The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 14th May 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr G Browne, Mrs M Hallahan, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Dr R Kinsman, Dr D Lewis, Mrs L Luke, 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 H Ray, Dr C Reynolds, Dr V Schrieber
1. APOLOGIES
Dr P Bunyan, Dr N Burger, Dr P Coney, Dr K O’Connor
Annual General Meeting
For the
Worcestershire Local Medical Committee
The Chairman opened the AGM of the Worcestershire Local Medical Committee and asked members if they remain happy to adjourn for a year and transfer the working of the LMC to Worcestershire Local Medical Committee Limited. Secretary apologised to the committee that the elections for this year had not yet been done. Paperwork has now been sent out to all doctors in the south of the county. The Secretary proposed co-opting the existing members for 2 months and then to have the election for South Worcestershire. Dr Pike seconded and all members agreed.
Annual General Meeting
For the
Worcestershire Local Medical Committee Ltd
Secretary said he had spoken to Shanee Baker at BMA Law about the Ltd company arrangement. She said there has been much debate about our tax position but it has now been agreed with HMRC and they are happy with the arrangement that we have. Initially there was a formal agreement between the LMC and the Ltd Company but we do not need that anymore. It has to be agreed that the LMC will devolve its work to the Ltd Company. HMRC agreed that the LMC can act as the paymaster for the Ltd Company and the LMC will not have to pay VAT. Secretary said that if agreeable will keep it the same and have an extraordinary meeting in two months to appoint the officers. This was unanimously agreed.
The AGM was followed by the usual business meeting:
2. MEMBERSHIP
a. Dr Horton’s replacement
Secretary said that there were two GPs interested but waiting to hear back from both of them.
b. Dr Ounsted’s resignation
The LMC has received a letter of resignation from Dr Ounsted who is retiring from general practice at the beginning of September. His last meeting will be 9th June. Chairman read out letter from Dr Ounsted. The Secretary had received a letter from Dr Neil Townsend from Evesham GPA saying that all 5 practices have unanimously agreed that they would like Dr David Herold to take over from Dr Ounsted as the Evesham representative. Chairman asked the committee if they were happy to co-opt Dr Herold. All members unanimously agreed.
c. New Non-Principals rep is Helen Ray
Chairman welcomed Dr Ray who will be representing the non-principals.
d. Election for South Worcestershire LMC Members. Secretary
Discussed earlier.
e. NB Register of Interests
Chairman said that the folder of the Register of Interests was available to be viewed by members.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 31st MARCH 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
Lynda Dando and Simon Hairsnape updated the committee on what is currently happening within the PCT. Ms Dando asked the committee how the process in the past had took place regarding selecting the practices for the QOF audit checks. Secretary and Chairman gave an overview and all agreed that this year we would hold the process at the Chairman’s surgery as we had last year.
i) Update on Enhanced Services
All practices should have received a list of enhanced services and understand the process. Ms Dando gave a recap to why they have reviewed them. There are different types of enhanced services. There will be a list of services that are primary care enhanced services which will be funded by the enhanced service floor. Then there will be PBC enhanced services which will sit under the primary care PBC umbrella and will fall under the enhanced services funding until further notice. There will be a basket of services where there is no understanding or paperwork at present, so PBC clusters will look at these by the end of June and give their recommendations to the PCT. There is a small amount of services where there are odd things which they are also looking into. The final list is a bit of a wish list and new proposed services, it is a mixture of new national things that practices are going to be asked to do and some local needs, e.g. nursing homes. What the PCT will need to do next is to understand what they have left of the original floor and decide what they are going to do. The timescale for this is the end of June. Some of the work has already been done and appropriate people are involved. Payment will not be withdrawn while this work takes place. Simon Hairsnape said it will give clarity across Worcestershire which was something that needed to be done.
Secretary asked about vascular screening. Ms Dando said this has been identified as a new service and Public Health are coordinating the work around this. There is no more information on this since the last meeting but they will discuss with practices when they meet them. Dr Radley asked about the workload of this and the targets given by the Government. Ms Dando said it has to be targeted but it is for the PCT to agree what the target group is. Dr Ingrams said nationally they are not sure what they are doing with it so it seems to be a work in process. Ms Dando said they will still be monitored on it.
