PRESENT:
Mr D Beckett, Dr N Burger, Dr K Hollier, Dr G Ingrams,Dr R Kelsey, Mrs L Luke, Dr F Martin, Dr K O’Connor, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr D Pryke, Dr D Radley, Dr K Rainsbury, Dr J Rankin
Chairman welcomed Trevor Neatherway, new Acting Head of Primary Care.
Mr Neatherway introduced himself and gave an overview of his background. He had a good relationship with his previous LMC in South Wales so hopes to do the same here in Worcestershire. He has been here for four weeks now, just getting into things and there is a lot to do. There has been a big turnover of staff and the Primary Care team is still understaffed and they have lost a lot of knowledge as people have left so things are quite difficult at the moment and this is one of the things he has been tasked with improving. He has many areas he has been asked to work on including PMS contracts which unfortunately they didn’t have in Wales so this is also a steep learning curve for him too. He will also be looking into Childhood Immunisations and the National supply problem which has resulted in rationing of supply to practices, and the expectation that through no fault of theirs, they may miss the targets for full payment.
Dr O’Connor asked Trevor Neatherway about the PBC Clusters and that not all practices are in the clusters, and for those that are not they have not been sent the Choose & Book forms that you give to patients to confirm they have been offered Choose and Book. These practices were represented in the PCT by Rosemary Williams but now she has left she has not been replaced and therefore they now have no representation within the PCT. The Secretary reiterated and said a handful of practices are not in clusters so Mr Neatherway does need to be aware of this. Mr Neatherway said he didn’t know what the answer was but will take this away and will find out what they can do to put it right.
Dr O’Connor also asked about the GP led health centre and how has Herefordshire PCT got round the Government dictat? Mr Neatherway said that Paul Bates has said that Herefordshire are doing the same as Worcestershire but the Secretary said this was not the case. Herefordshire are adapting it to make it more useful but Worcestershire is not doing this and says they can’t do this. The Herefordshire plan is not the same but apparently has had Government approval. Secretary said he feels this is a shame because what they are doing would work in Worcestershire. It is probably too late now. Richard Taylor MP has brought this up and intends to go and see Paul Bates to discuss this in more detail. Mr Neatherway said he hasn’t been too involved with this as it’s quite a long way down the line now. There is to be a briefing session for all those who have expressed an interest next week. The question was asked about the proposed target date of having something in place by 1st April 2009. Mr Neatherway said this may be tight but not aware of any other dates.
Secretary asked Mr Neatherway about the INR LES. Rumour is that it has been put back till the 1st April 2009. Mr Neatherway said this is not what he understands but that they are trying to sort this out. They had a meeting a couple of weeks ago with the Acute Trust and should be in a position to resolve this before the 1st April. Secretary said we did tell Simon Haresnape at the last meeting that the nurse who ran Redditch INR department has gone to a private hospital so it looks like the bloods get sent to WRH and the practice nurses feel this is a recipe for a potential disaster. On safety grounds there are concerns and we have no idea who is doing what. We have been told that nothing would change with the system, but this is not the case and it is now dangerous. Secretary said that the Acute Trust do things without telling anyone on a regular basis and gave some examples. Mr Neatherway said the situation in Redditch was mentioned but not gone into in great detail so this wasn’t really picked up. Issues around safety are very important and we do need to tighten up all the systems so will be looking into this. The Secretary agreed and said this falls down in shared care, so something does need to be done to resolve this before a problem occurs.
Secretary asked Mr Neatherway about the PMS contracts and said a date would be useful when these will be completed. Mr Neatherway said a lot of practices have sent it back on the proviso of the amendments and some others not sent it back as yet. Secretary said that practices which have sent them in have not heard anything back, had no reply at all. He apologised for this and said he will get an acknowledgement out to the practices that have sent them in. The next step is to work through them. Dr Abudu doesn’t want them signed off until the baseline problem is sorted out. There are two issues outstanding, coil fitting and minor surgery and need to define them in an addendum. Dr Rankin said could they also look at quantities and not just procedures. Mr Neatherway said this is one of the jobs he has to sort out quickly. He is not sure on timescale, hopefully by the end of the summer.
