No.

302
November 2016

DVTIMPORTANT NOTICE
CHANGE OF ACCESS
with immediate effect (24/11/2016)
Problems with the newly designed referral form and VSU process
have been widespread. Feedback from general practice has been
taken on board and the safety issues recognised.

Cornwall & Isles of Scilly

LMC Newsletter

The process will change to the following while the process is reviewed.

1) GP completes referral form as currently but email to thrombosis

team not VSU
2) We will contact patient directly to allocate scan - responsibility
will remain with GP to sort AC pending scan and transport where
needed.

Andrew McSorley
Thrombosis Nurse Specialist
01872-253827

Inside this issue:

Sessional GP Newsletter

Your Chairman writes

The State of Medical

Education and Practice Report
2016.

PrivateNHS Interface

Menopause and Womens

Health.

Events

Here is a link to this months

Sessional GP Newsletter, which
this month, amongst other things,
focuses on the Uber judgement,
the relationship between Sessional GPs and LMCs, and the
gaps in GP training.

PMS Scheme and ALAMAC

Vacancies
Situations Wanted
Dr Basil Bile

7-9
9
10-11

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
e-mail dawn@kernowlmc.co.uk

Your Chairman writes ..

It was my privilege to open the Cornwall and Isles of Scilly LMC Practice Managers Conference earlier
this month at Lanivet (near Bodmin). I did a straw poll of manager experience within the room and was
slightly but not totally surprised. It confirmed what I had suspected that our managers are among some of
the most experienced and longest serving people in our workforce.
I reflected back to them that they are the unsung heroes of General Practice. Those of you who are partners might ask themselves the following question :- Who would be easier to replace in your organisation,
a GP or your manager ?. We hear all the time about how overworked we are as GPs and about GP shortfall. Well I have news - we are not the only ones ! Practice Managers are in short supply and as a group
have the same demographic issues facing us GPs. Many of them will soon retire, many are leaving early
and the reasons are escalating workload, escalating demands, increased responsibilities, unreasonable
expectations etc. Sound familiar ? So, if you think you have it bad, spare a thought for your manager who
has probably already heard you moaning about how bad GP life is and is listening whilst his or her workload backs up.
Teamwork is one of the core strengths of General Practice and each member of the primary healthcare
team is a valuable and essential asset to ensure its smooth running. Lets try and remember that when we
think, this is the end of General Practice as we know it - it might well be if you lose your manager !

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The State of Medical Education and Practice Report 2016

At the end of October the GMC published its latest report on The state of medical education and practice in the UK .
This is the sixth annual report on the state of medical education and practice. It considers some of the current challenges facing the profession and the systems in which it works, and how the make-up of the profession continues to
change.
Sections of particular interest to GPs
Chapter 4 looks at complaints to the GMC. While GPs have one of the highest levels of complaints they also have
one of the lowest levels of complaints leading to an investigation. Over three-quarters of complaints about GPs come
from members of the public, higher than for other groups.
Chapter 5 provides an analysis of the distribution of the medical workforce across the UK and offers particular insights into the GP workforce. While the overall level of doctors relative to the population in the south west is close to
the UK average the number of GPs relative to population is higher than most other parts of the UK.
Other highlights from this years report:
Overview: This section introduces the report by highlighting the state of unease within the medical profession across the UK as a result of increased pressures on health and social care services. It points out the growing
pressure on doctors and a dangerous level of alienation among doctors in training, and says that the GMC has a
role to play in addressing these issues by making regulation as light touch as possible and by continuing to work
with others to reform the way doctors education and training is organised.
Chapter 1 takes an overview of the UK medical register; it considers how the make-up of the medical workforce continues to change in terms of age, gender and ethnicity. The profession is becoming more ethnically diverse
and the proportion of female doctors is edging closer to making up 50% of the register. We examine how the profiles
of particular specialties have changed since 2011 data shows some are growing while others are shrinking, and
some have a greater reliance on older doctors and non-UK graduates.
Chapter 2 examines how the population of doctors in medical education has changed between 2012 and
2015, with a particular focus on gender, ethnicity and numbers of doctors in individual specialty training programmes.
While there was a 22% increase in emergency medicine trainees (in specialty training stages 4 to 6) in that time and
a 2% increase in GP trainees, both obstetrics and gynaecology and psychiatry have seen a 10% reduction in trainee
numbers.
Chapter 3 explains the number of complaints the GMC received in 2015 and how they were resolved. In 2015
the number of complaints about doctors fell to 8,269 a 7% reduction on 2014 and two thirds of complaints were
closed immediately. The number of investigations also reduced by 18% as a direct result of work to speed up fitness
to practise procedures and reduce the stress on doctors and patients.
Chapter 4: While only a relatively small number of doctors receive complaints in a year 3% of doctors were
the subject of a complaint in 2015 we know some groups of doctors are at higher risk of complaints and investigations from particular sources and about particular allegations. Our data tells us that employers are more likely than
the public to make complaints about BME doctors and non-UK graduates. Complaints about clinical competence
account for nearly a third of investigations arising from public complaints, but less than one in ten of those made by
employers.
Chapter 5: looks at how the workforce of GPs and specialists, and doctors who are neither, varies between
different parts of the UK and regions in England. We look at the number of doctors per person in each area, as well
as their age profile and diversity.
Chapter 6, the final chapter of the report, discusses the future of healthcare regulation in the UK. Traditionally regulators have been associated largely with taking action against professionals who fall below expected standards. However the reality is that the vast majority of professionals will never do this. Regulation must be relevant to
their practice and not an unnecessary burden. We conclude that we must direct our resources to support good practice and, where we can, mitigate the risks of harm occurring by understanding and using data to target our regulatory
interventions effectively and fairly.
The full report can be downloaded from: http://bit.ly/SOMEP2016
The GMC Regional Liaison Service is available to provide sessions on this report and other aspects of GMC guidance.
Contact: John Davey, Regional Liaison Adviser (South West)
Email: john.davey@gmc-uk.org Website: www.gmc-uk.org/rls
Telephone: 0161 240 8148
NO . 3 0 2

