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SOUTH ESSEX LOCAL MEDICAL COMMITTEE
Minutes of a Meeting of South Essex Local Medical Committee held at
Rayleigh Parish Centre, Rectory Garth, Rayleigh on
Thursday 23rd March 2017 at 2.15 pm
PRESENT: Dr Manjeet Sharma (Chairman)
Drs Aderonmu, Aung, Balmer, Barusya, Butler, Deshpande, Hunt, McMahon, Monk, Nanda, Okoi, Otte, Porter, Raja, Ramoutar, Srivastava, Tayo and Waiwaiku, Mr Bradshaw and Mrs Pedder.
PART ONE
The Chairman began by asking if there were any matters to be taken in Part Two. There being none, she proceeded with the agenda.
APOLOGIES FOR ABSENCE
Apologies for absence had been received from Drs Chisnell, Dhanjal, Khan, Kittle, Morgan and Siddique.
DECLARATION OF INTERESTS
It was noted that Dr Okoi is now a GP Board Member for Thurrock CCG and a Case Investigator for NHS England.
MINUTES
The minutes of the meeting held on 23rd February 2017 were confirmed by the Committee and agreed for publication to the LMC website.
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MATTERS ARISING
P1 Anglia Ruskin School of Medicine: The project continues to progress through the GMC approval process. Dr Balmer will provide further information as it becomes available.
P1 General Practice Forward View: Mr Bradshaw had now received responses from all Essex CCGs and will produce a report for next month’s meeting. Dr Balmer also advised that funding for Practice Manager training in the Eastern region, announced as part of the GPFV, had been “parked” with an Essex CCG. Local LMCs will be responsible for organising this training.
P1 GP Resilience Funding: Funds for 2016/17 had now been allocated to practices.
P1 GPDF: No volunteers had yet come forward. GPDF had not been able to advise the frequency of meetings but it was not expected that they would exceed three per year.
P3 Shared Care Arrangements: BB CCG had recently chosen to decommission anti-coagulation within historical enhanced services arrangements and repackage it as an AQP covering levels 2-4 only. As a consequence of the new arrangements a constituent practice that had been providing anti-coagulation at level 1 had given notice to the CCG to withdraw from the service. The CCG continues to maintain that level 1 anti-coagulation does not specify the prescribing of warfarin and therefore such prescribing falls within the essential services of the GMS contract.
The Chairman, together with Dr Butler and Mrs Pedder, had met with representatives of Basildon and Brentwood CCG on 2nd March in an effort to resolve the issue. The Chairman stressed that from a clinical perspective the prescribing and monitoring of warfarin cannot be easily separated and the clinicians present at the meeting appeared to recognise the risks for practices, particularly given the stance taken by CQC that practices should be viewing and actively monitoring INR results. Currently IT systems do not enable practices to do this.
The meeting had been extremely useful with both the CCG and LMC agreeing to seek further advice. Mrs Pedder had sought the view of GPC on a draft letter to practices which was tabled for members’ information.
A separate issue had arisen in Thurrock CCG where anti-coagulation is commissioned via a Local Enhanced Service (levels 1-4). A practice had given notice five weeks ago to withdrawn from the service but was now being asked by the CCG to continue for the time being whilst new IT was being introduced.
The LMC continues to support both practices and Mrs Pedder will provide an update once clarification has been received from GPC.
DISCUSSION TOPICS
1. Essex Multi-Agency Risk Assessment Team (MARAT)
The Chairman introduced Jane Marley, Head of Information Governance for Essex CCGs and Information Governance Lead for NHS Central Eastern CSU, and Jane Herriot, Associate Designated Nurse Safeguarding Children. Members received the Joint Domestic Abuse Triage Team (JDAAT) draft Information Sharing Protocol which was originally shared with the LMC office last year together with corresponding legal advice obtained from BMA Law. The document was now scheduled for review and Ms Marley and Ms Herriot had been invited to todays’ meeting in an effort to resolve any outstanding concerns regarding the sharing of information by practices.
Ms Marley began by providing some background to the process. With effect from July 2016, the JDAAT had been absorbed into new Multi-Agency Risk Assessment Teams based in Chelmsford (for Essex), Southend and Thurrock. The MARAT teams work to protect and safeguard vulnerable victims and children of domestic abuse and comprise representatives from Essex Police, Social Care, Health, Womens’ Aid, Community Drug and Alcohol Team, Housing, and other agencies.
The 2009 DASH (Domestic Abuse, Stalking, harassment and Honour based violence) risk assessment model is used to help identify those who are at high risk of harm and whose cases should be referred to a Multi-Agency Risk Assessment Conference (MARAC). At this stage individual agencies will be asked to share information to inform the MARAC and enable an action plan to be drawn up to support the victim. Currently information requests will only be made in respect of the victim, but this may be expanded in the future to include perpetrators.
