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WORCESTERSHIRE LMC LTD
MINUTES
_________________________________________________________
The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 13th May 2010 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr N Burger, Dr L Butcher, Dr P Coney, Dr M Davis, Dr K Hollier, Dr R Ingles, Dr G Ingrams, Dr R Kinsman, Dr J Leach, Mrs L Luke, Dr F Martin, Dr J O’Driscoll, Dr S Parkinson, Dr S Pike, Dr D Pryke, Dr J Rankin, Dr H Ray, Dr V Schrieber, Mr J Waits
1. APOLOGIES
Dr P Bunyan, Dr D Herold, Dr D Lewis, Mrs M Hallahan, Dr E Penny, Dr D Radley
2. MEMBERSHIP
Secretary reported that having circulated the proposed changes in Wyre Forest there has been no indication contrary to the proposals. Therefore he proposed that Dr Butcher take over Dr Schreiber’s seat as the elected member for Wyre Forest and as he is now retiring from General Practice, Dr Schrieber be co-opted back onto the LMC as Associate Dean. This decision was endorsed by the Committee.
Action: Newsletter
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE
15th APRIL 2010.
4. REGULAR ITEMS
a. Worcestershire PCT
i) Jane Freeguard attended the meeting to discuss prescribing issues. She advised the LMC that the budget notification letters have been sent out to practices and is proposed that the support teams within individual practices will help them to try and deliver financial balance in GP prescribing. Unfortunately there is a 0.75% overspend last year and this will need to be recouped in the current year. They are going to focus on the current cost improvement programme looking at PPIs; Statin and ACE. Generics will also be considered. They are currently producing information that will be sent around the PCT and also PBC Leads. Dr Leach reinforced the reality check of the current financial situation. The committee then discussed some of these issues. The Secretary suggested that perhaps it is time for explicit rationing policies to be produced. Such a document agreed by all would have a great deal more clout and he suggested as a possibility ‘lifestyle drugs’. Dr O’Driscoll mentioned that the on-going problems of Acute Trust prescribing and the lack of real implementation of the formulary. The Secretary also raised his ongoing concern of the large number of ongoing prescriptions being issued so that chemists can dispense in 7 day boxes. Other PCTs have stated that it is the requirement of the pharmacies to produce these for vulnerable patients and that 28 day prescriptions are adequate and there is no need for the additional cost of 7 day prescriptions.
ii) Dr Jonathan Leach then updated the committee on premises issues. He announced that funding had been agreed with Alymer Lodge and Northumberland House and subject to final signoff Bewdley Health Centre. They are currently pushing the Provider Arm with regards to the Kidderminster Health Centre as that is the rate limiting step. It is likely that the PCT will have to take a view on the space needed by the Provider Arm so this development can take place. In addition the Berwyn Avenue and St John's House proposals have been agreed in principle and further details are awaited from the District Valuer about St John's House in Worcester. The issue is looking at a global view of how practices are doing and recognising that any practice that has a rate limiting step, holding them back is poor premises. Finally he stated that the issue of Dr McGregor’s practice in Church Hill is still in hand and they are working with the developers who are planning to re-develop the whole of the Church Hill Centre. There are ongoing issues with the valuations given by the District Valuer. In summary he stated that the PCT has moved a long way but in the medium term there will only be surgery developments in exceptional cases.
Dr Frank Morgan has been appointed as the new Clinical Governance Lead and is working on altering the QOF visits to take those away from being a policing exercise to be something more of a learning process and advisory role in the similar way to the Risk Assessment visits done by the Medical Protection Society. In due course a working group will be set up to look at the whole issue of QOF visits and Clinical Governance. This may well be something that will help with CQC Registration. Perhaps a practice development tool could be produced.
