The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 9th June 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Bunyan, Dr L Butcher, Dr M Davis, Mrs L Dando, Mrs M Hallahan, Dr D Herold, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Mr D Jago, Dr R Kinsman, 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 H Ray, Dr V Schrieber
Chairman welcomed Dr Lynne Butcher and Dr Matt Davis who have put themselves forward to take over from Dr Horton, one of the Wyre Forest representatives. The committee agreed that Dr Davis will take over from Dr Horton and the committee agreed to co-opt Dr Butcher. Chairman welcomed Dr Herold who will be taking over from Dr Ounsted, one of the Wychavon representatives next month. Chairman also welcomed Dr Bryan Smith, Worcestershire PCT Chairman.
1. APOLOGIES
Dr N Burger, Dr D Lewis, Dr K O’Connor, Dr C Reynolds
2. MEMBERSHIP
a) Dr Lynne Butcher & Dr Matthew Davis
As above.
b) Resignation of Dr Gerry Browne
Dr Gerry Brown has resigned.
Dr Coney will continue to represent the Registrars
c) Dr David Herold
Dr David Herold attended the meeting with Dr Ounsted. Dr Ounsted retires this month and Dr Herold will take his place on the committee.
d) Too many Worcester City members!
Secretary reported that too many people have put themselves forward for re-election for the Worcester City area. Dr Burger has taken on the representative role as she put herself forward first so Dr O’Driscoll agreed to be co-opted on to the committee, both as the BMA representative and the LMC Treasurer. Mrs Hallahan asked if Dr O’Driscoll could still sit as Treasurer for the LMC in a co-opted position. Secretary agreed to double check this with the constitution.
Action: Secretary to look at constitution
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING
HELD ON THE 14th MAY 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
Lynda Dando reported.
i) Review of Referrals/Demand Management
Lynda Dando said this was an important piece of work and communication is very important to the PCT. The PCT feel it is good practice to do this but also because of the 8% increase in outpatient numbers and the knock on effect this will have. The PCT are trying to change the current situation by looking at the reasons for the increase and what can be done about it. The PCT recognise that success will only happen with good communication with practices and are seeking the view from the LMC at the start of this process to make sure that the right approach is taken. They would like to get an idea on what the LMC think of the current process and what else the LMC feel the pct needs to be doing. Dr Ingrams asked if they had read the BMA’s report on the same issue as there has been work done in other parts of the country, and he gave examples of what the report contained. Dr Ingrams agreed to email the document to the LMC and they would in turn email this to Ms Dando. Ms Dando said no conclusions have yet been made as it is early days. Dr O’Driscoll said similar discussions had taken place over 20 years ago and he has never seen a set of guidelines which, if followed, would reduce the number of referrals he makes. If protocols are followed then this can increase the number of referrals and the PCT should bear this in mind. The LMC Chairman said there had been no input from clinicians into this group, and as they are the people who do the work the PCT should invite somebody sensible in from the start to discuss the plan and structure of the group and how this work should be done. Lots of discussion took place regarding this amongst the committee. Ms Dando agreed and took on board the comments made. The Secretary said that he would advise changing the title of the document and also feels ethics of this process have to be considered carefully. The Chairman agreed and said he didn’t think the ultimate paragraph was a good message to put in the document, where it says if practices do not deliver the PCT will bring in a referral management scheme. Dr Smith asked if protocols would be helpful or unhelpful. Chairman said protocols can make you refer more, also when you refuse to refer a patient on a protocol then there can be a lot of paperwork. Dr Butcher disagreed and said that some things do work with protocols. Dr O’Driscoll agreed with rationing as long as it is done fairly throughout the county. Dr Kinsman said that policing has to take place if a patient is referred from one practice but cannot get referred from another practice then this is unacceptable and the PCT have to be very clear that the protocols are for all practices to adhere to. Lynda Dando reiterated what was discussed and went over the points again.
Action: Mrs Hallahan to forward document to Lynda Dando
ii) PCT update
Ms Dando said the Clinical Senate has been approved by the Board. A timescale for the first meeting has not yet been agreed. The Medical Director appointment has been agreed, the only issue outstanding is whether it is full or part time. The Secretary said he didn’t see how you can have a full time Medical Director who is also going to be the Responsible Officer because that role needs a practicing clinician. Dr Smith said if the PCT are going to have a Medical Director they need to get one quick so they are there from the offset. Chairman told Dr Smith that Dr Butcher had been a Medical Director in the past for Wyre Forest. Dr Butcher said she did two days at the PCT but this was just for Wyre Forest. The LMC Chairman said it was a very functional group with good clinical engagement. Mr Jago said there should be support for the Medical Director from someone who has experience of clinical business processes on the ground, for example a practice manager.
