Cornwall & Isles of Scilly

Cornwall & Isles of Scilly LMC Newsletter No. 258 March 2013 Your Chairman writes... What a time to be a GP! Very shortly April 1st will be upon us and life as we know it in Primary Care will change, probably forever, For a start the PCT will have disappeared to be replaced by the CCG, an organisation run largely by GPs. If you don t feel connected then I urge you to talk to your practice lead, cluster lead or CCG rep. If this nascent body is to have any meaning for us then it must have input. It really is up to us to shape the future of Primary Care (within a static and, in real terms, shrinking budget). Challenging times indeed. As if that wasn t enough April 1st brings a new incarnation of ngms following the government s consultation - a process which involved listening to bodies such as the RCN, Family Doctors Association and others (oh yes the BMA). Basically they ignored everything GPC suggested apart from a couple of minor alterations. It remains to be seen if GPC has any real role to play in future negotiations with HMG. This is an issue that will hopefully be addressed at the LMC conference. Individually and collectively we are left with some difficult choices. I urge you to look at contractual changes now (see BMA website) and discuss as practices and groups of practices how you will approach the year ahead. It is likely that additional challenges will be forthcoming from the Area Team (the local incarnation of the National Commissioning Board). They will be under pressure from their bosses to measure performance in Primary Care. Now add to this already toxic mix, CQC and it all looks fairly unpalatable. Don t despair, at least not yet. GPs have always proven themselves to be adaptable and resilient. Use this moment to analyse what you do and how you do it - adapt and survive. We will try and signpost pitfalls and opportunities. Stay healthy - remember most of us work to live and not live to work. The new world will produce great pressures. The LMC can help individuals and practices that are struggling. Use us. Inside this issue: Sharps Guidance Official lease documentation for practices in PCT-owned premises Locum Superannuation Prescribing Guidance Updates PGD Guidance New Public Health System Pathology Laboratories at the Royal Cornwall Hospital GPC Regional Elections Occupation Health Study Day RCGP Tamar Faculty Study Vacancies 6 RCGP CPD Meetings 7 Dr Basil Bile 8 2 3 4 5 Meet you MP This is your chance to meet and question your MP on the changes in the NHS. Wednesday 10th April. 7.30pm Penventon Hotel. Redruth or Lanhydrock Hotel, Bodmin Please contact the office for more information. 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

Sharps Guidance The Health and Safety Executive are introducing new regulations in response to a new European directive on preventing sharps injuries in the healthcare sector (Council Directive 2010/32/EU). http://www.hse.gov.uk/healthservices/needlesticks/eu-directive.htm The HSE have not yet confirmed when the regulations will come into force, but the directive must be implemented by 11 May 2013. We advise all practices to make use of the outline of the requirements of the directive available on pages 8-9 of the Royal College of Nursing's Sharps Safety leaflet, and the employers' checklist on page 17. http://www.rcn.org.uk/ data/assets/pdf_file/0008/418490/004135.pdf Official lease documentation for practices in PCTowned premises GPC has previously advised LMCs that it is imperative that arrangements between GP tenants and PCT landlords are officially documented. The GPC position is that formalised lease arrangements will ensure that both parties (tenant and landlord) are protected by the terms contained within the agreements and are treated fairly throughout the duration of the lease. Since advising LMCs to urge PCTs to develop formal lease arrangements, GPC has cautioned against unnecessary regional variations in these agreements. LMCs that have been approached by PCTs should not approve / endorse local lease agreements unless they are sure the terms contained within them are fair. For instance, the wording within a lease agreement should not transfer cost liabilities to practices (e.g. for external repairing or insuring) without recourse to apply for reimbursement costs under the provisions contained within the Premises Costs Directions. Furthermore, as independent contractors, GPs should always seek their own expert legal advice before signing any type of commercial agreement such as a lease. Some lease agreements do attract stamp duty land tax (SDLT). The Department has informed us that this will be a one-off payment, but may not apply in every case (consideration will be given on a case-by-case basis). GPs should, however, still seek advice from the practice accountant. SDLT can be very costly and can cause cash flow problems if, for instance, it is not given consideration before agreeing to move premises. SDLT will continue to be reimbursable via the 2013 Premises Costs Directions (up to 100%), but this will require PCT / Area Team approval as they have discretion on all new reimbursements provided for within the Directions. GPC understands that, following the transfer of premises ownership from PCTs, NHSPS plans to negotiate better deals on service charges for its premises estate. This could include utilities costs, cleaning, maintenance of communal areas etc. Finally, the Department of Health and the NHS Commissioning Board have decided that it is impractical to obtain official documentation for all PCT-owned premises before 1 st April 2013 (i.e. the deadline for the transfer of ownership to NHS Property Services). The process will roll into the new financial year, so practices and LMCs have adequate time to negotiate lease agreements or agree on suitable updates to existing leases. NO. 258 Page 2

