LMC Newsletter August 2015

NICE Antibiotic Prescribing

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 [email protected]

Your Chairman writes 2

Supporting sustainable General Practice in the South West

3

BMA, Chaand Nagpaul 4-5

Tips for Employing Locums Subject Access Requests

6

Meningococcal B Vaccinations Paracetamol Advice

7

Display Energy Certificates Change in requirements

8

Events 9

Top and Tail Carr-Hill Formula

10

Vacancies 11-12

Dr Basil Bile writes 13

Inside this issue:

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No. 287

August 2015

Please find below a statement from the BMA following a clarification from

NICE regarding their story on GP prescribing habits.

Dr Chaand Nagpaul, BMA GP committee chair said:

The BMA has met urgently with NICE today and expressed our concern

at reports that GPs should face sanctions including GMC referral for 'over

prescribing' antibiotics. This claim unfortunately has distracted from the

launch of new guidance which we believe is helpful, especially as the

BMA has been pushing for GPs to have better individual prescribing data

for some time. We are pleased that following our meeting, NICE has

clarified that inappropriate prescribing is not widespread amongst GPs

and have made it clear that they wish to support all GPs, and not

admonish them in public.

GPs are aware of the need to be prudent with antibiotic use, but they do

work in a difficult environment, seeing patients early in their illnesses, with

limited access to diagnostic tests and follow up. GPs are often prescribing

for people with complex medical or social needs. They are also under

pressure to avoid patients with infections being admitted to hospital, and

these factors need to be taken into account. There are now multiple

routes for patients to access antibiotics, many of which are not centrally

recorded. Given this climate, we need to support GPs in using their

clinical judgement, which is what the vast majority of GPs do, for the

benefit of their patients.

Advance Notice

Kernow Health CICs AGM

Kernow Healths GP Shareholders Annual General Meeting to be held on 29th September 2015, from 7pm at Kingsley Village, Fraddon (Conference Suite, 1st Floor).

Postcode for Sat Nav: TR9 6NA.

NO. 287

The Future of General Practice

Although summer seems to have by-passed this particular part of Cornwall, the weather has not diminished the almost insatiable appetite for primary care medical services in the GP surgery. As we start to gear up for the flu season, the winter looms and discussions are well under way about winter pressures. Meanwhile I have been attending local and national discussions about the Future of General Practice. Many of you have expressed to me the view that you think GP has no future; others are more sanguine and think that the current difficulties will blow over. This is something I have written about before and although some of you are probably thinking, here we go again with another negative polemic; I would like to highlight some positives. In Cornwall we are in a unique position to redesign and take control of our destiny. We as general practices own a county wide provider company (Kernow Health CIC), we own our Out of Hours Provider (Cornwall Health) and we are all members of the single CCG in Cornwall (Kernow CCG). In other words, we have our destiny in our own hands. If we accept that the current way of delivering primary care is unsustainable (demand, recruitment and retirement) then we have to build a sustainable future that can cope with escalating demands and needs and that is attractive to young doctors. I think this will involve is working closer together and taking more control of our working environment and conditions. Waiting for national negotiations to deliver something different could be a long wait. Its clear that a one size fits all provision of primary care cannot work. For instance we have differing needs to a young metropolitan population.

At some point our CCG will want to move towards fully delegated commissioning i.e. to effectively decide what they want from primary care. The thing is, it isnt a they its an us as we are the CCG, it being a membership organisation and we being the members. I see this move to delegated commissioning as an opportunity for us to move at pace in service redesign, building something fit for our future in Cornwall. We all need to be aware of the opportunities (and potential problems) with delegated commissioning. For a start it will need a change in the CCG constitution and your LMC will be involved in the constitutional change process.

Bizarrely although the Health and Social Care Act has been at times quite destructive, it is presenting us with an opportunity to effect real change in our county and I think we should welcome it with open arms.

Page 2

Your Chairman writes ..

August Sessional enewsletter

The August edition of the sessional GP enewsletter is available here

The Deputy Chairs message discusses the busy summer period, the enewsletter also features top tips to help ensure locums pay their pension contributions within 10 weeks, and a number of blogs: One blog discusses the benefits of joining a local sessional GP group, another lists things you should consider before resigning, the third introduces Dr Faisel Baig (the newest member of the Sessional GP Subcommittee Executive), the fourth details a GPs difficult experience completing a ALS course and the final blog outlines how one sessional GP made sport their day job.

