Glasgow Area Medical Committee

[Private & Confidential]

GLASGOW AREA MEDICAL COMMITTEE

General Practitioner Subcommittee

MINUTES of the MEETING of

the COMMITTEE held on 18th May 2015 in the Committee’s offices at 40 New City Road, Glasgow G4 9JT

SEDERUNT: / Drs Katie Adair, Bob Ballantyne, Ronnie Burns, Maureen Byrne, Vicky Clark, John Dempster, Mark Fawcett, Gordon Forrest, John Ip, Jim Mackenzie, William Macphee, Chris McHugh, Kathryn McLachlan, Hilary McNaughtan, Bob Mair, Paul Miller, Patricia Moultrie, Kerri Neylon, Jim O’Neil, Alan Petrie, Alex Potter, Jean Powell, Michael Rennick, Paul Ryan, Mohammed Sharif, Alastair Taylor, Andrew Townsley and Raymund White.
CHAIRMAN: / Dr Alastair Taylor, Chairman of the Committee, chaired the meeting.
APOLOGIES: / Apologies for absence were received from Drs Norrie Gaw, Michael Haughney, Susan Langridge, Andrew McCall, Alan McDevitt, Mike McDonagh, Graeme Marshall, Chris Tervit and Professor Graham Watt.
ATTENDING: / Mrs Mary Fingland, Secretary of the Committee
REVISED AGENDA: / The GP Subcommittee received the Revised Agenda.
MINUTES: 15/099 / The GP Subcommittee received the Minutes of the meeting held on 20th April 2015.
The Minutes of the 20th April 2015 were approved and signed by the Chairman.
MATTERS ARISING:
15/100 / (a)  On the Move – Presentation Mr Jonathan Best, Director of Regional Services, NHS GG&C
The Chairman welcomed Mr Best to the meeting and introduced him to members.
Mr Best began by telling members that the new structure would see A&E in the North Sector covered by the Glasgow Royal Infirmary with the South serviced by the new Southern General Hospital (nSGH). The nSGH had been signed off and the transfer of patients to the new site started. The GP Subcommittee heard that:-
·  Newer equipment in the hospitals/clinics undergoing closure or change of location had been transferred. Older equipment was not suitable for the new site.
·  Problems had been encountered with Wi-Fi connections but this was being addressed.
·  The Royal Hospital for Sick Children at Yorkhill closes mid-June.
·  The Yorkhill site will then be used as an ACAD for the Western.
·  The demolition of the old surgery block at the Southern will take place a few weeks after the move is completed.
·  One floor of the Princess Royal Maternity has now been given over to Urology.
·  The A&E department in the Victoria is closed.
·  The Mansionhouse unit in the Victoria will be empty by 31st May.
·  The nSGH has 1109 beds.
·  There are 118 Acute Receiving beds in the nSGH.
·  There is a 79 bed HDU/CCU/ICU department.
·  The new RHSC will have 256 beds and 2 to 9 theatres and 9 wards.
·  The new RHSC will now treat children up to the age of 16 years following national guidance.
·  The aim is to have an early discharge rate of 40%.
·  The nSGH Acute Receiving will be Consultant led 8am to 8pm.
·  The critical care department has room for expansion if needed.
·  Discharge planning is key to the running of the hospital and will be very protocolised.
·  GP referral pathways will remain the same.
·  Only change will be for the endocrine department from Western.
The GP Subcommittee heard that Lanarkshire Health Board had been concerned that Hairmyres might be overrun as there was agreement reached with the Scottish Ambulance Service (SAS) to take all emergency life threatening cases which would normally have gone to the Victoria to Hairmyres (as the nearest hospital) instead. Members noted this was around 250 emergency cases annually and should not adversely affect Hairmyres.
Members heard that patient groups had been very involved in the design of the new hospital especially with regard to signage and communal space. The GP Subcommittee was told that Gartnavel would become the central hub for breast services as it was close to the Beatson.
The Chairman thanked Mr Best for his presentation and invited questions and comments from members.
A member told Mr Best that on contacting the new telephone number for medical receiving he had been advised the new hospital was not admitting patients because of the backlog of patients being transferred into the new hospital. Mr Best asked the member if he could put his experience into an email which he would take back to the hospital.
Members queried the provision of pharmacy services at the new hospital especially with regards to the recent paper on dispensing for the RHSC when it moved to the new site. Mr Best told members he was aware of their particular concerns. A member noted that the new hospital had a smaller pharmacy which would serve both sites (adult and children) and there was concern that if urgent medicines could not be dispensed there was a fear that patients would be directed to GPs for the prescription. Mr Best told members he was happy to find out what provisions there were for adult prescriptions.
Another member asked if there was provision for family accommodation at the new RHSC and was advised there was and that the Board had tried to redesign the new children’s wards with proper beds for parents. Members noted the beds were stored in the wall space in each room if parents needed to stay overnight with their children.
A member queried where the 40% discharge rate had come from and heard that the Board had looked at other Health Board areas to establish the best discharge rate and from this it was agreed it should be set at 40% at the assessment centre.
Another member welcomed the investment in healthcare in GG&C but stated he hoped the pharmacy pathways already in force remain. The member noted that the set-up in the nSGH was being followed nationally and wondered if there would be a single point of contact for GPs if they encountered problems. Mr Best advised that there was a senior management team based on both sites and that initially set-up liaison groups had worked very well in Yorkhill and thought that these would be re-established. A member agreed with this statement as they had felt the pre-op assessment groups in particular had undertaken useful work but was disappointed there was no longer formal discussion as there was still a need to engage with Primary Care. Mr Best agreed and told members the work of the groups had fallen by the wayside as the focus had moved in the last few months to the actual hand-over of the site and its planning and preparation to receive patients. Members heard there was also a need to get patients to take more responsibility as many were ‘out and about’ in the new hospital when attending clinics, causing delays.
A member asked about the ‘Maryhill’ bulge and where the cut-off point was going to be. In response Mr Best told members that the GRI was geared up with additional staff and medical beds and there were additional beds at Lightburn however the big issue was whether patients should go to the GRI or whether they should come through the Westend and over the bridge to the nSGH.
