No.

262
July 2013

A Committee Member writes.

Pete and Jon are on hols, so time to play.
Some years ago I stood against a GMC ruling on the grounds that, as a
doctor, I believed my licensing body was wrong. I am still licensed, and it
eventually concurred.

Cornwall & Isles of Scilly

LMC Newsletter

For me, the importance was that my duty as a doctor to my patients

overode any strictures of the GMC, although I would always try to abide
by their sensible rulings. We now have an onslaught of rulers- DoH, GMC,
CQC, Area Team, KCCG, all with their own agenda. None of us ever
actually signed the Hippocratic Oath but we, as doctors, signed up to a
professional duty beyond that of our political masters and our licensing
bodies.
We see failings across the professions, with shameful results. It strikes
me that increasing external governance makes these failings more likely,
not less.
I dont want to whistleblow after the event, I want to prevent those events
ever happening, and that means being active, not passive: it means being
a professional.
We should listen to and learn from the many bodies that now seek to
inspect us, but should remember our own core values, and our
responsibilities as Doctors.
To thine own self be true.
Easier said than done.

Inside this issue:

GMS & PMS Uplifts 2013/14

GMS & PMS Uplifts 2013/14

contd/.
Out of Hours Care
Redundancy, Restructuring
and Re-organisation

Guidance on Multicompartment Compliance Aids

Refreshing the NHS Mandate

DVLA Survey
IPP Panel

Flu Vaccine for Children

Vaccine stock and potential
shortages.
Shingles Vaccine FAQs
GP Locums employed through
Limited Companies

Introduction of Care.data
Vacancies

7-10

We would like to congratulate

Dr Beth McCarron-Nash from
Lander Medical Practice on
being elected to the GPC
Negotiators,
regaining the position she lost
a year ago.
Our congratulations also go to
Dr Chaand Nagpaul on his
election to GPC Chair.
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

GMS & PMS uplifts 2013/14 Statement to LMC and GP

Practices:
National Guidance:
All practices should receive the same 1.32% uplift in overall contract income. This will be achieved by increasing Global Sum Equivalent payments.
Locum employer superannuation
Following the recent Pensions Regulations consultation, the Government has decided to transfer responsibility
for funding employer superannuation costs for GP locums. Locums themselves, as self-employed contractors,
will be responsible for making both the employer and employee superannuation payments to the NHS Pensions Agency.
To reflect this change in responsibility, we are transferring to GP practices the funding currently spent by PCTs
on these costs. This funding will be added to GMS Global Sum Equivalent funding, as the BMA suggested in its
consultation response.
Key effects
As a result of the contract uplift and locum superannuation funding, the GMS price per weighted patient will
increase by 2.44% from 64.67 in 2012/13 to 66.25 in 2013/14.
As core (Global Sum Equivalent) funding represents around 60% of overall practice income, the increase to
total practice income will be around 1.47%.
PMS
Decisions on contract uplift and on handling of locum superannuation costs for PMS and APMS contracts are a
matter for the NHS Commissioning Board.
NHS Commissioning Board Guidance
Contract uplifts have been agreed at 1.32% for each GMS/PMS contract. Additional guidance agreed with the
Operations Directorate as follows:For GMS practices, there are broadly three categories of spend: (a) global sum or global sum equivalent;
(b) other income streams that are within the scope of the annual % uplift, ie QOF, Directed Enhanced
Services, seniority pay; (c) other income streams that are outside the scope of the % uplift, eg premises
reimbursement, IT reimbursement.
GMS practices are getting a 2.2% increase in category A payments and a 0% increase in category B payments in order to deliver a 1.32% increase in category A/B combined.
Area teams should treat PMS contracts in the same way.
The closest equivalent to GS/GSE expenditure for PMS practices is their 'baseline' funding, ie that element
of their funding that includes PMS 'growth' monies (and potentially some enhanced services, seniority
and other payments) but excludes QOF and DESs.
Area teams should uplift this 'baseline' element by whatever amount is needed to give a 1.32% uplift in
overall PMS funding (excluding the equivalent of category C).
If, for instance, a PMS's baseline forms 70% of its overall contract income (excluding category C), then its
baseline would be uplifted by 1.32% divided by 70% = 1.89%.
Contd/...
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GMS & PMS uplifts 2013/14 Statement to LMC and GP