NO. 287

After three months of development and piloting, in August, NHS England South (South West) will be launching an initiative aimed at helping General Practices to considering their sustainability status and to explore options for responding to the current challenges facing General Practice and the wider Primary Care environment.

The initiative has been developed as a result of dedicated NHS England funding for the South West and is led by a dedicated project manager.

The Supporting Sustainable General Practice initiative aims to fulfil NHS Englands ambition to support innovative and improved models of primary care, by designing a process which can take Practices on a journey from the provision of tools to enable to them to identify viability and sustainability, to helping them explore aims and objectives, potential design solutions and transform into sustainable organisational forms

Whats On Offer?

For South West General Practices, NHS England has developed a range of support mechanisms and resources aimed at the initiating and supporting the life cycle of business change, as follows: Assessment of General Practices sustainability, using the General Practice Health-Check Tool Presentation and exploration of potential options for business change Guided facilitation of discussion within or between General Practices to help consideration of

change options and ways forward Facilitation of communication between General Practices to initiate collaboration and exploration of

partnership initiatives Support and guidance for planning business change Support and guidance for realising plans and objectives, including provision of project management

expertise Guided facilitation of discussion between change initiative partnerships to review and consider

current outcomes, successes and lessons learnt Provision of a range of information resources, including guides to collaboration, networks and

federations, mergers and managing projects. Access to General Practice early adopter innovation models across the South West

NHS England has developed these resources and approaches in collaboration with a range of subject matter experts, including: Clinical Commissioning Groups Local Medical Committees General Practitioner Partners General Practice Managers and Business Managers Regional Pharmacy Personnel NHS Englands Supporting Sustainable General Practice initiative is being project managed by Robert Connor and is part of the NHS England South (South West) Primary Care Transformation

Programme. For more information, contact Robert on 07788 290538 or 0113 824 8945 or by email at

[email protected]

Page 3

Supporting Sustainable General Practice in the South West

As your representative body, one of the key roles of the BMA GPs committee is to provide guidance for GPs and LMCs (local medical committees) and briefings on changes affecting general practice, helping you to plan ahead and respond to challenges.

We have produced no fewer than 25 guidance documents and briefing notes for GPs in the past six months, all of which are available on the BMA website. These have been written with everyday GPs in mind and I've listed some of the key resources we have published most recently below:

New GP contract guidance: Changes came into effect in April 2015 and it's important that practices are aware of the work that is no longer necessary, such as that on the patient participation DES (directed enhanced service) and alcohol DES, as well as the significantly reduced reporting requirement for the avoiding unplanned admissions enhanced service. There are also new benefits, including non-discretionary funding for maternity leave cover. We have produced detailed guidance on: how to deliver new contract IT requirements; the requirement for patients to have a named, accountable GP; publication of GP mean net earnings; and how all these changes affect sessional GPs.

Managing your workload: If you haven't already done so, I would strongly urge you to look at our Quality first: Managing workload to deliver safe patient care toolkit. At a time when GPs are overwhelmed with work, which can compromise safe care, this resource provides templates that practices can use locally to challenge inappropriate and unresourced work. We have had very positive feedback from GPs and practices who have used this guidance, with many reporting tangible changes to their workload.

GP networks: A dedicated section of our website details how GP practices can work together in federations, GP provider companies and other collaborative alliances. We have created specific guidance on: how to set up a network; common legal structures for practice networks; and some guiding principles. One prime function of GP networks should be to help members manage their workloads. This includes helping struggling practices, for example through peer support, workload management and the sharing of staff and expertise.

Becoming architects of new care models in England is a discussion document on the NHS Five Year Forward View, informing GPs, practices, networks and LMCs of new integrated approaches to providing healthcare and how this could work for GP networks. In addition, we have produced guidance on NHS Englands new care models vanguard sites.

Out of area registrations: Despite our expressing strong concerns, the Government has allowed patients in England to register with GP practices away from their home residence since January 2015. Read our guidance and FAQs to find out what you need to do contractually if you register such patients.

Sessional GPs appraisal and revalidation guidance provides essential tips tailored to the specific needs of sessional GPs.

