No.

310
CQC News
July 2017
The Care Quality Commission has launched the second phase of its
consultation, seeking views on specific proposals for how it will:
regulate primary medical services and adult social care services
improve the structure of registration, and clarify our definition of
registered providers
monitor, inspect and rate new models of care and large or complex
providers
use our unique knowledge to encourage improvements in the
quality of care in local areas
carry out our role in relation to the fit and proper persons
Cornwall & Isles of Scilly

requirements. You can take part in the consultation here.

GPs face added workload burden as CQC proposes annual practice

reports GP practices will be expected to provide information to the CQC
every year on how they plan to improve the quality of care, under new
proposals.
The regulators consultation document on the next stage for inspections
says that the annual information gathering will replace the current system,
where GPs have to provide evidence for every inspection.
Under the new regime, practices will need to provide annual evidence on
what changes have occurred in the past year affecting their quality of
care, examples of good practice and provide 'effective and responsive
LMC Newsletter

care to each of the population groups. Read more in the Pulse article.

Inside this issue:

Your Chairman writes
GP Patient survey
BMA ballot reminder
IR35
Cornwalls Opioid Strategy
Sessional GPs e-newsletter
2
The latest sessional GPs news-
3 letter can be found here.
4

Practice Staff Training 5

Change of Date
Practice Manager Changes
Locums
Events 6
Items for the Newsletter should be
sent to the Editor, Dawn Molenkamp
Vacancies 7-10 at Victoria Beacon Place, Room
B314, Station Approach, Victoria,
Roche, St Austell, PL26 8LG
Dr Basil Bile 11-12 Tel :01726 210141
e-mail dawn@kernowlmc.co.uk
Your Chairman writes ..
Normally summer is a quiet time in terms of GP politics but certainly not in terms of the GP working day.
The previously observed ebb and flow of demand is now for most of us a year round torrent. If Perran-
porth is anything to go by, the holiday season starts before Easter, has a minor lull and then kicks off in
early June and extends until the end of October. Temporary Residents bring their own challenges but we
are seeing increasingly complex patients who are holidaying with multi-morbidity and chronic illnesses ne-
cessitating input from large numbers of the Primary Health Care team with particular demands on our
practice nursing teams. Unfortunately we cannot pick and choose the sorts of patients we see and treat
including those who require dressings. If we offer the service to our own patients we would be on very
dodgy ground trying to deny the same service to a TR on the basis that it was time consuming.

Many of you will have become aware that Richard Vautrey has become Chair Of GPC, taking over from
Chaand Nagpaul who is moving up the political ladder becoming Chair of BMA Council. However, we
dont expect much to change soon in terms of the GP landscape. Richard will make changes in messag-
ing but negotiations will continue in a similar manner to that which has proceeded his tenure as Chair. The
biggest challenges are the hardest to solve, notably workforce and indemnity.

With regard to workforce I think it is clear that a conversation needs to happen nationally about the role of
GPs. What do or should we do and more importantly what should we stop doing and what could be done
by others? I think it is clear we can no longer be all things to all people - this approach is strangling the
profession, encouraging early retirement, part-time working and stifling recruitment. Many practices are
diversifying their work force and looking at roles within their practices to try and best utilise their scarce
resources. If we are to survive the tsunami of demand we need to define the limits of our roles more clear-
ly and allow others to take some of the strain.

GP Patient Survey 2017

NHS England has released the results of the GP Patient Survey 2017.

The summary of findings is available at this webpage

NO . 3 1 0 Page 2
 REMINDER: BMA ballot of GP practices in England on
collective list closure

GPC England is balloting GP practices in England as to whether they are prepared to collectively close their
practice lists. On Monday 10 July a letter was sent to each practice in England from the Electoral Reform Ser-
vices explaining how each practice can take part in the indicative ballot. Each practice should have received a
unique identifier to log into the ERS website to complete the ballot, as well as a FAQs from the BMA.

If your practice has not received this information, please contact info.gpc@bma.org.uk as soon as possible.
We really want to hear whether practices would actually be prepared to undertake this action, so please make
sure you discuss as a practice and come to a practice decision. Whether you would or would not take this ac-
tion, please tell us through this important ballot. We are encouraging and recommending that partners engage
salaried and locum GPs in these discussions, as the decision will affect the whole practice not just the partners.

We have received a number of queries about the ballot. Please note the following important points:
The purpose of this ballot is for GPC to understand what practices would actually be prepared to do. GPC is
not advising practices to vote yes or to vote no to either of the options in the ballot.
GPC has not proposed that all practices collectively (or otherwise) close their lists at this stage.