Ms Dando said the next meeting for Vascular Screening/Health Checks will be taking place in July and she understands five practices are being identified to pilot the software to try and capture the patients as they come through. Public Health will be producing updates once this takes place.
Ms Dando said the Violent Patient Scheme is being done via the GMS/PMS Commissioning Group. Letter will be coming out by the end of the week with a proposed meeting to take place during July.
Ms Dando said the INR letter came out on Monday with a timescale of the end of July, and to let her know if there is need for an extension.
iii) PMS Pay Award
Ms Dando said the 0.7% recommendation will be going to the Commissioning Executive the week after next with the recommendation that it is implemented.
iv) Patient Survey
The PCT have so far received 18 letters from practices on the advice received from the BMA. The PCT are in the same position as everyone else and have received a letter from the DOH. The DOH will continue to meet with the GPC to discuss what can be done at a national level. The PCT have resurrected the QOF disputes policy but are hoping to resolve this outside this formal process. Dr Ingrams said the GPC did not agree with how this has been done.
v) Managing Elective Demand
Discussed earlier in the meeting.
The LMC Secretary gave an update on the current situation with TCN. The PCT have commissioned independent evaluators who have since produced a detailed report. Initially they produced an interim report because they had found areas of real concern. The PCT agreed, following the interim report, that once a detailed report was produced then a meeting would take place. In the meantime spot checks were agreed to be done by the PCT and GPs. Staff seemed to be pleased to see these people and gave a lot of information which backed up the interim report. Secretary said when he was there it was quiet so there were no issues of patient safety. The last meeting was last Monday when they went through the report, as well as the TCN response to the report. They now have a date for the next meeting where the detailed report will be discussed with managers from TCN and then a discussion of what will be done will take place. Dr Radley said that TCN had sent a letter to practices offering new rates of pay for the bank holiday weekend, which were generous. Secretary said that many practices had received this correspondence but he had received a complaint from other clinicians that were not offered this rate of pay. Dr Penny asked if this report was based on what the staff had said about TCN as she was concerned that they may be biased. Secretary said this wasn’t the case; it was based on evidence obtained. Secretary also said the Quality Care Commission rang earlier today as they would like to interview him about TCN as they are doing an independent report. Dr O’Driscoll said he was happy that others have found out the same concerns to what he had already reported and said that the auditors haven’t asked him about the issues. With regards to rates he did speak to Dr Kelsey to ask why this work with this rate of pay was only offered to principals and not to other GPs. Dr Kelsey said this was a good point and he will put this issue to TCN management. Dr O’Driscoll said this new rate is just a temporary arrangement but stressed it is not an enhanced rate; it is approximately the same rate as they received in previous years. TCN may offer this it local Non-Principals. Dr O’Driscoll asked the PCT if they have given TCN any more money to offer this new rate of pay. Dr Smith said that TCN were not the cheapest tender but were chosen as they were thought to be the best. Ms Dando said she didn’t know if they have been paid any more money. Dr Smith was also unsure as to whether they had been offered any more funding. The LMC Chairman said when the LMC were told about the bidding process they were reassured that they would not receive more funding and the LMC feel this is very unfair on other bidders. The LMC did write to Dr Abudu about this issue and never got a response. Dr Abudu had said that it wouldn’t happen but in the local papers Dr Abudu had said that TCN had received more funding to cope with the Christmas period.
Chairman thanked Dr Smith and Ms Dando for coming to the meeting.
b. Education
Dr Schrieber said that on Thursday the Annual Review of Competence and Progression of GP Trainees will take place. Over the next month they will be running an update course for Practice Managers to let them know how to run a training practice. They have updated the Hereford & Worcester website and hope that practices will get more information out of this. They have had some provisional information about funding for this year and there seems to be less for trainer support. Trainers are going to be getting their £750 grant for professional development but this will probably be the last time. Trainers will have to apply for it and information for this should be coming out in July.
c. Dispensing
Dr Ounsted mentioned the motions that refer to dispensing taking place at the LMC Conference this week.
d. Out of Hours
Discussed earlier in the meeting.
e. Non-Principals Group
Dr Ray gave an update from the recent Non-Principals group meeting. They have decided to be more proactive in the group with locums and salaried GPs where they would bring events to the group and have clinical discussion and use the group as a forum in that way.
f. Registrars
No report.
g. P.M. Groups
No report.
h. Administration Issues
No report.
