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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 9th July 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr N Burger, Dr M Davis, Mrs M Hallahan, Dr D Herold, Dr K Hollier, Mrs L Luke, Dr K O’Connor, Dr J O’Driscoll, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Radley, Dr J Rankin, Dr H Ray, Dr V Schrieber
Secretary chaired the meeting in the Chairman’s absence, due to ill health.
Secretary welcomed Dr Charlie Harris from Elgar Healthcare who has come to update the Committee on their latest position.
Dr Harris began by saying that the walk in centre is due to open on the 7th August. There have been some delays but they are now due to complete on the 5th August. Elgar Healthcare wants to look at ways in which they can share information with GPs regarding their patients at the walk in centre. There are two elements, their registered patients and the walk-in patients. They feel the best way of sharing information is via NHS mail in a similar way to TCN, they are using EMIS PCS. Dr Radley asked if they would just send a copy of the consultation to practices and Dr Harris confirmed that this is what would be sent. Dr Harris said there were other issues regarding sharing of information about patients, vulnerable patients, children at risk, violent patients etc and they have devised a form for this, which Dr Harris passed around to members. Secretary suggested putting a review date on the form and putting it on one page. They will be sending out newsletters to update practices on any changes that are happening. They have negotiated with the PCT contract figures and an appointment system, when patients walk in they will be offered an appointment dependent on availability. Dr Harris asked what GPs would prefer regarding referrals for walk-ins, would GPs like their patients to be referred directly on or the patient bounced back to GPs for them to refer? They are hoping there will be no inappropriate referrals but think the cost will be out of practice budgets rather than theirs. A lot of discussion took place regarding this and there was much discussion whether all referrals should be bounced back, and the question was asked about 2 week wait referrals and whether these should be in fact be bounced back or referred straight on. There was also discussion about the reasons why patients went to the walk-in in the first place and the fact that they cannot find the time to attend their own practices in the day and may not be able to go to see their own GP if their referrals are bounced back. From a patient care point of view then if urgent and serious then it might be difficult to send back to GP. Secretary suggested that Elgar Healthcare ask the Worcester City GPs at the next GPA meeting as these will be the ones mostly affected. Dr Penny said that in Gloucestershire they discourage direct referrals apart from in appropriate circumstances. Dr O’Driscoll said that you will get patients who work the system so have to be clear on the procedure. Secretary agreed and suggested that patients should be told that an urgent fax would go to their practice detailing what they have found and suggest for them to contact their practice the next day to speak to their GP. Dr Herold agreed but said that the GP under most circumstances should be then able to refer them on from this correspondence and in most cases wouldn’t have to see them. All agreed that this may be the sensible way for referrals to be done in the foreseeable future with a review later. Dr Harris said that Elgar Healthcare will be using Choose & Book but the Secretary stressed that it doesn’t work well in some areas. Dr Harris also asked about tests and should Elgar Healthcare do them? Discussion took place about this, varying opinions, secretary said medico legally think they should look into this because if they do the tests then they are responsible. Dr O’Connor asked Dr Harris about the drugs budget for walk-in patients. He confirmed that they will have their own budget. Elgar Healthcare will also be collecting QOF data for walk-in patients. Secretary asked how many staff will there be working there? Dr Harris confirmed at the moment 3.3 whole time equivalent GPs, 3 of these sessions in an administrative capacity. Dr Schrieber asked how many doctors they currently have and Dr Harris confirmed that they have 3 at the moment and 4 nursing staff. Dr O’Connor asked how many doctors would be working at a time. Dr Harris confirmed that at the moment shifts are 4 hour sessions with 4 x 4 hour sessions throughout the day. There will be one GP on at a time with a 1 hour overlap. Secretary asked if they had defined their practice area with the PCT. Dr Harris said no the area has not yet been defined but it will be impractical to go on visits that are too far. Dr O’Driscoll said that his practice is the closest practice to this health centre and their worry is that Elgar Healthcare will cherry pick and just take on the healthy patients. Dr Harris said this is not the case and they cannot refuse any patients, same as other practices. Secretary thanked Dr Harris for coming to talk to the LMC.
