Newsletter 121 – November 2011
Editorial – Dr Mark Sanford-Wood, Executive Chairman, Devon LMC
It seems at the moment that every week brings some new development of major significance to General
Practice. Rules and regulations regarding GP Clinical Commissioning Group (CCG) ‘footprints’, democracy
and constitution arrive on an almost daily basis. The NHS Quality, Innovation, Productivity and
Prevention (QIPP) pressures are landing on practices with increasingly stringent Quality Outcome
Framework (QOF) requirements to manage referrals. Uncertainties continue around this year’s national
contract negotiations, confusing statements are made regarding revalidation and appraisal, concerns
are voiced over the new NHS 111 service and locally our PCT cluster has signalled its intention to
proceed to contract with Shared Business Services to deliver PCT finance functions. Many of these
strands are covered in this month’s extended newsletter.
On top of all of this upheaval and chaos the profession faces a serious threat to its pensions scheme, despite
the fact that it was reorganised only three years ago and generates a surplus of over £1 billion per year for the
Treasury. That the Government should seek to increase the contributions to such a safe scheme strongly suggests unhelpful political
opportunism.
To analyse this most important of issues, last month Devon LMC ran an on-line survey to garner the profession’s opinions on pensions,
and the results make for chilling reading. The full summary appears in this newsletter and I would urge you to read and digest its
contents, but the take home message for all to see is that this cynical attack on the NHS’s entire hard-working workforce could well
backfire. If a significant number of GPs aged over 55 retire as the poll suggests they might then our political masters will have
managed to turn a profit making, sustainable scheme into a financial albatross around their necks. The possibility of this must be the
ultimate triumph of ideology over common sense.
The numbers of you who completed the survey should prompt some sober reflection. 340 of Devon’s GPs responded – 30% of the
profession. The significance of the findings could not be greater, and I thank you all for taking the time to respond and for sending
such a clear message to anyone who is prepared to listen.
I believe we could be facing a crisis in General Practice the like of which we have not seen before. The inexorable rise in workload and
the financial constraints of QIPP are taking their toll. We have seen no new investment in the service for three years while costs,
expectations and demand rise, and if current negotiations produce a further squeeze then combined with the pensions threat it is
clear that many of the profession’s most experienced and capable leaders will simply retire. Many seem tired of being attacked by the
media, painted as greedy and lazy, and are fed up with ever increasing constraints on their clinical freedom to fulfil their duty of care
to the individual patient sitting before them. This will occur at the very time the Government says it wants us to manage the NHS and
lead it into a new future.
The BMA has made it very clear that it does not rule out industrial action if this becomes appropriate. In the final analysis, however,
the attitudes revealed by our survey suggest that the greatest damage could be done to the NHS by disillusioned GPs who have finally
had enough simply walking away. Ultimately, apathy is far more destructive than fevered opposition, an observation that our political
masters would do well to heed.
On a more positive note, I am very pleased to announce that Dr. Anthony
O’Brien has accepted the offer of co-option to the LMC Board and will be
joining us together with our other continuing co-optees for the coming In this issue:
year. Anthony is relatively new to the LMC, but made a significant Editorial by Dr Mark Sanford-Wood .............................. 1
contribution at the National LMC Conference on behalf of Devon GPs, Summary of Devon LMC Pensions Survey ..................... 2
and I am sure he has a great future with Devon LMC. Public Sector Pensions Day of Action ............................ 3
I would also like to highlight the financial report given by our Treasurer, NHS Breast Screening Programme – Age Extension ...... 4
Dr. Mike Richards at this year’s AGM. The organisational changes we Introducing the Newly Co-opted Member of the
have introduced over the last two to three years together with our Board, Dr Anthony O’Brien ........................................... 4
finance team’s careful stewardship have led to a reduction in LMC costs NHS South of England – Launched ................................ 5
in the order of £100k per year, allowing us to set a levy of 54 pence per Vault Cytology ............................................................... 5
patient. This is a dramatic reduction, and all the more noteworthy at a Prescribing Specials Guidance ....................................... 5
time when almost every other LMC in the country has seen rising costs SBS Update .................................................................... 5
and levies. Local Procurement of NHS 111 Services ....................... 6
Safeguarding Children Update ...................................... 7
Finally, I would like to draw your attention to the new Devon LMC A Note about Sending Medical Records to PCSS ........... 8
website (www.devonlmc.org). This has been many months in preparation Veteran’s Health in General Practice ............................ 8
and an enormous amount of work has gone into creating it. The CCG Electoral Process .................................................... 8
Executive Team are to be applauded for their efforts and I strongly Events ............................................................................ 8
recommend that you start using this new resource which has been ‘Practice Imperfect’ Chapter Two.................................. 9
designed to be as user-friendly as possible. We continue to strive to Practice Scam Alert ....................................................... 10
improve the usefulness of the site and would welcome your feedback. Available for work ......................................................... 11
Vacancies ...................................................................... 10
A Summary of Devon LMC Pensions Survey
Imagine a Public Sector pension scheme that provided guaranteed benefits to its members whilst making lots of money for the
Treasury. Imagine a scheme well-funded by those members and with a fair but capped employer contribution. A scheme that had
recently undergone significant structural change in order to ensure its long term viability. A scheme that as a result of those changes
poured over 1 billion pounds each year into the coffers of the Exchequer. What a wonderful scheme that would be for it’s members,
the taxpayer and the Government. In these times of credit default, deficit reduction and unsustainable Public Sector costs you would
be forgiven for believing such a scenario to be an unattainable pipe-dream. But this is not so. What is described is the NHS Pensions
Scheme as it currently stands. In view of these facts it is a very reasonable question to ask why the Government is proposing further
changes to the scheme to make it more expensive to its members, bearing in mind that it was extensively overhauled in only 2008.
