The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday 8th May 2008 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr G Browne, Dr P Bunyan, Dr K Hollier, Dr R Horton, Dr R Ingles, Dr G Ingrams, Dr A Kelly,Dr D Lewis, Dr F Martin, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr S Pike, Dr D Pryke, Dr D Radley, Dr J Rankin, Dr V Schrieber
1. APOLOGIES
Dr N Burger, Dr R Kelsey, Dr R Kinsman, Mrs L Luke, Dr K O’Connor, Dr K Rainsbury, Dr C Reynolds
The Chairman welcomed Dr Abudu and Dr Kelly to the meeting.
Dr Abudu gave an update on PCT matters and apologised for the slowness of some of the issues currently being raised within the PCT. The PCT have seconded Trevor Netherway as the new Acting Head of Primary Care and are advertising for the substantive Head of Primary Care post and are interviewing for another Primary Care locality post.
Dr Abudu gave feedback to the meeting with the LMC Chairman and Secretary. She gained another perspective on the INR LES, so will be looking further into this before coming back to the LMC. She has a meeting with the Acute Trust on the 20th June on how they will handle the transition phase, costing issues and more on the monitoring service. There was much debate with the committee regarding the INR LES, especially regarding the monitoring and initiation and the committee wanted to stress that it was important to get a clear understanding of what service general practice are going to provide before talking to the Acute Trust. Dr Horton said it would be much easier to do it all yourself, otherwise the patient the falls between the two areas. Chairman agreed and echoed the sentiments. Dr Pryke said patients like their practice to provide both, they want a seamless service. The LMC has supplied her with activity data from practices.
Regarding the IM&T DES, the LMC has received a letter from Daphne O’Connor. The PCT will pay each practice for Component 2 based on a self-declaration from the practice, one of the requirements is that it has uploaded CHART and is running e-audits in order to clean up the practice data. Don Beckett said it had to be done, but using CHART or something similar. Dr Abudu said she would be happy to use something else as long as John Thornbury is happy to sign it off. Dr Ingrams also confirmed that CHART is the online data monitor and you should upload it at least once to show you are carrying this out. Information can be found in Appendix A in the Brown Book.
On Extended hours, the PCT are to have further discussion with the PEC whilst they are waiting for National Guidance. The Secretary stressed that if we have a flexible scheme practices will run with this. Dr Abudu said the PCT will try and build as much flexibility into the LES as they can and doesn’t think they will be making any major fundamental changes. Chairman asked if there was local variation and Dr Abudu replied that they are taking the individual needs of the practice into consideration. Practices have to put forward their needs and why so they can consider them. Dr Abudu stressed that there will be one LES but with flexibility, as the LMC have asked for flexibility to meet needs of different practices, but the principles are the same for all. Dr Kelly reiterated this and said the PCT are trying to be as flexible as possible. The Chairman was concerned if they offered one scenario for one practice then they should offer it for all, e.g. Saturday working. Dr Abudu said they are not insisting that practices do Saturday mornings for the first three months but after that time she wasn’t sure what the situation would be. The Secretary stressed that Saturday working was a big sticking point for many practices. Dr Radley felt that if Saturday mornings were forced upon them then he didn’t think practices would do them, it should be voluntary. Dr Abudu said they will continue to be as flexible as they can and will continue to engage in discussions with the LMC. The paper will go to the PEC next week. Secretary asked when the draft paper will be available for us to see. The answer was they will get the paperwork out as soon as possible.
Dr Abudu said the PCT were to have a Joint Area Review in June regarding Childrens Services across social care and will be talking to other providers. There will be 10 case reviews. She isn’t sure if this will involve Primary Care as yet. Vicky Preece will try and make sure all information is circulated to practices, and individual practices may be approached.
Action: To put this in Newsletter
Regarding PMS baselines the Secretary asked if there was any more on this. Dr Abudu said no, not yet. Secretary said he has suggested that practices sign it and that it will be clarified at a later point.
