The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 10th December 2009 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Bunyan, Dr N Burger, Dr L Butcher, Dr P Coney, Dr M Davis, Mrs M Hallahan, Dr D Herold, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Dr D Lewis, Dr K O’Connor, Dr J O’Driscoll, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr D Radley, Dr J Rankin, Dr H Ray, Dr V Schrieber
1. APOLOGIES
Mr S Hairsnape, Dr R Kinsman, Mrs L Luke
The Chairman welcomed Dr Jonathan Leach, Medical Director of the Worcestershire PCT and Margaret Jackson, Non-Executive Director from Worcestershire PCT.
2. MEMBERSHIP
Dr Martin wishes to take up co-option and her first meeting will be in January.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 12th NOVEMBER 2009.
4. REGULAR ITEMS
a. Worcestershire PCT
i) GMS / PMS Commissioning Group.
Ms Dando said they have now had the second meeting and are looking at services. The other big issue is how to develop the Minor Surgery service in Worcestershire which they are looking into in more detail, how to fund it and ensure the funding is paid to primary care. A document showing where they are currently has been circulated to members. The Secretary said he felt this Commissioning group was going to be very important but one problem he can foresee is in Public Health. A number of LES’s which are very worthy and aimed at Public Health issues are not detailed enough, the content is fine but how you implement it in Primary Care is not and there are lots of gaps. For example the Alcohol LES is an example and the Secretary felt this may not work and be effective. The Health Screening LES is a big issue for general practice because of the numbers being so high and this work is supposed to start at the beginning of April. The Software, MSDI is supposed to target the patients and be loaded onto every practice. The software goes through the practice data and gives you 10% that you have to screen. There was further debate about this LES and the problems with doing blood tests and the collection of these as this service would probably be done later in the day. There are many little details that have not been thought about. The communication feedback appointment has to be face to face and cannot be a telephone call. The Secretary said he has tried to explain that a phone consultation would be just as effective. He went on to say that the LMC needs to speak to Public Health earlier in the process when looking at LES’s so we can help and get more involved. Dr Leach said he spoke to Richard Harling about his role and agreed that where there are public health initiatives there would be discussion with Dr Leach and Ms Dando as a minimum and they will have an opportunity to comment on them, so he will be involved from a practical point of view on many of these issues. The Secretary asked Ms Dando where the Alcohol LES came from. Ms Dando said from the DOH initially, but the SHA have said that the alcohol DES is going to run for one more year so it gives them time to work on this further.
The Chairman asked about the Stop Smoking LES. Dr Leach said that they were going to offer three options which were either to do nothing; continue with the LES or offer the service under the new contract.
The Chairman asked Ms Dando if she felt the payment for Minor surgery, e.g. Chryo was a fair price? Ms Dando said that yes at this time this she felt it was a fair starting point but agreed that there was more work to be done and if anyone has ideas they are prepared to consider them and they should do this either through the LMC or PBC Clusters. There has to be a fair payment scheme across the board for all practices.
Dr Coney said he didn’t see anything about accreditation for general practitioners to perform minor surgery and thought proof was needed for them to undertake this work. Dr Ingrams said this isn’t necessary and practitioners work up to their own competency. Dr Rankin said he believes there is a need for accreditation but has looked into this and cannot find courses to attend. The best courses are normally run by primary care surgeons.
The Secretary reported on the Violent Patient Scheme. After the last LMC meeting he asked on the LMC Listserver about how other LMCs handle violence. He received some very useful documents, one especially from North Yorkshire and York PCT. There were a few very useful things in the document and the Secretary has agreed to meet with Nigel Higenbottam and Jo Hall to discuss this. The big problem area is what do we do about potentially violent patients, the ones who haven’t got a police record number and who are likely to get one. This document covers this so hopefully this will be something can look into in the future.
ii) Anti-Smoking LES
Discussed earlier. Secretary reported that can continue with the LES.
