Local Medical Committee Meeting7 October 2014

Local Medical Committee Meeting7 October 2014

MINUTES OF THE COUNTYDURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 7 OCTOBER2014 IN THE BOARD ROOM AT APPLETON HOUSE

Present:

James McMichaelChair – (Chester-le-Street)

David Robertson Hon Secretary

Tanya JohnstonChester-le-Street

Fiona McConnellChester-le-Street

Jon LevickDerwentside

Frances WhalleyDurham

Matt HackettDurham Dales

Nari PindoliaDurham Dales

Sanjay GuptaEasington

Rushi Mudalagiri

Kamal SidhuEasington

Norbert DielehnerSedgefield

Robin WadeSessional

Claire ElderLMC

Invited:

Sarah BurnsDDES CCG

Sheila AlexanderHome Office

Steve BallDurham Constabulary

Graham MilneDurham Constabulary

Item
L14/95 / Apologies for Absence
Anne Holmes (Durham)
K V Reddy (Easington)
Heather Prestwich (Sessional)
Andrea Jones (Darlington CCG)
L14/96 / Minutes of the Meeting held on 2 September 2014 – were signed as an accurate record with an amendment to show that Dr Tanya Johnston had submitted her apologies.
L14/97 / Matters Arising
L14/93
Adraft template was tabled and it was agreed to take it to the Link Practice Managers Group for their views.
L14/98 / Firearms
Steve Ball and Graham Milne from Durham Constabulary along with Sheila Alexander of the Home Office attended the LMC to update the Committee on the CDD LMC & Durham Constabulary Firearms Licensing Pilot.
Members were informed that due to advice to licence holders from nationalshooting organisation to the effect that they should not volunteer to take part in the pilot, take up of the process had recently dropped by about 50%.
Durham Constabularyexpressed appreciation for the support provided by GPs and Practices as a lot of additional relevant information about license holders had been gathered with GP help. It was highlighted that County Durham & Darlington had been the first area to attempt a new scheme and that information had been fedback to the Home Office working group with representatives drawn from:
BMA
Police
Shooting Organisations
The BMA had written to the government regarding weaknesses in the present system for firearms licencing.
A set of medical questions had been compiled to go along with the Firearms License request for a second phase of the pilot and the Home Office wondered what members’ views were on how the trial had gone and how they see future developments.
In general feedback from the trial had been positive from both GPs and the police. It was unclear whether the additional questions offered any advantages to GPs.
SA reported that other areas (Wiltshire/Essex and Hampshire) were piloting slightly different systems to see how they worked out.
The Committee was informed that the firearms licence fee did not cover the cost of the Police work and members wondered why the Police did not increase the cost of the application to include a more reasonable cost for the force and for medical report costs.
It was pointed out that the pilot process had identified some existing license holders who should not have been granted a licence as a result of previous failure to self-declare a medical problem. At least one prosecution had arisen. It was noted that the work of providing medical information tended to fall disproportionately on smaller rural practices.
SA explained that many within the gun community felt that the amount of information supplied by GPs was over and above what the Police needed to make a decision and there where issues around limiting the medical information to that relevant to holding a gun licence. Members felt that the template for a report could be amended to capture an appropriate subset of medical problems from GP clinical software systems.
SA reported that the cost of obtaining a medical report to the licence holder had been raised as a concern. The various potential difficulties of setting a fee were explained to the Home Office and Police but that the committee’s view was that the current £25 was reasonable particularly when judged against the overall cost of gun ownership and bearing in mind that a report was generally only required once every 5 yrs.
SB explained that Durham Constabulary had taken a reputational hit due to the bad press around the charging for medical reports. SB wondered where the medical profession saw the present process going and members felt that it should continue.
The Secretary offered to attend the Working Group to give input if the Home Office felt that was of some use to them.
The Committee thanked Steve Ball for his hard work in this matter – Graham Milne would now be taking up this process as SB would no longer be dealing with this matter.
L14/99 / Care.data
Nothing new to report.
L14/100 / ISIS
David Graham had been asked to develop a LIS for providing support to ISIS beds and the committee’s view had been given to him.
L14/101 / PMS Review
NHS England guidance has been circulated to area teams, setting out a minimum transition period of 4 yrs and directing that any savings from PMS premium should be reinvested in the general practices of the relevant CCG. However it also suggested that this money could be used for development of premises.