Practices are currently able to take the decision to temporarily suspend patient registrations (provided they
have reasonable and non-discriminatory grounds for doing so), or apply to close their lists, based on their own
specific circumstances, for example in order to protect the quality of patient services. This ballot is separate
from this. If enacted, the BMA would be calling for collective cessation of patient registration as part of a cam-
paign of industrial action.

It is important that we get as high a turnout as possible so please complete the ballot before the closing date on
10 August.

Best wishes
Dr Richard Vautrey
GPC England chair

IR35

NHS Improvement had previously issues guidance to NHS and Foundation Trusts recommending that all
individuals providing services through an intermediary should fall within IR35 and therefore all locum,
agency and bank staff would be subject to PAYE.
The BMA wrote to NHS Improvement to seek clarification on this advice and we welcome that NHS Im-
provement has now published further guidance confirming that assessment of whether or not IR35 ap-
plies to an individual must be carried out on a case by case basis rather than by broad classification of
roles.
Further information is available on the BMA website.

With thanks to Gloucestershire LMC.

NO . 3 1 0 Page 3
 Cornwalls Opioid Strategy the demedicalisation of chronic
pain.

We all know the opioid crisis in the USA is taking tens of thousands of lives a year (more than road traffic
accidents and gun crime together) and hundreds of thousands are addicted - prescribed opioids being
largely to blame. The situation in the UK is nowhere near as bad though plenty of personal and societal ill
health occurs. In the last couple of decades we have been duped into believing that high doses of strong
opioids will benefit patients with chronic pain and they will not suffer addiction. This hoax, initiated by the
pharmaceutical industry and propagated by experts with conflicts of interest has got us into a terrible
mess.

Now the evidence is clear and weve got to sort it out. There is NO RCT evidence that opioids benefit
chronic pain long term and the short term trials are biased and flawed. There is PLENTY of evidence of
the misery (side effects, dependence, abuse, addiction, hospital admission, overdose and death), which
increase with higher doses.

Cornwall is quite a heavy prescriber of opioid analgesics (70th centile of UK CCGs) and there has been a
desire for a long time within GP practices to do something to get a handle on prescribing but no-one
quite knows what to do since we dont have decent alternatives for patients.
Well, we do now. Myself and pain/psych/gastro consultants have written information for patients and infor-
mation for clinicians which includes lots of online resources to:

help patients with chronic pain without relying on drugs and

to give you, the GPs, deprescribing suggestions and ideas e.g. what patient groups to identify how
to start going about making a change.

This information is hosted on the Cornwall Formulary website. In the first instance please can I ask you to
watch this 15 minute video powerpoint presentation which describes everything in more detail and shows
you how to access our work entitled Cornwalls Opioid Strategy the demedicalisation of chronic pain.

https://youtu.be/7S_3Pw5V1rg

The CCG and prescribing team are sorting out financial incentives for engagement and success (FY 16/17
GPPSQ and enabling funds). Phase 2 means us working with GP practices to plan what to do, how, with
which patients and ways to measure success. Ideas and feedback gratefully received! Ill keep you updat-
ed.

We really appreciate your input in winding back the harms weve caused.

Dr Jim Huddy
GP Perranporth and NHS Kernow clinical lead for Chronic Pain

Page 4 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 Practice Staff Training Programme 2017/18
Thank you everybody for your support with this after an initial slow start the courses are now getting
booked right through to the end of the year, but there is still plenty of availability on them however, I would
hasten to add if you are thinking of sending staff on them dont leave it until the last minute please!

The feed-back we have received from the courses so far has been very encouraging and it seems that
everybody has benefitted from the course they have attended giving the courses top marks for content
and presentation along with the unexpected bonus of networking with other practices. So, we seem to be
hitting the mark. Good to know that we appear to have chosen the right courses to present to you. But
please do remember that if you think there is anything lacking please let us know.

There are no courses being held from the middle of July through to the middle of September due to school
holidays and with so many people taking their holidays during this period as well. So, the first course after
this period will be Medical Terminology held on Wednesday 20th September. This course is nearly full and
at the time of writing I have 4 places left so dont leave this too much longer if you want to book staff onto
it.

This is followed by an Employment Seminar held by the ever-popular Darius Ferrigno from Primary Care
Law. The topic for this seminar being Changing Contracts plenty of spaces available for this one.

Also attached to the newsletter is the programme showing all the courses available for the rest of the year
from mid-September through to March 2018.

