The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 12th November 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Dr P Bunyan, Dr N Burger, Dr L Butcher, Dr D Herold, Dr R Ingles, Dr A Kelly, Dr D Lewis, Mrs L Luke, Dr K O’Connor, Dr J O’Driscoll, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr D Radley, Dr H Ray, Dr V Schrieber
1. APOLOGIES
Dr P Coney, Dr M Davis, Ms L Dando, Mrs M Hallahan, Dr G Ingrams, Mr D Jago, Dr R Kinsman, Dr J Rankin
Dr Ros Keeton, Chief Executive, Ms Jan Ditheridge, Operating Officer, Ms Kate Glenholmes, Business Lead, Dr W Creaney, Director of Medical Development and Dr Alan Farmer, Lead Consultant Community Business Unit all attended from the Mental Health Trust.
The Chairman welcomed them to the meeting. Dr Keeton raised particular issues she wanted to address, which were improving access to psychotherapies, the Primary Care Business Unit and issues about older adult services and the need to extend the services due to the increased number of patients with dementia. She also mentioned Adult Acute Care Pathways and the new A&E Liaison Service. There is currently a half time consultant in post and this service will be steadily built up.
On the issue of psychotherapy she informed the committee that a DOH initiative to improve access had been led by the PCT. This was aimed at common mental health problems towards the NICE compliance interventions. Initially large sums of money had been proposed but this has been changed and now PCTs have been given an allocation which will reduce the likely funding for this county. It was expected £750,000 per annum will be allocated for this but the implementation team is currently revising the model and looking to this, particularly issues of skill mix, counselling and equity of access across the county.
Members of the committee raised the issue of inappropriate discharge of chronic patients back to the community. The Secretary highlighted some particular cases raised by practices. The committee was assured there had not been a change in policy and if GPs felt this was being handled inappropriately we could flag them up to managers.
On the issue of urgent assessments Jan Ditheridge advised that there were two issues, firstly the problem of trying to ring during the day time and then the changeover of services between day time and out of hours service. They have looked at these services and how to address it and make it easier. Currently practice is variable across the county. The plan is to introduce a single number to call and it is likely this will be trialled from the 1st January. They will be looking for feedback as to how this works. The Secretary asked that if we had a single point of access for urgent referrals it would be appropriate to have a faxed back response sheet so that the GPs know exactly what is being proposed.
We discussed the issue of children in Mental Health Services between the age of 16 and 18 when CAMS and the Mental Health Trust take over care. A particular issue remains over emergency admissions. This is currently the responsibility of the provider unit. It was suggested that the committee raise this with Teresa French and Paul Bates at the PCT. It was proposed that early intervention service will go down to the age of 14. The crossover seems confusing as patients between 16 and 17 if they are at school remain the responsibility of CAMS and out of school they go to Adult Services. Sadly CAMS funding does not allow full cover up to the age of 18. The committee remains unhappy about this which has been a problem highlighted a number of times over the years.
On the issue of Foundation Trust application Dr Keeton said that there had been no new Foundation Trusts made recently and she felt that the DOH had become rather nervous about this. Nevertheless the process has proved useful and has certainly brought about this current discussion.
The committee had a long discussion about the issue of communication and welcomed the offer of a service user’s manual which the Trust are currently processing and are likely to pilot shortly. It was also suggested that there were some guidance for Mental Health Services on discharge letters and clinic letters. Members commented that in some areas of the county these letters were taking six weeks to come and are inadequate. The Secretary pointed out that a patient of his recently has been seen for 18 months and no specific diagnosis had ever been put on the letters. The committee felt that even if a definite diagnosis was not made a tentative working diagnosis would be helpful for GPs. On the issue of communication the Secretary pointed out that in his 20 years of attending LMC meetings this was only the second time anybody from the Mental Health Trust had attended an LMC meeting. We very much welcome their presence and they indicated they would like to come back in five or six months time to assess progress. The Chairman thanked them for coming to the meeting.
2. MEMBERSHIP
Dr Fiona Martin had indicated to the Secretary that she was working again in Worcestershire at the Walk-In Centre and had expressed an interest in rejoining the committee. This was supported. The Secretary will contact her to see if she is actually interested in taking up the vacancy as co-opted member
Action: Secretary to contact Dr Martin
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 8th OCTOBER 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
i) Lynda Dando sends her apologies.
The Secretary welcomed Lynda Dando’s briefing notes which she had sent as she was unable to attend.
ii) GMS / PMS Commissioning Group.
The Secretary discussed the first meeting of the GMS / PMS Commissioning Group and reported that he felt this grouping was going to be very important because it was looking at a range of issues, particularly relating to funding of primary care. The first meeting had dealt with the terms of reference, had an update on medium term financial strategy and an update on the review of enhanced services. There was then a long discussion on the primary care mental health surgery service and finally the Violent Patient Scheme was reviewed.
iii) Appointment of Medical Director
Secretary informed the committee that Dr Jonathan Leach is due to start in post as new Medical Director on the 1st December. He has already rung and arranged a meeting with the Secretary on the 23rd November.
iv) Violent Patient Scheme
On the issue of Violent Patients the draft document had been sent to members for their comments. The Secretary has already stated that the problem with the Violent Patient Scheme that has been raised on a number of times by practices is a fault of the regulations and not the local scheme. He agreed that he would highlight this to the GPC and in the meantime he felt that the proposals from the PCT were within the rules.
