Meeting Date: Thursday 9th October 2008
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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday 9th October 2008 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr G Browne, Dr P Bunyan, Dr P Coney, Dr K Hollier, Dr R Horton, Dr R Ingles, Dr A Kelly, Dr R Kelsey, Dr R Kinsman, Dr D Lewis, Dr K O’Connor, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr D Pryke, Dr J Rankin, Dr V Schrieber
1. APOLOGIES
Mr D Jago, Mrs L Luke, Dr F Martin, Dr D Radley, Dr C Reynolds
2. MEMBERSHIP
Dr Phil Coney has taken over from Dr Kathy Rainsbury as Registrar Representative.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 11th SEPTEMBER 2008.
4. REGULAR ITEMS
a. Worcestershire PCT
Chairman welcomed back Dr Lola Abudu who gave an update on the latest information at Worcestershire PCT. Linda Dando, the new Head of Primary care was due to start on 1st October but her start date has been delayed due to personal circumstances. Hopefully she will start in November. Mr Neatherway will provide some cover in the interim. Primary Care contract roles will soon be going out to advert. A process has been put in place to assess Primary Care Trusts to assess areas such as commissioning competences and achieving health outcomes. The focus within the PCT has been on developing the package of documents and plans for the DOH and to work on a strategic plan. They will be consulting key stakeholders from November. They are also working on a medium term financial plan.
i) TCN
Dr Abudu reported that TCN had started last week on their model of service and asked for the LMC’s view on how this was going. She said that there have been teething problems initially but they are dealing with these issues.
Secretary reported that following the last meeting where TCN said they were willing to talk to us about pay rates, despite writing and several emails they haven’t responded so will put something in the newsletter this month. Some practices have real concern about the information being sent to them regarding their patients that are seen in the OOH and in the way the information is being sent. Dr Burger said that one of their patients had over an 8 hour wait for a telephone call back from a GP in the OOH Service. The Chairman said that he didn’t regard this as a “teething problem” and this is something that the PCT should be looking at immediately. Dr Abudu agreed that it was not acceptable and that the PCT had sent members of their own staff including herself to be on-site at the call centre since the day they switched over.
Dr Abudu said the I.T. system they use gives them a good overview of the activity across the county. They have five cars on the road and they moved them around well but it was very busy at the weekend which was very overwhelming and they had to bring in extra support from Ipswich. She agreed that there is work that needs to be done and that staff have to get used to the new I.T. system. They have had difficulty accessing information and are trying to respond to all issues. The PCT have told them that they need to do better. The Chairman asked how long they were going to give them to resolve all these issues. There was no response. The Secretary asked Dr Abudu if she was aware of the issue with the rota, and that the LMC were sent a different rota to that which was on their website. The Secretary then discussed some other issues and concerns from practices who had emailed the LMC regarding the OOH Service. Dr Abudu agreed to feed this back to TCN.
Another issue that many practices are having is that you have to print out the reports emailed in and cannot save them into the patients notes. Dr Horton said there was a way round this and told the committee how he has managed to do this. The committee agreed that if there was a way to do this then clear instructions need to be sent to all practices on how they could do this. Dr Abudu agreed and would mention this to TCN.
Dr Kelsey said he was disappointed that there were technical problems on Sunday evening. They had a few doctors who didn’t turn up and TCN had not managed to recruit enough ECN’s to cover this. It certainly wasn’t any better than in the past. This weekend there will be an extra ECP to do visits. If the doctors had all turned up it may not have been so bad. They are also used to the old Adastra system where they can see all the activity that is going on across the county on one screen. This means they can control what is going on much better. A lot of time was wasted because of this and on the new system you cannot see everything on one screen. On Adastra there was a clear way of finishing, from start to finish. On the new system there isn’t a straightforward way to do a follow up; you have to type into the notes freehand. Dr Horton mentioned that there was a facility for FP10’s on the system, apparently there is an icon to do this. Again practices need direct instructions about this and need this to go in the newsletter.
