1

DRAFT / Title of Meeting: / GP Reference Group Committee
Time: / 12.30pm to 3.30pm
Date: / Wednesday 29th August 2012
Venue: / G.04 Elm Oak House
Chairman: / Dr Leonard Jacob

Members or deputies Present:

Dr Leonard Jacob (LJ), GP, Thrybergh Medical Centre / Chair/ Central 2
Dr Simon MacKeown (SM) GP St Ann’s Medical Centre / Health Village
Dr Naresh Patel (NP), Broom Lane Medical Centre / Central North
Dr Geoff Avery (GA), Blyth Rd / Maltby / Wickersley
Dr PG Thomas (PT), Parkgate Medical Centre / Wentworth South
Dr Bipin Chandran (BC), Treeton Health Centre / Rother Valley North
Dr Sophie Holden, (SH) GP, Market Surgery / Wath / Swinton
LMC Representative
Dr S Sukumar, LMC Representative / LMC
Apologies
Dr Rob Evans (RE) Swallownest Health Centre / Rother Valley South
Robin Carlisle (RCa), Deputy Chief Officer / NHSR
Keely Firth, (KF) Chief Finance Officer / NHSR
Neil Thorman, LMC Representative / LMC
Barry Wiles, (BW) Maltby Service Centre/Clifton MC / Practice Managers’ Rep
In Attendance:
Dr David Tooth (DT), Chair Rotherham SCE / SCE
Chris Edwards (CEd), Chief Officer Designate / NHSR
Dawn Anderson, (DA) Head of GP Commissioning Development / NHSR
Cheryl Rollinson, (CR) Officer Manager / PA / NHSR
Lynne Hazeltine (LH) York Road Surgery / Practice Managers’ Rep
Dr Ian Turner (IT) SCE Lead for Primary Care – Item 3 / SCE
Dominic Blaydon (DB) Head of LTC and Urgent Care – Item 3 / NHSR
Julie Kitlowski (JK), SCE Lead for Clinical Referrals & Pathways – Item 4 / SCE
1. / Apologies and Introductions
Apologies - Noted as above.
Introductions–Introductions were made for Emma Royle who will be covering during Dawn Anderson’s maternity leave. DA reiterated to members that only minutes will be produced at future meetings which will be distributed within a week of the meeting so that key issues can be discussed at locality meetings. / LOCALITIES TO NOTE
2. / Minutes of Previous Meeting & Matters Arising
2.1 Minutes of last meeting – No issues or inaccuracies raised, minutes dated 25 July 2012 were agreed
2.2 Matters Arising
2.2.1 Finance Training Session – (item 4.2.5 in previous minutes), this has now been arranged for 26 September, 15:30 (after next GPRC) all members to note and to advise of any apologies to CR.
2.2.2 Epilepsy Prescribing – (item 4.2.6 in previous minutes), DA still to follow up with medicine Management about an update on the contract review of Epilepsy Liaison Nurses.
2.2.3 Finance Final Position – (item 4.2.4 in previous minutes), agreed NP, CEd & KF would not meet as the same concerns have been expressed a number of times via different avenues. Noted that Strategic CE have been tasked to prepare proposals for ‘downsizing’ which will GPRC will consider. This will ensure that the work is undertaken once and in a co-ordinated manner. Proposals to be brought to October meeting.
2.2.4 NHS 111 Roll Out – (item 4.2.8 in previous minutes), members were advised that a PLT session could not take place but it was possible for individuals involved in 111 to attend a future GPRC. Noted that the paper circulated in respect of item 3.3 includes proposals of how the 111 number will be integrated. Timescales for implementation is nationally set but the implementation of a contact point is flexible at local level. Agreed a briefing paper on 111 would be circulated with the minutes.
2.2.5 EPR Update – (item 5 in previous minutes), CE reported that the RFT have provided assurance that issues have been resolved. Cancer 2 week wait breaches have been reported but RFT have provided assurance that there will be no 18 week wait breaches. Some members felt that it takes consultants twice as long to see a patient due to the amount of data needing to be reported. A suggestion was made that a paper copy of the referral provided in outpatients may speed up the process, agreed this would be fed back to Dr P Birks. Concerns were also raised that discharge letters are not eligible because they are hand written even though they are submitted electronically via the record, again this would be fed back to Dr P Birks.
All members were encouraged to submit any EPR concerns to Dr P Birks with evidence.
