No.

278
November 2014

Cornwall LMC Conference

Our biannual conference is being held on Wednesday 11th and
Thursday 12th February at the Atlantic Hotel in Newquay.

Cornwall & Isles of Scilly

LMC Newsletter

We have some very interesting speakers, someone to appeal to

everyone on such diverse topics as Limited Share Partnerships,
CQC and Federating - all of which should be food for thought at the
very least for the future of General Practice. Darius Ferrigno, an
employment law barrister, who many of you know will be available
all day to answer short employment law questions.
We have also been lucky enough to have Chaand Nagpaul, Chair
of the GPC coming. Chaand is always worth listening to and
makes for a very interesting and thought provoking speaker.
Still to come are two more speakers for day two, and the afternoon
of the second day will comprise of workshops, the outcomes of
which will be circulated after the conference, and hopefully giving
some new ideas that can be taken forward by the Cornish
practices.
Attached to the newsletter are booking forms and provisional
programmes. Day 1 is pretty much set in stone, but there is still
some flexibility for the second day, which will be very much
delegate led. Please complete the forms and return them to the
LMC office as soon as possible.

Inside this issue:

Upcoming Legislation

Your Chairman writes.

A Goodbye from Sue

The Cameron Fund

Guaranteed Loans.
Family and Friends Test.

Prime Ministers Challenge

Fund - Wave 2.
The Use of Salbutimol Inhalers
in Schools.
Out of Area Registration.

Out of Area Registration.

A new offence of driving with

certain controlled drugs above
specified limits in the blood is
expected to come into force on 2
March 2015.
More information will be in the
next edition of the
LMC
Newsletter.

5/6

Vacancy.
Updated Ebola Guidance for
Primary Care.
Guide to Premises Issues.

Dr Basil Bile

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Sedgemoor Centre, Priory Road,
St Austell PL25 5AS
Tel :01726 627978,
e-mail dawn@kernowlmc.org.uk

Your Chairman writes ..

Many practices have received recent communications from the Early Intervention for Psychosis Service,
part of CMHT. The contents of these communications have led to some heated letter and email traffic to
and from the LMC. I will be writing to every practice about this matter shortly. Suffice to say, no matter
what exhortations are made of practices dressed up with evidence and guidance we are not commissioned to do this work and until we are, I suggest a simple and straightforward NO is all that you have to
do. Please use our rebuff form and do NOT undertake the tasks suggested by the Early Intervention for
Psychosis Service until this work is commissioned by the CCG with the express approval of your LMC.
Please use our rebuff form and do NOT undertake the tasks suggested by the Early Intervention for Psychosis Service until this work is commissioned by the CCG with the express approval of your LMC. This
does not affect any contractual undertaking which you might wish to undertake as part of the mental
health provisions of QOF which are of course, voluntary, although they do represent 'good practice'.
Amid much huffing and puffing in the national press, CQC released their Intelligent Monitoring Reports. I
have little to add to the general sense that these reports are not particularly intelligent. Some LMCs nationally have taken to releasing press statements about them. As yet, apart from fellow LMC officers, I
have had no comments from constituents about these reports. Not one patient has mentioned them and I
am inclined to let the issue blow over unless I hear strong views from GPs to do otherwise. We are stuck, I
am afraid, with this sort of monitoring but with luck, hopefully, at a national level we can exert some influence and try and refine it. Personally I dont think we have anything to fear in Cornwall about the quality
of our practice and in fact I have always felt that the promotion of quality will bring its own rewards both
professionally and financially. However, quality comes at a price and if commissioners locally and nationally want a quality Primary Care led Health Service then they will need to invest a bit more of the NHS
budget than the meagre 8.5 % we get at present.
If we can convince commissioners that we can deliver outcomes as well as measurement of activity then I
think we will see larger investments in Primary Care. This will not be achieved with the small corner shop
model of GP but it does NOT mean the end of it. The challenge of getting larger but delivering locally is
one with which we are trying to wrestle both in Cornwall and nationally. I am hoping to get to see a number of innovative projects throughout the country within the next couple of months so that this can inform
some of our discussions in Cornwall.
Finally, Susan Hayes who has worked so ably in our office for the last 7 years is leaving for a new life
abroad. Her departure will leave a hole in the office for a few weeks while we re-structure. So thank you
and good luck to Sue and in the meantime, please be kind to Dawn.