Mobile: 07586 616 767

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Private-NHS Interface
One of the issues exercising LMCs up and down the country is how to limit GP workload by preventing
transfer of unfunded work from secondary care to primary care. To this end there are various LMC/GPC
sponsored template letters to re-direct unfunded work back to the requester (see Kernow LMC website for
further information). Furthermore the GP Forward View is removing any barriers from specialist to specialist referral for related conditions which should also help (provided we continue to rebuff the Gp please
refer on requests).
One interesting variant to the theme cropped up last month when I had referred a patient to see a consultant privately and after seeing the patient the consultant wrote back asking me to arrange a series of tests
on the NHS. I felt this was inappropriate, particularly as the patient was insured, but the consultant was
surprised that I should raise the issue. I sought a bit of up the chain clarification from the BMA and this
was their response:
Having consulted with the BMAs General Practitioners Committee (GPC), Medical Ethics Committee
(MEC), and Private Practice Committee (PPC), I can now provide the following response to your query.
While it is clear that a patient does not relinquish any rights to NHS treatment - and can therefore move
between NHS and private as he or she chooses - a professional obligation, rooted in codes of practice,
falls upon the private consultant to organise all treatment and investigation for any single episode of
care. As it is a private episode of care, any treatment or intervention will attract a cost. Consultants should
not seek to mix a single private episode of care with NHS-funded treatment in order to reduce costs to the
patient. In this way doctors have duties here that are not symmetric with the rights of patients to move between NHS and private care. There is nothing though to prevent a patient seeking NHS treatment at any
stage in the process, but this would be deemed to be a separate episode of care.
The general principles are as follows:
1) a clinician who feels that a test is warranted organises it and takes responsibility for acting on its result,
and does not devolve that to another. If the GP agrees the test is warranted and is happy to act on it then
they can do so; if they do not then they need to ask the specialist to arrange the test.
2) a specialist in private practice ought not to use GP NHS access to tests in order to circumvent charges
for those investigations were they done directly in the private sector, whilst the patient remains in the private sector for clinical care. If there is an issue around affordability then all care should transfer into the
NHS.
Shades of grey?! I think the conclusion is that a privately referred patient should have consultation, investigation and treatment arranged privately by their specialist and I suppose there is a significant benefit to
the NHS if this occurs. However if the patient is uninsured and cannot afford to pay for anything other than
the initial consultation then the patient (and only the patient) has the right to request ongoing investigation
on the NHS. However if this occurs the subsequent specialist follow up must be on the NHS and not back
in the private rooms.
Hope that helps.