Dr Pryke said he is unhappy with the Choose & Book LES. Their practice has been doing C&B but under the new LES their income will drop by two thirds, so have no incentive to take this on and do not feel this is something they will continue to do. He asked the question whether this was a done deal or is there scope to change this. Mr Neatherway asked Dr Pryke to email his calculations. Dr Pryke said he had already sent these to Fay which he had received a reply which he was not happy with. Secretary said Dr Ian Morrey had copied him in regarding different issues so will forward these emails to Mr Neatherway.
Chairman thanks Mr Neatherway for coming to the meeting and introducing himself to the committee.
1. APOLOGIES
Dr G Browne, Dr P Bunyan, Dr R Horton, Dr R Ingles, Dr A Kelly, Dr R Kinsman, Dr D Lewis, Dr C Reynolds, Dr V Schrieber
2. MEMBERSHIP
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 5th JUNE 2008.
Amendment on page 5, item J in the line it should have mentioned CHART as it was unclear.
4. REGULAR ITEMS
a. Worcestershire PCT
i) Trevor Neatherway, Acting Head of Primary Care from Worcestershire PCT in attendance (as above).
ii) Annual Public Health Report.
Secretary reported that the document was very good, interesting and clear.
iii) Worcs PCT – Developing a Strategy for Health document.
Secretary said this was an interesting document and it mentioned the LMC twice which he felt was very positive and he welcomed the frankness of the document. It is unusual for that reason!
b. Education
No report.
c. Dispensing
Dr Ounsted reported that the meeting between Lisa Silvers and David Cameron was very good, and the positives that have come out of this is that we have both the Liberal Democrats and the Conservative Parties on board. Dr Ounsted then gave an update on the last DISPEX meeting which was well supported. The panel were asked some very good questions and the feeling at the end of the meeting was more positive. Dr Ounsted mentioned that colleagues in other areas have met with their LPC and can we push this with our own LPC. The Secretary confirmed this has been done and we are just awaiting dates.
Dr Rankin said he, together with representatives of Abbotswood and Upton on Severn had met with Harriet Baldwin, Conservative PPC to replace Sir Michael Spicer at the next election, to discuss the pharmacy white paper and its effects on services for patients.
d. Out of Hours
Secretary reported that TCN are proposing to send a representative to the LMC meeting in September.
The Secretary has contacted the PCT with a proposal to levy doctors working in the OOH. Dr Abudu has been tasked to look into this. Dr Kelsey said this relates to his question of now they are working for a private company would they still have the same relationship with the LMC? Secretary thought that if doctors are working in a practice as a locum then yes but just purely private work then it may be more complicated. Need to look into this more. Chairman asked if they would still want to be formally represented. Dr Kelsey said yes they would, most salaried doctors are part time, only two in the OOH are full time. Dr O’Connor wondered if TCN would allow membership to the LMC. Dr Ingrams said that an LMC has a duty to represent doctors who are salaried if they have told the PCT they want to be represented.
Dr O’Connor said that Teresa French advised them that TCN have promised they would honour every contract that exist at present and would honour as long as the person wishes to work in the OOH. Dr Kelsey thought this was a misunderstanding and it meant those that were on a salaried contract, under TUPE they have to do this, but those working in the service as additional hours are not covered under TUPE. Dr O’Driscoll said that he had a contract from the PCT in 2005 which specified rates of pay, and he is not a salaried GP, just doing extra hours. The BMA believes this is not covered by TUPE. Dr O’Connor reiterated again that Teresa French thought they would honour all contracts. Dr Kelsey said they were reassuring the salaried doctors at the meeting Dr O’Connor was talking about. Dr O’Driscoll went on to say the new pay scales were despicable and they are offering a pay cut. Pay rates haven’t increased since 2004, and there was an initial incentive scheme which has been withdrawn. These are significant pay cuts, TCN are now offering £50 per hour, and £55 for the red eye shift when before it was £60 & £70. No mention of superannuation on the new rates, before there was 14% on top of the hourly rate. Dr Martin said that superannuation has not been mentioned in the offer, although you cannot contribute to the NHS pension if working in a private organisation. Dr O’Driscoll thought that if they offered superannuation then they could pay it into a private scheme instead. The question is if they get it at all, not where it goes. Secretary said that Badger Harmony did the same in South Staffordshire and he told Paul Bates. This is a real issue, especially as we may lose GPs who can supervise registrars. Dr Martin said the real danger is that registrars coming through have to do 72 hours OOH training in their final year so the capacity won’t be here to do this. Only way we can do this is to have local GPs who work in training practices to enable us to do this. Dr Martin has asked TCN for a significant raise in the hourly rate to supervise registrars. Had two speedy replies saying they will discuss it at the meeting next week.
