No.

281

Cornwall & Isles of Scilly

LMC Newsletter

February 2015

Your Chairman writes ..

Medico-politically this should be a quiet time of the year. We are approaching a
General Election and although the political parties are setting out their policies
ahead of their manifestos, no one wants to upset the NHS applecart especially in
the light of the Five Year Forward View (http://www.england.nhs.uk/wpcontent/uploads/2014/10/5yfv-web.pdf). Cornwall, however, is quietly undergoing
a small medical revolution. The major news of course is that a GP owned
company has won the GP OOH contract. How did we get here ? Lets recap the
events that have brought us to this point.
A year ago the LMC led a series of countywide events entitled The Future of
General Practice. The overwhelming majority of attendees expressed support for
the development of a Cornwall GP provider company with the intent to protect and
develop Cornish General Practice and to bid for the GP OOH service. Very rapidly
Kernow Health CIC was born (http://www.kernowhealthcic.org.uk) and a further
company Cornwall Health has evolved from Kernow Health and Devon Doc. It is
this company that will run our OOH service.
The work with Devon Doc and the formation of Cornwall Health is the culmination
of the decisions taken at those Future of General Practice meetings. I think this
fact highlights a number of issues. Firstly, when GPs act together they can effect
large and seismic change in the healthcare environment. Secondly the future is in
our hands. It is my strong belief that standing still will create a vacuum that others
will fill. We must continue to innovate and make bold decisions about our futures.
However, this aspect of our future will require continued hard work and
commitment. I am hoping that many of you will make a small commitment to
working in our new OOH service. I will be working some shifts to support Cornwall
Health but also so I can meet colleagues and support my registrar OOH. We can
and should use this service to develop other services to support and evolve
Cornish General Practice. These are challenging but interesting times. It is up to
us to describe what our future looks like in Cornwall but for the moment I think you
can all reflect and be proud of what General Practice in Cornwall has achieved
over the past year.

New CQC Guidance

Inside this issue:

GP engagement with child
Protection issues

National Child Measurement

Programme

Publication of NHS Payments

to General Practice &
publication of GP earnings

Events
Vacancies

Vacancies

Dr Basil Bile

New
guidance
on
CQC
inspections has been published
on the BMA website. This is a
practical guide aimed at GP
practices on how to prepare for a
CQC inspection. It includes
helpful tools including a check
list, a presentation brief, key
questions an inspector may ask
and general hints and tips.

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

GP Engagement with Child Protection

As our working days become ever more pressured we find there is less and less time to do all that is
asked of us. The request for attendance at a Child Protection Conference can feel like the straw that will
break the camels back. The requests come with short notice, and we are conflicted by our responsibility
to the child in question, but also to the already fully booked morning surgery off 15 other, as needy, patients.
Unfortunately the short notice of the meeting is a challenge for all the professionals involved. For cases
not already known to Childrens Services, once a referral has been made to MARU and a Child Protection
(CP) concern has been recognised, an initial strategy meeting is held within MARU, using the data that
they have gleaned from the various agencies contacted. If the decision is made that an Initial Child Protection Conference (ICPC) is needed there is a legal requirement to hold this conference within 15 working
days of the initial Strategy Meeting that led to a decision for CP enquiries to take place ( Sec 4 7 Children
Act 1989 ) Working Together to Safeguard Children - March 2013 The Independent Reviewing Unit (IRU)
should be informed by the involved Social Worker within 5 working days of the Strategy Meeting and is
required to arrange the CP conference and send out invitations within the 10 working days remaining of
the 15 working days timescale. During these 10 days they are ascertaining certain details about the case
and compiling a list of professionals to invite to the CP conference. And suddenly it arrives on the GPs
desk with no time to plan it into their week
The GMC guidance GMC 0 -18 Guidance for all doctors 2007 clearly states our responsibility to cooperate
fully in child protection procedures, including going to CP conferences, strategy meetings and case reviews, to provide information and to give our opinion. Hearing the conversation, whilst sitting around the
table at a CP meeting, may trigger contributions. The CP team is interested in our professional intelligence
to help in the decision making process around any necessary CP planning.
If it is not possible to attend in person, a GP must try to provide relevant information about the child or
young person and their family to the meeting. There are various ways that this can be achieved, and the
consensus is that we need to take a pragmatic approach to facilitate this valuable contribution. This view
is also supported by the team at the Independent Reviewing Unit, who coordinate the Child Protection
conferences. Ideally a report should be provided to the meeting and the GP template - Child Protection
Conference Report provides help in making that contribution. There is also a multi agency template available on the CIOS safeguarding Children Board website (www.safechildren-cios.co.uk) The report can then
be emailed to the IRU. Alternatively information can be discussed with another professional involved with
the family, e.g. the health visitor, so that they can give an oral report at the meeting. The social work Team
Manager in each locality is always invited to every CP meeting so a conversation could be had with them.
These Team Managers are being encouraged to build relationships with their local GP practices, so do
please open your door to them!
Dr Kate Gurney
GP Lead for Safeguarding Children
February 2015

