Meeting Date: Thursday 8th October 2009
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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 8th October 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Dr P Bunyan, Dr L Butcher, Dr P Coney, Dr M Davis, Dr D Herold, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Dr D Lewis, Mrs L Luke, Dr K O’Connor, Dr J O’Driscoll, Dr S Parkinson, Dr D Radley, Dr J Rankin, Dr H Ray, Dr V Schrieber
1. APOLOGIES
Mr D Beckett, Dr N Burger, Ms L Dando, Mrs M Hallahan, Dr E Penny, Dr S Pike
2. MEMBERSHIP
Dr Reynolds has been unable to attend a significant number of meetings due to other commitments and therefore reluctantly has resigned. It was agreed to advertise in the newsletter for another co-opted member from the ranks of salaried doctors / non-principals.
Action: Newsletter
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 17th SEPTEMBER 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
Nobody from the PCT attended. Lynda Dando had already sent her apologies.
i) Secretary reported that the interviews had taken place for the appointment of a Medical Director / Responsible Officer and Dr Pike had attended on behalf of the LMC. Committee awaited the outcome of this. Secretary advised the committee particularly following the discussion that recently took place at the GPC West Midlands Nuts & Bolts meeting, he and the Chairman had discussed this at length. An email had been sent to Paul Bates suggesting that the PCT needed to rethink this appointment. Paul Bates replied that it was too late and he was happy to proceed. The Chairman and Secretary feel that this role is too big for one appointment and that the two posts of Medical Director and Responsible Officer should be separate appointments. The guidance from the speakers at the GPC meeting suggested that the Responsible Officer role in itself will be a full time job. Paul Bates seems to think that this is a role where the work can be delegated to others and indicated that there may well need to be further appointments in due course. However he agreed that this thought would be shared with the applicants.
The Secretary informed the committee that the appeals meetings for the PE7 and PE8 disputes were being organised and again Dr Pike will be taking on this role as both the Chairman and Secretary have appeals in hand. Initial indications are that the steer from the SHA is very much to reject these appeals. Dr Ingrams did point out that perhaps this could still go to Harrogate if they wish to take this further.
The Chairman advised the committee that he is aware that the PCTs list size adjustment is in progress and that for some practices potentially there could be significant over payments. How this is recouped needs to be considered. Dr Ingrams pointed out that regulations should cover this and other examples where practices have in good faith been paid and PCTs have not sought to recover the funding. Secretary will seek guidance from the GPC on this matter.
The Chairman and the Secretary advised the committee that there were concerns from practices about the degree of late payments from the finance department at the PCT. The Secretary has already written to Brian Hanford pointing this out and also discussing a new claim form. This has not been shared with the LMC but had been shown to practice managers at a recent meeting. Whilst the form itself seems reasonable there is a clause which states that unless claims are received within 5 working days of the deadline no payments will be made at all for that quarter. This has serious impacts for practice cash flow and does seem excessive as there may be legitimate reasons why one area of the claim form cannot be completed. Considering the PCT can take months to pay this seems to be treated rather harshly. The Secretary will chase the response from the finance department.
Action: Secretary to seek guidance from GPC on list size
Secretary to chase response from the PCT
ii) Terminal Care LES
The Secretary apologised to the committee that he had inadvertently appeared to agreed to this LES without sharing it with the committee. The Chairman had expressed concerned that the LES had come out stating that the LMC had supported this. The Secretary felt that when the draft was shown to him this was just a preliminary stage and had not realised that the roll out of this LES was imminent. However, broadly the committee supported the LES.
b. Education
Dr Schrieber reported that the Deanery is concerned about how extra training that is required can be continued with a reduced budget. He also pointed out that there were new trainers courses being planned and these will be announced shortly. The website, www.hwgpe.org.uk has been updated. He asked if the LMC would include details in our newsletter and put a link from our website. Finally he advised the committee that the PMETB will be visiting the West Midlands Deanery next week for a review.
