_________________________________________________________
i) INR LES
The Secretary asked Mr Hairsnape a question regarding INR, he has said there is a rumour that the PCT are to transfer all anticoagulation services from the Alexandra Hospital to Worcester Royal. No formal discussions have taken place about this. Mr Hairsnape had not heard about this so will find out about this and come back to the LMC. Dr Kelly said he had heard that a key staff member at the Alex was leaving so perhaps this was the reason. Dr Kelly went on to say that the PCT were looking further into the INR LES as they were not aware that not all practices initiate warfarin, so looking at various levels. The Chairman said that a cost should be agreed plus the cost of consumables. Dr Kelly agreed and was confident that the PCT will finalise this soon and get the funding right.
ii) Extended Hours LES
The Secretary reported that we understand 27 practices have taken up the LES. The PCT are pleased with the initial response and are hoping to have the draft LES out soon, which will be a 12 month agreement. Practices are assuming the LES will be the same or better. Dr Kelly said that the PCT have agreed annual leave cover, 6 weeks holiday and study leave, pre booked telephone consultations - 2 per session, nurse time will not be funded but the PCT will support up to 50%. Regarding Saturday opening, the aim is to provide 25% of the monthly hours. (One Saturday per month approx).
The Chairman stressed that some practices are still not happy with Saturday working and asked Dr Kelly if he could take this back to the PEC. Dr Kelly said he would but felt that this was a good LES and much better than the DES. The Chairman agreed but said it was still unpopular in principal even though the LES is not as bad as it could be. Dr Horton said the PCT was obliged to do this. The committee agreed that Saturday mornings was still an issue for some practices, so some practices may not continue or take up the LES.
iii) GP Led Health Centre
The Chairman asked Mr Hairsnape why the new Health Centre was called a “GP Led Health Centre”, and what are current practices? Mr Hairsnape said this was to make it more obvious, as the health centre could be led by other professionals, such as nurses. It will be dual purpose, walk in and registered patients health centre and wanted it to be clear that for registered patients it would be no different to other practices.
The Secretary asked what the practice area for their registered patients was going to be. Mr Hairsnape said this had not yet been confirmed. Discussion took place about the practice area and about the role regarding registered patients and walk in patients. GPs must visit their registered patients and there must be a GP there at all times.
The Chairman said they have been told it will be located in Worcester and that the Scrutiny Panel said it wasn’t needed. The LMC has written to the PCT to ask when the consultation took place about the location. Dr Kelly said it has been decided on a variety of reasons, and Worcester City was where they felt it was needed, but he did confirm that there had been no formal consultation for the location. It has to be provided somewhere in the county and this was the best choice for patient need.
The Chairman said that practices will receive a letter from Heather McDonald informing them about the new GP Led Health Centre and asking for any feedback, she stated that the location hasn’t been finalised. This is misleading. Simon Hairsnape said that the exact location hasn’t been finalised as the provider can sort its own premises out or this can be done by the PCT but it has to be in a certain geographical location within the Worcester City area.
A lot more discussion took place regarding the GP Led Health Centre, with the timescale being a huge issue, and the PCT really pushing to get this through. The LMC felt that it could be slowed down so that more genuine consultation time could take place.
Dr Ingrams read out a statement from Ben Bradshaw regarding figures originally used in the house which shouldn’t have been used. He felt that yes all PCTs have to do this but he would rather PCTs were more honest and spoke out against it.
iv) PMS Contracts
Nothing has yet been done, waiting for Trevor Netherway to start.
v) Uplift to the PMS Contracts
The Secretary wrote to the PCT to see if they were going to uplift the PMS contracts in line with the review body. The DDRB award is still under negotiation and we have been advised to do nothing. The GPC do not know when it will be and are awaiting clarification from the DOH. Dr Ingrams said this only affects GMS and has no impact on PMS. But the PCT letter states they should await the outcome.
vi) Choose and Book LES
Dr Horton asked if the results of the Access Survey were available. Dr Ingrams said not yet, they will not be released until July, although they are out. Simon Hairsnape said he would look into this and let us know.
Simon Hairsnape said we were at the bottom of the West Midlands table and there was a lot of pressure for Worcestershire to do this. A lot of work has been done with the Acute Trust to make sure more slots are available and the Health Authority are giving support on the IT side. It was a new simpler Local Enhanced Service with rewards for those using it. This is another “must do” category for the PCT. They need to get to 50% use by September. They are putting a large sum of money in to try and encourage practices to take this up.
Dr O’Driscoll said the system has got much worse over the last few months with a lack of appointment slots. Simon Hairsnape said a lot of work is being done on releasing more slots so hopefully this will improve.
Dr O’Connor asked if we could continue to get monthly reports on who is using C&B as this was really useful in the past. Simon Hairsnape thought these had been sent out so will chase this up.
Dr Horton said you still cannot refer to named consultants. Simon Hairsnape said there is now a provision to refer to named consultants, although they prefer you not to. Secretary stressed that this was choice so should always be offered. Dr Horton said that this was fine if practices had the facility for the patient to take the appointment away with them but many practices do not have this. The Chairman said this was something Mr Hairsnape should take back to the PCT.
