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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 17th September 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Coney, Dr M Davis, Mrs M Hallahan, Dr D Herold, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Dr D Jago, Dr R Kinsman, Mrs L Luke, Dr J O’Driscoll, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr J Rankin, Dr H Ray
1. APOLOGIES
Dr P Bunyan, Dr N Burger, Dr L Butcher, Dr D Lewis, Dr K O’Connor, Dr D Radley, Dr C Reynolds, Dr V Schrieber
2. MEMBERSHIP
Chairman asked Members of the Committee if there were any further nominations for the role of Vice Chairman, apart from Dr Pike who is very happy to stand. Dr Parkinson nominated Dr Pike, Dr Ingles seconded and all members agreed.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 9th JULY 2009.
4. REGULAR ITEMS
The Chairman welcomed Dr Bryan Smith, Brian Hanford and Linda Dando from the PCT.
a. Worcestershire PCT
i) Lynda Dando
Ms Dando gave an update on Enhanced Services. The identification of PBC and Primary Care enhanced services has been done and PBC clusters have been consulted on this. The only outstanding issue is the need to commission two more DES’s; Childhood Immunisations and Minor Surgery and they have a meeting scheduled to talk about this. Ms Dando talked about what was left in the current budget and how they plan to finance the rest of the year. There is no new money and what flexibility they have will be used to commission new services such as nursing homes and IM&T. One of the most difficult areas at the moment is how to simplify the payment process. A letter will be send out to all practices the next day with a revised claim form; how to claim; where the information needs to go and what are the cut off dates where payment won’t be made until the following quarter. They know they have not got it right as yet but when they do it will be better than it is currently. They are hoping this work will be completed by the end of September. Mrs Luke said the cut off date was very rigid and Ms Dando said that the letter will explain it in more detail and give help in what practices can do to help them with this. Discussion took place around the table about the minor surgery DES with some members not really understanding or agreeing with what Ms Dando said. The Secretary requested early sight of the draft DES.
Ms Dando gave an update on the PE7 and PE8 appeals. The PCT currently have six lodged as formal appeals from practices with evidence to go forward under the Local Disputes Process. The PCT will establish a panel to receive those appeals by the middle of October at the latest. This will not stop other practices putting in appeals during the next 3 years but they want to try and resolve this as soon as possible. There will be a member of the LMC, the PEC Chair and an Executive Director from the PCT on the appeal panel.
Ms Dando gave an update on QOF 09/10. They have started the road shows with practices and so far there has been one in Redditch & Bromsgrove and one in Wyre Forest. The Commissioning Executive have agreed that they expand the inclusion of all practices in this process so they may have to visit all 67 practices which means they need to increase the number of GP assessors to do this. All practices have been written to asking for extra assessors and they have already had 5 enquiries. Mrs Luke asked about having a practice manager representative. Ms Dando said she had no strong views on this; they can always review the process and have money in the budget to go ahead which is very positive
Ms Dando gave an update on vascular screening. The next working group meeting is on the 22nd September. The software is currently being tested by Bewdley Medical Centre and if this is successful then the software will be rolled out to the other practices also in the trial. Following this a draft LES will come out and go to the LMC. Secretary asked where the money was coming from for this. Brian Hanford said this was within the Public Health Budget.
Secretary asked about the Violent Patient Scheme Review. Ms Dando said this will be undertaken of the GMS/PMS Commissioning Group at their first meeting. Secretary said he has volunteered to go to the first meeting but it might be better for someone else from the committee to go instead so he asked members to think about whether they would like to take over after this first meeting.
Secretary also asked when the Clinical Senate was going to meet. Ms Dando said no date has yet been agreed but think it will be in October.
ii) Brian Hanford – finance update
Brian Hanford gave a brief overview of this year’s financial situation. In terms of this year they have set themselves a controlled target of meeting £5m surplus and as of month 5 they believe the target will be met. Some things that they need to use the reserve for are continuing healthcare in the PCT which is a rising area of expenditure; review of processes, there is a national drift upwards and so they have been benchmarking where they sit in the West Midlands and in the country. They sit in the middle, but other counties locally spend more. One area they think they will spend up to £1m more than expected is around Acute Commissioning and are currently looking into the activities there, with most pressure around outpatients. There has been lots of debate about this area so this will be reviewed. They are still forecasting that Acute Commissioning will cost more than in the plan. Another area that is quite volatile is GP prescribing as it is hard to predict. Mental Health placements are another area of pressure but are hopeful they will meet the controlled target.