Practices:
PMS Uplift mechanism to ensure equity with GMS
The Open Exeter quarterly Global Sum report will be used as at 31/3/13.
This report is generated by the Exeter system and shows the Global Sum for every practice including a notional
amount for PMS and APMS practices. It shows the Global Sum they would be paid if they converted to GMS.
The PMS baseline uplift value will therefore be calculated as follows:
PMS Practice National Global Sum multiplied by Global Sum rate increase of 2.44%
National guidance states that Global Sum is approx. 60% of total practice income therefore the overall increase
in total practice income will be 1.47% (1.32% inflation and 0.15% Ers pension funding).
This will ensure that a consistent approach is applied to all practices regardless of contract type as is the overriding aim of National and Commissioning Board guidance above.
A contract variation reflecting this funding change will be issued in due course.

Out-of-hours Care
Following the recent media coverage and a major debate at LMC Conference, the GPC has published a
position paper on developing out-of-hours care. This paper provides a recent history of out-of-hours care
in England and sets out the GPCs proposals for developing out-of-hours care to meet the challenges
facing the NHSs urgent care system. It is intended to provoke policy changes in the way out-of-hours
care is commissioned, delivered and supported.
The paper is appended to this edition of negotiating news but is also available on the BMA website here:

http://bma.org.uk//media/Files/PDFs/Working%20for%20change/Negotiating%20for%20the%20profession/General%
20Practitioners/GPC%20Outofhoursposition2013.pdf

Redundancy, Restructuring & Re-organisation

The dates of this seminar have been changed and it will now be held on Wednesday 9th October &
Thursday 17 October 2013 at The Cornwall Hotel Spa & Estate, Pentewan Road, Tregorrick, St Austell
PL26 7AB.
GPs as well as Practice Managers are welcome to attend.
For further details please contact Susan at the LMC Office.
susan@kernowlmc.org.uk

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Guidance on Multi-compartment Compliance Aids (MCA)

We recently received a joint letter (below) from Dr Bill Beeby (Chairman, Clinical and Prescribing Subcommittee) and
Alastair Buxton (Head of NHS Services, PSNC) regarding the recently published Royal Pharmaceutical Society
(RPS) guidance on Multi-compartment Compliance Aids (MCA) . The Royal Pharmaceutical Society (RPS) has today published a report: Improving patient outcomes: The better use of multi-compartment compliance aids which
includes guidance and recommendations for health and social care professionals.
Most GPs and community pharmacists have experienced demands for multi-compartment compliance aids from patients, their relatives and social care workers, to assist patients to use their medicines correctly. Following such demands there has often been little reflection as to whether that intervention improves patient outcomes and the
MCAs have been supplied almost on-demand.
RPS has considered the evidence base, which indicates that MCAs are not a panacea for medicines use, and that
they should not automatically be the intervention of choice for all patients. Not all medicines are suitable for inclusion
in MCAs and health and social care professionals should recognise that re-packaging medication from the manufacturers original packaging may often be unlicensed and involves risks and responsibility for the decisions made.
Dear colleague
Multi-compartment Compliance Aids (MCA) (also known as Monitored Dosage Systems)
The Royal Pharmaceutical Society, the professional body for pharmacists and pharmacy, has today published a report: Improving patient outcomes: The better use of multi-compartment compliance aids which includes guidance
and recommendations for health and social care professionals. The report can be downloaded from
www.rpharms.com.
Most GPs and community pharmacists have experienced demands for multi-compartment compliance aids from patients, their relatives and social care workers, to assist patients to use their medicines correctly. Following such demands there has often been little reflection as to whether that intervention improves patient outcomes and the
MCAs have been supplied almost on-demand.
The Royal Pharmaceutical Society has considered the evidence base, which indicates that MCAs are not a panacea
for medicines use, and that they should not automatically be the intervention of choice for all patients. Not all medicines are suitable for inclusion in MCAs and health and social care professionals should recognise that re-packaging
medication from the manufacturers original packaging may often be unlicensed and involves risks and responsibility
for the decisions made.
With the lack of evidence of benefit to patient outcomes, it is a recommendation of the Royal Pharmaceutical Society
that the use of original packs of medicines, supported by appropriate pharmaceutical care, should be the preferred
option for the supply of medicines in the absence of a specific need for an MCA as an adherence intervention.
The improvement of patient outcomes will require substantial change in behaviours, with understanding and teamwork needed across primary and social care.
The General Practitioners Committee and the Pharmaceutical Services Negotiating Committee, encourage LMCs
and LPCs to collaborate on highlighting the publication of this guidance document to local:
GPs;
community pharmacists;
hospital pharmacists and other hospital professionals who may be involved in recommending the use of MCAs
CCG clinical leaders; and
social care professionals and commissioners.
In order to promote an integrated approach across health and social care, so that patients receive the best possible
support to use their medicines, we also recommend that LMCs and LPCs facillitate local discussions by the individuals listed above on the implications of the guidance to local working practices.
Yours sincerely
Dr Bill Beeby

