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ISLINGTON LOCAL MEDICAL COMMITTEE
Part 1: (LMC members only)
Wednesday 27 August 2014
1:30pm – 3:00pm (sandwich lunch available from 1:00pm)
Islington CCG Offices, 338-346 Goswell Road, London EC1V 7LQ
AGENDA
1.0 Welcome and Apologies 2.0 Declarations of Interest
Members to declare any conflicts of interest in connection with
any items on the agenda or in the light of subsequent debate.
3.0 Minutes and Matters Arising 3.1 Minutes from the Part 1 LMC
meeting on Wednesday 18 June 2014 (pages 3-7) 3.2 Matters Arising
not elsewhere on the agenda 4.0 Members Reports of Meetings
attended as LMC representatives 4.1 Draft minutes from the Chair
and Vice-chairs meeting with NHS E LAT (pages 8-14) on Wednesday 16
July 2014 4.2 CEPN Steering Group – feedback on meeting held on 11
July 5.0 Items for discussion 5.1 Everyone Counts: Planning for
Patients (£5 per vulnerable patient) 5.2 Co-commissioning (Please
see paper on Part 2 agenda) 6.0 Part 2 Agenda 7.0 Health Education
NCEL update 8.0 Items to Receive 8.1 GPC News: June 2014 – Issue 17
8.2 GPC News: June 2014 – Issue 18 8.3 GPC News: July 2014 – Issue
1 8.4 GPC News: August 2014 – Issue 3; Issue 3 Appendix - dementia
extraction - opt-out form (click on link and see under
‘GPC News - August 2014 (3)’) 9.0 Newsletter Items 10.0 Any
Other Business
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http://www.lmc.org.uk/visageimages/newsletters/GPC/News%2017%20-%2012%20June%202014%20-%207th%20interim%20update.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%2018%20-%2020%20June%202014.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%201%20-%204%20July%202014%20-%20with%20appendix.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%203%20-%208%20August%202014%20-%209th%20interim%20update.pdfhttp://www.lmc.org.uk/article.php?group_id=11392
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11.0 Date of Next Meetings Wednesday 22 October Wednesday 17
December
Venue: Islington CCG Offices, 338-346 Goswell Road, London EC1V
7LQ
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Islington Local Medical Committee
Minutes from the Part 1 meeting held at 1:30pm on Wednesday 18
June 2014 at Islington Clinical Commissioning Group Offices,
338-346 Goswell Road, London EC1V 7LQ
Present: LMC Members: Dr Robbie Bunt (Chair) Dr Simon Hazelwood
Dr Antonia Lile Dr Anita Nathan Dr Catherine Steven Dr Clifton
Woolf In Attendance: Londonwide LMCs Greg Cairns, Director of
Primary Care Strategy Sarah Martyn, Assistant Director of Primary
Care Strategy
1.0 Welcome and Apologies
The meeting started at 1:40pm.
1.1 Dr Robbie Bunt welcomed everyone to the meeting. Apologies
were noted from Dr Paddy Glackin, Bernadette Edwards and Dr Vicky
Weeks (Londonwide LMCs).
2.0 Declarations of Interest
2.1 There were no new declarations of interest.
3.0 Minutes and Matters Arising
3.1 Minutes of the meeting held on Wednesday 23 April 2014 3.1.1
The minutes of the meeting held on 23 April 2014 were agreed as a
correct record, subject to the
following changes: Paragraph 4.3.1: the word “practices” in the
third sentence should be changed to “premises”. Paragraph 5.1.1:
the sentence should be reworded to read “Dr Hazelwood advised
that
Mitchison Road Surgery were discussing options.” Paragraph 10.3:
the first sentence should reworded to read “Concern was raised
that
practices had been paid 50% for the work upfront but were unable
to complete the work due to an unworkable computer system.”
3.2 Matters Arising 3.2.1 Membership of the LMC: Greg Cairns
advised that this had been followed up and Dr Glackin
had promised to get back with a decision. It was agreed to
follow this up again and bring back to the next meeting.
ACTION: to follow up with Dr Glackin his position and bring back
to the August meeting.
LLMC
3.2.2 Christmas Opening Update: Dr Bunt advised that the GPC
were now taking this up formally so
there was little point looking at this locally, but asked that
an update on the latest position was obtained.
ACTION: to circulate the latest GPC position on the Christmas
Opening Hours.