The Committee discussed a letter that had been circulated to them from TCN regarding the interface between in-hours and out-of-hours service. Dr Rankin felt there should be a cut-off otherwise it can create unharmony and that each service will not know where they are. Dr Horton and the Chairman agreed. Dr Kinsman said it would be much more disruptive to have calls coming in first thing in the morning and policing it would be impossible. Dr Hollier agreed and said he felt it wouldn’t be clinically safe to hand over their patients to the OOH when they had received the call themselves. Chairman asked the committee if it was agreed that there should be a cut-off. All agreed.
Action: Secretary to write back to Dr Browning at TCN
Dr Abudu to speak to TCN about procedures / instructions
To put information in the Newsletter
ii) Locally Enhanced Services
Secretary reported that there are still ongoing problems yet to be resolved in regard to LES’s. Various LES’s are being worked on at the moment including INR; Diabetes and COPD. The LMC are receiving emails from PBC doctors asking who does what and is responsible. The PCT need a strategy on how they are doing this and who is responsible for what and should include what the LMC’s role is in this. Dr Kelly agreed that the PCT need to get the PBC clusters involved in the Clinical Care Pathway Group so any developments done county wide will have a buy in and the clusters will have more input. The Secretary was not sure this would work, and asked the question “isn’t it for PBC clusters to do their own if it is in their budgets?” Dr Kelly said that not all areas are involved and they way they are doing this at present is a fairer way as it would then be done equally amongst all the PBC Cluster groups. Chairman suggested that the PCT should grid the DES’s and LES’s across the county so they can see which cluster is involved with what. Dr Abudu said that Mr Neatherway has already started to do this work and that he is looking at what historical information they have in the first instance before identifying what schemes are available already. The Chairman said that LES’s are biddable and available to everyone. Secretary suggested that the PCT need Worcestershire LES’s and countywide LES’s and went on to say that there is a lot of enthusiasm from around the county for people to get on and do things. He never knew the Pathway Partnership existed until someone told him about it and felt that the PCT should have mentioned this. Dr O’Connor said the LMC had had this discussion with the PCT six months ago and so something needs to be done now. We need structure and processes in place on what needs to be done. Dr Kelly said that there are groups that need to involve the clusters and perhaps this is the way they can organise things better. The Secretary asked the question “shouldn’t PBC be moving things away from the PCT so that the clusters do the work”. Dr Kelly said that the PCT need to know what the clusters are doing and this has to be equal across the county. The Chairman asked who they should approach at the PCT so we can inform practices through our newsletter. Dr Abudu said the Care Plan Partnership contact is Sandra Rote and PBC Development is Trevor Neatherway who is seconded into this role until March next year. She said part of the work being done in the PCT is looking at the development of PBC protocols and pathways and that PBC Cluster Chairs will be participating with this. A discussion took place regarding the work of the commissioners and providers and the difficulty in getting approval for specifications from a locality point of view. Dr Abudu said the answer was to get clinicians into the PCT to work alongside them. Dr O’Connor stressed that to do this the clinicians need to know they are going to get results and this work will be funded appropriately by the PCT. Dr Lewis said that funding and remuneration is an issue but the other issue is communication and need a Communications Director in the PCT that will liaise with everyone across the county. Dr Kelly said in South Worcestershire a newsletter comes out every month. Dr Abudu said that she will take the LMCs views back to the PCT.
Action: Dr Abudu to review with the PCT
iii) Extended Hours LES
The Secretary reported a discussion he had with Trevor Netherway who has said that the PCT has reconsidered its position regarding the Extended Hours LES. They now want a LES to run alongside the DES that would encourage more of us to do the DES. They are thinking of a LES to pay for a nurse and receptionist to work with a GP and have more “normal” services e.g. open reception/phones. They are wondering about costing this and mentioned £1 per head. They have not yet identified where the funding will come from but clearly they are being pressed to get the 50% implementation.
