FP10 Forms

No. 290
November 2015

Cornwall & Isles of Scilly

LMC Newsletter

An issue which is likely to affect GPs is that the use of FP10 CDF forms
for the requisitioning of CDs is to be mandatory from the 30th November.
Only the new FP10CDF available online is valid. FP10 CDF requisition
forms previously ordered from NHS SBS which GPs may have in their
possession will not be valid after this date. Please note that this
information is of particular relevance to dispensing practices who
will be required to use FP10 CDF requisition forms to order CDs
from their wholesalers. We advise that dispensing practices should
contact their wholesalers directly to agree local arrangements.
Please be aware that the use of FP10 CDF forms for the requisitioning of
stock of controlled drugs will be mandatory from 30th November.
The Home Office Circular introducing the new mandatory requisition
form for Schedule 2 and 3 controlled drugs has been published. The
circular can be accessed at
https://www.gov.uk/government/publications/circular-0272015-approvedmandatory-requisition-form-and-home-office-approved-wording.
Only this form is legal from 30 November 2015 but can also be used
prior to this date. Please note that the FP10 CDF forms that
you currently possess will not be valid after this date.
The new form is made freely available on the NHS BSA web pages but
with security features incorporated. A link to the specific page is available
from the Home Office circular.
Please note that GPs can use either their NHS Prescriber Code or Private
Prescriber Code to complete this form.

Inside this issue:

Your Chairman writes

2/3

From your BMA Committee

Chair.
Five Year Forward View - New
Care Models.

4/5

Here is the link to this months

sessional GPs e-newsletter.

Patient Registration.
The Treatment of Foreign
Visitors by GPs.
Temporary Resident Issue.
CQC Publications

Resus Training for admin Staff.

DWP and consent.
Anti Microbial Resistance e-learning package

Vacancies
Dr Basil Bile writes

Sessional GPs
E-Newsletter

8/9
10

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Victoria Beacon Place, Room B314,
Station Approach, Victoria, Roche, St
Austell, PL26 8LG Tel :01726 210141
e-mail dawn@kernowlmc.co.uk

Your Chairman writes ..

GP Representation
Cornwall and Isles of Scilly LMC is the only GP representative body in Cornwall. LMCs were established
in statute in 1911 by David Lloyd George as Local Panel Committees. Two years later they were named
Local Medical Committees. The LMC has been in existence for over 95 years and is still the only local,
elected and representative body of General Practitioners. More about your committee can be found here
and about the history of LMCs here . Membership is individual and being a partner is not a pre-requisite
for being a member of the LMC. If you are salaried, your employing practice will pay a levy on your behalf
to the LMC. Non-principals who are not attached to practices e.g. locums can pay the levy themselves
and ensure access to LMC services
The CCG is a membership organisation that commissions secondary care and some aspects of Primary
Care (Local Enhanced Services). It is likely that as we move to co-commissioning arrangements it will
have a bigger influence over commissioning Primary Care. All practices are CCG members. This is a
practice based membership organisation. The LMC has regular meetings with officers of the CCG on a
formal and informal basis.
Kernow Health CIC is our provider company. All practices are members and have shares in the company.
It provides services on behalf of GPs and their practices and may well employ some of you in varying capacities. Like the LMC and CCG it has its own governance rules and structure. As your Chair, I represent
the LMC on the board of Kernow Health.
The Primary Care 2020 Group is a group of managers and practitioners brought together by the CCG to
develop strategy suggestions for consideration by the CCG. It is not a decision making group and has no
mandate to decision make. It can help the CCG shape its strategy by developing ideas that will then be
subject to the CCGs normal governance and decision making processes. The group has a number of
CCG board members, RCGP representation, CCG managers and myself. I represent the LMC on this
group.
The Area Team (AT) is the local NHS England organisation which at the present time holds our contracts.
Myself and Beth McCarron (an LMC cabinet member and GPC negotiator) meet the AT on a monthly basis together with Devon LMC and the CCGs from Devon and Cornwall.
Workload
Managing workload is becoming increasingly difficult. Many of you are using the LMC rebuff template to
help with this struggle. The BMA has produced useful documentation and templates to help manage workload. They can be accessed via our website. When using any of these forms or template it is important
that they are applied correctly and judiciously. Its tempting to fire them off in response to every request,
letter or discharge sheet. These forms are confusing for people outside GP as they see us as a bottomless resource or as a means of managing their own workload. We need to be clear about what is effectively a transfer of new work that is yet to be commissioned (please use the templates in these circumstances) or for which GP is just not suitable as the governance around the work transfer is unclear. A good example of the latter is the weighing of children with eating disorders. This service is already commissioned
from the paediatric service. Following a recent meeting between Cornwall Foundation Trust, NHSE, LMC
and CCG, I can confirm that weighing and monitoring of children with eating disorders is not GP work for a
whole host of reasons (mostly to do with governance issues). I would be happy to discuss this further with
any of you but this work, as it is currently commissioned, does not belong in General Practice.
Managed Repeats
This is the name given to the system whereby pharmacies order monthly repeat prescriptions on behalf of
patients. It is superficially attractive as it should theoretically provide a seamless supply of monthly repeat
prescriptions to patients. Where it works well, it can be very effective but the LMC has over the years received continuing concerns about the widespread use of the scheme which can add to GP workload and
increase waste. Patients are sometimes unwittingly signed up to these schemes and medicines are requested that they may not need. The CCG prescribing team would be happy to discuss their views around
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Your Chairman writes ..

