No.

315 Vaccine ordering for 2018-19 influenza

season
January 2018
This advises GPs and Community Pharmacists on influenza vaccine for
the 2018/19 season.

We are currently reviewing the clinical evidence, including advice from the
Joint Committee on Vaccination and Immunisation (JCVI) and cost-
effectiveness data from PHE in respect of influenza vaccines for 65 year
olds and over and those in at risk groups who are under 65 years old.

We will provide definitive guidance to general practice and community

pharmacies on influenza vaccine for the 2018/19 season on Monday 5th
February. No further orders for influenza vaccine should be made
and no provisional orders should be converted to confirmed orders
until this national guidance is issued for adoption.
Cornwall & Isles of Scilly

Where CCGs hold leadership responsibility for influenza vaccine they will
need to adhere to this position.

Yours sincerely
Professor Stephen Powis Dr Arvind Madan

National Medical Director Director of Primary Care

NHS England NHS England

N.b. FLUAD have extended the early bird discount until the 16th Feb
LMC Newsletter

(DM)

Inside this issue:

Sessional GP Newsletter
Your Chairman writes 2 This month’s newsletter covers:
DWP Links
• Sleep deprivation and fatigue
Increase in syphilis 3
• E-consulting
Update on adjuvanted trivalent 4
flu vaccine. • GPC elections
Police assistance mentally
unwell patients • ‘Alternative careers’
Supporting GPs—GP Health.
Survey on LMC engagement with Ses-
Locum A&B pension
sionals and GP trainees
Payments

LMC Training Courses 5 • Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
Events 6 at Victoria Beacon Place, Room
B314, Station Approach, Victoria,
Vacancies 7 Roche, St Austell, PL26 8LG
Tel :01726 210141
Dr Basil Bile……. 8
• e-mail [email protected]
Your Chairman writes ……..
So what will the New Year bring UK General Practice ? Whilst we wait for judicial review of the ACP pro-
cess the first thing it will bring is some uncertainty. However, we must balance any of this uncertainty with
the certain knowledge that General Practice is a pivotal part of all of the new models of care and is unlike-
ly to be superseded anytime soon. We also know that there are new monies heading our way. Unfortu-
nately this is in the usual form of capital (winter pressures, ETTF) funding rather than the much needed
revenue into the bottom line of our global sum. Trying to corral these pots of money is a difficult challenge
and one which is addressed by your LMC in conjunction with the CCG in our Primary Care Development
Group.

2018 will hopefully be the beginning of the end of our eye wateringly large indemnity fees. The MDU has
moved into a transitional arrangements whereby my personal indemnity fees have decreased by £8000. I
am hoping that this is not too good to be true but having been previously bitten by the St Paul debacle I
am not holding my breath, but it’s a more than promising start.

The New Year will also bring additional ‘extended access’ hours into General Practice at a point when we
are struggling to provide the core hours to which we are already contracted. I was reminded, in the rush to
claim these hours for localities/practices, of the 2004 contract and how we liberated ourselves from even-
ing and weekend contracted working. The effect of this was transformational , not only for individuals GPs
(it saved careers and lives) but for the profession as a whole which saw a gender re-alignment of the
workforce and the proliferation of part time and peripatetic work. General Practice was once again an at-
tractive career option for young doctors. Let’s hope we don’t throw the baby out with the bathwater in our
efforts to make this work. A glance at the current workforce figures reveal that a significant percentage of
the Cornwall GP workforce is over 55 and intends to retire within the next 3 years. As a medical communi-
ty we need to find ways of extending GP careers - perhaps extended hours is one of them, we shall see.
Finally one of our GPs has just turned 65 and is still going strong as a GP partner. The fact that I have to
mention this at all shows how much the face of General Practice has changed over the last 15 years. So
chapeau to Tony Nash of Camelford - the NHS should strike a medal in your honour.

DWP link contact

Please find attached to this newsletter a letter from the Department of Work and Pensions (DWP). To-
gether with Peter Holden of the Professional Fees Committee (PFC) and John Chisholm (representing the
Royal College) we have been liaising on a number of matters. DWP were keen to make contact details of
district managers available to GPs to aid local communications.

