Meeting Date: Thursday 13th November 2008
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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday 13th November 2008 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Bunyan, Dr N Burger, Dr P Coney, Dr K Hollier, Dr R Horton, Dr R Ingles, Dr G Ingrams, Dr A Kelly, Dr D Lewis, Dr F Martin, Dr K O’Connor, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr D Radley, Dr J Rankin, Dr V Schrieber
1. APOLOGIES
Dr G Browne, Mr D Jago, Dr R Kinsman, Mrs L Luke, Dr D Pryke, Dr C Reynolds
2. MEMBERSHIP
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 9th OCTOBER 2008.
4. REGULAR ITEMS
a. Worcestershire PCT
Chairman welcomed Linda Dando, Director of Primary Care who gave an overview of her background before coming to Worcestershire.
Chairman began the discussion. He had received a reply from the PCT referring to the letter he sent regarding the use of choose and book for 2 week wait referrals. The letter did not address the issue at all so he will be writing back to ask the question again.
Dr Abudu gave an update regarding the PCT. She is pleased that Lynda Dando has started and they have also appointed a couple of Primary Care Commissioning and Contracting Managers and sees this as an opportunity to re-establish the links with practices as they need to rebuild relationship and get 2 way dialogue going. World Class Commissioning is on their minds and they will be going to a public board meeting in November. Once their strategic 5 year plan has been received by the Board in November they will have some communication with key stakeholders and a consultation period. Regarding extended hours they have now circulated the DES Plus and are hoping to get a positive response from practices and will have to take a view on the next steps dependant on the uptake. The PEC have been discussing anticoagulation, the LES documentation has been agreed in principle but the PEC feel more work needs to be done to get maximum assurance for transfer but there are no huge issues. The QOF process has started and their first visit was the 5th November. Dr Horton asked for clarification for the DES Plus and the payment of the additional 50p. Dr Abudu clarified that the 50p will be a one off payment for the quarter. Secretary said he felt it is a “bung” and should be an ongoing payment. He said other SHA’s around the country have interpreted the DES differently and asked the committee if we should discuss this with the SHA again. Dr Radley asked Dr Abudu what feedback they have had from practices. Dr Abudu said they would like more uptake. Secretary said he didn’t think they will get a big uptake. Chairman stressed that the LMC were not having a go at the PCT about this, it was an SHA issue and the LMC would be very supportive if they wanted us to contact them. Dr O’Driscoll said this should be addressed at regional LMC level if we were going to take it to the SHA. Dr Ingrams said that other areas have negotiated another LES on top of the DES to give patients what they want and make it do-able. Secretary asked Dr Ingrams if we could look at this at the next GPCWM meeting.
Dr Kelly discussed the issue of anticoagulation. They have reached a point where they have agreed levels 1 and 4 but have no idea how many practices would move up or down. The Acute Trust will need to review the service it provides. The next step is to ask practices who wish to do it / continue to do it and which level. The Chairman said that as an LMC we must support practices to do any of this and if they are giving it back it would be a good idea to have a 12 month phasing out period.
Dr Lewis raised the issue on the GP Led Health Centre and where they were with it. Dr Abudu said they hope to be in a position by the end of the year to award the contract. There are many still in the running for the bid.
The committee asked Dr Abudu about the current situation with TCN and her views on how it was going. Dr Abudu said in terms of progress it is still early days and a lot of the initial problems were to do with clinical notes which appear to be sorted. The Secretary said this has still not been sorted. Dr Abudu said it was a way in which the notes are presented on the screen. Secretary said he would make some examples available to Dr Abudu so she could see the extent of the problem. Dr Martin said that entering the information onto the system is a lot better than on the Adastra system and said there are three screens and it seems to be random which one practices are getting if they do not get them all. TCN have been running for many years so this should be right from day one and they need to get it sorted to be clinically safe. Chairman asked Dr Abudu if TCN’s workload goes up can they ask for more money. Dr Abudu said no, it is a fixed amount. Dr Coney said that Registrars have booked shifts with TCN, turned up and been told it has been cancelled and their trainers had not turned up. Secretary said that TCN had told the LMC that this was going well and had extended the slots for trainees. Dr Schrieber said that some slots had been booked where Registrars had not turned up. Committee agreed that this was TCNs responsibility to make sure there were enough slots booked. Dr Hollier gave an example of a problem with getting through to TCN and in the end reverted to calling an ambulance. Dr Abudu said in terms of stats on the performance data it has improved. In terms of specific issues Dr Abudu said she needs written complaints about them. Dr Martin said they are over doctoring the service and slots for walk-ins have increased so at the moment they are very well staffed in the centres which is good news. There were other discrepancies from what TCN had told the LMC, for example they said they were not using Connect any more but there was evidence that Connect were still supplying doctors to the OOH service. Another issue is that GPs are not sending TCN information for terminally ill patients so agreed this should be put in the Newsletter.