Secretary asked about the INR LES and whether it has yet been finalised. Ms Dando said that there is still one geographical area within the county that they are still having discussions with but once that is resolved it will be finalised. Dr Radley said there was also a problem in Malvern regarding the setting up of a town wide scheme, which was awaiting a reply from the PCT. They are also working more closely with secondary care about the process and the next meeting for this will be in June.
Secretary asked if there was any update on the Medical Director and Clinical Forum. Mr Hairsnape said that both were discussed at the Board meeting yesterday. They have agreed on the Medical Director position but there is still debate on the requirements for this post and are looking at different options. They may advertise and see who comes forward and wrap the post around the individual. There will be a national advert going out shortly. The PCT have separated out the clinical senate and the executive positions. PEC members have agreed and this will be phased in over a couple of months so it will be a big group with different type of members. The Secretary said that the LMC felt that the role of the Medical Director should be an existing practising G.P. He also said this could be a huge role and when revalidation starts this could be a very big and challenging job for one person to take on and the PCT have to be careful that this person doesn’t get swamped. Mr Hairsnape said that they are still trying to work round this but it would be good for the LMC to feed this back to Paul Bates. Secretary said had already done this but would write about this again.
QOF Review has been sent by the PCT. Secretary will put in newsletter. Dr Ingrams said the patient survey results are back and Worcestershire should be receiving them soon.
Dr O’Driscoll mentioned the Violent Patient Scheme and said it isn’t working which the Chairman reiterated. Chairman gave scenario of the problems for both Tier 1 and Tier 2 patients. Ms Dando said response to date is as the agreed policy but if this isn’t working then it will need reviewing as it has been 4 years since it was last looked at.
Chairman thanked Ms Dando and Mr Hairsnape for coming.
Action: Secretary to email Paul Bates regarding the Medical Director post.
b. Education
No report
c. Dispensing
Dr Rankin mentioned the pharmaceutical needs analysis and if he could write on behalf of the LMC that dispensing practices be included as he felt that the PCT could go ahead without including them. All agreed that Dr Rankin should do this.
Action: Dr Rankin
d. Out of Hours
No report
e. Non-Principals Group
Dr Ray gave feedback to the recent meeting. There is concern about revalidation regarding locums and part time GPs and how it is going to work; how many sessions and the support if one fails. Discussion took place but it looks like it will be put back to 2011 now and it is not clear how it will run.
f. Registrars
Dr Browne talked to his colleagues about their concerns with TCN and their specific allegations but no one would put it in writing. Dr O’Driscoll said they can write to him and he will keep it anonymous. Dr Browne said he will feed this back to them.
g. P.M. Groups
No report
h. Administration Issues
The LMC Levy for 2009-2010 and pay awards was discussed. The Chairman, Secretary and Mrs Hallahan left the room whilst these discussions took place. It was agreed that Mrs Hallahan should receive 2.5%, Chairman and Secretary to receive 1.5% and all members to receive 1.5% increase.
i. P.B.C. Issues
The Chairman and Secretary fed back from the LMC PBC meeting that took place with PBC Leads on the 12th May 09. They discussed what was currently happening. The general perception is that it is coming together and a real recognition that they need to work together as a clinical forum. There is a lot of confusion about what the Medical Directors role will be. It was felt that we should all work together; all the issues from the different areas seem to be the same so they will be approaching the PCT as a united voice. It was a good and useful meeting. Secretary and Chairman spoke about current problems and scenarios and gave examples of what is happening in the different PBC areas.
j. I.T. / GPSoC
i) Primary Care Working Group – April and May 09 meetings
The IT working group have discussed the Vascular screening LES and related IT issues. Amazingly six practices claimed as part of their IMT DES submissions that they had a hosted server – use a remote server for clinical data. They do not and there are none in the county. The inaccurate claims reflect badly on GP practices. John Thornbury suggested that only practices connected to the COIN are likely to have a good enough connection. Any practice going down the hosted server route may be asked to sign a disclaimer relating to their internet connection.
