6
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 26th January 2017 at 2.15 pm
PRESENT: Dr Manjeet Sharma (Chairman) Dr P Chisnell (Vice Chairman)
Drs Aderonmu, Aung, Balmer, Butler, Deshpande, Dhanjal, Hunt, Khan, Monk, Morgan, Moss, Nanda, Okoi, Otte, Porter, Ramoutar, Srivastava, Tayo and Waiwaiku, Mr Bradshaw and Mrs Pedder.
PART ONE
The Chairman began by welcoming two new members – Dr Otte representing Southend and Dr Monk, a newly qualified GP in Castle Point and Rochford who had been co-opted. The Chairman then asked 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 Barusya, Kittle and McMahon.
DECLARATION OF INTERESTS
There were no new declarations of interest.
MINUTES
The minutes of the meetings held on 27th October and 8th December 2016 were confirmed by the Committee and agreed for publication to the LMC website.
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MATTERS ARISING
October
P3 Anglia Ruskin School of Medicine: Dr Balmer advised that those practices that had expressed an interest in medical student placements will be contacted within the next few weeks.
P4 GPC Survey of GPs: The results of the survey are due to be published shortly and will be included on the agenda for the February meeting.
December
P2 Success Regime: The Chairman reported that the first meeting of the Primary Care Leadership Group attended by herself and Dr Balmer had been quite productive with some innovative ideas being proposed. Continued LMC participation in future meetings was therefore recommended.
DISCUSSION TOPICS
1. Draft Multispecialty Community Provider Contract
Members received and considered the NHS England document “GP Participation in an MCP”, a BMA press release dated 5th January 2017 and the BMA Focus on the Draft MCP Contract.”
Members agreed that the BMA documents, whilst taking a more cautionary view, provided a succinct summary:-
Ø The MCP contract is entirely voluntary.
Ø Each MCP contract will cover at least 30,000-50,000 patients.
Ø There are three MCP models – virtual, partially integrated and fully integrated. The virtual and partially integrated options allow practices to retain their national contract.
Members felt that the move towards MCPs was driven by political ideology and that there are alternative ways for practices to work collaboratively without an MCP Contract. Members noted several references in the document which were cause for concern:-
Ø The fully integrated model requires the national contract to be relinquished. There are clear risks in giving up the national contract as there will be limited opportunities for GPs to return to the exact contract arrangements that they were previously on.
Ø The MCP contract is time limited and will therefore be subject to further procurement processes in the future when practices may have to compete with commercial organisations to retain their contract.
Ø Host Arrangement (Page 10) – Reference is made to one organisation, eg. NHS foundation trust, hosting the MCP contract with a discussion forum for decision making. The paragraph continues “GPs could be represented on this forum”, demonstrating a lack of GP engagement.
Ø Mixed Economy (Page 25) – It is possible that practices within an MCP area will have different preferences with regard to contractual models. Individual practices may feel pressurised to accept the choice of the majority.
Ø Under the partially integrated model, there are some changes to income streams (including Enhanced Services and QOF) which practices would need to take into account.
Ø It is inevitable that prescribing and referral habits will vary between practices.
Ø NHS England state that there is an in principle agreement to allow access to the NHS Pension Scheme for GPs working under an MCP Contract. However, the necessary changes to the NHS Pension Scheme Regulations are not yet in place and are subject to public consultation this year.
Ø Premises – there are potential risk to practices in respect of lease arrangements.
Ø MCP Contracts would be prime candidates for privatisation.
Ø It was unclear how much support there was from the profession for the MCP model. Dr Balmer expects to bring a paper on GP support to the February meeting.
The general view of the Committee was that whilst there are obvious advantages to providing care across organisations and new models of care need to be developed, practices should be aware that participation in an MCP would not be without risk.
2. Primary Care Workforce Strategy
Members considered the draft Primary Care Workforce Strategy document from NHS Professionals which had been commissioned by Essex wide CCGs in their role as part of the local Community Education Provider Network.
Members felt that the document was generic in nature and did not include any information specific to Essex, despite this having been provided by both the LMC and EPIC. They were disappointed to note several areas of work identified in the document that had either already been commissioned from, or completed by, EQUIP/EPIC.