2. MEMBERSHIP
Chairman welcomed Dr Kelly who is to be the PEC Member representative on the LMC.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 10th APRIL 2008.
Dr Ounsted said that regarding the Pharmacy White Paper he wanted it stressed that it wasn’t just dispensing practices that this will affect but all practices.
4. REGULAR ITEMS
a. Worcestershire PCT
Discussed earlier with Dr Abudu
i) IM&T DES.
Discussed earlier in the meeting.
ii) Meeting with Paul Bates.
Chairman & Secretary reported on their meeting with Paul Bates. Paul is keen to stress to the Committee that the selection for the OOH Provider was totally above board, and that he was not involved himself. They were chosen on merit and the Board was not aware of who they were. TCN were successful, they currently provide drivers for the OOH Service. Dr O’Driscoll said this has given a lot of anxiety to GP’s working for the OOH. TCN have said they will continue to employ them but they haven’t as yet received a contract. This is because there is a 10 day cooling off period, once this is over then they should be in touch. Dr Kelly stressed it was a very fair process with out of county GPs on the Board.
The LMC Chairman also commented that PBC seems to have dropped off the radar. The Secretary also felt that different people in the PCT say different things and he is getting different messages from everyone. Nothing is really happening, just a lot of meetings and no real action. They had discussed this with Paul Bates as well as mentioning the issue of extended opening. Unfortunately they had differing replies from within the PCT so we will have to wait and see what does come from further meetings.
iii) Extended Hours LES – meeting with Heather MacDonald.
Secretary reported on the meeting he had with Heather MacDonald. The PCT is to put a paper to the PEC at the next meeting. He has also written to members of the PEC outlining our concerns which are:
· Not enough money, for £2.99 get minimum service
· 12 months rolling contract
· Cover for leave and sickness particularly small practices (Heather going to check some flexibility)
· Telephone appointments - can they be included.
· Emergency / drop ins – how they will be handled.
· Whether the PCT is interested in commissioning extra nurse time. Or can nurses do some of the work alongside the doctors?
· Hours of work & Saturday mornings
· Coterminous working
Chairman told Dr Kelly of his concerns about the real issue of safety and that this really has to be taken into consideration. Dr Kelly agreed.
b. Education
Nothing to report.
c. Dispensing
Dr Ounsted gave an update on the DISPEX meeting re review of entry to pharmacy on the 26th April. The meeting was with Conservative MP’s. Tim Boswell MP has taken all our points on board. Lisa Silver, a GP in Nettlebed is to meet with David Cameron, so hopefully is going to push all the points through the political line. Dr Ounsted went on to say that prescribing GP’s will lose some LES’s and DES’s to Pharmacists and the pay that goes with them. Their prescribing will be monitored to ensure it complies with NICE and local protocols. Small pharmacists will lose out to big chains.
James Rankin said that Chapter 8 of the Pharmacy White Paper has huge implications for General Practice and we should all be worried about it. He reiterated what Dr Ounsted said at last month’s meeting that it isn’t just dispensing practices that it will effect.
Dr Ingrams agreed and said that another letter had been sent out from Russell Walsham and that dispensing practices are worried but we should all be worried as they are probably the least ones to lose from this White Paper.
d. Out of Hours
Discussed earlier in the meeting.
e. Non-Principals Group
Nothing to report.
f. Registrars
Nothing to report.
g. P.M. Groups
Nothing to report.
h. Administration Issues
i. LMC Levy 2008-09
Secretary stressed to committee that we do need to set the LMC Levy. Committee agreed and a discussion followed on pay..
ii. LMC Pay Structure – Chairman to report.
The Chairman, Vice Chairman and treasurer met earlier in the month to discuss the Secretary, Officers and Administrators pay. The Chairman and Secretary left the room whilst members discussed the issue of the Secretary and Officers pay.
