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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday 11th September 2008 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr G Browne, Dr K Hollier, Dr A Kelly, Dr R Kelsey, Dr R Kinsman, Mrs L Luke, Dr F Martin, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr D Pryke, Dr D Radley, Dr J Rankin, Dr C Reynolds, Dr V Schrieber
Chairman welcomed Dr Kennedy, Medical Director and Jan Thomas from TCN
Dr Kennedy from TCN gave an overview of what is happening with the Out of Hours. The new system goes live on the 1st October. They have had consultations around the county, some of which are still ongoing. The new call centre will have call handlers; technicians and clinicians. The call handlers will take the basic details, will then put the patient onto the contact database and triage commissioners will call them back unless they are an emergency or warm, where they are kept on-line. When they are called back by triage, there are 3 potential outcomes, telephone advice; told to visit Out of Hours or home visit. This system is based in Worcester and is backed up by the system in Ipswich. If one system goes down the other backs it up straight away. They use HMS and not Adastra, and have used this for over 2 years. The system will be recorded and this is also backed up by Ipswich. The mobile I.T. uses rugged computers which are built to army specification. All cars will have mobile I.T.; phones; printers and the normal range of stock. Defibrillators will also be going back into the cars before the launch date. The model they use is a flexible model, using differing skillmixes and they will be starting to introduce advanced nurse practitioners and emergency care practitioners who have experience in their current system. Their complaint levels are similar if not better than GPs. If ECP’s or ANP’s ring GPs for advice then the GP is not responsible for their actions, they are just offering advice. ENP’s have to undergo an 18 month training programme. TCN are very strict that they have the training and have adequate and appropriate experience before they are allowed to work in the system. There are certain calls they do not get involved in. They don’t see or treat patients that need controlled drugs and also severe mental health issues. The model looks at some improvements in terms of amount of cover on shifts. They are intending to do a dry run on the system on Sunday 28th September and then further dry runs on the Monday and Tuesday prior to going live. They have done 2 similar implications in the last 12 months. They hosted 2 days of Pathway Development Workshops recently which will not be the finalised version, just a starting point to be developed. They use pathways to support the implementation of the servers and delivery. They work with competent clinicians and encourage and support them to use clinical skills within the model. There is a development programme for staff, ongoing development for older staff, clinical and non clinical.
Dr Kennedy gave an overview on how TCN started and how they have always been involved in registrar training. Dr Schrieber has given them advice locally and also distributed the TCN workbook and policies to educational lists in the area for their approval. Trainers who do shifts with TCN will be paid a £90 increment. A new system which they are evolving in Suffolk is broken down into 3 modules, and he explained how this worked.
Jan Thomas had brought a copy of the model that will go live from the 1st October and handed this round to the committee. The methodology they use when they go out to tender in a new area is to develop the model based on data given to them. They put together a basic model that they take forward, once they do work on the ground and meet people they find out more and readdress the model and then put additional shifts in as needed. This is how they have done it in Worcestershire. The model they are going live with is not the same as on the website as it has the additional shifts. Dr O’Driscoll asked why, if this were the case, had local doctors not been told this weeks ago; indeed why had they been specifically told this was not the case and there would be no more doctor hours on the rota at two previous meetings with TCN, the last only two days earlier. Dr Martin said she had discussed this and is pleased that the model handed around at the meeting is better than what is currently on the web. Dr Browne asked if there will be enough training doctors. Dr Kennedy said they welcome trainers. There are three types of trainers, existing trainers, some of whom work in system already and some trained clinical supervisors in the system. Dr Schrieber said he recently ran a training programme and TCN have said they would like to run the same training programme again and has had interest for this from existing GPs. Dr Browne asked if existing registrars will be able to book in to sessions from 1st October and how many sessions are there. Ms Thomas said they will highlight the training sessions on the rota but didn’t know how many there were at present and would have to look into this. Dr Kennedy said that TCN will guarantee that every registrar will get their training. Get in touch through the booking team, Catherine Wilkins. They can double check how many sessions there are but they didn’t have the information to hand.