Exceptional Customer ServiceCourse Change of Date

Please note we have changed the date of the course Exceptional Customer Service. The date has
been changed from Wednesday 25th October 2017 to Wednesday 1st November 2017, due it being half
term at the end of October. Hopefully this will make it easier for you to send any staff that needs this
course.

Changes in Practice Managers

It seems there have been one or two changes in recent months please can you let me know of any
changes so that I can keep our records and email lists up to date.
If you could email these details to: admin@kernowlmc.co.uk it would be much appreciated.
Many Thanks

Locums We Still Need you!!

Please dont forget to let us have your contact details so that we can keep in contact with you and put
you on our mailing list for the monthly newsletter at least.

Our contact email address for your details is: admin@kernowlmc.co.uk.

Page 5 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 Updates for Primary Care -Headland Hotel, Newquay
The programme, developed upon feedback from previous years and delivered by local specialists and aimed at
GPs, Trainees and Primary Care Nurses, is shown below.

Monday 2nd October 2017

Dermatology (am) Neurology (pm)

Tuesday 3rd October 2017

Occupational Health (am) Respiratory Medicine (pm)

Wednesday 4th October 2017

Womens Health Update Day

Thursday 5th October 2017

Haematology (am) Paediatrics (pm)

Friday 6th October 2017

Joint Injection Workshop (am) Sports Medicine (pm)

Visit this web page for the Terms and Conditions and link to on-line booking:
http://www.updatesforprimarycare.org.uk/Registration_U4PC.asp

Mindfulness Based Stress Reduction Course for Healthcare

professionals and NHS Staff
Mindfulness is developed by purposefully paying attention in a non-judgmental way to your experience of your
body, mind and the world around you. Mindfulness is about being focused and aware, living in the present, rather
than dwelling in the past or anticipating the future.
Staying in touch with the present in this way, from one moment to the next, may lead you to experience yourself dif-
ferently, perhaps feeling less stuck, or recognising more strength, balance and confidence in yourself. Most people
completing the programme report lasting physical and psychological benefits including:
Greater self-confidence and more acceptance of life as it is.
An increased ability to cope effectively with both short and long-term stressful situations.
An increased ability to relax and experience calm
More energy, enthusiasm and appreciation for life.

Mindfulness based stress reduction: This eight week course is designed to improve quality of life and reduce stress
reactivity. Held at the Postgraduate centre at Treliske, there are two courses planned for the coming year. It will run
from 5.45-7.45pm on Wednesday evenings and is open to both clinical and NHS administrative staff across Corn-
wall. It costs 160, this includes all course materials and one Sunday day retreat.
Course 1: Wednesday September 6, 13, 20,27, October 4, 11, 25, November 1
Course 2: Wednesday January 10,17,24, 31, February 7, 21, 28, March 7/14
Stephanie Jackson is a GP and Training Programme Director for the Cornwall GP Training Scheme and is in the
fourth year of a Masters in Teaching Mindfulness Based Approaches at Bangor University. Email Stephanie to find
out more or book a place.

NO . 3 1 0 Page 6
 Mevagissey Surgery
6/8 Session Salaried GP Vacancy at Mevagissey Surgery
Part time also considered

Enthusiastic GP required to join our friendly, small, dedicated practice team.

We welcome part time or full time interest. You will be joining a GMS dispensing Practice which is located in a
picturesque fishing village of Mevagissey, close to the beautiful Lost Gardens of Heligan and with a branch sur-
gery in the nearby seaside village of Gorran Haven.

The surgery has a high QoF, enhanced services and prescribing achievements, supported by experienced
nursing and administration teams.

We provide placements for medical students, and are keen to be involved in GP training in the future.

We have a long established very active Friend of the Surgery group who fund raise on behalf of the surgery,
and also our Mevagissey Patient Participation Group which actively delivers patient views on how the practice
meets the needs of our rural healthcare community.

Information enquires/practice visits are welcome: Contact Nikki Deakin (n.deakin@nhs.net) or Dr Kathy
James (kathyjames@nhs.net) Tel: 01726 843701

Phoenix Surgery - GP Vacancy

Phoenix Surgery are looking for an enthusiastic and motivated GP to join our committed and friendly team at
Phoenix Surgery in Camborne, Cornwall. We are especially looking for a GP who shares our aims of delivering
personalized, patient-centered care, whilst providing a happy and healthy working atmosphere for our team.

Initially this will be a salaried post with a view to partnership for four to six clinical sessions a week or a partner-
ship for the right candidate. There are no building buy-in costs as the surgery in located rented premises.

