Local Medical Committee Meeting1 October 2013

MINUTES OF THE COUNTYDURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 1 OCTOBER2013 IN THE BOARD ROOM AT APPLETON HOUSE

Present:

Jame McMichaelChairman – Chester-le-Street

David RobertsonSecretary

Fiona McConnellChester-le-Street

Tanya JohnstonChester-le-Street

Rob CowleyDerwentside

Jon LevickDerwentside

Anne HolmesDurham

Francis WhalleyDurham

Donna BoydDurham Dales

Nari PindoliaDurham Dales

Kamal SidhuEasington

Norbert DielehnerSedgefield

Heather PrestwichSessional

Claire ElderLMC

Invited:

Jill SimpsonAT

Joseph ChandyDDES CCG

David GrahamND CCG

Number / Item
L13/94 / Apologies for Absence
K V Reddy (Easington)
John McGuire (Sessional)
Robin Wade (Sessional)
Mike Spence
L13/95 / Minutes of the Meeting held on 3 September2013 –were agreed as an accurate record.
L13/96 / Matters Arising
MCA
DAR is to get together with the LPC to discuss.
IT Systems
Finance for IT has been placed with the AT.
System 1 implementation takes 5 weeks of IT support from NECS and there is not the capacity to help more than 2 Practices per CCG per year.
EMIS has confirmed that they would only need 2 weeks of IT support for an EMIS Web implementation as it tended to be a more intuitive change from LV.
Funding for System 1 is presently supported centrally in this region
It was suggested that IT support would eventually be withdrawn and Practices would have to find the costs for funding themselves.
Care.Data
Members were concerned that anonymous data is being taken by the DoH and they will then sell on this data.
eDSM
The LMC was successful in delaying implementation slightly to allow practices to become more familiar with the use and implications of eDSM. eDSM has gone live elsewhere but there has been little dialogue about this system in contrast to the debate about summary care records.
L13/97 / Safeguarding Children – Information Storage
No present updates received.
L13/98 / Improving General Practice – “ACall To Action”
Jill Simpson from the AT attended to update on the Committee on a new survey “A Call to Action”. Jill presented slides which had a local flavour and showed that in County Durham & Darlington there is a large rise in population alongside increased number of people living over the age of 85.
The slides highlighted the further problems of:-
High deprivation levels;
Complex needs;
Disease prevalence;
Performance issues (ie smoking, breast feeding, teenage pregnancy, etc);
Rise in Urgent Care (use);
Greater reliance on General Practice;
Workforce pressures;
Inequity;
Quality and Safety; and
Reduced resources.
Jill therefore strongly recommended that medical colleagues fill in the online survey at:

The sooner the survey was completed the greater input GPs could have on decisions made for the future of the NHS.
Further information can be found at:

