GLOUCESTERSHIRE
LOCAL MEDICAL COMMITTEE
ANNUAL REPORT
2012 - 2013
1
LMC CHAIRMAN’S INTRODUCTION
We live in a world of progress and change. From the earliest days of modern medicine new discoveries and new ways of working have transformed the role of the doctor and expanded the opportunity for better health, emotional well-being and longevity. As we enter the age of stronger medical leadership and the introduction of clinical commissioning groups, our profession finds itself dealing with new challenges: coping with excessive demand; managing limited capacity and juggling with ever-scarce resources.
Over this time Local Medical Committees like our own in Gloucestershire have continued to represent local professional opinion, offer representation and negotiate the best path to deliver the public’s expectations, the politician’s aspirations and the general practitioners’ deserved recompense.
This year we have seen many changes to the system of healthcare delivery in the NHS and a stronger emphasis on clinical engagement with commissioning, professional regulation with the introduction of revalidation and significant strain brought on by workload pressures in our surgeries. The LMC continues to be the only local democratic representation for GPs. We will continue to work closely with new organisations to provide reasonable and constructive representation, to listen and advise the membership and to help further facilitate the best course of action when considering future challenges to doctors and their practices.
The LMC Office, headed by Mr Mike Forster our Lay Secretary, continues to provide an extremely professional service to our 85 practices and to the LMC Executive. By providing an information hub and resource for all, we are stronger as an organisation and this will allows us to be more proactive to needs as well as reactive to constituents concerns. The list of work carried out by the LMC this year is covered in the secretary’s report but I should add that this task has been achieved again this year without increasing our levy contributions, thus recognising the financial strain many practices have felt in the last few years.
I firmly believe that the national network of Local Medical Committees have their greatest challenge still ahead of them. With sound judgement we will continue to balance representation and fairness for doctors with the responsibility of professional duty. With this ideal in mind we intend to work constructively to achieve a sustainable primary health care service for the population of Gloucestershire. The impact of NHS 111, the reconfiguration of secondary care services, new chronic disease pathways and the significant organisational management change around us will need careful and considered debate and evaluation. This will provide us with the direction of future planning and will drive LMC policy to represent our interests.
The greatest danger to GPs this year is to allow them to waver in their professional resilience in the light of growing workload pressures and attacks on their reputation. We GPs need to enhance and strengthen our profile and to demonstrate the undeniable fact that the real value of our health service continues to lie in the core institution and philosophy of a well-delivered primary care service led by highly-trained and well-motivated generalist doctors delivering a patient-centred service in general practice.
As always it has been an honour to Chair and serve the LMC and hopefully to continue to help and deliver this message to all those who have ears to hear.
Dr Phillip Fielding FRCGP
Chairman Gloucestershire Local Medical Committee
SECRETARY’S REPORT
NATIONAL ISSUES
National Finances. Ever since the Conservative/Liberal Democrat parties formed a coalition government the underlying theme of all that they have done has been the inherited bad state of the country’s finances. One of the undoubted pressures on the public finances must be increasing life expectancy and weight and co-morbidities, the rate of inflation of medical costs, the advances in medical science and the Treasury’s insistence that savings must nevertheless be made.
Reorganisation of the NHS. The implementation of the Health & Social Care Act 2011 is an attempt to meet these pressures, but it remains to be seen whether local CCGs and area teams will be allowed to operate sufficiently independently to achieve the required savings.
Pensions and Contracts. The year saw a series of changes to the NHS pensions, contracts and terms of service for GPs. On the strength of outspoken opinion from GP representatives at the LMC Conference the GPC called for a day of action over pensions, which was ill-supported. This has damaged the bargaining power of the GPC with the Department of Health; negotiated changes to the contract for 2013-14 have now been replaced by imposed changes.
LMC Conference – Liverpool. The pressure on London accommodation etc at the time of the London Olympics forced a move of the LMC Conference to a windy and sunny dockside location in Liverpool. All considered it a great improvement.
LOCAL ISSUES
General. 2012 was possibly the wettest year in living memory, but we were fortunate that the 2007 flooding of surgeries was not repeated.
The Clinical Commissioning Group (CCG), or ‘Clinical Commissioning Gloucestershire’ as they prefer to be called, has spent the year preparing to take over the financial authority for the NHS budget in the county. The LMC office was closely consulted over the drafting of the CCG’s Constitution. The CCG have shown much willingness to work with the LMC to ensure that changes they propose will meet with success in practice, although their main link with practices is, inevitably, through Localities. That said, they are usually represented at our main and executive meetings and have now agreed to meet our negotiators on a monthly basis. They (and the local authority) will be responsible for letting what until now have been called local enhanced services, but which will now be called ‘community-based services’.
The Area Team. The national NHS Commissioning Board has set up Local Area Teams to administer primary care contracts. Our area team (the term ‘local’ having now been dropped) is responsible for Gloucestershire, Swindon, Wiltshire and Bath and will be divided into two operating locations, one of which will continue to be Sanger House in Brockworth. Negotiations by the LMC will now have to take place with both the CCG and the area team, in separate shifts on the same occasion.
Premises. The Landlord function for NHS premises will move in April from the defunct PCTs to a Property Company. There were 12 practices involved in a review of their leasehold documentation to ensure that by the end of the year they would be in a good legal state to go forward. The LMC was involved.