these issues together with suggesting suitable alternatives for some patients.
Special Conference
GPC recently voted in favour of the following motion: That, in the light of concerns about the crisis in General Practice expressed by Local Medical Committees
responding to their members' concerns, the GPC is calling a Special Conference of Representatives of
LMCs in the new year to decide what actions are needed to ensure GPs can deliver a safe and sustainable service.
Your LMC is not convinced that a Special Conference of LMCs will deliver any real change and is worried
that it will simply provide catharsis for a number of LMCs in the current climate. whilst in itself, this may not
be a bad thing we would like to see some concrete proposals emanating from the Conference. When we
discussed this at Committee number of issues came to the fore as follows: - CQC, sale of goodwill, occupational health, workload, indemnity, secondary care interface, appraisal and of course 7 day working. We
would be pleased to hear your views prior to the Conference so that we can represent you in an appropriate manner
7 Day working
At a time when we are struggling to provide 5 day services it seems ridiculous to even contemplate 7 day
working. Most of you want this to go away, I want it to go away but no matter how much we wish for this to
happen I am afraid that the bad news is that it is here to stay. No its not contractual, no its not reasonable
or wanted but ALL funding is now directed to this end. The recent announcement of the financial settlement for the NHS going forward is predicated on providing 7 day services. We must plan for the worst and
hope for the best. We would be foolhardy to ignore the direction of travel. The people who pay our wages
want 7 days services and GP at scale. GPs have always been adept at evolving and surviving. In Cornwall we have a unique opportunity to respond to these challenges - we control OOH (Cornwall Health) and
now we have a big say in the provision of community services through the CICs work with RCHT and
Cornwall Foundation Trust. If you havent read the 5 year forward view, I suggest you do as this document
describes our future.
Cornwall Health
Finally, can I urge you to support our GP OOH company over the festive period. I will be doing the odd
shift over Christmas to help out (and earn money). Cornwall Health is vital to us, helping us shape the future and providing some of the solutions to the challenges listed above.
TEP forms
TEP is short for treatment escalation plan. TEP forms are secondary care forms that define what treatment is felt to be appropriate for a particular named, usually frail older patient. They include resuscitation
decisions and it is intended that they will replace (eventually) ANDO forms. Although you may be asked to
complete these forms, you are under no contractual obligation. You may, however, find them useful when
you are compiling your personal care plans (PCPs) as part of the preventing admissions DES. We would
be pleased to hear from constituents who are having issues with these forms.