iii) LMC Representation on the Clinical Senate
The Secretary reported that he had received a letter from Dr Anthony Kelly who feels that any additional representation on the Clinical Senate would be destabilising and a conflict of interest, especially to the other providers represented. He felt that the LMC presence on the PMS/GMS subcommittee was a much more important area for input. Dr Leach said there were many GPs on it already and agreed that other organisations would benefit from the LMC input more. Dr Kelly’s view is that they seek the LMC view but not have an actual LMC representative on the board. The Chairman said he felt this was a shame and didn’t agree that the LMC should not have representation. Dr Leach said if we felt strongly about this then he can take this view back to Dr Kelly. The Chairman said that the committee will discuss with Dr Kelly direct. There was further discussion about the role of an LMC representative amongst members.
iv) Swine Flu for under 5’s
Documentation circulated to members. £5.25 has been offered. Dr Ingrams said that the GPC negotiations had stopped and they had turned this down as they did not feel that this was right for patients and practices. Other LMCs have reached a better deal. Dr Ingrams said the Government were playing a game with general practice and not just with swine flu. The Chairman asked the committee what their thoughts were and said it was right that this group get immunised but under what circumstances? Dr O’Driscoll said the principle was to get their patients immunised but the circumstances are not right as they have not been given more time to administer this. Chairman said that this will be a problem because appointments will take longer as parents will be anxious and will want to ask more questions. These appointments will be taken from the chronically ill as they cannot do both. If they are to free up extra time then practices would look for a sympathetic hearing which the GPC negotiators were trying to do. Dr Leach began with offering sympathy for the work load implications and said that the PCT have looked at the nationwide position and some areas like Warwickshire and London have accepted the £5.25 with London also getting a £100 fee. He said they have had direction from the SHA that it has to be £5.25 with no flexibility. Dr Ingrams said that London and Warwickshire were told the same but they got additional flexibilities as well. Dr Leach said this was helpful but 10 practices had already agreed. Dr Ingrams said it will be interesting to see how far they get through it! The Chairman said that if practices wanted to sign up for this that was fine as long as not all practices were put in the same bracket. Secretary mentioned the practices that cannot do it. There were differing views amongst the committee but many felt that there had to be more flexibility.
v) GP notification of new registrations and children 0-5 years to health visiting.
Ms Dando said that as a result of the internal audit of health service records there was a problem with Health Visitors not being informed of new childhood registrations so they are not picking up and aware of children at risk. Ms Dando asked what can the PCT and practices do to help safeguard children and make sure they pass onto the Health Visitors information of children moving to a new practice. This internal audit was followed up by letter via the DOH Safeguarding Children Board who believes this is for wider discussion. Secretary said he will put this in the newsletter. The Secretary asked how the Health Visitors are informed now. Ms Dando said some practices give a print off of new patients and give to the Health Visitors, so it would be good if we could get this replication in all practices. Secretary asked the question of whether central records could do this. Dr Ingrams said that a micro search on the central records server could be done. Dr Radley said that a list would be the best way to make sure it is done. Chairman said that some practices would be better than others for doing this and you cannot ensure they will all do this. Dr Radley said then perhaps it should be down to the Health Visitors to ask for it. The Secretary asked what the current policy was. Ms Dando said this is what the internal audit has identified so far. Secretary said this might be worth looking into further and agreed the Secretary should reply to Marie McCurry, and copy Dr Leach and Ms Dando into any communication. The Chairman said we have to get it right because of medico- legal implications. Agreed to put it on the agenda for the next meeting. Secretary to find out what other practices in the county currently do.
Action: Secretary to write to Marie McCurry,
c.c. Dr Leach and Ms Dando
Contact practices on what they currently do.
vi) PGD’s. Secretary to report.