LLMC
3.2.3 Child Protection: it was agreed that Dr Vicky Weeks would
be asked to follow this up on behalf
of the LMC as there had been a number of issues outstanding for
some considerable time.
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ACTION: to follow up on the child protection issues with Sarah
Humphreys
LLMC
4.0 Member Reports of Meetings attended as LMC
Representatives
4.1 It was noted that the meeting on 11 June had been a Learning
and Development Session for the Chairs and Vice Chairs. It was
agreed that the notes of the Chairs and Vice Chairs meeting with
the NHS England London Area Team on 10 April 2014 would be
circulated. The meeting with the London Area Team planned for 16
July would be put on the Part 2 agenda for the August LMC
meeting.
ACTION: to circulate the minutes from the Chairs and Vice Chairs
meeting with the NHS England London Area Team on 10 April 2014.
LLMC
ACTION: to put the minutes from the 16 July 2014 Chairs and Vice
Chairs meeting with the NHS England London Area Team on the LMC
Part 2 agenda for the August 2014 meeting.
LLMC
5.0 Items for Discussion
5.1 Membership and Vacancies 5.1.1 Dr Bunt advised that
Bernadette Edwards was talking to the Practice Managers’ Forum
about a
representative for the new term. It was noted that the CCG were
having a similar problem in recruiting new Board members as the LMC
were attracting new members and it was just felt that GPs just do
not have the time to take anything new on.
5.2 Londonwide LMCs Areas Sector Team Changes 5.2.1 The LMC
noted that Dr Vicky Weeks was the new Medical Director and the team
were carrying
two vacancies for Committee Liaison Executives.
5.3 Commissioning a LCS for Abnormal Liver Function Test Pathway
5.3.1 Dr Bunt asked the LMC whether it would like to ask the CCG to
consider putting together an LCS
for supporting the clinical pathway. The LMC agreed that the
question should be asked at the Primary Strategy Meeting.
5.4 CEPN Steering Group – Appointment of a Deputy to attend the
meetings on 11 July and 12 September 2014
5.4.1 It was agreed that Dr Catherine Steven would deputise for
these meetings.
6.0 Part 2 Agenda
6.1 Minutes of the meeting: Paragraph 6.1.2 should be deleted as
this was repeated. Alison Blair had agreed in principle that an LMC
representative would sit on the Contract
Monitoring Group, however, this had not yet been confirmed. This
would be followed up in Part 2.
The LMC noted that the Mental Health Primary Care/Secondary Care
Interface Agreement had been through the CCG Governing Body.
The information on population increases in the south locality
had not been received. The LMC noted that Public Health had been
involved in working on a premises needs
appraisal in South Camden and there had been some conversations
with Islington practices. There had been a big population growth
and there were some new developments, with money attached).
ACTION: to check out what was happening with the premises needs
appraisal in South Camden.
Greg Cairns
6.2 Co-commissioning of Primary Care: Greg Cairns advised that
the expression of interest was
due in on 20 June and Islington were part of a North Central
London proposal. LLMCs paper had
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not been attached to the papers and it was agreed that it should
be circulated in time for the LMC members to consider it before the
next meeting.
ACTION: to circulate LLMCs Co-commissioning paper to stimulate
the conversation at the August meeting.
LLMC
6.3 Locally Commissioned Services: Dr Bunt asked if practices
had been written to regarding
Locally Commissioned Services (LCS) for 2014/15. Dr Woolf had
seen the NHS contract changes and has spoken to Paul Trevethick
regarding practice boundaries the details of which are awaited.
6.4 Clinical Commissioning LCS: Dr Bunt advised that the funding
for the LCS had increased for
2014/15 but noted that there were two figures and these needed
to be clarified in Part 2 with the CCG. In terms of the new
components that the LMC would be happy with – 1, 2, 5 and 6 –
though there was concern that bits of Component 5 were above and
beyond the core contract. A new part of the specification was that
the referrals and reflections work on QP markers were no longer in
the contract but now in this LCS.
6.5 Clarity was required around Component 4.4 and general
practice would need read codes and an
incentive to use them. It was noted that the CCG would only be
able to monitor this if they knew which patients were being
referred. The time allocated and money seemed fair but it needed to
be made clearer about what GPs were being asked to do. It was noted
that there was no incentive in the contract to look at referrals.
The funding only equated to one GP session and there was an
additional £50 per 1,000 patients, but would depend on the precise
detail.
