March 2015 282

 

 With apologies to W. Wordsworth

No. 282

 

I waited lonely, as a doc

March 2015 

 

Who floats on high o'er all their ills

 

When all at once there came a flock A waiting room requesting pills; A hacking cough, dysuric pee:

 

 

Where were the ones that wanted me? Continuous as the stars that shine And twinkle with a sickly look

 

 

They stretched in never  ending line -

 

  y    l    l    i   c    S    f   o   s   r   e   e    l    t   s    t    I   e    &    l   s    l    l   w   a   e   w   N   n   C   r   o   L    M    C

 

 

All searching for their Choose and Book A days worth saw I at a glance: -

The next one I saw in a trance.

 

 

The aged sick still home may rest

 

Outdone by needs of "me" and "I" For one, I can't but try my best To ignore all of them and try

 

 

 

 

And try and try , with heartfelt thought To answer all that you have brought. -

-

For oft when on my couch you lie

 

In sickness or in health ( you lier) -

It flashes on my inward eye

 

 

This is the moment to retire

 

And then my heart with pleasure fills And dances with the daffodils

 

 

Anon.

 

Inside this issue:

Your Chairman writes  IG Toolkit Survey launched 

QOF Guidance 2015/2016 2

Workforce Minimum Data Set   3/4

Introduction from the new Responsible Officer  

5

Safeguarding Children Update  New IT Requirements 

6

Zero Suicides across the NGS  7

The QOF guidance for 201516, applicable from 1 April 2015, has now been published on the NHS Employers website.. A link to the guidance website has also been published on the BMA website QOF guidance pages. pages. 

9-10 

Dr Basil Bile writes….  

11 

Items for the Newsletter should be sent to the Editor, Dawn Molenkamp at Sedgemoor Centre, Pr Priory iory R Road, oad, St Austell PL25 5AS Tel :01726 627978, 

Update -Intelligent Monitoring  8 Vaccs & Imms  Vacancies 

 



e-mail dawn@kernowlm [email protected] c.org.uk

 

 

 Your Chairman writes ……..  Time never stands still in medicine and the same is true of the LMC office We have appointed two new members of the team to t o replace Susan Hayes. They are Julie Wickett and Chrissie Moore. Both are from non-medical backgrounds but are keen to learn the arcane ways of General Practice. I hope that they en joy working with with us at the office. They They will provide provide much needed needed help for Dawn Dawn Molenkamp, our executive executive manager. Our other piece of news is that we have re -launched our website which is now situated at: www.kernowlmc.co.uk   All our guidance guidance and communications communications will will be available available through the site. site. When we upload upload guidance, guidance, we automatically automaticall y send out a tweet to t o that effect so I would urge all of you to follow us @Kernowlmc. If you have never used twitter I urge you to register. It is a great source of information and amusement.  For many of us the end of March is not only the end of the QOF year but also the tax year. Income is, for most of us, going down or at best flat f lat-lining and therefore the announcement of the reduction in pension lifetime allowance (LTA) will have been a further blow and will be encouraging many to head for the exit. Whilst this is a blow to those t hose of us in our 50s, I venture to suggest it is a disaster for younger colleagues. We have been in touch with Francis Clarke accountants and I am hoping that we will put on an educational event between us to look at the pensions issue. I do not foresee the LTA increasing again and it may well reduce so the thought that retirement planning could rely on the NHS pension is well and truly gone. For those wanting to augment their NHS pension, working some sessions in OOH may be of interest. Cornwall Health will soon be contacting you with a view to exploring your interest in working some OOH sessions. As many people keep reminding me, your chairman will be working a few OOH sessions. Why ? Well firstly to support Health and others to do the same butpractice secondly I think!  it will be a great opportunity to Cornwall meet colleagues andencourage make up for the anticipated loss of income I have been having some robust dialogue with our colleagues in Community Mental Health about the provision of their service. I am hoping, together with colleagues from Public Health, to meet the Directors of Cornwall Partnership trust to voice my misgivings about the service as it is currently configured. We appear to be assuming all of their risk, are being asked to prescribe outside normal areas of GP expertise and I feel patients are not getting great deal. I would be pleased to hear of any concerns about any aspect of the mental health service. Please ensure patient confidentiality when sharing information, but please share.  Finally, happy Easter to everyone.  

