Local Medical Committee Meeting7 May 2013
Minutes OF THE COUNTYDURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 7 MAY2013 IN THE BOARD ROOM AT APPLETON HOUSE
Present:
Jame McMichaelChairman
David RobertsonSecretary
Fiona McConnellChester-le-Street
Rob CowleyDerwentside
Francis WhalleyDurham
Sanjay GuptaEasington
Kamal SidhuEasington
Norbert DielehnerSedgefield
John McGuireSessional
Heather PrestwichSessional
Invited:
Mike GuyDDT area team
Sue MetcalfeDDT area team
Stuart FindlayDDES CCG
Martin Phillips Darlington CCG
Andrew JonesDarlington CCG
Kate BiddleNorth Durham CCG
Nicola BaileyNorth Durham CCG
Number / ItemL13/45 / Apologies for Absence
Anne Holmes
Tanya Johnston
Mike Spence
L13/46 / Election of Chairman
The committee was pleased to re-elect Dr James McMichael as chairman.
L13/47 / Minutes of the Meeting held on 9 April 2013
An amendment to item 38.01, para 1 was agreed:
38.01 Medicine Shortage
Members expressed concern about the shortages of a variety of prescription medicines and suggested that it would be helpful if community pharmacists could recommend an alternative when this occurred and also to inform Practices when medicine is once again in stock.
With this amendment the minutes were accepted as an accurate record
L13/48 / Matters Arising
L13/35 Conference Motions
The motions about LETBs and the disparity in pass rates in nMRCGP examinations have been incorporated into composite motions and would therefore be debated at the LMC conference.
L13/36 - Pending
L13/49 / Secondary Care Matters
It was agreed to ask Sue Jacques to the next meeting of the LMC
L13/50 / Area Team
50.01DDT Area Team NHS England and CCG introduction to LMCs
Dr Mike Guy introduced representatives from the Area Team and gave a brief overview of some areas of work that are particularly relevant for primary care.
NHS England was promoting a number of single operating models for area teams to work to. So far 3 of the 27 proposed standard operating procedures are in place.
MG is the responsible officer for revalidation.
Durham Darlington and Tees Area Team headquarters is sited at the Old Exchange, Darlington with additional support based in Rapier House, Sunderland.
An assurance framework is due for publication in July 2011 and is likely to be supported by a primary care web tool that provides a variety of metrics down to practice level. ( Geddes (GP, York) is the national Head of Primary Care Commissioning.
Some support for primary care has yet to be placed or re-provided.
Some public health functions are remaining with the area team: health visiting, screening, and immunisation programmes.
Drug and alcohol teams are now hosted by local authorities.
The committee asked a variety of questions around the MMR catch-up service specification details of which had just been announced.
Although the area team was responsible for looking at quality of services provided by primary care the interface with CQC and CCG's remains to be defined.
There was a discussion around complaint handling in the new NHS. Complaints could be handled at a practice level as before but should this failed to achieve a satisfactory resolution patients would be directed to a national call centre that could feed complaints back to area teams. Unfortunately area teams lacked the capacity to handle these complaints, although it was anticipated that they would have access to a limited number of staff who could support this work in due course. There was particular apprehension as no reports have been received by the area team from the national call centre for the month of April with a suspicion that a backlog was being held centrally. Furthermore, it appeared that the national call centre had yet to develop an approach to triaging complaints that have received.
MG outlined how any performance concerns would be fed through CCG quality leads to the area team and from there into the PerformanceScreening Group who could then refer on to the Performance Decision Panel.
MG contributed to a discussion around 111 (C agenda item below)
L13/51 / Primary Care Support
51.01Complaints Support
In addition to the discussion above the committee again regretted the demise of PALS.
L13/52 / Clinical Commissioning Groups
SF highlighted some important issues from CCG's.
A block contract had been agreed with CountyDurham and Darlington's major secondary care providers for 2013/14. This had benefits to both parties and allows some financial stability with time to develop new ways of working uninfluenced by payment by results. However, SF was keen to emphasise the importance of GP's managing their referrals appropriately despite these block contracts.
The contracts for emergency care and community services were being reviewed.
There is confusion around specialist commissioning budgets that might be in deficit and trying to clarify the position has been beset with technical accounting problems. Complications have arisen in identifying the funds that PCTs devoted to specialist commissioning combined with a changing definition of what specialist commissioning involved.
The ambulance contract with NEAS remains a cost and volume contract. Despite some CCG's hoping to include some local penalties this could not be agreed across the region. Notice has been served on NEAS over the PTS contract.
Under the block contract with foundation trust, KS clarified that there would be no penalties for 28 day readmissions.
The block contract with TEWV might be threatened by the movement to PBR for mental health services.
With regard to IT systems SF confirmed that GPSOC still exists and that GP still have the option to choose whichever clinical software system they like. SF planned to meet with EMIS to discuss the costs involved for practices migrating from EMIS LV to EMIS web. However, SF encouraged colleagues to recognise that the local environment is dominated by SystemOne and suggested that practices should consider their options carefully. Committee members were concerned with a number of issues should they choose to migrate from EMIS LV to SystemOne:
- data loss
- training
- complexity of QOF
- potential for sharing information between systems had yet to be fully realised.
SK asked if the community service review would leave to greater integration of district nurses with GPs. SF felt that the contract should have a locality flavour to allow for a good deal of flexibility in the way practices work with their community staff. SF also pointed out the increasing importance of relationships with social services and the local authority.
L13/53 / Out of Hours Issues
SF confirmed that the 111 service is a CCG responsibility. At the moment there is no single lead CCG in the north-east although it is anticipated that a lead CCG will be identified in June. Despite increasing concern around the 111 service it seems clear that national policy was to press ahead with its development. Implementation of the 111 service in the Tees area was going to go ahead.
AJ pointed out that clinicians need to feed in concerns consistently to provide the evidence to support change and development. Committee members pointed out the confusion between the 111 clinical feedback form and the local Safeguard system. The committee felt that was important to use a single method for feeding complaints and that it would most appropriately be Safeguard.
L13/54 / Communication from the BMA/GPC
54.01Superannuation Contributions for Locums
There was a lively discussion about the "LMC rate" that in the past has been used to guide payments for work GP's undertake outside their practices. The secretary emphasised that the LMC had not publicised such a rate for a number of years and that to do so would risk the LMC falling foul of legislation. The BMA provided guidance on how GPs could calculate their fees. (
However, in the light of the change in superannuation contributions the LMC agreed that it would pay the 14% superannuation contribution in addition to its usual fees that it is prepared to pay GPs for work carried out on behalf of the committee.
L13/55 / General Correspondence
55.01Performance Groups
Committee members were invited to consider putting themselves forward to serve on the various performance groups.
L13/56 / Housing Association request for medical reports
Members expressed concern about an increasing number of requests from patients for letters to support their application for housing.
The secretary reminded the committee that this had been the subject of discussions a few years ago but that he would look into it again.
L13/57 / Date, Time and Place of Next Meeting
4 June 2013 @ 19.30 in the Board Room at Appleton House
Private and Confidential