Dr Leach informed the committee that the PCT is being encouraged to work as a West Mercia cluster. The Strategic Health Authority has come up with this idea and Herefordshire, Worcestershire, Shropshire and Telford are lumped together. It is not yet clear how this will work but it could be useful to help with best practice and learning issues. Better co-working will be a good idea but whether this will realistically help with management cost is unclear at this stage.
iii) GMS/PMS Sub Committee
Secretary was unable to attend the meeting. Lynda Dando had sent a summary detailing some of the developments. For the Minor Surgery LES details have gone out to practices and 60 service plans have been reviewed of which 24 are willing to provide all or part of the DES for a number of other practices. A significant number of queries have been received and it will be discussed further at the next meeting on the 20th May.
With regard to the Care Home LES a business case has been produced for the Commissioning Executive and there has been positive response from the finance department. Jane Freeguard pointed out that it has been agreed that the medicines management part of this should be done by pharmacies. This would work better than individual practices trying to take on this work.
40 IUCD activity records have been received and this again will be reviewed on the 20th. Secretary wondered why no discussion had taken place further on this when at a previous meeting the LMC had been asked to provide a representative and Dr Burger had volunteered. We will raise this at the next sub-committee meeting.
The Treatment Room LES was well received at a SHA meeting and will be rolled forward. Further discussion is taking place about the Choose & Book LES for future years.
The Secretary advised the committee that he understood from Lynda Dando that the Strategic Health Authority have commissioned a new PMS contract. It is not clear why this is being done and the Secretary's view is that this is a complete waste of time and certainly is not something we would wish to revisit in Worcestershire. We did all this three years ago and moved very satisfactory to a Lockhart’s contract. He understood that at present it is not intended that this will be compulsory for all PCTs.
iv) Reorganisation of Community Nurses
The Secretary reported that he understood from a number of sources that issues are taking place with regard to District Nursing and a move to reduce the number of grade 7 nurses in the county. Apparently in Wyre Forest nurses have already been presented with these proposals. Dr Leach said he was not aware of this matter. The committee was concerned that this could seriously undermine the District Nursing Services across the county and felt this should be discussed in more detail. It was agreed that the committee should write to Teresa French at the Provider Arm expressing our reservations.
Action: Secretary to write to Teresa French
v) PCT / LMC Meeting – 20th May 2010
Lynda Dando, Dr Jonathan Leach and the team will be attending to present the proposals that the PCT has for primary care policy. The PCT has decided not to use the balanced scorecard approach which it feels will be counter productive. There is significant variation across practices and it is recognised that some of this is understandable and reasonable but there are areas which need to be looked at. He intends to apply clinicians view to see where this makes sense. Given the tight financial future it is felt that the PCT needs to expose to practices how this policy will be implemented and the potential implications.
b. Education
Dr Schrieber informed the committee that he met with representatives from Harmoni to discuss training issues. The new proposals will need to address the requirement for additional training slots coming in August. He felt that there was a reasonable system in place for booking induction and supervision of registrars.
The indications are from the SHA that the Deanery’s budget will not be as bad as feared. Hopefully they will be able to maintain current level of services. He advised the committee that a second phase of recruitment for Registrar posts is in place as generally across the country there has been reduced applications from all the specialties.
c. Dispensing
Dr Rankin reported that information gathering is taking place looking at the Pharmaceutical Needs Assessments. A questionnaire has been produced to send out to dispensing doctors. So far he has felt that the discussion has not been contentious. He did seek the advice of the DDA Chairman on a few questions in regards to the questionnaire and had some helpful advice.
d. Out of Hours
Dr O’Driscoll advised that the GP sub-committee had met twice in the last month and seems to be working as planned. As agreed the five local GPs only will have a vote on this committee and should have a lot of clout. A great deal of discussion has taken place to look at the key performance indicators. It is felt that looking at the number of local GPs working in the service is valuable but it is hard to define what actually is a local GP. It is proposed that this might be to look at the percentage of hours worked by a doctor who has done more than a certain number of shifts over a defined period. Secondly a questionnaire will be used to send out to all practices and finally a proportion of employed doctors from agencies.
