The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 11th February 2010 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 R Ingles, Dr G Ingrams, Dr R Kinsman, Dr J Leach, Dr D Lewis, Mrs L Luke, Dr F Martin, Dr K O’Connor, Dr J O’Driscoll, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr J Rankin, Dr H Ray, Dr V Schrieber
1. APOLOGIES
Dr D Herold, Dr K Hollier, Mr D Jago, Dr D Radley
2. MEMBERSHIP
Secretary informed the committee that David Jago would be stepping down as South Worcester Practice Manager Representative. He will ask the Practice Manager Group for a replacement representative.
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 14th JANUARY 2010.
4. REGULAR ITEMS
a. Worcestershire PCT
i) GP notification of new registrations and children 0-5 years to health visiting.
Dr Leach said that they should be contacting the Secretary directly. Secretary said he has not heard anything as yet and will chase this up.
Action: Secretary to follow up
ii) Practice premises (5/564). Letter from Dr McGregor
Secretary reported that he had received a letter from Dr McGregor saying that although they have letters of agreement from the previous Redditch & Bromsgrove PCT they have been told by Worcestershire PCT that they will no longer be supporting their application. Worcestershire PCT say they cannot find any paperwork to support this. Dr Leach has spoken to Dr McGregor and said that if they have the documentation and this confirmation in writing then they should contact the PCT with this evidence and the PCT would have to look further into this.
Dr Leach discussed the issue of premises in more detail. He is gradually visiting practices to discuss how they should progress. There is willingness from the PCT to try and sort this out.
iii) Transferring Community Health Services
Secretary discussed the Stakeholder Brief that went out in January and said that the LMC has not been informed by any other means. The PBC clusters were summoned to a meeting to discuss the government edict. The PCT have to produce a plan by the 18th February to go to the SHA for approval in March and then to be implemented in April 2011. This is also happening elsewhere in the country. Dr Leach said this is a direct government policy. Committees discussed the scale of this and about what services are included in this remit. Secretary said he had heard that the Mental Health Service would like to take over. Dr O’Connor said he had heard this but that they want to merge into a new organisation. Dr Kinsman felt that with such a short timescale it would put off organizations putting in a bid. More discussion took place by the committee regarding this. The Chairman said we should write to Paul Bates about the short timeframe for practices to consult with the PCT and other services. Dr Leach said this timeframe has been set by government so Paul Bates will be unable to do anything about this. Dr Ingrams said the SHA have been bullish and have pushed this. The Chairman asked the committee if they felt the LMC should put in a formal letter about this. The committee agreed that yes we should write to the PCT.
Action: Secretary to write to Paul Bates
iv) GMS/PMS Sub Committee
Secretary discussed issues from the last GMS/PMS meeting. The Minor Surgery LES is progressing very slowly and Sue Morgan who was working on this has now left. There was discussion about the Health Checks LES. Secretary said he is worried about the affordability and impact of this LES. He has had a discussion regarding taking of bloods which Dr Munroe is too look into. Secretary forwarded information on desktop analysers to Dr Leach but has found out that there is not enough money in the pot for these so waiting for more information on this. The most important bit of the presentation was about a computer programme called ‘McKinsey’, which is a facility to load in lots of data about practices and do comparisons with similar practices in similar PCTs across England. Secretary said this was interesting and saw that Worcestershire practices come out well. Secretary told Lynda Dando that it might be appropriate to present this to all practices in Worcestershire and that the PCT should support practices that are not doing as well so they can improve.
v) Out of Hours.
Dr Leach reported. TCN came to see the PCT just after Christmas. They recognised their position was untenable and wished to novate the contract. They can sign over their contract to somebody else, but only with the PCTs agreement. PCT would have to have very good grounds to refuse them so they told TCN to go ahead and have talks with other organisations. TCN did this and have asked to novate to Harmoni. The view from the PCT is that this is not a done deal and have made this clear both written and verbally. They have said there has to be detailed and meaningful communication with local GPs about the OOH provision in Worcestershire. Harmoni came and gave a presentation on Tuesday. There were also presentations from various Worcestershire organisations. The PCT have told Harmoni to go away and get meaningful GP involvement, which means they would like local GPs involved in the day to day running of the service and to come back when they have this. Without this involvement then a submission will not be acceptable by the pct.