The McAfee Antivirus software that most practices used stopped being updated in March 2009 when the license ran out. Practices will be upgraded to Microsoft forefront security in due course. It was surprising that GP practices had not already noticed and raised the issue. To put in Newsletter
Finance for IT hardware may be tight in the coming few years. Practices may need to consider how equipment falling outside any Service Level Agreement might be funded. For example making it part of commissioning a service rather than looking to IT to fund the hardware.
Dr Kinsman reported that the diabetic retinopathy screening service was not progressing to plan and that Savience were no longer going to be developing the service. A free trial of MSD developed software is planned at five separate sites vovering the main clinical software providers. The possibility of EMIS Web was being considered. (Grant Ingrams suggested that the GP Extraction Service may provide an alternative method in the future.) The failure was a great disappointment but the project has made Docman available to all 67 Worcestershire practices. It is installed in 65 practices. It may facilitate hospital letters being sent electronically in the future. A trial using EDT which allows XML data to be sent is being considered.
The new PCT website and Acute Trust websites should be available shortly. Any group working in primary care, such a s a GP practice should be able to purchase a license to use the software for a one off cost of £500. IT support would host the site at no ongoing cost. The software is said to be very easy to use. It allows you to do things like poll patients for their views on most things. If a practice wanted to use this to develop an Intranet then a further £500 would cover the necessary additional license. There is a training session or demo on 17th June at Alexandra Hospital Redditch. Please reply to invite from IT support if you intend going. To put in Newsletter.
Following a resignation by one of the GPs on the IT Working Group they are looking for one or two interested GPs to attend. Please contact Dr Kinsman if you want some more information at richard.kinsman@nhs.net. To put in Newsletter.
ii) Path User Interaction Subcommittee April meeting
If GPs have any issues they wish to raise they can channel them through Dr Kinsman at richard.kinsman@nhs.net. Meetings are held every 2 to 3 months. It would be helpful to have another GP or two attending. To put in Newsletter
The LMC committee raised the recent problem when the results stopped flowing. Dr Kinsman said this affected a specific number of days and gave an outline of the reasons why the acute rust response had been slower than normal to pick up on the problem. The LMC committee stressed how useful it would have been for practices to have been better informed about the whole incident.
The pathology order comms or electronic pathology reporting and then later requesting sites went live on the 5th May. Log on using web browser to view results and see what tests requested but not yet reported etc. It should be able to print off results and request particular results done in hospital are electronically sent to the practice. After 6 to 12 months practices should be able to request pathology tests electronically. Dr Lewis said that his practice is piloting it and it is working very well. Electronic requests for radiology, wheelchair supplies will follow.
National Blood Service is going to change. They will not do the routine anti natal screening anymore. It will be done by the local hospital and cost the PCT more money.
MRSA screening for all patients – microbiology said this could make up to a third of their workload. There was agreement that treatment was the responsibility of the screener, so we should not anticipate GPs being asked to be involved. Apparently the screening done by GPs can differ from that done prior to hospital admission. To put in Newsletter.
Pathology Transport – There is a wide variation in this. Some practices have a single collection at 11:45 so have to complete all blood taking by then. Dr Kinsman felt that a better level of service should have been included in the criteria for commissioning the service or alternative bidders should be sought. Comments on pathology transport invited and we will put something in the Newsletter about this. LMC Secretary asked about Saturday service but Dr Kinsman said that this hadn’t been discussed but would happily take it back to the next meeting.
There was criticism of the quality of pathology forms arising from of domiciliary requests. Dr Kinsman has suggested that a comparison of hospital versus GP originated requests is published to provoke some friendly rivalry. He was convinced that GPs could do better than their hospital colleagues. At present the fact that the clinical details we provide are not included in the report is unhelpful and not likely to lead to better completion of the form.
There was concern about the training of staff that emergency results are given to. Dr Kinsman suggested that if the hospital used nhs.net email addresses then they could email the result to avoid transcription errors and phone to highlight that the result had been sent.