A Goodbye from Sue

To all Doctors and Practice Managers.
I would like to thank everyone for the lovely presents and kind words I have received.
I have enjoyed working at the LMC and have come to make many friends over the years.
I will miss the people and especially working with Dawn.
Adis
Sue

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Introducing Cameron Fund Guaranteed Loans

We receive an increasing number of requests for assistance from GPs experiencing financial hardship
during re-training. In response, we have reserved a sum of money that can be used for the provision of
guaranteed interest-free loans to GPs assist with expenses during re-training. Repayments from these
loans will be used to finance further similar loans in the future.
Loans from this scheme are available to GPs who are undergoing re-training and are subject to the following conditions:

Completion of our application form, available from our web site, and the provision of supporting documentation;

Demonstration of lack of resources to meet essential living expenses;

Agreement to individually assessed repayment terms;

Finding a guarantor with sufficient resources to meet repayments in the event of default and both
applicant and guarantor signing a legally-binding loan agreement;

Successful completion of all parts of the Induction and Returner entry assessment and acceptance
for supervision by
an approved Educational Supervisor or successful completion
of equivalent assessment and supervision schemes where applicable.

GPs seeking a loan should complete our application form and send it with supporting documentation
to the address below.

Note: The maximum value of an individual loan is 15,000 and loans are limited to one per household.
The Cameron Fund reserves the right to refuse a request for a guaranteed loan if conditions are not fully
met and/or if there are not sufficient funds available.
The Cameron Fund
Tavistock House North
Tavistock Square

Tel: 020 7388 0796

E-mail: info@cameronfund.org.uk
Website: www.cameronfund.org.uk London WC1H 9HR

Family and Friends Test

Joint BMA, NHS England, NHS Employers guidance on data submission for the Friends & Family Test
(FFT) has now been published and can be accessed here.
This accompanies the GPCs more general FFT guidance published on the BMA website here.

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

Prime Minsters Challenge Fund Wave 2

Practices may have seen the recent announcement inviting applications for Wave 2 of the prime Ministers
Challenge Fund. As Devon and Cornwall benefitted from 3.5 million as a successful Wave 1 applicant for
pilot status groups of practices in this area will not be eligible to apply for Wave 2. The focus is on providing wider population coverage. There is however an opportunity to apply for 'sustainability funding' and we
will be putting forward a local application for some of that money. This is in recognition of the later than
expected start for most wave 1 projects and the need to have sufficient operational time to provide robust
data for evaluation prior to decisions as to whether the pilot can be sustained on an on-going basis or
should terminate.
FAQs states: The aim of wave two is to spread innovation and learning with a new cohort that improves
and extends access for more patients not already benefitting under wave one schemes. Practices successful in wave one cannot therefore bid in wave two. The web link is below.
http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/pm-ext-access/pm-fund-faqs/

The Use of Salbutamol Inhalers in Schools

Some practices have recently been contacted asking for letters /care plans for children who may need to
use Salbutamol during the school day. This is not the responsibility of GPs, it is schools being risk
averse. The DoH guidance for Salbutamol in schools can be found here . It is made quite clear that the
use of these inhalers is agreed between the school and the childs parents, Schools should also source
inhalers from a pharmaceutical supplier and not ask the patients GP to prescribe.
Please rebuff approaches for these unnecessary letters/care plans and refer the school to the documents
above.

Out of Area Registrations

NHS England has published the attached final set of documents, which have also been uploaded to the
NHS England website. Practices are advised to remind themselves of the GPC guidance on this issue,
which is available here:
In particular although the regulations remain in place, a practice should only register patients without
home visits knowing they have sought and obtained assurances from area teams that such arrangements
are in place for individual patients. It would neither be clinically appropriate nor practical to register patients without home visits whilst there is no assurance that arrangements for their care outside of the practice area are in place.
Practices are therefore strongly advised that they should not currently register any patients under
the new regulation.
http://www.england.nhs.uk/wp-content/uploads/2014/11/gp-con-guidance-out-area-reg.pdf
The Enhanced service letter can be found here.
Letter to Area Teams and CCG leads is available here.
More information is on the following two pages.
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Out of Area Registrations

You will have received a communication from NHS England Devon and Cornwall Team on 26th November regarding the Out of Area Registration Enhanced Service, with a deadline for response of 5th December.
It is important to remember that the Out of Area Registration Scheme (OoARS) falls into two parts:
1.

From 5th January NHS England intends that adequate arrangements will be in place to allow any practice to register any patient living at any address in England and if that address is outside the practices
declared area (outer boundary if you have declared one) to have no obligation to visit the patient at home
if their medical condition dictates that a visit is appropriate. Practices should only register such patients if
they have assessed the patients circumstances and have decided that OoA registration is appropriate
for that patient. They must also make clear to such patients the terms on which they are registering. (it
will still be possible to register a patient outside your practice area on the normal terms, i.e. with an obligation to visit)

2.