Prepare for a CQC inspection: The prospect of an inspection is daunting, but there are things practices can do to mitigate the stress and make sure you and your non-clinical colleagues are well prepared. Our detailed and practical guidance walks you through how to prepare for the three key stages of inspection pre-inspection, the day of the inspection and the outcome and what support your LMC can offer.

Our take on the new deal is a detailed analysis of the health secretary Jeremy Hunt's 19 June speech setting out his plans for general practice.

Clinical pharmacists pilot: Last month, NHS England announced a new national pilot of pharmacists working within general practices, with the aim of easing GPs' workloads. Read our guidance for full details and to learn what

From your BMA GPs committee chair

Missed any of our key guidance?

CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R Page 4

From your BMA GPs committee chairContinued


Focus on PMS reviews and transition to GMS is essential reading for all PMS practices, to help them understand and proactively prepare for funding reviews.

Rent reimbursement guidance: this is a must-read for leasehold and owner-occupied GP premises.

Focus on the global sum allocation formula gives a comprehensive yet easy to read explanation of how GMS practices are funded.

The induction and refresher scheme, which was launched earlier this year, supports GPs returning to work after a career break.

Our Patient Group Direction guidance explains the regulations on how nurses, or other registered HCPs (health care professionals) who are not qualified prescribers, can administer prescriptions or medications.

Fit for Work scheme goes live across England and Wales

GPs throughout England and Wales can now refer employed patients who have been, or are likely to be, off sick for four weeks or more for a voluntary occupational health assessment. Government information states that: 'The occupational health professional will identify obstacles preventing the employee from returning to work. A Return to Work Plan will be agreed providing recommendations tailored to the employee's needs, which can replace the need for a fit note.'

Further details are available on the Fit for Work website, while specific guidance for GPs can be found on the Government's website and we have also produced our own guidance and FAQs.

Finally, as always, you can keep in touch with the latest news at www.bma.org.uk/gpc.

With best wishes

Chaand Nagpaul

BMA GPs committee chair

Primary Care written complaints - consultation

The HSCIC is consulting on revisions to the K041b annual data collection on written complaints received by practices in England. Details of the consultation can be found here and the closing date is 24 August: https://consultations.infostandards.org/workforce/primarymedicalanddentalcarewrittencomplaints

They are proposing changes to the collection from next year. Practices are currently asked to submit the number of complaints (and the number of these that were upheld) received during the year by service area and subject of com-plaint.

The changes they are suggesting include:

Asking practices to specify the staff group complaints relate to;

Asking practices to specify the age and status (patient, parent, guardian etc) of complainants;

An increase in options practices can select under service area and subject area;

Removing the general comments box.

GPC is submitting a response to this consultation, including concerns about the extra workload for practices in sub-mitting this additional information. Also, the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 which underpin this collection do not require practices to collect or provide information on staff groups or details of the complainant. The regs only specify that practices should collect data on number of complaints, outcome of the complaint and subject matter.

Top Tips For Employing Locums


1. Always agree on terms of engagement when booking a locum (guidance on BMA website). These should include

expected duties, length of surgery, extras, visits and admin/paperwork. Pay and overtime. How much notice is

required for both parties to cancel.

2. Ensure the locum has proof of inclusion on the performers list, GMC and indemnity. All locums will have had an

enhanced DBS check on application to the performers list so will not need subsequent DBS checks for the purposes

of booking. Child protection, vulnerable adult and CPR training certificates are a performers list requirement and do

not need to be requested by the employing practice.

3. Ensure you give new locums some time to familiarise themselves with practice systems e.g.. the computer, how

to deal with results/correspondence, visiting policy,

4. Find out the locums name, introduce them to staff and ensure personalised logins where needed. Appoint a key

member of staff who the locum can approach easily with queries.

5. Show locums where the loos and coffee/tea facilities are and welcome them to the GPs/staff room for breaks.

6. Encourage the locum to discuss problems or cases with GPs, nurses and other staff.

7. If the locum is new to your computer system they may not be able to use your QOF templates. Allow for this by for

example getting the locum to list patients they have seen so that others can add the data to the system.

8. Give and ask for feedback from the locum when they have finished. This could be done informally and followed up

formally with a simple feedback questionnaire.

9. Include locums in your SEA and complaints processes. This is good governance for both practice and locum and

will help the practice with CQC and the locum with appraisal.