Myeloma screening was raised but does not seem likely to be reintroduced so practices must continue to recall patients themselves. To put in Newsletter
Action: Various items as above to be put in Newsletter
iii) IM&T DES
Dr Ingrams said that if a practice is on a hosted system with system supplier that will be accredited this year then the PCTs should consider paying component 4. If practices fall into that category then they have a case but otherwise they will not get payment for component 4. Ms Luke said that the tone of the letter that was sent out to all practices was unacceptable. This letter was sent out to all practices whether doing it or not.
5. MATTERS ARISING
Minute 5/526 ECG’s for Psychiatrists
B/F from last meeting. 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. This was discussed briefly two month’s ago but the decision was to carry this forward to this month so it could be discussed in greater detail. Dr Ounsted gave a summary to members and the issues that need to be resolved. Secretary suggested that this is a PBC issue. Chairman felt that this was not good practice and that the Psychiatrists should do this or it should be a definitive standard so that it is safe, e.g. a LES. The PCT have said that secondary care are not to prescribe so this will be pushed back to primary care. Chairman said that if the PCT want practices to do an ECG then they have to pay. Dr Ingrams said that this should be an agreement between secondary and primary care and needs to be costed. Dr Ounsted to feed back
Action: Dr Ounsted
Minute 5/432 Violent Patient Scheme
Discussed earlier in the meeting.
6. COMMITTEES
a. GPC
The Secretary went over the M8 Circular and issues in the latest Negotiating News.
b. GPCWM
i) Meeting 2nd April 2009
Dr Ingrams reported on the meeting. Revalidation; problems with the SHA and the new Chief Executive, Ian Cummings was discussed. Nuts & Bolts this year will be on the 30th September, each LMC normally has about 3-4 people. Dr Ingrams asked the committee to let him know if they would like to attend.
ii) The GPCWM AGM & Annual Dinner
This will be on the 4th June at the BMI in Birmingham.
7. NEW ITEMS
Minute 5/532 Worcestershire PCT Draft Policies
Two draft policies received from Nigel Higenbottam were circulated prior to the meeting for our comments. The policies were a Local Dispute Resolution Procedure and Policy and Procedure when dealing with a request from a practice to change its patient registration area. Dr Ingrams believes that the paragraph at the top of page 2 of the Local Dispute Resolution Prodecure is erroneous, which implies that if a practice does not have NHS Body Status, then court proceedings must be used. Dr Ingrams said this is not correct and said that for disputes relating to IT or premises there are separate considerations. The Secretary said that Shanee Baker from BMA Law agreed with Dr Ingrams statement.
Minute 5/533 Swine Flu
Secretary reported. There have been two meetings since the onset of this. At the meeting they said that practices should receive a document on proposals for a pandemic. The document will show how it will work and what input from general practices will be expected. Secretary gave an overview of what this document will outline. Questions were discussed around the table of possible scenarios.
Minute 5/534 Southbank Hospital
Dr O’Driscoll has written to the LMC about Southbank not providing NHS prescriptions for NHS patients which is a recurring problem. Dr O’Driscoll has contacted Paul Moran about this. He agreed it is a problem. He asked for this to be put in writing so he could speak to the Governors at Southbank about this issue, which Dr O’Driscoll has done. The matron rang Dr O’Driscoll and confirmed that this has now been sorted and prescriptions will now be available at Southbank. Dr Kinsman asked if we can put something about this situation in the Newlsetter.
Action: Newsletter
Minute 5/535 LES to Stop Smoking Services
Circulated to members prior to meeting.
Minute 5/536 BMA Business Consultancy Service
Secretary reported that BMA Law have been approached by Londonwide LMCs about a possible service and BMA Law think this could be rolled out nationally for other LMCs but people in the BMA council are objecting to this. Would the committee be happy for the Secretary to write to them saying that if they are going to roll this out in London then should offer it to other LMC’s. Lockharts are also now offering this service. Committee agreed that the Secretary should write to the BMA council.
Action: Secretary to write to the BMA
Items B
Circulated
Items C
Application by Lloyds Pharmacy Ltd for inclusion in the pharmaceutical List for 100 hour pharmacy in the vicinity of Turnpike House Medical Centre, 37 Newtown Road, Worcester. No objection.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.55
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