1. APOLOGIES
Dr P Bunyan, Dr L Butcher, Ms L Dando, Mr S Hairsnape, Dr R Ingles, Dr G Ingrams, Dr R Kinsman, Dr D Lewis, Dr D Pryke, Dr C Reynolds
2. MEMBERSHIP
a. Dr David Herold – new representative for Evesham & Broadway
Secretary welcomed Dr Herold, the new representative for Wychavon.
b. Worcester City representatives
Secretary confirmed the new representatives for the South Worcester area.
c. LMC Officer appointments – Chairman; Vice-Chairman; Treasurer and Secretary
Secretary confirmed that the LMC need to appoint Officers of the LMC and Limited Company. Secretary confirmed that Dr Ingles was happy to continue as Chairman. It was unanimously agreed to reappoint Dr Ingles. Secretary told the committee that since Dr Ounsted had now retired the LMC needed to appoint a Vice-Chairman and asked the committee if anyone would like to take on this role with the understanding that they wouldn’t automatically take on the Chairman role should the Chairman step down. The only formal duty would be to chair the meetings when the Chairman is not present. The Secretary asked all members to have a think and let him know if they are interested in this role. Dr O’Driscoll agreed to continue as Treasurer, all agreed unanimously. Dr Parkinson was happy to continue in the role of Secretary. All members unanimously agreed.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 9th JUNE 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
i. Lynda Dando
Apologies received from Lynda Dando.
ii. Anne Kingham – To discuss outpatient discharge letter
Secretary welcomed Anne Kingham from the PCT and Rachel Montgomery from the WAHT who had attended to discuss various issues. First of all a copy of the outpatient discharge letter together with a copy of the envelope was passed to members. Ms Kingham confirmed that this is now ready to be sent out. Ms Montgomery said she will be implementing this one directorate at a time in the Acute Trust to coerce them to do this, her first point of call being Outpatients. She also said that discussion took place about having a smaller box rather than a full summary on the sheet but the Consultants felt it was too small so this form is just for drugs and the summary of what tests etc have taken place will still be sent to practices as an additional document. They wanted to keep the section on urgent medicines small as this should be used in certain circumstances and not be a norm. Ms Montgomery said that they are looking to move to an electronic discharge system and hopefully this form will be sent electronically so fewer problems will occur relating to understanding handwriting. Dr Rankin asked if outpatient prescriptions have changed since this form has been implemented. Ms Kingham said that prescriptions should not be given in Outpatients unless there is an urgent change to their medication. Many Consultants no longer prescribe from hospital and this is now moving to the norm with only a few exceptions. There are small cost implications to the practice but the other positives outweigh this. The LMC Secretary thought this was good and a real improvement.
Ms Kingham discussed other primary care issues. Regarding additional practice pharmacy staff and time, this cannot be funded out of the commissioning side but has to go through PBC. Secretary asked if practices were not in PBC how would this work? Ms Kingham said so far this hasn’t been an issue. If practices are already using additional hours then this has already been approved and will not be affected.
Secretary asked Ms Kingham about the progress on the draft guidance on Immunisation and Vaccination. Ms Kingham was not sure and said she will look into this.
Ms Montgomery said that the problems with Choose & Book, particularly at the Alexandra Hospital were raised at a recent Acute Trust meeting. This is now being looked into and hopefully the issues can be resolved soon.
iii. Flu Planning. Secretary to report.
Secretary reported on some of the various meetings that have recently taken place. Swine Flu has come earlier than expected and the Secretary felt that the PCT have done well with planning so far. There was an initial idea of a countywide flu scheme with flu centres, but it looks like the national flu line will now no longer be available. They may move away from dealing with this as a national crisis and instead deal with it like “normal flu”. Getting rid of the flu line might be the first step and the decision not to give all patients Tamiflu but just patients at risk. The PCT is going to try and expand the number of pharmacies that can give out the Tamiflu and get some 100 hour pharmacies on line with this. The PCT and LMC held a GP meeting last week and two thirds of practices were there. There were various responses about buddying up with other practices, some practices want to do this and others do not. Secretary felt that as an LMC we should try and encourage colleagues to work together and look at big localities, e.g. 100,000 patients, have a control centre with a duty manager of the day and then they can work together. Dr O’Connor was hoping they would be buddying up with a nearby practice but it has since been suggested that buddying up would be about 15 doctors. Secretary said this has not been sorted out yet. If we have enough of these big groups then the PCT will support them but they cannot support many small groups. If practices are not in a buddying group the downside if anything goes wrong is there is no one to support you and the PCT may not be able to support you. If the national flu line does go Secretary said he is not sure if practices are going to give Tamiflu to everyone or just at risk groups. If they are to continue as before then the local flu line should continue but if it is just at risk patients it probably is not worth having a flu line. We should hear in the next week or so. Dr Pike asked if flu centres will be expected to work longer hours. Secretary said at the moment it is just to be day time hours, but if OOH struggle with the workload then flu centres may have to help with additional hours. Secretary said the PCT and LMC will send a letter out about this shortly, if all agree. Dr Burger asked how it affects non-principals. Secretary said that if it isn’t in their contracts and they do not wish to do this work then they could probably refuse but they may be “morally blackmailed” as medical professionals. The Government could declare a state of emergency where professionals will be requisitioned to work. Dr O’Connor said there is a draft document that will be going to the next Wyre Forest GPA meeting. Dr Pike asked if the Wyre Forest document is good then it would be worth sharing. Secretary agreed and said he would contact Dr Heywood for a copy.