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From your BMA GPs committee chair

Escalating GP indemnity costs are affecting patient services

I spoke at a round-table event arranged by NHS England chief executive Simon Stevens to discuss the
exponential rise in GP indemnity costs on 18 November.
A range of stakeholders were present, from representatives of NHS England, the Department of Health,
MDOs (medical defence organisations), the NHS litigation authority, to urgent-care providers. The mere
fact that this meeting was arranged highlights that this is an issue vexing the Government, given its impact on the GP workforce and patient services.
Earlier this year a snapshot survey by the Family Doctor Association reported a 25 per cent increase in
GP indemnity costs in just one year, with the average annual fee for a GP doing 10 sessions a week
reaching 11,320 in 2015. This personal expense borne by GPs has contributed to the 25 per cent reduction in GP income over the last decade. It is one significant factor leading to GPs wishing to retire early,
exacerbating the workforce crisis in general practice. Furthermore, we are increasingly hearing anecdotes
of GPs unable to obtain indemnity cover, or being quoted unaffordable figures on renewal.
We are advised that increased premiums are a result of rapidly rising claims and high pay-outs, now higher than in almost any other country in the world, including the USA. The MDOs are lobbying for legislative
changes to ensure a fair and proportionate litigation process, with appropriate levels of awards for damages, and which would lessen this financial burden.
We already know that excessive premiums for GPs working in out-of-hours or unscheduled care are
threatening adequate levels of GP staffing; this is deeply concerning as we approach winter with its added
pressures. Findings from a recent survey showed that, of the 430 GPs working out of hours, 79 per cent
were having to limit their number of shifts on account of clinical indemnity premiums, and 68 per cent
warned that they would consider either reducing or stopping their shifts entirely, if fees continue to rise.
Many GPs have shunned out-of-hours work as a result.
The emergence of practices working at scale something promoted by NHS England itself through new
models of care will additionally be undermined as MDOs opt to base premium calculations for extended
routine care provision on risk algorithms developed for out-of-hours work.
Furthermore, indemnity costs for healthcare professionals in practice teams are rising and will be detrimental to recruitment. We have heard of MDOs charging up to 8,000 premiums for some nurse practitioners, and there will be significant indemnity costs associated with Government-endorsed initiatives for
practice-based pharmacists and physicians.
Many salaried GPs indemnity costs are paid for by the employing practices, and increases in fees will
again be borne by GP contractors, fuelling the financial difficulties affecting many partnerships.
There was clear consensus at the roundtable that something needs to be done. The BMA GPs committee
has proposed options, ranging from the Government reimbursing increased expenses for GPs, dedicated
funding for working in specific environments such as unscheduled care, Crown indemnity to block cover
for GP practices to encompass all healthcare professionals. Each of these options will require new central
funding. We are pressing the Government for a solution, since one thing for certain is that failing to do so
is exacerbating GP workforce pressures, and adversely affecting patient care.
Support our junior doctors
You will be aware that the junior doctors ballot for industrial action went live on 5 November, with a closing date today 18 November and the ballot result being announced tomorrow. Three days of industrial
action are being proposed: from 8am, Tuesday 1 December to 8am Wednesday 2 December providing
emergency care only, and from 8am to 5pm on Tuesday 8 December and Wednesday 16 December
with full withdrawal of junior doctors' labour.
Contd/.
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From your BMA GPs committee chair