The Secretary had done an approximate costing and felt it would cost £1.50 per patient. Dr Kelly said that most practices had not felt the DES was acceptable and so the PCT were looking at introducing a LES plus with the idea of concurrent working. GPs do not have to put in more time but this would encourage practices to have an extra receptionist so they can welcome patients through the door and the phone being left on, and practice nurses to do more hours which would cover the issue of chronic nurse management and get over the security / chaperone issues. Dr Horton said that if practices have open reception then they would need more than one receptionist. He had also done a similar exercise to costing this up and said he felt that between £1.20 - £1.60 would cover it and not the £1 the PCT were offering. It was suggested that the money being offered would cover the nurse and one receptionist and the cost for another receptionist would have to come out of the DES money. Chairman asked Dr Kelly if the PCT could look at the figures again and said that this would have to be rolled out to practices and see what happens.
Action: Dr Kelly to review the DES plus with the PCT
iv) Two week wait for cancer referrals
The committee discussed a letter received from Chris Emerson on this. It was agreed that the PCT cannot insist on these only being done by Choose & Book and that paper referrals had to continue. It is clinically unsafe. GPs should ignore and the PCT should rescind. This has been passed onto Simon Hairsnape to get an answer on but have not heard anything back as yet. Dr Ingrams said it doesn’t matter if Choose and Book works, you cannot rely on it being your only system, even when it works there will be times when it doesn’t. He has raised this with the National team and they have agreed with him and if we get no joy on this issue he will take this back to them. Dr Abudu said that she has discussed this with Simon Hairsnape and they prefer that practices use Choose and Book. She said it is an issue for the Acute Trust and causing them problems by getting referrals from both Choose and Book and paper referrals. Chairman said this shouldn’t be an issue, they have to make it work, and that the PCT should be backing primary care in this instance. They are putting the wishes of the local Acute Trust over national policy. Chairman said he will write formally about this. Dr Abudu will take this message back to Simon Hairsnape again.
Action: Chairman to write to PCT
b. Education
No report
c. Dispensing
No report
d. Out of Hours
Secretary gave an update on the TCN Development (discussed earlier in the meeting)
e. Non-Principals Group
No report
f. Registrars
Dr Browne has a meeting with TCN next Tuesday and will report back how it goes. If they have any problems with trainee sessions then he will also report this back to the LMC. Dr Browne also introduced Dr Coney, the new Registrar Representative who takes over from Dr Rainsbury.
g. P.M. Groups
No report.
h. Administration Issues
Secretary informed the committee that the Conflict of Interest Policy was being updated and could all members email and post back their completed forms.
i. P.B.C. Issues
Secretary fed back from the Primary Care Working Group Meeting 22nd September 2008 and has suggested that the LMC might like to co-ordinate with the PBC Clusters without the PCT there and try and facilitate and get the ball rolling. Committee agreed.
Action: Secretary to contact the PBC Cluster Leads
j. I.T. / GPSoC
The problem with the email system was discussed again. Dr Ingrams confirmed that nhs.net mail is the only accredited system.
5. MATTERS ARISING
Minute 5/469 Meeting with LPC
Minutes were circulated to member. Feedback was given from the LMC / LPC meeting on the 17th September. Dr Ounsted said it was a good exchange of views and was a useful meeting.
Minute 5/484 Stakeholder Representative on the Council of Governors.
Following last month’s meeting an LMC Representative is needed. Secretary reported that Dr Trevor Jones of St Johns Surgery, Worcester would be interested in representing the LMC. Dr O’Connor asked if he would be feeding back to the LMC following the meeting and was concerned that as he isn’t an LMC member it might be dangerous to have someone not on the LMC doing this role and felt it should be an LMC member. Secretary suggested that we could co-opt Dr Jones onto the committee. Dr O’Driscoll said he would be happy to take on this role instead of Dr Jones. Committee all agreed that Dr O’Driscoll to take on the role as representative.
Action: Secretary to write confirming Dr O’Driscoll as the Stakeholder Representative
Minute 5/490 Choose and Book use for 2 week Cancer Referral
Discussed earlier in the meeting.
6. COMMITTEES
a. GPC
The Secretary went over the M2 Circular and issues in the latest Negotiating News. Dr Ingrams gave feedback of what is currently being discussed with the Department and the GPC.
b. GPCWM
Secretary reminded the Committee about Nuts & Bolts which is on the 28th October 2008. Dr Ingrams said he will try and record Dr Buckman’s speech.