A Health Liaison Officer will be responsible for researching records and liaising with relevant services to coordinate and present health information to the MARAC. The Health Liaison Officer will contact the GP and providing consent is given, will access the victim’s health record and determine what information is relevant and proportionate to the circumstances of the case. The
GP will receive details of exactly what information was shared and will also be advised of any actions required following the conference.
Ms Herriott referred to the high number of domestic abuse cases - there had been eight murders in Essex over a period of eighteen months - and read details from a case study to highlight how improved information sharing may protect victims from further harm. In the past agencies may have been unsure what information was relevant to a MARAC but the Health Liaison Officers will be in a position to identify the pertinent facts.
Members discussed the matter at length and noted the following key points:-
o Practices have a statutory responsibility as Data Controllers to protect the information that they hold but the risk of disclosure must be balanced against the need to protect a vulnerable patient.
o The Health Liaison Officer will play a key role in the process. Only information that is relevant and proportionate will be shared. The GP will be kept informed of what is shared and the reasons why.
o GPs will not be expected to search for information, but if a victim discloses relevant information the GP would be expected to make this available to the Health Liaison Officer.
o It is for individual practices to determine whether to share information. Practices are advised to always clearly notate on the patient record when requests for information are received, including reasons why such information was, or was not, shared. Practices must be able to demonstrate that the disclosure followed informed discussion and decision making.
The Chairman thanked MS Marley and Ms Herriot for attending today.
2. LMC Budget 2017/18
Members 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 and adopted by North Essex LMC at its meeting earlier this month. South Essex Members unanimously agreed to adopt the budget.
3. Essex Locum Deck
Members 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%).
The electronic platform will be funded by means of a 5% commission on locum’s fees, payable by direct debit, although it will be free for locums to use for the first six weeks. Members congratulated Dr Porter on this initiative which it was hoped would be operational within a matter of weeks.
4. Special Allocation Scheme
Members 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).
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.
Whilst 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.
It was also noted that the template letter on Page 33 of the document makes reference to behaviour towards a named individual “on the practice premises”. Members asked that it be highlighted to NHS England that it is not appropriate to name an individual and also that patients may be referred to the SAS as a result of behaviour that has taken place somewhere other than the practice premises.
Dr Balmer will feedback to NHS England accordingly.
5. Chief Executive’s Report
5.1 LMC Board Meeting
Members received draft notes of the meeting of the Board of Directors held on 21st February 2017. Notable points were:-
o The need for a new website to be developed following the existing site being hacked.
o The continuation of the retainer with BMA Law.
o Possible hosting of EQUIP – Dr Balmer is meeting with representatives from Mid Essex CCG on 27th March 2017 and hopes to be able to bring the matter to a conclusion soon in order to protect the valuable service provided by EQUIP.
5.2 STP Update
Members received for information a joint letter from Simon Stevens and Jim Mackey to STP leads dated 27h February 2017.
5.3 Success Regime
Members received for information a briefing dated 15th March 2017. Dr Balmer is meeting with Clare Panniker, Chief Executive of Basildon & Thurrock, Broomfield and Southend Hospitals, on 28th March 2017.
5.4 Firearms Licensing Process
Following lengthy discussions with the Home Office, the BMA had now published a GP Support Guide which was received by Members and will be circulated to practices. Whether to provide this service remains a matter for individual practices to decide.
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5.5 Primary Care Support England
Members received a letter to Dr Chaand Nagpaul dated 7th February 2017 providing an update on progress one year on from Capita taking over the contract for primary care support services. Mrs Pedder continues to seek feedback from practices on the service and any information received is shared with GPC and NHS England. 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.
5.6 Ongoing Issues with NHS Property Services
Members received for information a letter to practices from Ian Hume dated 24th February 2017.
5.7 Action to get A&E Performance back on Track
Members received a joint letter from Simon Stevens and Jim Mackey dated 9th March 2017 to NHS Provider Trusts and CCGs regarding actions required to free up hospital bed capacity and manage A&E demand in the future.
5.8 General Practice Forward View
Members received for information details of forthcoming engagement events being held to discuss the GPFV.
Ø Mid & South Essex: 26th April 2017 1:00-4:00pm and 6:00-9:00pm at Basildon
Ø Suffolk & North East Essex: 27th April 2017 1:00-5:30pm at Copdock, Ipswich
6. DATE OF NEXT MEETING
The next meeting will be held on Thursday 27th April 2017 at Rayleigh Parish Centre, Rectory Garth, Rayleigh at 2:15pm.