Action: Secretary to contact Dr Heywood
iv. QOF Workshop 18th June
Secretary reported on the QOF workshop held on the 18th June. The Secretary gave a summary of what was discussed. Dr Radley also attended.
b. Education
Dr Schrieber said since the last meeting RCP Panels and Worcester Trainees are doing well. They held a Nuts & Bolts course for practice managers which was well received. He believes they will have a decrease in funding for next year so training practices will be affected.
c. Dispensing
No report.
d. Out of Hours
Dr Penny reported on Out of Hours. Their work load has been steadily increasing. They have been promised some extra doctors but they are still having difficulty filling regular shifts. Dr Kelsey has said they are reviewing sessional rates to try and encourage a better caliber of doctors. She is getting herself known as the LMC representative for the OOH doctors. There are not many salaried doctors left at TCN now.
Dr O’Driscoll reported that the scheme where they were trying to attract local principals and were offering a better rate has been withdrawn, within 3 weeks of starting it. Secretary said that he had seen a letter the PCT had sent TCN indicating that they will be reviewing the service monthly and listing their concerns, which are to be addressed.
e. Non-Principals Group
No report.
f. Registrars
No report.
g. P.M. Groups
Mr Beckett said the only issue at the moment were the Enhanced Services claims forms. He has now submitted his 3rd attempt; it just seems to be going on and on. The deadline is tomorrow. The Secretary said he is going to talk to Lynda Dando about this. Dr O’Connor said there were discrepancies on the figures, some were monthly whilst others were quarterly, it is a real mess. The PCT do not really understand what practices are being paid for.
Action: Secretary to talk to Lynda Dando
h. Administration Issues
No report.
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
i) Primary Care Working Group
No report.
ii) Path User Interaction Sub-Group
No report.
iii) Pathology reporting software.
No report.
5. MATTERS ARISING
5/539 Letter from Dr Ashton
Secretary reported about the letter we had previously received from Dr Ashton and that Ms Dando from the PCT did not know anything about this. The LMC has received a further letter which the Secretary read out to members. All members felt this further correspondence did not change the LMC view at all regarding both issues. All agreed that the Secretary would respond to Dr Ashton.
Action: Secretary to write to Dr Ashton
6. COMMITTEES
a. GPC
i. The Secretary went over the M10 Circular and issues in the latest Negotiating News.
ii. Dr O’Driscoll gave a summary of the LMC Conference and the issues discussed.
b. GPCWM
No report.
7. NEW ITEMS
Minute 5/540 Blue Badges
Secretary reported on the latest on blue badges. We have received more letters from GPs regarding this. Mrs Hallahan rang the Hub and discussed this in detail. They have to follow national guidance and cannot tell applicants that they cannot go to their GP but suggested perhaps a form whereby all applicants will be instructed that they will have to pay any charges if they go to their GP. Secretary asked the committee their thoughts. All agreed that they did not want to take on this work at all and therefore this would not be the answer to this problem. Agreed to retain the status quo and that the Secretary will write to the hub about this.
Action: Secretary to write
Minute 5/541 BMA ARM
Secretary gave a brief summary of issues from the BMA ARM, and recommended it to members for next year.
Items B
Circulated
Items C
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 09.30 p.m.
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