Local Medical Committee Meeting 5 May 2015
MINUTES OF THE COUNTY DURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 5 MAY 2015 IN THE BOARD ROOM AT APPLETON HOUSE
Present:
James McMichael Chair
David Robertson Hon Secretary
Tanya Johnston Chester-le-Street
Fiona McConnell Chester-le-Street
Rob Cowley Derwentside
Niamh Telford Durham
Francis Whalley Durham
Matt Hackett Durham Dales
Kamal Sidhu Easington
Catherine Doidge Easington – Practice Manager
Denise Scott Easington – Practice Manager
Norbert Dielehner Sedgefield
Robin Wade Sessional
Claire Elder LMC
Invited:
Stewart Findlay DDES CCG
Number / ItemL15/45 / Apologies for Absence
Richard Harker (Darlington)
KV Reddy (Easington)
Rushi Mudalagiri (Easington)
Heather Prestwich (Salaried)
Andrea Jones (Darlington CCG)
L15/46 / Minutes of the Meeting held on 3 March & 14 April 2015 – were agreed with the following amendment to the 14 April minutes from Andrea Jones:
For the Jenny Steel item.
AJ suggested to the LMC that they might wish to invite Jenny Steel from Primary Healthcare Darlington to share provisional thoughts on the vision for Primary Care in Darlington at the June meeting.
L15/47 / Matters Arising
Healthwatch County Durham
Information will be forwarded shortly, information has been requested from Healthwatch Darlington.
Compliance Aids
Awaiting confirmation that FP10(HP) prescriptions pads should be on all wards, Trust should issue dosette boxes not GPs.
DAR to write to TEWV and North Tees & Hartlepool.
L15/48 / NHS England
Nil to report this month but invitation had been sent to new director of NHSE North to meet the LMC.
L15/49 / Clinical Commissioning Groups
DDES – Stewart Findlay
Budgets
DDES CCG is examining Mental Health budget formulas and indicative practice based budgets. Agreement has been reached on a fair shares formula for practice based budgets with a review planned in 3 years. The CCG remains keen to invest in Primary Care and would anticipate that any cost efficiency savings would be available for reinvestment in primary care.
A lively discussion followed with members expressing concern that these budgetary changes could be seen to be unfair to certain practices. SF explained that 75% of practices had voted on a choice of proposals and in any system of moving to a fair shares budget there were likely to be winners and losers.
Members also questioned how any overspenders would be managed. SF felt whilst they would be supported by the CCG to remain within budget there might also be a role for Federations to put help their member practices to remain within budget.
Winter Pressures
The NHSE has advised that there are eight high impact actions that must be done to manage winter more effectively:-
1. No patient should have to attend A&E as a walk in because they have been unable to secure an urgent appointment with their GP.
2. 111 Calls that result in 999 disposition should undergo clinical triage prior to that disposition being made.
3. The local directory of services supporting 111 should be complete.
4. SRGs should ensure that the use of see and treat in our local ambulance services is maximised.
5. Care homes should have adequate input from primary care pharmacy and falls prevention.
6. A&E departments should make sure that patients are reviewed by a senior doctor at an early stage.
7. Consultant led morning ward rounds in hospitals should take place seven days per week resulting in discharges at the weekend being at least 80% of those during a weekday and at least 35% of discharges each day are to be achieved by midday throughout the week.
8. SRGs will look to make sure that we minimise delayed transfers of care of hospital and that this rate should be no more that 2.5%.
Members raised concerns about this as many felt that increasingly doctors (especially those relatively newly qualified) tend to be risk adverse and therefore admissions are to be expected.
IFR (Individual Funding Requests)
The decision has been made to copy Northumberland’s scheme, that a “Golden Ticket” must be produced when requesting exceptional treatment. If secondary care provide treatment without this, payment will not be made for these services.
Members felt that “tongue-ties” should be added to the list of treatments not funded.
Contracts
TEWV/ North Tees/ City Hospitals/ NEAS – are all nearly agreed.
CDDFT – almost agreed.
All will be PBR contracts, which gives no protection to CCGs. DDES has organised separately from the other CCGs this year.
