The Minutes of the Worcestershire Local Medical Committee Ltd held on Thursday, 3rd June 2010 at 7.30pm at The Charles Hastings Medical Centre, Worcester.
PRESENT:
Mr D Beckett, Dr P Bunyan, Dr L Butcher, Dr M Davis, Dr D Herold, Dr K Hollier, Dr R Ingles, Dr R Kinsman, Dr D Lewis, Dr S Parkinson, Dr E Penny, Dr S Pike, Dr D Pryke, Dr D Radley, Dr H Ray, Dr V Schrieber, Mr J Waits
Mr Steven Donald, the Development Director of Harmoni attended the meeting. He advised the committee that in his role as Development Director he was spending most of his time in Worcestershire supporting the local team during the transfer of services from TCN to Harmoni. He stated that usually the company have many months in advance to plan the takeover but in this case they only actually signed the contract on the morning of the 1st April 2010. Their aim has been to maintain continuity and the safe service whilst doing their investigations and filling the gaps in the existing service.
Dr Penny asked if the issue of the supply of controlled drugs had been resolved and he advised that the Home Office license was due at the end of June. It has not been possible to speed up this process.
There was discussion regarding the issue of responsibility for patients calling the Out of Hours Service before 8.00 a.m. Mr Donald stated that he believed that if it was not an urgent visit then it is the responsibility of Harmoni staff to have a dialogue with the practice about how those patients are dealt with. The Chairman reminded the committee of a previous decision when this had been debated at some length. The committee felt that ‘what comes in under your watch’ remains your responsibility.
Mr Donald was asked about recruiting of local GPs and continued problems filling the shifts. He pointed out that a former out of hours doctor had left due to lack of confidence in the service and was now wondering whether it was safe to come back. He felt there was still an element of wait and see. Local GPs have approached them with the view of working in the Out of Hours Service. Elsewhere they operate a fixed rota system but this has not been the system used by TCN. Every week they have to fill the rota from scratch. In addition TCN paid a late shift booking premium so doctors left it very late before shifts were filled. Harmoni no longer pay a premium and a fixed rota system is in hand. He advised the committee that over the first two months of their operations they had used 84 doctors in the county which he felt was far too many.
Dr Schrieber raised the issue of sessions for trainees. He had spoken to Dr Kelsey regarding the current issue and also the fact that in August increased capacity for registrars is needed as the second year registrars will also need out of hour sessions. Mr Donald was keen to get feedback from GPs and was happy for us to include his email address and mobile number in our newsletter. In addition they are planning a bi-weekly audio conference.
The Chairman thanked him for attending and wished Harmoni well for what is undoubtedly a very difficult situation.
1. APOLOGIES
O’Driscoll Dr N Burger, Dr G Ingrams, Mrs M Hallahan, Dr J Leach, Mrs L Luke, Dr K O’Connor, Dr J
2. MEMBERSHIP
3. FORMAL APPROVAL OF THE MINUTES OF THE MEETING HELD ON THE 13th MAY 2010.
4. REGULAR ITEMS
a. Worcestershire PCT
i) Dr Leach sent his apologies.
ii) PCT/LMC Meeting 20th May 2010
Following the presentation at the Charles Hastings Centre Lynda Dando sent out an email to members of the GMS/PMS group looking at collecting data from practices about consultation rates and other capacity figures. The Secretary had emailed back stating that he felt that this was unworkable. It had been indicated to him that the questionnaire will be sent out shortly to practices and he strongly suggested to the PCT that this was stopped. Lynda Dando is currently on holiday so it has been suggested that this matter was delayed until the GMS/PMS group can meet next. The committee agreed with this suggested.
The Secretary reported that on the 20th May he attended a morning training session on performance list regulations produced by Mills & Reeves Solicitors. It was an excellent detailed presentation which only reiterates his concern that the current regulations are not fit for purpose. Clearly PCTs administering the current regulations have a very difficult time meeting the legal requirements that are now expected.
b. GMS/PMS Subcommittee
The next meeting of the committee takes place on the 17th June. The two GP vacancies on the committee have been filled with Dr Glenn Ralphs from Pershore representing the GMS and dispensing doctors and Dr Lynne Butcher representing Wyre Forest.
c. Education
Dr Schrieber reported that the annual review of competency and progression for trainees is due in the next few weeks and currently the second phase in the recruitment process for the local registrar post is now taking place and he felt there had been many good applicants.
d. Dispensing
Dr Rankin and Dr O’Connor were not present and the Secretary was not aware of any dispensing issues.
e. Out of Hours
The Secretary advised the committee that he had a telephone call from a member of the CQC regarding their forthcoming report. They were seeking to clarify some of the issues that are currently in dispute. Drafts of the report have been sent to the relevant organisations for their comments. Once these drafts have been reviewed and discussed a final document will hopefully be produced shortly. From these discussions the Secretary thought this would be a wide ranging and very interesting document.
The Secretary receives the minutes of the Out of Hours GP Management Board. They have been looking at key performance indicators and the following have been suggested:
i) Proportion of GPs that work more than an average of two sessions per month.
ii) Percentage of total GP hours worked by agency staff.
iii) An Out of Hours satisfaction survey of practices to be conducted by an independent survey organisation in August 2010.
