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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Wednesday, 25th February 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Coney, Mrs L Dando, Mrs M Hallahan, Dr K Hollier, Dr R Horton, Dr R Ingles, Dr A Kelly, Dr R Kinsman, Mrs L Luke, Dr K O’Connor, Dr J O’Driscoll, Dr M Ounsted, Dr S Parkinson, Dr S Pike, Dr D Radley, Dr V Schrieber
1. APOLOGIES
Dr G Browne, Dr P Bunyan, Dr N Burger, Mr D Jago, Dr D Lewis, Dr E Penny, Dr G Ingrams, Dr J Rankin, Dr C Reynolds
2. MEMBERSHIP
Dr Martin has resigned from the LMC Committee. She started a salaried position in Birmingham in February. She has emailed her colleagues via the non principal group and they will be looking for a new representative for the committee. She will continue to work as a course organiser in Worcestershire. Secretary will write and thank her.
Action: Secretary to write to Dr Martin
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 11th DECEMBER 2008.
4. REGULAR ITEMS
a. Worcestershire PCT
Lynda Dando gave an update on PCT matters. Dr Abudu left the PCT on the 12th February and since then there has been ongoing discussion about how the structure needs to change to reflect the current issues. As a result of this a couple of transitional arrangements have been put in place. Primary Care Commissioning and Non Acute Commissioning now sits within Simon Hairsnape’s directorate. Strategic Planning and Joint Commissioning also sit in the same directorate. A proposal is currently being discussed whether the PCT actually needs and will benefit from a full time Medical Director post. This position requires the candidate to have GP experience. If they decide not to recruit for this position then the PCT will need independent GP advice, so they will look for a Responsible Officer also in charge of GP Appraisal; GP Governance Lead and GP Tutor. This could be a part time position. Ms Dando is hoping a decision will be made on which way they will go by the end of March. Dr O’Driscoll asked if that is not what the PEC do? Dr Kelly said it’s a much bigger role. Dr O’Driscoll said it adds to the credibility if the person still did GP duties at least one day a week. Ms Dando said that many other PCTs are adopting this model.
i) Engagement meeting
Ms Dando said there had been an engagement meeting with various people in attendance including Richard Harling, Dr Abudu, Dr Parkinson, Dr Veronica Wilkie and herself. It was a good debate and they understood that there is a lot to do to improve clinical engagement. They have distributed the communication flow chart which was circulated to the LMC members prior to the meeting and are hoping that this will have an impact. Richard Harling is working on this plan and will specify in great detail the role of the groups. He has also written to the SHA expressing interest in the GP Clinical Leadership Programme that the PCT would fund. The next step is to build on the plan and set out how to implement ideas brought forward and resurrect a locality approach to clinical governance but improve this by having a wider information exchange in the PBC clusters and with practices on day to day issues. They are hoping that communication will improve and decisions will be made more quickly.
ii) Revalidation / reaccreditation meetings
The PCT are still discussing the role of the Responsible Officer and who would want to do it. There have been a number of meetings at the PCT which have been led by Richard Harling to try and identify as many issues as possible. Dr Michael Jenkins has produced a project plan identifying the various milestones. Next meeting is early March. Dr Parkinson, Ms Dando, Dr Jilly Cooper, Dr Trevor Jones and Dr Michael Jenkins are all involved. Secretary said there has been a lot of discussion, they want something that is going to work smoothly and try and get the balance right, especially with the lack of national guidance. There is to be a Task and Finish group specifically looking at support mechanisms in place. The Chairman expressed an interest in seeing this policy at an early stage.
iii) Vascular Screening LES
There is to be a meeting on the 10th March involving some GPs and PMs by the Public Health directorate. This is to be an exploratory meeting to try and understand how they can achieve the overall target of 25%. They are still struggling with the finance of it at the moment. Dr Kinsman asked how much money is in the LES with regard to taking on more staff. Ms Dando said there has been no money set aside currently for this, only a small amount of money identified locally. The DOH have given £250,000 for start up costs only. They will have to map out when practices might undertake this screening to work out the resources involved which will be a new cost pressure. Secretary thought about practices employing someone between them, we may have to think outside the box.
iv) “Other GP issues”
The Secretary reported that the DOH has done an MPIG survey on behalf of the GPC and NHS Employers. In Worcestershire there are 4 practices that are abnormally high but the PCT are not aware why they are. The Secretary put a message on the LMC listserver and it seems this is the story elsewhere. The GPC say they will have to talk to the DOH to say that this isn’t going to be straightforward, it is very complicated and would have a destabilising effect if they pulled the plug on MPIG. Ms Dando said this information has also gone back to the SHA. Dr Kinsman asked if this information was freely available. Secretary said he wasn’t happy to show this. Ms Dando said she would have to contact the practices in the first instance as a courtesy. Members said that this came under the Freedom of Information Act so should be able to see it.