Here is the GPC guidance on locum superannuation from April 1st 2013. Please note the advice very carefully. 1.The 14 % is based on 90 % of the locum fee and must be shown on an invoice. 2. Please ensure that you agree with any locum you engage after April 1 what the remittance will be (including superannuation). 3. You are not obligated to immediately increase locum payments by (90/100 x fee) x 14/100. 4. We cannot advise on locum fees, this is a matter for the locum and the practice. there is no set rate and it is up to you to define a rate. This may be an opportunity to define the role and what it entails. 5. We are unsure what if anything will happen to compensate those practices that are PMS. 6. You cannot refuse to pay the contribution - make sure the proportion of the payment that is for superannuation is identified. eg Locum session payment 200 Pensionable pay 180 Superannuation 28 TOTAL PAY 228 Locum Superannuation Prescribing Guidance Updates We have updated our Prescribing in General Practice http://bma.org.uk/-/media/files/word%20files/ Practical%20advice%20at%20work/Managing%20your%20staff%20practice%20services/ prescribingingeneralpractice.docx guidance which includes updated advice on medicine shortages, the transcribing of medication directions, the use of multi-compartment compliance aids and supplementary and independent prescribers. This guidance replaces the Information and guidance for prescribing in general practice (2004). We have also updated the Focus on excessive prescribing http://bma.org.uk/-/media/files/pdfs/ Practical%20advice%20at%20work/Doctors%20as%20managers/gpfocusexcessiveprescribing% 202013.pdf guidance so that it includes a section on shorter duration prescribing. All our guidance on prescribing is available on the drugs and prescribing pages http://bma.org.uk/ practical-support-at-work/doctors-as-managers/prescribing on the website. the PCT/KCCG strongly encourage 28 day prescribing to reduce drug wastage PGD Guidance The NHS PGD website team is updating the current guidance, and the existing PGD guidance document produced by the National Prescribing Centre (now the Medicines and Prescribing Centre at NICE), is also in the process of being updated, expected to be published in June. As the principles and legal requirements remain the same, organisations will still be able to use the existing document to guide them through the legal framework governing the use of PGDs, and as a practical guide on their use. Page 3 CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R