Secretary asked how much the swine flu campaign is costing. Mr Hanford said when they looked at the contingencies they forecast approximately £1m, so they have put aside £¾m - £1m. They do not believe they will get an extra allocation so this money will have to cover everything and extra investment in OOH & vaccinations. Dr O’Driscoll asked how much they have given TCN up to date. Mr Hanford confirmed £40,000.
The Chairman asked if it was true that savings made by practices under PBC have to be spent in year and they cannot carry this forward. Mr Hanford said this was mostly true. They have agreed with the PBC clusters a scheme around how savings are achieved and have set aside £2m this year to reward those who have saved money before. Practices have to manage their resources and forecast how much money they will spend each year, the PCT cannot give practices an open ended agreement. If practices have a specific question, they take this to the PBC cluster and they will contact the PCT with this specific question.
Mr Hanford talked about longer term finance. They will be looking at modelling for the next 3 years. He will come up with 3 scenarios to put to the Board to plan for. The most likely scenario is that they won’t get any new money in the following year. What will be important as a PCT is what the government will do with the national tariff. The PCT will need to have discussions with the public and primary care about the levels of service. Dr Bryan Smith said they had a debate on this at the last Trust Board meeting. A reporter from Worcester News was there so may have reported on this. There has been lots of talk about what will or will not happen. The PCT are already working alongside the other players, the Acute Trust, Mental Health and County Council and they also need to work with primary care about the way to go forward.
Secretary asked about the pregnancy stop smoking and NHS stop smoking service. Practices have received documents from the Public Health service. The contract is 198 pages and we understand this has come from Public Health/SHA/County Council. Mr Hanford said the PCT have not been consulted, but they were asked if they could come up with a tariff and knows Richard Harling was involved in that. Secretary said the document has now come out and most practices have looked at it with total horror. Many practices will probably not do it as it is very bureaucratic. The questionnaire is 35 pages long, the contract is 198 pages then there is another 26 page document you have to fill in. Dr Hollier agreed and said that for a handful of patients it is not worth the work involved. The Chairman said this is fine if you have a lot of clinics but for small rural practices doing this work it will not be worth it. Mr Jago said it is based on substantial savings in secondary care. Chairman said this is just too much work and should not apply to practices. Mr Hanford said he will take this back to Richard Harling and get him to look at smaller level providers.
Secretary said the issue of MRSA screening has been flagged up again. He said he had written to the Acute Trust about the clinical issues but did not get a reply. When the committee discussed this there did not appear to be clear protocols and so clinical errors will occur. Mr Hanford asked if we could send him a copy of the letter.
Secretary asked if the PCT knew when the report on TCN from the Quality Care Commission was due to come out. They believe this to be early 2010. Dr O’Driscoll said it is still going on as he has his meeting with them shortly. Mr Hanford said he will check on this.
Action: Copy of letter to Brian Hanford
iii) GMS / PMS Commissioning Group. Secretary to report.
Discussed earlier
iv) Appointment new Medical Director
Adverts out and applicants have been received. Interviews are on the 6th October. Secretary said he is sitting on the interview panel.
b. Education
No report.
c. Dispensing
No report.
d. Out of Hours
i) The Chairman asked Dr Penny if a policy had been written by TCN on the 7-8 o’clock handover period. Dr Penny said they are still working on the policy. TCN are assuming there is doctor available from 8 o’clock at all practices. The issue arises when patients are told that if they ring the practice a GP will come out and see you straight away. Secretary asked if TCN are writing any protocols yet. Dr Penny said yes they are. Dr O’Driscoll mentioned an incident in Kidderminster regarding a shift where a doctor left at 6.00 a.m. instead of 8.00 a.m. and there was no one available to cover the last 2 hours. Dr O’Driscoll said there has been an initiative to get local GPs to work now and they are offering them £85 per hour without superannuation. Dr Ray said that they still have not contacted non-principals. Dr O’Driscoll said there are some non-principals working in OOH. Dr Coney confirmed that with regard to Registrars, it is slowly starting to happen.
ii) Update on TCN discussed earlier.
e. Non-Principals Group
No report.
f. Registrars
Dr Coney mentioned the letter from Dr Martin Wilkinson, West Midlands Deanery regarding Registrars being involved to help in a pandemic. He said it is a bit vague in terms of having 3 months out dealing with Swine Flu and because of this missing a valuable 3 months in chronic disease. They have talked about this and if this did happen and the Registrar did not have enough training in this area then the training would have to be extended by 3 months.
g. P.M. Groups
Mr Jago said practices are getting fed up with all the extra bureaucracy with the PCT. The Secretary agreed and has raised this with Lynda Dando.
h. Administration Issues
i) Accounts for year end 31st March 2009 circulated and agreed.
ii) Declaration of Interests Policy. New forms passed around for members to sign.
i. P.B.C. Issues
Discussed earlier.
j. I.T. / GPSoC
i) Primary Care Working Group
Meeting next week looking at GPSoC again.
ii) Path User Interaction Sub-Group
No report.
iii) Pathology User Group
Minutes circulated prior to meeting.
