City and Hackney LPC

MINUTES - OPEN Part

18 May2017

13.30 – 17.30

Tomlinson Centre - Queensbridge Rd, London E8 3ND

Attendance:

Member Name / Initials / Attendance
P= Present,
A= Absent,
Aa= Apologies sent. / Attendance this financial year
Raj Radia (chair) / RR / P / 1 of 1
Stewart Evans / SE / Aa / 0 of 1
Kirit Shah / KS / P / 1 of 1
Peter Muska / PM / p / 1 of 1
Anish Patel / AP / P / 1 of 1
Parag Oza / PO / Aa / 0 of 1
Dee Fasan / DF / P / 1 of 1
Sunil Patel / SP / P / 1 of 1
Kirit Sonigra / KSo / P / 1 of 1
Nickil Patel / NP / P / 1 of 1
Kerry Webb / KW / P / 1 of 1
In Attendance
Hitesh Patel (CEO) / HP / P
Stuart Brown (Minute taker) / SB / P

1. Welcome by the Chair and to note any apologies

Apologies were noted from SE and PO.

2. LPC membership

Declarations and Conflict of Interest

None were noted.

3. Approve minutes and follow up Actions from Open section of meeting – 15th MARCH 2017.

Accuracy

The members then stated that the minutes are an accurate account.

Actions and matters arising

Previous Action - HP/RR To invite a member of the LMC to an upcoming LPC meeting:

RR stated that he had sent an invite email to the chair of the LMC. RR added that he had not had a response from her.

HP stated that he would contact the London wide LMC secretariat.

Action no. / Description / Who to action / Completed
1 / To contact the London wide LMC secretariat to be able to invite a member of the LMC to an upcoming LPC meeting / HP

RR suggested that the LPC work with Pharmoutcomes to develop such a solution.

HP stated that to use Pharmoutcomes a fee would have to be paid. HP added that PSP Ltd. currently holds a license for Pharmoutcomes for the city of London until September 2017. HP added that 20 pharmacies in Hackney use Pharmoutcomes for the substance misuse services. HP stated that Pharmoutcomes have just won the contract with Hackney Public health to provide the I.T. solution for all public health services except stop smoking. HP stated that he had talked to Pharmoutcomes and the LPC could buy a secondary license for approx. £1600.

KS asked why an I.T. solution would have to be paid for.

RR stated that Pharmoutcomes could provide a means to collect data for CP to demonstrate the service’s worth to commissioners and its value.

HP stated that Pharmoutcomes could provide a bespoke solution for the LPC. HP proposed that the contractors who are currently providing the service could pay approx. £60 per year to buy this secondary license. HP added that Pharmoutcomes also provides the HLP dashboard.

SP suggested that using a software solution would help with ensuring compliance wrt. all the elements of this service.

KW stated that in some areas Pharmoutcomes has been set up to link with ProScript.

SP encouraged the use of Pharmoutcomes.

Action no. / Description / Who to action / Completed
2 / To meet outside of the LPC meeting during the next week to discuss the MOS service. / HP/NP & RR
3
(previous action) / To look at developing an I.T. solution for the MOS. / HP

Previous action point -To contact Richard Bull so that HP can get invited to attend the Long-Term Conditions Board meetings on a regular basis:

Action no. / Description / Who to action / Completed
4 / To contact Charlotte Painter (Long Term Conditions Programme Manager atNHSCity and Hackney CCG) to obtain an invite to sit on the Long-term conditions board. / HP

HP stated that the CCGs are now solely commissioning the GPs from the 1st April 2017. Before this the NHS/CCG and before that the NHS were in charge of commissioning this group.

Quadrant meetings:

Action no. / Description / Who to action / Completed
5
(previous action) / To bring an anonymized example of a patient’s medical history obtained from “GP Record Viewer”. / RR
Action no. / Description / Who to action / Completed
6
previous action / To send a link for LPC members to accessthe CCG intranet - in order to access guidelines (e.g. Vitamin guidelines). / HP

Long term conditions board:

Previous action – HP to obtain details of Hillingdon COPD service:

HP stated that this service had been running in Hillingdon for a year now, and their 100 contractors were meant to have carried out a minimum of 500 screenings, and only 50 had been carried out to date. HP stated that instances like these make him reluctant to push a new service like this one in C&H, for fear of contractors not delivering.