The proposed alterations are set out in the consultation document which can be found at:
http://www.dh.gov.uk/en/Aboutus/Features/DH_128785. The main thrust of these changes is to increase contributions for most
doctors up to almost 11% of income. One would therefore assume that the NHS scheme is in financial trouble. Not so. In fact it
generates an enormous surplus that funds Government spending. The excess generated (the money left over from all the
contributions after all pensions have been paid) by the NHS Pensions Scheme under the current system is given to the Government via
the Consolidated Fund. The amounts paid since 2008 are shown in Table 1 opposite. The source of this 2008 £ 1.204 Billion
data can be found at: http://www.nhsbsa.nhs.uk/Pensions/Documents/Pensions/0300.pdf at the top of 2009 £ 1.221 Billion
page 30 on the row marked “Payables (within 12 months)”. This demonstrates clearly that NHS Pension 2010 £ 1.373 Billion
Scheme members have supplemented general taxation over the last four years to the tune of more than 2011 £ 1.339 Billion
£5 Billion. That is quite a windfall for the taxpayer. It is hardly surprising that Pension Scheme members Total £ 5.137 Billion
all over the country have received the Government’s proposals with anger. It is nothing more than an Table 1
extra tax and has nothing to do with maintaining a viable Pensions Scheme.
As a result of this widespread disquiet, Devon LMC has commissioned a survey of our members – the rank and file of General Practice
in our county. The responses are alarming, and should send a clear message to the Government about the possible unforeseen
consequences of their actions. The survey was completed by 340 of our local doctors, representing a response rate of over 30%, which
is unparalleled for an unsolicited survey request. This demonstrates amply the strength of feeling within the profession, and gives the
survey high statistical significance. These results cannot be ignored.
The age distribution of the survey is shown on the left and demonstrates that
whilst slightly more of those doctors closer to retirement took the time to
respond, this is an issue which the whole profession sees as vital.
The survey also shows that the reorganisation in 2008 of the Pensions Scheme
had little effect on behaviour. Most people recognised the need for reform in
order to create a stable
scheme with a long-term
viable future. This is
shown in our second
response tabled on the
right with 12.9% of
respondents stating that
they reduced super-
annuable out-of-hours work, but only 4.4% reduced their in-hours work
commitment. When we asked what people would plan to do if the current
proposed changes were brought into effect the responses were very different.
The next chart delineates the future intentions of our members and makes for
sobering reading, especially to a Government pinning its hopes for the future
leadership of the NHS on the talent of the most experienced in General Practice.
This shows that little more than a third of the profession
would make no changes to their work pattern if these
reforms are imposed. Alarmingly, 64.7% of people intend
to take either early retirement or 24-hour retirement,
with another 17.6% of people declaring that they will
stop paying into the scheme altogether. 19.4% would
either reduce or stop their NHS work.
This will be a catastrophic blow to the workforce in
General Practice. And there is cold comfort to be had
from the group taking 24-hour retirement. Their
intentions are shown on the right demonstrating that
only 28% would return to anything like full-time working.
No-one should be under any illusions – these results
show that the General Practice workforce will be
decimated by these proposals, as people for whom the
balance of cost no longer incentivises them to continue
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Devon LMC Newsletter 1 November 2011 2
working simply retire. In the vernacular, those who can leave will leave.
So can we console ourselves with the belief that those who may retire represent a small
fraction of the workforce? Sadly, again the answer is no. The next bar chart shows the
number of respondents who work within a practice with partners who are over the age of
55. Only 28.5% of respondents
are not in that position, which
means that if those who can
leave do leave then over 70% of
remaining GPs will have
partnership vacancies they will
find difficult to fill.
Those leaving are also likely to
be the profession’s most experienced members. These are the very people
that the Government hopes will lead their proposed health reforms. The
lack of planning and foresight is breathtaking, and the potential for these
unnecessary pensions changes to derail the implementation of well-led
health policy is enormous.
Unfortunately, the magnitude of the folly is yet greater still. It does not take
a genius to work out that senior clinicians in their mid to late fifties are generally at the higher paid end of the profession and are
therefore paying disproportionately into the scheme. It is these high-end contributors who are likely to be in a position to retire,
turning them at a stroke into beneficiaries drawing on the scheme’s funds. The Government is therefore in danger of destroying a self-
sustaining system that also helps to pay off our national debt and replacing it with a scheme in deficit.
The sole reason for this Government proposal appears to be greed. It amounts to nothing more than a thinly veiled extra tax on NHS
staff. Increases in contributions are neither required nor justifiable. No doubt the Government believes that it can tar NHS staff with
the same “unaffordable pensions” brush as other Public Sector workers, but they should think again. There is genuine anger in the
ranks, because this is a genuine abuse of power. If they push this through then we will see a genuine workforce crisis which threatens
the very basis of the NHS itself. As a result of this policy the British public should be prepared for a future in which they visit their
doctor, but find instead an empty chair.
Dr Mark Sanford-Wood, Executive Chairman, Devon LMC
mark.sanford-wood@nhs.net
Public Sector Pensions Day of Action – Wednesday 30th November 2011
Dr Hamish Meldrum – Chairman of BMA Council alerts GPs to Public Sector Pensions Day of Action:
I want to update you on BMA activity on NHS pension reform in the run-up to the union-wide Day of Action
on 30 November.
As you know, the BMA has decided against a ballot on industrial action at this stage. However, we are
supporting the Day of Action and need the help of Local Medical Committees to assist GPs who wish to
demonstrate their opposition to the reforms, and to provide them with advice on issues arising from
industrial action by other unions.
We hope you will be able to join us in encouraging members to visibly show their support for the Day of
Action. Campaign materials, carrying a simple message of support, will be mailed out to individual members
with the BMJ ahead of the day. We would also like you to help us ensure all doctors are informed about the
proposed pension changes, and engaged in efforts to fight them.