L13/99 / Area Team
GP support
The Committee reviewed a revised list of which agencies are responsible for providing elements of support for general practices.
Although in general support could be mapped to a new provider the committee expressed doubt that this replicated with level of service that had been provided previously.
There was specific concern about complaint handling as there seemed to be no conciliation/mediation service for primary care. The process appeared to be that patients could complain to their Practice and if they were not happy with the response then the next step is to complain to the NHS Ombudsman. Representatives from the NHS Customer Care Centre were due to attend the regional meeting of LMCs on 2nd October 2013.
Occupational Health was another area which was of grave concern to Members. A slight anomaly in funding for County Durham & Darlington had ensured continued provision for the time being whereas in all other areas this funding has been removed. Members did not want to remove this service from the area as it was deemed as essential and an excellent service, which had been well used over the years. Removal of the service had the potential for leaving sessional GPs particularly vulnerable. The Secretary confirmed that he had written to the AT to oppose withdrawal of funding for Occupational Health Service for GPs.
Members reiterated their previous view that GP Choices was a service that should strongly be supported.
PMS Funding Review
The AT has been tasked with this exercise but members are very concerned with the accuracy of information.
In Derwentside the Practices have requested a spreadsheet asking for the formula they are using – though this formula will change over time and it could be a significant change. The present formula would give Practices a potential idea on the loss of funding that may happen.
Calculations are now on an average practice size of 5700 and not the previous figure of 6900 – 20% reduction.
Members felt that the LMC should provide practices with information on how they can find out what their GMS equivalent would be.
L13/100 / Clinical Commissioning Groups
100.01 LES reviews
It was felt that Local Enhanced Services are likely to disappear in the future but may be protected for a year or so.
Members wondered if they were federated would there be more possibility of gaining contracts as the CCG then put work out to tender.
Members wondered whether the LMC should be giving advice on how to stop providing work that fell outside their contracts.
100.02CCG Incentive Schemes
100.03DDES – Update
Joseph Chandy attended on behalf of DDES. JC informed the Committee that he had changed role from Director of Performance to Director of Primary Care.
The risk profile for DDES has been sent out.
In common with other CCGs, work has started on reviewing Local Enhanced Services.
FAQ to Practices.
Primary Care Development is having a tough time with things such as QoF.
Complementing JS presentation JC reported that DDES had produced a refinement of questions posed by A Call To Action and had tested this at CCG wide event. Interpretation of the responses was limited by a low completion rate but this was something that the CCG planned to take further.
100.04ND – Update
David Graham attended and update the Committee about the Primary Care Web tool which has been circulating for a few months.
Some members round the table did not find the site of much use and some had not even heard of the tool. There was concern that some data contained within the tool was very out of date and that information needed to interpreted with caution.
ND recognised that some elements of the website are out of date and there was concern that information could be used by agencies with this fact not being taken into account; ND has written to Mike Guy about improving the timeliness of information within the tool.
DG informed the Committee that the Primary Care Development Strategy is in draft form and when in its final draft will be sent to the Committee for feedback.
L13/101 / Federation for General Practices
The Committee discussed its position on Federation of Practices. Practices are faced with a changing balance between workload, income and expenses.There was a generally feeling that workload was increasing particularly because of the more complex demands of QOF and work creeping from secondary care to primary care.
Federating offered practices the potential for maintaining or increasing income by bidding to provide services and reducing expenses through greater buying power and sharing of some back office functions.
If Enhanced Services are to be lost then CCGs/LAs would be more likely to contract with large organisations such as a Federation than individual practices.
JL reported that at a recent conference a presentation on super-practices suggested that this offered even more advantages than federation and might well prove attractive in the longer term.
The LMC agreed that it supported the move towards federation.
L13/102 / Work Creep
Members felt that work was coming from outside of Primary Care ie letters from Consultants requesting dressings, sick notes, dosset boxes etc which all cost Primary Care with no additional resource to fund this work.
Members informed the Committee that other LMCs highlight such local issues.
It was felt that Members should supply examples of such “workcreep” and that the LMC should ask practices to provide similar examples.
Members felt the LMC should once again write to local Trusts with regard to local issues.
Members recognised that raising these concerns might antagonise the CCG, FT and the AT and would need to discussed frankly so that all parties understood the challenges that work creep posed to practices and that it needed to be addressed.
L13/103 / Accounts
Were agreed and signed by the Chairman.
L13/104 / General Correspondence
Any Other Business
104.01 Training – Health Education NE
Matter cancelled by applicant.
104.02 Global Sum Payment – locums
Jon Levick had just wished to raise the awareness that this is being added as a block payment to GMS but not PMS.
104.03Primary care data collection drug misuse scoping audit specification
FW raised the issue of information being requested anonymously (but with a little detection the patient can be worked out). FW felt the request was a data trawl and of no real use. DAR requested that the information be forwarded to him.
Date, Time and Place of Next Meeting
5 November 2013 @ 19.30 in the Board Room at Appleton House

Private and Confidential