Practices may sign up to the OoAR Enhanced Service before 5th December. They will need to agree
with the AT an area for which they will be responsible (which may, or may not, be bigger than their registered practice area. They will then be responsible for providing urgent Essential Services to any patients
living within that area who have registered with a practice outside that area who are unable to attend
their registered practice and whom that registered practice has deemed to be in need of urgent Essential
Services.

There are pros and cons for practices in engaging in either element of the scheme:-

Registering Out of Area patients

Pros
1.

It will generate income for the practice. As always, each newly registered patient will attract a capitation
fee, starting in the Quarter after the one in which they register.

2.

It will enable you to provide continuity to patients who move outside your practice (albeit fragmented care
if they fall ill in their new area).
Cons

1.

In determining whether it is appropriate to register a patient who is resident outside your practice area
you must be non-discriminatory under the terms of the Equality Act 2010, despite the fact that the
OoARS regulations do not place a specific duty on you. You will therefore have to draw up a policy for
making that determination and apply it without exception. This could mean that your list size grows rapidly. We have no indication yet as to whether, once a practice starts to accept OoAR patients, it will be allowed to stop doing so without jumping through the sorts of hoops that are required for list closure; the
regulations are silent on the matter and we have no idea how NHS England would react to such a situation.

2.

Newly registered patients generate extra work. Your list turnover could increase. These patients, by definition are mobile. Some may not stay for the 3 months required to generate the first capitation fee.

3.

Any costs generated by such patients if you decide that they need seeing in their home area will be
charged to your practice budget or that of your CCG. You will have no control over how the provider in
the home area decides to treat the patient.

4.

GPCs view (and the LMCs) is that it would be inappropriate to register an OoA patient unless you have
definite evidence that the patients home Area Team has secured appropriate services for treating the
patient in his/her home area if necessary. Even if

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Out of Area Registrations contd/..

you have received adequate reassurances prospectively you will remain accountable for monitor
ing and ensuring the quality of all care received by all your patients during core hours. This will be
come especially important when the named doctor obligation for all patients comes into force on
1st April 2015.
4.

NHS England has reserved the right to reduce the capitation fee for OoAR patients at any time in
the future. We have no indication yet as to whether if that happened and you determined that
OoAR patients were no longer economic you would have the right to remove OoAR patients from
your list on that ground. Even if you had that right (and, again, the regulations are silent on the
matter) we do not know how the Ombudsman and the GMC would react we do know that both
bodies regard removal of patients from a standard list as close to a mortal sin, despite the fact that
the standard regulations do give you the right to remove patients under certain circumstances.

5.

The OoARS guidance from NHS England states that, urgent care is where the patients
medical condition is such that, in the reasonable opinion of the patients registered practice,
attendance on the patient is required and it would be clinically inappropriate for the patient to go to
their registered practice. Clearly, the question of what constitutes clinically inappropriate reasons
for going to the registered practice if it is many miles distant from the patients home provides even
more fertile grounds for patient complaints than if the practice is close at hand.

Signing up for the Enhanced Service to provide services to OoAR patients residing in
your area
Pros
1.

It will generate income for the practice. The rates are set out in the Enhanced Service. Only you
can decide if they are economic. We do not how whether or how they will be uplifted in the future.
Cons

1.

The workload will be unpredictable but it will always fall under the heading of unscheduled. It could
mean that you need to make adjustments to the way in which you commit practice resources
(mainly workforce) between routine and urgent care.

2.

You will not have access to the patients full record. NHS England has recently determined (quite
wrongly, in our view) that it is impossible for a primary care provider to deliver in hours Essential
Services without access to the full record (on Christmas Eve and New Years Eve) but it is asking
you to sign up to do exactly that. There are obvious medico-legal and contractual risks here.

3.

When a patient contacts you for this service his/her registered practice (and probably also the 111
service) will already have informed him/her that there is a need for urgent Essential Services in his/
her home area. You may disagree. Clearly, there is potential here for patient complaints

4.

The Enhanced Service allows for a practice to withdraw but no notice period is specified and the
mechanism for withdrawal is not specified. We understand that ATs are expected to deal with this at
a local level and we advise practices not to sign up to this service unless this is clarified. Enhanced
Service

5.

We understand that only a minority of practices indicated at the local meetings about this Enhanced
Service that they were likely to be interested. The AT must commission services for the whole of
Nottinghamshire and Derbyshire. We therefore anticipate that there may be pressure on those practices that do express an interest to agree to cover a much larger area than their own practice area.
We advise practices not to bite off more than they can chew and, in any case, not to sign any document that does not clearly specify the area to be covered.

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Veor Surgery, South Terrace, Camborne.

An opportunity has arisen (due to relocation) for a full time or part time , Salaried GP permanent post (job
share would be considered ) with a view to partnership in the near future, to join our friendly and progressive PMS practice with 8,700 patients. We are looking for flexibility, enthusiasm and commitment to
providing high standards of clinical excellence.