2.2.6 Macmillan Community Cancer Pilot – (item 9 in previous minutes), Clarity requested regarding responsibility of redundancy costs and context. Agreed CE would seek clarification.
2.2.7 High Potassium Levels – (item 4.2.3 in previous minutes), Members were asked to note LJ’s letter to Keith McMillan which was circulated with the agenda. Contents of the letter are self explanatory. / ALL GPRC GPS TO NOTE
DA
To be noted at locality level
LOCALITIES TO NOTE/ DISCUSS
ENC 1
DA
LOCALITIES TO NOTE
CE
3. / Unscheduled Care
3.1 Update on Non Elective Position (SEE ATTACHED)
3.1.1 Emergency admissions broken down per practice were circulated at the meeting, noted that the data reflects all sources and all locations. Where practices are outliers it was agreed that this would be discussed at locality meetings.
3.1.2 Papers circulated with the agenda outlines the current stresses within the system and highlights cost issues should the current position be maintained.
3.1.3 Members were informed that Strategic CE and the Unscheduled Care Management Committee feel that everything possible is being done to date to improve the position. A paper is being prepared for GPRC consideration which will detail emergency measures.
3.1.4 Robustness of the practice variance data is being reviewed because at present there is no measure of significance attached to the data, caution was urged when reviewing the data. LJ felt that more feedback from practice level would be useful which may help understand the trends in practice variance. A survey is also being prepared to understand how each practice assesses urgent admissions.
3.1.5 It was also noted that reception staff in practices would also have policies around triaging. It was unclear if the policies are unified across Rotherham or whether member practices should be asked for common uniformity.
3.1.6 A suggestion was made to implement ‘Spotter Practices’ who could undertake random coding spot checks.
3.1.7 It was also acknowledged that reviewing good practice already undertaken in practices, including the effective use of available tools, would be beneficial. The information collated could be shared via a model or framework.
3.1.8 Some members also expressed concerns that patient circumstances and choices also influence where a patient gets admitted which is out of GP control even though limited health resources are trying to be used more effectively. Acknowledged that protocols are needed, patient choices cannot be changed but options available can be more clear and limited. The Unscheduled Care Review will be looking at the system as a whole.
3.2 Communications Plan(see enclosed summary)
3.2.1 An outline communications strategy had been circulated with the agenda, the purpose of which is to ensure that all CCG representatives were reiterating the same messages and using the same language to maintain consistency. These key messages would also be used to form the basis of media communications.
3.2.2 All members were asked to review the document and provide feedback to Fiona Topliss () regarding the wording and messages
3.3 Care Coordination Centre (CCC)
3.3.1 Members were advised that the CCC is not part of the Unscheduled Care Review. The purpose of the CCC is to achieve a central point of reference to understand what services are available.It is not a triage services.
3.3.2 Following discussions, majority of members felt that the concept of a Single Point of access was a good idea and a positive step forward.
3.3.3 Members felt a flexible service was needed, members were advised that the CCC would be in a position to ask GP’s specific questions to find the best service appropriate for the patient.
3.3.4 Proposals had been discussed at locality and practice levels and specific questions were asked and the following answers were given:
  • A consultant will still be available to seek advice but there will be more available options.
  • Responsibility for the care of patients will depend on the location. Operational responsibility (i.e. arranging transport) will be with the CCC but medical responsibility will remain with the GP until transferred.
  • Next steps and timescales regarding a patient’s care will be confirmed by the end of the call to CCC.