To help with queries relating to the Day of Action, please see our FAQs:
http://www.bma.org.uk/employmentandcontracts/pensions/nhs_pensions_reform/publicsectorpensionsdayofaction.jsp?page=3
You may also find it useful to direct colleagues to the following resources:
Modeller on the impact of the changes – http://www.bma.org.uk/nhspensionreform
Briefing paper explaining the threats to doctors’ pensions and addressing some of the media myths:
http://www.bma.org.uk/press_centre/pressnhspensionscheme.jsp
It is essential that we demonstrate to the Government that doctors will not accept these unfair attacks on our pensions and
encourage them to take part in genuine negotiations about the future of the NHS scheme.
http://www.bma.org.uk/employmentandcontracts/pensions/nhs_pensions_reform/publicsectorpensionsdayofaction.jsp
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Devon LMC Newsletter 1 November 2011 3
NHS breast screening programme - Age extension programme
for women aged 47 to 49 and 71 to 73 years
In December 2007 the Department of Health’s Cancer Reform Strategy announced that from
2012 the NHS Breast Screening Programme would be extended to cover women between
the ages 47 and 73.
Roll out of the age extension programme across England commenced in early 2010 with all
services expected to have started by 2010-11. For further details see NHS Breast Screening
Programme ‘Good Practice Guide No 11, September 2010’
http://www.sph.nhs.uk/scqarc/sph-files/breast-screening-qa/age-expansion-
implementation-good-practice-guide. The roll-out will initially run as a randomised trial over a period of six years. For those providers
included in the trial; this will result in 50% of women across the two age groups being invited for screening. A feasibility study was
undertaken prior to the decision to randomise. These results can be accessed via http://www.ncbi.nlm.nih.gov/pubmed/21852703.
Breast screening is provided to NHS Devon through three programmes. Each provider commenced age expansion at a different time
(Table 1). Table 1: Programme and start dates
Programme Provider Age Expansion Group Start Date Contact No.
North and East Devon: In Health, Not randomising but inviting all January 01392 262600
Exeter women aged 47 to 49 2011
South Devon: Randomising women aged 47 to Expected 01803 655723
Torbay Hospital, Torbay 49 and 70 to 72 January
2012
West Devon & East Cornwall: Randomising women aged 47 to December 0845 1558167
Derriford Hospital, Plymouth 49 and 70 to 72 2010
Those women randomised for screening will be invited in accordance with the current screening plan as for those women in the 50 to
70 year age group. Women in the extended age group, who have not been invited, can be screened on request.
Due to the nature of this pilot it is inevitable that there will be differences in the process for inviting women. However, the findings
from this process will be used to inform future screening policy in the UK.
Further information can be obtained from the NHS Breast Screening Programme website: www.cancerscreening.nhs.uk/breastscreen/
Jayne Stewart, Public Health Screening Lead, NHS Devon. jayne.stewart@nhs.net
Introduction to Dr Anthony O’Brien – Newly Co-Opted Board Member
I have worked as a GP in Silverton for the last 10 years. We are a rural, Dispensing, Training, Research
accredited PMS Practice. I am a GP Trainer and have been teaching students from PMS since 2004.
I am a relative newcomer to medical politics. I was encouraged to stand for election to Devon County LMC in
2009 by Peter Joliffe after I had expressed exasperation at my perceived lack of influence over the rapidly
changing Primary Care landscape. Since serving as a LMC representative I have been actively involved in
encouraging debate around the role of DART and the importance of accountability in any new management
systems that are developed as a result of the Health and Social Care Bill. I attended the LMC National
Conference as a Devon GP delegate last summer and spoke to oppose changes to the e-Portfolio (used by GP Trainers & Trainees). I also
contributed to debates on the future of General Practice and Government budget setting.
I am married and have three children. I live on the edge of Dartmoor and spend summer Sunday mornings cycling on the Moor.
As a co-opted member of the LMC Board I hope to contribute positively during what
promises to be a tumultuous period for GPs. I will continue to work to ensure that our
representatives in the newly developing health service bureaucracy are directly answerable
to grass root GPs and will carry out our wishes.
“Bad officials are elected by good citizens who do not vote.” The nature of our jobs, our
salaries, our pensions and the future of Primary Care are probably going to change in the
next few years. It is essential that as many of us as possible participate at every opportunity
we have, to influence the future.
anthony.obrien2@nhs.net
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Devon LMC Newsletter 1 November 2011 4
NHS South of England – Launched
As part of the NHS reforms three former Strategic Health Authorities (NHS South West, NHS South Central and
NHS South East) officially joined together to become the NHS South of England at the beginning of October.
This new ‘cluster’ organisation held its first Board meeting in Newbury, confirming Dr Geoff Harris as Chair
(right) and Sir Ian Carruthers OBE as Chief Executive (left), as well as all other Board
members.
From 31 March 2013 the ten clustered strategic health authorities in England will be
succeeded by the new NHS Commissioning Board.
NHS South of England will serve a population of 13.4 million; oversee an annual budget of £20.7 billion and an
NHS staff of 284,000.
Further details about NHS South of England can be found in their new monthly newsletter in our website library:
The Month South Oct11.pdf.
Vault Cytology
Following discussions in 2010, the Advisory Committee for Cervical Screening has written to GPC to reconfirm their views that the
responsibility for follow up care of women who require vault cytology lie with their gynaecologist, not their GP. The Advisory
Committee and the British Society for Colposcopy and Cervical Pathology (BSCCP) agreed that gynaecological clinics were the best
place for cytology samples to be taken. There is still some flexibility in that GPs who wish to continue this practice, can do so on a
case by case basis in agreement with their local gynaecologist, however there is no contractual requirement for GPs to do this work.
The GPC recommends that this should be an exceptional situation and GPs should not be pressured to undertake the recall and
continued surveillance for women whose indication for ongoing vault smears will have been a malignant diagnosis.