Dr Schrieber sent an email saying he has concerns about the opportunities for training if all our local GPs decline to take a pay cut and are thus not providing supervision. He doesn’t know the state of play of the current salaried doctors. He is due to meet someone from TCN as they are keen to get accredited for training but he will be unable to do that unless he has assurances that suitable doctors will be available for supervision. He supports Dr Martins move to ensure decent rates of pay for those who are able to supervise (trainers, other docs in training practices or salaried docs who have participated in their training). He could provide training for TCN doctors (at TCN's expense) but would need to be assured that these were permanent members of staff not just doctors bussed in for odd shifts.
Dr O’Driscoll says he doesn’t want us to miss the main point. All local GPs should be paid a reasonable rate and TCN have said from the start that they are desperate to encourage local GPs. There are about 20-25 people on the email list who are talking about having a meeting and are looking at going elsewhere or giving up the extra hours entirely. Dr O’Driscoll went on to say Paul Bates said the OOH service was inadequate soon after he arrived, which we knew, thanks to underfunding. Instead of simply recommending adequate funding and developing the system in place, he insisted on this hugely expensive service review with subsequent appointment of providers of what seems destined to be a far inferior service with active discrimination against involvement of local GPs, both training and non training. When challenged he seems to respond only by distancing himself from the commissioning process, insisting it was all done correctly and independently from him. The truth is that he is entirely responsible for this likely impending and possibly disastrous deterioration in the County OOH service, and he must take responsibility now for putting things right or accepting the consequences for patient care.
Dr Kelsey said the salaried doctors have shared their concerns that if the quality of the doctors supporting them falls then the quality of support will not be in place.
Dr O’Connor asked if there was any point in writing to the PCT as they are still responsible. Mr Neatherway said he will take all this back to the PCT, about our concerns about where this is going and the points about rates of pay. He felt it was very important to sort out the issue on training. This is an important point that needs sorting out with the Deanery as this has a knock on effect as to whether trainees work in Worcestershire in the future. The PCT are monitoring what TCN do but he didn’t know what mechanisms were in place to do this as yet. He did say that TCN were the employers and therefore the PCT probably cannot interfere if the GPs are willing to work for those rates.
Dr Radley said the OOH service would have been better if they had just put more money into the older system. Dr Ingrams said a lot of pressure to put the OOH service out to tender had been put out nationally, and said it may be worth writing to say these were our initial concerns and they have been proven right.
Dr Ounsted said that in regard to superannuation there was an indication in the Darzi report of an intention to introduce legislation to correct this anomaly. Commercial companies won’t want to offer this as it will cut their salary costs by 14%.
Dr Kelsey said could we put something in the Newsletter to remind GPs that for any patients having blood tests done in the day could they put down a telephone number for the patients so they can contact the ones who have abnormal blood tests, as it is time consuming and frustrating having to find this out. Discussion took place; it would be possible to alter their systems so the telephone number is printed out on the labels.
Action: Newsletter
e. Non-Principals Group
Discussed earlier in meeting.
f. Registrars
Dr Rainsbury reported that Registrars are now coming through but there are few jobs available and said that although the pay isn’t great doctors will be willing to work for lower pay. They do want to support what is going on but they also need to work.
Dr O’Driscoll said he agreed with the BMA advice that practices should treat qualifying doctors properly and take them on as partners. Dr Ounsted said that looking at the adverts for jobs in all the publications they seem to ask for salaried rather than partners. Secretary agreed and said with the way things were at the moment practices were not confident enough to take on partners with the current climate.
g. P.M. Groups
Nothing to report.
h. Administration Issues
Executive Officer reported that following discussion on the LMC listserver regarding paying member’s mileage allowance it has come to our attention that any amount over 40p per mile is taxable and members will be taxed on this. It was put to the vote and was carried.
i. P.B.C. Issues
The PBC Forum has been cancelled because no one is going. Adverts are going into the Health Service Journal for Assura Vertis LLP services for Dermatology and Echo Cardiograph. There is still a lot to do and the main concern is that there still appears to be no internal communication between the internal PBC groups.
