Local Medical Committee Meeting7 June 2016

Local Medical Committee Meeting7 June 2016

MINUTES OF THE COUNTY DURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 7 JUNE 2016IN THE BOARD ROOM AT APPLETON HOUSE

Present:

Tanya JohnstonChair

David Robertson Secretary

James McMichael Chester-le-Street

Caren PurvisDerwentside – Practice Manager

Niamh TelfordDurham

Rajiv MansinghEasington

Rushi MudalagiriEasington

Kamal SidhuEasington

Norbert DielehnerSedgefield

Tom GormanSessional

Heather PrestwichSessional

Claire ElderLMC

Invited:

Jill WilsonPrescribing Support Sevices

Anita PorterNECS

Patrick OjechiND CCG

Joseph ChandyND CCG/ DDES CCG

Sue JacquesCDDFT

Tom HuntCDDFT

Ria WilloughbyCDDFT

Paul PeterCDDFT

Number / Item
L16/58 / Apologies for Absence
Andrea Jones – Darlington CCG
Richard Harker – Darlington
Niamh Telford - Durham
Gopal Chealikani – Easington
L16/59 / Minutes of the Meeting held on 3 May 2016 – were agreed as an accurate record.
L16/60 / Matters Arising
IFR – it was unclear whether additional clarification had been provided to GPs following last month’s discussion. DAR to chase up.
Appointed GovernorCDDFT –Meetings are held at 17:30 on Wednesday evenings four times a year. Members were asked to consider sitting on the Board. The LMC agreed to sponsor a member attending with the proviso that the appointment would be reviewed to see if it was worthwhile for the LMC.
Capita –it was noted thatproblems were still being still being experienced although with some variation between practices.
Firearms – DAR met with representative of Durham Constabulary and reported that although the requests for information from GPs were supposed to be sent before a license was granted, the home office computer system has not been updated so these requests are being sent after a licence had been granted! However, it is anticipated that this will be addressed sometime in June. CDDLMC has a good relationship with the local police and the police are very grateful for the co-operation that they get from local GPs.
L16/60a / County Durham and Darlington Integrated Diabetes Model
Anita Porter, Commissioning ManagerNorth of England Commissioning Support attended to update the Committee on the new Diabetes Model. This new system will involve a greater integration of primary & secondary Care when dealing with diabetic patients. Dr Paul Peter from CDDFT expressed his excitement at this new way of working and felt that this would provide a way of meeting the needs of the increasing number of patients with diabetes. He also knew from experience that most diabetic issues did not need to be seen within a hospital environment and could be treated closer to home. It was felt that the present system of dealing with diabetes could not be sustained and this service had to be reformed.
Training would be given to Practices to upskill staff.
Members were once again concerned that this new programme would send back the main bulk of the work to Primary Care where it was already struggling to meet demand. Members wondered if this was the way forward and would other speciality areas insist on the same system?
Concern was expressed with how this would be implemented in Practices who did not run diabetic clinics.
Questions were raised around funding and whether this would be sufficient as the service was rolled out.
AP reassured the committee that as the service bedded in, these issues would be reviewed.
L16/61 / Clinical Commissioning Groups
ND & DDES CCG – Joseph Chandy
Arbitration – the CCGs and CDDFT have been to arbitration and the CCG felt that it had achieved a favourable and fair settlement.
Community Contract – the CCGs were examining this contract in detail to see if there was a difference between how much the service cost CDDFT to provide and the amount of funding given by the CCGs.
Career Start (North Durham) – This scheme is being twinned with DDES to avoid competition between areas.
Risk Register – Sustainability issues. DAR will discuss this matter further with JC together with plans for reinvestment of “PMS premium”.
Work Creep – Gareth Forbes is developing a list of workcreep items.
L16/62 / Local Authority
Nothing to report.
L16/63 / Prescribing Support Services
Jill Wilson from PSS attended and explained the service they provided.

L16/63a / Secondary Care
Sue Jacques, Tom Hunt, Dr Paul Peter & Dr Ria Willoughby all attended from the Trust. SJ explained that the Trust wished to work collaboratively and in July further members (Jeremy Cundall, Shane Longdon & Jane McCabe) would attend the LMC.
They explained that the Trust had re-organised itself into 5 new Care Groups with the intention of improving clinical leadership and working relationships. They would be meeting regularly within the Trust to talk about “real” issues and wished to work more closely with GPs. Each care group is led by a senior clinician but with robust management support.
It had been a challenging year for the Trust (2015-16), they have a deficit of £14.2 million. To recover from this level of deficit SJ outlined a range of efficiency and cost reduction measures that the Trust would be exploring.
2016-17 needed to provide more sustainable services and this would not come without re-design. This would come in the shape of centres of excellence and care closer to home.
Ria Willoughby – updated the Committee on the changes within Family Health - Paediatrics would be working closely with Director of Operations and Director of Nursing. Challenges within this Care Group would be working more closely with Primary Care and their GP colleagues and establishing good working relationships. They are committed to taking on any thoughts and suggestions which would help them establish better communication. Members suggested that working closely with the CCGs and the newly establishing Federations and that continual contact with the LMC was always appreciated and a way to filter back information to Primary Care. Members raised concerns around referring to CAMHS.Members also felt that meeting with Link Practice Managers would be helpful to the Trust.
Members raised concerns with regard to Out of Hours. Members explained that the Trust do not provide a service that patients, CCGs and GPs need. The Committee also felt that the Trust was not a good a good employer of GPs for number of reasons. Paul Peter agreed that there had been a breakdown in communications in the past but pledged to work in partnership with primary care.
The Trust raised the issue of a space on the Board for an appointed Governor Role which would give the LMC a voice within the Trust.
The Trust informed the Committee of the changes to secretarial roles and that Consultants no longer have an assigned individual secretary. Secretaries now work in teams and support groups of consultants. This should allow an increase in working hours across the whole team. Members raised issues of the recently introduced telephone system; members found getting through and leaving messages for specific consultants almost impossible. SJ asked for some patience as the telephone system was new and needed some time to iron out initial teething problems. However the FT was keen to hear from GPs and their staff where issues were arising.
Community Services – the matter was being looked at – there would be an update at next month’s meeting.
The Trust realised they needed to improve on:-
Clinician to Clinician conversations (both within the Trust and Primary Care);
Telephone systems;
Education Programmes – coming out to Primary Care and meeting and discussing with ways to improve.
DR explained that Tom Hunt was leaving the trust and thanked him on behalf of the LMC for his help over the years and wished him well in his retirement.
L16/64 / Out of Hours Issues
L16/65 / Communication from the BMA/GPC
65.01LMC Conference
The Conference report was noted. GPC had been instructed toinvestigate what industrial action was open GPs and ballot GP about the range of industrial actions that they were prepared to take over the range of issues that are affecting practices and patients.
65.02 GPC Reform
It has been decided by the GPC to set up a GPC England as there was already a version for Wales and Scotland. This would mean that the annual conference of LMCs would be split into one specifically for England (as the devolved nations already have) and one for the UK.
L16/66 / General Correspondence
L16/67 / Any Other Business
67.01 Anti-coagulation – Kamal Sidhu
KS raised the issue of funding for NOAC monitoring following recent guidance from the APC -there was much discussion regarding this matter and members felt that this matter could be resolved under an ES.
L16/68 / Date, Time and Place of Next Meeting
5 July 2016 @ 19.30 in the Board Room at ND CCG Rivergreen, Durham

Private and Confidential

Ref: CNE/MINUTES/AGENDAS/LMC/Minutes 2015/LMC Minutes 5 APRIL 2016