Simon Hairsnape said that Fay Harrison was working on improving C&B and if there were practices who were having problems then to get her to come and look at your systems to see if they can improve them. Dr Radley said that the problems should be sorted out centrally rather than going out to individual practices. Richard Kinsman agreed and said even the IT subcommittee group had problems with getting it to work.
Lisa Luke brought up the fact that when slots were available and you managed to book an appointment, the hospital invariably rings you and says this slot is no longer available. More slots are being released to resolve this and are being released by speciality. Dr Burger stressed that they needed to give more choice with a larger variety of dates.
Simon Hairsnape said that Worcestershire had the largest rate of failed attempted bookings in the midlands and it was a 50/50 chance if you were going to get an appointment so this is why the PCT have put money in to try and sort this out.
Dr O’Connor asked where the money has come from to put into Choose & Book. Simon Hairsnape said the PCT will use money they have kept back for incentives and other areas. The Chairman asked how this appears in the PCT accounts. There is an agreed £1.5m in incentives in the budget. Chairman said it would be interesting to know how much was set aside to incentivise GP’s; it would be nice to have a figure to put in the newsletter.
The Chairman thanked Simon Hairsnape for coming.
b. Education
No report.
c. Dispensing
Dr Ounsted informed the committee the next Dispex meeting was the day after the LMC Conference. He is pleased that the media has picked up on the White Paper and the affect it will have on all practices. They intend to do as much as possible to fight this and mentioned to the committee that there is a website on “Save our Dispensary” and asked for support. Dr Ounsted showed the committee the leaflet for this.
The Secretary is still waiting for more dates from the LPC to meet. We will chase them up on this.
d. Out of Hours
TCN Circular has been sent to all practices. They will be holding open day / evening information sessions in May and June. Dr O’Driscoll said they are taking over before September but won’t change anything until then. Dr Ounsted and Dr O’Driscoll have already been to one of the meetings. They didn’t really learn anything more from this.
Dr Kelsey said he knows a bit more about the structure of the service they are going to provide. They have been told that there will be a centralised call centre in St Marys Road, with a manager on duty all the time. All calls will be fielded by a call taker initially and then the nurse will ring back. They will be introducing ECN’s probably from October which will probably alter the number of doctors they will employ, but they will not substantiate this and have said that at night there will still be 3 doctors on call and will be adding a nurse. They will be introducing a new software system called “HMS” in October. Catherine Wilkins is the Resource Manger and she will be getting in touch with the local GPs who still want to work in this area. Dr O’Driscoll said that Catherine Wilkins led him to believe that they would give them rates of pay etc at this meeting but they didn’t tell them anything at all, no terms of service, just a verbal agreement that they will continue to employee doctors for the first two months then terms will alter after this time. Dr Ounsted has given them the LMCs contact details so they can contact us with a possibility that they may wish to come and talk to the LMC about the service they are going to provide. Journalists have also been in touch with them. Dr Ounsted suggested they may like to get in touch with local journalists but they didn’t intend to do this.
The Secretary asked the committee if the LMC should write and invite them to come and talk to us. There was a mixed response. The Chairman said we do represent the doctors, agreed that we should do this but not sure how useful it will be. Committee agreed that the Secretary should write and invite them to come to the September meeting, hopefully by then they will have firmer details.
Dr O’Connor asked if they had heard if the nurses were applying elsewhere. Dr O’Driscoll didn’t know, not heard this at all. Dr Kelsey said that TCN are looking at their employees continuing in the NHS pension but need to apply to do this. Dr Ingrams said this wasn’t possible, as they do not fall within the organisations that are eligible for the NHS pension scheme.
Action: Secretary to write to TCN
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
Spreadsheet circulated. Discussed LMC pay structure (as below). Levy for 2008-2009 to be 32.59p, statutory 26.52p and voluntary 6.07p.
ii) LMC Pay Structure – Chairman to report.
Figures circulated prior to meeting to the LMC Officers. The committee discussed the weighted average for England and agreed to pay the LMC Secretary and LMC Chairman by these rates. It was agreed that the LMC Honorarium should be increased by the rate of inflation, 2.75% for this year only with a view that we would look into this during the following year to be evaluated next year. Dr Radley proposed and O’Driscoll seconded. The majority agreed.
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
Secretary reported on his meeting with Daphne O’Connor. The 5% selection out of the hat was done for the in-depth QOF audit again. The secretary said they also discussed the IM&T DES. Andrew Hughes had told the PCT different information to what he has told practices. IM&T has to be done by clinicians and will be paid pro rata. The aim is to get data quality accreditation as much as possible. Dr Kinsman said it was very slow online and it may be worth inviting the Primis Facilitators to come out and help. Lisa Luke said they had been to two practices in Redditch and in one instance had deleted their whole Docman system. It took two days to get it back. Dr Ingrams said they use this in his practice and it has worked well. Dr Radley said you have to do it before you can put in the claim to get the money for this year.
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