Ms Dando said that on Dr Abudu’s last day she signed off all the PMS contracts and Lockhart’s variation documents.
The Secretary reported that the Adult Safeguarding Board are keen to meet the LMC and PCT. They have started asking practices for information so it may well be worthwhile to meet with them to find out what they need and what they are currently working on.
Regarding the Anticoagulation LES Ms Dando emailed a letter to all practices today setting out the decision and conclusions that were arrived at by the PEC. What has been agreed for a number of reasons is to go with the National Specification that was agreed in 2004, although over the past 4 years quality and safety requirements have changed so these need to be added to the specification and the issues identified in both primary and secondary care. The PCT wrote to practices about the two levels of care in November and then a number of issues were raised at this time which they have since looked into. Issues included what to do about housebound patients. The perception was that the PCT were trying to move a primary care service back to secondary care but Ms Dando stressed that this wasn’t the case. The PEC has agreed we will revert to the national specification but add to it the quality and safety issues that have been highlighted along the way. Payments will stay the same as originally proposed, level 1 to be £19 per patient; level 4 will receive £128 per patient plus the cost for a box of strips so a total of £153 per patient. In addition to that, and alongside, those started patients initiating will get £110 per patient. Because they are reflecting the national specification there will be a payment for practices to pay staff who visit housebound patients. A small cohort of patients who may be high risk will continue to need secondary care monitoring. Those who have venous samples taken will need to have these analysed in secondary care. The issue of contestability has come along on this, becoming clear that the further they move away from a primary care agreement the more they are coming into the realms of contesting this. It is working well and they feel they can make it work even better. Dr Ounsted said that the PCT should have received a couple of letters about the prices remaining unchanged and practices not being able to offer the service for the cost of reimbursement. Dr Kelly said they have looked into the costings and think it is a fair costing and practices should be able to work within this. Ms Dando said she felt the costings were fair. Secondary care are offering this service for £7.50 per patient and believes the price, particularly with the initiation price is over and above what other PCTs are paying. Dr Ounsted said he would be interested in seeing the reply to these two letters. Ms Luke asked if practices can do both, level 1 and 4 and Dr Kelly said yes and a combination of both. Dr Ounsted asked if the PCT had approached Gloucestershire Acute Trust for prices. Ms Dando said yes there has been discussion with other providers and all have been made fully aware of what is happening.
Dr O’Connor wanted to discuss home educated children. A mother brought her teenage daughter who was home educated to discuss the HPV vaccine. He contacted Public Health and the school nurse team but no one was interested. Practice can order vaccines for year 8 girls onwards but the worry is that practices are not aware of which children are home educated and they can slip through the net. Dr O’Connor asked Ms Dando if there was any way the PCT can work with the County Council to make all guardians of home educated children know that they should inform their practice that these children may fall out of the loop. The committee felt this would be something they could flag up with the Safeguarding Children Board. Dr Horton said it was a responsibility of Social Services and the School Health Service. The Secretary agreed to write to the Safeguarding Children Board.
Dr O’Connor asked Ms Dando about addendums from Lockhart’s they receive regarding the PMS contracts. Should practices sign these? Ms Dando said yes, these are keeping the PMS contracts up to date and should be signed. Dr O’Connor asked if they should only sign those received from Lockhart’s and Ms Dando confirmed that this was the case.
Ms Luke said that she had received numerous emails about protocols and have had them returned because they haven’t got their practice address or date on them. She feels what they are asking for is irrelevant. Ms Dando said that they don’t want to be working on these all the time either and it is meant to be helpful. Chairman said this was another issue of a lack of communication but if they contact us and tell us what they want then we can sort these issues out. Ms Dando said the PCT have engaged a practice manager from a local practice, Mary Taylor, who is helping the PCT to get to the place where they want to be in developing protocols.
Don Beckett said that he had been receiving a vast amount of communication from the PCT. General emails that he gets because they don’t know who to send it to so they are bulk sending just in case. Ms Dando said role number 7 on the communication plan will be looking at this.