GPC is fully behind our junior doctor colleagues, since this is an issue that affects the entire profession,
as is the need for fairness and safety to be integral to any negotiations. I am additionally in regular contact
with BMA junior doctors committee chair Johann Malawana to discuss the implications for GP trainees.
Furthermore, the BMA has published guidance for GP practices (in England only) who may be affected
by industrial action, and I would urge you to read this if you have a GP trainee working in your practice.
Further research confirms little demand for routine seven-day opening
A recent study published last week in the British Journal of General Practice reveals strikingly that only
2.2 per cent of patients wanted routine GP services available on Sundays. This comes on the back of an
independent evaluation of the prime ministers Challenge Fund pilots published last month, showing
poor patient demand on Sunday and for Saturday afternoon appointments.
The study, undertaken by the University of East Anglia shows that most people do not think they need
weekend opening, and concludes that, while seven-day services may benefit certain patient groups, such
as younger people in full-time work, Sunday opening, in addition to Saturday, is unlikely to improve access.
Given the Governments pronouncements on valuing patients views, this study mandates it to rethink its
policy on seven-day GP opening. It vindicates GPC's consistent message to ministers to use our cashstrapped NHS budget responsibly, and not be profligate in spending it on political ideology that will take
resources away from those who are the most ill and needy.

Five Year Forward View New Care Models

Last week the BMA brought together members and key stakeholders in Yorkshire to discuss plans to integrate
services and providers. The panel consisted of leaders from local vanguard sites which are testing the new
care models outlined in the Five Year Forward View, including an MCP (multispecialty community provider),
PACS (primary and acute care system), EHCH (enhanced health in care homes) and ACC (acute care collaboration). The event was webcast and is available to watch online now.
With 50 vanguard sites developing across England, this is a conversation that needs to happen everywhere.
Join the discussion on the dedicated BMA Community.

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Patient Registration
The NHS England guidance on patient registration is now live:
https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf
This should be read in conjunction with our guidance here:
http://bma.org.uk/support-at-work/gp-practices/service-provision/patient-registration-for-gp-practices

The Treatment of Foreign Visitors by GPs

The BMA has just issued new guidance on the treatment of foreign visitors by GPs
The rules have not changed but the interpretation has.
This apparently followed MP complaints about charging to NHSE, involvement of NHSE lawyers and double checking of NHSE conclusions by BMA lawyers
If requested, GPs are supposed to provide NHS care to any foreign visitor
See http://bma.org.uk/support-at-work/gp-practices/service-provision/patient-registration-for-gp-practices

Temporary Resident Issue

It is suggested all the patients are told that if they do register as temporary residents then they will be treated without access to their notes which is a patient safety issue. It would be perfectly legitimate to offer them the choice of
remaining registered with their current GP and only seeking treatment locally in respect of immediately necessary/emergency treatment or, if the length of stay is uncertain, offering to register as permanent patients so that their
records can be obtained and they can then benefit from the full range of services they require, which might not be
provided as a TR. . After all there is no guarantee the stay I the practice area will be less than 3 months. The bottom
line though is that the patients should be given the choice of the 3 options- temporary resident, permanent registration or current GP.

CQC publications
The CQC is planning to publish two tools for GP providers and professionals on our website.
The first is an Introduction to guidance for GP practices. The new web-page www.cqc.org.uk/gpintroguide will
give a brief overview of the inspection process, and sign-post to essential and recommended reading. This resource
has been put together following feedback from primary care professionals around the clarity and accessibility of our
guidance to providers. We hope that this new resource will make CQC guidance easier to find and use in preparing
for inspection.
We are also planning to publish Examples of inadequate practice from our GP inspections. The new web-tool
highlights the common features of inadequate practice that we have found in our inspections so far by using anonymised examples from inspection reports, and showing the impact they have on the quality and safety of care. This
follows on from the examples of outstanding practice web-tool for GP practices that we published in July, from which
we received positive feedback from the GP sector.
You will be able to find both these web-tools on our website, and we will be promoting them on our social media
channels (@CareQualityComm and @CQCProf). We will be sending out a letter from Chief Inspector Steve Field to
all GP providers to inform them of these new tools on our website shortly after they are published.
James Smith
Provider Engagement Officer
Care Quality Commission
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Resus Training for admin staff

As you will no doubt be aware, the 2 education and training QOF indicators Ed11 and Ed 5 were withdrawn in 2013/14. These required clinicians (GPs and nurses) to have had BLS within the preceding 18
months and non-clinical staff BLS training within the preceding 36 months respectively.
So, that being the case, advice is given by the resuscitation council which can be found here.
Although it stipulates clinical staff should have update training every 6-12 months there is no set timescale for non-clinical staff. However, it does go on to say that staff are expected to be able to start CPR
whilst waiting for an ambulance and so, update training every three years as a minimum would be desirable.

