NORTH ESSEX LOCAL MEDICAL COMMITTEE
Minutes of a Meeting of North Essex Local Medical Committee
held atthe Boreham Village Hall, Main Road, Boreham
on Thursday 9th March 2017at 2.15 pm
PRESENT:Dr Hodgkinson (Chair)
DrsAhmed, Ayers,Balmer, Casey, Dabas, Harrod-Rothwell, Ipakchi,Muir, Onuorah, Parikh, Roberts, Sweeney, Taylor, Wier and Wijekoon, Mr Bradshaw.
PART ONE
APOLOGIES FOR ABSENCE
Apologies for absence had been received from Drs Basra, Chowhan, Guille, Gunatillake, Kataria, Koralage, Obisesan, Oliver and Rao.
The Chairman began by asking Members if there were any matters to be taken in Part Two. There being none, sheproceeded with the agenda.
DECLARATION OF INTERESTS
There were no new declarations of interest.
MINUTES
The minutes of the meeting held on 12th January 2017were confirmed by the Committee and agreed for publication to the LMC website.
MATTERS ARISING
P1Multi-Speciality Community Provider Contract: A set of draft criteria, based around the NHS England guidance, had been produced by Dr Balmer and included in the February agenda papers. No negative comments had been received from North or South Essex members and the document had since been shared with GPC. It will be circulated to practices in due course.
P4Cancer Monitoring: No further information was available at this time but no negative feedback had been received from members.
P4Co-commissioning: Members learned that the decision of Mid Essex CCG to take on fully delegated commissioning responsibilities had not been ratified by NHS England. The CCG will remain as a joint commissioning CCG.
DISCUSSION TOPICS
- LMC Budget 2017/18
1.1Members received the proposed budget and LMC levy calculation for 2017/18 that had been considered by the Board of Directors at their meeting on 21st February 2017.
1.2They were pleased to note the slight reduction in the levy for 2017/18 and unanimously agreed to adopt the budget.
- GMS Contract Changes 2017/18
2.1Two documents were received and considered by Members - Dr ChaandNagpaul’s letter to the profession highlighting the key changes to the GP Contract for 2017/18 and a summary from NHS Employers.
2.2Members agreed that the contract changes announced this year were largely positive and welcomed the fact that the majority of payments were not discretionary. They did however request that the office formally seek clarification from GPC on precise funding flows:-
CQC: Will related costs be moved into the Global Sum or will practices claim reimbursement after making the payment?
Indemnity reimbursement: As this will not be weighted, how will it be accounted? Also, will the Sessional Sub-Committee be producing guidance for GP locums in respect of the indemnity insurance? A general guide as to what percentage uplift should be applied to locum rates would be helpful.
Payments need to be clear and identifiable: How will practices be able to identify the contract changes in their NHS England statements?
Timeframe: Many practices are experiencing cash flow issues and it would be helpful to know when the various uplifts will be paid.
2.3There was also some concern that the changes in respect of maternity payments were discriminatory against full-time GP partners. It was suggested that this could be the basis of a Conference motion.
- Essex Locum Deck
3.1Members received and considered a draft paper produced by Dr Kamilla Porter outlining the future plan for the EQUIP locum register. Dr Porter had been working with the National Association of Sessional GPs to develop an online booking system for locums which would remove the need to use locum agencies and thereby avoid the associated fees (currently around 15%).
3.2Members agreed this was an exciting new venture which would enable practices to engage with locums from a wider geographic area and hopefully would also contribute to encouraging GPs to remain in Essex.
3.3The only reservation Members had was that the service would only be free to use for the first six weeks, and that this would result in locums increasing their rates to cover the cost. It was, however, understood that Dr Porter is continuing to negotiate on this point.
4.Special Allocation Scheme
4.1Members received an e-mail from NHS England dated 21st February 2017 together with an updated service specification for the provision of services for patients registered with a Special Allocation Scheme (SAS).
4.2Dr Balmer advised that for some time NHS England has been trying to introduce a right of appeal for patients but this has always been opposed by LMCs nationally. Following comments from the LMC office on the first draft regarding the mechanism to identify and investigate inappropriate referrals, NHS England had removed the Exceptional Referral Panel and instead, was proposing that if a contractor identifies a referral that may not meet the criteria, they will notify the Commissioner who will review and make a decision.
4.3Whilst this revised specification mostly follows the current contract and is an improvement on the first draft, concerns remained that if a patient feels their referral into the Scheme does not meet the criteria, they have the option to raise a complaint. Members felt strongly that if a GP had acted within their contract in referring a patient into the Scheme, they should not be subject to having a complaint raised against them. Members reinforced the need for the provisions of the specification to comply with the Regulations.