Action: Secretary to write to Safeguarding Children Board regarding Home Educated Children
v) Chlamydia LES & General LMC involvement in LES development
Chlamydia Screening LES appeared to all practices with no discussion beforehand. Ms Dando said this shouldn’t happen again with the new structure in place. Ms Luke said that letters have also gone out to patients too.
b. Education
Dr Schrieber gave an update. Lots more people want to be trainers and they are appointing a new course organizer. There are still some difficulties in trainees getting booking sessions with TCN. In regard to Indemnity, Martin Wilkinson has produced a more sensible letter. Secretary said this letter has gone to Shanee Baker, the GPC lawyer, once she is happy with the letter it will be sent out.
c. Dispensing
No report.
d. Out of Hours
There was a Worcestershire County Council's Health Overview meeting on the OOH Service on the 10th February. Unfortunately neither the Secretary nor Dr O’Driscoll could attend. The Secretary sent some comments about local issues and a lack of communication to the meeting beforehand and has looked over the minutes since the meeting took place. There is to be a follow up meeting.
The Secretary wanted to bring to the attention of the committee a conversation that took place with Dr Abudu at an LMC meeting last year when she was asked if TCN asked for more money to cope with more work would the PCT give them additional resources in which she said no. There was an article in a local paper saying that TCN had worked well over the Christmas period but it stated that Dr Abudu had said the PCT had put in additional resources. The Secretary asked Dr Abudu if they had given them more money and she confirmed that they had. Secretary has raised this with Paul Bates.
Dr O’Driscoll discussed the issue of statistics with TCN. They are currently sending more than one piece of paper per patient and each piece of paper they send per patient is counted as a contact. Each individual one of these contacts may be subject to a different target for response time and therefore it is possible to manipulate the targets. Dr O’Driscoll discussed this in more detail. Secretary asked if perhaps we should query this with the PCT. Dr O’Driscoll also went over other examples of patients not getting seen by TCN and poor performance and also mentioned the letters TCN had not responded to from the LMC. Dr Radley suggested looking at previous year Christmas figures against this years. Chairman asked if anyone could go to the meeting in March. Would email the date to members and if anyone could go could they let the Secretary know.
Action: Mrs Hallahan to email date of meeting to members
e. Non-Principals Group
No report.
f. Registrars
Dr Kinsman suggested putting something in the Newsletter to practices to encourage trainees to make sure they get their sessions in with TCN.
Action: Newsletter
g. P.M. Groups
No report.
h. Administration Issues
i) Revamping the Newsletter
Secretary wanted to make sure that the committee were happy with the current newsletter, or whether they felt it needed revamping. Committee happy with the way it currently is.
ii) LMC Levy for 2009-2010. Forecast circulated.
Committee agreed to wait for more information on what the pay rise is likely to be for this year before deciding on the levy.
iii) LMC Purchasing Scheme
Dr Jonathan Wells sent an email about other LMCs setting up buying groups and the possibility of Worcestershire LMC doing something similar. We put this in the last newsletter but had no response at all from practices wishing to take us up on this. Secretary said that he looked at this when he first became Secretary of the LMC but got nowhere. Redditch and Bromsgrove already do this for stationery and disposable items, and Dr Radley said that his practice joined a buying group and they get discount through this. All agreed that they didn’t think the LMC should do this.
i. P.B.C. Issues
Already dealt with before the meeting.
j. I.T. / GPSoC
Dr Kinsman gave an update on I.T. issues.
IT Support is likely to offer space for practices to host their website and intranet. Practices would need to pay a license fee of £500 for the website and intranet. Using both would mean buying two licences. There would be no other costs after this. If practices already have their own website they could transfer to this arrangement or without payment have a link to it on the website that is being created. The software is like using word so very easy to use compared to other web page authoring software. Practices are encouraged to at least consider this option when it becomes available. A few expressions of interest might help the project move along. Let Dr Kinsman know.
The I.T. Diabetic Retinopathy Group project is failing to deliver. The Diabetic Retinopathy Screening Service which will continue. The automatic data extraction and electronic result sending is bogged down at present.
Security and encryption. If practices use USB sticks at your surgery they must be encrypted. Practices should be asking themselves why they are using them when online storage is available and better. If practices are on the WHITS domain or COIN then they can store things on the central server which is backed up to an extremely high specification. Laptops and any mobile device such as a PDA must be encrypted to the necessary standards. This advice has been issued repeatedly. Contact IT support for advice and guidance if needed. Practices will not be able to use a lack of awareness as an excuse for not considering and resolving these issues.
Encrypting some older and maybe some brands of new laptops may cause the device to fail. Funding for replacing such laptops has not been agreed but all such instances MUST be reported to IT support so that funding can be bid for. The final date has passed but please contact IT support if this affects you. If you are purchasing a new laptop then consider choosing from the DELL website then order through IT support since they will ensure encryption and support if thereby avoiding the issues that may arise if you buy elsewhere then encrypt the device.