Alastair Buxton

Chairman

Head of NHS Services

Clinical and Prescribing Subcommittee

PSNC

General Practitioners Committee

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Refreshing the NHS Mandate

The government is consulting on refreshing the Mandate to NHS England for 2014 to 2015. The Mandate sets
the governments ambitions for the NHS as well as the funding available to achieve the kind of care people
need and expect.
There have been crucial developments and new evidence that has emerged since the publication of the first
Mandate, which calls on the government and NHS England to act.
The main proposed changes reflect these core priorities:
the actions being taken forward by NHS England in response to the Francis Report to transform the care people receive working with NHS England to develop a vulnerable older people plan, which will improve support for
older people and those with long term conditions, particularly through reform of primary care given its pivotal
role within communities the need for the NHS to contribute to the recovery of the economy and make better
use of resources in light of the challenging financial climate
The government is also proposing to make a number of targeted changes to the current Mandate objectives
that are thought to be essential to achieve improvements in peoples care.
The Health and Social Care Act 2012 requires the Mandate to be reviewed on an annual basis to ensure that it
remains up to date. It is important to provide the NHS with stability and continuity of purpose and we therefore
propose to carry forward all the existing 24 objectives.
You can respond to the consultation here:
https://www.gov.uk/government/consultations/refreshing-the-nhs-mandate

DVLA Survey
The DVLA have asked us to send a short online survey to practices on the questions about cognition that are
currently used on DVLA questionnaires.
The aim is to improve the DVLA questionnaires so that they best capture the necessary information to enable a
correct licensing decision. This survey is being undertaken to canvas the views of GPs about the red flag
questions which are currently used on DVLA questionnaires, to determine what you anticipate is the effect of
your answer to these questions on licensing decisions. The DVLA have asked for suggestions from you for
additional red flag questions the DVLA could ask which might help GPs to inform DVLA more comprehensively about your patients likely fitness to drive.
This survey is entirely voluntary but if you would like to take part the link for the survey is
https://www.snapsurveys.com/swh/surveylogin.asp?k=136731174402
Please note: you no longer need to read the NEURO2 questionnaire before you start the survey as the DVLA
have reworded the survey.

IPP Panel
Administration of the Individual Patient Placements (IPP) Panel has been transferred to the Individual Funding Requests Team. Please note that the email for all IPP applications is now
individualfundingrequests@kernowccg.nhs.uk
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Flu vaccine for children

Following some confusion about the process for ordering flu vaccine for children, NHS England has confirmed that Fluenz is the recommended vaccine for children and that this will be centrally supplied. Practices will be able to request the vaccine via IMMSFORM.
Where two and three year olds are contraindicated to Fluenz, contractors will be required to make an alternative Inactivated Trivalent Influenza Vaccine (TIV) available. Inactivated TIVs which have already
been ordered by GPs for two and three year olds in clinical risk groups can be utilised for the contraindicated two and three year olds. Practices will be reimbursed for this as per children in clinical risk groups.
If practices experience difficulties in sourcing inactivated TIV for the contraindicated 2 and 3 year olds
please contact the ImmForm helpdesk on 0844 376 0040 which will be able to assist in ordering inactivated TIV. Further information will be available in the tri-partite letter which will be issued shortly.

