Meningococcal B for infants – FAQs Items for the Newsletter should be sent to the Editor, Dawn Molenkamp at Victoria Beacon Place, Room B314, Station Approach, Victoria, Roche, St Austell, PL26 8LG Tel :01726 210141 e-mail [email protected]Meningococcal B for infants 1 Your Chairman writes 2 BMA, Chaand Nagpaul Sessional GP’s e-newsletter Retired QoF Indicators 3-4 Vaccine Update Menopause Referral Service 5 Dementia Extract Flu Immunisation 6 National Child Measurement Programme (NCMP) CCG Practice Agreement 7-8 Events 9 CQC Duty of Candour Vacancies 10-11 Dr Basil Bile writes 12 Inside this issue: Cornwall & Isles of Scilly LMC Newsletter No. 288 September 2015 NHS Employers have updated their vaccs and imms FAQs in relation to meningococcal B for infants to explain the eligible age cohort (2 – 13 months), as well as a catch-up cohort up to 2 years for children born on or after 1 May 2015. The FAQs also explain what practices can do if parents approach them about having children outside of the cohort vaccinated privately: Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how? A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice. In addition to this FAQ, the GPC would like to reiterate the advice that whilst GPs can provide private prescriptions, they are not allowed to charge their own NHS patients and we would therefore recommend that patients (outside the cohort) access a comprehensive private service provided by another practice or service provider, who would Phasing out of seniority payments Please see the link on our website. Focus on phasing out seniority October 2015
Transcript
Meningococcal B for infants – FAQs
Items for the Newsletter should be sent to the Editor, Dawn Molenkamp at Victoria Beacon Place, Room B314, Station Approach, Victoria, Roche, St Austell, PL26 8LG Tel :01726 210141
National Child Measurement Programme (NCMP) CCG Practice Agreement
7-8
Events 9
CQC Duty of Candour Vacancies
10-11
Dr Basil Bile writes 12
Inside this issue:
Co
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No. 288
September 2015
NHS Employers have updated their vaccs and imms FAQs in relation to meningococcal B for infants to explain the eligible age cohort (2 – 13 months), as well as a catch-up cohort up to 2 years for children born on or after 1 May 2015.
The FAQs also explain what practices can do if parents approach them about having children outside of the cohort vaccinated privately:
Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how?
A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice.
In addition to this FAQ, the GPC would like to reiterate the advice that whilst GPs can provide private prescriptions, they are not allowed to charge their own NHS patients and we would therefore recommend that patients (outside the cohort) access a comprehensive private service provided by another practice or service provider, who would
Phasing out of seniority payments
Please see the link on our website. Focus on phasing out seniority October 2015
The following has just popped into my email inbox: -
‘Dear colleagues
Health Education England has launched the ‘There’s nothing general about general practice’ campaign. This campaign is designed to encourage foundation doctors, specifically those in year 2, to consider GP specialty training and is being run in partnership with NHS England, the Royal College of General Practi-tioners and the British Medical Association.
You can find out more on:
The campaign page on the GPNRO website– https://gprecruitment.hee.nhs.uk/Recruitment/Nothing-General
The campaign Facebook page– https://www.facebook.com/nothinggeneral
The first campaign video on YouTube – https://www.youtube.com/embed/WfajPqPrRkM
The press release announcing the launch of the campaign - https://hee.nhs.uk/2015/09/24/new-campaign-launched-to-inspire-young-medics-to-choose-general-practice/
We are hoping to spread the word about this campaign far and wide. Please help by sharing these links and the attached image on relevant social media channels (even your own!) and emailing your col-leagues.
Look out for our campaign posters and flyers – please contact us if you would like some to help promote the campaign in your area.
The campaign is also being supported by GP ambassadors who will be attending events across the coun-try and helping to promote general practice as a career.
