No.

282
March 2015

With apologies to W. Wordsworth

I waited lonely, as a doc
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

Cornwall & Isles of Scilly

LMC Newsletter

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:

QOF Guidance 2015/2016

Your Chairman writes

IG Toolkit Survey launched

Workforce Minimum Data Set

3/4

Introduction from the new

Responsible Officer

Safeguarding Children
Update
New IT Requirements

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
has also been published on
the BMA website QOF
guidance pages.

Update -Intelligent Monitoring

Vaccs & Imms

Items for the Newsletter should be

sent to the Editor, Dawn Molenkamp
at Sedgemoor Centre, Priory Road,
St Austell PL25 5AS
Tel :01726 627978,

Vacancies

9-10

e-mail [email protected]

Dr Basil Bile writes.

11

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 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 enjoy working with us at the office. They will provide much needed help for Dawn Molenkamp, our 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 and communications will be available through the site. When we upload guidance, we
automatically send out a tweet to 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-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 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 Cornwall Health and encourage others to do the same but secondly I think it will be
a great opportunity to meet colleagues and make up for the anticipated loss of practice 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 published by the National Information Board,
proposed that HSCIC should, by October 2015, relaunch the Information Governance Toolkit 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.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 . 28 2

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 Commissioners 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 governments 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 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, 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).

Page 3

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

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
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 under the DPA is removed, practices are advised to inform their staff of this data submission, to comply with the fair processing principle of the DPA. The HSCIC will provide practices with a template fair
processing notice and this will be made available soon.
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 website, which includes a specification overview and set of FAQs.

Page 4

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

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 any questions. (Attached to the newsletter).
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

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

Safeguarding Children Update April 2015

The GP Level 3 Experiential Learning Template for Safeguarding training has been updated to reflect the recent
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 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 is achieved I have
been assured that the existing arrangements will apply.
My role as the Lead GP for Safeguarding 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].
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 Childrens Board website has a health page containing lots
of useful information www.safechildren-cios.co.uk.
Dr Kate Gurney

Focus on the new IT requirements of the GP contract

in England
The latest guidance can be found here and includes the following.

Referral management and use of the NHS Number

Summary Care Record

GP2GP record transfers

Online prescriptions

Online appointment booking

Online record access

Page 6

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

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.
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

Page 7

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

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 CQCs 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 wasnt 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 requirements for 2015/16 contract changes have now been published on NHS Employers
Vaccs and Imms pages. The service specifications for Childhood flu, Seasonal influenza and pneumococcal, MenC freshers, Pertussis (pregnant women) and Shingles (catch up) vaccination programmes are
available from the NHS England Commissioning page.
The BMA website vaccinations and immunisations page has also been updated to reflect the changes for
2015/16 and has links to all the guidance documents and service specifications.

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

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 environment with higher still aspirations
Encouragement in developing your medical interests
The opportunity to teach medical students, F2s and GPSTs
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 the Cornish culture and lifestyle
You offer
Commitment, enthusiasm and a team orientated style
A focus on clinical quality alongside business aptitude
A flexible attitude and are open to change
Application in writing please by 24/04/15 with attached CV to Judy Cole, Old Bridge Surgery, Station Road,
East Looe, Cornwall, pl132hw. For an information pack or to arrange visit/informal discussion please contact:
[email protected] or 01503 266965
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 to [email protected]

Newquay Health Centre - Practice Nurse required

Newquay Health Centre has a practice list size of approximately 16,500 patients managed 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. Closing
date for all applications Friday 10th April.

Page 9

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

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 . 28 2

Page 10

DR BASIL BILE WRITES

I was sitting in what my father would have called the barbers 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 Landslides
dodgy dossier was, and remains, an 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 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 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 Ive been to consult
him at the Surgery. Everybody says Im 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 Fruitcakes 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 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

Page 11

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