Full guidance can be found in ‘Colposcopy and Programme Management - Guidelines for the NHS Cervical Screening Programme,
Second edition’. The GPC has raised concerns that these guidelines could be interpreted ambiguously on the follow up of women
who had undergone hysterectomies, with the risk of inappropriate delegation to GPs, and the guidance will be amended accordingly.
Prescribing specials guidance
The National Prescribing Centre (NPC) has published guidance for prescribing specials. The guidance explains what specials are and
advises on when to prescribe a special. Appendix 2, Prescribing Specials: a quick checklist for prescribers may be of particular use for
GPs. The guidance is available on the NPC website:
http://www.npc.co.uk/improving_safety/prescribing_specials/resources/5_guiding_priciples_V2.pdf
Changes in Diamorp hine Dosing
We have recently had a number of incidents involving diamorphine dosing in patients who have not previously received a strong
opioid. Until now, there has not been clear guidance in the BNF as to the initial dose to be used in these patients.
However, the latest version of the BNF (Issue 62, September 2011) now has improved guidance
on dosing:
Chronic pain, by subcutaneous or intramuscular injection,
adult not currently treated with a strong opioid analgesic, initially 2.5–5 mg every 4 hours,
adjusted according to response;
adult currently treated with a strong opioid analgesic—see Prescribing in Palliative Care;
by subcutaneous infusion,
adult not currently treated with a strong opioid analgesic, initially 5–10 mg over 24 hours,
adjusted according to response;
adult currently treated with a strong opioid analgesic—see Prescribing in Palliative Care
The Electronic BNF can be accessed free of charge for short periods of time by completing the ‘Free Registration’ option.
Richard Croker, Assistant Director of Prescribing Management, NHS Devon. richard.croker@nhs.net
SBS Update
Many practices have contacted the Executive Team to express their unhappiness and anxiety at NHS Devon’s decision to proceed
to contract for FHS services with Shared Business Services (SBS). Devon LMC has echoed these concerns to the PCT, but ultimately
we must also ensure that we foster constructive working relations with any organisation involved in the delivery of resources to
practices. We have received an assurance from NHS Devon that we will be involved in the final definition of the contract they will
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sign with SBS, including the Key Performance Indicators (KPI). This is due to take place from the 8 – 10 November. If you have
any specific contractual issues you wish us to raise that cause you anxiety in terms of running your business smoothly then please
contact the Executive Team.
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Devon LMC Newsletter 1 November 2011 5
Local Procurement of NHS 111 Services
Following the excellent article by Dr Laurence Buckman on the planned NHS 111 service for urgent care featured in the LMC
September 2011 Newsletter: Issue 119 September 2011
I will write just a few lines to explain how this initiative might progress locally.
This is a national political imperative which suddenly leapt forward as a priority on the 4th August when a
letter from the Department of Health to Strategic Health Authorities entitled: “Rolling out the NHS 111
Service” instructed them to decide on local procurement for a 111 service to replace the NHS Direct
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national phone number which will be switched off on 31 March 2013.
Discussion of the planned roll out with support of local shadow Clinical Commissioning Groups (CCGs) was
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essential but plans had to be returned to the DH by 23 September 2011 to allow time for the procurement
process to ensure a replacement for NHS Direct.
If local areas did not present their plans by this date they would be “opted in” to a nationally procured replacement service (in other
words “do unto yourselves or be done unto”). Locally this presented CCGs with a big challenge as consulting on plans and agreeing
them across multiple PCTs and CCG areas in the middle of summer holidays is not easy. Options that had to be considered were over
what area the service would be based and whether it should include Out of Hours (OOH) call handling for GP services.
Anyway, everyone did their best within the timeline and what has now been agreed is that there will be a local procurement exercise
for a replacement to NHS Direct but at this initial stage call handling for OOH GP services will not be included. There were varying
opinions on this issue but the local majority felt that there was too great a risk of destabilising OOH GP services with a new untried
and untested system and it would be safer and wiser to look at this option at a slightly later date when the 111 service is up and
running.
The service is most likely to be procured across a Devon and Cornwall geographical footprint. For now we can expect no immediate
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changes but on 1 April 2013 NHS Direct will be turned off and the replacement 111 service turned on. A computer based triage
program (probably the NHS Pathways version) will be operated to triage calls and try to direct them to the most appropriate service or
despatch an ambulance if that should be necessary.
The DH claims that of the five national pilots the one in Darlington and County Durham is showing a reduction in A&E attendances but
the DH’s own internal analysis of the pilots really only shows a consistent reduction in calls to NHS Direct across the sites as an
outcome at this stage.
In Devon our rural nature presents particular challenges so it will be important to ensure 111 does not flood current providers of
urgent care with inappropriate demands but links closely to in-hours and out-of-hours providers to simplify access to services to
patients. Noting no evidence of reduction in demand on services it seems sensible to proceed with caution, attempting as ever to
adapt a top down, nationally imposed policy to our local environment whilst making it work for patients within the resources we have
available.
Dr David Jenner, Devon LMC Board. david.jenner@nhs.net
Procurement of the NHS 111 service – Message from Pam Smith, cluster Director of
Transition
The cluster has set up a project group to ensure smooth progress on the development of a cluster-wide 111 service. 111 will be a
single point of contact for the public for urgent, but non-emergency health services and is expected to be operational by April 2013.
The group will be complemented by a 111 clinical reference group to ensure appropriate clinical and CCG engagement takes place.
The aims of the project group are to:
Feed into the regional procurement process to ensure the needs of Devon are met;
Create the environment to challenge existing provider models and maximise the use of the 111 service;
Ensure the cluster of NHS Devon, Plymouth and Torbay have sufficient practical involvement in the procurement process;
Work with a mixed clinical and operational reference group to create a communication route with localities and sufficient
engagement;
Ensure that contract managers understand NHS 111 potential and align changes in contract at the right time;
Work towards bridging the financial gaps for NHS 111 and to complete a benefits realisation;
Oversee a communications plan for the cluster;
Identify the risks and opportunities related to IT systems and mitigate accordingly;
Ensure that the cluster of NHS Devon, Plymouth and Torbay participate in the clinical governance process for NHS 111;
Monitor progress of procurement and ensure it is kept on track.