If you have any questions about this campaign, please email [email protected]’
I apologise for the long post but I hope the irony is not lost on you. At a time when recruitment into GP is fundamental to the development of our NHS there are plans to reduce the pay of our registrars by up to 30 %. How is this possible? At present our registrars receive an Out of Hours supplement – it’s a hangover from the old contract and is partly to prevent financial penalty for those doctors in training when the move into the community (all those unsocial hours worked in hospital at present attract a premium payment alt-hough this too is set to change). Most of our registrars will now only have to do a dozen or so OOH shifts per year (usually supervised) which is often a dozen or so more than their trainers (although I hope they are all signing up to do shifts for Cornwall Health). The re-working of the junior doctors’ contracts as it is presently constructed is an affront to them and we should be vocal in our support for our younger col-leagues. Some of you my wax lyrical about things being worse in previous years (1 in 3 rotas, UMTs – units of medical time paid at 1/3 rate). In some senses it was but in others it wasn’t. The lot of a junior doc-tor work these days is relentless and can be utterly soul destroying. They deserve our respect and sup-port. The plans for our Registrars are nothing short of ludicrous and will damage recruitment, maybe fatal-ly. Why not simply make them do more OOH sessions to qualify for the OOH supplement – it would be a win-win situation. Hopefully the madness will go away but in the meantime please be vocal in support of
As a working GP, you will know that general practice is at a critical juncture as GP services struggle under sustained pressure from a decade of rising patient demand, underinvestment and staff shortages.
This situation cannot go on.
Today the BMA’s GP committee (GPC) has launched its vision for the future of our profession: Responsible, safe and sustainable: Towards a new future for general practice.
This important report is the culmination of a year’s work and builds on our largest ever survey of 15,560 GPs, which many of you answered , as well as feedback from patients and several LMC events across England, including input from sessional and newly qualified GPs.
Our recommendations are based on the experience of everyday GPs and how they want to work in the future. Our vision demands an end to the short-term headline grabbing of recent years and outlines a programme of reform for a sustainable, modern and flexible service that enables GPs to care for their patients. This includes:
- putting a properly resourced NHS general practice at the heart of the community with an expanded multidisciplinary team of healthcare professionals, including
community nurses and other practitioners, which interacts and collaborates better
with the rest of the NHS
increasing year-on-year funding for patient care so that general practice can keep
pace with escalating demand
- a new national campaign designed in collaboration with patients, government and
healthcare professionals to promote and support patients to effectively self-care
and signpost to other services to lessen pressure on GP services
- creating a long-term infrastructure fund to invest in GP facilities in order to expand
their capacity to treat patients
- better use of technology to improve patient care and lessen unnecessary workload,
including phasing out of paper records
- making a career in general practice more attractive and accessible for medical
graduates by reforming the training curriculum and making the career path for new
GPs more flexible.
Our vision for the future of General Practice
CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R Page 3
You can find the key recommendations from the report by watching the online video – on our web hub .
Watch the video
Most importantly, I want your views about the ideas we are proposing.
You can join the debate on twitter by using #NewFutureforGPs and share your opinions on BMA communities. What should the future of general practice look like? Are GP networks/federations the way forward for your practice?
Our vision offers the government, NHS England and commissioners a clear framework for investment. It will hold politicians to account to deliver on their pledge to resource general practice properly. It lays out a new, bold future for general practice; where GPs can do their jobs providing safe, quality care to patients, and a career that will appeal to a new generation of doctors, in a manner that will be rewarding to existing GPs. It is incumbent upon government to create this renaissance in general practice, since a failure to do so would be a dereliction of its duty of care for the nation's health.
With best wishes,
Chaand Nagpaul
BMA GPC Committee Chair
Page 4 CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R
Our vision for the future of General Practice Contd/.....
Retired QoF Indicators
This month’s sessional GPs e-newsletter is available here.
The Chair’s message focusses on the national occupational health service for GPs suffering from stress and burnout and a further update on what we are doing to change the unfair rules on death in service benefits for locum GPs. Included in the blogs this month is one from sessional GPs subcommittee mem-ber Mary Anne Burrow on doing out-of-hours work.
Sessional GPs e-newsletter
The Indicators No Longer In QOF (INLIQ) Business Rules v32.0 have now been published and are available here:
Influenza vaccine supply for the children’s part of the national flu vaccination programme September 2015
Ordering of Fluenz Tetra® for the children’s flu programme in 2015/2016 is expected to commence in England on the dates set out below:
Programme delivery method Indicative date for ordering to start
Schools Thursday 24 September
GPs Week ending 2 October
Ordering restrictions
Ordering will open for the 2015/16 season with no restrictions for either schools or GPs in the first instance.