An additional issue that might prove relevant to the capacity of Area Teams to undertake PMS reviews was the recent launch of a consultation to amalgamate Area Teams.
The committee was concerned about the potential for using the PMS premium to fill the gap in funding of premises development. The committee felt that any money should be redistributed to practices.
A proposal to devise a mechanism whereby the transition funding was redeployed based on patient demand by practice was thought to be too complex and it was suggested that a simpler model of redistributing the money based on weighted list size and used to fund practice staff would be more practical. Although the effect of any redistribution on PMS practices would be diluted by the effect of adding in the GMS practices there would be an element of fairness in this.
The committee acknowledged the inequities in funding across practices for a variety of reasons
Members were concerned with the lack of NHS memory with regard to current intentions based on experience of previous changes in funding streams.
L14/102 / Secondary Care
L14/103 / Area Team
Consultation process noted as above.
L14/104 / Primary Care Support
L14/105 / Clinical Commissioning Groups
DDES – Sarah Burns
Rural Ambulance Services – a challenging public consultation has been concluded and it was likely that ambulances staffed with a single paramedic supported by an EMS will be phased in at a slower pace than previously suggested. A clinical review will take place in April 2016.
CCDFT – The funding mechanism (block contract / PBR) has gone to arbitration since agreement had not been reached in negotiations. Stewart Findlay has been in mediation with the FT.
Specialised Commissioning – Commissioning will be with the CCG for things such as:-
Neurology
Bariatrics, etc.
Some CCGs will be working together for specialised services.
ISIS – working with practices at present. A LES will put together but is complicated by differences across the CCGs. David Graham and Joseph Chandy are working together on this matter.
Urgent Care – CCGs were working on redesigning Urgent Care Services in collaboration with CDDFT. At present there are different services at each CCGs. DDES wished to expand provision of GP care beyond the contracted hours of 08:00 – 18:30 and aimed to transfer funding back into Primary Care to enable this to happen. The Committee had a lengthy discussion about the inequity of finances across the county. SB explained that at present the overall amount paid to the FT was over and above what is paid elsewhere although it was recognised that a significant number of patient contacts were provided by urgent care services that would not easily be re-provided by practices.
Members wondered if the whole service could be re-tendered. SB confirmed that it could be re-procured on a correct contractual footing, but timescales are unknown at present.
8 – 8 – SB explained that patients would like longer working hours from practices. Members felt there was too much choice and that many surgeries did offer extended hours and therefore there seemed to be a duplication of services.
During the course of discussion it became apparent that the LMC lacked a cohesive understanding of what changes to urgent care were proposed and asked that this should be considered again next month.
L14/106 / Out of Hours
L14/107 / Communication from the BMA/GPC
A new contract had been agreed for 2015-16. It was noted that the early conclusion to negotiations and the limited contractual changes had arisen at least in part because of recognition of the strain that practices are under.
L14/108 / LMC Accounts 2013-14
The Accounts were reviewed and will be signed by the Chairman.
L14/109 / General Correspondence
Nothing to note.
L14/110 / Any Other Business
110.01 Change of Meeting Venue
Due to issues with room availability for evening meetings within Appleton House it has been arranged for the LMC to meet at Rivergreen where ND CCG is hosted. CE is going make sure that the venue is suitable.
110.02 GP Choices
RW informed the Committee that GP Choices had funded for a further year. The committee expressed their pleasure and appreciation for this news and thanked the GP Choices Team for the work they carry out.
110.03 Letter to Stakeholders
The Secretary shared a draft letter to be sent to Stakeholders in Primary Care – DAR asked the Committee what it felt about sending an open letter to partner organisations regarding the challenges facing general practice. Members felt strongly agreed that this would be a good idea. Many members were having problems recruiting partners, salaried and locum GPs to their Practices.
Members wondered if matters would get worse after salary publication.
L14/111 / Date, Time and Place of Next Meeting
4 November2014 @ 19.30 in the Board Room at Appleton House

Private and Confidential

Ref: CNE/MINUTES/AGENDAS/LMC/Minutes 2014