7. NEW ITEMS
Minute 5/495 Consultation on Dispensing Doctors / Pharmacy White Paper
Email circulated to all practices encouraging dispensing doctors to respond individually and copy to the LMC. Secretary reported that he had not received anything back. Dr Ounsted said that dispensing doctors should be encouraging patients to do various things, such as not using the website to respond but to write letters. Dr Ounsted went through issues in the White Paper. Chairman asked as a committee for Dr Ounsted, Dr Rankin and Dr O’Connor to formally respond to this document and asked the question “are we happy as committee to delegate this to formulate an appropriate response.” All agreed with this.
Action: Dr Onsted, Dr Rankin and Dr O’Connor to respond
Minute 5/496 LMC Conference 2009
Secretary reported that the Annual Conference of LMC’s next year will be held on 11 – 12 June 2009, at the Institute of Education, University of London. Application forms will be sent out to LMCs in October. Dr Ounsted said he wished to go. Secretary asked the LMC members if they could let us know if they would like to attend. Review at the next meeting.
Minute 5/497 MP Meetings
Secretary reported on various MP meetings he has had during September and October.
Minute 5/498 Pharmacy White Paper Consultation Meeting
The LMC is organising a meeting on behalf of the GPC entitled “Pharmacy White Paper Consultation – What it means to you”. The speaker will be Russell Walshaw. This will take place on Monday, 10th November from 7.00 p.m. All dispensing practices have been invited and are being urged to attend. We have also invited dispensing practices from Herefordshire; Gloucestershire and Warwickshire.
Minute 5/499 The work of the LMC document
Document circulated to committee prior to meeting. A couple of amendments but apart from that all were happy for the document to be circulated to practices.
Action: Michelle Hallahan to finalise document and circulate
Minute 5/500 Controlled Drugs self assessment
Document circulated to committee prior to meeting. Jane Freeguard from Worcestershire PCT has written to the LMC about changes to legislation and good practice around the prescribing, storage, supply and record keeping for controlled drugs. One of the changes, the Controlled Drugs (Supervision of Management and Use) Regulations 2006, introduced the role of the Accountable Officer in each healthcare organisation and enabled Accountable Officers to request a periodic declaration and a self assessment from a general medical practitioner on its medical performers list. The self assessment is intended to help inform other monitoring and inspection activities. It is also hoped that any gaps will enable PCTs to identify where support and/or advice is needed to ensure the highest standards and safety in the management of controlled drugs. The PCT have sent the LMC a copy of a declaration and self assessment form and would welcome comments from the LMC before they circulate it to practices later this month for completion.
Dr O’Driscoll said the form was too long. Secretary said it probably needs to be this long and feels we should support it, as it is the law. Dr O’Driscoll asked if perhaps we could have a simplified version. Chairman said it was probably easier not to have any controlled drugs!
Minute 5/501 Life Line Screening
Secretary reported that this issue had come up on the LMC listserver. An American company are advertising to patients that for approx £150 they will undertake various health scans. Their information and leaflets are turning up in local papers and patients are turning up at practices saying their scan results are showing up certain conditions. Practices are therefore having to rescan their patients. The committee didn’t think there was anything we can do about this, but to be aware this is happening. Dr Schrieber asked if this was a Trading Standards issue? The Chairman asked Dr Kelly if this was something the PCT could look into for us. Dr Kelly said he would.
Action: Dr Kelly to bring this matter up with the PCT
Minute 5/502 Worcestershire Mental Health Partnership NHS Trust
Secretary reported on the Foundation Trust Consultation document. He had received a leaflet which has been sent to everyone but has not heard direct from the Mental Health about this. On page 8 of the document general practice was not included as one of their partner organisations. Committee agreed that the Secretary should write to the Mental Health Trust.
Action: Secretary to write to Mental Health Trust
Items B
Circulated
Items C
No items C
CLOSED MEETING
The Chairman closed the meeting at 9.36 p.m.
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