Information Governance (IG) Toolkit Survey launched Personalised Health and Care 2020: a framework for action  action  published by the National Information I nformation Board, proposed that HSCIC should, by October 2015, ‘relaunch the Information Governance Tool Toolkit kit to reflect enhanced information governance and data security requirements’.  To support development of the new toolkit, HSCIC has launched a survey to asking GPs what they think about the current toolkit, what they like about it and how it might be improved.

You can access the survey at https://consultations.infostandards https://consultations.infostandards.org/information .org/information-governance/igt2015 . The closing date for responses is Wednesday 25 March. Your comments and feedback will help shape the development of the new look toolkit.

NO. 282

Page 2

 

 Workforce Minimum Data Set - GPC position – March 2015 (Updated further to January 2015 position statement) Introduction

 

The GPC has been active in dialogue with the Department of Health (DH), HSCIC and the Information Commissioner’s Office (ICO) to address some of the concerns about the submission of the Workforce Minimum Data Set (WMDS), particularly around workload and information governance. Practices have been asked to supply data on their staff, including recruitment, vacancies, absences and personal details, such as date of birth, National Insurance (NI) number and gender. The data collection is to allow the DH, NHS England and Health Education England (HEE) to understand the current NHS workforce and plan for future needs. The data collection replaces the annual GP census and practices have been asked to submit data through the Primary Care Web Tool (PCWT), with the first data submission due by the end of May 2015 (with the May submission to reflect the practice position as at the end of March 2015). Practices will thereafter be asked every six months to confirm the information held within the tool is correct. This data collection is being exercised under legislative levers provided in the Health and Social   Care Act 2012, and is considered by the DH as a contractual obligation by practices to provide necessary information “for the system to operate effectively”.   GPC has also independently contacted the ICO which has stated that the provision of the WMDS does not breach the Data Protection Act (DPA).   Practices are therefore required by law to provide the information requested for the WMDS.   GPC has nevertheless taken a number of actions and is continuing in active dialogue to seek to address concerns.   Resourcing

 

The GPC position is that it is wholly unreasonable to expect practices to take on this additional work unresourced, given the increasing gulf between workload demands on practices and their capacity to deliver essential services to their patients. It is our view that declining to resource this work is another example of the government’s failure to understand the pressures faced in general practice. As such, GPC calls upon local commissioners to fund practices to undertake this work, and is raising this with NHS England, given this data will will support the delivery of the 10 point workforce plan. A key purpose of this data collection is to allow CCGs and area teams to understand the local workforce and they should therefore facilitate practices in taking part by providing them with the necessary resources to do this additional work. Reducing the burden

 

The WMDS team is not prepared to reduce the dataset, but has committed to reviewing the data items on an annual basis.  

GPC has also negotiated a phased approach to the data collection. For the March 2015 collection (with the submission deadline of May), practices will be asked to complete additional data items for clinical staff only, only, rather than the whole workforce within a practice. This is likely to reduce the workload burden as much of the clinical workforce data will be pre-populated within the PCWT.  Contd/.  For all other staff, the deadline will be extended to the end of November 2015 (to reflect the practice position as at 30 September 2015).

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

 Workforce Minimum Data Set - GPC position

Contd/. 

For all other staff, the deadline will be extended to the end of November 2015 (to reflect the practice position as at 30 September 2015).  Information governance

 

Legal position  GPC has written to the ICO to clarify the legal position for practices in providing this data. The ICO considers that providing this information required by the HSCIC would not be a breach of the Data Protection Act (DPA) as it is a disclosure required by law.  This is in line with the legal advice previously sought by the GPC. Under Section 259 of the Health and Social Care  Act (HSCA), the Health and Social Care Information Centre (HSCIC) has the power to collect information considered  Act  ‘necessary or expedient’ for the purposes of any function it exercises. For the WMDS, the HSCIC is collecting this data under direction from the DH and NHS England. Practices are therefore required by law to provide the information requested for the WMDS.   With regards to personal data, information such as NI number, name, date of birth, gender and ethnicity will be collected. Under the DPA, Section 10, an individual is entitled to object to the processing of their personal data likely to cause damage or distress. However, the DH direction for this collection, under Section 259 of the HSCA, imposes a legal obligation on NHS bodies to provide the data, and this in turn overrides Section 10 of the DPA.    Although the right to object o bject under the DPA is removed, practices are advised to inform their staff of this data submission, to comply with fair principle soon. of the  DPA. The HSCIC will provide practices with a template fair processing notice andthe this willprocessing be made available National Insurance Number 

 