LMC Note
GPs are not infrequently asked to attend case conferences. This is usually at short notice which
is unfortunately due to the legislation and timescales that social services have to adhere to once
concerns have been raised. If GPs do attend then you can charge a fee for this. If you don't attend then it is encouraged that you try and send a report or brief a colleague. For a factual report
you shouldn't charge but if you are then asked to provide a more detailed report you can charge
for this. Of course finances shouldn't get in the way of the safeguarding of children.
Fees for attending are claimed under the collaborative arrangements (therefore these are not set
and are for the practice to negotiate).
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The National Child Measurement Programme in Cornwall And

IOS: Some Key Facts and links for Primary Care

Each year in Cornwall and Isles of Scilly, we measure the height and weight of around 10,000 reception and
year 6 children as part of the National Child Measurement Programme (NCMP).

The data is analysed locally and nationally to help inform obesity planning and commissioning.

In 2013/14 25.3% of reception children and 30.9% of Year 6 children were overweight or obese in Cornwall.

Parents/carers are informed of their childs measurements and weight category in a letter which also contains
links to self-help healthy weight resources, the Cornwall Healthy Weight website and the local Promoting
Health Information Line (PHIL). PHIL can advise families, signpost to further self-help resources or refer to
Cornwall Healthy Weight for advice, support and access to free weight management programmes for the
whole family. Families may also self-refer directly to Cornwall Healthy Weight.

Parents are frequently surprised and sometimes angry when they receive a letter informing them their
child is overweight. Many parents also disagree with the result or question the validity of using BMI centiles to assess weight status in children.

We receive a number of calls each year from parents with these issues. As a result we have produced a booklet of frequent comments and questions about the NCMP which is now sent with the results letter. You can
view the content of this booklet here: https://www.cornwallhealthyweight.org.uk/pdfs/
NCMP_Questions_booklet.pdf

Parents/carers may present to Primary Care following receipt of an NCMP results letter for support
and advice, to dispute the result or to ask for the GP or Practice Nurses assessment of their childs
weight status.

The NCMP uses BMI centiles to assess weight status in children. Despite some limitations, BMI centiles are
still considered the best, evidence-based method for this and are recommended by NICE, SIGN and the
DoH.

GPs and Practice Nurses assessing weight status in children should remember the following guidance:

BMI centiles should be used to diagnose overweight and obesity in children (SIGN 115)

Relate BMI measurement in children and young people to the UK 1990 BMI charts to give age- and genderspecific information (NICE CG189)

Waist circumference is not recommended as a routine measure. Use it to give additional information on the
risk of developing other long-term health problems (NICE CG189)

Raw BMI and height/weight comparison should not be used to assess weight status in children. Children who
are in proportion for height and weight can still be overweight.

You can find a link to the currently recommended BMI centile charts for children, where to order hard
copies and the current CIOS Childhood Obesity Care Pathway in the Professional area of the Cornwall
Healthy Weight website here: https://www.cornwallhealthyweight.org.uk/professional/child-obesity-pathways/

Health Professionals should remember that using BMI centiles to assess weight status in children has
a few limitations: it wrongly classifies a small proportion as overweight who are a healthy weight and a small
proportion as a healthy weight who are in fact overweight. BMI centiles are less accurate, for example, in children who are especially muscular and in certain ethnicities. As always, clinical judgement should be used
when using BMI centiles as part of an holistic assessment of weight status in children. NICE guidance
(CG189) states: Use BMI (adjusted for age and gender) as a practical estimate of adiposity in children and
young people. Interpret BMI with caution because it is not a direct measure of adiposity.

We think NCMP results should be shared with Primary Care. We think the height, weight and weight status of children on your practice list is important child health information you should have access to. We are
currently investigating how we might progress this.