The members wondered what the barriers had been to carrying out this service.

Action no. / Description / Who to action / Completed
7 / To ask Hillingdon LPC to provide the SLA and thedetails on why the COPD screening service had not been embraced by the contractors. / HP

Previous Action – HP to set up a QUALITY PAYMENT and NMS workshop YOUTUBE video for contractors (including a practical demonstration element)

HP stated that he had produced this and had sent links to this for all contractors.

KS asked how many people had viewed the videos.

HP stated that the quality payments video had received 45 views and the Asthma videos had received 75 views.

The members agreed for HP to keep making these workshop videos.

RR urged the members to use the software program “maps”.

Action no. / Description / Who to action / Completed
8 / To resend the MAPPS link / HP
Action no. / Description / Who to action / Completed
9 / To make a YouTube training video on practical best practise for the NMS service. / HP

Previous action – HP to make “opportunities from the JSNA meeting” – report from NP, an agenda item at the next meeting:

Action no. / Description / Who to action / Completed
10
Previous / To send a link to the “2016 Health and the Environment” of the JSNA when it becomes available to all LPC members. / NP
11 / To contact Public Health to obtain an ETA on when the “2016 Health and the Environment section” of the JSNA would become available / NP
Action no. / Description / Who to action / Completed
12
Previous / To include and divide up sections of the JSNA to the LPC work stream spreadsheet. / HP/NP

NP stated that the data contained in this section of the JSNA must be used to try and get new services commissioned.

STP:

HP urged members to read Hemant Patel’s CP plan “Indispensible”.

New services – discharge medication service -

Previous Action – HP to follow up on the PharmOutcomes development as part of the new discharge medication service:

HP stated that Pharmoutcomes were going to demonstrate their module for this service at Homerton Hospital. HP proposed that CP should only want toinvest in this if there would be a payment for contractors for this service.

There was no outcome to this discussion.

Meeting with Sotiris Antoniou - Atrial fibrillation Program:

Action no. / Description / Who to action / Completed
13
previous / To ask Sotiris Antoniou whether the UCL partners could help with an independent evaluation of CP services (such as MOS). / HP

CEPN update:

Previous Action – HP to ask Sanjay Ganvir about the state of regional funding for IP training:

HP stated that there was no funding currently available for IP training. HP added that he felt that the focus for training was on p the placement of IPs in GP surgeries.

NP agreed with HP’s comments. NP added that contractors could fund IP training themselves – paying privately costs approx. £2000. NP added that following a GPHC inspection he had gleaned the following insights:

  • An IP can prescribe and dispense privately provided they have robust policies in place.
  • Services must be audited.
  • The patient must be told that they could take this prescription to any pharmacy they like.
  • No extra ACT or second pharmacist will be required.

Hackney Public Health:

Stop Smoking:

Action no. / Description / Who to action / Completed
14
previous / To contact Miranda wrt. Hackney GPs doing Smoking cessation consultations over the phone for housebound patients / RR

Substance Misuse:

KS stated that WDP had set up a mandatory training meeting on the 30th March 2017, and he had attended and this had been a complete waste of time (it lasted 45 minutes).KS stated that a webinar should have been employed instead of a meeting such as this.

4.NHS England London

Summary Care Records – Update

HP stated that a second version of the SCR system would be coming out and that it would be less clunky. HP added that SCR vers. 2 would be easier to access. HP reminded that SCR training is currently provided by CPPE.

Minor Ailments Service

HP stated that a London wide MAS had been in development for some time and the plan was for it to only cover six conditions. HP added that this London wide service would probably not be going ahead. HP stated that he currently getting 6-7 emails a week from contractors re. the marketing materials for the MAS. HP reminded the meeting that the LPC was currently paying for the posters, leaflets and the reg. cards, and their distributions.

The members were happy for the LPC to continue paying for these.

HP added that he was still forwarding the orders for the vouchers to the printers.

Report from HP from last NHSE/LPC meeting

There was nothing to note from this meeting.

NUMSAS update

HP stated that contractors could only start this service when they had a shared NHS mailbox set up, so that referral emails could be sent.