Dr O’Connor said that we still have no idea how many practices are not affiliated to a PBC group and suggested that the Secretary contact all practices to see who they are affiliated with. Dr Radley suggested we ask for those who are not within a cluster.
j. I.T. / GPSoC
i) Back up tape encryption.
The LMC received an email from the GPC about this. Dr Ingrams explained that GPs had always relied on the fact that unless someone had access to the same clinical system it is highly unlikely that if a practice back up tape was stolen or lost that the data could be accessed. This is no longer considered acceptable, and the proposal is to have encryption software on all practices' servers so all backup tapes are automatically encrypted. There is a national procurement plan to reduce the cost. The issue has been raised that there may be a requirement for some surgeries to have an upgrade to their server or software to cope with this. Dr Ingrams said that the LMC should advise practices it is coming, that it is best practice, and will be funded by the NHS.
ii) IM&T Des
Mike Arnold from Spring Gardens Health Centre emailed the LMC regarding the email sent by Daphne O’Connor. He was concerned regarding the wording of the email which says “Although payment will be made ahead of formal recognition of achievement of data quality accreditation, please be aware that the PCT will recover any monies paid under Component 2 from practices that have not achieved 90% clinical data accuracy in most areas by the end of the financial year 08/09”. Mr Arnold believes the standard of 90% does not form part of the initial agreement as per the brown book p222, paragraph 12. He also went on to say that although he has uploaded data to PRIMIS there are significant problems with ISoft & Miquest reporting.
Dr Ingrams confirmed that Mike Arnold is right and this is incorrect as per Appendix A of the IM&T DES. We have written already to Daphne O’Connor and haven’t heard back from her. We will chase this up with Trevor Neatherway.
Action:
i) To put in the Newsletter
ii) Contact Trevor Neatherway regarding the above
5. MATTERS ARISING
Minute 5/474 Superdrug Allergy Testing
We have received a reply from Professor Lewis at the Acute Trust who fully shares the concerns of the LMC that this will generate more work without perhaps it having a positive outcome for the patients concerned. This whole area has been looked at by the Select Committee on Science and Technology and unfortunately there is nothing we can do to prevent this type of allergy testing. He went on to suggest that it may be useful to audit the workload generated by this across the county. He sent pages of the report for information. Secretary doesn’t think we can do anymore for this.
6. COMMITTEES
a. GPC
i) M10 Conference News circulated
Secretary reported that this was the biggest ever contingent from Worcestershire. It was an interesting Conference and less controversial than in previous years as everyone is universally upset! There was a great deal of unity and more determination from all four countries to work together. Laurence’s speech was very good, it was very determined and he got three standing ovations. Steve Field was invited to talk which was very supportive and it was clear there was no rift between the two groups (BMA/GPC and RCGP). The best bit was that so many people signed the petition which has clearly upset the Government. The Federation of Police also sent a letter of support to Hamish Meldrum! It was a good Conference.
ii) Dynamising Factor – GPC Focus document circulated
Document circulated to members. There have been many complaints to the Pensions Agency on how long it is taking to sort out the pensions. There is a huge delay in getting pensions summary and this is taking longer than usual. Secretary said he writes every year to do this, only have a 3 month window to correct it.
b. GPCWM
Nothing to report.
7. NEW ITEMS
Minute 5/477 Central Regional Forum
Secretary reported on the BMA Meeting on the 18th June. This was addressed by Steve Coney, the Director of Communication and Public Affairs at the West Midlands Strategic Health Authority about the impact of the Darzi review across the West Midlands. Secretary said his speech was incredibly political and we didn’t get a straight answer about anything. We tried to pin him down about the rationale behind the GP Led Health Centre which he managed to avoid. Best answer got was “its business”. He talked about the 10 working groups across the West Midlands and how good they were but Mark Porter said he was on the Maternity Group and it didn’t do what it was meant to do so they weren’t as good as Mr Coney indicated. The meeting was very concerned at the content and presentation of the Darzi review by the SHA.