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
i) Primary Care Working Group
Following a document that was sent by Dr Kinsman and put on the LMC website Dr Ingrams was not happy that it was factually correct. Dr Kinsman said he will look into this and bring it to the next meeting.
Action: Dr Kinsman
ii) Path User Interaction Sub-Group
No report.
iii) Pathology reporting software.
No report.
5. MATTERS ARISING
No matters arising.
6. COMMITTEES
a. GPC
The Secretary went over the M9 Circular and issues in the latest Negotiating News. The LMC Conference starts this Thursday.
b. GPCWM
Secretary gave feedback from the GPCWM AGM & Annual Dinner which took place on the 4th June. Officers of the GPCWM remain the same. Secretary went over the issues that took place during the AGM. The Nuts & Bolts will take place at Studley Castle in Warwickshire on 30th September. Dr Buckman will be present for one of the regular “meet the Negotiators” sessions.
7. NEW ITEMS
Minute 5/537 Meningitis Swabs
Dr O’Connor gave an example of one of his patients that was admitted to WRH with Strep A Meningitis. The doctor was asked by a doctor at the hospital to take swabs of members of the patients family on two occasions. The hospital doctor said that they could not provide antibiotics without these being done. Secretary asked if this is the responsibility for the Public Health Department and if not who is responsible and who should be paying for it? Dr Ingrams said that GPs can do it but the question is who should pay. Perhaps if this is a one off incident then perhaps yes this could be done but if it is more frequent then the question needs to be asked. Dr Ingrams suggested the Secretary ask the advice of the GPC. Committee agreed.
Action: Secretary to write to Matthew Isom at the GPC
Minute 5/538 Health Trainer Scheme
The LMC received an email from Darren Plant from the Public Health Department at the PCT. They are going to be commissioning a new Health Trainer Scheme for Worcestershire which will commence from 1st April 2010. Frances Howie, the Asst Director of Public Health has asked if we could identify a possible GP that could sit on the tendering evaluation panel along with a number of other senior Public Health/SHA/Voluntary sector representatives. The requirement for this is to evaluate, score and shortlist potential providers, before awarding the tender. It amounts to 3 days across September/October/November with some pre reviewing/scoring in between. Dr Ingrams said in theory they should have people from the community as well. Secretary said this goes out to tender on the 3rd August, and asked if anyone was interested in attending. Dr O’Driscoll said he would be willing to attend. Secretary agreed to forward the information to Dr O’Driscoll.
Action: Secretary to forward information to Dr O’Driscoll.
Minute 5/539 Letter from Dr Charles Ashton
The Secretary read out a letter he had received from Dr Charles Ashton at the Acute Trust. There were two issues that needed discussing. The first was the risk associated with anticoagulation and the discharge of patients who are being anti-coagulated. They have suggested that routinely it would be safer if anti-coagulation with Warfarin was not commenced as an in-patient and that this should be left for the GP to instigate on discharge. The patient would then generally remain on low molecular weight heparin whilst an in-patient. Discussion took place around the committee. The Chairman said there were two issues, firstly the principal of this and also if they agree it unzips the INR LES. In principal committee felt this was wrong and it was very difficult as they discharge people on a Friday and therefore felt it was unsafe to leave them over the weekend. Dr Butcher said that the Acute Trust want to stop doing something because they cannot do it properly, and they need to get the flow of information right to enable them to do it right. Committee was not happy with this suggestion from the Acute Trust.
Secondly the Acute Trust has recently agreed that it would be preferable to only stock Qvar and not Clenil. Committee did not agree with this due to patient safety.
Action: Secretary to respond to Dr Ashton and copy PCT into the discussion.
The LMC Chairman told members that Dr Nikki Burger had given birth to baby Dylan and wanted to offer congratulations to her. Mrs Hallahan agreed to organise some flowers.
The Chairman also told the committee that this was Dr Ounsteds last meeting and gave thanks to Dr Ounsted for his service over the many years. The LMC will be organising a retirement dinner very soon.
Items B
Circulated
Items C
Application from Mr B Atwal for preliminary consent to establish a pharmacy in Pershore Road, Hampton, Worcestershire. Dr Ounsted said this was a threat to one practice and we should object that it is unnecessary, there was also a 100 hour pharmacy opening in Boots shortly.
Application from Knights Chemist Ltd for preliminary consent to establish a 100 hour pharmacy at the new primary care centre, Market Street, Bromsgrove, Worcestershire. No objection.
Application from Helen McCague for preliminary consent to establish a 100 hour pharmacy at Jesmond House Practice, Tewkesbury, Gloucestershire. No comment.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.10 p.m.
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= No Agenda
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