DWP and Consent

John Canning from the GPC met with senior DWP Officials who are aware that some GPs are insisting on
sight of the written consent for reports for the DWP and their agents.
GMS / PMS Regulation requires GPs to accept the assurance of the DWP and its agents that there is
consent.
The relevant extract from the GMS Regulations (the PMS Regs are the same, with different numbers) is
posted below.
The GMC guidance is also clear that doctors may rely on an officers consent the guidance can be found
here.

Antimicrobial Resistance - e-learning package

As part of the 5 year antimicrobial resistance strategy, Health Education England has produced an e-learning package to help healthcare staff understand the threats posed by antimicrobial resistance.
http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/ (select the open access session)
The updated Health & Social Care Act Code of Practice now contains 'Antimicrobial stewardship' (AMS), defined
as 'an organisational or healthcaresystemwide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness' and recommends:
3.6 Providers should ensure that all prescribers receive induction and training in prudent antimicrobial use and
are familiar with the antimicrobial resistance and stewardship competencies.
The NICE AMS systems and processes guideline also recommends:
1.1.10 Consider using the following antimicrobial stewardship interventions:
educationbased programmes for health and social care practitioners, (for example, academic detailing, clinical
education or educational outreach).

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WANTED
Enthusiastic GP passionate about patient care, team work
and enjoying life.
Dynamic practice in Newquay, Cornwall a growing coastal town with beautiful scenery and surfing
16,000 patients, run by a well renumerated, occasionally witty, practice team
Seeking replacement of full time hours of GP due to retirement, as full or part time, salaried or partnership.
Actively involved in Education (Medical Students, Foundation Doctors and Registrars), research, commissioning and Cornwall Health
Supportive of flexible and portfolio careers for healthy work life balance.
Please contact Sheena Pappin, Practice Manager on 01637 893668 or email sheena.pappin@nhs.net for more
information or to arrange an informal visit.

STILLMOOR HOUSE MEDICAL PRACTICE, BODMIN, CORNWALL

We are looking for a full time partner or salaried GP to join
our practice
Due to retirement of senior partner, we are looking for a fulltime partner or salaried GP for a total of 8 sessions
per week. An ideal start date would be 1st April, 2016, however we will wait for the right person.
We are a GMS dispensing practice with 7 partners, and excellent admin and nursing support team. Our list
size is 10,600 patients and we currently operate daily telephone triage in addition to pre-booking.
We have an excellent QOF record, and are rated as good by CQC. We are involved with our local Medical
School, teaching medical students through placement at the practice. Our future plans include achieving training practice status.
We participate in enhanced services including minor surgery. We are members of the North Cornwall Locality
Group. Our temporary resident levels are low.
We work as part of a team managing in-patient care at our local community hospital.
There is currently no out-of-hours commitment, but voluntary additional sessions are available through the local Community Interest Company.
For more information or informal discussion please contact 01208 72488 or 72489 to speak to a GP partner, or
site visits welcome.
Please apply in writing with covering letter and CV to: pratley.michelle@nhs.net
or by post to:
Michelle Pratley, Business Manager
Stillmoor House Medical Practice
Bell Lane, Bodmin, Cornwall
PL31 2JJ
Closing Date 16th December 2015

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Locum GPs at RNAS Culdrose

We offer superb opportunities to join the close-knit and highly motivated healthcare teams as a locum Civilian
Medical Practitioner (CMP) and experience some of the best working conditions that can be found anywhere.
We have vacancies for locum GPs at RNAS Culdrose, (the largest helicopter base in Europe) on the Lizard
Peninsular.
asap until October 2016
From 30th November to 29th April 2016
another from 30th November until 29th April 2017
Duties will include running Primary care clinics for the service personnel, their families and civilian staff on the
base.
You will be working 37 hours a week, Monday to Friday.
To find out more about these exciting and rewarding roles please call Cheryl on 01792 224224
or email Cheryl@med-co.com

GP PARTNER / SALARIED GP
Full time or Part time option
WESTOVER SUGERY, FALMOUTH
Practice. We are a long established Practice based in the centre of Falmouth and can promise challenging but rewarding work. Flexibility and a sense of humour are essential!