Some of the members were confused as to how to set up this kind of shared mailbox.

HP stated that these mailboxes could be linked to Microsoft Outlook.

Action no. / Description / Who to action / Completed
15
previous / To produce a YouTube video which will instruct how to set up a shared NHS mailbox for use with the NUMSAS service. / HP

RR stated that a token must be printed to start delivering this service.

FLU Service – Update

HP highlighted the following points:

  • The service came to an end at the end of March 2017.
  • The final number vaccinated in London was 182,086 -
  • 166,500 of these were administered using the National Service.
  • 14,000 of these were administered using the London Service.
  • This number had increased on last year due to the addition of new cohorts –
  • Carers.
  • Patients on substance misuse.
  • London Ambulance staff.
  • The homeless.
  • Approx. 2000 PPV vaccines had been administered.
  • 5000 PPV vaccines had been administered in 2015/16.
  • In C&H –
  • 6423 vaccines were delivered under the National service.
  • 340 vaccines were delivered under the London service.
  • 133 PPV vaccines had been administered.
  • A few contractors had not signed up to the National service and some of these had not been paid for the vaccines they had administered.
  • This year the focus will be again on carers and those patients with mental health issues.
  • Much more referrals need to be made into carer services.

HP stated that for this next Flu season the carers who work for Hackney Council could be targeting via a private vaccination service.

Market Entry – Update on New applications

RR stated that a separate report had been sent to LPC members re. these applications.

HP highlighted the following:

Date of Notice / Existing owner / Address / New Owner / Area / Result
7th April 2017 / Day Lewis / 170-172 Stamford Hill London N16 6QX / Pyramid Pharma T/A Spivack Chemsit / Hackney / Granted
23rd April 2017 / Pharmacy Warehouse / Relocation to Unit 3, 2 Somerset Road, Tottenham, N17 9 EJ / Distance selling / Granted
26th April 2017 / Good Health Pharmacies Ltd / 112 West Green Road, Tottenham, N15 5AA / Distance selling / Application
11th May 2017 / DP Mark / 51 Old Hill Street, London N16 6LU / Pyramid Pharma T/A Spivack Chemsit / Hackney / Granted
11th May 2017 / DP Mark / 4 Grand Parade, Green Lanes, Haringey N4 1JX / Pyramid Pharma T/A Spivack Chemsit / Haringey / Granted
16th May 2017 / MyMeds HealthCare Ltd / Unit B,10 Quaker Street, London E1 6SZ / Distance selling / Refused

RR reminded that the LPC should be commenting on all Market Entry applications.

SP stated that the new PNA would be produced next year and all gaps in service provision should be looked at in the C&H area.

Action no. / Description / Who to action / Completed
16 / To visit the one C&H contractor that has not carried out a MUR. / RR

Quality Payments - Update

HP stated that, according to the PSNC, 11,000 out of 13,000 pharmacies have successfully registered to receive the quality payments.

HP stated that the LPC’s new focus must be to ensure that C&H contractors receive the HLP quality payment going forward.

Action no. / Description / Who to action / Completed
17 / To resend the email from Jessica Veltman re. HLP application help. / HP

5.Prescribing Program Board

Report from HP for March 2017 meeting

HP stated that he had updated this meeting on the Quality payment figures and he had talked about the NUMSAS and Flu service numbers and issues.

EOLC – New Hackney Service Update

HP stated that 10 Pharmacies would be taking part to improve access to medication for local patients reaching the end of their life.

Participating pharmacies stock an agreed range of medicines (from a formulary of 2000 drugs) used at the end of life and the pharmacists have undergone extra training in palliative care.

Patients can be directed to participating Hackney pharmacies if their local pharmacy does not stock the medicines needed and are part of an out-of-hours rota ensuring 24/7 access to these medicines.

HP highlighted:

  • The CCG has commissioned this service, via PSP Ltd.
  • The CCG will pay for the drugs and will replenish the drugs should they expire.
  • The pharmacies will be on a ROTA to be on call (for a period of ten weeks each).
  • Fees will be paid –
  • Per week.
  • For bank Holidays
  • For every callout.

HP stated that this service will be starting from this Monday.