However, the ability to allow free ordering throughout the programme requires customers to adhere to the guidance that has been issued to order/hold no more than 2 weeks stock at any time.
Applying restrictions such as an allocation system, or order cap will be considered by PHE at a later date if stock runs low.
Shelf life of Fluenz Tetra®
Fluenz Tetra® is a live attenuated vaccine and as such has a very short shelf life. Please bear this in mind when ordering. The first batches will have December 2015 expiry dates. You will be able to place an order every week and deliveries will be made weekly alongside your usual deliveries of vaccines. Where possible do not order more than you will need for the next two weeks. This is to minimise vaccine wastage due to the vaccine passing its expiry date before it can be administered. The vaccine will be available to order throughout the entire flu season to ensure there is in date stock available into the New Year. Subsequent deliveries of vaccine will have later expiry dates.
Page 5
Public Health England - Vaccine Update
Menopause Referral Service
At the end of June KCCG determined that the menopause referral service would cease in order to save money. This decision has not been disseminated and caused confusion. I have contended that the loss would result in increased cost and compromised patient care. There will be NICE guidance published in November advocating the use of expert advice in complex cases. The economic case is now being re-examined along with the support provided to clinicians by email. However I am still unable to accept refer-rals at the current time.
If you are interested to learn more about managing women with hormonal problems yourself consider the FSRH Menopause Theory Course which will be running in Bristol 12th-13th November. This will be a week before the NICE publication and will answer the inevitable questions that the publicity will throw up. Details available on http://www.crescetis.co.uk/womens-health-training-menopause.html#spsk
NO. 288 Page 6
Dementia extract
Practices should have received a series of communications from the Health and Social Care Information Centre (HSCIC) on a forthcoming GP extract entitled ‘Quality and Outcomes Framework (QOF) Subset Extract for Dementia Prevalence 15/16’ (also known as SoS Dementia). The HSCIC confirmed that practices were required to participate in this extract through the Calculating Quality Reporting Service (CQRS) by 31 August, and that they are legally required to comply under Section 259(5) of the Health and Social Care Act (HSCA). To clarify, this extract is unrelated to QOF, despite being labelled a QOF subset. It was given this name because the data closely matches a subset of QOF indicators. GPC has asked the HSCIC to use different terminology in future to avoid any confusion. The HSCIC has confirmed that 617 practices are yet to enable this collection through CQRS, and they have written to these practices to request they accept the extract by the end of Thursday 29 September 2015. GPC recommends that practices comply with this request, which is a legal requirement under the HSCA. The Joint GPC & RCGP IT Committee (JGPITC) was consulted on this extract, as confirmed in the HSCIC’s communications. The Committee accepted the legal basis of this collection through the HSCA, and that the extract had been approved by both the General Practice Extraction Service (GPES) Independent Advisory Group (IAG) and the Standardisation Committee for Care Information (SCCI). The collection is of non-identifiable, aggregated data specifying the number of people at each practice with a diagnosis of dementia, broken down by age and gender, as well as the number of the practice’s total registered population. This is non-identifiable data and therefore not subject to the fair processing provisions of the Data Protection Act. There is therefore no requirement to inform patients. Further information is provided within the Data Provision Notice sent to practices.
Flu immunisation for patients with BMI>40 - GPC advice
Following the issue raised on the LMC listserver asking whether practices should or should not immunise those with BMI over 40 as per the JCVI recommendations, GPC contacted NHS England for clarification. They have confirmed that there will be no changes to the current enhanced service to include the morbidly obese as a stand-alone cohort, as the recommendation for this cohort came in after the eligible patients and funding had been secured for 2015-16.
The wording in the service specification addresses this (page 24, footnote 33 of the specification):
33 JCVI have advised that morbidly obese people (defined as BMI>40) could also benefit from a seasonal influenza vaccination. Many of this patient group will be eligible for vaccination under another risk category due to other health complications that obesity places on them. However, funding has not been agreed to cover this cohort as part of this ES. Practices are able to use clinical judgement to vaccinate patients in this group, but vaccinations for morbidly obese patients with no other risk factor are not eligible for payment under this ES. The inclusion of this cohort in subsequent years is under consideration.
In addition NHS England confirmed that the morbidly obese are not included in the pharmacists additional service so they should not be directed to pharmacists unless recommending a private vaccination.