The Secretary reported that an ongoing concern being addressed to him was the matter of the handover of patients before the 8.00 a.m. changeover slot. At least three complaints has come to the LMC where the Out of Hours Service has declined to deal with a patient and has told them to contact their own doctor at 8.00 a.m. This has not been agreed by anyone. Dr Leach confirmed he felt this was inappropriate and stressed that letters about these issues come direct to him. The Secretary wondered if this should be a performance indicator.
Dr O’Driscoll reported that prior to the last bank holiday he had felt so concerned that he sent out a strongly worded email about the impending crisis. Harmoni agreed to increase the rate of pay to time and a half and even with this there was still some minor gaps in the rota. However last weekend 18% of the shifts were unfilled on Sunday. This remains a problem and the Secretary also felt this needs to be looked at as a performance indicator.
Dr Leach stressed that Harmoni are under the microscope but said that the PCT was concerned that if they were rejected who else would be available and would anybody else be better. The Chairman asked that the Out of Hours Service and practices should be dealt with in a similar consistent way. He felt that in the past this clearly had not taken place and TCN had not been managed in the same way the PCT would manage local practices.
Finally Dr O’Driscoll reported that Steve Donald from Harmoni had asked if he could attend an LMC meeting and it was agreed to invite him to the June meeting.
e. Non-Principals Group
No report.
f. Registrars
No report.
g. P.M. Groups
Jim Waits advised that Jeannette Giles attended the Worcester Practice Manager group and particularly asked for feedback of QOF reviews. It was suggested that this might go in the newsletter.
Action: Newsletter
h. Administration Issues
No report
i. P.B.C. Issues
No report.
j. I.T. / GPSoC
i) Primary Care Working Group
ii) Pathology User Group
Minutes of the Primary Care Working Group and Pathology User Group were circulated. Dr Kinsman was glad that more GPs and managers are now attending.
iii) Summary Care Record
Dr Davis advised that there had been no meeting since it was switched off! Dr Ingrams informed that the Summary Care Rollout had not been suspended just the proposal to upload data. The accelerated process had failed and the Department of Health finally recognised this was a problem. Proposals are that once engagement with the practice and public are sorted along with issues of consent then it will restart. Agreement has been made that upload will cease until initial work has been done. This will also depend now on policies of the new Government.
5. MATTERS ARISING
No matters
6. COMMITTEES
a. GPC
Nothing to report.
b. GPCWM
GPC AGM & Dinner. The Secretary pointed out that the AGM and Annual Dinner was taking place on the 19th May if any other members wished to attend. He also advised the committee of the sad news that Dr Ingrams has decided to stand down. His work has been invaluable in the West Midlands and he will be greatly missed. Further details of proposals to replace Dr Ingrams will be announced after the AGM.
7. NEW ITEMS
Minute 5/585 PBC Clusters
Dr Watson from Great Witley Surgery has written to the LMC enclosing correspondence from Trevor Netherway at the PCT essentially coercing his practice to join the South Worcestershire cluster. The practice has expressed a concern whether the PCT can do this and has also stated that they would prefer to be in a cluster with Malvern Hills. The Chairman stated that it has always been LMC policy that practices would be better off in large clusters and indeed that is likely to be the policy of the new Government. However, the PCT cannot force a practice to do this under the current regulations. The Secretary will reply to Dr Watson.
Action: Secretary to write to Dr Watson
Items B
Circulated
Items C
a) Application by Morrison’s to open a new pharmacy at their store on Roman Way, Malvern Link. (Not a 100 hour application but exemption due to size of shopping centre.)
In the absence from any representative from Malvern the Secretary will ask if there any implications for local dispensing practices but he understood this application has been made using the exemption that can be obtained for very large stores. Jo Hall had informed him that this was the case for this application.
b) Application by Boots for a 100 hour pharmacy at Abbey Retail Park, Redditch. Existing application has now lapsed.
This is a re-application. The current 100 hour pharmacy application has now lapsed.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 09.31 p.m.
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