Friendly and well respected Practice

Team of 6 GPs
List size of 8,000 patients
Minor Ops
Training of Medical Undergraduates
Full range of nursing services and Chronic Disease Clinics
Supported by excellent nursing and admin teams

Start date flexible for right candidate.

To apply, please send letter and CV to David Whitworth, Westover Surgery, Western Terrace, Falmouth,
Cornwall TR11 4QJ. For further information or informal discussion please contact David Whitworth,
01326 212 120, david.whitworth@nhs.net
Closing date: 31 December 2015

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DR BASIL BILE WRITES

Junior Doctors are revolting. They really are. In my day doctors in training wore shoulder length hair, bell bottom trousers, their fingers and wrists generously decorated with Carnaby Street bling, and that was just the blokes.
Not forgetting the floral design kipper ties. Whatever happened to kipper ties? Now the young medical practitioners
are all bare at the neck and bare from the elbows down, far too much nudity for my liking. Revolting indeed. However, they are also revolting as far as the increasingly ghastly Mr H is concerned. As I tap out this mini masterpiece on
my Olivetti typewriter, awaiting with keen anticipation the ting of the bell as I reach the end of each line, I am aware
that Jeremiah has blinked first in his pointless and provocative stand-off with the Belligerent Medics Association in
Tavistock Square.
Who knows if the emollient intervention of ACAS will bring justice and common sense to bear, but it must be worth a
punt. If JH succeeds in his mission to shaft the junior docs you can be damn certain it will be us in the bally firing line
next.
Meanwhile, the Daily Torygraph is desperately trying to outdo the Daily Maul when it comes to front page
splashes aimed at the collective groins of those of us foolish enough to be still practicing the noble art of Family
Doctory.

ber.

Patients Unable To Arrange GP Appointments, squealed its latest trumped-up effort on Friday 27th Novem-

Well this is transparently untrue. At the Abandonhope Surgery we are clogged up to the gills with patients
from morn until night, customers who have self evidently been able to arrange an appointment, otherwise they
wouldnt bloody well be there on the consulting room chair in front of me, bleating on endlessly about needing a note
to assist with their appeal against not being awarded the latest version of whatever the
current flavour-of-the-month-benefit is.
You know I never leave the house Dr Bile, on account of my clostridiophobia.
So how come you are here in my consulting room today?
Id like to switch to Dr Bunnytunnel. You dont understand me.
If only all consultations could end like that. But that is too much to hope for.
According to the latest National Audit Office report, 27% of patients experienced difficulty getting through on
the phone to their practice, up from 19% three years ago. And of those who succeeded in 2014, 67 million had to
wait at least a week to be seen.
All of this will come as no surprise to those of you working at the coalface of the NHS. The truth is there
simply are not enough GPs to meet the ever increasing demand, and those dedicated souls that do heroically remain
lashed to their consulting room desks are overwhelmed with an ever increasing work-load. Every time Jeremiah Hunt
blunders around like a bull in the proverbial china shop, evermore experienced Family Docs opt for exiting early
doors, while young aspiring GPs head for the antipodes.
The Governments solution to all of this will be only too predictable. Firstly, move the decreasing number of
GPs out of their practices and in to commissioning groups, never to wield a stethoscope in anger again. Next, replace Family Doctors with Practice Nurse Prescribers, who are cheaper than GPs. Then, replace Practice Nurses
with Health Care Assistants, who are cheaper than Practice Nurses. And finally, the piece de resistance, replace
Health Care Assistants with Girl Guides and Boy Scouts, as they only charge a bob-a-job

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