Dr Martin asked what incentive is there for local GPs to work for TCN as information has not been correct and how are TCN advertising for local GPs to work for them. Dr Kennedy went on to talk about pay rates; increments; training and making the system easier and safer for clinicians to work in. They are meeting with local GPs, showing the systems and changing the pay rate to £50 per hour. Dr O’Driscoll had previously noted that these rates did not contain 14% superannuation, unlike current published rates. Dr Kennedy agreed this was true. Dr O’Driscoll pointed out that this was a 30% decrease on current rates of pay, rates that had already been found to be inadequate to fully staff the service with local doctors, and how could they call this ‘encouraging local GPs to work for the service’. This point was not answered, but Dr Kennedy repeated that TCN thought this was the market rate. Dr Martin asked again if they were 100% sure that this is the model that is going to happen from 1st October. Ms Thomas said yes, and that the model that will be run from 1st October. Dr Radley asked where they were going to get the people from to cover this last minute increase in the number of shifts being offered. Ms Thomas said again that this will go live from 1st October but they will revisit the model to meet demand. Dr O’Driscoll asked if they could guarantee that they will not employ EU doctors from other countries that do not speak English well. Dr Kennedy said that all doctors have to have excellent English. Dr O’Driscoll asked why TCN are paying agencies more than local doctors – offered £55 per hour to Connect rather than £50. Dr Kennedy denied this and said that TCN are not paying any more to agency staff. Dr Martin said you cannot see how many agency doctors are booked, and you cannot tell how many of the doctors booked come from agencies. At a local meeting with local GPs, Malcolm Cairns said they were not going to negotiate rates of pay with GPs; it would have to be done at the LMC. Secretary said he was happy to organise a separate meeting. Dr Kennedy agreed.
1. APOLOGIES
Dr P Bunyan, Dr N Burger, Dr R Horton, Dr R Ingles, Dr G Ingrams, Mr D Jago, Dr D Lewis, Dr K O’Connor
2. MEMBERSHIP
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 3rd JULY 2008.
4. REGULAR ITEMS
a. Worcestershire PCT
Mr Neatherway gave an overview of what is happening with the PCT.
i. The PCT have recruited a new Head of Primary Care, Linda Dando, who has worked in South Gloucestershire and Cardiff before this. Mr Neatherway will be staying with the PCT for a while, primarily working on PBC for Simon Hairsnape. For any ongoing discussions currently taking place with Mr Neatherway, to keep forwarding this onto him for now and he will pass on any information to the relevant person.
ii. Extended Hours –
The DES has been circulated. Mr Neatherway has said this guidance is much firmer than the interim guidance and gives the PCT very little leeway. This guidance is very clear that where existing agreements are in place they have to be reviewed to be more in line with the DOH guidance. They have to offer this DES by the end of the month, but will honour the LES until the 31st March but they have to be clear that from the 1st April 2009 it will then be the DES. The PCT will be writing to all practices shortly.
The question was asked about the additional 5 DES’s that have to be published – where will they be getting the funding from. Mr Neatherway agreed and said that these 5 DES’s were going to cost the PCT half million pounds which they had not budgeted for and cannot afford, but said there was a bit of leeway in the PCT budgets which will just cover this but nothing else. Dr Kelly was worried that with the new Extended Hours DES, if practices do not do this then we may be falling into the Government trap by not doing it and encouraging GP Led Health Centres. Secretary agreed with this and said most areas may not get up to the 50% uptake, which may encourage more spin against GPs. Lisa Luke said following a meeting earlier that day, other areas in the country do not have to take up the DES and their PCTs are being more flexible, so why are Worcestershire PCT not as flexible? Mr Neatherway didn’t know about this but said this has come from above and they were in the opinion in was nationwide.
iii. INR LES
Mr Neatherway said this document has been circulated for final comments, once they receive this further information hopefully it should be then ready to go out. Dr Hollier said he was concerned about domiciliary visits. This is not compulsory. Dr Hollier also asked about the extra training for the accredited course and who was going to fund this. Mr Neatherway did wonder if PBC would provide funding for development.
iv. Enhanced Services uplift
The national deal on the uplift to GMS is nothing on baselines and similarly for PMS baseline but there is an uplift on LES’s by 2.3%, which is the national tariff increase for 2008/09.