Dr O’Driscoll passed round the table a report from the meeting and went through this paper with members of the committee. He said that Harmoni have given no real indication of rates of pay; number of doctors on rota in their plans, and certainly gave no immediate commitment of any sort to increase either above the current rates, but they seem very plausible as TCN did before. Dr Penny said that OOH doctors would rather work for a non profit making service rather than a shareholders one. The ethos should be that the patients are at the centre of the service.
Dr Leach said it would be helpful if the LMC would respond to the PCT about this process so far.
Secretary reported that on Monday there was a meeting in Redditch where Harmoni came to talk to PBC leads to see if they would like to work in co-operation with them. The PBC groups emailed the LMC today to say that they do not want to work with Harmoni. Paul Bates has since contacted the Secretary to ask if the LMC could have a ‘robust, independent voice’. He is very concerned that GP involvement is crucial. Secretary agrees with this. Harmoni had not been told this was crucial before they came up to Worcestershire. Secretary said he is not sure what the LMC can actually do about this.
Dr Schrieber asked if there were other companies in the bidding. Dr Leach said no, other organisations have approached the PCT but there are legal implications to consider. TCN are under contractual obligations by the shareholders to sell themselves to the highest bidder. The only thing the PCT can do is to say ‘yes or no’ to Harmoni taking over the contract.
The Chairman asked the question “has TCN behaved in such a way that the PCT is in a position to terminate the contract?” This can be a ‘yes or no’ and if yes then surely the possibility of re-procurement is a question. Chairman asked Dr Leach if from the evidence from the CQC could TCN be sacked and another provider found? Bearing this in mind there are more options than just the question of Harmoni? Dr Leach said the strategy is as he described it. Chairman said he felt that both scenarios should have been put forward for discussion. Dr Leach said the Board wants a far greater involvement of local GPs in the provision of OOH and it is not acceptable to go back to the way things were in fairness to patients. The Chairman said the PCT need to be more specific on what they want and what type of GP involvement they want.
More discussion went on around the table. Chairman asked if there had been any more injection of money into TCN. Dr Leach said ‘no’. Dr Ingrams said there were many OOH Services across the country that do a good job, some co-ops; some run by PCTs and some commercial so this is not a problem with the national contract; it is a problem with the commissioning by the PCT. Dr Coney said there had been good feedback from trainees after the initial problems. There is a worry that if there is a changeover of provider there will be a problem with the trainees getting their hours in by the end of April. Dr Penny said she didn’t feel this would be a problem. Dr Pryke said there are some anxieties that GPs will not be listened to by such a big company.
This was discussed in greater detail in the closed session.
Action: Secretary to write to Paul Bates
b. Education
Dr Schrieber said there was a worry with the current arrangement with OOH that GP Trainees have to do 72 OOH’s and they need to complete this before they can get their final certification which is looked at in June. He wanted to reassure them that there will be an arrangement of some sort that if they cannot complete within the time then they may be able to afterwards. Dr Schrieber discussed the timetable of GP Trainees and that they may also have to do some OOH work in their 2nd year too. This will not come in until August.
c. Dispensing
Worcestershire Pharmaceutical Needs Assessments.
Dr Rankin has been in discussion with Julie McCann, a Worcestershire PCT Community Pharmacy Advisor with regard to local implementation of these assessments. Ms McCann is involved in developing Pharmaceutical Needs Assessments in Worcestershire. There is to be a new Dispensing Contractors Committee (name not yet known) which will be comprised of representatives of the PCT, LPC, LMC and other interested groups. Ms McCann will be liaising with Lynda Dando, Jane Freeguard and Dr Jonathan Leach regarding these. Each PCT must have its first PNA produced by Feb 2011 and it is apparent these will need to be thorough. Within this part of The Act (draft regulations) there is currently a period of consultation which ends on February 28th. Dr Rankin believes the DOH intends the regulations to be in force by April this year. In April 2011 changes included within The Act will affect how pharmacy licenses are granted.