The next meeting will take place at the end of November.
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Safeguarding Children Update
On the new Devon LMC website any policy and guidance information regarding Safeguarding Children will
be quick and easy to locate. The bulk of the current safeguarding resources are found on the ‘Information’
tab, with further documents within the ’Library’. The following important resources are all available:
- Safeguarding Training for Practice Staff
- Safeguarding Children Young People-A Toolkit for General Practice
- Information about the Multi Agency Safeguarding Hub (MASH) and the MASH enquiry form.docx, which should ideally be
completed to follow up any referral into the MASH
- The template for submitting reports to Case conferences: Case Conference Report Template.doc
- A list of the named Devon Plymouth Torbay and Cornwall Child Protection Professional Leads. Please do feel free to discuss any
cases with them especially those which you feel push you outside your comfort zone
- Guidance for the Practice Safeguarding Lead: Safeguarding Children Practice Lead Guide
‘See the Adult, see the Child’
This is the title of a paper that was presented to the Devon Safeguarding Children Board (DSCB) in September, reminding us all how
the health of adults can impact on the safeguarding of children. This document is available online via this link: See the Adult See the
Child
Below are some of the sobering statistics from Devon’s population reminding us of the size of the problem within our own locality.
Again the importance of information sharing in child safeguarding cases is reiterated. We are also reminded to think of the unborn
child – further guidance is available in the paper.
A case analysis of adult/carer needs in Common Assessment Frameworks (CAFs), Child Protection Plans and Serious Case Reviews
within Devon has been undertaken. Parental needs around adult substance misuse, adult mental health needs, domestic violence,
adult ill health/disability, single parents and parenting needs were examined.
Highlights from the analysis are as follows:
Of 259 cases analysed where CAFs were undertaken: 14% had parental substance misuse noted; 32% had adult mental health needs;
22% had adult drugs issues; 36% had adult alcohol issues.
In 26% of cases, 3 parental vulnerabilities were noted and in 12% of cases, 4 parental vulnerabilities were noted.
Of the 5 Serious Case Reviews that have been undertake in Devon between 2007 and 2012 there were issues of domestic violence in 3
cases, adult disability /serious illness in 1 case, mental health problems in 4 cases and substance misuse in 1 case.
Nationally, it is estimated that 200,000 children live in households where there is a known high risk case of domestic abuse and
violence, with very many more affected at some point in time. Approximately 450,000 parents are estimated to have mental health
problems; an estimated 250,000 – 350,000 children have parents who are problematic drug users, and around 1.3 million children live
with parents who are thought to misuse alcohol.
In view of these high numbers of possible vulnerable unborn babies, children and young people it must be assumed that figures
relating to parental issues within CAFs and Child Protection Plans are under reported. It is for this reason that Guidance between
adult and children services around safeguarding is of such importance. It is vital that the whole workforce is aware of the possibilities
of parental issues affecting the lives of their children or those for whom they have responsibility and work together to ensure that
children are safe.
All staff in adult and children services should be made aware of their responsibilities around confidentiality and safeguarding. It is
critical that all practitioners, whether working with children or adults are in no doubt that where they have reasonable cause to
suspect that a child or young person may be suffering significant harm or may be at risk of suffering significant harm, they should
always make an enquiry to the Multi-Agency Safeguarding Hub. Practitioners should discuss any concerns with the family and, where
possible, seek their agreement to make a MASH enquiry. This should only be done where such discussion and seeking of an agreement
will not place a child at increased risk of significant harm. The child’s interest must be the overriding consideration in making such
decisions.
Where a child is not suffering significant harm, parental permission should always be sought for the sharing of information. Parents
should be made aware that information will be shared between partner agencies in the Multi-Agency Safeguarding Hub to ensure that
their child is safeguarded and to ensure that an appropriate, timely and informed decision is made regarding any services their child
may need.. Emphasis should be put on the help and support which can be accessed by the family as a result of sharing information
with other agencies.
The RDE is currently looking at a proposal to ensure GPs are made aware when 0-18 year olds do not attend for an outpatient
appointment. This is may be an indicator of possible safeguarding concerns, and we are encouraged to review these children’s names
and notes in case it may be such a case.
Dr Kate Gurney, Devon LMC Safeguarding Children’s Lead, GP Partner at Coleridge Medical Centre admin@devonlmc.org
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A note about sending Medical Records to the Primary Care Support Service (PCSS)
When you need to send Medical Records for storage (e.g. when a patient leaves the practice) please continue to use the NHS Courier
service, but remember to clearly address these items to “Medical Records, PCSS, Newcourt House”. This is because the Courier
system is operated by the RD&E with most items passing through their post room, and so any items just addressed to “Medical
Records” are likely to be delivered to the records department within the RD&E – this could result in records being incorrectly filed, or
a delay in retrieving the records.
Phil Stimpson, Information Governance Manager, NHS Devon. philip.stimpson@nhs.net
Veterans' Health in General Practice
A new e-learning course to support GPs in meeting the healthcare needs of veterans has been launched by the Royal College of
General Practitioners (RCGP).
Veterans' Health in General Practice identifies the psychological and physical issues that are commonly faced by veterans and their
families and outlines the useful resources that can help GPs to improve their care:
http://www.rcgp.org.uk/news/press_releases_and_statements/e-module_for_veterans_care.aspx
Approximately 8% of the UK population are veterans so the average GP practice with 2000 patients
can expect to have approximately 160 veterans on their list.
The RCGP has developed the e-learning course because many veterans have specific health needs,
related to their time in service. For veterans who have suffered serious physical injuries, these
needs might be obvious to the GP but many others experience ill effects such as mental health
issues that are harder to recognise.