6.6 Concern was raised around how the buddying arrangement would
work. If the payment per
practice was £1,200 per practice it would equate to just over
one reflection per 1,000 patients. Dr Antonia Lile advised that
locum GPs were signed up to this piece.
2:20pm – Dr Catherine Steven entered the meeting.
6.7 Dr Bunt advised that it was not clear how Component 5 would
work and queried if a YoC DES template should be updated each year.
He felt the process was over-complicated but the main aim was to
get money into primary care. Component 5.1 was the enhanced version
of the DES specification, and it was noted that the CCG had
requested permission to use an adapted YoC template for DES
purposes. In Component 5.2 it was noted that there was also some
additional work for Children MDTs.
6.8 Closing the Prevalence Gap: there was concern that the
letter was not correct and there were
implications for practices in that unless a final solution was
found the money would be clawed back at the end of six months.
6.9 Long Term Conditions: concern was raised that that the paper
was now saying that the
amalgamation of the existing workstreams was delayed for another
six months because (1) of the risks of going live with an untested
template; and (2) failure of EMIS core components continued to
hamper additional work on the heart failure component and the
second phase of the ‘Closing the Prevalence Gap element. The LMC
noted that the CCG had been asked for 50% funding up front with an
inflationary uplift. In addition they had been asked to commission
for a longer period though there had been no response as yet. The
LMC asked for the embedded specification to be circulated.
ACTION: to email the embedded document to the LMC. LLMC
6.10 Avoiding Admissions Enhanced Service/£5 vulnerable elderly
funding: Dr Bunt noted that
there was another template to be completed and assumed it was
accessible, and printable, on EMIS. There was concern that the £5
per elderly patient that was supposed to support over 75s was being
directed to community health services.
6.11 Patient Access to Records Roll Out Plan: concern was raised
that GPs would need to be more
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cautious when writing patient notes. 6.12 Everyone Counts: Dr
Bunt advised that the paper was a first stab at how the money
should be
spent but it did not make it clear whether the money could be
negotiated. There would be an iterative process by member via the
forums. He proposed that the LMC suggested what services it would
like to see commissioned from GPs and alternative providers. It was
agreed to offer the use of Task Force groups as a way forward.
There was concern that the CCG did not have sufficient resources to
produce all the new services and that the LMC would offer its
help.
6.13 Primary care Prescribing Budget Setting: Dr Bunt advised
that the LMC, as a representative of
practices, needed to be careful and clear about what the changes
were. Dr Woolf wished to emphasise that it be clinically led and
that the team should continue to be mindful of that. Dr Bunt asked
the LMC if they accepted the statistical model that had been
modelled by public health. Dr Steven advised that the changes
needed to be discussed as well as the route for flagging up issues.
The changes had been capped and practices would not be penalised if
they did not come in on budget. Dr Woolf explained that this was
clinically led and noted that the team were mindful of that. He
asked that if patients were on expensive drugs would it be
moderated if necessary. Dr Bunt asked if this was not already taken
into consideration and how it could be challenged. There was huge
amounts of work some of which was not relevant to practices as
there was no money to be made out of it. He felt it was pretty
nebulous to say that the formula could not be changed as practices
still came in on budget. There were also questions around the
markers and whether the list was reasonable given the things that
could affect prescribing costs.
6.14 Developing Services in Islington: it was noted that a
letter had gone out after the
announcement of Prime Minister Challenge Fund bids. Dr Bunt
advised that he had pointed out the COI and equity for practices
that had been invited in for further discussions.
6.15 Public Health: Dr Bunt felt that the relationship with
public health was faltering as Dr Steven was
to have been the LMC representative working with them and felt
that the documents should be discussed with a LMC representatives
rather than the whole committee having to wade through long
documents. It was noted that these could have been commented upon
via the listserver. He was particularly concerned with the sexual
health LCS and the fact that tests would only be paid for if they
were was positive.
6.16 It was noted that the Smoking Cessation LCS had been put on
the listserver and Dr Bunt felt that
there should have been a covering sheet detailing the
differences. It was felt that the long term follow up was made much
more difficult as there was a 30% turnover of patients. The
document did not contain any financial information either and Dr
Bunt felt that there should be an 1% uplift at a minimum. He also
suggested that for the following year Public Health were asked to
produce a short covering paper detailing all the changes.