v. PMS
Mr Neatherway is still working on this and needs to clarify with Dr Abudu about signing this off. The issues remain about the baselines.
vi. Care Home LES
They are working on the LES and will clarify at a later date.
vii. DM LES
These have been sent out and there are some concerns that they didn’t come through the LMC. The Secretary raised with Simon Hairsnape months ago the whole issue of agreeing new LES schemes and said that if PBC clusters cannot do their own then they shouldn’t be in the budgets. Need to get this sorted to see if clusters are to have their own LES’s. Dr Kelly said PBC clusters and the PCT are producing their own guidelines that need bringing together and stressed that the PCT need to sort this out and be clear who is involved etc.
viii. Allocations policy
Still reviewing this.
On another issue, Dr Pryke said that practices had received a letter from Chris Emerson at the PCT dictating that from 8th September the only way to book a 2 week wait cancer referral is via Choose and Book. They have not had any discussion with the PCT about this and C&B is not working well. Mr Neatherway said he would look into this when he got back into the office.
Mr Neatherway said they were about to send the COPD LES out.
The Secretary said he was worried about the training course for the new Learning Disabilities DES, and said it was the PCT’s responsibility to organise training. Mr Neatherway said he would talk to the Learning Disabilities Team to sort this issue out.
The Chairman thanked Mr Neatherway for updating the LMC on the current situation within the PCT.
b. Education
Dr Schrieber confirmed that Martin Wilkinson has been appointed the substantive Director of GP Education for the West Midlands. There is to be a national campaign to increase the number of training places, so something will be going out to training practices to check training capacity and also to non training practices to ask whether they would like to consider training. Agreed to put something in the Newsletter. There is some confusion about trainers CPD payments. In the past they have had to claim the money from Dr Schrieber. They should have received correspondence from him to send in their 2007/08 claim direct to him, but from 2008/09 this claim should be sent to the Deanery. They may have received two lots of correspondence but to be clear this is for different claim years. If anyone is still confused they can ask Dr Schrieber.
Action: To put in Newsletter
c. Dispensing
Dr Ounsted has offered his resignation from the Pharmacy & Dispensing Subcommittee. The Chair wanted Dr Ounsted to step down. The Secretary said it was not an LMC right to sit on this committee. Dr Ounsted has written to the committee about this and wanted it on record that he was most unhappy about this request. Dr O’Connor happy to continue to go. The question was asked if we should have a deputy when Dr O’Connor was not able to go. Dr Rankin said he was happy if it was just a deputising post. The Secretary to write and tell them.
Dr Ounsted said he had received an email from Peter Holden who is willing to come and speak to GP’s about rural issues as the GPC representative. Dr Ounsted said he could hold the meeting in Evesham and invite people from other areas such as Hereford and thought the LMC should chair the meeting. The committee agreed this was a good idea and said if Evesham GPA wanted to organise this then the LMC would be happy to help.
The document “Pharmacy in England” is on the next Agenda for Dispex. We should encourage patients to write and not fill in the questionnaire on line.
Action: Secretary to write to Pharmacy & Dispensing Subcommittee
d. Out of Hours
Discussed in the closed session.
e. Non-Principals Group
Dr Martin said mostly discussed earlier but stressed there will be big implications if the OOH issues are not resolved.
f. Registrars
No report.
g. P.M. Groups
No report.
h. Administration Issues
Secretary reported on a current Limited Company issue. When we formed the LMC Ltd Company we were informed by the GPC that there were no VAT liabilities. HMRC were not interested in just the levies but became interested in LMC’s as a whole and have looked into them. We have now heard that we do not have to pay VAT on statutory levies but we have not yet heard about the voluntary levies. The documentation will have to be changed for the Limited Company. The LMC will become the ‘Pay Master’; the LMC will give the money to the limited company as income as any other business would do.
i. P.B.C. Issues
The Secretary said the issue of LES’s needs sorting out. He attended a meeting with the PBC Cluster Manager for Redditch & Bromsgrove and said they are now beginning to make progress. Issues with the Acute Trust needs sorting out and GPs need to feed back to their clusters the problems they have with the Acute Trust. The Acute Trust are now starting to send representatives to the PBC cluster meetings but we need to feed back any problems we may have. All PBC Leads meet at the PBC Forum. Committee said we should bring the clusters into the PCT so that there is a countywide voice. Dr Kelly said that this is done at the PBC Forum and minutes are sent to the LMC Secretary following these meetings. It was agreed that these minutes should be circulated to the other LMC members.