Secretary met with Sue Lunec and Jane Freeguard to talk about this. The reason this has been an issue is the use of Twinrex. The PGD for Twinrix has been withdrawn but all others still apply and a letter has gone out to practices spelling it out. Dr Leach said there were issues with PGDs for TCN and they were currently looking into this, they do not want to reinvent the wheel and want to try and make sure they are evidence based. Dr Ingrams said that PGDs were not needed in general practice, but Dr Leach did not agree. Secretary said he wasn’t sure if he agreed with Dr Ingrams as when we contacted the GPC we were told they were in the process of rewriting the guidance on PGDs and the Medicines Agency guidance contradicts this. Dr Ingrams said that the guidance that came with the Act makes it very clear that it is the exception rather than the rule and they are not there for normal business processes, just for exceptions. They do apply to Out of Hours and Walk in Centres. Dr Leach said the best thing would be for him to take this away and look into this further.
Action: Dr Leach to take this back to the PCT
Secretary to seek up to date GPC Guidance
b. Education
No report.
c. Dispensing
No report.
d. Out of Hours
Concerning out of hours provision, Dr O'Driscoll stated that TCN seem to have partly implemented there new rota with reduced doctor numbers, despite assurances that this was not going to be done last month. In particular, with regard to weekday evenings, the number of visiting doctors for the whole county seems to have been reduced to one. Previously there were doctors based at Worcester, Kidderminster and Redditch to see patients at base on a weekday evening. In addition, there were 2 visiting doctors, one for the south of the county based at Worcester and one for the North of the County based at Kidderminster. This was found to be an inadequate number in the pre TCN days of 2008, when it was widely agreed by those working in the service that a visiting doctor was also needed based in Redditch on weekday evenings, as the Kidderminster doctor was hopelessly overstretched trying to visit from East of Redditch to Tenbury, via South Birmingham and Bromsgrove. TCN have now reduced the number of visiting doctors to one for the whole county, along with three non visiting base doctors in Kidderminster, Redditch and Worcester as before. However, their new system allows the Redditch doctor to be replaced in the hospital base by a non doctor who sees the patients, so that the Redditch doctor can then visit in the north of the county if needed. Thus TCN will say that they have the ability to have 2 doctors visiting, but it is clear that they have actually decreased the number of doctors available on a weekday evening by one replacing doctors with non medically qualified ECPs.
Secretary said that we had also received a report from Link, the new patient forum. They have raised many concerns, all of which have been raised before. The Chairman said that if this was a practice not performing in the county the approach by the PCT to that practice would be completely different. The PCT do not seem to be doing what they say they are doing. Dr Leach asked if the LMC would copy him in with all future correspondence. He is meeting Dr Kelsey next week so will know more then. He said there is a national issue with OOH provision so this is a broader problem than just Worcestershire. Secretary told the committee that Suffolk have told TCN not to use overseas doctors any longer, which means even more shifts not filled. Dr Leach said the PCT are still waiting for the Care Quality Commission report. Dr O’Driscoll said we have been waiting a long time for this report. Chairman agreed and said that if anything goes wrong whilst waiting for this report and someone dies this will not be a good enough reason not to take action.
e. Non-Principals Group
No report.
f. Registrars
No report.
g. P.M. Groups
No report.
h. Administration Issues
The LMC Meeting dates for 2010 were circulated to members and agreed.
The issue of all LMC’s needing to obtain Professional Indemnity Insurance was discussed at the GPCWM meeting. Dr Ingrams had put an email on the LMC Listserver asking if this could be discussed at the Secretaries Conference. LMCs are annoyed because we pay into the Defence Fund but now have to sort out their own insurance and it cost a lot more to do it individually rather than through the GPDF. Secretary confirmed we have looked into this and we definitely have to get ourselves insured, if the LMC is sued all members are liable. The GPDF has been advised it cannot have a group policy to satisfactory cover each and every LMC as they are so different. Dr Radley asked if we have received a reduction from the GPDF to cover this cost and the answer was yes, more than enough to cover the policy. Dr Ingrams said this rebate has also been promised for next year. Secretary said if the committee agrees we will go ahead and get this done. All agreed.