Dr O’Driscoll led the discussion with Dr Ounsted Chairing. Dr O’Driscoll stressed that it was necessary to be clear to the committee and its constituents (i.e. those who pay the Levy) that the principles of remuneration should be fair, transparent and robust. At the moment officers are paid in relation to Consultants pay scales with no consideration for merit awards, so this is not a true reflection of what they should be paid. GP Educators pay was also discussed and agreed that this was not a true cost to the practice. The Secretary should be paid in relation to GP pay and should be reimbursed to the practice for losing his service for loss of time.
A figure should be arrived at on a yearly basis for average GP pay. This should be obtained by finding average PMS full time partner pay, average GMS fulltime partner pay, adding the two together and dividing by two. The figures should be obtained from the Association of Specialist Medical Accountants and relate to GPs in England. This figure should then be multiplied by the number of sessions the secretary works per week, (in this case 4) and then divide by 10. Finally this figure should be uplifted by 5% to reflect both a practice disturbance factor and the fact that figures for average pay will necessarily be obtained retrospectively, so that pay will always be based on the previous year's average GP earnings. Hence the pay for the secretary doing 4 sessions per week will be average PMS pay + average GMS pay divided by 2 times 4/10 + 5%.
There was discussion amongst the committee on how many sessions were classed as full time and should be used in the calculations with a consensus that 10 sessions should be used. Dr Ounsted reiterated that the Secretary should be remunerated and paid for the job he is doing. It has to be a direct correlation to current GP pay and not be financially disadvantaged. Dr Radley said this was fair and that Worcestershire was a cheap LMC to run in comparison with many other LMCs.
Dr Ounsted asked committee if they were happy with criteria, all agreed. Dr O’Driscoll proposed and Dr Pike seconded.
The question was asked if sessional rates should be the same for the other Officers. All agreed.
The question was asked about sessional rates for other members and honorarium payments. Chairman asked the committee if they would be happy for the Officers to meet and decide and would they give authority for them to do this. Dr Radley asked what they were thinking to base their calculations on. Chairman said that practices should not take a financial loss on not paying the appropriate rate. Dr Horton said that the sessional rate should apply to the sessional rate in proportion. The Officers will review this formula and apply it to the honoraria.
Regarding the LMC Administrators pay, the Committee considered the current pay scale and agreed it was appropriate but felt that in addition the LMC should make 7% pension contributions.
i. P.B.C. Issues
Nothing to report.
j. I.T. / GPSoC
Following on from the Primary Care Working Group meeting it was agreed that touchscreens would be funded and also to support business continuity and home visits. 1 handheld device and associated software per 3,000 patients would be funded. The PCT has to fund the upgrade to all practices servers/backup drives to ensure they can encrypt backups for when tapes are taken off site. John Thornbury has arranged for PAT testing of IT equipment at practices to take place in the near future. Dr Ingrams said this was very generous and well above the spec. This is to happen now.
Action: To put in Newsletter
Dr Ingrams asked if the LMC would support an emergency motion on new business following the findings from the University College London. The motion to be:
“That this conference welcomes and endorses the review of the Summary Care Record Early Adopter Programme by University College London, and recommends that GPs should not engage with the Summary Care Record until:
1) All the concerns within the UCL report have been addressed
2) The purpose and scope of the summary care record has been clearly defined
3) The information to be held on the summary care record has been agreed to consist only of a summary of morbidities and prescriptions generated from general practice detailed care records, and that there is an undertaking by the Department of Health that no further information will be added unless agreed in advance with the British Medical Association.
4) Lessons from successful similar schemes from elsewhere – including Scotland and Wales – have been learned and good practice incorporated into the summary care record.
5) That the consent model is changed to patient consent to view at the time of the healthcare episode.”
The committee were happy to do this.
5. MATTERS ARISING
Minute 5/440 Junior Members Forum 2008
Not discussed in Dr Burgers absence.
Minute 5/443 “Worcestershire GP Campaign”
Letter received from the GPC “Support your Surgery campaign – we need your help” circulated to committee. The GPC is developing a national campaign to both promote and defend general practice. The campaign will take place in late May / early June. Material is being developed and is currently undergoing market testing and will be available for LMCs and Practices to use to support the campaign. The GPC would like us to start to plan how we can support the campaign and encourage GPs to become actively involved.