Comments from Members are summarised below:-
Ø The EPIC Workforce Development Centre was set up to address the GP recruitment and retention crisis in Essex and has a dedicated website offering advice and information to those working, or thinking of working in Primary Care in Essex.
Ø EQUIP offers comprehensive training and professional development across all primary care staff groups.
Ø Leadership structure – EPIC offers leadership training and has a forthcoming event in March.
Ø EPIC has conducted a survey of nurse practitioners and a training programme is currently being delivered.
Ø Health Education England Workforce Strategy – this has not been shared with EPIC or the LMC.
Ø EQUIP has a register of over 100 locums. This is accessible via the EQUIP website.
Ø The figures quoted on Page 11 for the number of GP vacancies are taken from the LMC Workforce Survey (2014). More recent data is available.
Ø Pre-Employment/ Apprentice Style Scheme - Belinda Brook is the “Talent for Care” Co-Ordinator for Essex.
Ø There is no reference in the document to the GP Retainer Scheme
Ø The suggestion of a locum rate cap could be counter-productive and has been proved not to be effective in secondary care. Many locums enjoy the flexibility of choosing when and where they work and would not want to be forced into joining a locum pool.
There was general consensus that the document showed a lack of understanding of the GP workforce and of the work already underway in Essex. It was suggested that it might be helpful for any subsequent drafts to be separated into sections covering GPs/practices, wider GP hubs and maybe STPs.
The LMC office will share Members’ comments with Jill Jarvis. It was understood that EQUIP and EPIC had already submitted comments on the draft.
3. Submission of General Practice Forward View Plans by CCGs to NHS England
Members received a letter to LMCs from Dr Chaand Nagpaul dated 5th December 2016 highlighting key elements that should be included in CCG local operational plans. CCGs are required to submit bids for various funding streams identified as part of the GPFV.
Mr Bradshaw had contacted all Essex CCGs asking for their draft plans to be shared with the LMC prior to submission. A copy of Mr Bradshaw’s e-mail dated 8th December 2016 was received by Members for information. To date, only Castle Point and Rochford CCG had responded.
Members were particularly concerned about the allocation of the GP Resilience Funding, with the first tranche of funding needing to be spent by 31st March 2017. The allocation of this funding was now being administered by Ernst and Young who had been in contact with Dr Balmer in recent weeks. Dr Balmer and Mr Bradshaw have been invited to be part of the review panel and will attend a meeting on 31st January at which submissions received from practices included in the programme will be considered.
4. Possible Future Hosting of EQUIP
Members received for information a diagram illustrating the organisational structure of the LMCs and Supporting Health (Essex) Ltd (SHEL), and the proposed structure if the hosting of EQUIP goes ahead.
Dr Balmer advised that SHEL had been operating for seven years. It shares offices with the LMC and functions as a separate provider company, running short term contracts with the aim of preserving and protecting general practice.
Discussions have been ongoing for over a year with Mid Essex CCG who currently host EQUIP but do not wish to continue with the arrangement. If the move goes ahead, existing EQUIP staff would remain employed by Mid Essex CCG but would be seconded to SHEL. The intention is to preserve the excellent resource provided by EQUIP to Essex practices.
All stakeholders will be formally consulted at the appropriate stage.
5. Shared Care Protocols
Draft shared care agreements were discussed at length by the Committee at its meeting on 8th December 2016 and Members were aware that the Chair and Mrs Pedder had previously met with Denise Rabbette from the Medicines Management Team for Basildon/Brentwood and Thurrock CCGs.
Following the December meeting it was agreed that a letter should be sent to practices highlighting the risks and responsibilities associated with prescribing protocols for certain drugs, particularly given increased scrutiny from GMC and CQC.
Having considered a draft letter prepared by the Chair, Members asked that it be amended to include information on the process of giving notice to CCGs of a practice’s intention to cease providing the service. They also asked that links to the BMA template letters regarding unresourced work be included.