6.17 Dr Bunt was concerned that there had been not LMC
representative on the NHS Healthchecks
Steering Group but noted that it was a well written and precise
specification. There had been some changes with a decrease in money
if it was electronic. If it still required a paper form to be
filled in the old rate should be continued to be paid.
7.0 Health Education NCEL Update
7.1
This was not discussed.
8.0 Items to Receive:
8.1 The LMC noted the GPC News for April 2014 (two editions) and
May 2014.
8.2 The LMC noted the BMA “Your GP Cares” Campaign.
9.0 Newsletter Items
9.1 There were no items identified for the newsletter.
10.0 Any Other Business
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10.1 There was no other business.
11.0 Date of Next Meeting
11.1 The next meeting was noted as Wednesday 27 August 2014 at
Islington CCG Offices, 338-346 Goswell Road, London, EC1V 7LQ.
The meeting ended at 3:10pm
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North Central and North East London Chairs and Vice Chairs
Meeting with NHS England Local Area Team
Thursday 16 July 2014 2:00pm – 4:00pm
in Woburn House Conference Centre, 20 Tavistock Square, London
WC1H 9HQ
Present: LMC Members: Dr Jackie Applebee (Tower Hamlets
Vice-Chair) (arrived 1420; items 2 to 11)
Dr Robbie Bunt (Islington Chair) Dr Claire Chalmers-Watson
(Camden Chair) Dr Martin Harris (Barnet Vice-Chair)
Dr Simon Hazelwood (Islington Vice-Chair) Dr Clifton Marks (City
and Hackney Vice-Chair) Dr Saidur Rahman (Newham Vice-Chair)
Dr Fiona Sanders (City and Hackney Chair) Dr Ambrish Shah
(Redbridge Chair) (arrived 1500; items 4 to 11)
Dr Sella Shanmugadasan (Tower Hamlets Chair) (chaired the
meeting) Dr Constantinos Stavrianakis (Haringey Vice-Chair)
NHS England Local Area Team Alan Keane, Assistant Head of
Primary Care Commissioning Londonwide LMCs Greg Cairns, Director of
Primary Care Strategy Dr Tony Grewal, Medical Director Steven King,
Committee Liaison Executive
The meeting started at 2:00pm
1.0 Welcome and Apologies
1.1 Dr Shanmugadasan welcomed everyone to the meeting. Members
introduced themselves.
1.2 Apologies were received from Dr Surendra Dhariwal (Newham
Chair), Dr Michal Grenville (Waltham Forest Vice Chair), Dr Manish
Kumar (Enfield Chair), Dr Martin Lindsay (Haringey Chair), Dr
Yvette Saldanha (Barnet Chair), Rylla Baker ,Fiona Erne, and Neil
Roberts (NHS England North Central and East London), Sarah Martyn
and Dr Vicky Weeks (Londonwide LMCs), Dr Madhu Pathak (Barking,
Dagenham and Havering LMCs)
2.0 Minutes of meeting held on 10 April 2014
2.1 Minute 2.0: Practice Payments Update Dr Bunt asked why there
had been delays in payments. Dr Hazelwood reported that that
practices had had problems reconciling payments which had been made
and payments which had been deducted. Dr Bunt said that after a GP
had left a practice payments had been deducted incorrectly from the
practice in relation to that GP. Mr Cairns reported that there were
a number of cases where practices were owed money where NHSE had
referred them to the CCG which in turn had referred them to the
legacy team, which no longer existed, so there was no one to talk
to. There was also a matter of the inaccuracy of remittance
advice.
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Dr Grewal said that there were a number of sanctions which
practices could take up against NHSE in relation to practice
payments. These included legal actions, requesting interest on late
payments and resignation. Dr Chalmers-Watson said that practices
were concerned that payments systems had not been embedded in the
new structures, leaving the possibility that they might be put out
to tender. Mr Keane said that NHSE was developing a specification
setting out the terms and conditions to provide the service with a
view to moving towards open procurement resulting in the most
efficient way to deliver the service. Dr Grewal was concerned that
LLMCs had not been invited to contribute to the specification for
the service. Dr Shanmugadasan said that when the payment problems
had arisen, LLMCs had provided members with a contact telephone
number at NHSEL and had negotiated the resolution of the problem.
There remained the issues of was this a matter for NHSE or the
people running the finances and who would take over the running of
the finances. Dr Shanmugadasan said that members who were having
problems with receiving payments could e-mail [email protected] for
assistance.