Action: Newsletter
b. Education
Dr Schrieber said they had the annual trainer’s event last week which went well. They are trying to encourage practices to take on more learners but haven’t had many bids so they may be able to up the money if people want to reconsider. He will be contacting practices about this. The money is for equipment and structural changes. At the moment the suggested money is between £1,000 and £5,000, but they are looking to top this to up to £10,000. They are currently working on a new contract where the contract will be with the practice rather than the trainer. Martin Wilkinson is currently working on this and will hopefully be in a position to send this out in the next few weeks. Dr Schrieber gave an overview of the new system.
c. Dispensing
Dr Rankin has put together an LMC response to the Pharmacy White Paper and gave an overview on this task and what the white paper contains and highlighted that it is so much more than just dispensing. All agreed that the response is excellent. Secretary reported on the Monday evening GPC/LMC meeting hosted by Russell Walshaw which put everything very much in perspective. Chairman thanked Dr Rankin for putting this document together. Secretary said we would send to appropriate people; PCT and pharmacy representatives. For information Dr Rankin said that 31% of practices in Worcestershire are dispensing. The Secretary said that Monday evening meeting went very well. The DOH have received 25,000 letters to date and MP’s have received hundreds of letters. Dr Rankin said that they have received a vast amount of patient responses in his practice. The Department have asked the GPC with the DDA to go and present their findings next week.
d. Out of Hours
i) Meeting with TCN on Monday 10th November
The Secretary gave feedback from the meeting on the 10th November and gave a quick overview of statistics and information received by TCN. They have appointed a Lead GP, Dr Kelsey. Secretary read out the letter received from Dr Kelsey who said that he has accepted the position as Clinical Lead for TCN in Worcestershire, which will be part time management and part time clinical. His main priority is now obviously to represent TCN rather than the doctors working for the OOH and for this reason Dr Kelsey has relinquished his position on the LMC as OOH representative. He will be happy to continue to have contact with the LMC and attend meetings as required to provide updates and take on feedback from the LMC. He would be happy to attend as a guest for the beginning of the meetings and then leave once the other issues are discussed. He is hoping that the relationship between the LMC and TCN can be developed.
Dr Schrieber said he felt this was the right thing to do and perhaps we need to think about someone else to take his place on the committee. Dr O’Driscoll said he could email the OOH doctors. Dr O’Connor asked what the LMC role is to represent doctors and clinicians that are employed by another company. Dr Ingrams said the NHS Act 2006 enables us to represent all GPs in our area and that the LMC represents general practitioners not practices. Dr O’Connor asked if we got money for GPs not in practices. Practices pay on a capitation basis so do we set a nominal fee from them but not other GPs. Dr Ingrams said that other LMCs do receive monies, some from the PCT and some from private companies. Chairman said that TCN said that they feel it is for individual doctors to sort out. Dr Ingrams said that if the PCT has specified the BMA contract it mentions the levy so they will have no choice. We should check this out with the PCT if the BMA contract is used and if it is then we will talk to them about the levy.
Secretary said they discussed the training and emailing issues and TCN have said they will look at these issues again. They discussed pay. TCN will not change the £50 payment (which does not include superannuation) and said that they are paying more here than elsewhere. When they discussed pay they talked about enhancements but they did not negotiate at all on the actual hourly rate. Dr Ingrams said that if they are not having problems recruiting then they are not going to offer more. Dr Martin mentioned a performance issue because of a lack of doctors being able to work in the service. Secretary stressed that this should be relayed back to the PCT and performance list panel and she has a duty to report her concerns to the PCT and stress that TCN let them work. The Chairman said that this meeting with TCN was not a productive meeting.