10. Locums can struggle to get patient and colleague surveys for appraisal. If you are arranging these surveys at

your practice then consider including locums that you use. Again this benefits both parties.

Remember that if you treat locums well you will have more chance of recruiting them into partnership or as

employees.

If you employ a locum regularly they might be regarded as employees by HMRC.

Pay locums promptly on receiving invoices.

Late payment will damage your reputation with locum groups and make it more difficult to get locums. Locums need

prompt payment especially of pension contributions (form A) which they must submit within 10 weeks.

Provide locums with a receipt of invoice (usually now done electronically) and itemise payments separating the

professional fee, pension contribution and expenses.

Subject Access Requests for Insurance Purposes

August 2015

Please see the attached updated version of the BMA guidance Focus on Subject Access Requests for insurance purposes. Please note that the advised approach for responding to a SAR for insur-ance purposes has had to be updated following the ICOs input. We have now also included guidance on responding to SARs from third parties for non-insurance purposes.

The guidance is also on the BMA website.

Meningitis B immunisation is thought to be more likely to cause a fever than many other immunisations

The practice will be following what has been agreed between NHSE, PHE and the BMA

This is that at 2 and 4 months parents should be advised to give 3 sequential doses of paracetamol beginning at or soon after the time of the immunisation (paracetamol is thought to be less needed at 1y)

Practice nurses should give a national leaflet to all parents at the time of the first immunisation (and second if it appears such updating might benefit the child) See https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/450890/9413-paracetamol-menB-2page-A4-05-web.pdf

Please note that the dose recommended for post immunisation pyrexia is 60mg. This is contained in the cBNF, on the paracetamol bottle that parents can buy themselves, and is also emphasised in the parental leaflet.

Many parents will already have infant paracetamol (120mg/5ml) or be prepared to buy it soon after leaving the practice

For those parents who would find this difficult, PHE has provided practices (via IMMFORM) with stocks of paracetamol sachets and a dosing syringe.

Nurses should routinely identify if a parent wants a supply of a single sachet to start the recommended course, and if so, supply it with a syringe when they give the leaflet. The leaflet contains instructions on how to administer paracetamol from the sachet using the syringe.

Liquid Paracetamol is on the general sales list of medicines that can be sold in an ordinary shop, so nurses should be reassured that they are acting in a similar way, albeit without charging for the supply of medicine.

Paracetamol advice for parents of babies being given meningitis B immunisation


Meningococcal B vaccination

As from 1 September 2015 the Men B vaccination has been added to the Childhood Immunisation Programme in England.

The programme is for all infants born on or after 1 July 2015, and consists of three doses at 2, 4 and 12 to 13 months, with a catch-up element for children born on or after 1 May 2015, who can be vaccinated up to 2 years on an opportunistic basis.

JCVI has recommend three doses of prophylactic paracetamol (2.5ml of infant paracetamol 120mg/5ml suspension) following the vaccinations at 2 and 4 months. 5 ml sachets and dosing syringes are available to order via ImmForm.

We are aware that many practices have been asked by parents to provide this vaccine privately to children outside the cohort. Although practices would be able to offer this on private script they would not be able to claim the cost of the vaccine, nor would they be able to charge the patient for providing it (as per Schedule 5 of GMS Regulations 2004 which lists the limited circumstances in which GPs may charge fees for providing treatment to their NHS patients). We would recommend that practices advise their patients requesting this to attend another practice, who are then able to charge for providing the vaccine. Further information about the meningococcal vaccine, including a protocol for healthcare professionals for Men B and paracetamol use is available on the Public Health England website.

The service specification for this vaccination is available on NHS England website and Vaccine update also has some useful information, including a parent information leaflet.

General information about all the vaccination programmes is available on the BMA website vaccinations pages.


Display Energy Certificate (DEC) - change in requirements

As many of you are already aware, a DEC is required for any building that exceeds 500m2 which is

frequently visited by the public. Please note that this is changing from the 9th July 2015.

A DEC will be required where the total useful floor area of the building exceeds 250m2 which 'is occupied

in whole or part by public authorities and frequently visited by the public'.

We asked the BMA legal department for a view on whether they think practices would be covered. They

have said that for the purposes of a GP practice the definition of a public building is likely to include

surgery premises, as GP practices are in receipt of public funds and provide a public service to large

numbers of people who visit regularly.