With thanks to Dr Will Hynds, Portscatho Surgery

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C O R NW A LL & I S LE S O F S C I LL Y LM C NE W S LE T TE R

Menopause and Womens Health

After nearly 16 years, NHS funding for my specialist level clinic has been withdrawn and the service has
ceased. I did my best to review the most complex patients by the end of October and all others expecting
a further appointment should by now have been written to.
I will have some flexibility next year to be able to offer locality based, once a quarter specialist/training
clinics. I would be very happy to have a member of the team sit with me to learn. I cannot think of any other way to teach in such a practical area. Clinics would be invoiced and paid as you do a locum but not at
the same rate. Contact me if you want to discuss this. Otherwise the only option for patients is in the private sector.
Please offer this option to women and, if they want to proceed, a referral letter would be really helpful.
You would get, in return, a full letter to explain the clinical decision making. It is worth being aware that
menopause in general and me as a GP are not usually covered by UK based health insurance.
Some of the women who have previously had estradiol implants have already made their decision to pay
for themselves. This is eminently reasonable if that is the only option which works for them. Before an implant a woman will need an estradiol level to ensure that it has dropped low enough for a further implant to
be appropriate. The final decision is based on a synthesis of symptoms, risks and the blood level. It is for
you to decide whether you are prepared to authorise this at NHS cost.
If you feel that your patient has a tertiary level problem (as 20% of the women I saw did) and that in any
other field the NHS would provide for her then consider an exceptional funding request. I hold full credentials and could see women in either the Duchy Hospital or NuffieldHealth, Plymouth both of which hold a
variety of NHS contracts.
I thank you for your support over the years.
Sarah Gray
Referrals to
admin@drsarahgray.co.uk
Tel:

01872 242192

Fax:

01872 242197 (secure)

PMS Scheme and ALAMAC

PMS Scheme and ALAMAC daily pressure system reporting measures: just a reminder that the ALAMAC
Team are in Cornwall again next week and if you havent yet managed to start reporting your measures
then they will be able to help. A number of practices are already up and running and they have also offered to support those using the same clinical system
details from Jonny Morgan jonny.morgan@alamac.co.uk

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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

EVENTS
The Art of Brilliance
Following the success of The Art of Brilliance presentation by Martin Burder at the LMC Practice Manager
Conference earlier in November, we have asked Martin to come back to Cornwall on Friday 24th February
2017.
The event will be Held at Victoria from 9am3pm, lunch is included and the cost of 35 per person which
represents excellent value.
So if you want to know why you should wear your special pants on a Monday, fill in the attached booking
form and come along for a truly uplifting and inspiring day.
The event is open to any member of practice staff, including GPs and team leaders who might need a lift
and a day of laughter. Mood suckers especially welcome.

Colorectal Care in Cornwall.

GP Study Day
The National Marine Aquarium
Thursday 26th January 2017
8.30am5pm
Please see more details and booking form attached to this newsletter.

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Page 6

GP Partner
Port View Surgery
We are looking for an enthusiastic GP to become part of our friendly, committed team. We are flexible in how we fill
this vacancy, Partnership/Salaried or Retainer. We need to fill 4 sessions a week.
What we can offer:
A stable list of 6500
4 GP partners
Excellent nursing and admin support
Clinical management of 9 community hospital beds
Partner owned premises wth outstanding views out to Plymouth Sound
Flexibility around session timings
Emis Web
Patient care remains at the centre of all we do
What we are looking for
Enthusiasm and commitment
A pro-active approach
Team orientation
Please contact Tina Seedhouse - Practice Manager
tina.seedhouse2@nhs.net
Tel: 01752 840115
Website: www.portviewsurgery.co.uk

We are looking to recruit a GP Partner or Partners who want to join our friendly and successful practice based on the
south coast of Cornwall. Our full time Senior Partner is retiring but we can be flexible in how we replace the six to
eight sessions we want to fill.
Situated in the vibrant university town of Falmouth, with easy access to everything that Cornwall has to offer, The
Falmouth Health Centre Practice is a six partner practice operating from Health Centre-based premises with in
house access to community colleagues. We are an innovative training practice and we are actively involved in commissioning and locality working.
We offer

Friendly efficient Doctors and staff

High QOF scores and enhanced services

Over 8750 patients who consistently reward us with high satisfaction scores

EMIS Web, paper light

Active involvement in postgraduate and undergraduate education

Extended hours

Variety in the working day

No property buy-in costs for partners

We enjoy our work and our team, and seek to appoint progressive thinking and committed GPs who will enhance
that spirit. See our website www.faldoc.co.uk for more information about us.
Informal enquiries welcomed
Enquiries/applications to:
Geoff Dennis Practice Manager
Tel: 01326 310160 or 07921 240856
Email: geoff.dennis@nhs.net
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Page 7

NEWQUAY HEALTH CENTRE

Wanted - Enthusiastic GP, passionate about patient care, team work and enjoying life.

Dynamic practice in Newquay, Cornwall a growing coastal town with beautiful scenery and surfing

PMS practice with 16,000 patients, run by a well re-numerated, and occasionally witty, practice team

Seeking replacement of full time hours of GPs due to retirement - as full or part time, salaried or partnership.