Dr Clare Gerada, Chair of the RCGP, said: "For a variety of reasons, GPs are not always aware that
particular patients are veterans but this should not result in any disadvantage when they need care.
The new e-learning course takes only a couple of hours but it has the potential to transform thousands of patients’ lives. We urge all
GPs and their practice teams to undertake this training."
There is anxiety over the future care of ex forces personnel especially considering current and recent conflicts, and recognising their
needs can be difficult. The module helps to address that, and also directs to some helpful links. The link for the RCGP module is-
http://www.rcgp.org.uk/news/press_releases_and_statements/e-module_for_veterans_care.aspx
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On the 11 November 2011, our Day of Remembrance, we will be thinking of those who put themselves in harms way as members of
our Armed Forces at home and in some of the most dangerous places in the world. We have a high concentration of veterans here in
the South West as well as serving Armed Forces personnel and their families, and as GPs we must strive to provide appropriate and
effective care for these brave men and women.
All clinicians can access referral information and advice via NHS Choices: enter ‘veterans’ into ‘search’.
Veterans UK: www.veterans-uk.info/ - ‘welfare and support’ and the Veteran ‘Medical Assessment Programme’ across the UK: 0800
1695401 for mental health issues
The Royal British Legion: www.britishlegion.org.uk/ - for benefit/general advice. Combat Stress: www.combatstress.org.uk/ - for
mental health issues
Dr Ian Morris, On behalf of The South West Armed Forces Forum
CCG Electoral Process
Devon LMC has now produced a recommended electoral process for CCGs to elect Board members and Chairs.
The system we suggest follows BMA policy of offering one practitioner one vote, and running a single
transferrable vote system. The LMC has resolved to run elections on this basis free of charge for this
financial year. The policy is available online via this link: Election process for CCGs.pdf.
Events
RCGP Engaging with Commissioning Workshop - Thursday, 24 November 2011, 10 am – 4 pm
Engineers House, Bristol for more information http://commissioning.rcgp.org.uk/2011/09/workshop-engaging-with-commissioning/
The RCGP Tamar Faculty run regular workshops and events – follow this link to their October newsletter: Tamar News October
2011.pdf
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GP Trainees Conference – ‘Get Ahead: The Essential GP Trainees Skills Day’ Wednesday 30 November at BMA House -
http://www.bma.org.uk/whats_on/employment_related_courses/gptrainees.jsp
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Devon LMC Newsletter 1 November 2011 8
Occupational Health for Occupational Health Team Presents: PRACTICE IMPERFECT
Primary Care in SW Devon and
Cornwall
Chapter Two
Dr Bathsheba Bungler stood up and touched all four corners of her consulting room desk at
the Soddem Health Centre, tapping twice each time. She then made her way to the sink in the corner of the immaculately tidy room
and washed her hands for the tenth time in as many minutes. She felt the tension easing away. She glanced in the mirror over the
wash basin and regarded her reflection with the usual distaste. “Poor Old Pudding” was what Daddy called her, but at least it was an
affectionate epithet. Her mother was less forgiving. “My Ugly Duckling” and “The Runt of The Litter” where two of the more gentle
descriptive references she used for her eldest daughter.
Her younger by two years Sister Belinda was a different kettle of fish, universally adored by all she encountered. Lonely Bathsheba had
endured Friday evenings of her late teens listening through the thin adjoining bedroom wall to Belinda entertaining a succession of
the Sixth Form’s best looking boys. Fridays were her father’s weekly evening meeting of The Railway Modellers’ Club and her mother’s
night for visiting Gran in the nursing home.
When Bathsheba had got a place at medical school she thought that at last her parents would begin to feel proud of her, but
predictably Belinda entered medical school two years later, met and fell in love with Beautiful Ben The Brain Surgeon, and indecently
shortly after their spectacularly lavish wedding gave birth to the world’s most beautiful twins. Bathsheba’s mother couldn’t make her
mind up who to drool and simper over the most, the Beautiful Twins or the Beautiful Ben.
At least her patients gave Bathsheba their unquestioning and unconditional respect and gratitude; that was until the Letter of
Complaint arrived.
Occupational Health Assessors – initial thoughts on Dr Bungler
Most doctors’ worst nightmare - The Complaint.
And it has happened to someone with very few personal resources with which to cope with it.
Once again, as with the previous doctor in difficulty, she seems to have succeeded in concealing her problems from her colleagues and
the cost to herself is enormous.
Bathsheba has striven all her life for approval and a sense of self-worth and has found it in her work and specifically, in the regard of
her patients. In her view, she is a failure in all the other areas of her life. She is enormously vulnerable.
Her colleagues may be unaware of her hand-washing and her low self-esteem or they may be aware of her fragility and unsure of how
to approach her and wary of precipitating an emotional response with which they feel unable to deal.
Bathsheba certainly lacks the confidence that a request from her for help or advice would be met with kindness and support and we
have no indication in the story that this might or might not be the case.
She needs 2 stages of input:
1. A sympathetic and supportive approach by a Partner colleague to enable her to manage the Complaints process without breaking
down and to feel that she is not condemned by her colleagues. Indeed it is likely that at least some of them will have experience of the
process themselves, but Bathsheba will almost certainly not have imagined this for herself. She will need on-going support while the
Complaint is addressed and encouragement in obtaining the necessary input from her Defence organisation.
2. She also needs clear and non-judgmental recognition of her psychological issues with reassurance that they do not lower her in the
esteem of her colleagues and with the re-assurance that they can be addressed and resolved.
For this, she needs referral to Occupational Health Service for Primary Care through the use of her Green Card – she does have one,
doesn’t she? Or at least are they available in the surgery?
Bathsheba requires crisis support from the Practice, although this may be difficult to obtain it is something that should have appeared
at Appraisal with a sensitive appraisal, and she will be difficult to engage as she does feel shamed and terrified. Also, she is only used
to conditional approval and can rarely even get that. Therefore, the process of initial assessment/engagement will have to be
managed with considerable sensitivity otherwise there is a significant chance that her defences will break down and she will be
seriously at risk.