The district manager for Cornwall is Michelle Maslen, St Austell Job Centre.

Email: [email protected] Tel: 01726 294040

NO . 3 1 5 Page 2
 Increase in syphilis in Devon and Somerset

Over the past six months there has been a notable increase in the number of cases of syphilis diagnosed by local Sexual
Health services in Devon and Somerset, with cases also seen across the wider South-West. Cases have been seen in
men who have sex with men (MSM), but women and heterosexual men have also been affected.
These cases have been diagnosed at various stages of syphilis infection; primary, secondary and early latent and I am
writing to you to raise awareness of this situation to help us identify cases early and ensure that the subsequent treatment
and partner notification, which is vital to reduce ongoing transmission in the community, can be initiated.
Primary syphilis:
Primary syphilis usually presents at the site of inoculation with a chancre (painless ulcer) (e.g. genitals, rectum or mouth)
around three weeks after contact (range 9-90 days). Chancres in the rectum or mouth often go unnoticed and heal without
intervention, usually within six weeks. Ulcers may occasionally be multiple or painful and may be clinically indistinguisha-
ble from genital herpes.
Secondary syphilis:
Following untreated primary syphilis most cases will develop secondary syphilis 4-10 weeks after the initial chancre.
Manifestations of secondary syphilis include:
• Rash – Widespread muco-cutaneous rash, classically non- itchy and may involve palms and soles
• Constitutional symptoms that may be mild
• Mucous patches (buccal, lingual and genital)
• Condylomata lata (highly infectious, mainly affecting perineum and anus)
• Hepatitis – especially if secondary to anal transmission
• Splenomegaly
• Glomerulonephritis
• Neurological complications including acute meningitis, cranial nerve palsies,
Uveitis, optic neuropathy, interstitial keratitis and retinal involvement.
Routes to Diagnosis
If you suspect syphilis please advise your patient to avoid any sexual contact and refer them to local sexual health services
for a clinical opinion and testing, serology may be negative early in the course of infection. In secondary syphilis serology
will be positive so a serology sample can be sent for testing via local microbiology services; advice can be sought from
microbiology or sexual health services. We would recommend that anyone with a suspected diagnosis is referred to
sexual health.
Sexual contacts of syphilis:
Syphilis has a long incubation period of up to 90 days. Anyone presenting as a possible contact of infectious syphilis
should be referred to Sexual Health services for consideration of treatment, rather than just testing.
Anyone presenting with sexual health concerns and anyone diagnosed with a sexually transmitted infection
should be encouraged to have a complete sexual health screen including serology for syphilis and HIV.
All men who have sex with men should be encouraged to have sexual health testing including tests for syphilis
and HIV annually, or 3 monthly if they report frequent partner change.
Contact details of Sexual Health Clinics in the area are:
North Devon and Exeter: Exeter: 01392 284982 / 284983 North Devon 01271 341562
www.thecentresexualhealth.org.uk
Somerset: 0300 124 5010
www.swishservices.co.uk/wheretofindus
Plymouth: 01752 431 124
www.yourship.uk
Torbay and South Devon 01803 656 500
www.torbayandsouthdevon.nhs.uk/services/sexual-medicine-service/clinic-opening-times/
Further information and resources are available at:
https://www.bashh.org/; or https://www.fpa.org.uk/sexually-transmitted-infections-stis-help/syphilis

Yours faithfully,
Dr Nick Young Consultant in Communicable Disease Control
0300 303 8162 option 1 option 1 [email protected]

NO . 3 1 5 Page 3
 Update on use of adjuvanted trivalent flu vaccine for 2018-19
flu season
The NHS England guidance is available here.