Modern purpose built premises.

Consistently high QOF Achievement

Emis Web Clinical Systems

Nurse Led Chronic Disease Management clinics

6 weeks annual leave including one week study leave

GPs and nurses with special interests

Active members of our local commissioning group

NHS Pension Scheme

Please send expressions of interest and a copy of your current CV to our Practice Manager:
Teresa Kemp, Veor Surgery, South Terrace, Camborne, Cornwall. TR14 8SN 01209 611171 or e-mail to
Teresa.kemp@ veor.cornwall.nhs.uk

Updated Ebola Guidance for Primary Care

Please see link below to updated Ebola guidance for Primary Care.
The only real changes from previous version are that the temperature level has been decreased equal to
or above 37.5 and that patients who are reasonably well can be transported by ambulance rather than
use private transport.
I discussed both these issues with the Deputy CMO at the drafting stage and raised my concern about the
ability of the ambulance service to cope with this in the event of an increase in possible cases. I have
been assured (but not reassured) that the Ambulance service have been involved in developing the guidance and can deliver.

Ebola: infection prevention and control for primary care (NEW)

Dean Marshall
GPC Executive Team

Guide to Premises Issues

The answers to many premises questions can be found on the BMA website, including guidance on
Collaborative GP alliances and federations, Stamp Duty Land Tax and legionella control. All of the items
and more can be found here.

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DR BASIL BILE WRITES

I have had another personal e-mail from Chag up at the BMA. He often writes to me. I am not sure why he
chooses me out of all the GPs in the United Kingdom, but I dare say my considerable knowledge and wisdom when it comes to matters Family Doctorial has something to do with it. And in these difficult times I
am only too glad to be of assistance. Strangely he never responds to my helpful replies, but I do know he
has a lot on his plate at the minute.
If I can be critical in a spirit of supportive kinship for a moment, he does tend to waffle and fill his missives
with initials. I can cope with GP, NHS, and GDP, but MCP and PACS crept in to this weeks effort
which only served to confuse me. Apparently the former stands for Multispecialty Community Provider,
and the latter for Primary and Acute Care Systems. The only Multispecialty Community Provider I am
aware of is Gloria, who has set up an Exotic Massage Parlour (EMP) over the road from the Abandonhope
Surgery. We have been doing a roaring trade as our part in PACS by treating an epidemic of musculoskeletal injuries in elderly male patients ever since she arrived on the scene.
Meanwhile, just when you thought the Bonkers Brigade had run out of daft ideas they prove you wrong by
dredging up a real pearler. Paying Family Docs fifty-five quid each time they diagnose Dementia has to be
just about the most cognitively impaired notion I have come across in a long long time, and I have come
across a few I can tell you. As background to all of this in March this year NHS Fruitcake set aside a ninety million smackeroo sum to help meet dementia targets.
Presumably this paves the way for similar payments for diagnosing chicken pox, tennis elbow and piles.
Whoopee! That salmon pink Rolls Royce beckons. The fact that it is part of our professional duties to diagnose such conditions seems to have slipped someones mind. Jeremiah Stunt and his henchpersons up at
the Department of Horror presumably believe that without a cash inducement we would fail to make an
Alzheimers diagnosis, as the thought of being able to fully invest in this years ISA will somehow sharpen
our clinical acumen to razor point. However, to be fair and balanced (which as you know I always like to
be), most of my customers are definitely not playing with a full pack so the scheme should allow me to retire to the Cayman Islands within the next financial year. The more I think about this, the more it seems to
be a ripping wheeze. As is my prerogative, I have changed my mind. Jolly well done to all concerned!
Finally, news has just reached me that a member of our profession has been struck off for claiming sick
leave whilst working as an international equestrian commentator. The F1 junior doc, who was part of the
human plumbing department in Scunthorpe, was noted returning from frequent sickness absences sporting an impressive suntan, in spite of the weather in Scunthorpe being its usual rainy self. This could have
been explained by the fact that the weather in California, Philadelphia, and Holland was better than that in
Scunthorpe, which wouldnt have been hard to achieve. Lets face it, the weather in Siberia in deepest
winter is better than that in midsummer Scunthorpe.
Had he been commentating on motor racing you could have understood his being confused about the
term F1, as it could easily have been interpreted as Formula One. However, no such defence existed, and
he is now free to concentrate on his day job.
The upshot of all this was that I was shocked when watching Match of the Day last Saturday evening to
recognise the dulcet tones of our junior partner Clint Thrust providing commentary on the Newcastle United versus Liverpool game. The appropriate authorities have been informed...

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