A separate e-mail will be sent to practices regarding the issue of prescribing and monitoring Warfarin. Practices in one locality in the BB CCG area had given collective notice as a locality which had been refuted by the CCG. Practices appear to be reluctant to give notice individually but should be reminded that whilst they continue to provide an un-commissioned service, the situation will not improve. Mrs Pedder is continuing in her efforts to arrange a meeting with William Guy from BB CCG and will update Members in due course.
6. Chief Executive’s Report
6.1 Tamiflu
Members received a letter from CPR CCG to practices dated 22nd December 2016. The issue of prescribing Tamiflu for the prophylaxis of influenza in care homes was discussed at length by North Essex LMC at its meeting on 9th January. Following the meeting the LMC sent the enclosed e-mails to North Essex practices (dated 13th January) and to Dr Mike Gogarty (dated 16th January) outlining the BMA and LMC view. The BMA wrote to PHE in February 2015 confirming that the GMS Regulations clearly state that the provision of Tamiflu for the prophylaxis of influenza in nursing and care homes is not included under essential services that practices are required to provide for their registered patients and that such additional work must be commissioned and funded separately as an Enhanced Service. Whilst this guidance was issued almost a year ago, Mr Bradshaw had checked with the BMA and received an assurance that this remained extant. However, national discussions are ongoing.
Members agreed that a similar e-mail should be sent to South Essex practices advising that, for the reasons stated above, they should not undertake this work unless it is properly funded and capacity exists within the Practice to safely provide the service.
6.2 Collaborative Arrangements
Members received for information a new guidance booklet produced by Mrs Pedder which provides information on the payment mechanisms across Essex for work carried out under Collaborative Arrangements. Unfortunately it had not been possible to establish the arrangements in relation to Castle Point and Rochford CCG and Basildon/Brentwood CCG. Contact details for the Chief Finance Officers are included in the document and practices are encouraged to make contact directly with these CCGs for clarification.
6.3 Clinical Pharmacists in General Practice
Information from GPC, BMA and NHS England regarding the opening of practice funding applications for the next cohort of Clinical Pharmacists was received for information. This had been shared with practices.
6.4 Chadwell Medical Centre
Members received a stakeholder briefing regarding the procurement process for the Chadwell Medical Practice. The current contract held by Drs Mohile and Lie will end on 31st March 2017.
6.5 Letter to the Prime Minister
A letter from Dr Mark Porter, BMA Council Chair, to the Prime Minister dated 17th January 2017 was received for information. The letter refers to the perceived “scapegoating” of GPs for the current crisis in the NHS.
6.6 GPDF
Members received a letter dated 14th December 2016 from Dr Stewart Kay, GPDF Chair, which provided clarification on the new membership structure. One nomination was being sought from each of the Essex LMCs. Any expressions of interest should be forwarded to the LMC office as soon as possible.
6.7 Coroner’s Office
Mrs Pedder was aware of the difficulties being experienced by practices with the newly introduced system and has for some time been trying to arrange a meeting with a representative from the Coroner’s Office. A new Operations Manager, Hannah Brown, was now in post and Mrs Pedder is hopeful that a suitable date will be agreed very soon. Feedback had been sought from practices and shared with Ms Brown. GP representatives from both LMCs had already agreed to be present at a meeting once convened. Further information will be shared with Members as it becomes available.
6.8 Essex County Council Family Operations Hub
Members received a letter from Essex County Council dated 19th January 2017 regarding changes to phone lines and the way non-urgent service requests are made. The office will test the website to ensure that the changes will not impact on GP referrals/requests for information.
6.9 Motions to LMC Annual Conference 2017
Motions are required to be submitted to the BMA by 13th March 2017. Therefore, Members are asked to submit any suggested motions to the LMC office in order that they can be considered at the February meeting. As in previous years, practices have also been invited to suggest motions for consideration.
6.10 LMC Professional Indemnity Forms
Members were asked to complete and return the declaration to the LMC office by 30th January 2017.
7. DATE OF NEXT MEETING
The next meeting will be held on Thursday 23rd February 2017 at Rayleigh Parish Centre, Rectory Garth, Rayleigh at 2:15pm.