Police assistance with mentally unwell patients

The law has recently changed on this. So, now, Section 136 can be used in places other than public
ones, although not in “a private dwelling”, which a GP’s surgery is not. The law is therefore now more
about where it cannot be used, rather than where it can, but is helpfully extended.
http://www.rcpsych.ac.uk/policyandparliamentary/changestos135and136mha.aspx

Supporting GPs - GP Health

GP Health continues to see GP colleagues throughout England, from GPs in training through to a year
after retirement if needed

We are pleased to welcome new colleagues, and so currently in the GPs can choose from the following
(consultation localities shown)

Most GP clients now use the App, however we all pleased to be contacted to arrange an appointment.
Some of us consult in more than one place, so direct contact to arrange is useful if a convenient appoint-
ment does not show
the App is accessible once a GP has registered, they are given a code to allow them to book an appoint-
ment

0300 0303 300 or email [email protected] to contact GP Health www.gphealth.nhs.uk

Locum A&B Pension Payments must be made online

We’ve been informed that PCSE apparently now require sessional doctors to make their pension contri-
butions via BACS and to send an accompanying an email notification on the standard PCSE enquiry
form. Please note that you need an NHS mail email address to do this.
The good news is that you will at least get an acknowledgement of the email for your records, but it
seems that any emails send after 20th Dec 2017 to the old address will not be responded too and that
it will not be monitored in future

Details of the process can be found at: https://pcse.england.nhs.uk/help/gp-pensions/locum-a-b-

pension-contributions/
Though the information there does not yet seem to have been updated to recognise the latest changes.

NO . 3 1 5 Page 4
 LMC Sponsored Training Courses

Stop Press!! GPDR Course – Extra Day

Due to demand we are putting on an extra course on the afternoon of Thursday 1 st March. The booking form is at-
tached (please make sure you use the correct form). In order to confirm your place please return the form with pay-
ment (or if paying by BACS the date payment is made) – it can be emailed to [email protected].
We only have 20 places so in the first instance it is one place per practice and not to have attended our previous
courses on 24th January 2018. So, in order to secure your place early booking is advised.

Attention Would be Delegates!

We still have some places available on the following courses:
Managing Change in GP Surgeries – Weds 7th Feb 2018 – All day
Fine Tune Your Appraisal Skills – Weds 7th March 2018 – all Day
In order to book your place please complete the booking form attached to the newsletter and arrange payment

Active Signposting/Care Navigation

As you are aware, I am sure the Active Signposting training has become a requirement for practices as part of the 5
Year Plan. Therefore, the LMC is arranging to hold training sessions. The course is split into 4 Levels and the LMC
is proposing to run Levels 1 & 2 in the first instance.
We have set dates for the first 2 Levels as follows:
Level 1 (half day) Weds 18th April 2018 – Morning
Level 2 (Full day) Weds 16th May 2018
The cost of the 2 days will be £150.00 per delegate, the cost of which has been subsidiarised by the LMC. This cost
will include lunch on Level 2, being a full day. Places are limited on this course and early booking is advised. At-
tached to the newsletter is a booking form (please make sure you use the Signposting booking form), please return
the form to us here and arrange payment for the course which must be made before the course date.
For further information on the course content please email: [email protected].

Practice Managers and Practice Admin Staff Training Courses

April 2018-March 2019
Attached to this newsletter is the training course programme for 2018/19 so far. We are planning to add to this pro-
gramme as the year progresses depending on the demand on the courses. Therefore, if you would like to see any-
thing other than we have planned please let either Dawn or I know, and we will look into it.

Booking forms for all the courses (Signposting, full day and half day courses) are also attached – please note that in
order to book a place/s a completed booking form and payment must be received before the course takes place. If
you are paying by BACS, please return the completed booking form with a date of the BACS payment. You will also
notice that we have also had to put the price of the courses up by a small amount – this charge is to cover room hire
and refreshments plus lunch where the course is a full day.
Booking forms can be emailed to: [email protected]
Please remember courses do get booked fairly quickly so early booking is advisable to secure the place/s you re-
quire.