This is the type of case that needs to be identified if possible at a very early stage through networks of support in Primary Health Care
and good education so that vulnerable doctors like the above can be engaged safely without it becoming catastrophic, and receive
therapy from an appropriately trained intervention. Given the very poor attachments described it is unlikely she will engage in any
significant cognitive work and although she might have a flight into health with some symptom resolution, fundamentally she needs
to address the very difficult attachment issues that she has experienced.
In summary
1. The Practice would benefit from a review of its in-house processes for dealing with colleagues in difficulty. And does it have a system
in place for dealing with complaints?
2. Bathsheba requires crisis support and input both from the Practice and from OH as she is extremely vulnerable; her GP may need to
be involved and she will need to be helped to trust the confidentiality of the process as she is likely to be feeling extremely exposed and
shamed, as well as terrified.
She also needs to engage in the therapeutic programme offered by OH Service for Primary Care with financial assistance in paying for
it offered through that system should she need it.
Drs Ben Charnaud, Anne Read, and Andy Stewart, GP Occupational Health Service
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Devon LMC Newsletter 1 November 2011 9
Practice Scam Alert
Two practices in Bournemouth have been contacted by telephone by a company calling itself HCRA (Health Care Research
Association) to ‘verify’ an ‘order’ that was allegedly placed for a publication of the latest ‘Compliance for the NHS
Standards 2012 for the CQC rules and regulations etc.’ at a cost of £299+VAT. In both cases the Practice Managers names
were used and they were told that someone from the practice had placed the order by phone.
When told that the CQC guidance for General Practice had not yet been finalized the caller said it just had been (not true of
course!)
He went on to say he was merely confirming delivery details and when told it wasn’t wanted responded that the practice
needed it due to the year’s commitment that came with it as the CQC information was changing all the time and therefore
it would be updated. He then apparently became more aggressive when told no, stating that it is the most widely distributed
publication of this type, it wasn’t mass produced and was tailored to each order. When asked to provide proof that the order had
been placed he gave up and told the Practice Managers that the order was on hold and that the sales team would be in contact.
The caller left a phone number 0845 519 8738. When dialed, this number was answered by a company called ‘Motivation’ and when
asked what their business is responded ‘we are a Marketing Fulfillment Company’!
Please be aware, if you come across this please contact Andy Pavey at the NHS Counter Fraud Team on: 01803 653329
andrew.pavey@nhs.net.
Availab le for wor k...
Locum GP Available for work – Dr Charlotte Massey MBChB Dr Edward Waller MBBS,MRCGP,Postgrad Cert in Sports
Performers List: Plymouth Medicine
Availability: Monday – Thursday I have been a GP for 4 and half years now and I am looking for
To work in: Exeter, Mid Devon, South Hams, Teignbridge, Plymouth locums in the Central and Southern Devon area. I have
and Torbay experience in Sports Medicine and can do steroid injections for
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Details: Experienced GP available to do locum work from 9 various Musculoskeletal conditions. I also do Acupuncture and I
November 2011, short or longer term. I have been a principle for am working towards a Diploma. Have experience in working on
22 years in a busy inner city practice so am used to dealing with Emis and Vision computer systems and willing to be trained up
whatever is thrown at me. on others.
Contact: charlottemassey@nhs.net 07745475759 Contact: waller999uk@yahoo.co.uk 07779256236
Dr Alka Bhikha MBBCh, MRCGP, DFFP, DRCOG NMC Registered Practice Nurse Available
North Devon area. Female GP with 4 years experience as a locum, Practice nurse with 6 years experience, including baby and travel
including on-calls and OOH. 8 years previous hospital experience. immunisations, hormonal injections, minor injuries, dressings,
Available immediately for long or short term Locum work. North ear syringing, phlebotomy, cervical cytology, diabetes,
Devon based and happy to travel. Enthusiastic & friendly, reliable & hypertension, asthma, Doppler, assisting in minor ops and gynea
hard-working. clinics. Available to work in the Newton Abbot, Torbay and
Somerset VTS trained - North Curry Health Centre. Familiar with all Exeter area on Tuesdays, Thursdays and Fridays.
main clinical IT systems. QOF aware. Contact: 07818638896 or louisa.cullen@hotmail.com
For Locum Pack please contact: Phone: 07906 336 213 Email:
alkabhikha@yahoo.co.uk
Locum GP Available for work – Dr Helen Kimble BSc, MBBS, DCH, Locum GP Available for work – Dr Edward Mather, MB BCh,
DFFP, MRCGP DRCOG, DCH, MRCGP, MRCP
Performers List: Devon Performers List: Devon
To work in: South Hams and Plymouth Availability: Monday – Friday
Availability: Wednesdays and Thursdays To work in: East Devon, Exeter and Mid Devon
Details: Having completed my VTS in East Sussex in 2007, and Details: Recently moved from Cardiff to live by the sea in Lyme
subsequently worked as a locum within the Brighton and Sussex Regis, originally from Cornwall.
areas, including several longer-term locum positions, I have Finished GP training in 2003. Interested in general medicine,
recently relocated to Devon. Hard-working with good recently obtained MRCP. Experienced locum and out of hours
communication skills, I am based in Ivybridge and will be available provider. Proficient with System 1, EMIS and Vision. I value the
for work from January 2012. CV and references available upon opportunity to offer high quality care in a friendly environment.
request. Contact: epmather@live.co.uk 07968142485
Contact: helenkimble@doctors.org.uk or 07946391432
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GP Available for work - Dr Genevieve Riley BSc (1 ) MBChB DRCOG DFSRH MRCGP
Performers list: Plymouth
Availability: Monday, Wednesday and Friday
To work in: Plymouth, South Hams, and the A38 corridor from Ashburton to Liskeard
Details: Graduated Liverpool 1998. Broad training base. Completed Plymouth VTS 2004.