We received a letter from the DOH regarding the No. 10 petition. It sounded like a standard reply so we have written back asking for a more personal response. We have heard nothing back.
Minute 5/397 ARM Reps
Secretary discussed the accommodation for the BMA ARM. Secretary will liaise with Dr O’Driscoll to organise this together with flights.
Minute 5/444 Protocol for dealing with sudden or unexpected deaths
The final full and condensed version of the Protocol for the management of sudden & unexpected deaths in infants & children has been received and circulated to the committee.
Dr Horton queried Appendix 7, Agreed Pathway of Professional Responsibilities. The usual issue of confusing confirmation and certification of death is included. The flowchart seems to imply that after a doctor has confirmed death the patient then goes to hospital where resuscitation is attempted. The committee agreed that the flowchart needs rewriting.
Dr O’Driscoll said this was totally impractical for something that may only happen once in your career and that you were not likely to read it just before you need it and learning it verbatim just wasn’t practical.
Action: Feed this back to Adrianne Plunkett
6. COMMITTEES
a. GPC
i) M8 Circular circulated
Secretary went through latest M8 circular and Negotiating News. Dr Ingrams said that with what is happening to DDRB there is no reason why PMS practices should not get the 2.7% as it is a locally negotiated contract. .
Action: Secretary to write to the PCT
b. GPCWM
Newsletter and letter to all GPs circulated The GPCWM AGM and dinner is to be on the 22nd May. Members to let Michelle know if they wish to attend.
7. NEW ITEMS
Minute 5/466 IM&T DES Directions
Document circulated to members. Discussed earlier in the meeting.
Minute 5/467 HPV meeting with PCT
Secretary reported. Sue Bosworth and Dr Bhanerjee came to talk about what they are going to do about the HPV vaccine. Initially it looked like there would be little or no role for GPs but as the discussion carried on it became apparent that there would be work for GPs. It will be done in schools by nurses. There will be three sessions, parents will be asked for permission on the first session. They are unsure what to do about appointments that are missed and have asked what our thoughts are. They have discussed the possibility of having community clinics within practices. The problem with this is that the vaccine is expensive and there is a limit on the number of vaccines available, as well as having to be audited. They don’t want practices to stock up and then run out elsewhere so not clear how to get round this. There are no national targets. The campaign will be starting soon and leaflets will be sent out.
The question was asked, should the PCT commission practices to do ‘DNA’ on a locality basis to run this? They suggested having one practice in each conurbation to run the catch up for them instead of them running catch up clinics. Secretary asked committee what they thought about this. The committee felt that people will not travel so it has to be local. Dr Radley asked the question; would that mean bidding against each other? The Chairman agreed this would not be good to do. There was no overall decision. The committee agreed to wait and see what the PCT decide to do.
Minute 5/468 Communication issues related to PBC
Secretary reported on meeting with Dr Chris Heath who was concerned about the failure of the progress of PBC and that the main issues seem to come from a lack of communication. The PBC Forum are not having a desired effect. Secretary asked the question of whether we should communicate on a wider forum and see if others are having the same problems, and so not reinvent the wheel. This is not an LMC traditional duty but is it something we should support, mentor or encourage, and try and make things better. The Chairman agreed that we do need some proposals. Dr Kelly said this was a huge problem, the PCT are trying to work geographically and are being quite secretive about it. Committee agreed to flag it up in the newsletter.
Action: To put in the Newsletter
Minute 5/469 Meeting with LPC
Email received from Les Yeates, Chief Officer, Worcs LPC. He would like to meet with the officers of the LMC to look at areas where the two organizations could collaborate.
Dr Ounsted thought this was a good idea, we have done this in the past and it was very useful. Dr Radley agreed and said yes should respond. Dr Ingrams said that with small pharmacies under pressure it was important to do this. Committee agreed that representation from the LMC should meet up with them. Dr Ounsted, Dr Rankin, Dr O’Connor and the Secretary should be representatives.