The IT Working Group met with the TCN I.T. Manager on improving communication with practices. She has not been in the job for long. The group felt that electronic transmission of the outcome from an OOH contact in a user friendly format should have been a pre-requisite for any bid and will insist upon that if consulted in the future. IT support offered full support for developing such a process and indicated that they felt this was a high priority. The TCN representative appeared to understand what was being said. A follow up meeting was requested.
NHS Mail changes. The GPMTA server has been switched off. Most issues recently were to do with forced password changes and accounts locked and blocked. It was noted that you have to use an N3 connection to reset and change passwords and that attempts to connect via Outlook or a non-N3 connection may lock and block accounts. . NHS mail is the future. Practices are encouraged yet again to use xxx@nhs.net email.
IT Support are looking at continuity support for all practices possibly using EMIS web which works for Vision and EMIS but not for iSOFT. Each practice should have a spare printer. Dr Horton asked about having a spare computer but Dr Kinsman said whilst this wasn’t in the specification the working group agreed that this was a good idea. Newly supplied printers should be Kyocera if for prescriptions and HP B&W or Colour if network printers. If any practice has an issue about these “replacement printers” then please let John Thornbury know so that we can review the models being used. It is the wish of the working group to limit the brands and range of printers in use.
The Chairman said that the PCT have encouraged all practices to go paperless and in light of this they need to have remote access from a laptop for home visits. The Chairman said if the PCT wants practices to go paperless then they should fund this. Mr Beckett said that the working group agreed with this but there wasn’t enough money to do this so it was a lower priority than other issues. The Chairman asked the committee for their views and all agreed that they thought the LMC should write to the PCT about this. (Dr Kinsman adds that working group felt that if such a device was used then the device and not just the access fees should be funded and supported).
Action: Secretary to write to the PCT
5. MATTERS ARISING
Minute 5/405 084 phone lines
Secretary urged the committee to respond to the consultation process that is currently happening regarding the use of 084 numbers as per the last newsletter. The LMC has submitted a letter for the Consultation to the Department of Health.
Minute 5/459 GP Led Health Centre
Secretary said that he had been expecting to get a briefing but had not heard anything. Dr O’Driscoll said that it was their AGM that evening but he had a briefing paper from them. They will be open 8 a.m. – 8 p.m. Location to be Farrier House, Farrier Street, Worcester. They will take registered patients as well as drop-ins and are expecting to grow by approximately 1200 patients per annum. They will be advertising in the likes of BMJ for their doctors. They will have 3.5 doctors on a rota of 4 x 4 hours overlapping a day and 9 nurses. The opening has been put back to the end of July but could even be later. Discussion took place on the general topic of these GP Led Health Centres. The majority in the West Midlands have gone to GP consortiums but they are not being pressurised by the PCTs into getting these open quickly.
Minute 5/492 HPV Vaccine LES
Chairman reported that they have had a small number of patients who have asked if they can have the Cervarix vaccine. They have asked the PCT if they can prescribe this to their patients but the PCT have said that it will not support prescribing outside the national programme and action would be taken. There was a mixed feeling on this. If practices follow the national guidelines then they can always defend their actions by saying they are following these. If they make a decision outside of this then as long as they can justify their reasons and it is proved to be clinically right they will have a strong case. The LMC cannot offer advice on this and cannot support practices to go against the guidelines.
Minute 5/502 Worcestershire Mental Health Partnership NHS Trust
a) Letter received from Dr Ros Keeton following a letter sent from the LMC. The Trust has agreed to increase the Stakeholder Constituency to include a representative of the Worcestershire Local Medical Committee. Dr Keeton will try to come to the LMC meeting in March.
b) Dr O’Driscoll had concerns regarding the parlous state of Mental Health services in Worcester, recently brought to our attention by Dr Crellin. Dr O’Driscoll, who is becoming increasingly concerned, read out a letter he had received from Paul Bates and went through what these problems were. The Choice Agenda does not mention Mental Health and there seems to be a loop hole here.
Minute 5/511 QOF Review Meetings
The Chairman and Secretary both went to QOF road shows. This is supposedly a consultation process, clearly the decision for NICE to undertake the reviews has taken place. The LMC have already sent in a response and we will have to see what happens next.