They have added that their opinion is that it would be for the occupier of the building, rather than the

owner to arrange the DEC (the use of the building will usually be dictated by the occupier so it would

make sense for them to arrange same if the above criteria is applicable to them). However, the position

might be different if NHS Propco owns the building, rather than a private landlord, in which case they will

probably be responsible for obtaining and paying for the DEC. The guidance does also state that where

there is doubt over whether a DEC is needed, it is good practice to obtain one (Guide to Display Energy

Certificates and Advisory reports for Public Buildings). The DEC is purely based on the overall output of a

building and not each single piece of equipment.

The assessment must be undertaken by an accredited energy assessor using the methodology approved

by the Secretary of State. To check that an energy assessor is a member of an accreditation scheme, a

search facility is available on the central register website: www.ndepcregister.com

To view the Regulations please visit:

http://www.legislation.gov.uk/uksi/2012/3118/regulation/14/made

The following provides an overview of the validity periods for a DEC:

Floor area (M2) Validity of DEC Validaity of

recommendation report

>1000 12 months 7 years

501 - 1000 10 years 10 years

>250 - 500

As regulations are currently

written, when the floor area

threshold is reduced to 250m2

from the 9th July 15, it is

presumed that these DEC will

be valid for 10 years

As regulations are currently

written, when the floor area

threshold is reduced to 250m2

from the 9th July 15, it is

presumed that

these recommendation

reports will be valid for 10 years

Musculoskeletal Update for GPs

How to get the best out of Assessment of the spine, hip, knee and shoulder.

To be held at The Headland Hotel, Newquay

On 19th and 20th November 2015

Page 9 CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R

Better togetherFirst Joint Conference

For Primary and Community Nursing in Devon and Cornwall

To be held at Sands Resort Hotel, Newquay

On 8th October 2015

Please see attached flyer for more information.

Peninsula Community Health

Better togetherFirst Joint Conference NHS England

Updates for Primary Care

The Headland Hotel, Newquay

12th - 16th October 2015

For further details please see attached flyer or contact

www.updatesforprimarycare.org.uk

Practice Management Master Class, with Darius Ferrigno

How to Keep In Touch With, Discipline and Dismiss Sick Employees at;

The Cornwall Hotel and Spa, St Austell

Tuesday 22nd September

For further details please contact the LMC Office [email protected]

Please note: 1 place available due to cancellation.

NO. 287 Page 10

Partnership Opening - Quay Lane Surgery, St Germans

Due to a reduction in Partners hours there is a rare opportunity to join Quay Lane Surgery. We are seeking a highly motivated Partner to join our friendly cohesive team from July 2016. The number of sessions will be flexible for the right candidate.

Quay Lane Surgery is a rural dispensing practice with a stable list size of 4,500 patients. Nestled in the heart of East Cornwall we dispense to approximately 95% of our patients and have a branch surgery in the beautiful seaside village of Downderry. Whilst having easy access to Cornwalls stunning coastline and its amazing array of outdoor activities, we also maintain close links with the city of Plymouth which is easily accessible by rail and road and situated about 12 miles away.

We are a forward thinking practice with our main focus being on high quality, holistic patient-centred care.

About the Practice: 3 Partner GMS practice Microtest Evolution IT system Partner owned, modern, purpose-built premises with Dispensary Consistently high QOF achievement & a range of Enhanced Services Branch Surgery open five days per week in Downderry Active involvement in Kernow Clinical Commissioning Group Active Patient Participation Group

Apply with a covering letter and CV to: Mrs Debbie Todd, Practice Manager. Quay Lane Surgery, Old Quay Lane, St. Germans, Cornwall, PL12 5LH. Telephone: 01503 230088 For more information or to arrange an informal visit please contact Mrs Debbie Todd: E-mail: [email protected]

Website: www.quaylanesurgery.co.uk

Top and Tail

We would like to remind you all that practices are contractually required to provide GMS to their practice patients

between 0800 and 1830 on weekdays (excluding b/h). To put your phones through to an answering service without

ensuring that service has access to an appropriate clinician during our hours of responsibility is a potential breach of

Focus on the global sum allocation formula (Carr-Hill Formula)

If you are unsure how a general medical services global sum is calculated, you can read our recently published focus on the global sum allocation formula.