Action: Secretary to write to Les Yeates and set up a meeting.
Minute 5/470 Outpatient prescribing
Letter received from Dr Ashton and circulated to committee. He agreed that they have moved too fast on this and he has asked the consultants to return to the pre April position pending further discussions on the matter. He went on to say that the precise clinical circumstances of when it is appropriate to prescribe in outpatients and when this should be left to general practice need to be defined carefully along with the timescales and mode of communication and has asked for the LMCs view on this.
Dr O’Driscoll said he made some good points in his letter. The problem is the delay in communication and could we ask for the Secretary to be present in the outpatient clinic and type up the letter straight away to give the patient when they leave. Dr Radley said there needs to be a more simple approach. Dr Ingrams said that in Coventry they have tear off pads. Occasionally you get one you cannot read but it works 99.9% of the time. The Chairman asked if we could have a copy of one of these. Dr Ingrams agreed.
Action: Dr Ingrams to send the LMC a copy of the form used in Coventry.
Minute 5/471 Performance Process
Chairman reported. Sandra Rote has been drawing up another performance process document. There are two issues with this, one is that he is not sure it fully cross-links with national guidance so the LMC will be meeting with her to make sure it does, secondly it hasn’t been through the PEC nor to the LMC so still in draft form. The worry was that it was run as a pilot recently, there was no adverse outcome but this is an important issue, as clinical governance is the national guidance and not performance, and another worry is if you have someone who is hostile implementing the guidance it could be a problem so the guidance has to be right. The Chairman said he would like to go back to her that the Committee would like them to meet national guidelines and be clinical and not performance related.
Dr Schrieber cannot see why Worcestershire PCT are developing their own guidelines as there are other guidelines that work, and so reinventing the wheel. The Secretary said there is a move to have a SHA wide policy, he met up with them to discuss this but the cost was £270,000 a year to run without actually doing anything so this will probably not take off. The existing policy is wrong. Dr Horton said putting extra things into a policy just makes it more complicated and not workable and they have to be very careful how they go about writing this.
Dr Ingrams said clinical governance is about trying to improve someone; NCAS says you must have a local procedure but do not say how you go about doing it.
Dr Lewis said he is an appraiser and if anyone wants to discuss any issues with him he would be happy to be a point of contact.
Minute 5/472 Provision of dressings for patients
Secretary reported on an old issue of stocking up rooms with provisions. Patient gets prescriptions and dressings come back to the practice. This is still happening in some practices. Dr Rankin said he has a document that we can refer to.
Action: To put in the Newsletter.
Items B
No items B
Items C
Application from Mr Randeep Ghateaura for preliminary consent to establish a pharmacy in Cookley, Kidderminster. Discussed with committee. Secretary to respond to PCT indicating we are opposed to this.
Application by Knights Chemist Ltd to establish a pharmacy at the new Primary Care Centre, Market Street, Bromsgrove. Support.
Application from Matrix Primary Healthcare for preliminary consent to establish a pharmacy in the vicinity of Aylmer Lodge Surgery, Broomfield Road, Kidderminster. No comment.
Application by A2Z Healthcare UK for inclusion in the Pharmaceutical List at The Rubery Late Night Pharmacy, 196 New Road, Rubery, Rednal. Committee do not support.
Application from Knights Chemist Ltd for preliminary consent to establish a pharmacy at 404 Grovely Lane, Cofton Hackett, Birmingham. No comment.
Application from Knights Chemist Ltd for preliminary consent to establish a pharmacy at 207 Sutton Road, Kidderminster. No comment.
Application by Tesco Stores Ltd for Inclusion in the Pharmaceutical List at Tesco Instore Pharmacy, Worcester Road, Evesham. No comment.
Change of ownership from Lloyds Pharmacy Ltd at 202 New Road, Rubery currently owned by Independent Pharmacy Care Centres Ltd. No comment.
The Chairman closed the meeting at 10.02 p.m.
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