ACTION: NHSE to advise on why there had been delays in making
payments.
Mr Keane
2.2 Minute 5.4: Minor Surgery DES Dr Grewal reported that LLMCs
had asked NHSE to exclude infection control in a DES but NHSE had
said that they would retain the DES in its present form. The matter
could be taken up with CCGs at borough level. – I think he said
exclude?
ACTION: Seek infection control DES from CCGs.
LLMCs
3.0 Patient Participation DES
Members raised a several concerns about the implementation of
the DES. These included:
some practices had had their claims rejected but had not been
informed of this
some practices had been informed that their claims had failed
but they had not been told why
when practices had previously provided information on age, sex
and ethnicity of their Patient Reference Group (component 1) were
not required to provide this information again, but some of these
practices had failed on component 1
the success and failure of practices had been mixed and differed
between boroughs
the timescales had been unrealistic. They needed a further month
or two. The Chair said that the DES had been implemented with
national guidance and there is a process to ensure compliance. Dr
Sanders expressed concerns that practices which were not approved
for the DES might be wary about signing up to other DESs. The
Committee agreed that it was the patients who suffered as a result
of these problems. NHSE should undertake an audit of the DES and
report the findings (the figures and what practices had achieved)
to the Committee.
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Dr Grewal said that if practices failed in their appeals they
could resort to litigation. He said that NHSE would have to ensure
that its process was robust in order to defend any claims
adequately. NHSE should provide practices which had failed with
confirmation that they had failed, the reasons for the failure and
the evidence upon which it had been based, and reasonable time to
allow them to prepare a response. Dr Grewall suggested that less
than one month’s notice would not be reasonable, two to three
months’ notice might be reasonable. NHSE should also inform
practices about the dispute resolution procedure. Dr Marks said
that the dispute resolution process was time consuming. He believed
it could have been avoided had NHSE handled the process
differently. Mr Cairns said that a key failure in the process was
that there had been no dialogue between NHSE and LMCs, in
particular in relation to the application procedures and in
relation to issues which could have been allayed through informal
discussion. Mr Keane addressed the points which had been raised. He
said that practices could apply for dispute resolution up to 20
July. Dr Shanmugadasan requested that there should be a LMC
representative as an observer on the dispute resolution panel and
that the Committee should receive a report on the outcome of
disputes which had been adjudicated by the resolution process.
ACTIONS:
Investigate failures in communications with practices
LMC representative to attend the dispute resolution panel as an
observer
NHSE to inform the Committee of the outcome of disputes which
had been adjudicated through the resolution process
NHSE to undertake an audit of the DES and report its findings to
the Committee.
Mr Keane
4.0 PMS Reviews
Dr Grewal reported that LLMCs was monitoring the PMS reviews but
it was not a priority for NHS E at the present time.
5.0 MPIG
Dr Shanmugadasan reported that practices were losing a lot of
income as a result of MPIG. Dr Applebee said that nothing practical
was being done to support them. If nothing was done some practices
might be forced to close. The MPIG formula should be renegotiated
as a matter of urgency, but this was unlikely to happen before the
end of September. There were 22 practices at risk in East London.
If they were forced to close, thousands of patients across the area
would be without a GP. Something practical and sustainable had to
be done. Dr Applebee expressed further concerns that NHSE had not
written to practices to inform them that they were at risk through
loss of payments under MPIG. She believed that the survival of the
NHS was at stake. GPs were the gatekeepers of healthcare. If GPs
were not able to provide services it would result in problems for
secondary care. Dr Sanders read from the letter written by Neil
Roberts, Head of Primary Care, NHSE (London Region, North, Central
& East) setting out the support which was being offered to
practices which would lost funding under MPIG. The Committee agreed
that none of the support being offered addressed the essential
needs of practices which would be put at risk due to the withdrawal
of MPIG funding. Dr Sanders added that the problem did not rest
solely with the MPIG funding, the problem lay predominantly with
core funding, which should be addressed. Enhanced services did not
make up the money which practices were losing because they involved
a lot of work. Dr Roberts said that NHSE should be campaigning on
behalf of practices. She believed that there
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were many systems for which NHSE was responsible which could
save work and costs if they were addressed. Dr Chalmers-Watson said
that LMCs had difficulty in dealing with this matter as it was not
clear who was dealing with different aspects of the MPIG policy.
She asked if NHSE could clarify to LLMCs who owned which issues
relating to MPIG. Mr Keane said he would follow up the matters
which had been raised.