This details the various components that make up the Carr-Hill Formula, as well as the limitations of this funding methodology, and may help you plan for the future.

You may be aware that NHS England has recently commenced a review of the Carr-Hill Formula in the hope for it to better reflect workload.

GPC is represented in this process, and it is clear that the formula is not suitable for a significant minority of practices that have atypical populations, and who have only been financially viable through receiving correction factors.

We have consistently argued that such practices should not suffer as a result of phasing out the minimum practice income guarantee. GPC will also continue to remind the Government that the review must not distract from the real funding problem facing all practices, which is grossly inadequate overall investment in general practice, particularly in the context of the increasing demands of an ageing population and care moving out of hospitals.

NO. 287

Really motivated, stable and happy team Rated as outstanding by the CQC Training practice with current ST3 in post Great working environment on the beautiful North Cornish Coast just 400 metres from the beach High QOF achievers Experienced Practice Nurse team including Practice Nurse triage service Expanding list size (currently 4500) between 2 full-time partners and 2 part-time salaried GPs Look after local community hospital Flexible

We are looking for someone who is equally motivated, flexible, interested in General Practice, and good quality care to patients.

Sessions are negotiable but ideally 6-8 per week.

Start date - October or November, but happy to wait for the right person

Please enquire by email to Dr Dowling [email protected] or ring 01288 270580 to speak to one of

Page 11

Salaried GP, Neetside Surgery, Bude

Required from 1st October 2015. Partnership or permanent post available but fixed term contract will be considered.

We are a friendly, supportive and cohesive 4.5 wte partner (1wte salaried GP) semi-rural practice with 9500 patients in a beautiful Cornish town.

Partner-owned, harbour side property and dispensing rural branch surgery.

You will have encouragement in developing your medical interests, and the opportunity to teach medical students, F2s and GPSTs.

For further information or to arrange an informal visit please contact:

Practice Manager, Judy Cole - email [email protected];

GP - Old Bridge Surgery, Looe

GP - Launceston Medical Centre

We are a large, friendly, rural dispensing practice in the beautiful countryside of East Cornwall. We look

after a stable rural population whilst having the security of size (17,500 list).

Our position offers excellent quality of life with stunning countryside and coastlines close by. We benefit

from easy access to Exeter and good transport links to the rest of the country.

We have recently been granted NHS funding for expansion of our purpose built premises and, with the

retirement of our senior partner, are looking for enthusiastic, patient centred Doctors to join our team. We

are happy to consider both partnership and salaried roles to fit the preference of the successful applicant.

Applications to Mr Peter Harper, Business Manager, Launceston Medical Centre, Landlake Road,

Launceston, Cornwall PL15 9HH

NO. 287

NHS Kernow is looking for GPs who would like to sit on the four Individual Funding Request

panels. These panels make difficult decisions on the funding of care and treatments which are not

routinely commissioned. Funding decisions are not taken lightly and meetings involve rigorous debate

around clinical and cost-effectiveness, equity and fairness. Training is given. Payment is made for your

time and travel.

More information about these ethical decision-making processes can be found at

https://www.kernowccg.nhs.uk/media/659529/ifrpolicy2015.pdf

Page 12

Seeking GPs With an Interest in Ethical Decision Making

Why survive when you can thrive? Here at Stirling Medical Group we are committed to embedding resilience into our primary care service to ensure that we can continue to provide high quality care despite the current challenging environment.

Due to a retirement we have an opportunity for a committed GP to work 6-8 sessions within our service. You can work within a dedicated multi-disciplinary team to maximize the impact of your skills for your patients and gain the satisfaction of providing primary care excellence to the practice population in the city of Plymouth.

We work from two sites and there is no requirement to buy in as the premises are rented. We use the Emis-Web clinical system and are well organised with many administrative tasks such as repeat prescribing and routine workflow dealt with by trained staff freeing up your time to do what you do best .

We are enthusiastic about education and have medical students and F2s coming on a regular basis. On the horizon we anticipate implementing further innovation in how our service is delivered and are also exploring working with other practices in federation.

If you would like to come and see how we work and meet for a chat please get in touch.

Please contact Dr Bodo Brockmann ([email protected]) or Amanda Plunkett, Managing Partner ([email protected]), by email or call us on 01752 322265 to have an informal chat, or to arrange an informal visit to the practice.