Secretary mentioned the Choose & Book Master Class on the 7th October. Dr Ingrams said he could not see the point in going and didn’t feel that practices would gain anything from it. Nobody expressed any interest in attending!
5. MATTERS ARISING
No matters arising.
6. COMMITTEES
a. GPC
Secretary reported on the M1 Circular and Negotiating News & Dr Ingrams gave an overview from the last GPC meeting. Dr Rankin asked about Dr Buckman’s letter of the 15th where it mentioned the comprehensive package. Dr Ingrams confirmed that this relates to the bullet points Dr Ingrams said the main topic was PE7 and PE8 with which detailed guidance will be coming out shortly. Secretary asked Dr Ingrams about what is happening elsewhere regarding PE7 and PE8. Dr Ingrams went through this and about reiterating to practices that they do not need to fit the criteria the PCT has come out with. They have three years to appeal but if they are going to appeal they should do so straight away so that all appeals go in together. Dr Herold said that Ms Dando said there were six going forward with evidence, does that mean that others do not have the evidence and therefore the PCT are not putting them forward. Secretary said he did not know about this, but will mention this in the newsletter.
b. GPCWM
i) Meeting 30th July 2009
Secretary & Dr Ingrams gave feedback from the meeting on the 30th July 2009. Secretary mentioned the problem with System 1 in Solihull with regards to patient notes on a shared database and the problems which have occurred. Dr Ingrams said there is a fix coming out for the system that will solve it forever. Dr Ingrams also mentioned other issues such as hospital letters going to senior partners and also that he has written three times to the SHA Chief Executive about lack of correspondence with GPCWM but did not get a reply. He has since emailed him direct and the Chief Executive has this time come back to him and is interested in meeting the GPs from the West Midlands.
ii) Nuts & Bolts meeting – delegates.
There are three delegates going from Worcestershire. Dr Ingrams said it is completely full.
7. NEW ITEMS
Minute 5/542 Patients on depot antipsychotic medication
Secretary and Dr Herold reported. Secretary read out correspondence received from Alexander Graham from the Mental Health Pharmacy regarding moving the injections of stable schizophrenics to Primary Care, although those patients attending for frequent depots are not to be transferred. The Secretary wrote to them about this and they have written back saying that the policy has not been changed, but that the WMHPT has been transferring very small numbers of stable patients back to primary care since the publication of the NSF for mental health and subsequent guidance documentation since 1999. Secretary also reported that a Worcester GP had spoken to someone who works in the Mental Health Trust who is concerned with what is going on, clinicians are been told not to talk to GPs and there are to be staff cuts in Worcestershire; removal of staff grades and discharging of clients. Secretary has suggested that this person should look at the whistle blowing document and the LMC would be very happy to talk to them if they would like to talk to somebody. Dr O’Driscoll reiterated that Dr Crellin wrote to us last November about this and the situation has not got any better. Secretary said that the Mental Health Trust said they would come back and speak to us in November so should we invite them back next month instead. Chairman agreed this would be a good idea. Other members gave incidents about situations that were evidence of the poor service. Secretary asked if anyone had any evidence to send it to him so he could collate and detail our concerns.
Action: Secretary to write to Mental Health Trust and ask them to attend LMC meeting in October.
Minute 5/543 Urgent Care Conference
Email received from Dr Ingrams which was forwarded to Lynda Dando at the PCT to see if any of the PBC leads could go. Ms Dando confirmed that she has forwarded this out and will chase up for attendance. This was circulated to members, practices and PCT to go to PBC leads. Discussed earlier in meeting.
Minute 5/544 Evaluation of Primary Care patient accrual in West Midlands South
Secretary reported that he had received an email from Krysia Saul, Research Manager at Coventry (Warwick and Coventry Primary Care Research Team). They are planning to undertake an evaluation of primary care recruitment in West Midlands South which has been supported by their local Comprehensive Local Research Network. They have asked if we would circulate the letter and protocol to the LMC for members' approval to undertake this work in Worcestershire. Agreed.