Page 5 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R

 Events
RCGP Cornwall CPD - 7 February
Wednesday 7 February Speaker: Mr Sean Dixon Topic: Shoulder surgery
Time: 19:30, hot Buffet and drinks are available from 18:30 Venue: The Duchy Hospital, Truro, TR1 3UP
Parking: Staff car park behind the Duchy Hospital
Conferance room: opposite the Staff car park, please press the PUSH PAD to enter
These events are free to attend and RCGP membership is not re-
quired.
Alice Sefton, Faculty Administrator-Tamar | Faculties, Royal College of General Practitioners
University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU
Tel: 0139 272 2744 | [email protected]
Funded places available to ST2 & ST3 GP trainees RCGP members

GPC Roadshow—21st February

The GPC will hold a local roadshow about the 2018/19 contract changes and provide an update about national develop-
ments in general practice early next year – and local GPs are encouraged to ‘save the date’.
Dr Mark Sanford-Wood, Deputy Chair at the GPC, will be presenting and there will be plenty of opportunities for local GPs
to ask him questions.
The event will take place at Plymouth Science Park on Wednesday, 21 February. Doors open at 6:30pm for a light buffet
and networking, with the main event taking place from 7-9:30pm. A final agenda – and further details – will be communi-
cated in due course.
Please confirm your attendance via email to [email protected] by noon on 9th February. Places are available on a
first come first serve basis, as we will be joined by GP colleagues from Cornwall on the night, hence why the event is be-
ing held on the Devon-Cornwall border.

Hot Topics in Primary Care—23rd February

Lanhydrock Hotel, Bodmin

Friday 23rd February
Please see attached flyer

Cornwall Hospice Care –Throughout the year

Please see the attached flyer with dates of the 2018 Training programme or visit the Cornwall Hospice
Care website

LARC UPDATE – SAVE THE DATE -2nd May.

The LARC update meeting I organised in October was over-subscribed, so we proposed a second date in March. This has
now had to be re-arranged for 2nd May.
As before, this will offer a morning session covering IUD provision (3 hours CPD). This will include the very latest changes
to guidance and product range. The afternoon session will cover contraceptive implants (3 hours CPD). It will cover the
theory base for this method and set the context for making a choice between the hormonal methods.
Details and a booking form will be available very shortly on www.crescetis.co.uk

NO . 3 1 5 Page 6
 Vacancies

For vacancies – see “Jobs” on our website - https://kernowlmc.co.uk/ for full details

Practice Manager/Business Manager, Boscastle – Closing Date End February 2018.

Salaried GP 6 Months – Narrowcliff Surgery, Newquay – Required from April 2018

GP (Salaried or Partner) – Old Bridge Surgery, Looe – C/D Friday 2nd March 18

GP (Salaried/Partner), The Stennack Surgery, St Ives – Start Date Flexible.

Salaried GP (Potential view to Partnership) – Cape Cornwall Surgery

Salaried GP— Roseland Surgeries

Positions wanted

Locum GP Available,

South East Cornwall – please contact Michelle Raspa

[email protected]

NO . 3 1 5 Page 7
BASIL’S POLITICALLY INCORRECT POETRY CORNER

COCKNEYITIS

I had a patient once who was Cockney born and bred

I couldn’t understand a single dicky bird he said
We got on very well until he used the dog and bone
You’d have thought that I was Mutt and Jeff and in the room alone

I met him in the frog and toad, dragging both his plates of meat
He lifted up his Uncle Bert saying “I hope you’ll be discrete”
Elephant and trunk he was, having just been Tom and Dick,
He told me “There’s a Conan Doyle upon my Hampton Wick”

He cried “I’m feeling ginger beer, with sweaty Barnet Fair,

When I rub my aching orchestra stalls, it makes the ladies stare”
There is no doubt he’d be better off tucked up in Uncle Ned
With a weeping willow and ice-pack to soothe his loaf of bread

I said “You’re a pain in the fife and drum, I’m sorry to tell you this,
Far too much of the rub-a-dub-dub, forever on the hit and miss
In to your North and South there goes a torrent of gay and frisky
The trouble is, my china plate, for your cheerful giver that’s risky

Your skin and blister tells me that you’re out of bees and honey,
Boracic lint is what you are, iron tank says things ain’t sunny
You take too many ball of chalks down to the battle cruiser
Less pig’s ear in the Old Jack Tar would make you less of a loser.”

The first person to successfully translate the whole poem into English and send it to the
editor will receive a prize.

Page 8 C O R NWA LL & I S LE S O F S C I LL Y LM C NE WS LE T TE R