Vaccine stock and potential shortages

Public Health England (PHE) has not received any reports from the suppliers of potential flu vaccine
shortages for this coming season. If there are any problems PHE will inform practices via the Vaccination
newsletter for health professionals and immunisation practitioners.
https://www.gov.uk/government/organisations/public-health-england/series/vaccine-update

Shingles vaccine FAQs and supporting information

NHS England, Public Health England and the Department of Health have published a letter
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212235/Shingles_vaccine_l
etter.pdf
and FAQs
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212231/PHE_shingles_Q_
A_for_healthcare_professionals_FINAL.pdf
explaining the introduction of a vaccine programme for people aged 70 years (routine cohort) and 79
years (catch-up cohort) to protect against shingles, available on the DH website. Links to these documents will also be available on the vaccines and immunisation pages on the BMA website.
http://bma.org.uk/practical-support-at-work/doctors-as-managers/managing-your-practice/vaccination

GP Locums Employed Through Limited Companies

You may have seen an article in The Times on 28 June that referred to dozens of NHS Trusts in England
being under investigation by HMRC over their alleged use of schemes to avoid VAT when employing locum or part-time doctors.
In light of that, please be aware of the position of GP locums employed through a Limited Company, often
referred to as a service company. The services they provide are subject to VAT when the registration
threshold for VAT has been reached. The threshold level includes all charges made by the company including but not limited to fees and the recovery of expenses. The registration threshold is currently
79,000.
Doctors working as locums through an agency should, if they have not already done so, take advice on
the application of VAT to their work and if registration has not been effected on time how to mitigate any
penalties and interest charges accruing for late registration by making voluntary disclosure.
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Introduction of Care.data
Since April 2013 the new GPES system has been authorised to collect personal confidential data from GP systems, including patient identifiers, as part of the care.data project. Under the Health and Social Care Act 2012
practices can be required to provide such information. The objective is to try and collect all the activity data for
individual patients using their demographic identifiers which will then be stripped out when the data is made
available to potential users. As with the Summary Care Record, the default position is that data will be collected, but patients can opt out and either have the upload blocked ( add code .9Nu0 to notes) or they can allow
the upload but block the sharing of any personal data outside the national HSCIC database ( code to be released when available). See BMA advice at http://bma.org.uk/search?query=care.data
NHS England, the BMA and the RCGP have worked collaboratively to produce guidance and FAQs
http://www.england.nhs.uk/ourwork/tsd/data-info/ to support this process.
Supporting guidance from the BMA for professionals. http://bma.org.uk/-/media/Files/PDFs/Practical%
20advice%20at%20work/Ethics/Care%20data/caredataguideforgps.pdf
http://www.england.nhs.uk/2013/05/29/nhs-england-annou-tech-guide/
There have been issues with the opt out codes and we have now sourced the correct ones which are:
#9Nu0.00 and XaZ89 Dissent from secondary use of GP patient identifiable data
#9Nu1.00 and XaZ8A Withdraw dissent from secondary use of GP patient identifiable data
Are for dissent for data to leave PRACTICE to HSCIC, and
#9Nu4.00 and XaaVL Dissent from disclosure of personal confidential data HSCIC
#9Nu5.00 and XaaVM Dissent withdrawn disclosure personal confidential data HSCIC

Wadebridge, North Cornwall

We are looking for a 6 8 session Salaried GP or Partner, to replace a retiring partner.
7,500 patients, 6 Partners, 1 Salaried GP

Dispensing

High QoF Achievers

Training Practice & Medical Students

Branch Surgery

Excellent Primary Health Care Team

Enquires to Sonia Geach, Practice Manager

sonia.geach@wadebridge.cornwall.nhs.uk 01208 812222
Closing date for applications 7 September 2013

Interview date 28 September 2013

To start December 2013, but this is negotiable

Wadebridge & Camel Estuary Practice
www.wadebridgedoctors.co.uk
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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
Closing date for applications 31.08.13

Tamar Valley Health, Cornwall

GP vacancy: prospective partner or salaried, full or part-time
Our rural practice is situated in beautiful east Cornwall, within easy reach of Plymouth and the Cornish
coastline. We care for over 16,700 patients at the Callington & Gunnislake Health Centres, both purposebuilt and practice owned. Each health centre has a dispensary and we also have our own pharmacy and
primary-care pharmacists. We offer a wide range of services, including minor injuries; have high QOF
scores; are extensively computerised with Vision; and are actively involved in commissioning.
Following the retirement of one partner and another moving to a medical directorate, we need to add
someone with a passion for the core values of general practice to our team of partner and salaried GPs.
Starting dates flexible June-Sept 2013. For further information, please contact Kathie Applebee, Strategic
Management Partner at
kathie.applebee@call-gunn.cornwall.nhs.uk or Gunnislake Health Centre, The Orchard, Gunnislake,
Cornwall, PL18 9JZ. Closing date for applications 6 May 2013.
www.tamarvalleyhealth.org.uk