Supportive of flexible and portfolio careers for healthy work life balance.

Actively involved in Education (Medical Students, Foundation Doctors and Registrars, Nurse Students),
research, commissioning and Cornwall Health

Outstanding rating for 2015 CQC inspection

Mixed workforce Partners, Salaried GPs, Nurse Practitioner, Clinical Pharmacist, Minor Illness/
Practice Nurses, HCAs

Minor ops, shared care, contract for Newquay Hospital ward rounds, active involvement in commissioning/locality group

PPG & Friends of Newquay Health Centre

Please contact Sheena Pappin, Practice Manager on 01637 893668 or email sheena.pappin@nhs.net for
more information or to arrange an informal visit.

VEOR SURGERY Camborne, Cornwall

GENERAL PRACTITIONER (Portfolio)
Our Practice is located in the historic mining town of Camborne surrounded by a rich Cornish heritage, some of
the most beautiful beaches in the Country and an idyllic place to live and work.
We are a medium sized GP Practice in West Cornwall with an ambition to develop a range of new services
with a view on the future requirements of General Practice.
To allow us to achieve this we are looking for a GP willing to work up to 8 sessions a week. We would like to
offer interested GPs the opportunity to develop a portfolio career with us whereby you can pick a number of
sessions in our Practice and possibly include work within the Referral Management Service, the Acute GP Service or the Out of Hours Service.
We will actively manage this for you after you have stated your preference because we believe that a varied
career is also an exciting one. Having said that if you would like full time General Practice hours we would be
happy to oblige!
Looking to the future we are developing Academic Research, we are a Student Nursing Practice, soon to be a
GP Training Practice with a Pharmacist joining us shortly and plans to expand the existing footprint of the Surgery.
Your salary, indemnity insurance and CPD requirements we would be keen to negotiate with you. The important thing for us is that you are looking to join a friendly, forward thinking progressive practice with scope for
partnership if required. We would be interested in attracting a GP with a range of special interests to enhance
the clinical services that we offer.
If you would like to discuss this further please phone 01209 611172 or email amanda.menear@nhs.net or if
you would like to apply please send us a copy of your CV and brief summary of why you would like to join us.
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Carnon Downs Surgery

is looking for a new General Practitioner
to join our team
This is a fantastic opportunity for a skilled doctor to enjoy a satisfying career in general practice. Come
and join our stable and effective team of expert clinicians and administrative staff. We pride ourselves on
providing excellent personalised clinical care to our patients, and a supportive and caring environment for
our team.
We are a dispensing practice caring for a rural population of 5300 patients, though our list size is growing.
We are actively involved in our community, in GP training and in clinical commissioning. We are well organised, enjoy an excellent reputation and score highly on all external quality markers.
Carnon Downs is conveniently placed between Truro and Falmouth with easy access to both the North
and South coasts of Cornwall
We are looking for a GP who:
is patient centred and aiming for clinical excellence
enjoys working as part of a small and caring team of doctors, nurses, dispensers and administrative staff
wants a longitudinal relationship with patients
is looking for a salaried role, either part-time or full time
For further information, to arrange a visit, or to make an application please contact Mrs Sally Rickard,
Practice Manager on sally.rickard4@nhs.net or telephone 01872 863221
Closing date 23rd December 2016

TRESCOBEAS SURGERY
SALARIED GP TO COVER MATERNITY LEAVE

We are a friendly, expanding and forward thinking GP Practice located in Falmouth that is looking for a 6
session salaried GP to cover maternity leave from March 2017.
9900 list with 6.5 WTE partners. Purpose built surgery with a central location
High QOF performer, recently CQC inspected, operating a total telephone triage system.
Salary negotiable but dependent on experience and duties.
For further information and / or to apply please contact the Practice Manager, Mr Yorick ONyons, Trescobeas Surgery, Trescobeas Road, Falmouth, TR11 2UN, E-mail yorick.onyons@nhs.net or telephone
01326 315615
Closing date Friday 23rd December for interviews in January

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CARN TO COAST HEALTH CENTRES