ACTIONS:
NHSE to write to practices to inform them of the sums of money
they would lose each year under MPIG. NHSE to provide a copy of the
letter to Dr Grewal
NHSE to update the Committee on the concerns which it had raised
at the next meeting, on 22 September
Mr Keane
6.0 Co-Commissioning of Primary Care
Mr Cairns reported that all CCGs had submitted expressions of
interest. It was not clear how these would be evaluated and what
would happen thereafter. Mr Keane said that there were four
categories of expressions of interest: A: Greater CCG involvement
in primary care commissioning. B: Joint commissioning C: Delegated
commissioning management , which would require legislation D Other
forms of co-commissioning. EOIs had been rated as ready now, soon
or later. NHSEL’s evaluation criteria would include:
clarity in respect of governance to ensure that there were no
conflicts of interest
consistency across London
patient flows
targets should be achievable not simply currently achievable
targets
support improvement in services Mr Cairns said that in some
areas CCGs had not engaged with local stakeholders or GPs. In one
area, to his knowledge, even members of the GGC governing body had
not been informed of the processes. Issues had been raised which
had not been reflected in EOIs. NHSE had not set out its strategy
to inform stakeholders in relation to co-commissioning process. Mr
Keane said that the process had been peer led. Whoever had
submitted EIOs should have had input from peers to inform the EOI.
He believed that failures to engage peers in the process would be
identified at the evaluation stage. Dr Grewal said that if NHSE
claimed that EOIs had been made on behalf of CCG members, they were
likely to be challenged where CCG members had not been engaged in
the EOI process. He suggested that NHSE should ask for further and
better particulars from CCGs in relation to their EOIs. Dr
Chalmers-Watson said that NHSE failed to prioritise matters
according to their importance and urgency. The letter seeking EOIs
had been issued in May with 20 June as the closing date for EIOs to
be submitted. She did not believe that the EOIs were urgent
compared with some other matters so they should have been given a
more realistic timeframe. Dr Shanmugadasan asked how practices
could be expected to undertake more work without
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additional resources.
ACTIONS:
Clarify to LLMCs how EOIs would be evaluated and the
co-commissioning process thereafter
Inform LLMCs of the outcome of the evaluation of EOIs
Mr Keane
7.0 Issues with CQRS
Dr Grewal reported that NHSIT had acknowledged that CQRS as it
had been originally introduced had not been fit for purpose. He
believed that things were improving. The Committee noted Dr
Grewal’s report and acknowledged the work that NHSE had done in
improving CQRS.
8.0 Choice of GP Practice
Mr Cairns requested an update on this matter. Mr Keane reported
that from October all practice would be able to register patients
from outside their boundaries. In doing so they would not be
required to provide home visits. NHSE was awaiting proposals. When
they had received them they would send the proposals to LLMCs. Dr
Grewal said that NHSE was responsible for providing general medical
services or primary care for any patients under the scheme. There
was no information regarding how patients were to be informed about
the scheme so that they could make an informed choice. In
particular, what they would do if they could not attend their
practice. Dr Grewal believed that practices should be allowed to
refuse to see patients for immediate necessary treatment if they
were registered elsewhere under the scheme. He expressed concerns
that if an unwell patient contacted a local practice, the practice
would have to make an assessment regarding whether to see the
patient. If the practice refused to see patients because they were
not registered with the practice, the GP could be liable to a claim
for impairment of fitness to practice. It was therefore imperative
that NHSE informed patients and practices what they would be
required to do under the scheme. Dr Shanmugadasan said that the
proposed scheme could have an impact on the commissioning budget if
practices referred patients who were not registered with them. He
asked if patients would be permitted to register with their local
practices for emergency visits and what would be the impact on
budgets for secondary care and drugs. Dr Bunt asked what would
happen to locally commissioned services and local pathways in
relation to these patients. The Committee agreed that there was
little information in respect of the proposed scheme. It requested
NHSE to provide more information. Dr Applebee requested the results
of the pilot scheme, although she appreciated that the results of
the pilot would be skewed by the enthusiasm of the
participants.
ACTION: NHSE to provide LLMCs at the next meeting with the
following information in respect of the proposed scheme:
the specification
the responsibilities and rights of the GP and patient
payments
the timescale for its introduction
pilot scheme results
Mr Keane
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9.0 Any Other Business
9.1 Patient records – receiving records of newly registered
patients Dr Shanmugadasan reported problems with receiving records
of newly registered patients from their previous practices. He
provided a list of 170 patients in this position to Mr Keane, who
said he would look into the matter.