New Public Health System The public health system changes on 1 April, with the local team moving from the NHS to Cornwall Council (and also serving the Council of the Isles of Scilly). Tackling inequalities, reducing harm from obesity and alcohol and improving the everyday determinants of health like housing and education are among the broad range of local authority responsibilities. However, local public health expertise, such as epidemiology and evidence based practice, will continue to support the NHS through a Memorandum of Understanding with the Clinical Commissioning Group. At the same time, the NHS Commissioning Board and Public Health England will take on new roles leading areas like screening and immunisation. A useful overview of the new responsibilities and links between organisations can be found here. These national changes have required a significant reorganisation of commissioning arrangements. Cornwall Council has needed to set up new contract and payment arrangements to meet its new statutory responsibilities. Although new processes are being used the aim is very much to keep continuity in services offered to local people and this is a common approach across other local areas in the South West. Colleagues in primary care continue to be a key part of public health support in areas like better sexual health and drug and alcohol treatment and your expertise is valued. We will continue to work with you in the design of local public health services to meet the needs of local people. Look out for more information in due course as we offer opportunities for you to share your views. In the meantime, if you have any questions about the changes to or delivery of public health support please do not hesitate to contact me. The team and I would also be really interested to hear from you about how things could be improved on. Thank you for the work that you all do that improves the health of the population, particularly those that have the least. Felicity Owen, Director of Public Health, Cornwall and the Isles of Scilly fowen@cornwall.gov.uk Want the latest news from the Pathology Laboratories at the Royal Cornwall Hospital (RCH)? Lab Med News is a newsletter for Primary Care with articles and information from the Clinical Chemistry, Immunology, Haematology, Microbiology, Histology and Cytology laboratories. Each edition is published as a pdf and delivered via email at the start of each even month of the year. Lab Med News provides information on a large variety of topics including sample collection & handling, laboratory tests, changes in service, audits, MHRA warnings and good news stories just to name a few; as well as any recommended books, websites and guidelines. Archived editions can be found on the Pathology RCHT intranet site (http://intra.cornwall.nhs.uk/intranet/azservices/p/pathologydirectoratercht/newsletters.aspx). We have GPs, Practice nurses, Phlebotomists and Practice managers on the email distribution list. If you or your colleagues wish to receive Lab Med News, please email Anna.Barton@rcht.cornwall.nhs.uk Miss Anna Barton Principal Clinical Biochemist and Editor of Lab Med News, Department of Clinical Chemistry, RCHT. Contacting the Clinical Chemistry Laboratory at the Royal Cornwall Hospital (RCH) To provide an extra path of communication between the laboratory and its users, the Clinical Chemistry laboratory at RCH has set-up a dedicated email clinchem.rcht@cornwall.nhs.uk The account is checked daily Monday to Friday, and can be used to request urine bottles, for general enquires and for clinical enquires which will be passed onto the Duty Biochemist. NO. 258 Page 4

GPC Regional Elections 2013-2016 The election of a regional representative to the GPC will be happening in the next few weeks. Our previous rep. Dr Mark McCartney will not be standing as he is abandoning Cornwall for the warmer climes of Australia. Can I please urge you all to cast a vote for our local candidate Dr Beth McCarron Nash, an LMC Committee member, former GPC Negotiator and now a partner at Lander Medical Practice, Truro. Beth is eminently qualified for the position and would represent Cornwall with a firm knowledge of Cornwall and a passion to speak up for Cornish GP. Your vote could make the difference between Cornish GPs being represented by a Devon GP or a Cornish one. Study day 2013 Occupational Health for Primary Care in The Cuthbert Conferencing Centre, Buckfast Abbey Friday 17th May Guest Speaker Dr Gwen Adshead -Consultant Forensic Psychotherapist, Broadmoor Hospital For all concerned with and interested in Primary Care practitioners health. No charge for places booked by 12th April 2013. For more information or to register for a place, please contact Sharon Trevarthen on 01752 762112 or via sharontrevarthen@bhsfoh.co.uk. RCGP Tamar Faculty Study Day The Patient Paradox, Patient Choice and the Patient Experience Tuesday, 14 May 2013 The Pavilion Centre, Royal Cornwall Showground, Wadebridge PL27 7JE For full details and to book a place, please go to: http://www.rcgp.org.uk/courses-and-events/sw-england-and-wales/tamar-faculty/rcgp-tamar-facultyannual-study-day.aspx NO. 258 Page 5