Practice Summary:-
List size of 5851 patients
Team consisting of 5 GP partners (4 WTE), 3 GP Registrars, 3 practice nurses, 2 HCA, 1 phlebotomist
and associated administration and reception staff
Clinical system used EmisWeb
High QOF achieving and recent CQC overall rating of good
Medical student teaching and VTS Training Practice, with three approved trainers including one of the
local Training Programme Directors
Very well supported by skilled on-site district nursing team, community matron, palliative care nurse and
health visitors

Prospective candidates are very welcome to visit the practice on an informal basis, and/or to speak to a mem-
ber of the medical team. Please call 01209 714876 to arrange.

Please send a CV and covering letter to: Alison Henley, Practice Manager - ahenley@nhs.net

NO . 3 1 0 Page 7
 VEOR SURGERYCamborne, Cornwall
GENERAL PRACTITIONER

Are you enthusiastic about Social Prescribing? Does research float your boat? Do you think General Practice
should be an active part of the community?

Our Practice is located in the historic mining town of Camborne which is part of the World Heritage Site, some
of the most beautiful beaches in the Country and an idyllic place to live and work.

We are an innovative and growing Wellbeing Centre in West Cornwall. We are establishing a range of exciting
new services including social prescribing, developing research portfolio, young peoples clinics and a range of
other wellbeing services.

We are looking for a range of new team members to join us as we turn our exciting vision into reality. A key
role in this is a dynamic and innovative GP looking to practice embracing all of our new approaches. We are
flexible to create a role that builds on your clinical interests. You will be joining a friendly and supportive team
that includes Urgent Care Practitioners and Social Prescriber.

To give you a flavour of what we are doing Veor is a Centre of Wellbeing, learning and education. We are in-
troducing social prescribing, working with a range of voluntary sector partners, and in the very near future we
will start a young persons wellbeing clinic working with a well-known voluntary sector organisation. Education
and learning is at our heart and soon hope to be a GP training practice again.

We will provide, in addition to your salary, your indemnity insurance and time off for CPD as well as supporting
you in Academic Research etc.

We would welcome a discussion with you about our exciting plans, please phone 01209 611199 or email
amanda.menear@nhs.net If you would like to join our team please send us a copy of your CV and a brief
statement on how you can help us achieve our ambitions.

NO . 3 1 0 Page 8
 St Clare Medical Group, Penzance
Transformation & Integration Manager - 18 month fixed term

Salary NHS Band 8A (40,428 - 48,514 pa)

The St Clare Medical Group is an exciting collaboration of the Alverton Practice, Rosmellyn Surgery and
Sunnyside Surgery in Penzance, West Cornwall. In Summer 2018, all three GP surgeries will be moving to a
new build health centre in the town with a combined list of approximately 19,000 patients.

This flagship primary care development has created the need for a Transformation & Integration Manger / Pro-
ject Manager to work alongside the three existing Practice Managers to relocate all clinical services and admin-
istrative functions, ensuring that all the opportunities that this collaboration presents are fully optimised. The
post holder will drive the integration and delivery of existing services, as well as developing new services in
partnership with other care providers, patients and relevant local organisations.

The successful applicant will have a proven track record of success in delivering integrated outstanding ser-
vices through effective project management. They will be confident in supporting the change management
process required bringing an entrepreneurial, creative and autonomous approach, whilst having a genuine en-
thusiasm and commitment to the organisation's ethos and culture. This role requires an experienced project
manager who is not afraid of getting practically involved. This is an emerging organisation which will require
input at strategic, operational and delivery levels. We are seeking someone who will be engaging, pragmatic
and passionate about driving best practice in an environment that has an appetite and need to change. A sen-
sitivity to existing cultures and local working practices will be essential.

The portfolio of the project will include human resources, health and safety, security, compliance & policy, op-
erational delivery, logistics & premises, business development, IT and communications, training, finance and
external liaison. There will be very limited scope for delegation and this will therefore be a challenging, but
highly rewarding position. Whilst your experience may have been gained in a variety of areas, experience of
the health and care sector and the NHS will be a distinct advantage.

To register interest, please submit a curriculum vitae accompanied by a supporting letter which describes how
your experience and skills meet the requirements of the job description.

All applications will be assessed against the job description. Selected candidates will be invited to a joint ses-
sion to meet with staff groups, followed by an interview & candidate presentations.