Action: Newsletter & Website
c. Dispensing
Dr Rankin discussed pharmaceutical needs assessments. He had written to the PCT about this and was concerned that he had not had a response. This issue affects all dispensing practices and indeed all GPs as it relates to pharmaceutical services in all areas. He had written asking for GP involvement and had finally been told that this process had stalled. Apparently Lynda Dando has been asked to lead on this as it was felt it could have much wider implications. The Secretary will contact Lynda Dando and ask for a progress report on this matter.
Dr O’Connor pointed out that a recent Pharmaceutical Sub-Committee had taken place and that neither he nor Dr Rankin had been invited to attend. Secretary will investigate. Committee is mindful that the LMC do not have a statutory place on this committee but historically our pharmaceutical representatives have been present at the first part of the meeting and have been given the opportunity to comment on applications.
Dr Herold reported dismay amongst dispensing doctors at the reduction of the dispensing fee and the impact on practices. He commented that Laurence Buckman at the recent GPC West Midlands meeting reported that this was a very bad deal but no action had been possible. The Government had clearly made its mind up and it was difficult to see how anything different could have been achieved. The Secretary commented that at this meeting he had stated there was a real threat to market town dispensing in the long run and that for rural practices, particularly small branch surgeries that are supported by dispensing will be threatened. Dr Ingrams pointed out to the committee that ministers do not listen and that these are political decisions taken even if the Department of Health is supportive. However agreement has taken place to do a review on the whole of dispensing costs and dispensing which may well have a more favorable outcome. It is not clear when this will take place.
The Chairman reported to the committee a growing concern about parallel exports. This has been brought to our attention by David Oval from the LPC. A number of drugs such as ranitidine and sartas are affected. It seems to relate to particular drugs where there is one manufacturer and they are restricting supplies. Dispensing practices are finding that supplies are withheld and it is thought that a number of Acute Trusts have reduced their supplies. The reason for this is the fall in the pound and it is now financial beneficial to sell these drugs abroad. Dispensing doctors have been approached by companies asking if they will sell ‘surplus stock’. Dr Ingrams said this was a national problem and had been raised officially. He felt that the LMC should brief local MPs on this matter.
Action: Secretary to contact Lynda Dando
Secretary to contact the Pharmaceutical Sub-Committee
Secretary to write to local MPs
d. Out of Hours
Secretary discussed the recent Care Quality Commission report which had been shared with members. A few days after this an anonymous letter had been received at the LMC office and was also shared with LMC members. This had been forwarded to the PCT who are investigating. Other sources have suggested to the Secretary that TCN are planning to change the visiting rotas, particularly in the ‘red eye’ shift. This has real concerns, particularly as it appears the PCT had not been fully briefed about this. The Chairman said he was very unhappy that the PCT appeared to be in the process of sending out press releases talking about very favourably about TCN. He felt the LMC should ask the PCT to stop publicity about TCN to maintain objectivity, particularly as the LMC had studiously kept to our part of the agreement and not to go public with our concerns. It was agreed that the Chairman and Secretary should arrange a meeting with PCT officers to discuss developments with TCN. The Secretary reported that the PCT had written to him advising him that they plan to continue regular spot checks and have produced a format for those visits and remuneration. The Secretary will be taking part in this process along with a number of other doctors.
Dr Kelsey had emailed the LMC mentioning the issue of visit requests around 7.00 a.m. He was looking to devise a protocol and wondered if the LMC was the right forum. The committee agreed that it should come to us and the Secretary will respond to Dr Kelsey. It also raised the issue of accommodation around Redditch and whether a Redditch practice may be interested in sub leasing rooms for out of hours use. The committee had no comments to make about this. We finally discussed the issue of whether GPs might be interested in providing triage for TCN, particularly at weekends when they are doing extended hour clinics. Members did not feel this was something many GPs would wish to do.
Action: Secretary to reply to Dr Kelsey
Secretary to organise meeting with the PCT
e. Non-Principals Group
No report.
f. Registrars
Dr Coney reported that the registrars are now able to book out of hours shifts.
g. P.M. Groups
Lisa Luke commented that the issue of the PCT finance department had already been discussed.
h. Administration Issues
The Secretary discussed the issue of roles & responsibilities of LMC members. There had been some debate on the LMC list server recently about this matter and a number of LMCs had attached their own documents. The Chairman expressed some concern about this being yet another protocol but the Secretary felt it was appropriate that this was defined as the LMC was paying members out of funds raised from GPs and for propriety sake this should be addressed. It was therefore agreed that the draft document would be copied to members for comments and discussion at the next meeting.
