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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday 11th December 2008 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr G Browne, Dr P Bunyan, Dr N Burger, Mrs L Dando, Dr A Garner, Mrs M Hallahan, Dr K Hollier, Dr R Horton, Dr R Ingles, Dr A Kelly, Dr R Kinsman, Dr D Lewis, Dr F Martin, Dr K O’Connor, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr D Radley, Dr J Rankin, Dr V Schrieber
1. APOLOGIES
Dr P Coney, Dr G Ingrams, Mr D Jago, Mrs L Luke, Dr C Reynolds
2. MEMBERSHIP
The Chairman welcomed Dr Emma Penny – New OOH Representative.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 13th NOVEMBER 2008.
4. REGULAR ITEMS
a. Worcestershire PCT
Lynda Dando gave feedback to the meeting she had with Dr Parkinson on the 8th December and gave the LMC an update on what is currently happening within the PCT.
Following discussion regarding Extended Hours the LMC sent an email to all practices. There has been a press release which shows Worcestershire PCT as being in the worst 5 in the country. Lynda Dando said since the email had been sent they have made more progress and have had some positive emails and have been speaking to practices individually. She said practices wanted to discuss the reasons why they hadn’t been able to take up extended hours, and the obstacles that were in their way. This has led to discussions about what the PCT can do to aid them to take on extended hours. The PCT have discussed this with the PEC and they are still trying to do all they can to identify where the flexibilities lie, probably in the size of the practice. They have contacted the West Midlands SHA for a better understanding and definition of what their interpretation is and are hoping for a resolution at the beginning of the following week. Dr Kelly reiterated this and said that this would help with concurrent working. The Chairman said that in the past it has been deemed that the LMC have been awkward where really they have the same goal and the LMC and PCT need to continue to work together. The problem in the past has been in the PCT not having a primary care lead but now that Ms Dando is in post the dialogue is now happening which has to be commended. Chairman said we want to make it work for Worcestershire and now we are represented hopefully this will move forward. More discussion took place regarding extended hours. We will now wait and see what happens next.
Ms Dando went on to talk about Enhanced Services. The PCT did give notice to all practices that it was going to review enhanced services across the board. Now that the three separate PCTs have come together there are a lot of variations in many areas so it makes sense to look at them as a whole. Ms Dando acknowledged that this creates huge anxieties and the PCT needs to be very clear about what they are going to implement and if there were to be any implications, and soon.
Regarding the Anticoagulation LES, the changes to this are for the same reasons as the other enhanced services but they need to bring in MPSA Safety Quality measures. There is a group established to look at what a new LES might look like and the pricing mechanism attached to that. It has been made very clear that it wouldn’t be safe to move from one to the other overnight and there has to be transitional arrangements put in place. It was agreed at the PEC that Ms Dando would write to all practices saying what they were currently doing; any issues that have been identified and then to try and understand what practices felt was the level they would like to provide and what issues this would create. This would lead to transitional phase; and those practices providing Level 3 will need training to provide Level 4. Part of the transitional plan will be on how they will provide this training. The cut off date was Monday to get as much information before they moved on. Since writing to practices she has been made aware by one of the PBC Clusters that she has overstepped the mark as they understood a different mechanism was in place and this was part of the PBC budgets. She has since spoken to them and agreed that they need to work together to resolve this. The PCT needs to clarify the roles and responsibility of PBC framework and PBC commissioning and be clear what is in and what is out. We need absolute clarity to stop this confusion happening again. Ms Dando said she will still continue to collate the information as it is useful knowledge to have and then evolve a process that tries to identify where the wider responsibility sits. That is the current situation and hopes it will be resolved quickly. This was discussed amongst the committee. The issue of Domiciliary not being looked at came up. The Chairman said the issue of LES’s does need looking at but there is an urgency with this as contracting between primary and secondary care has to be finalised by 1st April.
