secretary was asked to give a resume of the proceedings of the Special Panel Committee Conference
attended by him in London on May 11th 1918. This request was complied with, the Secretary amongst
other matters particularly pointed out that the greatest difficulty was occasioned the Central Acts Committee by the London and Kent Committees not notifying their intention of supporting the suggested demand for a 10/- capitation grant. The Government also begged the Conference to cause it no embarrassment as the Cambrai Crisis was at that time at its height. The Government however is in a generous
mood towards rural practitioners and Panel doctors, rural or urban whose net income falls short of 500
Per annum and promised in such cases by a special grant to bring up same to the sum mentioned providing application with proof were provided.
Case of Dr Hingston
The case having been referred back to the Committee it was decided that the following should be written
on the report form:That at that time there were no facilities in Cornwall for carrying out the 606 treatment free of charge,
and that this was explained in full to the patient and she herself asked to have it done at her own personal
expense. The cost was communicated to her, and she was requested to take time to consider, which she
did, and came back and repeated her desire.
Venereal 606 Treatment
The BMA offer to provide instruction in the 606 injections was considered but the chairman pointed out
that this was now being taught on request in any part of the county on application being made to the
county M.O.H. who would arrange to send an expert.
No election of Panel Committee
A notice from the Commissioners was read stating that unless application was made otherwise, another
years service was expected from the existing Panel Committees and their terms of office is extended until
July 15th 1919.
Case of Dr Joule
Dr Joule of Mullion having requested the Cornwall Insurance Committee to release him from his contract
to attend his panel patients forthwith as his wife is ill and himself is in indifferent health . The Cornwall
Insurance Committee expressed a desire that the Panel Committee should consider the case but stipulated
that they could not release him unless he provided for insured patients. The Panel Committee instructed
their secretary to write to Dr Rodgers, Mullion and Dr Randall, Ruan Minor, to discover if either could
render the necessary service so that The Cornwall Insurance Committee could release Dr Joule forthwith.
Medico-Political Union
Dr Trinder gave notice that he intended to bring before the next Cornwall Panel Committee the case of the
Medico-Political Union.
Secretary Honorarium and Expenses to London May 11th 1918
It was proposed, seconded and carried that the expenses of the Secretary contracted through attending the
special conference in London on May 11th be paid. It was also proposed, seconded and carried that the
Secretarys Honorarium due in Nov. 1918 be paid at that time.
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