Practices had raised concerns with the inclusion of the National Insurance (NI) number in the dataset. The purpose of the NI number is to act as a unique identifier to map the workforce across different sectors. Following GPC raising the concerns being expressed by practices, the WMDS team has agreed to make the NI number a desirable rather than essential item for the March collection only. This will allow time to consider options for a unique identifier to become mandatory from September 2015 across all sectors and a subgroup will be established to take this forward.   Privacy impact assessment consultation

 

GPC responded in detail to the privacy impact assessment consultation. The HSCIC are reviewing all responses and will be publishing a consultation response shortly.   Summary

 

The legal position is that practices are required under the HSCA to provide the information requested for the WMDS. The ICO has clearly stated that they would not consider practices to be in breach of the DPA in providing this information required by the HSCIC.   GPC remains concerned about the burden placed on practices in completing this collection and would reiterate our view that CCGs area teams should fund practices in taking part. For the forthcoming May deadline, data items for clinical staff only are being requested, rather than the whole workforce within a practice. For all other staff, the deadline will be extended to the end of November 2015 (to reflect the practice position as at 30 September 2015). The PCWT is open now for data entry.  

Further information on the dataset, including the data to be collected and the process for submission is available on the HSCIC  HSCIC website, which includes a specification overview and set of FAQs.  

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

Introduction from the new Responsible Officer Dear Colleague, 

I am writing to introduce myself as your Responsible Officer. I have recently been appointed to the newly realigned NHS England role as Medical Director for the South Region, South West which now covers Bristol, North Somerset, Somerset and South Gloucestershire (BNSSSG) Devon, Cornwall and the Isles of Scilly. (DCIOS) I have been a Medical Director and Responsible Officer for NHS England covering the BNSSSG Area Team for the last two years and prior to that was Director of Public Health in Somerset.

In this new role I have responsibility for appraisal and revalidation of General Practitioners for the South West and performance issues relating to GPs, dentists, pharmacists and optometrists. I have oversight of the Controlled Drugs  Accountable Officer function and lead the four Strategic Clinical Networks that cover cancer, CVD, mental health, neurology and dementia and maternity and children. I will be working closely with my colleagues both in the South West and across the South Region.  

I would like to reassure you that many of the key contacts that you have within NHS England for questions about appraisal and revalidation remain in place, as will the processes that have been set up to support you in appraisal.

In the two years between 2013/15 60% of our doctors have been revalidated and during 2015/16 the remaining 40% will be considered for revalidation before the cycle starts again. I appreciate that practices and GPs are spread over a large geography but I do hope to be able to make links via the LMC and appraisers, and be able to meet as many of you as possible over time.  

For ease of reference I attach a list of key contacts, should you have have any questions. (Attached to the newsl newsletter). etter).  

Yours sincerely,  Dr Caroline Gamlin MBChB, DRCOG, MRCGP, FFPH  Medical Director and Responsible Officer   NHS England South Region, South West   (Bristol, North Somerset, Somerset, South Gloucestershire, Devon, Cornwall & Isles of Scilly)  

Telephone: 0113 825 5073 | 0113 825 5115 Email: [email protected]   NHS England | South West House | Blackbrook Park Avenue | Taunton | TA1 2PX  

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

Safeguarding Children Update April 2015 Template   for Safeguarding training has been updated to reflect the recent The GP Level 3 Experiential Learning Template changes in the Intercollegiate Document and sources of e -learning available to Primary Care. The Appraisal and Revalidation Team continues to encourage all GPs to use this template in their annual appraisal, to demonstrate their ongoing competence in child safeguarding issues. Dr Caroline Gamlin, the Medical Director for NHS England South (South West), has shared the template with David Geddes, the National Lead for Primary Care, for consideration as a national tool. 

NHS England has funded access to the National Skills Academy safeguarding e -learning courses: www.nsahealth.org.uk/e-learning learning   for all staff working in Primary Care, from receptionists through to GPs. A project manager has been identified who will be contacting all practices to arrange access to online training for both Safeguarding Children and Adults. Every GP on the Performers List will have access even if not employed by a specific GP practice. 

The reconfiguration of the Area Team as of 1st April 2015 has inevitably resulted in the bringing together of different systems and practices across the wider South West. For example, there have been different approaches to Collaborative payments in DCIOS and BNSSSG. Some clarity is needed around this issue, and until this iis s achieved I have been assured that the existing arrangements will apply.

