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Minutes of the Meeting held on Tuesday 17th November2015

University Clinical Education Centre

Southport & Formby District General Hospital

Southport, PR8 6PN

Present:
Dr M Bond
Dr U Pfeiffer
Dr G Berni
Dr L Campbell
Dr K Chung
Dr M Evans / (Chairman)
(Vice Chairman) / Mr J Chattin
Dr N Williams
Dr L Grant
Dr H Obuchowicz
Mrs B Hartley / (Hon. Secretary)
(Treasurer)
(Minutes)
Agenda Item / Action
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Item 1 / Welcome/Introduction
The Chairman, Dr Bond, extended a warm welcome toCommittee Members to the November meeting and thanked everyone for attending.
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Item 2 /

Apologies

Apologies were received fromDr W Coulter, Dr B Fraser and Dr R Sinha.
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Item 3 / Minutes of the Meeting held on Tuesday 20th October 2015
The Minutes of the Meeting held on Tuesday 20th October 2015, copies of which had been circulated to each Member, were approved, signed and dated by the Chairman as a true and accurate representation of the meeting.
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Item 4 / Matters arising from the Minutes
None.
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Item 5 / Notice of Any Other Business
None.
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Item 6 / Chairman’s Report
Dr Bond reported that he had represented the LMC at the Liaison Meeting between the LMC, the Sefton Clinical Commissioning Groups (CCGs) and NHS England Merseyside (NHSE [M]) and also meetings with; Jan Leonard to discuss the flu campaign; Angela Parkinson and Lesley McKinnell to discuss the Local Quality Contract (LQC); Paul Shillcock to discuss the GPSoC agreement; and Susanne Lynch to discuss the tiers of shared care. These items are included in the Hon Secretary’s report to the Committee.
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Item 7 / Treasurer’s Report:
Dr Grant had received a letter from the Royal Bank of Scotland to inform him that the transfer of RBS to Williams & Glynn is progressing.
Agenda Item / Action
Item 7 cont. / Dr Grant had also received a letter from the Cameron Fund requesting a donation to its’ Christmas Appeal. The Committee felt that the annual donation to the fund was sufficient. The request was therefore declined.
Committee members were provided with cheques to cover their annual travel expenses to and from LMC meetings.
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Item 8 / Reports from LMC Sub Committees and Hon. Secretary’s Report:
a)Reports from LMC sub-committee attendance:
Dr Williams had represented the LMC at the Joint Medicines Operational Group (JMOG). The following items were reported:
Terms of Reference – JMOG is in the process of updating its’ terms of reference.
ADHD – JMOG is intending to look at prescribing data to establish the number of children with ADHD, who are under a shared care agreement between Dr Naidoo and general practice. However, this prescribing data would not be accurate, as some children are under the care of Alder Hey Children’s Hospital. The medicines management team will therefore audit the prescribing of ADHD drugs in general practice. Of note, there is no agreed shared care in place at this time.
Covert administration – JMOG held the view that covert administration should be undertaken at the nursing/care homes’ risk rather than being managed by general practice at individual patient level.
Dr Campbellraised a query question about the administration of homely remedies, as they appear to be coming under the scrutiny of Care Quality Commission (CQC)inspection of care homes. She mentioned thatHelen Ramsbottom, practice pharmacist, is trialling the use a form, whichis quite onerous. However, CQC is stipulating individually prescribed medications. Dr Evans felt that GPs should not take onresponsibility for this problem. He recommended that practices say “no” to these requests, thereby putting the responsibility back on nursing homes to ask relatives to purchase homely medications.
Midodrine – has been removed from the Red List. JMOG is worried that this may cause a cost pressure relating to hypotension.
Bio-diabetic products – pharmacies may dispense bio similar products that are not equivalent and there is also concern about high strength insulins. JMOG will send a warning out to practices.
Diabetic meters – JMOG mentioned that good deals are being provided on diabetic meters but that the monitoring sticks are expensive.
Lithium agreement – JMOG had agreed that hospital registrars may prescribe and make changes to these drugs under the agreement, as they are acting under the direction of the consultant.
Tapentadol –there is a high level of expenditure on this opiate drugin South Sefton, which is thought to be generated by Dr Franks’ clinics. JMOG would not recommend cross-prescribing.
Atypical antipsychotics–Dr Williams and Mr Chattin had attended a meeting with medicines managementand clinical leads from Merseycare, to discuss proposed changes to the administration of the shared care arrangements for antipsychotics in Sefton - from the suggested “Amber Maintained” to that of “Amber Initiated. This would result in the discharge of the patient and would place the responsibility for prescribing and monitoring of antipsychotic medication in primary care