Dr Rankin went through the document with committee. The Pharmacy contract is in 3 parts, 3rd part on enhanced services. There is a possible threat to existing dispensing practices and will have an effect on the GP contract and dispensing pharmacies. A decision is needed as to what LMC representation is on the committee. The Chairman said we should have as much as possible. Secretary agreed and said the LMC should contact them directly. Dr O’Connor said that the PCT did want them to do this. Secretary suggested two representatives, one dispensing and one non-dispensing with deputies. Committee agreed with this. Dr Rankin said he was happy to draft a reply and send it to the Secretary for him to send out. Secretary was happy for Dr Rankin to do this. Dr O’Connor said it was important for a non-dispensing doctor to be on the committee. Secretary asked for volunteers. Chairman said he would be happy to go for a short while.
Secretary said that Jane Freeguard had rang him about MTRAC which is up for renewal but the SHA is in a mind not to fund it and is looking to set up a new organisation to do what MTRAC does. We might be able to get some GP involvement in the new organisation. The second thing discussed with Jane Freeguard was whether there should be a local GP prescribing committee. There is currently an area prescribing committee with some GP involvement but Ms Freeguard would like a primary care prescribing committee and asked what the LMC thought about this. Committee agreed this was a good idea and Dr Rankin said that there used to be three local groups when it was the old three PCT areas.
Action: Dr Rankin to draft and send to Secretary
Secretary to reply to Jane Freeguard
d. Out of Hours
Discussed earlier.
e. Non-Principals Group
No report.
f. Registrars
No report.
g. P.M. Groups
No report.
h. Administration Issues
i) Annual Dinner at Rossini’s Restaurant on 17th March. Guests to be invited.
Committee agreed to invite Jonathan Leach, Lynda Dando and Jo Hall
ii) Financial planning and levy payments for 2010-11.
Circulated prior to meeting. Committee was happy with advanced notice of finances.
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
i) Primary Care Working Group
Minutes circulated. Membership has increased. Don Beckett said a letter had gone out from Brian Hanford saying they were going to cut funding for I.T. The Secretary asked the committee what were the feelings about the service as he feels in his practice the service has gone down. Dr Ingrams said there is a survey going to be done through the SHA about local support because GPSOC are getting concerned with the amount of complaints they are receiving. Dr Ingrams said he will get this sent out via the BMA news. Dr Kinsman said that John Thornbury was very committed to primary care but the staff in the organisation tends to put the Acute Trust first.
Action: Dr Ingrams
ii) Path User Interaction Sub-Group
Secretary went through the Minutes. Practices get a minimum of two collections a day. Secretary has also raised the issue of Saturday morning collections. Secretary said a volunteer was needed to go to this meeting. PCT do reimburse expenses, thinks it is £225 for half a day. The meetings are normally on a Tuesday morning for a couple of hours and rotate between the hospital locations. Chairman stressed it was very important to get people onto these committees and doesn’t have to be an LMC member. Secretary will put this in the newsletter.
Action: Newsletter
iii) Summary Care Record.
Minutes have been circulated. They are also looking for volunteers to go to these meetings. Dr Ingrams said this was to be rolled out nationally over the next two years but PCTs are not looking at how they are going to support practices. There are already 17 PCTs that have gone live with this.
5. MATTERS ARISING
Minute 5/547 Mental Health Services – Discharge Letter
Letter received from Dr Ros Keeton, Chief Executive, Worcestershire Mental Health in relation to the quality of discharge letters. Dr Alan Farmer has been working on standards which were discussed and agreed at the Medical Advisory Committee in January. The Trust’s Medical staff will formally be asked to comply with these standards. Dr Creaney and Dr Farmer are leading the initiative. Secretary has sent this out to practices and would be interested for feedback from practices on what is happening.
Minute 5/565 Shared Care Protocol EPA
Dr Leach said earlier in the meeting that he had not heard anything about this and the Secretary confirmed he will chase up. Dr O’Driscoll said that Simon Gartland is now dealing with him and enquiries need to be sent to him directly.
Action: Secretary to write to Simon Gartland
6. COMMITTEES
a. GPC
Secretary reported on Negotiating News.
b. GPCWM
Secretary reported on meeting on the 28th January. There was a lengthy discussion about the service from the GPC and support not being as good as it has been in the past. Dr Ingrams said Matthew Isom was going to come to the GPC Meeting to discuss guidelines in place. Dr Ingrams suggested that all correspondence to the GPC be copied to him in future as he may be able to help where Matthew cannot. Discussion took place about hospital letters again going to senior partners. All those who have applied to go to the ARM should have been contacted to go into the ballot for GP places. Dr Ingles and Dr O’Driscoll said they had not received anything. Secretary said he would look into this.