My role as the Lead GP for Safeguarding Children Children across Devon and Cornwall comes to an end. The CCGs have been given funding from NHS England to appoint nurses to support Primary Care. These posts have yet to be filled, so until they are, any queries should be addressed to the Area Team Offices on the following generic email: [email protected] [email protected].. 

The Devon LMC Website Library has a wealth of information in the Safeguarding Children folder, so it might be worth a look there first. Likewise in Cornwall the Safeguarding Children’s Board website ha has s a health page containing lots of useful information www.safechildren-cios.co.uk cios.co.uk.. 

Dr Kate Gurney 

Focus on the new IT requirements of the GP contract in England The latest guidance can be found f ound here here  and includes the following. 

· 

Referral management and use of the NHS Number  

· 

Summary Care Record 

· 

GP2GP record transfers 

· 

Online prescriptions prescriptions 

· 

Online appointment booking 

· 

Online record access

Page 6

CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

Zero Suicides across the NHS Dear LMC colleagues,  I suspect many of you will have heard Nick Clegg in January calling for 'Zero Suicides across the NHS', but you may not be aware that Cornwall are already part of a South West 'Zero Suicide Collaborative'. I was asked to  join this programme as an ST4 trainee late last year, and find myself the only GP representative for the entire South West region!  I appreciate that the Zero Suicide headline can be contentious - Are all suicides preventable? Is zero the right aim? but looking past the headline, though thankfully suicide feels very rare, we have over 70 suicides a year in Cornwall and Isles of Scilly, with a rate above the national average.  75% of those who end their lives by suicide are not known to any element of secondary mental health services in the year before their death, so this is an issue that cannot be solved by solely focusing there. The hope of setting an aspiration like zero and developing solutions in collaboration with people with lived experience and voluntary sector organisations as well as healthcare professionals, is that we may make a difference for those that can be helped.  We are holding a half day seminar to develop a shared action plan to prevent suicides in Cornwall, under the banner of 'Zero Suicides' at Truro Health Park, on 7th May 2015, from 09:30 to 12:30. This brings together the suicide prevention strategy for Cornwall & Isles of Scilly and the South West region clinical collaborative Zero Suicide programme.  Draft agenda:

 

What do we know about suicides in Cornwall & Isles of Scilly?   Results of local audit.  Dr Sara Roberts, Consultant in Public Health, Cornwall Council  What do we hope to achieve via the Zero Suicide programme, and how?  Dr Ellen Wilkinson, Consultant Psychiatrist & Medical Director, CFT  Emerging action plans. Participants of the Zero Suicide South West region learning events. Next steps, including the formation of the Cornwall Zero Suicide steering group group..  To sign up for this event, please contact  Ros Meagor   [email protected]   Tel: 01872 327829  or Linda Howarth  [email protected]  Tel: 01872 327830 by 24th April 2015 

If you are unable to attend, but would be prepared to offer some thoughts or experience around this work I would be delighted to hear from you, as it is lonely work at the moment!  I am keen to hear of cases where the system worked and didn't work, and thoughts about how we could make it better.  Have you made changes in your surgery to reduce suicide risk? What might a 'Suicidal Patient Pathway' look like? What would useful educational resources for practicing GPs look like? Would you be prepared to be part of a email GP reference group that could offer thoughts about the suggestions of the collaborative?  I can be contacted via email: [email protected]  or mobile: 07736 471562.  Many thanks,  Becki 

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

Update to GP Intelligent Monitoring from the Care Quality Commission Ref no: EC201  Dear colleague,  Today, the CQC advisory group of GP leaders and experts in GP data and quality met. A range of issues were discussed relating to CQC’s use of data to inform inspection and regulation. All parties are committed to the principle of the appropriate use of data to inform the regulation of general practice.   CQC has listened to the concerns of the GP profession and as a result it has agreed not to  continue with the use of bandings for GP Intelligent Monitoring, as well as changing the language used to highlight variation between practices so that it does not imply a risk to patient safety. This was agreed at the CQC Board meeting yesterday and was favourably received by members of the advisory group.   The BMA, the RCGP and others had raised serious concerns with CQC on the use of data in producing “bands”, which were seen as a direct judgement of care.  Concerns had also been raised about the use of the word “risk” when analysing variations in the data.  CQC has carried out a thorough review of GP Intelligent Monitoring analyses, including how the public uses this information, following the errors found last year in the original publication. CQC will be correcting GP Intelligent Monitoring reports to improve them, particularly around the analysis of variation between practices. These will be updated next week to reflect the changes needed.   What we published wasn’t right regarding the use of language around risk, and on the analysis of variation between practices. We apologise. We also acknowledge that bandings have been perceived as judgements about the quality of care. That was not our intent but today we confirm we are removing them for GP Intelligent Monitoring nonetheless.  In conclusion, we are at the beginning of a journey to use data effectively to regulate general practice. We will continue to improve and are committed to continuing productive and engaged discussions with GP stakeholders on our developing approach to regulation, which will continue to be underpinned by the appropriate use of data. CQC has listened to the concerns raised by the profession and are addressing those concerns.   Yours sincerely  David Behan Chief Executive  Care Quality Commission   