Action: Obtain Professional Indemnity Insurance
i. P.B.C. Issues
The LMC have received a document from Paul Bates regarding the failure of PBC. This document was not formally sent to the LMC and the committee was not sure what to make of it. The Secretary said the perception from PBC Clusters is that PBC is not working so suspects this is what has provoked this document. The Chairman said that the LMC note the comments made in this letter.
j. I.T. / GPSoC
i) Primary Care Working Group
Nothing to report.
ii) Path User Interaction Sub-Group
Nothing to report.
iii) Pathology User Group
Chairman asked if Dr Lewis would be interested in going to this. Dr Lewis said unless it was Thursday or Fridays could not do. Secretary will find out when this is.
Action: Secretary to find out date
iv) Summary Care Record.
Chairman thanked Dr Rankin for his work on this. Dr Kinsman asked if we would like to meet John Thornbury before they go ahead with the implementation of SCR. Secretary said he will speak to John Thornbury about this. Dr Ingrams explained how SCR and the funding work. Dr Radley said the money does not improve what they want to do and the money is better spent elsewhere. The Chairman agreed. Dr Ingrams said the money was available this year but not in future years but thought it was the right thing to do. Chairman asked the committee for their views. The Secretary read out Dr Kinsman’s email. This would be very beneficial for OOH and the sharing of information. There was a difference of opinion and much discussion took place regarding this. It was then put to a vote around the table with 6 for SCR and 3 against.
5. MATTERS ARISING
5/550 Smoking Cessation LES
Discussed earlier in the meeting.
6. COMMITTEES
a. GPC
M4 Circular & Negotiating News circulated to committee members.
b. GPCWM
Secretary reported on the GPCWM meeting on the 26th November. They discussed the Darzi Health Centres and their lack of success around the West Midlands. There is still the ongoing problem with hospital letters going to senior partners. Dr Ingrams said this was raised at parliament today and formally complained to the Information Commission Office (ICO) and said the ICO are coming to meet with them next month. Date for the Negotiators meeting is the 25th March.
7. NEW ITEMS
Minute 5/561 LMC Conference 2010
The dates for the LMC Conference 2010 will be the 10th & 11th June. Paperwork has been circulated to members. Representatives are needed. Dr Ingles, Dr Parkinson and Dr O’Driscoll would like to go. Dr Davis is interested in attending but needs to confirm the dates first and Dr Burger will let us know once she checks the dates. Secretary confirmed that the date for the ARM is 28th June to 1st July.
Minute 5/562 LMC Secretaries Conference – 3rd December
The Secretary reported. On Thursday they received the conference address from Laurence Buckman, followed by breakout groups. Secretary attended one on the potential effects of a change of government on primary care. There was talk about GPs taking over the commissioning of OOH Services. They received a talk from Professor Steve Field, PRCGP. The Royal College and the BMA seem to be saying the same things. They also talked about the proposals of Revalidation and Reaccreditation and the remediation, funding of and organising of it, which was good to hear. There was a session on PCO and LMC relationships and then a Negotiators briefing. The second day was about quality in modern general practice and getting ready for the new agenda. The first speaker from the DOH was quite vague about what it really meant and then Cynthia Bower gave a talk. Other speakers were Professor Steve Field and Dr Laurence Buckman regarding quality and Professor Helen Lester on practice accreditation and there were more breakout groups during the day.
Minute 5/563 Primary Care Cancer Audit
Secretary reported that following an email from Dr Butcher he has had confirmation that the full funding from the 3 counties cancer network will be paid.
Items B
Circulated
Items C
Change of ownership received from RAK Medical Services Ltd for Claremont House Pharmacy at 119-121 Church Street, Great Malvern. Currently owned by Pasab Ltd. No comment.
Application for preliminary consent prior to inclusion in the pharmaceutical list at Pershore Road, Hampton. Not necessary 0.7 mile from nearest healthcare facility, already served well. LMC to reply.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.35 p.m.
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