The Secretary had suggested that in addition to this there should be a review of the number of unfilled shifts and also in the quality of communications to practices and prescribing. He suggested the latter may be looked at by the PCT Pharmaceutical Staff.
f. Non-Principals Group
No report.
g. Registrars
No report.
h. P.M. Groups
Mr Jim Waits reported that PMS practices have received some variations to their PMS agreements. He had some concerns about some apparent omissions. The Secretary reiterated the reason why the LMC on behalf of all the PMS practices had strongly encouraged the PCT to move to Lockhart’s so that we would have automatic variations produced by the independent solicitors. The Secretary suggested that this query be sent directly to him and he would look into this for Mr Waits.
Action: Secretary
i. Administration Issues
No report
j. P.B.C. Issues
No report
k. I.T. / GPSoC
i) Primary Care Working Group
ii) Pathology User Group
Dr Kinsman reported that MSDI is causing major problems. There have been issues with this system not working and the roll out across all the practices in Worcestershire seems to be very delayed. This obviously has real implications for the Health Checks LES. It was suggested that the LMC write to the PCT to seek clarification.
Action: Secretary to write to the PCT
iii) Summary Care Record
Dr Davis reported that there had been no further news on the roll out of the Summary Care Record. The current understanding is that patient information programme letters have been sent to all patients and information packs have been sent to all practices. The anticipated roll out will be over the next 12 to 18 months for those practices that have compatible clinical systems (EMIS PCS does not yet have the functionality and so far only 57% of Worcestershire practices have either received the necessary accreditation or are awaiting an accreditation visit).
5. MATTERS ARISING
Minute 5/569 Quality of Care issues at Worcestershire Acute Trust
Chairman and Secretary discussed this issue again. Despite raising a number of issues with the Acute Trust over a period of time the LMC has had no formal or concrete response. Dr Kelly felt this really was an issue for the Clinical Senate and it was agreed the Secretary would put together a letter for formal discussion at this meeting. Particular issues relate to discharge summaries and also the prescribing breach forms. The committee was advised that the PCT were producing a new Discharge Policy for community hospitals and that unsurprisingly there is no primary care input in this process.
Action: Secretary to write to Clinical Senate
Minute 5/573 Admissions to MAU
The committee had finally received a reply from the Acute Trust. Dr Vathenen, Clinical Director for Emergency Care had replied stating that blocking referral to MAU on the grounds that the doctor had not actually seen the patient within 24 hours was inappropriate. Dr Vathenen will feed this back to the MAU staff on both sides.
6. COMMITTEES
a. GPC
Secretary reported on the M9 circular & Negotiating News.
b. GPCWM
Secretary reported on the recent AGM and annual dinner. He particularly commented on the very sad news that Dr Grant Ingrams has now stood down as Secretary of GPC West Midlands. For the time being this post is being taken on by Dr Fay Wilson but a new replacement will be required. He gave details of the post to members and suggested that if anybody was interested they should approach him directly. The after dinner speeches at the GPCWM dinner were fascinating. These were given by Dr John Ball, Dr David Dickson, the Chairman of the GPCWM and the Chief Executive and Chairman of the Strategic Health Authority. The latter both gave speeches that were well received and seemed very much in line with the current policies being undertaken by our Primary Care department. The Secretary felt this was somewhat at odds with the kind of messages being received from elsewhere in the SHA and he had suggested afterwards to the Chief Executive that there was not enough dialogue between the centre and the periphery. (i.e. grass roots GPs).
7. NEW ITEMS
Minute 5/586 Abortion Act Forms
Dr O’Driscoll raised a significant issue regarding the new Early Medical Terminal Service at the Moor Street Clinic. In his absence there was some discussion about the matter but it was felt this should be brought back to the next meeting.
Action: C/F to next LMC meeting
Minute 5/587 Housing Department, Worcester City Council
Dr Ingles had received a letter from Emma Jordan, Housing Needs and Advice Officer asking for a detailed medical report. The letter stated at the end that “unfortunately Worcester City Council do not have the funds to pay for this information”. It was agreed that this would be included in the newsletter and that the committee would write to the City Council pointing out that such requests of medical information should not be made by administrative staff and that appropriate reports can be obtained but that a fee is essential.
Action: Secretary to write to Worcester City Council
Minute 5/588 Podiatry Services
Dr Ian Inglis from Bewdley had emailed the Secretary an interesting message to two particular issues. The first was the steady reduction in services offered to patients by Podiatry. This then related to the general issue to the reduction of services about the board and its impact on GPs. Patients had been sent back to their GP to see whether or not they meet referral criteria and this seems to be taking up a lot of valuable time. It was felt that it would be appropriate to raise with both the PCT and the Acute Trust an agreement in principle that where service boundaries are redrawn in the future and reduced that GPs are not used as either the messenger or the whipping boy and that departments should explain that criteria to patients who contact them directly and should not request re-referral for existing patients and should not leave the outside possibility that perhaps if you see your GP he or she might be able to get something done. The committee entirely supported the principle of his email but questioned whether or not this is something we can deal with. Again it was felt this might be an issue for the Clinical Senate.
Action: Secretary to write to the Clinical Senate
Items B
Circulated
Items C
a) Application for preliminary consent to establish a pharmacy at Elgar Retail Park, Blackpole, Worcester, WR3. The LMC do not support this application
b) Application by Boots for a 100 hour pharmacy at Elgar Retail Park, Blackpole Road, Worcester WR3.
CLOSED MEETING (if appropriate)
Chairman closed the meeting at 9.30 p.m.
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