Action: Document to be sent out to members
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
i) Primary Care Working Group
ii) Path User Interaction Sub-Group
iii) Pathology User Group
In Dr Kinsman’s absence the Secretary raised two issues that Dr Kinsman had brought to his attention.
John Thornbury from the PCT I.T. department had asked whether the LMC supported the national role out of the Summary Care Record or would prefer a local scheme. Dr Ingrams discussed this and advised that this currently covers less than 1% of the population. Some areas believe the national roll out will not actually happen or will not be sufficient and are planning local schemes. Take up is extremely variable. However, with local schemes if a patient taken ill outside their PCT area cannot be helped by this as their notes cannot be accessed. PCTs have to pay for local information schemes to deal with this and the issue of patient consent. BMA policy continues to require individual consent. The Secretary suggested that at time of financial constraints when the PCT had already been asking us thoughts of where funding can be saved this could be an area and perhaps we should not support the roll out of this at a time of massive cuts. Dr Ingrams pointed out that he had not been able to find out what the anticipated costs of this were. The committee agreed that we would not support this process at a time when services are likely to be cut.
iv) EMIS National User Group Meeting
Secretary reported that at a recent EMIS National User Group meeting EMIS had presented EMIS WEB, the new system. They had also presented a scheme that allowed practices to send text messages to patients reminding them of their appointments. We brought these to the attention of John Thornbury. He replied that he was meeting EMIS shortly and was aware of these developments and would be looking at the cost implications. Dr Ingrams felt that the EMIS WEB would not be a new system but would be an evolution of existing systems and so should be covered under national funding agreements. Whilst on this issue members asked about the legislation regarding testing of electrical items. There seems some confusion about what is required. Dr Ingrams agreed to find the appropriate guidance and this will go into the newsletter. Practices do however do need to look at their individual requirements from their insurance cover.
Action: Dr Ingrams to find guidance
5. MATTERS ARISING
5/542 Mental Health Trust issues
Following discussions at the last meeting and in the newsletter the Secretary had written to the Mental Health Trust asking them if they could bring forward their attendance to the committee. They had declined but had sent through a briefing paper. The committee felt this was singularly inadequate and had not really addressed the issues. The Secretary reiterated to members that they should find specific issues, chapter and verse of deficiencies in the Mental Health Trust and these can be brought to the representatives of the Trust when they attend the next committee meeting. Wyre Forest GPs are very concerned about the development of single point of access for mental health services in their area and although this has been the case in other parts of the county many GPs are unhappy of this restriction in their choice of referral and indeed the patients. It is mindful that patient choice does not apply to mental health but nevertheless the principals should stop. This will be discussed in more detail at the November meeting.
5/550 Smoking Cessation LES
The Secretary reported that following discussions at the last meeting he has heard nothing from the PCT and intended to chase up Brian Hanford for a response. He had received an email back from Julia North who had initially contacted the LMC with this documentation who stated that this had been agreed by Paul Bates on behalf of the PCT. Dr Wells, the Chairman of the Redditch & Bromsgrove PBC Cluster had expressed dismay at this process and the lack of consultation. Indeed the LMC had received an email from one of the anti smoking advisers who had read all about this in our newsletter and was also totally in the dark about this. The committee remains of the view that this whole process is unworkable and will raise this formally with Paul Bates. It seems likely that most practices will boycott this as it stands.