  • Acute admissions will be arranged by the CCC who will also provide other available options to speed up the process
  • The intention of the process is to only make one call by the GP to the CCC.
  • The CCC is not a triage service and GP knowledge of the patient’s condition will be taken into account. The GP will have ultimate responsibility to make the final decision.
  • The CCC is a co-ordination service to ensure patients access the most appropriate service available and will not make any refusals.
  • The CCC will be accessible by all services in the health community not just GP’s.
  • The current model to man the CCC is 2 qualified nurses (Band 6 – Senior Nurses) but this is flexible. TRFT are recruiting to these posts therefore background and experience of these nurses is unknown but it was stressed to members that the actual number is not being reduced across Rotherham, only relocation to one central point.
  • An answer machine service is not anticipated.
  • The number of calls likely to be received by CCC has been analysed and 2 senior nurses plus call advisers is appropriate for the service.
  • Non-recurrent funding is being provided to TRFT to set up the service but TRFT expect it to be self-funding under the contract next year.
  • The assumption is that only one referral letter to the CCC will be needed rather than one for each service. This will be tested via the soft launch.
  • The service will be based at Woodside.
  • For a short period of time the CCC and TRFT switchboard will be running in parallel. If the GP community feels the change is suitable following the soft launch then the switchboard will automatically transfer calls to the CCC.
  • Soft launch is scheduled for 15th October 2012.
  • Potentially a case may be seen via a community assessment but this will be agreed between the GP and CCC.
  • The nurses will be facilitating the operational aspects of the assessments; they will not be responsible for referrals.
3.3.5 Members felt that the time it takes for the CCC to answer calls would be critical.
3.3.6 Discussions are taking place with TRFT about who will actually lead the service but the final decisions will be TRFT’s.
3.3.7 An operational based briefing paper was requested. Agreed DA would produce a briefing note based on the questions raised by localities. / Enc 2
LOCALITIES TO NOTE/DISCUSS
Enc 3
LOCALITIES TO NOTE/DISCUSS
LOCALITY REPS
DA
4. / Clinical Referrals
4.1 INR / Warfarin Testing
4.1.1 JK informed members that a process for agreeing secondary to primary care transfers would be coming to the GPRC for consideration. This is to ensure a robust process is place.
4.1.2 Members undertook detailed discussions regarding Anti-Coagulation issues and the 900 patients which could be followed up in Primary Care. Agreed that JK would ask Helen Baker to write to all practices regarding the transfer of care for stable patients. Noted that if practices don’t currently do any monitoring then they will just decline the invite. These figures would then be discussed at September locality meetings and provide feedback at the next GPRC as to whether the current LES should remain (which is optional) or if the work should transfer to the new overarching Primary Care LES (which is compulsory).
4.2 Back Pain Scoring System
4.2.1 Members undertook detailed discussions regarding the proposed tool. JK reported that it was now actually unclear how much of an issue the increase of referrals actually is, conversations with Orthopedics is taking place. Majority of members felt that the template should not be made compulsory and there were concerns in relation to referrals increasing. Agreed that JK would find out more information from Sheffield as to why their referrals haven’t increased and how the tool actually helps to triage patients better before a final decision is made regarding the tools usage. / LOCALITIES TO NOTE/DISCUSS
JK
5. / Feedback from Localities
5.1 Feedback summary noted and where appropriate actions and answers had been included on the summary document.
5.2 Majority of feedback submitted from localities had been in respect of the CCC and was addressed in Section 3 Above.