Action: Secretary to check if TCN have a BMA contract
ii) Email from Dr Kelsey
Discussed earlier in the meeting.
e. Non-Principals Group
No report
f. Registrars
No further report.
g. P.M. Groups
Mr Beckett mentioned the ongoing problem with the nhs emails. Even with the new email addresses not everyone getting them all. Dr Ingrams said that all practices have a generic email box so could always send information to this.
h. Administration Issues
Secretary reported that the GPC Law Seminar we are due to run on the 4th December has had very little uptake. If we do not get more signing up for this we will have to cancel it. We will send a reminder out and then make a decision whether to cancel it for now.
i. P.B.C. Issues
After the last meeting the LMC contacted the PBC cluster chairs. We received a very positive response and will organise something soon. Dr O’Connor asked about the practices not within a cluster, committee confirmed we should contact them direct. The three not in a cluster are Cookley; Ombersley and Great Witley.
Action: To contact the three practices not in cluster and organize this meeting.
j. I.T. / GPSoC
Pathology wants to go paperless and would like to stop paper results being sent to practices, but there are one or two practices that have not agreed. Secretary asked the committee for their views on this. Dr O’Connor said it was personal choice. Chairman agreed and said practices should be able to do both, if the server goes down this could be an issue. Dr Ingrams said it is all about clinical safety and what the practice feels is the safest system for them. LMC agreed that it should stay the same and not be paperless.
5. MATTERS ARISING
Minute 5/496 LMC Conference 2009
Paperwork has now been received and representative names to be received no later than 9th January 2009. Because we have 8 fewer GPs this year we have only been given three delegate seats. Secretary asked who would like to go. Dr Parkinson, Dr Ounsted, Dr O’Driscoll and Dr Lewis all would like to go so one will be as an observer. Committee agreed to put the same names forward for the ARM.
Minute 5/502 Worcestershire Mental Health Partnership NHS Trust
The LMC received a reply from the Chairman and Chief Executive regarding the Mental Health Trust Foundation Bid. They are very grateful for the LMC comments and keen to explore with the LMC the concerns expressed about the links between general practice and mental health services. They are reviewing the current organisational arrangements in anticipation of becoming an NHS Foundation Trust and planning to create a primary care mental health business unit and would like to discuss with the LMC the most appropriate way to involve general practitioners in the management of this unit. They will arrange a meeting with the LMC to discuss the matters raised.
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 M3 Circular and issues in the latest Negotiating News. There is a spreadsheet that has been circulated on the listserver that allows you to calculate the QOF points and the impact on your practice. Further information can be found at www.gpcontract.co.uk . The Secretary will send this information out in the next few days. Dr Ingrams said there has been a lot of discussion at the GPC about sharing of data, dispensing and practice accreditation. Cremation Form guidance is changing and is now available. Again this will be sent out shortly to practices via the newsletter.
There is to be a QOF Consultation regarding changes to the QOF and whether NICE will decide on QOF in future or there to be a local QOF. The BMA will be organising a series of events for people to go on and will be encouraging people to attend these when they come to the West Midlands.
Action: Newsletter
b. GPCWM
Dr O’Driscoll gave detailed feedback from the Nuts & Bolts day. There is £50m left to be distribution nationally between PCTs for GP pay. It was agreed the LMC should contact the PCT to make sure they don’t use it for other things and ask them to identify where and how this money is being spent.
7. NEW ITEMS
Minute 5/503 LMC Meeting dates 2009
Preliminary dates were circulated to members.
The committee confirmed that the dates for 2009 would be:
Thursday 8th January
Thursday 12th February
Thursday 5th March
Tuesday 31st March
Thursday 14th May
Tuesday 9th June
Thursday 9th July
No meeting August
Thursday 10th September
Thursday 8th October
Thursday 12th November
Thursday 10th December
Action: To book the room and confirm dates to members.
Minute 5/504 ARM 2009 dates
29th June – 2nd July 2009. Discussed earlier in the meeting.