Action: Secretary to circulate minutes to members
j. I.T. / GPSoC
Dr Kinsman said that there is a big problem with the email server, which is going to be ongoing. He asked if we could put something in the Newsletter to encourage doctors and practice staff to move to nhs.net email addresses. If they obtain these new email addresses all mail going to their old addresses will be forwarded to their new addresses for a temporary period of time.
Lisa Luke reported that there is a problem with the Help Desk and support and gave an example of one of their PC’s going down, it took 3 weeks before they had any response and then the problem was not rectified. It was only after John Thornbury was involved that the problem was sorted out. She asked if John Thornbury would consider practices having a spare PC. Don Beckett said the trouble with this is that if the PC is not regularly used then they will not be up to date. It would be better if you could rely on the service. An alternative way would be to have a laptop, which would be a better way of giving backup. Will put this in the newsletter.
The LSP Administration System is being upgraded and letters have been sent out addressed “dear doctor” or “senior partner” for a temporary time. This is not used in Worcestershire so practices will only get correspondence from elsewhere.
Action: To put in the Newsletter
5. MATTERS ARISING
Minute 5/469 Meeting with LPC
The LMC and the LPC are meeting on the 17th September at 7.30 p.m. at the Hilton Hotel, Bromsgrove. Dr Parkinson, Dr Ounsted and Dr Rankin are to attend. The LPC have four issues on the agenda which are Minor Ailments; Repeating Dispensing; MURs and Future Collaborative arrangements. The LMC agreed that we would put the following on the agenda for discussion: Building the Relationship between the LMC and the LPC and the Pharmacy Review.
6. COMMITTEES
a. GPC
The Secretary went over the M1 Circular and issues in the latest Negotiating News.
b. GPCWM
i. Secretary fed back from the GPCWM meeting on 24th July
ii. Nuts & Bolts is on the 28th October 2008 and the agenda has been circulated to the committee members. The Secretary will be unable to go on this occasion and urged the members to go if they were able. Dr O’Driscoll said he may be able to go and will confirm as soon as possible. The Secretary said that members can claim expenses and may be able to claim other expenses but we will need to check this.
7. NEW ITEMS
Minute 5/484 Stakeholder Representative on the Council of Governors.
Secretary reported that the LMC has received a Letter from Michael O’Riordan, Chairman of Worcestershire Acute Trust who has suggested that the LMC appoint a stakeholder representative on their Council of Governors as they become a Foundation Trust. The LMC agreed that this is an offer we need to take up, and to have a representative and a deputy. The Secretary to find out the commitment, when meetings are and if there is any remuneration.
Action: Secretary to write to Michael O’Riordan
Minute 5/485 IM&T DES
Letter received from Daphne O’Connor following the LMC contacting the PCT regarding the payment of Component 2. She has confirmed that the PCT will honour Andrew Hughes’ promise to practices that they could be paid ahead of achieving the data accreditation standards provided they have fulfilled the requirements bullet-pointed in the same letter. The clause states that monies for Component 2 would be recovered from a practice if the practice had not achieved the level of clinical accuracy set out by PRIMIS. IM&T Facilitators have been to the majority of practices and will be there to support and help practices achieve this, and the impression from the PCT is that they will probably not be in a position of having to recover monies at year end. Daphne O’Connor was appointed Dental Commissioning Manager as of 1st July and in the interim Trevor Neatherway will be taking on the work of the QOF and enhanced services for GPs.
Action: To put in newsletter
Minute 5/486 Possible BMA Law Seminars
Secretary reported that BMA Law has developed two more seminars. They are two potential 1½ hour slots on Procurement Tendering and the Rules and Contractual Law & Negotiation. The question was asked if it was worthwhile offering these if we can get the drug companies to sponsor them. Agreed it was a good idea, we will explore this and come back once we have an answer from the drug companies.