NHS 111. The LMC was involved in considering the local implementation of NHS111, replacing NHS Direct. More work still needs to be done, particularly on the Directory of Services.
CQC. Registering with the Care Quality Commission and preparing for possible visits by the CQC have taken a considerable period of time for all practice managers. The LMC has provided advice and help where possible.
Revalidation. No one would argue that it is comforting to the public to know that doctors are up to date and able, and are proving themselves to be so. The irony is that Revalidation was introduced as a reaction to the Shipman case but it is acknowledged that revalidation is unlikely to prevent a similar case, should one arise. Meanwhile the corner stones of revalidation are annual appraisal, 360 degree colleague and patient feedback and reflection. The LMC Office is involved in checking some 360 degree surveys to ensure that comments are not so adverse that they need to be put over more carefully and that the maker of the comments is not revealed.
‘Mandatory’ Training. The general rule is that GPs have been abundantly and exhaustively trained and it is their responsibility to ensure that they remain fit to practise. They are not obliged to undertake every box-ticking, update training session organised by anyone unless they believe, on reflection, that they need to do so. The LMC keeps pushing this message.
Employment of GPs in Community Hospitals. The LMC were closely involved in seeing fair play during the recent round of contract negotiations for the employment of GPs in community hospitals.
Workload Survey. All the LMCs in the South West Region surveyed their GPs about their opinions on GP workload. The results were grim, and pretty uniform across the region. Gloucestershire had 215 responses, out of a GP population of just over 500, with a good spread of ages, size of practice etc. The strong preponderance of views was that GPs are working longer, more intensively and on more complex cases for less pay than 3 years ago; that this pressure is not sustainable now and that it is likely to get worse next year. Reactions varied fairly evenly between taking some form of retirement, looking for other sources of income, working even harder to maintain current income, or working at current intensity for a reduced income. Very few opted to work less hard for a much reduced income. Nearly two thirds of responders feared that their practices would struggle to remain financially viable. Eight per cent thought they might have to close or merge within the year.
Practice Boundaries. The LMC has consistently expressed the view that practices are capable now of allowing a patient to remain registered with them after the patient has moved out of the practice area if they feel that they will still be able to support that patient. The LMC welcomed the GPC agreement with the NHS Employers that where a current boundary is sufficiently large then the ‘outer boundary’ can be contiguous with the existing boundary.
Practice Manager Training. The LMC organised a well-received day’s training on premises management which will be repeated in the next annual period.
LMC MATTERS
The LMC remains in good heart.
Hails and Farewells.
We congratulate Dr Andrew Sampson on his accepting a partnership at the Prices Mill Surgery in Nailsworth; this created a vacancy for a freelance representative, which has been ably filled by Dr Jethro Hubbard.
We have seen the departure of two very long-serving members of the committee: Dr Peter Fellows and Dr John Salter. In addition we have lost Dr Katharina Nehrig. We wish them all well in their retirements from medical politics and, in Dr Fellows’ case, from medical practice altogether. Dr Fellows has also been for many years the Avon & Gloucestershire representative on the GPC. At the time of going to press it is not known who will take his place at the by-election.
Meetings. Following the decision in December, LMC meetings started to be held at quarterly intervals, but this experiment proved too great a gap between meetings and was, for several reasons, unacceptable. In November 2012 the LMC decided to move to meetings every other month, starting in January 2013.
Constitutional Changes. Perhaps because of the turmoil being experienced by practices this year we found that doctors were reluctant to take up vacancies on the LMC. We concluded that the adequacy of local representation would not be harmed by a slight reduction in member numbers, that individual members would not be overburdened by representing a relatively large number of GPs, and that a fully recruited (if smaller) LMC would provide a better public image. The necessary constitutional amendments were therefore carried into effect in March 2013, bringing the geographically elected representatives down to 17 from the previous 23. Cheltenham and Gloucester will now each be represented by 4 members, the Forest of Dean by 2 members and South Cotswolds by one member. The Stroud/Dursley areas have been reassigned between 4 members. North Cotswolds and Tewkesbury will each continue with one member.
Support to GPs and Practices. One of the main tasks of the LMC has always been to listen to, support and advise constituent practices and GPs who are in trouble or distress. We have three specialised ‘LMC Advocates’ to whom GPs are referred. The Chairman and Secretary also offer help as required. The LMC now plans to provide every practice with a copy of ‘STOP The Stress of Medical Practice’ and to pass copies on to trainee GPs to help them prepare to deal with stressful situations later in their careers.
LMC Finances. For yet another year the LMC has been able to hold its levy at the same level, despite inflation. This is largely due to holding fewer meetings than were originally budgeted for and there being fewer members than formerly. We hope to be able to keep the levy frozen again this year, as we are well aware of the financial pressures on practices. We shall also be looking to see whether, as a membership organisation, we should be largely free of Corporation Tax in future. (Income from a share in the commission from the Federation of LMC Buying Groups is a very small sum, but would be liable to Corporation Tax.)
The Federation of LMCs’ Buying Groups. The LMC continues to suggest to practices that they should always review whether they can obtain better value for money for goods and services which they have to buy, and that one source is the LMC’s Buying Group Federation. There was an unfortunate and unforeseeable failure of Crucell in producing flu vaccines this year, but overall there is an increase in use of the Federation’s offers by practices.