Professor Steve Field Chief Inspector of General Practice   Care Quality Commission 

If you wish to respond to this message, please email our National Customer Services  Centre or call the enquiry team on 03000 616161. 

 Vaccinations and Immunisations guidance and service specifications The Vaccination and Immunisation programme 2015/16 – Guidance and Audit requirements  and the Technical requiremen requirements ts for 2015/16 contract changes  changes have now been published on NHS Employers Vaccs and Imms pages. pages. The service specifications for Childhood flu, Seasonal influenza and pneumococcal, MenC freshers, Pertussis (pregnant women) and Shingles (catch up) vaccination programmes are available availabl e from the NHS England Commissioning page page.. 

page  has also been updated to reflect the changes for The BMA website vaccinations and immunisations page 2015/16 and has links to all the guidance documents and service specifications.   Page 8

CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

Partnership Looe, Cornwall Us  Friendly, supportive and cohesive 5.25 wte partner semi -rural practice list size circa 9500 in beautiful Cornish seaside town. Partner owned harbour side property and dispensing rural branch surgery.   What we offer    A high achieving achieving environment environment with higher higher still aspirations aspirations 

 

Encouragement in teach developing your medicalF2’s interests The opportunity to medical students, and GPST’s  Involvement in the Primary Care Research Network SW   8 sessions FT but part time and salaried also considered  8 weeks annual leave   A chance to enjoy enjoy the Cornish Cornish culture and lifestyle lifestyle  You offer   Commitment, enthusiasm and a team orientated style    A focus on clinical clinical quality alongside alongside business business aptitude  A flexible attitude attitude and are open to change change   Application in writing please by 24/04/15 with attached CV to Judy Cole, Old Bridge Surgery, Station Road, East Looe, Cornwall, pl132hw. pl132hw. For an information pack or to arrange visit/informa visit/informall discussion please contact:  [email protected] ll.nhs.uk  or 01503 266965   [email protected] www.oldbridgesurgery.co.uk  

Salaried GP 6 - 8 sessions per week   The practice is going through an exciting development phase, having recently moved to new purpose built premises in Torpoint and looking to expand the services offered to patients from the new premises. The Rame Group Practice is a training practice and has a branch surgery in Cawsand.  Our practice has 4 GP Partners, 2 salaried GPs, 4 practice nurses and 2 HCAs looking after our 10,000 patients.  We are seeking an enthusiastic salaried GP to join our dynamic team. Initial enquiries to Claire Greaves, Practice Manager on 01752 813277 Please e mail applications applications to [email protected]  

Newquay Health Centre - Practice Nurse required Newquay Health Centre has a practice list size of approximately 16,500 patients manag managed ed by 11 Partners and 2 Practice Managers.  We currently have a vacancy for a part-time Practice Nurse, experienced in Chronic Disease Management to join our friendly team of 1 Nurse Practitioner, 5 Practice Nurses and 3 Health Care Assistants.  The vacancy will be for 6 sessions a week (25+hrs) plus cover for holidays and sickness.  Salary will be dependent on qualifications, skills and experience.  Please email [email protected]  or phone 01637 850002 for an application pack.  More information about the practice is available on our website www.newquayhealthcentre.co.uk. www.newquayhealthcentre.co.uk. Closing date for all applications Friday 10th April. 

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER

 

JOB VACANCY  AT SALTASH HEALTH CENTRE WOULD YOU LIKE TO WORK IN CORNWALL BUT BE CLOSE ENOUGH TO PLYMOUTH TO ENJOY THE BENEFITS OF A BIG CITY?  