This is a necessarily brief overview. If you have any questions about the NCMP in Cornwall IOS, or thoughts
about the sharing of NCMP results with GPs, please get in touch with Dr Libby Prenton, NCMP Co-

ordinator, on 01726 627928 or libby.prenton@cornwall.nhs.uk

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Publication of NHS Payments to General Practice and

publication of GP earnings
2015 will see the introduction of two new unrelated publication schemes relating to GP income.
Publication of NHS Payments to General Practice
On 12 February 2015 the Health and Social Care Information Centre (HSCIC) will publish NHS payments
to individual providers of general practice services (including practices, walk-in centres and health centres) in England for 2013/14. This will start an annual publication process. Practices do not have to do
anything in relation to this publication as data is taken from the HSCIC GP payments system. The report
will break down payments by category including Global Sum, MPIG, QOF, enhanced services etc.
GPs should use their Area Team contact for any queries related to the published figures.
If publication of these figures generates media interest the GPC will support practices. Please do let your
LMC know if you need help in this regard.
Publication of mean GP net earnings
From April 2015 it will be a contractual requirement for GMS practices to publish on their practice websites by 31 March 2016 the mean net earnings of the partners, salaried GPs and any locum who has
worked in the practice for over six months.

This includes income from NHS England, CCGs and local authorities for the provision of GP
services that relate to the contract or which have been nationally determined.

All earnings to be reported are pre-tax, National Insurance and employee pension contributions.

For contractors the figures are net of practice expenses incurred.

Income and costs related to premises will not be included in this figure.

Alongside the mean figure, practices will be required to publish the number of full and part time GPs in the
practice. The information must be published on practice websites before the end of the financial year following the financial year to which that information relates. Practices must also make available the information in hard copy on request recognising that not all patients will be able to access the website.
NHS England will publish guidance for GPs and their accountants on how mean net earnings should be
calculated. Practices, or their accountants, will have to generate the report themselves. NHS England
has acknowledged that it can be difficult to disaggregate income and expenditure lines precisely and will
recommend that practices should work within the reporting guidelines as far as is reasonably practicable.
Earnings for General Dental Practitioners will be published to the same timetable.

Fleur Nielsen
Committee Secretary (contractor GPs)
British Medical Association

NO . 28 1

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Making Sense of Evidence 2015 Workshops

Book now for PenCLAHRC's 2015 Making Sense of Evidence workshops: A introductory workshop on
the practical use of evidence in practice, this course is aimed at healthcare professionals based within
the South West region who wish to gain knowledge of finding and appraising evidence in everyday
practice where time is short. Previous attendees have said:
"Really good, enjoyable day! I have learnt a great deal."
"A valuable development study day with ideas to put into practice in the workplace. Inspirational.
Thank you."
Workshop dates and locations are available on the PenCLAHRC training pages and click here to book

St Austell Healthcare Group needs you!

Are you looking for an exciting permanent GP position that fits around your busy life?
Full time?.......... part time?.................school hours?................., term time only?...............
portfolio career?
We are looking for dedicated Doctors to join our team as partners / salaried partners and Salaried doctors
St Austell Healthcare Group is a new consortium comprising three practices in St Austell who will be
merging in May with a combined list size of over 30,000. We are looking to recruit GPs to this practice
which offers unparalleled peer support; the chance to influence the future of community based medical
care and the opportunity to earn well alongside an experienced and friendly team.
We are working closely with local commissioners and external agencies with a view to developing a wide
range of innovative services. Innovative plans include:

Separate urgent care centre on one site,

improved continuity of care for those with complex needs or more-serious and/or long-term health
problems

A mixed work-force with flexible shifts and opportunities to suit young parents, annualised sessional
contracts, portfolio careers and part-time or job share.
A clinical pharmacist independent prescriber with responsibility for repeat prescribing
In the longer term, provision of more services locally and integration of care through close working
with other providers such as Peninsula Community Health.
12 Partners
Busy 30,000 patient practice on 4 sites
High QOF achievement and enhanced services provision
Nurse-led chronic disease management and minor illness
Training and mentoring ST, FY2 and Medical Students
Systmone IT provider
Open and honest work ethos with a commitment to personal development
The successful applicants will be involved in the rota for on-call and extended hours surgery

For further information or to apply with your CV and covering letter please contact:
Bridget Sampson, Dr Stewart Smith or Dr James McClure on staustellhcg@gmail.com
Closing Date: 31/03/2015

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Salaried GP - 1 year post Port View Surgery