Action: Secretary to contact Brian Hanford and Paul Bates
6. COMMITTEES
a. GPC
The committee received the GPC M2 Circular.
b. GPCWM
The Secretary and Chairman gave a report on the recent GPC Nuts & Bolts meeting. The Chairman felt this was one of the best meetings he had attended. Dr Buckman started the meeting off with a detailed analysis of the current state of play. This was followed by a presentation by a GPC officer about revalidation which had caused great anxiety amongst the audience. This was relayed to the committee and discussed at length. There are real concerns about change in the appraisal process, multi source feedback issues and the issue of whether standards should be either locally derived or national. Further concern remains about the role of responsible officers and the lack of external moderation. The Secretary expressed his continued concern expressed for many years regarding the lack of support for doctors identified as being deficient by both the current and the future system. Guestimates suggest in the new system may be as many as 5% which has massive implications for local systems and also serious funding issues. He remains dismayed that this does not seem to being addressed nationally. In the afternoon at the GPC West Midlands Eamonn Kelly came from the SHA and discussed finance issues and the need for greater collaboration with GPs to make services more efficient. The Secretary reported that he found this exceedingly frustrating as he had heard this all before and clearly Mr Kelly had no idea of what was happening on the ground. Subsequent to the meeting the Secretary had written a detailed letter to Mr Kelly pointing out why PBC was not working and suggested he came back to his old patch in Redditch and Bromsgrove, met up with local GPs and found this out for himself. Interestingly at the meeting Shropshire GPs had been vitriolic in their condemnation of the SHA for foisting a GP Led Health Centre on Shrewsbury. Eamonn Kelly who had been a strong supporter of this process at the time appears to have changed his mind and implied this was a central initiative and said there was nothing that could be done about it other than no one had supported it in the first place! This had caused real anger at the meeting.
7. NEW ITEMS
Minute 5/556 Learning Disability Service
Dr Bunyan had copied to the LMC correspondence relating to learning disabilities patients moving into Worcestershire to an AALPS College in his practice area. There are plans to expand this to up to 29 residents. The practice has had difficulties referring them for local services and the Mental Health Trust has indicated that the provision of these services is the responsibility of the local Primary Care Trust. The LMC did not believe this was correct and that there is a responsibility to provide these services locally but that funding should be derived from the original PCT. The Secretary will write to the Mental Health Trust on this matter and ask for it to be discussed at our next meeting. Dr Ingrams suggested this was also copied to the BMA.
Action: Secretary to write to the Mental Health Trust
Minute 5/557 Pandemic Primary Care Organisational Group Meeting – 24/09/09
Secretary had attended a recent meeting where a wide range of issues relating to pandemic flu planning and swine flu vaccination had been discussed. Dr Ian Inglis from Bewdley has taken on the role of GP lead and has a large list of issues to be addressed in the coming weeks. The Secretary felt that there does seem a real willingness to make progress and support practices to what still could be a very difficult time.
Minute 5/558 Hepatitis B Patient Group Directive
Dr Radleys practice nurse had attended a recent immunisation meeting where they had been advised that travel patients needing Hep B cannot be immunised on a PGD but can for occupational reasons. The Secretary pointed out that he had heard discussions about this earlier in the year and had thought this was an error. Clearly somebody at the PCT is giving out inappropriate advice to practice nurses. PGDs do not apply to GPs and to patients registered on their list. What nurses and staff do within a practice is entirely up to the partners and cannot be dictated by others. GP partners will have to take professional responsibility for the work done in their practice. It is agreed that this will be put in the newsletter. However, members expressed concern that nurse advisers are giving the wrong advice to practice nurses who will feel very uncomfortable getting conflicting advice in this way. It was therefore agreed that we should ask the PCT to issue a correction about this error. The Secretary will put together some detailed information to go in the forthcoming newsletter.
Action: Newsletter
Items B
Circulated
Items C
Application for preliminary consent for inclusion in the Pharmaceutical List in Pershore Road, Hampton, Worcestershire. No objection.
Application for preliminary consent to establish a 100 hour pharmacy at the new primary care centre, market Street, Bromsgrove. No objection.
Minor relocation from Stourport Healthcare Ltd of Stourport Pharmacy from 32 High Street, Stourport to 13 York Street, Stourport. No objection.
Minor relocation from Knights Chemist Ltd of Knights Pharmacy from108-110 New Road, Rubery to 102 New Road, Rubery. No objection.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.40 p.m.
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