Dr Ingrams said that section 3.3 in the WMSHA Minutes mentions the BMA Campaign as follows:
“An issue which has caused a great deal of work for the programme team and communications colleagues at present is dealing with the media coverage and public enquiries regarding the current BMA campaign which is seeking patient signatures to petitions in opposition to the EAPC Programme. In terms of the progress of the Programme, however, this campaign is only a risk at this stage if it had had an adverse effect on the number of potential bidders. Given the high number of formal Expressions of Interest received this has not been the case. Nevertheless given that much of this campaign is based on inaccuracies and is, we believe, causing unnecessary upset to patients, this requires a robust response from the SHA and PCTs. To this end, we have circulated the recent DH guidance to communications leads and, have prepared some brief key messages as the basis for PCT responses and to encourage a more proactive approach to getting the message across.”
Minute 5/478 Neurophysiology Forms
Letter circulated to committee prior to meeting from Dr Blake at Worcestershire Acute Trust who was grateful for all GPs who participated in the trial for the Clinical Neurophysiology referral form. They found that the effect of the form was to greatly improve the quality of the referral letter that often came with it. They are not planning to use that tick box form any more, it was cumbersome, irritating to fill in and quite difficult to read. They have introduced a new general Neurophysiology referral form covering EEG’s, evoked responses and nerve conduction studies/EMG’s internally. They intend to send the forms out to practices by 1st August. They have sent a copy of the form to the LMC for any comments/amendments we feel might be appropriate. Practices will be able to continue to refer in the usual way with letters and ignore the form completely if they so wish.
Action: Newsletter
Minute 5/479 LMC Conference 2008
Discussed earlier in the meeting.
Minute 5/480 Pathology User Group
Dr Kelly has commitment from the PCT to fund backfill for a GP to attend the meeting on a regular basis. Dr Kinsman cannot attend the next meeting, is someone else able to go to this instead. The next meeting is on the 16th July at 9.30 a.m. and lasts for approximately one hour. The group meets every 2 months, but they wouldn’t expect the representative to attend every meeting. Secretary asked the committee if anyone can attend. No one came forward.
Action: Secretary to write to Dr Kinsman to let him know outcome.
Minute 5/481 Darzi Review
Circulated to committee prior to the meeting. Secretary and Chairman reported. Dr Ounsted said it was phrased well and very hard to criticize.
Secretary and Chairman read out sections they had highlighted from the report to the committee they felt were pertinent.
Minute 5/482 Letter Michael Foster MP
Tabled. Letter shown to committee during the meeting. Secretary also received a letter from Jacqui Smith MP which wasn’t quite as bad, and has suggested meeting both of them which neither has taken us up on. Secretary went on to say they haven’t grasped what this is all about and would urge GPs in Worcester City to write to Michael Foster individually. Secretary will also reply to his letter. The BMA’s Patient Participation Group Chairman spoke at Conference about why Government policies were wrong, and has written a very good three page briefing note which secretary will send to Michael Foster with his reply.
Secretary also spoke to Richard Taylor MP. His view about the GP led health centre is if we are going to get them anyway we may as well get them to work in our favour. His view is to go down the same route as Herefordshire PCT and put this GP led health centre near an A&E Departments where there is greater need.
Dr Ingrams said that after meeting with Coventry Labour MPs, they have agreed to try and set up a meeting with their PCT to try and change how they are going to do it.
Action: Secretary to reply to Michael Foster MP
Minute 5/483 Letter Lord Darzi
The letter was circulated to the committee prior to the meeting. Secretary will reply.
Action: Secretary to reply to Lord Darzi
Items B
Circulated
Items C
Application for preliminary consent to establish a pharmacy in Calder Road, Burlish Park, Stourport on Severn. No comment
Application to establish a new pharmacy at Priors Park, Tewkesbury, Gloucestershire PCT
No comment
CLOSED MEETING (if appropriate)
A brief closed session of the LMC took place.
The Chairman closed the meeting at 09.22 p.m.
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= No Agenda
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