RECRUITMENT ANNOUNCEMENT
Owing to continued expansion Carn to Coast Health Centres are looking to recruit more clinicians and
staff to meet growing demands. We would be interested to hear from:
GPs looking for salaried positions (with or without a view to Partnership)
We offer salaried GPs remuneration at 9,500 per session, per annum and pay their medical indemnity
premium costs.
Nurse Practitioners
Practice Nurses
Assistant Practitioners / HCAs
Reception / Admin Staff
Carn to Coast is a stable, successful and forward-looking 10- Partner training Practice with its main surgery at Pool Health Centre with 20,400 patients and two branch surgeries with dispensaries (Homecroft
Surgery in Illogan & St.Day) . We are actively involved in the North Kerrier locality with its primary care
hub at the Camborne Redruth Community Hospital (CRCH Barncoose) and we are also federated with
the Trevithick Surgery with a view to potential further merger. We are supportive of clinicians seeking portfolio careers and relish opportunities to support all our staff in their careers. We operate a modern, skillmixed team and are currently in a pilot scheme for the use of pharmacists in GP Practices. Our clinical
system is EMIS Web and our QOF performance is consistently 100%.
If you are interested please contact Stephen Holby, Strategic Manager by e-mail in the first instance:
Stephen.holby@nhs.net.

SITUATIONS WANTED

Experienced Practice Nurse available for locum work in

South East Cornwall
I am experienced in both treatment room duties, Minor illness clinics and Chronic disease management
(excluding Diabetes) having worked in Primary care for 20 years. I have experience of achieving QOF targets in the hard to reach groups.
Available for work from 28.12.2016
Telephone 07779712913
Or 01752842444
Email sarah.reed10@NHS.net

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DR BASIL BILE WRITES

Dr Sam Everintheheadlines, celeb GP and Ceeceegee Chairpersonage somewhere up in the
smoke, took the two hour Virgin Rail trip from Euston to Manchester recently in order to turn up at some
ghastly brouhaha masquerading under the vainglorious title 2016 Health and Care Innovation Expo.
Quite what an Expo is I have not the foggiest idea, but he certainly made an exhibition of himself by entreating all of us front line primary care NHS warriors to embrace the ghastly notion of communicating with
our flock via text-messaging. He told the attendees that providing select patients with his mobile phone
number had made positive improvements in his own practice.
Be compassionate, be a friend, have fun he was quoted as having uttered, whilst calmly informing the assembled worthies that using technology to communicate with patients via Skype and text should
become the norm.
My initial reaction was to head for the garden shed and lock myself in until all the fuss had died
down. I have enough trouble working out how to use my new smartphone (which unfortunately appears to
be somewhat smarter than me) without getting more deeply involved with a technology that clearly hates
me as much as I hate it. Compassion and fun are not high up on the list of emotions I experience. Why the
hell cant they provide an instruction booklet with the damned thing instead of directing you to an online
helpline which is about as much use as a cardboard condom?
However Dear Readers, as you know I am not one for passing by opportunities that might make
my life easier. So after careful reflection I decided to try an experiment on a very limited basis. I gave my
mobile phone number to one patient. You cant get more select than that.
Within twenty-four hours my phone made an odd noise that sounded like a tortoise being strangled. I had received a text. I opened it to find an attached photo of a very large swollen scrotum. Percy
Penshuns to be exact. He was informing me that his hydrocele was getting bigger. It was hardly the sort
of thing I wanted to be gazing at over my hurried lunch of a chewy past-its-sell-by-date garage forecourt
sandwich. Irritated beyond measure I attempted a hasty reply, but clearly pushed the wrong button as the
text vanished from the screen before I had typed a single syllable.
That evening I returned home totally knackered as per bally normal to get an even frostier-thanusual reception from Belinda.
How dare you Basil?!
How dare I what, my celestial sweetness?
You sexted me. You sent me a sext. She had obviously taken leave of her senses. Unabashed
by my incredulity she ploughed on. Why would I want to see a photograph of your private parts when I
spend most of our married life trying to avoid them?
A horrible realisation dawned. I had inadvertently forwarded Percy Penshuns graphic text to my
spouse.
Surely you can tell thats not part of my anatomy? I protested, genuinely hurt. The appendages
in question belong to a patient.

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DR BASIL BILE WRITES

I make it my business to keep my eyes tight shut when you get undressed Basil, she retorted.
Anyway, its too late now.
Whats too late? I enquired fearfully.
Ive already forwarded it to my Womens Group as I felt in need of their comfort and support.
I could see my career dissolving around me. I had often wondered how it would end, but hadnt
considered it being as the result of being referred to the GMC for circulating to third parties intimate confidential medical photographs without consent. Belindas mobile phone rang. She chatted away for five
minutes oblivious to my distress.
That was Sonia, our St Salive Action Against Men chairwoman. You can relax Basil. They know it
wasnt a photo of you. Someone recognised it as Percy Penshun .
They recognised him from his scrotum? I responded in sheer disbelief.
He sits as a male model for our Womens Art Group, or WAGs as they like to be known. They
painted him last week.
Hes eighty eight years old.
Aiden Turner wasnt available

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