v) Minor Surgery LES
The Committee discussed this at length. There are two strands to the discussion. The simple one is the proposal to enhance the amount of minor surgery done in primary care and transfer the work from secondary care. Clearly the LMC would support this. The changes to the LES cause some concern, particularly with regard to the PMS practices where it is suggested that the baselines are unpicked. This is proving very difficult and is contrary to the spirit of PMS. A number of practices who are PMS have reported that as part of the ethos of PMS not to do lots of data checks and claims they were not recording all the cryo therapy and cautry they perform. How the PCT unpicks the baseline will be very difficult. The Secretary will feed back our comments to Lynda Dando. The Chairman felt that if the PCT were going to unpick the baseline we need an undertaking that this will be a ‘one off’ and not the start of further attempts to undermine PMS contracts. The committee was very nervous about the proposals and felt more work needed to be done. It was suggested that this should put on hold for more consideration and not rushed through.
vi) Chris Emmerson – Demand Management update
Lynda Dando asked if it would be possible to update the December meeting about the Elective Demand Management work programme. The committee agreed with this.
vii) Health Checks LES
Lynda Dando had reported that the committee is taking place in the next few weeks to agree the software to support the Health Checks programme (formally known as Vascular Screening). A draft LES has been discussed and agreed in principle by the Health Checks Project Group. Some minor amendments are to be made in light of further discussions. She asked if attendance at the December meeting will be possible to present this information and this was agreed by the committee.
Action: Confirm to Lynda Dando that we agreed to have a presentation about Health Checks at the next meeting.
The Secretary reported on the Smoking Cessation LES, he has got absolutely nowhere trying to persuade people that the SHA proposals were unworkable. A large number of practices are boycotting this and so it is likely that the scheme will see a reduction in service rather than improvements. The LMC still feels that the PCT should still produce a simplified LES for Primary Care use. The Secretary will raise this again with the PCT.
MRSA Screening – Lynda Dando reported that this should be done entirely by the Acute Trust which is also the view of this committee.
b. Education
Dr Schrieber reported that further trainers courses are planned in the Spring and it was agreed to mention this in the Newsletter so that any practices wishing to embark on GP training can contact Dr Schrieber directly.
Action: Newsletter
c. Dispensing
The Secretary reported he had spoken to Jo Hall at the PCT and the reason no LMC members were invited to the last sub-committee meeting was simply that there were no issues really that required GP input. The LMC will be invited to attend when it is relevant.
d. Out of Hours
The Chairman briefed the committee on further discussions the LMC had had with the PCT regarding TCN. In particular this related to the anonymous letter received by the LMC advising us about the roll out of emergency care practitioners. The LMC had expressed some disquiet about this and sought reassurances from the PCT about how this was being managed. The LMC has subsequently been informed by the PCT they have asked for TCN to delay this for the time being.
The committee have been made aware that Cambridge PCT have brought forward the termination date of the TCN contract covering East Cambridgeshire. This was due to finish at the end of March and now will take place on the 1st of December. The LMC is concerned about the impact this will have on TCN and has asked the PCT for confirmation that they have a plan should TCN fail. We have received reassurances from the PCT that there are a number of contingency plans in place depending on the situation.
Committee members expressed concern that they are still aware of regular unfilled shifts. This was particularly a problem in Cambridgeshire and was one of the reasons why the TCN contract was cancelled. A number of local MPs have been in touch with the LMC about this as has the Chairman of the Health and Scrutiny Committee. The Secretary has briefed them on the relevant issues.
e. Non-Principals Group
No report.
f. Registrars
No report.
g. P.M. Groups
No report.
h. Administration Issues
The document on Roles & Responsibilities for LMC Members had been circulated and was agreed by the committee. It will be put on the website. Dates for meetings for next year will be circulated for discussion.
The Secretary reported that the Treasurer of the General Practitioners Defence Fund had recently written to LMCs informing them that the Indemnity Cover would be withdrawn. This was met with some degree of anger from LMCs who felt that this should have been discussed and indeed put to Conference. This had then resulted in a discussion about the status of the GPDF but nevertheless many LMCs around the country feel aggrieved about this and feel the matter should be debated and discussed. The issue will be on the agenda for the next GPC West Midlands meeting. In the meantime Michelle has sought quotes to ensure that the LMC will remain covered. The Secretary will watch this issue carefully.
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
No report.
5. MATTERS ARISING
5/550 Smoking Cessation LES
Discussed earlier in the meeting.
Minute 5/556 Learning Disability Service
Dr Bunyan had already informed the Secretary that the issue has been resolved satisfactory following his correspondence with Dr Keeton at the Mental Health Trust.
6. COMMITTEES
a. GPC
The committee received the GPC M3 Circular.
b. GPCWM
The next meeting will be on the 26th November. The newsletter had been circulated and we will include details in our own newsletter of the MTRAC vacancy.
7. NEW ITEMS
Minute 5/559 Meeting with Juliet Brunner, new Chair of HOSC
Councillor Juliet Brunner has recently been appointed as Chair of this committee. She is very keen to engage more with the LMC and to develop the role of this committee which perhaps recently has been rather ineffectual. The Secretary has had a long meeting with her where a range of issues were discussed including mental health issues and the out of hours service. Councillor Brunner had asked if LMC members might like to put themselves forward from the different council areas to be a contact point for discussion between councillors and primary care on health issues. The Secretary felt this was a good idea and will seek volunteers.
Action: Get volunteers from different council areas.
Minute 5/560 10:10 Campaign
Dr Thompson from Elbury Moor Medical Centre had contacted the LMC asking whether we had heard about the 10:10 campaign and whether we feel we would wish to sign up to it. Essentially this is a scheme whereby organisations try and reduce their carbon emissions by 10% during 2010. Members discussed this and felt that it was appropriate to encourage practices to look at the 10:10 website. This will be included in the newsletter.
Action: Newsletter
Items B
Circulated
Items C
Application from Stourport Healthcare Ltd for minor relocation from 32 High Street, Stourport on Severn to 13 York Street, Stourport on Severn
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 09.45 p.m.
= Agenda Only
= No Agenda
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