The GPC’s advice to practices is that there is no obligation to vaccinate patients with BMI over 40 and that no pressure can be applied to practices as this is not about clinical risk, but due to a funding decision by NHS England.
The National Child Measurement Programme (NCMP) in Cornwall And IOS 2015-16
The NCMP in Cornwall and IOS is now getting underway for the 2015-16 school year. You may find the following information helpful should parents present to you following receipt of an NCMP results letter.
The NCMP in Cornwall and IOS is now getting underway for the 2015-16 school year. You may find the following information helpful should parents present to you following receipt of an NCMP results letter.
The National Child Measurement Programme offers weighing and measuring to all reception and year 6 children in state maintained primary schools across England.
In Cornwall IOS, parents/carers are informed of their child’s measurements and weight category in a letter which also contains links to self-help healthy weight resources and information about how to access free, local healthy weight advice and support. Parents/carers can also consult their school nurse for advice should they wish.
Parents are frequently surprised and sometimes angry when they receive a letter informing them their child is overweight. Many parents also disagree with the result or question the va-lidity of using BMI centiles to assess weight status in children.
Parents/carers may present to Primary Care following receipt of an NCMP results letter for sup-port and advice, to dispute the result or to ask for the GP or Practice Nurse’s assessment
of their child’s weight status.
Helpful practice points:
The NCMP uses BMI centiles to assess weight status in children. Despite some limitations, BMI cen-tiles are still considered the best, evidence-based method for this and are recommended by NICE, SIGN and the DoH.
Current Clinical Guidelines suggest:
BMI centiles should be used to diagnose overweight and obesity in children (SIGN 115)
UK 1990 BMI charts should be used to give age- and gender-specific information (NICE CG189)
Waist circumference is not recommended as a routine measure. Use it to give additional infor-mation on the risk of developing other long-term health problems (NICE CG189)
Raw BMI and height/weight comparison should not be used to assess weight status in chil-dren. Children who are in proportion for height and weight can still be overweight.
You can find a link to the currently recommended BMI centile charts for children, where to or-der hard copies and the current CIOS Childhood Obesity Care Pathway in the ‘Professional’ area of the Cornwall Healthy Weight website here: https://www.cornwallhealthyweight.org.uk/professional/child-obesity-pathways/
Remembering the limitations of using BMI centiles to assess weight status in children can be helpful when helping a parent to interpret a result. BMI centiles wrongly classify a small proportion of children as overweight who are a healthy weight and a small proportion as a healthy weight who are in fact overweight. BMI centiles are less accurate, for example, in children who are especially muscular and in certain ethnicities. As always, clinical judgement should be used when using BMI centiles to assess weight status in children and of course other aspects of a child’s diet, activity and lifestyle should be taken into account as part of an holistic assessment.
The National Child Measurement Programme (NCMP) in Cornwall And IOS 2015-16 Contd/...
NICE guidance (CG189) states: “Use BMI (adjusted for age and gender) as a practical estimate of adi-posity in children and young people. Interpret BMI with caution because it is not a direct measure of adiposity”.
Sharing NCMP results with Primary Care
We think NCMP results should be shared with Primary Care and we are still progressing this. Sep-arateness of child health information systems and lack of an NHS number attached to a child’s NCMP record are currently barriers but we hope to be able to surmount these soon.