- Chief Executive’s Report
5.1LMC Board Meeting
Members received draft notes of the meeting of the Board of Directors held on 21st February 2017.
Dr Balmer provided an update on the possible hosting of EQUIP by Supporting Health (Essex) Ltd (SHEL). Discussions had been ongoing with Mid Essex CCG, who currently host EQUIP, for fourteen months but Dr Balmer was hopeful that the matter could soon be resolved and a new company had been formed in preparation for the transfer to take place. He was also able to confirm that the EPIC project had been extended until September 2017.
With regard to the proposed new medical school, a total of 120 placements across 40 practices had now been agreed, subject to a positive result to the consultation. Dr Balmer will feedback to the Committee in due course.
5.2Proposed Merger of NEP and SEPT
Members received a press release dated 28th February 2017 which included details of public engagement meetings.
5.3Firearms Licensing Process
Following lengthy discussions with the Home Office, the BMA had now published a GP Support Guide which was received by Members. LMC advice remains unchanged, that practices should refuse to provide such reports, but this is a matter for individual practices to decide.
5.4PCSE
Members received a letter to Dr ChaandNagpaul dated 7th February 2017 providing an update on progress one year on from Capita taking over the contract for primary care support services. A letter to practices dated 22nd February 2017 confirming the agreement to make a non-recurrent payment of £250 in recognition of the additional workload placed on practices as a result of the new records movement process was also received.
5.5Ongoing Issues with NHS Property Services
Members received for information a letter to practices from Ian Hume dated 24th February 2017. A further e-mail dated 3rd March 2017 regarding debt recovery letters sent out in error by SBS was also tabled.
5.6General Practice Forward View
Members received notification of engagement events being held to discuss the GPFV.
Mid & South Essex: 26th April 2017 1:00-4:00pm and 6:00-9:00pm at Basildon
Suffolk & North East Essex: 27th April 2017 1:00-5:30pm at Copdock, Ipswich
5.7Coroner’s Office
A summary of discussion at the meeting held on 20th February 2017 with Hannah Brown, Operations Manager at the Coroner’s Office was received for information. Ms Brown had taken the feedback obtained from practices on-board and as a consequence, was reviewing and revising the online referral form. Dr Balmer thanked those involved for their contribution.
5.8EPIC Newsletter
The February edition was received for information.
5.9Motions to LMC Annual Conference
Motions are required to be submitted to the BMA by midday on Monday 13th March. It was suggested that a motion be prepared around STPs, notably the lack of credible plans to underpin the realignment of secondary care services and the effect on general practice.
- ANY OTHER BUSINESS
6.1Rates Reimbursement
Following notification this week that her practice’s rates reimbursement will not be paid until May or June, the Chair intends to seek clarification fromNHS England as to exactly when payment will be received. It was assumed that this is being replicated across the county and with sizeable amounts of money involved,it is likely that the delay will result in cash flow problems for practices.
6.2GPFV Funding
Members were concerned that any funding not allocated before the end of the financial year may be lost. Should there be a real risk of this occurring, Dr Harrod-Rothwell reminded Members that there was provision within the Regulations for funds to be transferred to practices under a Memorandum of Agreement.
Dr Balmer was able to confirm that the GP Resilience Funding had now been allocated and distributed. NHS England had suggested that the funding for Practice Manager training might be allocated to LMCs but this had since been rejected.
6.3Additional Funding to Alleviate Winter Pressures
Dr Onuorah sought the views of Members on the Chancellor’s announcement of an extra £2bn for Social Care to alleviate pressure on the NHS. Members agreed that the Government has no concept of the role of general practice and suggested this might be a topic for a Conference motion.
6.4Private Practice
The BMA will be a holding Conference on Private Practice on 5th April 2017. Members’ views were sought on the how the increasing use of private GP practices affects the workforce and the role of the LMC.
It was noted that several LMC Members undertake some work in the private sector. They welcomed the benefit of having more time to spend with patients when working in the private sector and felt that it was no longer limited to wealthy patients. Private GP appointments were now being used much more widely, with access being the main driver.
Dr Balmer reported that two practices in South Essex had been trialling a link with Babylon, an application that combines artificial intelligence with advice from registered doctors. This had primarily acted as a signposting service and in one of the practices had resulted in an approximate 10% reduction in workload. The office was also aware that in some areas GPs are looking at providing a private service to their own registered patients.
However, as with NHS 111 and walk-in centres, the expectation was that increased access to GPs via the private sector would not significantly curtail demand in the long term.
- FOR INFORMATION
a)GPC News 20th January 2017 (Received)
- DATE OF NEXT MEETING
The next meeting will be held at 2:15pm on Thursday 13th April 2017 in the Goodwin Room, Boreham Village Hall.
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