Discussion took place regarding the QOF prevalence changes. The Secretary has sent an email out to all practices asking them to look at their numbers on the website. One or two practices are massive losers, others are losing but not to the same degree while some gain slightly. Secretary said that he didn’t think initially Worcestershire would have that many losers. The BMA do have figures on which practices lose but they cannot share this information. Chairman said this is very destabilising on confidence, practices will not think about staffing levels and taking on new people if they are losing funding. Dr Kelly agreed and said these issues need addressing. Ms Dando said the QOF is only one change, the PCT also need to take into account the GMS contract changes and DDRB recommendations. Whilst everyone is expecting her to make decisions on a lot of issues that have been outstanding she feels the PCT needs to make a decision overall on all the issues, the best decision on how to approach everything from April onwards. If they look at every issue piece by piece then Worcestershire will deteriorate even more, the PCT have to look at the whole package, look at bringing services closer to home where they should be. There will be some tweaks but they have to look at local provision and supporting primary care. They must not decide on things in isolation. Ms Dando said she appreciated that the PCT are running out of time as well. All national changes have to be looked at. The Secretary said it would be really useful if the PCT could write to all practices to say this as they are feeling vulnerable and this would be really helpful.
Ms Dando went on to discuss Choose & Book. This was discussed at the PEC. They want to gain a better understanding and look at the issues in secondary care. They will look at the practices that are using it and where it is working well to see if they can find out why it is working so well for them and perhaps roll this out to other practices. They will have an agreement with the Acute Trust that more booking slots are to be made available and they have been set targets to make sure they do this. Dr Kelly said that Worcestershire are also low on this target in the country as well. The Acute Trust are keen to move to paperless referrals but said this would not be until they can reassure practices that the system will work and not impinge on the work of GPs. The Chairman said that practices have tried to use it and make it work. He also asked the question about what happens when computers are down and there is no other way for referrals? Practices need backup support for when computers go down and there should be no waiting time for this. The Secretary said there is a perception that GPs really don’t want to do it but this is not the case, it just doesn’t work well and it has to be safe. Dr Bunyan said it worked well before but lately it is not working well with slots unavailable and it is getting harder to use. Dr Radley said that many are giving up because it is not working, this is down to the Acute Trust and something has to be done. Dr Lewis said it isn’t just about slot availability it is also unpredictable; it has to work every time. Dr O’Connor heard today that the Acute Trust had 900 referrals last month and 700 the month before so it probably isn’t just down to the I.T. Dr Ounsted said that the PCT should be communicating with all providers, not just Worcestershire Acute Trust.
The Secretary asked about the other PCT targets for the year, e.g. the Vascular Screening work. Dr O’Connor said that practices used to get a PCT pack that was very useful but these have stopped as well as running commentaries on how they were performing against various indicators which was also very useful. Don Beckett said that the latter was good in theory but if the PCT have to hold things up to do this then these are no good. Discussion took place about the Vascular Screening and Ms Dando said she would email the Secretary the current documentation they have received from the DOH on this.
The Chairman thanked Ms Dando for coming and updating the committee.
Action: Ms Dando to write to all practices to let them know the PCTs plans and intentions.
b. Education
Dr Schrieber said the new Deputy Director was Mike Deagan. The Secretary said that they discussed the issue of Provision of Indemnity at the GPC West Midlands meeting. Martin Wilkinson said he would write another letter to clarify the situation but the Secretary hasn’t seen it yet. Dr Schrieber said that this would have to be passed through certain individuals before sending out. Committee said we should chase this up.
Action: Secretary to chase up letter from Martin Wilkinson
c. Dispensing
No report.
d. Out of Hours
The Chairman said that it has been reported in the local papers how good the new OOH service is and that patients are saying it is going well. He said perhaps we should write to them and say well done for local PR but that they still haven’t replied to us! Dr Martin said that they were still having a problem in getting local doctors and that they are advertising locally at the moment. There was no doctor on an overnight shift recently. Dr O’Driscoll said this has happened before but they didn’t have problems getting local doctors in the past. The LMC had warned TCN that they should keep the local doctors on side. Dr Radley said that according to publicity they are doing well but Dr Penny also confirmed that TCN are not meeting their figures at the weekend. Dr Schrieber concerned that they only have contract doctors and is keen for them to have salaried doctors there to undertake the Registrar training. They only have a few salaried doctors who will not be replaced when they leave.
e. Non-Principals Group
No report
f. Registrars
No report
g. P.M. Groups
No report.
h. Administration Issues
No report.
i. P.B.C. Issues
Secretary reported that the LMC will be getting together with the PBC Cluster Leads in the New Year. Lynda Dando is trying to work through a sensible plan to sort this out and is currently working on a paper for the PEC. The PCT are aware of the practices that are not in clusters. Discussion took place regarding the PCT’s role with PBC. Some felt that the PCT were disinclined to let PBC Clusters run their own agendas although others didn’t and said that the PCT had already removed themselves as a Provider Board.