Starting July/August 2015
We are looking for an enthusiastic, committed GP to cover the extended sabbatical of one of our full time
partners. The position is for 8 sessions per week over 4 days. Port View is a friendly, professional surgery in Saltash with a stable list of 6500, 5 partners and a dedicated team of nurses and admin staff to
provide excellent support. We also currently manage the 9 community beds at St Barnabas Hospital. Our
clinical system is EMIS WEB and we are a high achieving practice with excellent patient care being at the
centre of all we do.
To find out more please contact our Practice Manager Tina.seedhouse2@nhs.net or GP Partner
Chrispoplar@nhs.net

Chair of NHS Kernow Clinical Commissioning Group

Governing Body
After two years of excellent leadership in developing the CCG following Authorisation, Dr Colin Philip has decided to stand down as Chair of NHS Kernow. We are therefore now seeking an individual with the right skills
and experience to take NHS Kernow forward.
The role is eligible to any GP registered on the Performers list and practicing in Cornwall and Isles of Scilly. The appointment process (see related documents) sets out the method of recruitment, which for the Chair
of the Governing Body will involve a shortlisting exercise, informal meet with Governing Body Members, Assessment Centre review and interview. If more than one candidate is successful at interview, a vote will be
held of those GPs practicing in Cornwall and Isles of Scilly area; this will be managed by the LMC.
The closing date for applications is 12 noon on Wednesday 11th March 2015. An assessment center and interview are likely to be held late March/early April 2015.
An application pack is available in related documents.

Serco Health
Due to current operational pressures within the whole system and some of our sessional GPs assisting in
other areas we would welcome any support that local GPs could give us this weekend- we have clinic and
car shifts available and can be very flexible with times. In order to comply with regulations it would be necessary to have out of hours indemnity cover and evidence of all the usual employment checks. If interested please contact Rebecca on 01872 222400 or
clinicalrota@sercohealth.cornwall.nhs.uk<mailto:clinicalrota@sercohealth.cornwall.nhs.uk
Thank you in advance for your support
Stephanie Gray-Roberts
Contract Director.

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DR BASIL BILE
The headline on the front page of BMA News on Valentines Day was a rather unromantic one. General
Practice In Crisis it squawked like an attention seeking child. What it should have said was
Abandonhope Practice In Crisis which would have been more to the bally point.
At Abdandonhope GCHQ we have had to employ a new Practice Manager. The last one eloped with the
Courier Van operative. A backlog of blood, urine and faecal samples has built up whilst awaiting a replacement driver, but every cloud has a silver lining as my rose beds and rhubarb patch are now all that much
more fertile.
The new PM is called Ms Gertrude Scarey, or Ghastly Gertie as the staff have dubbed her. She wears steel
toe-capped boots, goosesteps all over the place, and insists on being addressed as Sir, even by the Partners. We are supposed to be employing her, but it does rather feel the other way round. Her vice is very
much our versa.
She holds early morning inspections to check for nail varnish and any signs of forbidden cosmetics. Junior
partner Clint Thrust has twice been sent to the infestation shower room to remove his eye shadow. The
truth is she does rather give us all the willies, and were beginning to suspect she may have one of her own.
The BMA News banged on about how some GPs are seeing 60 patients a day. Twaddle and piffle. Lettie
Golately, our spunky Salaried Sessional GP, sees that many in a morning. Even I, with all my administrative, committee and commissioning duties, see six customers in a particularly heavy week. Stress levels are
at an all time high with recruitment and retainment being the proverbial brown stuff hitting the fan. The
GMC has spotted increased suicide levels amongst members of the profession undergoing their procedures
for performance issues. One might fairly observe that it is rather bizarre timing for NHS Fruitcakes myopic acolytes to be dismantling the flagship GP Occupational Health Service here in Devon and Cornwall. Oh
well, whats a few damaged doctors and patients compared with saving a few bob?
It seems we will have to take matters into our own hands to alleviate politically inspired hassles. And the
good news dear readers is that my suggestions are all backed up by hard science. Firstly researchers writing
in JAMA Internal Medicine have found that GPs become worn down by the cumulative demand of making
dozens of decisions and by late afternoon are more likely to over prescribe. Secondly, another study in the
USA suggests that patients are more likely to see a doctor with clean hands if they attend in the morning.
Long days at work lead to medical staff increasingly neglecting to wash their hands, resulting in an extra 34
infections per 1,000 patients.
The answer my friends is blindingly obvious. GPs should all go home at lunchtime and stay there.

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