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North Cornwall, Camelford - Partner

We are looking for a Partner 5/6 sessions a week to join our senior partner. We are a GMS practice in the
North Cornwall market town of Camelford. Our main surgery is in the town of Camelford with 2 branch
surgeries in the surrounding villages of Delabole and St Breward. Flexible for the right applicant.
Practice Population 3300
Fully computerised Microtest
High QOF achievers
Excellent nursing and administration team
Small Dispensary at St Breward branch surgery
Rural area incorporating Bodmin Moor
Please apply in writing with current C.V. to Mrs N Sherry, Practice Manager, The Medical Centre, Churchfield, Camelford, Cornwall, PL32 9YT, email: nicky.sherry@camelford1.cornwall.nhs.uk, Phone: 01840
213893

Marazion Surgery
GP Partnership 8 sessions
Due to the retirement of our Senior Partner, an opportunity has arisen for an 8 session GP Partner to join this
friendly, rural Dispensing GMS Practice. We currently have five GP partners and a list size of 7,000 patients.
The position is available from January 2014, however we would be willing to negotiate a mutually convenient
start date for the right candidate.
Marazion Surgery is in the historic seaside town of Marazion, overlooked by St Michaels Mount. West Cornwall is a rural area, with small picturesque villages, open countryside and scenic coastline.
We are a friendly, forward-looking Practice, with modern purpose-built premises:
Dispensing Practice

Microtest Evolution Clinical System

Paper-light

Nurse-led Chronic Disease Management Clinics

Supportive multi-disciplinary team

Consistently high QOF, DSQS and Enhanced Services achievement
Practice Website www.MarazionSurgery.com
For further information, or to arrange an informal visit, please contact Mrs Jackie Brown, Practice Manager on
01736 710505 or Email Jackie.brown@marazion.cornwall.nhs.uk

Please forward your application, with a covering letter and Curriculum Vitae to Mrs Brown by Email.
Closing date Friday 6th September
Proposed date for interviews Saturday 5th October
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VEOR SURGERY, CAMBORNE

Practice Nurse Vacancy
We are looking for a Practice Nurse to join our nursing team, previous work in Primary care and experience in
running asthma/copd clinics would be an advantage.
The position is full time 37.5 hrs. a week Monday to Friday. (Job share may be considered)
For an application form and job description please contact Veor Surgery on 01209 611199

THE STENNACK SURGERY

The Old Stennack School, St Ives.
We are looking for highly-motivated and suitably qualified clinical staff to join our Team.
Nurse Practitioner - Bank Practice Nurses
Further details and application packs available from :
The Stennack Surgery website www.thestennacksurgery.co.uk
Closing date 23rd August at 5.00 pm.

STILLMOOR HOUSE MEDICAL PRACTICE

FULL-TIME PARTNER/SALARIED GP REQUIRED
Due to the relocation of one of our existing partners we are looking for a Full time partner or salaried GP
to join our practice team. 8 sessions.
Find out more about our Practice at: www.stillmoorhousemedicalpractice.co.uk
List size 10500
Extended hours but no OOH commitment
8 weeks annual leave including study leave
Medical students (year 3)
Telephone triage system combined with pre-booked appointments
Assist with in-patient care at local community hospital on a daily basis.
Practice owned premises
Active in local Clinical Commissioning Group
Negotiable start date
Please telephone Sue Carthew/Michelle Pratley on: 01208 72488 if you wish to organise an informal discussion or visit to the Practice.
Please send CV with covering letter by post or e-mail to:
Mrs S Carthew Practice Manager Stillmoor House Medical Practice Bell Lane Bodmin Cornwall PL31 2JJ
or e-mail: sue.carthew@stillmoor.cornwall.nhs.uk
Closing date: 13th September 2013
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