Previous Portfolio career: GP locum, GP non-elective medicine at the Acute GP Service in Derriford hospital, and clinical skills Tutor to
Peninsula medical students. Partnership experience, QOF aware, IT literate most computer systems- preference EMIS. High level of
enthusiasm for General Practice.Happy to teach medical students, and happy to be contacted at short notice.
Contact: 0782 581 0046 gen.riley@nhs.net
M o r e in for m ation on all o f th ese vacan cies can b e fou n d on th e Devon LM C Web site
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Devon LMC Newsletter 1 November 2011 10
Vacancies...
Medical Receptionist / Health Care Assistant Required – Practice Nurse / Nurse Practitioner Required – South Molton
Bramblehaies Surgery, Cullompton Health Centre, North Devon
Details: 12 ½ hours per week, Wednesday, Thursday and Friday. Details: To lead the team in refreshment of pathways and
Some training required, communication, IT and blood taking skills protocols, managements of minor illness, Chronic Disease
required. Management to NICE standards. Nursing and leadership skills
Contact: Tracey Worley/Barbara Edbrooke required.
d-pc.bramblehaies@nhs.net or 0188433536 Contact: Melanie Cullen melanie.cullen@nhs.net
Closing Date: 04/11/2011 Closing Date: 03/11/2011
GP Partner Required – The Ridgeway Practice, Plympton, Salaried GP Required - Chelston Hall Surgery, Torquay
Plymouth Details: 6-8 sessions per week, salaried initially with a view to
Details: ¾ time; 12 months mutual assessment before buy-in to partnership. To start March 2012.
start in early 2012. Contact: Mark Thomas mark.thomas@nhs.net or
Contact: Michael Curran Michael.curran@nhs.net 01752 346634 01803 605359
Closing Date: 25/11/2011 interviews December 2011. Closing Date: 18/11/2011
Nurse Practitioner / Experienced Practice Nurse Required – The Practice Administrator Required – Brannam Medical Centre,
Foxhayes Practice, Exeter Barnstaple
Details: 37.5 hours over 5 days – job share considered. Based at Details: To take a lead role in the development and maintenance
the Clocktower and Foxhayes Surgeries. To start January 2012. of the practice IM&T systems and support the Practice Manager in
Nurse Practitioner or a Practice Nurse with Prescribing finance and other operations. Skills in Microsoft Word and Excel
qualification. essential.
Contact: Gillian Champion Gillian.champion@nhs.net or Contact: Dee Brown deebrown@nhs.net or visit
07751449348 www.brannammedicalcentre.co.uk
Closing Date: 27/11/2011 Interviews w/c 05/12/11 Closing Date: 10/11/2011 Interviews 16/11/2011
Practice Nurse Required – Stirling Road Surgery, Plymouth Salaried GP Required - The South Lawn Medical Practice, Exeter
Details: 10-14 hours per week. Interest in tissue viability desirable. Details: 4 sessions per week for 1 year fixed term contract
Experience desirable but not essential. commencing April 2012.
Contact: Julie Tucker or Amanda Plunkett Contact: Maggie Beckett Maggie.beckett@nhs.net 01392 281101
amanda.plunkett@nhs.net 0844 477 3925 Closing Date: 30/11/2011
HCA/Phlebotomist Required - Southover Medical Practice, Part-time Salaried GP Post/s - Brannel Surgery, St Austell,
Torquay Cornwall
Details: to cover a number of sessions starting as soon as possible. Details: 2-6 sessions by negotiation for 1 or 2 candidates.
Duties to include taking bloods, B12 injections, simple dressings, Contact: Liz Trevarton 01726 822254
first stage hypertension and health checks. Ability to do ECGs liz.trevarton@brannel.cornwall.nhs.uk
would be an advantage. Closing Date: 18/11/2011
Contact: John Burnham 01803 327100 johnburnham@nhs.net
IT Officer Required - Sid Valley Practice, Sidmouth GP Part Time Partner Required - Collings Park Medical Centre,
Details: 37 hours per week to include IT support for busy GP Plymouth
practice. Candidate should have good knowledge of IT applications Details: 5 sessions per week, ideally Monday, Wednesday and
and hardware maintenance. Various office duties to include some Friday, to start as soon as possible. 12 month mutual assessment
lifting. Clean driving license required. period.
Contact: Karen Colson karen.colson@nhs.net 01395 512601 Contact: David Russell david.russell1@nhs.net 01752 753794
Closing Date: 14/11/2011 Closing Date: 02/12/2011
Part Time Treatment Room Nurse Required – Torrington Health GP Partner Required – Stratton Medical Centre, Bude
Centre Details: to join 6 partner practice. Special interests encouraged,
Details: 15.5 hours over 2 sites plus holiday cover. dedicated time for peer-review and clinical work to support
Contact: Nikki Down Nicki.down@nhs.net 01805 622247 revalidation and best practice.
Closing Date: 04/11/2011 Contact: Kathryn Pengelly 01288 352133
Kathryn.pengelly@strattonmed.cornwall.nhs.uk
Closing Date: 30/11/11
GP Locum Required – Newcombes Surgery, Crediton
Details: To start January 2012, 8 sessions per week for 12 weeks.
Contact: Dr Joseph Mays, 01363 772263, joe.mays@nhs.net
More information on all of these vacancies can be found on the Devon LMC Website
Produced by: Devon Local Medical Committee, Deer Park Business Centre, Haldon Hill, Kennford, Exeter, EX6 7XX.
Website: www.devonlmc.org Email: admin@devonlmc.org Telephone: 01392 834020.
We would like to remind practices that Devon LMC cannot be seen to endorse adverts included in the newsletter and the
responsibility for conducting relevant checks on staff members remains with Practices.
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Devon LMC Newsletter 1 November 2011 11