6. COMMITTEES
a. GPC
The Secretary went over the M5 & M6 Circular and issues in the latest Negotiating News. Focus on Seniority Document circulated to members prior to meeting.
b. GPCWM
Secretary gave feedback from the meeting on the 22/01/09. Some Hospital Trusts have I.T. problems and are sending their letters to the senior partners only. The GPC Negotiators meeting is on the 26th March 2009 in Birmingham from 2-4 p.m. Please could LMC members let the Secretary know if they want to attend. Dr Ounsted indicated that he would like to attend. With regard to the LES payrises, Worcestershire have had 1.5% but many other West Midlands PCTs have not offered anything. The next GPCWM meeting is on the 1st April and is on re-validation. Steve Field will be attending. The Secretary has seen a draft copy of the new complaints procedure. You will have to notify the PCT within 3 days of a complaint being received and the PCT can act if they wish to get involved. Mrs Luke asked if this is for just complaints made in writing. Committee thought it probably was but we will need to review the documents.
7. NEW ITEMS
Minute 5/517 Home Educated Children
Discussed earlier in the meeting.
Minute 5/518 LMC Annual Dinner
The LMC Annual Dinner is confirmed as the 25th March. Pre order menus have been circulated to members. Secretary confirmed which guests have been invited.
Minute 5/519 BMA Junior Members Forum 2009
The 2009 Forum will be held at Clare College, Cambridge over the weekend of 28th and 29th March and will be on the subject of “Family values”. We will send out details to members and if anyone would like to attend please can they let us know.
Action: Mrs Hallahan to email date of meeting to members
Minute 5/520 Review of NHS Complaints Procedure
Mentioned earlier in the meeting.
Minute 5/521 EPS System
Jon Bennett from Worcestershire PCT sent an email giving an update on the EPS System. Secretary went through these figures with members of the committee.
Minute 5/522 Personal Health Budgets
The DH has launched a 3-year pilot programme on personal health budgets (PHBs).
PCT-led pilot sites will be announced in May, and the deadline for applications is 27 March. The pilots will commence work later in the summer. The Secretary said that we were not in the pilot so will have to see what happens with this.
Minute 5/523 Myeloma Screening
Dr O’Driscoll mentioned this screening programme which has stopped in Worcester. Dr Kinsman said he can deal with this through the Pathology User Group. Dr O’Driscoll will send the details to Dr Kinsman for him to deal with.
Action: Dr O’Driscoll to send the details to Dr Kinsman
Minute 5/524 Access to GP systems
Dr Kinsman said this was a real problem, if practices gave a password and access to a practice computer to a person not employed by them they could be in serious trouble. The Secretary asked the GPC on their views on I.T. and confidentiality. They have said they have no views on this. Dr Ingrams is of the view that unfettered access is not acceptable and certainly not without informing patients first and allowing them to opt-out. The committee discussed what the LMC could do as we cannot tell practices what to do. Secretary suggested we put something in the newsletter to say that they need to review and consider their own policy. Committee agreed and also suggested the Secretary write to the Caldicott Guardian at the PCT and let practices know that we will be doing this.
Action: Secretary to write to PCT and put this in the Newsletter
Minute 5/525 Prescriptions for pre-op patients found to have MRSA
Worcester GPA has raised this issue, which was initially raised by Dr Keeble, which relates to whose responsibility is it to organize and prescribe treatment for patients who are found at pre-op check to have positive swabs for MRSA. Dr O’Driscoll said that he wanted to discuss this with the LMC on behalf of Worcester GPA. This could potentially be a huge issue. Practices could start doing one or two of these and it could escalate into many more. Dr Kinsman suggested writing to Jane Stockley in the first instance. Committee discussed in more detail.
Action: Dr O’Driscoll / LMC Secretary to write to Jane Stockley
Minute 5/526 ECG’s for Psychiatrists
Dr Nederlof contacted the LMC about a new consultant psychiatrist for the elderly in Evesham. He wants practices to provide him with an ECG for every patient referred with memory problems. There was differing views on this, very similar situation to the subject above but the committee felt that they did not have enough time to discuss this fully and agreed to discuss this in more detail at the next meeting.
Action: C/F to next meeting
Minute 5/527 Ambulance Transport Bookings
Ran out of time. Committee agreed to discuss this at the next meeting.
Action: C/F to next meeting
Items B
Circulated
Items C
Application by Sainsbury’s Supermarkets Ltd for inclusion in the Pharmaceutical List at Abbey Trading Estate, Redditch. No objection.
Application for a minor relocation by Lloyds Pharmacy under 500 metres from 10 Cornmarket, Worcester to Spring Gardens Health Centre, Worcester. No objection.
Application from Mr A Tanday for a change of ownership of the pharmacy at 24 Comberton Hill, Kidderminster, currently owned by Knights Chemist Ltd. No objection.
CLOSED MEETING (if appropriate)
The Chairman closed the meeting at 10.05 p.m.
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