Minute 5/505 GP Training Practices – Provision of Indemnity
Email received from Jim Waits and forwarded to Dr Schrieber for his comments. Dr Schrieber responded. The letter was from Viv Tsesmells, Director of Operations at the SHA regarding Provision of Indemnity for GP Training Practices. Essentially the Deanery contracts with practices for the direct training support trainee GPs and because they are not directed provided by the Deanery/SHA it is not possible for the SHA to take out indemnity cover for the activities of educational support. The committee felt guidance is needed from Martin Wilkinson which should go out to all training practices. Dr Ingrams said the GPC has been chasing this for 3 years, it isn’t something new. Secretary agreed to send a copy of this letter to Dr Ingrams. The Chairman felt the LMC should write to the SHA to say this is something being looked at nationally and that this letter does not make sense and we do not recognise it. Agreed to raise this issue at the next GPCWM meeting.
Action: Copy of letter to Dr Ingrams, reply to Viv Tsesmells.
Minute 5/506 LMC Secretaries Conference – 6th November 2008
Secretary gave feedback to the LMC Secretaries Conference in London and discussion took place about the information that came out of this event.
The question was asked if the LMC should have LMC representatives attending PCT Board meetings. Agreed these were public meetings and it would be good for someone from the LMC to go. They meet every couple of months and move around the county. If we circulate the list then perhaps we can circulate who goes to them. The non-execs do not know who we are and what we do.
Chairman asked if we should invite PCT non-execs to LMC meetings or arrange an informal supper 3 or 4 times a year with the LMC. Committee agreed that the informal supper was a good idea as it works very well with MP’s.
Action: To find out list of PCT Board meetings and circulate them to members. Invite non execs to an informal supper.
Minute 5/507 Pharmacy White Paper Meeting – 10th November 2008
Discussed earlier in the meeting.
Minute 5/508 Mental Health Trust Counsellor – Access to Records
Following a request by the Mental Health Trust employed counsellor to have access to clinical software and suggestions that they could not provide the service if denied access. Dr Kinsman contacted the MDU who have suggested that a doctor could place themselves at risk facing criminal proceedings under the provisions of the Data Protection Act 1998 and also disciplinary proceedings by the GMC which could put a doctor’s registration as a medical practitioner at risk. The counsellor may of course discuss a case with the GP, and in very rare circumstances the GP may decide it is in the patient's best interests to disclose an item of confidential information, but even then, the GMC says the GP should first discuss the disclosure with the patient.
Dr Horton asked if they could look at this information if they signed a confidentiality clause. Dr Ingrams said this is privacy which is a different thing. A patient has a right to know who is looking at their records. He said there is growing case law with heavy fines. Best practice would be to say that you ask the patients to consent for anyone outside of the practice team to access your records.
Action: To put in the Newsletter
Minute 5/509 Gardasil
Letter received from Dr Bloch regarding the PCT has said that any prescription of Gardasil be treated as an example of inappropriate prescribing and that the PCT is employing totalitarian methods that preclude any professional judgement. Although the school vaccination programme are using Cervarix because of it no doubt being heavily discounted but for those not going through the school system then the price for the vaccines are the same and the logical decision would be to use Gardasil.
Dr O’Driscoll said he has a point as it is not black listed. Dr Ingrams commented that the NHS plan said it is down to individual clinicians to decide what they are prescribing; but you may have to justify the reason. Dr Rankin commented that the PCT are right in what they have done as they are establishing a principle for the policy. Chairman said this issue is the same as in other areas, clinicians have the right to make the decision, they can be advised but not dictated to. Dr Ingrams said that clinicians must be free to do the best for their patient and why is the department not releasing the information about the drugs. Committee agreed that the Secretary to write to Dr Banerjee
Action: Secretary to write to Dr Banerjee
Minute 5/510 QOF Consultation Process
Discussed earlier in the meeting.
Items B
Circulated
Items C
Application for preliminary consent from Matrix Primary Healthcare Ltd prior to inclusion in the pharmaceutical list in the vicinity of Aylmer Lodge Surgery, Broomfield Road, Kidderminster. No objection.
CLOSED MEETING (if appropriate)
The Chairman closed the meeting at 10.00 p.m.
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