Commissioning for Quality and Innovation (CQUIN)
The CDDFT CQUIN indicators:-
· AKI
· Sepsis
· Dementia and delirium
· Criteria led discharge
· End of life
· ED attendances
· Paediatric admission avoidance
· Learning disabilities
TEWV
· Physical health and health promotion
· Communication with primary care, enhancing improvement in discharge letters
· Peer support worker role development
· Positive behaviour support for LD patients
· Cardio metabolic assessment in psychosis
· MBT/DBT support for personality disorders
· Child in crisis access, joint scheme with CDDFT, getting them fast access to MH services to avoid unnecessary admissions
· Support for carers
NEAS
· Year 2 of a 2 year CQUIN
· Intermediate care and treatment service, improving the service received from NEAS on admission
· Increased hear and treat and see and treat
· Improved rural response times
North Tees and Hartlepool Indicators
· LD flagging and care planning
· Children in crisis
· Reducing admissions for mental health patients
· Family engagement in SALT services
City Hospital Sunderland Indicators
· ED attendance for mental health patients
· Liver disease
· Introduce Macmillan treatment summary
· Estimated date of discharge
· A local patient experience indicator
NECS
Leaflets will be out shortly to Practices regarding the services that NECS supply.
If there are any problems with NECS members could contact SF and pass these on to him.
Career Start
There have been 6 applicants, interviews are taking place. The adverts had placed nationally and it was felt that this was a great result given the current climate of difficulty in recruiting GPs
L15/50 / Secondary Care
50.01 Community Nurses TEWV – Mike Leonard
Mike Leonard, Clinical Pharmacist for TEWV attended the LMC to discuss the new monitoring tool the Trust will be piloting. This new tool will be an add-on to the PaRIS system the Trust use. The Trust has become aware that they have been passing on work to GPs which should be provided by TEWV, this has been because of:-
· Lack of skills within the teams (ie bloods being taken);
· No access to path labs;
· Lost passwords for ICE; and
· Too heavy a reliance on GPs to provide these jobs.
This will join Web Ice and PaRIS together.
The Committee expressed their concern over the TEWV FT IT system and the inability to link with GP systems such as SystmOne which most surgeries use. Members wondered why the Trust insisted on using this system (which they have had since about 2007) and why they have not improved it to be more productive.
ML explained that this system would only be an add on and would still mean that TEWV staff would have to log in and out of systems to make this new system work. Again, the Committee expressed concerns that a more robust up to date, compatible system was not being explored / purchased.
Members raised the issue of the BMA Quality First initiative and wanted to ensure that when clinicians from TEWV took bloods it was their responsibility to follow up the results.
ML explained that with the new system which is to be piloted would bring with it some extra funding from NHS IQ. This would mean admin staff already employed would be remunerated for the extra work being taken on with the new system.
Pilot will start at some point this year from pilot sites of Primrose Lodge and Lanchester Road.
ML said it would take some time to change an embedded culture of forwarding patients to Primary Care for bloods etc, but this would be a start to that problem.
Members felt that the Committee and the CCG should write to TEWV to employ a system that was fit for purpose.
L15/51 / Out of Hours Issues
The Committee was still aware of issues within the OoH Services. Members were advised that a directive had been issued that might be interpreted as suggesting that GPs should not keep drivers waiting by avoiding calling for transport until all existing clinical work had been completed. Members felt that this had the potential for further devaluing the work of GPs and introducing inefficiencies.
L15/51 / Communication from the BMA/GPC
Papers for the LMC conference had just been released and KS noted that CDD LMC was the lead in proposing a motion relating to complaints and the Health Service ombudsman.
L15/52 / Performers Group
Although NHSE had agreed to fund some elements of LMC representation on performance management groups there was still a shortfall in funding that the regional LMC had agreed to cover. LMCs in the Northern Region would contribute to this on a capitation basis.
L15/53 / Any Other Business
Work Creep / BMA Quality First
Rob Cowley raised the issue of receiving abnormal blood results specifically requested by secondary care. He was using the template letter provided as part of the BMA Quality First initiative and wanted to ensure that he was not alone in doing this. Members were encouraged to use the templates that had been distributed to practices for this purpose.
Complaints
CD raised an issue with regard to a complaints being forwarded by a CCG to Practices. An example being a complaint actually about a decision made by the CCG (de-commissioning of Community Matrons) that then had to be forwarded back to the CCG for response.
Minor Injuries (ES)
An issue was raised regarding dressings costs that are not included in the minor injuries scheme.
New Member – Niamh Teleford
The Committee welcomed a new member to the LMC – Dr Niamh Telford who would be representing Durham Constituency.
L15/54 / Date, Time and Place of Next Meeting
2 June 2015 @ 19.30 in the Board Room at ND: CCG Rivergreen, Durham
Private and Confidential
Ref: CNE/MINUTES/AGENDAS/LMC/Minutes 2015