Applications and interim informal enquiries should be directed to Lorna Nicholas, Practice Manager at
Rosmellyn Surgery: lorna.nicholas@nhs.net
Closing date: 8th September 2017
Interviews: 25th & 26th September 2017
Post commences: Autumn 2017

NO . 3 1 0 Page 9
 Harris Memorial Surgery - Salaried GP / GP Partner

We are seeking one or two ambitious, motivated GPs to join our innovative, dispensing GMS practice based in
mid-Cornwall. You will be joining a dedicated, experienced and friendly team of nurses and staff and enjoy our
attractive premises and large consulting rooms in Illogan, where we also host the community midwives. We
are located close the spectacular beaches of North Cornwall and coastal villages such as Portreath and St Ag-
nes.

The practice
Dispensing
5600 patients
Excellent access and parking
Microtest Evolution clinical system
CQC rated Good in 2016

The job
4 to 8 sessions and job-share or flexible working considered
Study leave and allowance
Regular clinical meetings
15 minute routine GP appointments
Partnership interest welcome
Competitive rate, depending on experience
Indemnity paid by practice
For an informal chat, please contact Dr Simon Knowles (simon.knowles3@nhs.net) or Dr Andrew Fripp
(andrew.fripp@nhs.net) (partners) or call the practice and ask for Karen on 01209 844300.

Applications with CV and covering letter to Karen.Beswetherick@nhs.net please. Closing date 31/07/17

NO . 3 1 0 Page 10
 DR BASIL BILE

Hilda was in an almighty mood last week. And when I say a mood, I mean a humdinger of a brood-
ing state. Hilda, lest any of you have forgotten, is one of my partners. Not my marriage partner you under-
stand. One of those is more than enough to contend with. No, I refer to my professional business partner
of countless happy years, Dr Hilda Bunnytunnel.

She and I have trampled side-by-side upon many a Secretary of State for Healths freshly sown
reforms with gay abandon. The best laid NHS plans of Tory, Labour and even Coalition plotters have been
treated with equal and well-deserved contempt by the pair of us. But last week something really got her
goat. We all knew it by the way she goose-stepped into the coffee room before morning surgery started,
causing our drug company freebie mugs to rattle in the sink. Even Cruella, our usually implacably ice-cool
Practice Manager, looked anxious.

Bloody cheek!

What is? I asked, not really wanting to find out.

On Radio Cornwall. This morning. Everyone complaining about a new doctor being a woman. Just
because shes Chinese. Sexist and racist. Its an outrage, she bellowed at the ceiling. My chocolate Hob-
nob disintegrated into dust as she banged her fist on the table.

Chinese? I ventured.

Dr Hu.

Aha. Dr Who?

That what I said, Basil. Dr Hu. Wash your ears out.

I thought it safer to agree rather than to get involved in a long and perilous discussion about the
gender merits or otherwise of the thirteenth incarnation of a fictional BBC Timelord.

Meanwhile I suppose we should be grateful that our Grand Duchy CCG has not shown the same
shifty initiative as their counterparts nestling amongst the dreamy spires of learned Oxford.

GPs will get bribes for taking drugs from the elderly, spouted the front page headline of The
Times newspaper.

At first I thought this might involve our being paid backhanders for indulging in the mugging of frail
senior citizens as they tottered out of the local pharmacy clutching their monthly supplies, a course of ac-
tion hardly designed to put us in the good books of the GMC.

However, as is so often the case Dear Readers, truth is stranger than fiction. What the NHS Boss-
es in Oxford had in mind was giving GP Surgeries a financial incentive to reduce prescribing costs by
sharing savings from doling out fewer drugs to our older customers. Last year Keith Ridge, Chief pill-
polisher for NHS Fruitcake, said it was a scandal that a fifth of tablets taken by elderly patients were point-
less, with thousands of pensioners ending up in hospital because their medicines interacted badly with
each other.

Contd/..

Page 11 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 DR BASIL BILE

Both the good folk at the BMA and Joyce Robins of the pressure group Patient Concern are equal-
ly peed-off with the whole shooting match. Telling GPs they can be better off by prescribing less to their
patients doesnt sound like a good idea, she told The Times Health Editor. You would think patient care
was their main priority, not cost savings. She might just have a point. Full marks then to the Oxfordshire
LMC for urging GPs to have nothing to do with it.

This all follows on from the controversy of family docs being paid to refer fewer patients for tests
and scans, not to mention fifty-five smackeroos in a brown envelope for every case of dementia we diag-
nosed. Hippocrates must be spinning in his grave. Whatever happened to his famous Greek Oath? Or has
it been replaced by The Hypocritic Oath?

Page 12 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R