It was agreed that future liaison contact with the GP Subcommittee should be through the Chairman and Medical Secretaries. The Chairman thanked Mr Best for attending and a most interesting presentation.
The Chairman asked if members had any further comments prior to moving to next business.
A member spoke of working in OOHs and attending patients at the furthest reaches of Camglen who, if needing admitted, wanted to go to the nSGH rather than Hairmyres and told the GP Subcommittee that distance was an issue for OOHs deputies now that the centre was based in the nSGH.
Another member thought the Western seemed to be the ‘sick’ bit of the whole system and was surprised that the Board thought it could achieve a 40% discharge rate. Another member was concerned about the lack of information in discharge letters with patients either not being seen again by the service or having no follow-up. A member felt that the Board should look at its QUIP data especially its re-admission rates and wondered how it proposed to deal with these patients as there weren’t enough support services in the community to take one this work. Another member noted that there was no such thing as ‘winter pressure’ as the system was under pressure all year now. A member commented that the assumption will be that the GP will do this work and suggested checking with practices if they are seeing significant change in what they are being asked to do for patients discharged into the community. Another member noted there was a need to get all other colleagues on board.
Members heard that a Consultant had commented that feels there was better communication between Consultants because of common issues brought about by the Clinical Services Review.
(b)  Spirit Training
A member told the GP Subcommittee that, following on from the last minutes, he would like to clarify that Spirit Training had actually been requested by the practice nurses themselves and had been provided free of charge with backfill for attendance. Members heard that PNs would not be asked to provide CBT but it was hoped that the training would help PNs deal with patients with mental health issues who turn up at consultations.
(c)  GP X-ray Reporting
The GP Subcommittee received and noted the memorandum sent out on 20th April to GP practices in the South Sector with regard to plain x-ray referrals, copies of which were emailed and tabled.
The GP Subcommittee heard that the original communication had been poorly worked and there was some surprise at it having been sent out. The GP Subcommittee noted that there had been a significant improvement in reporting time with 96% of results overall being returned within two weeks. It was thought this had been made possible by the use of private sector reporting.
Members noted that Diagnostics had an increase in x-ray requests from 7,500 to 7,800 per month nation-wide (across the UK). However, GP x-rays only account for roughly 15% of the total.
A member queried the timescale for chest x-ray turnaround and heard that the three week rule applied and if no result within this period it should be pushed up. Members advised that some reports were now very brief i.e. ‘vague shadowing” and wondered what did that mean exactly or “some abnormalities” without the report stating what the abnormalities were. The GP Subcommittee agreed that whilst there may be more communication back to practice, it was not of a quality expected. Members wondered if the private sector who was undertaking this work had access to all the relevant information it needed. One member commented that there would be concern if this was not the case. Members heard that a significant number of x-rays were now reported by senior Radiographers. There was also concern expressed that if the drop-in service was replaced with an appointment service as this may have a detrimental effect on patient access. A member noted that reporting back was following no discernible pattern.
GP REPRESENTATION REQUIRED 15/101 / (a)  Healthcare Support Workers Strategic Workgroup
Dr Ip was nominated as GP Subcommittee representative to the August and November meetings of this group.
(b)  Clinical Services Subgroup of the Sexual Health PIG
Dr Maureen Byrne indicated that she may be able to deputise for Dr Moultrie at this group but it was dependant on the timing of the meeting as she had an earlier meeting across the city.
Action: Check if the timing of the meeting could be put back to 4pm.
NOTES AND REPORTS OF MEETINGS (FOR COMMENT) 15/102 / (a)  Report of the Hospital Subcommittee meeting held on Tuesday 5th May 2015
The GP Subcommittee received and noted the report of the Hospital Subcommittee meeting held on Tuesday 5th May 2015, copies of which were emailed and tabled.
It was hoped that a member of the Hospital Subcommittee would be able to attend the GP Subcommittee.
(b)  Report of the Hospital Subcommittee meeting held on Tuesday 10th March 2015
The GP Subcommittee received and noted the extract of the GP Subcommittee Executive minutes of 30th March 2015 detailing the Executive’s comments on the report of the Hospital Subcommittee meeting held on Tuesday 10th March 2015, copies of which were emailed and tabled.
(c)  Report of the Women and Children’s Directorate Primary Care and Children’s Services Interface meeting held on Thursday 23rd April 2015
The GP Subcommittee received and commented on the Women and Children’s Directorate Primary Care and Children’s Services Interface meeting held on Thursday 23rd April 2015 together with a Pharmacy Discussion Paper on Paediatric Prescribing in the new RSCH, copies of which were emailed and tabled.
Members had already discussed pharmacy provision in the nSGH in Mr Best’s earlier presentation. It was agreed to email Mr Best’s response when asked about this paper to the GP Subcommittee member on the Interface Group.
A member felt there was no reason why specialist could not operate a repeat prescribing and heard the difficulty lay in Consultants using (or not) blue prescription pads. The GP Subcommittee was told this was an opportunity to change the current regime with a move to blue pads to allow a system nearer to that in General Practice. It was agreed that there was a need to develop systems that work. Members heard that the short life working group which had been looking at adult prescribing in the acutes had become mired in ‘development hell’. A member spoke of difficulties experienced on being asked to prescribe a drug that was unheard of for a child with ADHD. Members heard that a problem lay in that some GPs do such prescribing without realising the risks.