STIRLING HEALTH GROUP - GP VACANCY PLYMOUTH

Manor Surgery, Redruth

4 Session (2 days) Salaried GP Post

available from beginning January 2016

Long established and well organised training practice with an interest in clinical research. List size of 11,500 based in modern, purpose-built premises. Very sociable, diverse, motivated team achieving consistently high QOF results.

We are looking for flexibility and a willingness to participate in full.

To the right person we can offer support, commitment and a welcoming atmosphere in addition to an attractive salary package and your own PA.

Contact Julie Campbell on 01209 313313 or

e-mail: [email protected]

Manor Surgery, Forth Noweth, Redruth, TR15 1AU

I spluttered over my Oatibix and blueberries. I was perusing the sports pages, which were banging on about football manager Jose Mourinho and his treatment of Chelsea team doctor Eva Carneiro. He publicly chastised her for running on to the field of play without his say-so, when summoned by the referee to attend to an injured player. The Premier League Doctors Group stormed to her defence, saying that a refusal to run on to the pitch could have breached her duty of care to the patient, in this case an overpaid averagely talented pretty boy with something probably no worse than a stubbed toe. The Football Medical Association also piled in on her behalf, saying she acted with integrity and professionalism.

Well thats all very fine and dandy, but how come yours truly didnt receive the same rampant publicity and oleaginous professional sympathy when I was removed from my position as Medical Advisor to St Salive Thistle FC, following a not dissimilar incident? Where were the PDLG, FMA and RSPCA? Looking the other bally way is the shocking answer, presumably because I dont look as fetching as Dr Carneiro. I seem to be the victim of blatant sexism.

It is true that in my incident the injured person was the Referee, and it is equally true he had sent off three of our players and awarded two penalties against us. We were rock bottom of the Pascoes Pasties South Western District League 10 at the time, and 5-0 down after twenty minutes. Our manager, Wurzel Pascoerino, was of the opinion that we would have been better off if I hadnt resuscitated the man in black after our center forward, trying to get a packet of cigarettes out of his shorts while simultaneously meeting a left wing cross with his head, collided full pelt with the hapless aporth, knocking the stuffing out of him. On my return to the touchline, with the match official restored to rude health as a result of my sterling efforts, Wurzel emptied the trainers bucket of water over my head, causing my toupee to lurch to the left. I left the field of play with the laughter of the crowd (all five of them) ringing in my ears, one of which was covered by my soggy hairpiece. Thats the last time I buy a wig from Pound shop.

Thoroughly pissed off by the back page, I flipped over to the front sheet, at which juncture the old hypertension took a definite turn for the worse. Notwithstanding all the other crap currently galloping in the direction of us noble plyers of the ancient art of Family Doctory, NICE (The National Institute for Clinical Excuses) has added to the toxic mix by declaring that GPs who over prescribe antibiotics should be referred to their regulatory body to be hauled over the coals and made to repent their evil ways.

Threat To GPs Over Antibiotics, and Doctors Who Dole Out Too Many Prescriptions Should Face Disciplinary Action, Says Health Watchdog, were the harsh phrases which assaulted my senses.

According to them that knows such stuff, GPs are writing 10 million antibiotic prescriptions annually. Professor Mark Baker, director of the Centre for Clinical Practice at not-so-NICE, tells us patients addicted to antibiotics for every cough and cold are touring surgeries until they get a prescription. Since patients are meant to be registered with one particular practice, Im not sure how that would work, but it was his next statement that sent a shiver down my spine.

NICE has issued new guidelines on the subject of antibiotic prescribing. We all know issuing guidelines is something this august body does every thirty seconds or so. We have a skip full of them outside the Abandonhope Surgery to prove it. But on this occasion Prof Baker is saying that those docs who fail to adhere to his precious guidance should be brought before the GMC. Is this the beginning of a sinister move to have us referred for disobeying any and every NICE Dictat, ranging from the treatment of bunions to the removal of Lego bricks from childrens external auditory meati? A guideline is a guideline. It exists to offer guidance. It is not an absolute. We are supposed to be able to use our clinical judgement and common sense in the practice of medicine. Or are we?

Dont forget to look under the bed tonight. You might find Prof Baker there

DR BASIL BILE WRITES


LMC Newsletter August 2015

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Transcript of LMC Newsletter August 2015