Action: To investigate sponsorship in the first instance
Minute 5/487 GP Appraisal – Access to practice IT
The Secretary had received a letter from a GP. An appraiser who was given a consulting room to use accessed the practice computer without their knowledge and consent. The committee felt it was a disgraceful breach of confidentiality and they should be reported for it. Dr Kelly said it should be taken direct to the Lead Appraiser by the GP in the first instance. The committee summarized by saying that these are two separate issues. In regard to EMIS we should talk to John Thornbury about the security issue and then highlight this to practices. Regarding the second issue we should talk to Dr Ingrams, Secretary at GPCWM for his advice and ask the GP to write to the Lead Appraiser.
Action: Secretary to write to the GP and John Thornbury
Minute 5/488 GP Performance Review
The LMC has received a reply from Sandra Rote from Worcestershire PCT regarding the GP performance review. She apologised that they had not been in touch and consulted again with the LMC regarding the policy but all comments received had been incorporated into it and they were of the view that the LMC had concluded all of their comments and therefore the ‘final’ version was sent to the PEC for endorsement in May. The PCT will need to review the current arrangements and begin work straight away on developing the process for re-validation but they did say that they will work closely with the LMC on the process for revalidation. Dr Kelly said the PEC had agreed with the sub-committee that they should ask Dr Parkinson to go. Committee felt this was a good idea.
Minute 5/489 Redditch Community Mental Health Team
Practices had received a form that they needed to complete which the LMC was not happy about. Following a letter the LMC had sent about this we received a reply back from Terri Awaard. She said that although forms were sent out in her name it was without her knowledge and approval and admits that it was inappropriate that this was sent out.
Action: To put in Newsletter
Minute 5/490 Choose and Book use for 2 week Cancer Referral
Discussed earlier in the meeting.
Action: Mr Neatherway to look into this.
Minute 5/491 Prescribing MRSA patients
Secretary received an email from Dr Keeble who was asked to prescribe treatment for a patient who had screened positive for MRSA prior to an operation at WRH. Dr Keeble has raised this with Anne Kingham from the PCT who has said it is the GPs responsibility to do this. Dr Hollier said it doesn’t happen very often so really is not much of an issue. Dr Kinsman said it wasn’t urgent and was safer for GPs to prescribe than others. He did say that it should not be a faxed request as this appears to make it urgent rather than routine, but they do come through by fax which is inappropriate.
Action: Secretary to write to Anne Kingham
Minute 5/492 HPV Vaccine LES
Secretary reported. There have been various meetings about this, and the outcome is that all practices will be available to do HPV Vaccine and the catch up. Practices cannot order the vaccine directly, have to order 2 – 4 weeks ahead via the PCT, but delivery will be direct to the practice. Practices will be given a small stock of about 5-10 in each delivery. There are approximately 3,600 girls in the county in year 13, and a National Consent form can be used. Child Health need to be notified when they are done but this cannot be done electronically; you have to fax the form back to say they have been done within 48 hours. Practices will be paid £9 an injection. If the patient prefers the practice to do these rather than at school then this is fine. Cannot have a reciprocal arrangement with another practice. A detailed LES is being produced.
Action: To put in the Newsletter
Minute 5/493 MMR Catch Up
Secretary reported. The PCT have been given £30,000 to fund it. No one knows how many will come back, maybe 25-30% but it is a bigger problem in Malvern than anywhere else in the county. There are two groups, under 8s and over 8s. There is to be a national campaign, Child Health will send you a list of patients to do but the template letter is to come from practices. One of the issues they want to tidy up is the refusals, so the patient will not keep being called. Practices will be paid £7.51 per injection. A LES will be produced.
Action: To put in newsletter
Minute 5/494 “Improving Local Health Services – GP Centre”
Secretary reported. He received a phone call from BBC Hereford and Worcester regarding the information on the new GP Led Health Centre, the information on who would use the service is now out. Only 35% said yes they would use the service and only had a total of 357 respondents. Secretary read out results that have now been published to the committee.
Items B
Circulated
Items C
CLOSED MEETING (if appropriate)
A brief closed session of the LMC took place. The Secretary has informal notes on this discussion.
The Chairman closed the meeting at 10.20 p.m.
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