5.3 Health Village – SM reported issues in relation to RDaSH and not providing a satisfactory service in relation to missed and cancelled appointments. A specific case was highlighted to members by SM. Agreed that specific details need to be sent to Dr R Brynes for further investigation.
5.3.1 Mental Health Services – Members undertook a detailed discussion about services provided by RDaSH. It was felt that RDaSH had made positive steps in addressing issues and making improvements, however a further 6 areas were identified as needing further work in order to develop:
  1. Eating Disorder Service
  2. Psychology Service
  3. Start of Treatment for Dementia Patients
  4. Anger Management Courses
  5. Autism Services
  6. Beachcroft Services for Young Children and Adolesecents
Agreed this would be feedback to Dr R Brynes for raising with RDaSH. / DA
6. / Authorisation Update
6.1 CCG Values – Rotherham CCG Mission, Vision Values & Priorities has been reduced to a one page summary. No issues were raised and members agreed the document could be circulated to the wider GP community and CCG staff.
6.2 Key Lines of Enquiry (KLOE’s)– Members were advised that the documents submitted for Authorisation had been assessed and we have been advised of 63 green areas and 50 red areas. The panel day scheduled for the 11 Sept 2012 will look at the 50 red areas. CCG officers are currently reviewing the KLOE’s on the CCG’s behalf which fall into 4 key areas:
  1. Quality & Safeguarding
  2. Clear, Credible Plan & QIPP
  3. CCG Management Capacity and Resource Use
  4. Engagement with Health & Well Being Strategy & Joint Strategic Needs Assessment.
6.3 CCG Board Appointments – CE confirmed the following appointments:
  • Chief Officer (Designate) – Chris Edwards
  • Chief Finance Officer (Designate) – Keely Firth
  • Lay Member for Governance & Finance (Designate) – John Gomersall
  • Lay Member for Patient & Public Engagement (Designate) – Su Lockwood
  • Lead Nurse (Designate) – Sue Cassin (appointment confirmed today)
  • Lead Doctor (Designate) – Interviews are arranged for Sept
  • Deputy Chief Officer (Designate) - Interviews are arranged for Sept
No issues were raised and members supported the appointments. / LOCALITIES TO NOTE/DISCUSS
Enc 4
7. / Annual Commissioning Plan and CCG Cycle(see enclosure)
7.1 Members were informed that the plan circulated is for information and identifies when the draft commissioning plans will come to GPRC for consideration and early feedback. Localities will need to be aware of when the plan will need to be discussed at locality level. / Enc 5
LOCALITIES TO NOTE/DISCUSS
8. / Feedback of Key Issues Discussed at CCGC
8.1 All items discussed today have been raised at CCGC. Noted that the only item pending from the last meeting was the 111 proposals whereby LJ had been tasked to produce a written report regarding research collected by a Sheffield Research Group in relation to GP referrals and A&E attendances. No further items to note.
8.2 All papers submitted to CCGC can be located on the internet.
8.3 Appreciation was expressed by NP for the work undertaken by the CCG Committee.
8.4 Members were informed that a formal thank you is being arranged for the current lay members who will not be involved with the CCG moving forward. This will also be an opportunity to welcome new lay members.
9. / Key Issues Arising from Strategic CE
9.1 All items discussed today have been raised at SCE. Nothing new to raise.
10. / Unforeseen Items
10.1 Noted that the NCB Quality Framework has been published. Members were assured that the framework does not affect the Authorisation process. Agreed the Framework would be brought back to the October meeting to discuss further. / AGENDA
Items for Information
  • RDaSH Newsletter had been circulated with the agenda for information.

Next Meeting
Wed 26 Sept 12:30-15:30 (G.04 Elm, Oak House)
  • Agenda Items Deadline – 4pm Wed 12 Sept
  • Papers Deadline – 12noon Wed 19 Sept

Additional Enclosures Circulated with the Minutes

  • Enc 1 – Briefing Paper on 111 Roll Out
  • Enc 2 - Update on Non-Elective Position
  • Enc 3 – Communications Plan Summary
  • Enc 4 - Rotherham CCG Mission, Vision Values & Priorities
  • Enc 5 – Annual Commissioning Plan & CCG Cycle

Draft GPRC Minutes 29 August 2012