Agenda Item / Action
Item 8 cont. / Dr Williams and Mr Chattin had cited National Institute of Clinical Excellence guidelines and reiterated the concerns of the Committee relating to the ongoing management of these patients in primary care following discharge. Merseycare clinicians had agreed that the transfer of prescribing to primary care, rather than the discharge of the patient, was a more feasible option. However, the shared care documentation does not reflect this and is not detailed enough to enable the transfer of prescribing. The Pan-Mersey Area Prescribing Committee (APC) will pick this up and Dr Williams was invited to feed into this work. The Committee agreed that it would be beneficial for Dr Williams to participate in this work.
b)Liaison Meeting held between Sefton Local Medical Committee, NHS England (Merseyside) and Sefton Clinical Commissioning Groups - 17th November 2015:
Mr Chattin had attended the Liaison Meeting with representatives from NHSE (M) and Sefton CCGs. The matters discussed are recorded under Items 9 and 11 of the minutes.
An item discussed at the Liaison meeting, not included elsewhere within the minutes, wasthe approval of the Merseyside city region bid for devolution of local authority and health care budgets. The devolution of funding is anticipated to take 18-months. There would be implications for the structure of CCGs and the delivery of health care, which could develop into managed health care units with per-capita funding. The Committee felt that a coalition of LMCs would be required.
Also discussed at the liaison meeting, was Southport & Formby CCG’s financial deficit, which is thought to result from the older population.The CCG intends to rebalance the £1m deficit in year 1 and to make £9m savings in year 2. Dr Evans informed the Committee that he conducting an audit of the coding of hospital activity. / NW
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Item 9 / Current Issues and Action:
a)Local Quality Contract investment 2015/16 -2016/17
The variation to the Local Quality Contract (LQC) was discussed at the Liaison meeting. Some practices had not signed up to the full version of the original LCQ, which was issued as an NHS Standard Contract, since this had contained many items that were not relevant to general practice. The variation, issued by the CCGs stated that thiswas a variation of the original contract. It was agreed at the Liaison meeting that a new variation would be issued, which negates the irrelevant clauses.
Further discussion will take place about schemes for those practices who are losing funding, due to the atypical demographic of their practice.
b)Influenza Vaccinations in Sefton, Campaigns – arrangements for 2015/16
Discussion had taken place at the Liaison meeting about the process for claiming the fee for the flu vaccination of eligible nursing/rest home and housebound patients. The estimated number submitted by practices to the LMC office was higher than the number vaccinated last year. A fee of £10 had been agreed, based on 75% uptake. The CCGs will write to practices to confirm the process and the date for claims.
c)GP Practice Provider Collaboration – BMA funding network support – update
Fifteen out of seventeen practices eligible to join the GP provider federation in Southport & Formby have signed up, representing a population of 96.6k. Two practices abstained.
The Bootle locality has arranged for Hempson’s Solicitors to provide an information session about the legal/company structures available to federations. / JC
Agenda Item / Action
Item 9 cont. / d)Shared Care Medications/Protocols:
(i)JMOG – reported under Item 8(a)
(ii)Shared care framework
A meeting had taken place with Susanne Lynch to discuss the shared care framework, which has not been uprated since 2007. The LMC had proposed the following changes:
  • DMARDS – a rise from £150 to £180 per patient.
  • Basket – a rise from £500 to £1,500 per 5k patients since the basket had grown and now contains a number of amber drugs.
  • The insertion of a 3rd tier in-between. There is a desire to re-name this but there is no suggestion as to what would replace it - perhaps an administration fee of £30 to include Denusamab.
The proposals will be taken back to Martin McDowell for consideration.
e)Safeguarding – update
Dr Wendy Hewitt, newly appointed GP Safeguarding Lead, is representing Sefton at a Pan-Mersey meeting working group, which has been formed to review the referrals to, and information requests from, the safeguarding team.
f)Transgender care – update
No further update.
g)LPC/LMC repeat ordering protocol
Dr Bond and Mr Chattin had met with the Local Pharmaceutical Committee (LPC), at the request of JMOG to discuss “principles for pharmacies ordering prescriptions from GP practices”. JMOG had asked the local committees to consider the adoption of the same principles, as those agreed between Mid-Mersey’s LMC and LPC, which stipulates a maximum repeat ordering timescale of 10-days prior to a patient needing their medication. The local committees were unsure as what would be achieved by the introduction of this joint policy and had agreed that it was a matter for the medicines management team to address.