Minute 5/545 Blue Badges
Secretary said he is still getting regular emails from practices regarding blue badges and does not know what else we can do. Dr O’Driscoll has been told that a repeat prescription will be enough evidence. Dr Kinsman said local government should use their own assessment team. After contacting the hub, they have said that staff do not tell their clients to go to their GPs. Members agreed to put something about this again in the Newsletter.
Action: Newsletter
Minute 5/546 West Midlands SHA Strategic Plan
Secretary read out document produced by the BMA Regional office which reviews the PCTs main priorities. Dr Ingrams said this made interesting reading.
Minute 5/547 Mental Health Services
This was discussed earlier in the meeting.
Minute 5/548 Domestic Abuse Form
Letter received from Ros Walker at Worcestershire County Council. She is concerned by the lack of medical input to the work of Worcestershire Forum Against Domestic Abuse and believes that GPs play a key role in the early detection and prevention of domestic abuse and therefore could make a valuable contribution to the work of the Forum. She would like to attend an LMC meeting with a view to discussing Domestic Abuse in Worcestershire. All agreed that it would not be a good time at the moment to invite Ms Walker. Dr Ray agreed to meet with them.
Action: Secretary to reply to Ros Walker
Minute 5/549 Adult Safeguarding Board
Secretary reported on the meeting. There is a Children Safeguarding Board which has statutory power and it is anticipated that the adult board is likely to go down the same route at the moment but will not yet have statutory powers. They seem very surprised that GPs are not aware that this is happening and they want to establish proper collaborative arrangements between GPs and Social Services. Secretary has fed back to them the bad relationship between GPs and Social Services and that practices very rarely get a report back about their patient after they have seen them. They have said that they would like GPs on their committees and panels. Secretary has asked them if they are going to fund it and said they were surprised at this request but he said because of workload they would have to fund it. This was in July and he has not heard anything else since. Secretary said he was worried that the Children’s Board are becoming more active and thinks we should get GPs involved with the adult one. This could be a lot of work and they need sensible procedures and policies in place.
Minute 5/550 Pregnancy Stop Smoking Service / NHS Stop Smoking Services
Circulated and discussed earlier in the meeting.
Minute 5/551 Additional QOF Assessors
Discussed earlier in the meeting.
Minute 5/552 MRSA Screening
Discussed earlier in the meeting.
Minute 5/553 H1N1 vaccination arrangements
A letter from Laurence Buckman at the GPC was circulated to all practices detailing the arrangements for administration of the H1N1 vaccination. There is a PCT meeting in a couple of weeks to bring the flu plans together. PCTs are hoping that all practices will do this but they need to ask everyone.
Minute 5/554 Choose & Book Master Class
Discussed earlier in the meeting.
Minute 5/555 Walk In Centre – Feedback from Elgar Healthcare
Mrs Hallahan reported on feedback from Dr Charlie Harris. They are averaging 40 consultations per day and have maximum capacity for 72 consultations per day. When they first started 5 weeks ago this was 20 consultations per day. They now have 74 registered patients. They have had no complaints from patients or GPs and no other feedback. They have done a patient satisfaction survey and the result was 100% satisfaction. In regard to referrals for their walk in patients they do not have exact numbers, they can definitely say they have had at least two 2 week wait referrals and at least one emergency admission but there may have been more. They are looking at putting a monthly monitoring process in but it is still early days.
Secretary said he has had a number of emails and complaints about adverts for the new walk in centre on the back on buses in Worcester but rules have changed and everyone can now advertise. He asked the PCT who paid for this advertising and they confirmed that it was Elgar Healthcare and not the PCT.
The Secretary said he had also had a complaint about the quality of information coming back to the practice and recommended they feed this back to Elgar Healthcare.
Chairman asked members if we should invite Non Executive Directors from the PCT Board to come to an LMC meeting as they do not know what the LMC actually do. All agreed that this would be a good idea. Chairman said we should invite Margaret Jackson to be the first one to come to a meeting.
Action: Secretary to write to Margaret Jackson
Dr Kinsman said Peter Luff MP came to see them at the practice and talked to members of the practice team. He stayed for quite a while and would encourage practices considering inviting MPs to do it as they found it very beneficial.
Items B
Circulated
Items C
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.40 p.m.
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