j. I.T. / GPSoC
Dr Kinsman gave feedback to the following groups:
i) Primary Care Working Group
This group meets every month and it is funded by IT. The old (gp-m8) email server is to be switched off on 31st December and they are moving completely to nhs net mail. Secretary to put in Newsletter that it is being switched off at the end of December and if practices have any I.T. issues then to please send them through this group. They are trying to get encrypted memory sticks for practices to use. Dr O’Connor said that Richard Stringfellow said they are bringing in encrypted laptops at the PCT but every time they are used they don’t work. The Secretary said he has raised the issue of the I.T. budget with Lynda Dando who has said she will look into this.
ii) Path User Interaction Sub-Group
This group meet every two months in various locations around the county. They are usually in the mornings. Dr Kinsman has asked if someone else could go to this group as he will have trouble making this as he has too many other commitments. It is funded by the PCT and is aimed at ironing out any glitches in the system. Jane Stockley runs the meeting. Secretary suggested advertising it in newsletter to see if anyone else will do it.
Action: Newletter:
1) Email server being switched off 31st December and I.T. issues to go through this group.
2) Volunteer to attend the Path User Interaction Sub-Group
5. MATTERS ARISING
Minute 5/490 Choose & Book
Secretary reported that he has received various emails from Simon Hairsnape on this issue. He read out the various letters that he had received. In the latest communication the PCT do want to sort the issue out and get Choose & Book working efficiently and so has addressed a couple of the issues raised by the LMC. They were not happy that the LMC had said that they were acting unlawfully as this would have consequences for the PCT. They want to get choose and book into a situation whereby GPs want to use it rather than have to be ‘encouraged’ to do so. He said that the NHS is moving towards electronic referrals and they are being encouraged to move all GPs to this new system. The PCT have agreed to work with the LMC in trying to get Choose & Book to work. Dr Kinsman said he believes Choose and Book works well but the problem is with the Acute Trust. Doctors want it to work and find it embarrassing when they can’t refer people to their local hospital but have to send them to Birmingham instead.
Minute 5/505 GP Training Practices – Provision of Indemnity
Discussed earlier in the meeting.
Minute 5/484 Stakeholder Representative on the Council of Governors
Secretary reported that he had received a telephone call from Michael O’Riordan, Chairman of the Acute Trust. They are reducing the number of public bodied representatives on the Council of Governors and have asked if the LMC rather than have a seat on the Governors it would be better for the LMC to meet with them twice a year to discuss specific issues. He had discussed this with Dr O’Driscoll who was the nominated representative. Secretary said this may be better than the Board meetings and doesn’t think there is a lot we can do about it.
6. COMMITTEES
a. GPC
The Secretary went over the M4 Circular and issues in the latest Negotiating News.
b. GPCWM
The Secretary gave feedback from GPCWM meeting on the 27th November 2008. The issue of the Darzi Centres and GP Led Health Centres were discussed. Uniformly across the West Midlands the winning bidders for the GP Led Health Centres were private companies and not GP bidders so there is a degree of disillusionment. They also discussed Extended Hours. Martin Wilkinson talked about Learning and Development agreements and Indemnity and Cathy McGarry from the WMSHA gave a presentation on this. A detailed complex document will go out to all training practices and there will be a National pilot for it. Dr Schrieber said that this was a long winded document which is actually quite straight forward.
7. NEW ITEMS
Minute 5/511 QOF
Both areas of QOF discussed earlier in the meeting.
Minute 5/512 Inadequate Mental Health Care
Dr O’Driscoll reported that three practices in Worcester city were contacted by Richard Crellin, Consultant Psychiatrist and the inadequate Psychiatry Service. And that CBT has been withdrawn and he will no longer be above to provide this service. Dr O’Driscoll has discussed it at the GP Association Meeting and has written to Paul Bates and copied to the Mental Health Trust. They have had a very unsatisfactory reply from the Mental Health Trust which he has responded to. Dr O’Driscoll read out parts of the letter saying that CBT was fine; the real issue is that there is a problem with staffing across the Mental Health team. The Chairman felt we should write from the LMC to the Mental Health Trust and copy to Paul Bates that this is core business which they are duty bound to provide, they do not have the option to withdraw. The Chief Executive of the Mental Health Trust is saying they are providing it, so we need evidence to say they are not. The Chairman suggested we ask the Mental Health Trust to confirm what is happening to CBT first and in the meantime if anyone can get together specific evidence that contradicts this then we can write further.