LAUNCESTON MEDICAL CENTRE CORNWALL We are looking for salaried GP/s to fill up to10 sessions per week. We have a flexible approach and will consider full-time or job share, partnership potential. High achieving rural dispensing practice GMS practice list of 17,200 patients (8,000 dispensing) Practice owned purpose built premises Undergraduate teaching Full PHC Team, including Nurse Practitioners, Respiratory Nurse High QOF scores and patient satisfaction rating Close to the moors and beautiful Cornish coastline Informal visits and telephone enquiries welcome. Visit our Website at www.launcestonmedicalcentre.com Applications to Peter.Harper@launceston.cornwall.nhs.uk Mr. P. Harper, Business Manager, Launceston Medical Centre, Landlake Road, Launceston, Cornwall PL15 9HH Direct Line 01566 771060 Receptionist Vacancy - Lostwithiel A vacancy has arisen in the surgery for a part-time receptionist for 23 hours per week to fit in with an existing rota Mondays, Tuesdays and Friday afternoon and evening shifts with Thursdays alternating mornings and evenings. Duties will include meeting and greeting patients, booking appointments, dealing with all initial telephone enquiries and message-taking. There are routine administrative tasks to be undertaken during shifts but training will be given. Some experience of computer systems would be helpful. The person appointed will need to be flexible, meticulous and willing to be very busy. If you are interested in applying, please send your curriculum vitae to Tara Baron, medical secretary at Lostwithiel Medical Practice. NO. 258 Page 6

CORNWALL RCGP CPD MEETINGS NO Evening Meeting at Duchy in May Every month there is an educational and social meeting at Duchy Hospital, Truro, TR1 3UP for Sessional and Principle GP s, Locums, First5 s, AiT s, and Multi disciplinary Primary Care staff. Parking is free but there are building works in the staff car park, so you can park in the main Duchy car park at the front or on the side of the hospital. We meet at 7 pm and talk starts at 7:30. Food and Drinks are provided. The evening meetings are free and there is no need to book and RCGP membership is currently not required. However for Workshops and Course s please check the RCGP Tamar Faculty website http:// www.rcgp.org.uk/tamar for details. 27th Mar 2013 Wed 12:30-4.30pm Health and Work in General Practice Workshop: BT Telephone Exchange, Truro. For full information and to book a place, please visit: http://www.rcgp.org.uk/healthandwork 3rd Apr 2013 Wed 7:30-9:00pm Appraisal & Revalidation: Dr. Neil Davidson GP, Serco and Cornwall & IOS PCT NO Evening Meeting at Duchy in May 2nd & 3rd May 2013 Two day Minor Surgery Course, Alverton Manor Hotel, Truro. For full information and to book a place, please visit: http://www.rcgp.org.uk/courses-and-events/sw-england-and-wales/tamar-faculty/minor-surgerycourse.aspx 14th May 2013 Tue RCGP Study Day - The Pavilion Centre, Royal Cornwall Showground, Wadebridge 5th Jun 2013 Wed 7:30-9:00pm Antenatal Care for GP s: Ms. Aylur Rajsri Consultant Obstetrician, RCHT, Truro Dr. Shipra Rao GP and RCGP Faculty Tutor for Cornwall http://www.rcgp.org.uk/tamar Email: shiprarao@hotmail.com Mob: 07861390708 NO. 258 Page 7

Dr Basil Bile Writes Ode to a Fallen Feline Pussy Katz, Pussy Katz, where have you been? Up on the roof doing something obscene You fell through a rafter To loud peals of laughter Your QOF Target for Flying scoring 1 from 15 What was the reason for this cunning stunt? Surely not to impress Health Sec Jeremy Hunt? You courted disaster Now covered in plaster You ve got nurses attending to your every want As LMC deputy Chairman quite Vice You could have just dished out occasional advice Instead you ascended To heights unintended Bruising anatomical areas not covered by NICE Attention-seeking behaviour is all very well Being eclipsed by your chairman must be bally hell But if you d stayed safely deadpan You wouldn t be on that bedpan Being smothered in soothing bacterial gel Take a hint from an oldie when seeking promotion It s best to rely on undying devotion When in all honest truth Daft larks up on the roof Only cause very painful musculoskeletal commotion Some folk will do anything to seek public attention But there is just one small thing I really must mention Remain more aloof AND STAY OFF THE ROOF If you plan to collect your nice NHS pension Page 8 CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R