WE ARE LOOKING FOR A DOCTOR TO JOIN OUR TEAM

 

Strong team ethic (both work and social!)   Enjoy the job!   Committed to high quality patient care   13,000 patients, 7 doctors   Keen for doctors to explore career interests outside general practice   Teach medical students and F2 doctors   Considering reapplying for training practice status   Full nursing team, including nurse practitioner   Partner owned premises in centre of town  Mixed urban/rural population  Local supermarkets – Waitrose and LiDL!  We will be flexible with regard to partner/salaried/locum, full time/part time, long term/short term -  in order to get the right person to join our team  If you might be interested then contact us by phone or email for an informal chat and may be a visit  

Tel: 01752 842281 

Dr Robert Kneen 

Dr Josh Hamilton  

[email protected]  

[email protected] 

Lynn Chenery (Practice Manager)

 

[email protected] 

 Assistant Practitioner: Narrowcliff Surgery We are looking to appoint an Assistant Practitioner to work on a permanent basis in Newquay. 25-30 hours per week between 8:30 am and 6:00pm Monday to Friday.

Your role will include providing a range of services including treatment room duties, health surveillance and promotion. This is a friendly working environment where team work and flexibility are essential.

For an application form and job description, please contact the surgery on 01637 893696. Closing date for returned applications: Friday 24th April 2015.  NO. 282

Page 10

 

DR BASIL BILE WRITES……  I was sitting in what my m y father would have called the barber’s chair. My hair stylist was on a seek and find exercise involving what remains of my once lush locks. These days it is more phrenology than follicular husbandry, but what the hell. My visitations to Herr Kutz are well worth the large sums of loot I part with on a monthly basis, if only for the scalp massage involving something that smells suspiciously like mint tea. Fortunately for me, Herr Kutz delegates this tactile task to buxom blonde Betty, not information I have shared with Belinda. I would be grateful, if any of you should encounter her on one of her regular forays into Waitrose, for your silence on the subject.  

 

Whilst enjoying the sensation of hot water trickling down the back of my neck and making my collar soggy, I had the opportunity to reflect upon one or two matters of state. The fact that we have a General Election looming on the horizon is hardly a cause for celebration amongst the ranks of coal face NHS workers. New Governments inevitably mean new Secretaries of State for Health, followed almost immediately by NHS “reforms” designed to make life absolute bloody hell for those of us foolish enough to still be wielding a stethoscope. The currently departing bunch epitomise this sanguine observation par excellence. Andrew Landslide’s dodgy dossier was, and remains, an unmitigated unmitigated balls -up of the first water. And even as they head for the exit door, Jeremiah Stunt has inflicted Personal Health Budgets upon us long suffering Primary Care operatives. The idea of my lot at the Abandonhope Surgery managing their own NHS cash pot fills me with abject horror. They will will squander it either on St Austell Tribute Ale at the Floppy Flagon, or on Scratch Cards on the local garage forecourt. NHS Fruitcake estimates about ten thousand patients will take control of personal health budgets in what is described as the “first wave”. The salutary tale of King Canute comes to mind.   Talking of waves reminds me of of recently installed Practice Manager Ghastly Gertie, who has hit our humble little enterprise like a tsunami funnelling up the Tamar. “Basil,” she imparted in stentorian tones, “Can I have a word?” Truth to tell, I prefer it when she calls me Dr Bile or just plain Bile. The use of my forename usually heralds impending personal discomfort of some sort. She was sitting at her desk, with a portrait of Margaret Thatcher on one side, and Attila the Hun on the other.   “I have received a letter from a patient.”   OMG.  “They have praised you for making them feel better.”   Good grief. Pinch me, I must be dreaming. Then she began to read.   “Dear Ms Scarey, I wanted to say how much better Dr Bile always makes me feel after I’ve been to consult him at the Surgery. Everybody says I’m fat, but when I look at Dr Bile, it makes me feel positively sylph -like.” She looked at me over the top of her spectacles, perched precariously on the end of her beak. “Are you aware of an NHS Scheme to send overweight doctors to Slimming World?” she enquired villainously.  Actually I was only too well aware of NHS Fruitcake’s CEO Simple Simon and his contention that half of all health-care workers are obese or overweight. A trial has been set up at Imperial College referring tubby staff to clinical psychologists and specialist dieticians. I reached into in to a pocket and took out a round object wrapped in shiny paper.  “Would you like a Ferrero Rocher?” I left her inner sanctum to the sound of her teeth grinding on a golf ball…  

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CORNWALL & ISLES OF SCILLY LMC NEWSLETTER