Minute 5/513 PCT Board Meetings
As discussed earlier the LMC would like to send representatives to attend these meetings. The next couple of meetings are 21st January 2009 in Kidderminster and 18th March 2009 in Pershore. Secretary agreed to go to the first and Dr Burger agreed to go to the second. We can feed back to see how they go and review the dates after this if we feel they are beneficial to us.
Minute 5/514 3 Counties Network – Head & Neck Cancer Service
Secretary reported. He had received a phone call from Chris Ayshford, ENT Consultant. A development of the service has taken place in Gloucester, Hereford and South Worcestershire and has been agreed even though it doesn’t meet the national guidance. Worcester’s Head and Neck service will go and will be located in Gloucester. The Consultants do not want follow-ups in Worcestershire. One of our MP’s has written to Paul Bates asking for clarification of this. Sandra Rote replied saying it is being looked at as part of National guidance. So this is another cancer service we are losing. Dr Burger confirmed she had heard this was going to Gloucester. Dr Horton said it has to be concentrated in one area. Secretary said he agreed but Worcester always loses. Chairman said a Cancer Specialist Centre has to be a critical size and Worcester can’t offer this. Dr Horton agreed but said this doesn’t mean that there shouldn’t be an outpatient service locally and if we lose this then this is a shame.
Minute 5/515 Revalidation / Poorly Performing Doctors / Appraisal issue
Secretary reported on the PCT subgroup meeting on the 5th December Dr Mike Jenkins and Dr Trevor Jones were also part of the group. One of the major problems is that the PCT have to appoint a responsible officer who will be responsible for revalidation; poorly performing doctors and appraisals. The appraisal process is going to be a much more complex and detailed issue, each doctor will have to have done certain things before they are passed to be fit to work. The PCT have to fund this. So far this is guidance but it is on its way. Dr Conlen from Birmingham is the person responsible for this. It is a very complex procedure. The Responsible Officer will be the key person as they will make the decision if the doctor can work or not. Whoever takes on this role is key as dependent on the person and how they approach things will depend on the effect it will have. There is a training day in London in the New Year which the Secretary is going to attend to find out what is going on. There is a big question mark on the role of the Deanery in regard to appraisal. Dr Mike Jenkins is standing down as the Appraisal Lead in March.
Dr Schrieber asked the question of what is done for those who don’t pass? Some reports are predicting that 5% of doctors per annum will be flagged as having performing issues. Secretary said there is nothing in post on what to do if they fail. Secretary has stressed to the subgroup that Dr Schrieber needs to be involved in the discussions. Dr Lewis, who is an appraiser said that he had been to a meeting where Dr Conlen gave a talk on this and went through it in detail and didn’t think it was as bad as being said. He didn’t think it would be as much work as before. The Chairman said that he had received feedback from Dr Jones who didn’t agree and was very worried about this. The other worry was the issue of locums and the problems they will face trying to pass the criteria.
Minute 5/516 PMS & The Crouch Judgement
Secretary reported about a dentist who took on the DOH and went to the Court of Appeal regarding a clause with a PDS Agreement. Lockharts acted on his behalf and won. They have said that PDS and PMS agreements are similar in construction and believe the judgment in Crouch is very likely to be applicable to termination under a PMS arrangement. They have said that PMS practices who are currently being threatened with the termination of their PMS Agreements under a ‘termination by notice’ provision may be able to reject such a notice on the grounds that the PCT may be attempting to act beyond its power in terminating the PMS Agreement. They have advised that PMS practices look at their contracts again.
Items B
Circulated
Items C
Application by Boots UK Ltd for inclusion in the Pharmaceutical List at Spring Gardens Health Centre, Worcester. (100 hour application). No comment
Application by Boots UK Ltd for inclusion in the Pharmaceutical List at Evesham Retail Park, Worcester Road, Evesham. (100 hour application). No comment
Application by Boots UK Ltd for inclusion in the Pharmaceutical List at Abbey Trading Estate, Alvechurch Highway, Redditch. (100 hour application). No comment
For info
Application for preliminary consent for inclusion in the Pharmaceutical List at 404 Groveley Lane, Cofton Hackett, Birmingham
CLOSED MEETING (if appropriate)
The Chairman closed the meeting at 9.45 p.m.
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