If you have any questions about the NCMP in Cornwall IOS, please get in touch with Alexa Gainsbury, Public Health Practitioner – Children’s Health Improvement on 01872 327041 or
The CCG-practice agreement for the provision of GPSoC and GP IT services
NHS England has now published an agreement, for signature by practices and CCGs, setting out the pro-vision of GP Systems of Choice (GPSoC) and GP IT services. The CCG-practice agreement sets out the relative responsibilities of CCGs in providing these services, and each practice’s responsibilities in receipt. The agreement replaces the previous PCT-practice agree-ment. LMCs should note that the deadline for signature of the agreement by practices and CCGs is 31 Decem-ber 2015. Signature is necessary to ensure each practice’s right to a choice of clinical system is protected, and to help ensure CCGs meet their IT obligations. Where signature is not possible, a resolution should be sought through CCG escalation to their area team. The HSCIC has stated that central IT funding could be withdrawn from practices that have not signed the agreement by the deadline. The GPC’s IT Subcommittee recommends that LMCs and practices work with their CCG to ensure an agreement is reached; the subcommittee is aware that some CCGs are yet to initiate discussions with practices. The Joint GPC/RCGP IT Committee was consulted on the agreement and practices are ad-vised to familiarise themselves with its content. The agreement, plus supporting guidance, is available on the HSCIC (http://systems.hscic.gov.uk/gpsoc/order/contracts/index_html#ccg) and NHS England (http://www.england.nhs.uk/digitaltechnology/info-revolution/digital-primary-care/) websites. The HSCIC has also published some FAQs (http://systems.hscic.gov.uk/gpsoc/faqs/index_html#ccgfaqs). The HSCIC has advised that CCGs and practices are only able to update the three specific appendices. Appendices 1, 2 and 3, listed below, are subject to local agreement and should be completed by the CCG in consultation with practices. The agreement itself should remain as per the version on the HSCIC/NHS England websites.
· Appendix 1 – summary of services · Appendix 2 – support and maintenance service levels · Appendix 3 – escalation procedure
Keeping Patient Safe (and yourself out of trouble)
Avoiding pitfalls, understanding regulation and accessing local support
Tuesday 17th November 2015
9.30am -16.30pm
Westpoint Centre, Clyst St Mary, Exeter EX5 DJ
Please see attached flyer for more information
Updates for Primary Care
12 - 16th October 2015
The Headland Hotel, Newquay
Please see attached flyer for more information
Menopause Theory Clinic
12th & 13th November 2015
Holiday Inn, Bristol City Centre
Please see attached flyer for more information
Musculoskeletal Update for GP’s
How to get the best out of Assessment of the spine, hip, knee and shoulder.
To be held at The Headland Hotel, Newquay
On 19th and 20th November 2015
Please see attached flyer for more information.
Peninsula Community Health
Keeping Patient Safe
Primary Care Updates
Menopause Theory Course
NO. 288 Page 10
The CQC Duty of Candour
The CQC Duty of candour came into effect for all GP practices on 1 April 2015
This is covered by Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which sets out all of the Fundamental Standards. It aims to ensure that providers are open and honest with people when something goes wrong with their care and treatment.
When a service is meeting the duty of candour patients should expect:
A culture within the service that is open and honest at all levels.
To be told in a timely manner when certain safety incidents have happened.
To receive a written and truthful account of the incident and an explanation about any enquiries and
investigations that the service will make.
To receive an apology in writing.
Reasonable support if they were directly affected by the incident.
If the service fails to do any of these things, CQC can take immediate legal action against that
provider.
It is recommended that members read the mythbuster on the Duty of candour.
GP—Stennack Surgery
The Stennack Surgery, St Ives, Cornwall
General Practitioner
Are you looking for the perfect job balancing high quality progressive general practice with unrivalled lifestyle opportuni-ties?
We would like to welcome an enthusiastic GP into our harmonious team. We are a large practice proud of our high quality service, working from large premises in the beautiful seaside town of St Ives.
· Flexible number of sessions for the right candidate. · 12,500 patients, 8 partners, 4 salaried docs, nurse practitioners. · Extended range of services. On site MIU, minor surgery, pharmacy and physiotherapy. · Teaching practice with undergraduate and postgraduate trainees. · Research active. · Opportunities for GPs with special interest. · Spectacular sea views guaranteed with all home visits!
For further information please contact a member of our Executive Management Team:
Bottreaux Surgery is a high-earning dispensing practice located on the North Cornwall coast, renowned for its beautiful beaches and coastal paths. We are looking for a GP to join our long-established and popular practice with surgeries in the villages of Boscastle and Tintagel, serving a rural community of around 4,950 patients. We are offering a salaried post or with a view to partnership to an enthusiastic, self-motivated, pro-active, and committed GP to work with our three GP Partners, 2 Practice Nurses, and Assistant Practitioner. Commencing Spring 2016. 8 sessions. Microtest Evolution. No OOH. No weekends. Competitive salary package. Accredited teaching practice. To apply, or for more information, please contact: Matthew Gibbons, Business Manager Tel: 01840 250740 Email: [email protected] Informal visits welcome.