ACTION: To look into problems with sending practices old records
for newly registered patients.
Mr Keane
9.2 CQC Dr Chalmers-Watson reported that CQC were not doing a
good job in relation to inspections. She had arranged a meeting
with the LMC to seek to resolve the problems in a timely
manner.
9.3 Timescales for Unplanned Admissions DES Dr Sanders asked if
practices were required to use the standard template in applying
for the DES. She wanted to ensure that practices would not fail on
procedural points. This information was urgently required as the
deadline for completion of Care Plans was the end of September.
Ideally the information should be sent to practices before the end
of the week. Dr Bunt said that the scheme should have started on 1
April but this had been delayed because patients’ lists had not
been made available to practices until July. Although patients’
lists were provided through local arrangements, Dr Bunt said that
NHSE should take this into account in relation to the timescale for
the DES. Mr Keane said that there was a standard template but he
would seek clarification on whether practices were only permitted
to use this template. Mr Cairns said, once again, that issues could
have been resolved with better communication between NHSEL and the
LMCs. Dr Shanmugadasan reported that secondary care providers were
not informing practices for weeks about unplanned admissions, so
practices were not able to see patients within three days of them
being discharged. Dr Grewal reported that the requirement was to
see patients within three days of receiving the discharge summary.
– I think this should stay in, it reflects the discussion.
ACTION: As a matter of urgency to
seek clarification on whether practices were only permitted to
use a template to apply under the Unplanned Admissions DES or
whether the application process was more flexible
ascertain if timescales could be moved to accommodate practices
which had received patients’ lists late
send a copy of the standard template to LLMCs
confirm how often (e.g. quarterly) and two whom (CCG or NHSE)
practices were to report.
Mr Keane
9.4 Pharmacy Collection Points Dr Bunt expressed concerns that
practices were being offered financial incentives to have a
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pharmacy collection point on their premises. This would divert
prescriptions to that provider by encouraging patients to collect
their prescriptions there rather than go to community pharmacists.
Dr Bunt believed that this could lead to the closure of local
pharmacies reducing the part local pharmacies would play in meeting
the local healthcare strategy. Dr Grewal believed that these
schemes could constitute directing patients in relation to
dispensing which might result in claims for professional
misconduct. He understood that large sums of money were being
offered to practices to provide dispensing outlets. Practices might
not appreciate that where they earned more than 10 per cent of
their income from non-NHS sources the sums would be abated from
their notional rent. Providing a pharmacy collection point might
therefore give no financial advantage to practices. Some Committee
members agreed that the income from this service would be
beneficial to many practices where abatement of notional rent in
respect of the income would be minimal or even nil. Mr Keane said
that NHSE was revisiting this subject and he would seek NHSE’s
views on the subject. The Committee requested further advice to be
given to members on this matter.
ACTION: Advise members on the following in relation to pharmacy
collection points in practices:
Potential claims for professional misconduct in respect of
directed dispensing
Abatement of notional rent ACTION: Provide LLMCs with NHSE’s
view on the subject.
Dr Grewal
Mr Keane
9.5 Cancer diagnosis case studies in appraisals Dr Bunt said
that Dr Henrietta Hughes, NHSE Medical Director for North Central
and East London, was seeking cancer diagnosis case studies in all
GP appraisals. He was contractually obliged to undertake this for
revalidation. Dr Sanders said that it was voluntary but it was
being presented as compulsory. Dr Grewal reported that this
proposal had probably been superseded by events and LLMCs would
advise GPs not to participate in cancer diagnosis case studies are
part of their appraisals. GPs were required under their contract to
engage with NHSE’s appraisal process but NHSE was obliged to do
operate the appraisal process in consultation with the LMC. NHSE
could not impose changes on GPs without consulting with the borough
LMC.
ACTION: Advise members through the newsletter that it was not
compulsory to undertake a cancer diagnosis case study as part of
their appraisal.
Dr Grewal
10.0 Date of Next Meeting
10.1 The next meeting with the Area Team meeting was noted as
Wednesday 17 Septemnber 2014 at Woburn House Conference Centre, 20
Tavistock Square, London, WC1H 9BD
11.0 Close of meeting
11.1 The meeting closed at 4 p.m.
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