h)NHS 111, Special Patient Notifications (SPNs),Do Not AttemptResuscitation (DNAR) and Deprivation of Liberty Safeguards (DoLS)
A number of GP practices had experienced problems with NHS111’srecognition of the end-of-life (EOL) care of patients in the out-of-hours period. There have been instances where practices had EOL paperwork in place but there was no electronic record on the NHS111 system. This has resulted in ambulances being sent to patients’ homes inappropriately or in referral on to the coroner, which causes great distress to relatives. Mr Chattin informed the Committee that it would require a multi-organisational approach to resolve this issue. There is a regional conference on 3rd December for all parties to attend and local protocols would need to be agreed following this meeting.
i)Nurse Revalidation - implementation
Mr Chattinreported that he had checked with the General Practitioner Committee (CPC) about the provision of guidance to general practice on nurse revalidation. The advice received to date, was that this is a professional accountability issue for each nurse. However, the Committee felt that the employer’s responsibility might be to confirm compliance. It is understood that the Education, Training and Workforce Subcommittee of the GPC is reviewing this subject. / JC
Agenda Item / Action
Item 9 cont. / j)LMC membership: re-elections 2016
Mr Chattin confirmed that the administrator for Mid-Mersey LMC has agreed to provide the service of Returning Officer for the forthcoming LMC elections.
Mr Chattin felt that there is a need to raise awareness of the elections in order to recruit members to the Committee. Dr Evans informed the meeting that Pembroke LMC, who he had made contact with, has a Locum seat on its’ committee.
k)SSP Practices – interim providers
l)The interim management of the Alternative Medical Services Provider (APMS) contracts held by SSP was discussed at the Liaison meeting. Interest had been received for Freshfield, Hightown, Netherton, Crosby Village, Maghull and Seaforth & Litherland practices.
m)Schedule of LMC Meetings 2016
An updated schedule of LMC meetings for 2016 had been circulated to Committee members.
n)Annual Dinner - 2016
The date of the LMC Annual Dinner was confirmed as Friday 11th March 2016. Mr Chattin and Mrs Hartley had met with West Lancashire Golf Club to discuss the requirements. The Committee agreed to fund wine and long drinks until the end of the meal and a liqueur would be offered to guests with the cheese and wine course.
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Item 10 / Matters relating to Sefton Clinical Commissioning Groups:
a)Terms Governing GP Systems of Choice GPSoC Services and GP IT Services: CCG practice agreements
Mr Chattin had met with Paul Shillcock to feedback the Committee’s views on the GPSoC and IT agreement, in particular the funding of Docman, the hours of the helpdesk and the need to specify the COIN bandwidth.
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Item 11 / Matters referred by NHS England and Merseyside Area Team
a)PMS Reviews
No further progress on the provision of new PMS agreements, as these are deferred to April 2016. Mr Chattin reported that new Multiple Care Provider (MCP) contracts could attract a premium, but that these are voluntary would be locally negotiated.
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Item 12 / Matters relating to Primary Care Support England (PCSE) and NHS:
No items.
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Item 13 / BMA/GPC Strategic Matters and Information
a)Call for Special LMC Conference on the predicament of general practice
A proposal had been made on the national LMC discussion server for the GPC to call a special conference on the predicament of general practice. The Committee agreed to support this. / JC
Agenda Item / Action
Item 13 cont. / b)GPC/LMC representation local & regional
Dr Bond had been invited to a pilot regional GPC/LMC meeting on 21st January 2016, hosted by the Consortium of LMCs in Lancashire and Cumbria, as part of a network of meetings to be held nationally on the same day.The meeting will be opened by a video conference link with Dr Chaand Nagpaul.
c)The following items were received and noted by the Committee:
General Practitioner Committee (GPC) newsletters & briefing papers:
  1. GPC Newsletter, dated, 16th October 2015
  2. GPC Chairman’s Newsletter, dated, 5th November 2015

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Item 14 / Departmental/Hospital Circulars
None
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Item 15 / Any Other Competent Business
No items
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Item 16 / The Chairman concluded the Meeting at 9.32 p.m. and thanked Committee members for their time.
Date, time and place of the next meeting:
The next Committee meeting will be held on Tuesday 8th December 2015, at 7.30 p.m. in theBlue/Green Room, Litherland Town Hall Health Centre, Hatton Hill Road, Litherland, L21 9JN
.
Signed / Dated