Full Time GP—Camborne
Veor Surgery, Camborne, Cornwall
We are a busy but very rewarding GP Surgery in the idyllic County of Cornwall. Cornwall is an area known for its outstanding beauty and leisure pursuits.
An opportunity has arisen for a permanent full time (8 sessions) or part time contracted salaried GP (job share considered) with a view to partnership in the near future.
Our practice in the center of Camborne has approximately 8,500 patients. You will be joining our friendly and progressive PMS practice which enables the ideal candidate to have the life/work balance sought after by many GP’s. We are looking for flexibility, enthusiasm and commitment to providing high standards of clinical excellence.
Modern purpose built premises EMIS Web clinical system Nurse Led Chronic Disease Management clinics 6 weeks annual leave including one weeks study leave GP’s and Nurses with special interests Active members of our local commissioning group NHS Pension Scheme.
Please send expressions of interest and a copy of your current Curriculum Vitae to our Practice Manager:
Mrs Teresa Kemp, Veor Surgery, South Terrace, Camborne, Cornwall, TR14 8SN. Tel 01209 611171 or
Earlier this year Government advisers said the feminisation of the GP workforce had led to a short-age of family doctors, as more than half of family docs are now women, with many working part-time. As a doddering old fart, I can recall with misty eyed nostalgia the days when the coffee room at the Abandon-hope Surgery was full of sweaty blokes at the end of morning surgery, swapping risqué anecdotes and engaging in arm wrestling competitions with our free hand as we signed repeat prescriptions with the oth-er. Happy days. Alas and alack, roll the clock forwards to 2015 and if I have the temerity to suggest a belching tournament over our mint and herb infusions, I am on the receiving end of a volley of withering looks from the assembled oestrogenies, led by Hilda Bunnytunnel, salaried sessional GP Lettie Golately, and Ghastly Gertie our Practice Manger.
At least until this juncture I had a male ally in this ocean of ovarian niceties, but to my horror junior partner Clint Thrust turned up to work yesterday wearing a kaftan and dangly earrings, announcing that from now on he wants to be known as Clintella. Previously he and I shared the workload of the impotent and prostatically challenged inhabitants of St Salive. Now I am lumbered with the bally lot of them.
I was cheered in part by the unexpected blip of common sense escaping from the thin lips of our Secretary of State for Health. Jeremiah let slip during a recent broadcast that he doesn’t have a problem in principle with charging people for missed appointments. This followed a survey finding that more than sixty thousand GP appointments are wasted each day because punters fail to turn up. Doctors’ surgeries are losing the equivalent of one GP’s worth of clinical time a week, with twelve million slots missed each year at a cost to the NHS of one hundred and sixty million quid.
Personally my view is that having some precious time to myself is reward enough when the daft buggers fail to materialise, but the idea that the tills could ring in celebration of each DNA is too tempting a notion to leave alone. How to maximise the income stream from this potential nice little earner was the co-nundrum exercising my remaining grey cells. And then the light bulb moment. Eureka! Seagulls.
The number of seagulls in the UK has quadrupled in the past fifteen years, the gulls becoming ever more aggressive, with attacks on humans and pets being reported in Cornwall in the last few months. Our beloved Prime Minster and his wife are regular staycationists in the Grand Duchy, not least because of the stunning photo opportunities provided, and he has suggested a “big conversation” on the issue. The RSPB wants the Government to hold a “gull summit”.
Well, phooey to all of that. I have befriended and trained a Herring Gull called Herbert. He has a razor-sharp two inch beak, a one and a half metre wingspan, and impressive talons. With my encourage-ment he has adopted a roosting spot atop the Surgery roof which gives him an excellent vantage point. Before each surgery session I scatter fragments of pasty and chips around the car park and entrance to our Theatre of Cures, ensuring regular screeching swoops from Herbie. Pensioners, who make up a sig-nificant percentage of our footfall, are particularly deterred from crossing our threshold by his kamikaze antics. The highly satisfactory result of my innovative scheme is a) More Me-time ; b) At a tenner a missed appointment a tidy contribution to Basil’s Retirement Fund; and c) A very happy if somewhat over-weight seagull.
DR BASIL BILE WRITES……
CORNWALL & ISLES O F SCILLY LMC NEWS LETTE R Page 12