Action: Secretary to chase up ARM information
7. NEW ITEMS
Minute 5/569 Quality of Care issues at Worcestershire Acute Trust
Chairman said there were instances of various partners taking issue with the Acute Trust about the quality of care for critical incidents, where patients were going in on the wrong pathway and being referred back to the community, and where critical illnesses have been missed due to this. Chairman asked the committee if this was common around other practices. Secretary said this has happened in his practice. Chairman proposed that for a month we ask practices to fill out the critical incidents form, right across Worcestershire, gather this information so we can take it to the PCT. Practices have written to John Rostill in the past but nothing has changed. Chairman said this is why the LMC should collate this information and formally write from the LMC with evidence. Dr Kinsman suggested we write to the PCT and ask for the information back and also write to John Rostill asking how many have been reported and are they on the increase? By forcing them to give us the evidence it may have the desired result. Dr Davis said they had written to Dr Ashton and said that unless they did something they would take all their patients to Dudley. Nothing was done and so they now push their patients there instead. Chairman said he would be putting this issue to the Worcester GPA. Dr Rankin said one of the issues is that the patient is often under the care of a few consultants and this can be why it is difficult. Dr Penny asked if they feedback after receiving a critical issue form, but no practices do not get reports back. All agreed this needs to be looked into.
Action: Secretary to write to PCT and Acute Trust and also ask practices to complete the forms for one month
Minute 5/570 Health Overview & Scrutiny Committee
Secretary has received an email from Juliet Brunner, Worcestershire County Council, reviewing winter pressures. There is a meeting on the 10th March and the Secretary asked the committee if the LMC would like to speak at this meeting. All agreed that there was no need to speak but it would be good if someone could be present at the meeting. Secretary agreed that he would attend.
Action: Secretary to attend meeting
Minute 5/571 LMC Conference Motions
Secretary asked for motions before the deadline.
Minute 5/572 Worcestershire Link to conduct “Enter and View” visits in surgery
Secretary reported that he had been informed that it is the intention of the Worcestershire LINk to conduct “enter and View” visits to some GP surgeries to enable the LINk to look at the “winter pressures” which have been put upon GP practices in Worcestershire. They will undertake these visits at some time from now until 31st March. They will identify suitable surgeries and contact them directly.
Minute 5/573 Admissions to MAU
Secretary read out a letter Dr Herold had received from an Evesham GP who has had some difficulty admitting a patient to MAU. Because the patient had not been personally seen by a GP in the last 24 hours they refused to accept them for admission. The Secretary asked if they can they refuse an admission on these grounds and if there was a policy for this? Dr Kinsman said he did not think they could. Dr Burger said she has had the same problem. Committee agreed the LMC should take this up with the Acute Trust.
Action: Secretary to write to the Acute Trust
Minute 5/574 National Audit of Falls and Bone Health in Older People
Secretary informed the committee about a letter received from the Royal College of Physicians. This is part of the national clinical audit programme, funded by the DOH and commissioned by the Health Quality Improvement Partnership. The next round of the national audit will take place between September and December 2010. Trust audit departments will be contacting practices about a small number of patients. They have suggested that the contents of the letter be shared with practices via our Newsletter.
Action: Secretary to put in Newsletter
Minute 5/575 NHS Appraisal Toolkit Problem
There is a problem with the NHS Appraisal Toolkit. An email was sent to all practices from the LMC on this. Mr Beckett gave an incident where a doctor in the practice had wanted to change their appraisal date and were refused the flexibility of this. Dr Ray said she had no problem changing the date of hers and others also said it was flexible. Dr Lewis thought it would be back online on the 3rd March but Dr Ingrams spoke to someone earlier that day and it has failed with significant penetration testing so not sure when it will be back.
Items B
Circulated
Items C
Appeal against Worcestershire PCT decision to refuse an application by Mr B S Atwal for preliminary consent prior to inclusion in the pharmaceutical list at Pershore Road, Hampton, Worcestershire. No comment.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 10.00 p.m.
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