6.Devo Hackney/STP

RR stated that the transformation board had had its second meeting. RR added that devolution in Hackney has taken a backseat. RR stated that the development of the STP work has taken priority over the devolution work. RR added that CEPNs are currently focusing on the training of GPs.

7.Training Update

Report from NP

NP stated that he had nothing to report.

Action no. / Description / Who to action / Completed
18 / To set up a Survey Monkey to ask contractors what type of training they would like the LPC to organise. / NP

HLP / Health Champion Update

HP stated that there was currently a Health Champions Network and a HLP Leaders “WhatsApp” group. HP stated that he would add the LPC members to this group.

8.Community Education Provider Network Update (CEPN)

HP stated that the CEPNs are currently funded by the CCG and HEE. HP stated that the HEE funding has been cut year on year. HP is currently working with the local CEPN to obtain funding for Flu Vaccination training. HP asked the members to think of any training subjects that CEPN could possibly fund.

NP suggested that Flu vaccination with First Aid could be asked for.

Action no. / Description / Who to action / Completed
19 / To work up a bid for Flu Vaccination training to submit to the local CEPN. / HP

9.Pharmacy London - Report from Meeting on 11th May 2017

CCG funded desk clerks

RR stated that in KRT CCG have funded desk clerks who are currently taking prescription requests over the telephone – this is similar to the Luton Model.HP stated that there are two issues with this model:

  1. Information governance – patient data is being shared by these desks.
  2. CCGs are commissioners and should not be providers.

LETB funding

HP reminded that Sanjay Ganvir is currently employed to work on C&H LPC’s behalf wrt. attending NENCEL meetings and putting in bids. HP stated that Sanjay had criticised the fact that the three London LETBs are not communicating together and they should work together to bid for London wide training.

KS asked whether employing Sanjay was currently value for money.

HP stated that Sanjay had secured the funding for the recent Health Champion training, which many City and Hackney contractors had attended. HP stated that Sanjay has the time and expertise to put in quality bids to the LETBs.

PSNC

HP stated that Sue Sharpe willretire as CEO of PSNC at the end of 2017.

Judicial Review Outcome:

HP stated that the decision had not been ruled in CP’s favour. HP added that the Judge had been sympathetic.

Hub and Spoke:

The DoH are still looking into developing this model for Pharmacy.

ETP – Switching:

RR reminded the members that During the pricing of prescriptions, if the Pricing Authority does not agree with the charge group (i.e. paid or exempt) in which a prescription has been submitted, the prescription will be ‘switched’.

Exempt Forms:
For forms submitted as exempt: if a declaration of exemption is required on the reverse of the form, but has not been completed correctly, the form is ‘switched’ to chargeable and a prescription charge is deducted from a contractor’s payment for each item on that form.

Chargeable Forms:
For forms submitted as chargeable: if there is found to be a completed declaration of exemption or the patient is age exempt with a computer-generated date of birth or age on the prescription, the form is ‘switched’ to exempt andcharges are not deducted for the items on that form.

RR urged the members and contractors to regularly check their statements to compare which prescriptions had been marked as being exempt, and those which have actually been switched to chargeable. YP added that there is no compensation for wrongly submitted prescriptions.

Clinical Assessment training:

HP reminded that Sanjay Ganvir is currently the LETB lead for NW London and he has considerable experience at successfully bidding for services and training from HEE.

RR added that one bid has been for Clinical Assessment training. These Clinical assessments would allow CPs to carry out the following:

  • History taking.
  • Clinical examination – ears – using otoscopes.
  • Disease management.

HP added that HENCEL LETB has already commissioned a similar set of training – from a bid submitted by Sanjay.

Regional medicines Optimisation Committee:

HP stated that Rob Darracott had reported on this subject at PL. HP highlighted the following:

  • There are four RMOCs across the country.
  • There is currently places available for CP reps to join the four RMOCs.
  • RMOC purpose:
  • To look at how savings and efficiencies can be made, and to look at gross examples of system rule bending.
  • System wide advice will be filtered through the CCG route down through these RMOCs.
  • The four committees will have separate agendas – but they will be linked to the U.K. medicines information service.
  • The committees will meet four times a year.
  • Mayank Patel (PL Vice Chair) will be the preferred candidate to join the London RMOC.

10.Hackney Public Health