City and Hackney LPC
MINUTES - OPEN Part
15 March2017
14.00 – 17.00
Tomlinson Centre - Queensbridge Rd, London E8 3ND
Attendance:
Member Name / Initials / AttendanceP= Present,
A= Absent,
Aa= Apologies sent. / Attendance this financial year
Raj Radia (chair) / RR / P / 6 of 6
Stewart Evans / SE / P / 6 of 6
Kirit Shah / KS / P / 4 of 6
Peter Muska / PM / p / 5 of 6
Anish Patel / AP / Aa / 2 of 6
Parag Oza / PO / P / 5 of 6
Dee Fasan / DF / P / 4 of 6
Sunil Patel / SP / Aa / 4 of 6
Kirit Sonigra / KSo / P / 5 of 6
Nickil Patel / NP / P / 6 of 6
Kerry Webb / KW / P / 3 of 5 (from 14.18)
In Attendance
Hitesh Patel (CEO) / HP / P
Shazia Naji / SH / P
Stuart Brown (Minute taker) / SB / P
1. Welcome by the Chair and to note any apologies
Apologies were noted from AP and SP.
2. LPC membership
Declarations and Conflict of Interest
None were noted.
3. Approve minutes and follow up Actions from Open section of meeting – 19th january 2017.
Accuracy
The members then stated that the minutes are an accurate account.
Actions and matters arising
Action no. / Description / Who to action / Completed1 (previous action) / To invite a member of the LMC to an upcoming LPC meeting. / HP/RR
Action no. / Description / Who to action / Completed
2
(previous action) / To look at details of the specs. for the BBG MOS I.T. platform recording solution. / HP
Previous action point -To contact Richard Bull so that HP can get invited to attend the Long-Term Conditions Board meetings on a regular basis:
RR stated that he had asked Richard whether CP reps. could be invited to the Long-term conditions board meetings. RR added that Richard Bull had asked RR to send him details of “concrete ideas”, and then CP would be invited to attend this board. RR stated that the LPC had sent Richard ideas for services in the past, however there had been no funding available to take this work further.
HP stated that he had said to Richard that if CP does not attend the board meetings then they will not know what the CCG’s current priorities are – and therefore CP would find it hard to tailor service ideas to these priorities.
SE stated that the LPC should continue to send Richard Bull ideas for services and this work should be made part of the LPC work stream.
PO wondered whether Richard Bull could be asked what the CCG’s commissioning intentions and priorities currently are.
Quadrant meetings:
Action no. / Description / Who to action / Completed3
previous action / To bring an anonymised example of a patient’s medical history obtained from “GP Record Viewer”. / RR
RR reminded that both the Pharmacist and the GP need to be using the EMIS system for this viewer to be accessed. RR added that a patient’s blood test results can be seen on that record.
Action no. / Description / Who to action / Completed4
previous action / To gain appropriate access to the CCG intranet - in order to access guidelines (e.g. Vitamin guidelines). / HP
Long term conditions board:
Previous action – HP to find out information from Viral Doshi wrt. how many smokers had been recruited to a smoking cessation service via the use of the COPD service:
HP stated that Viral had presented at a Stop Smoking training meeting last week (which had been poorly attended). This meeting’s purpose was to inform contractors of the Eagle Study’s findings wrt. Champix. HP stated that 25 registered for this meeting and 12 had turned up.
HP stated that the SPC for Champix had been updated, but the PGD will not be updated until the end of its cycle.
KS wondered whether future non-attendees could be fined for not turning up to a meeting.
RR stated that he had purchased a portable vitalograph spirometer (which measures lung age). RR stated that he uses this device as part of his HL zones. RR added that he would recommend this device to contractors.
HP asked whether the COPD screening service (employed in Hillingdon) could be adopted in Hackney.
RR stated that this scheme could be sent in to Richard Bull.
Action no. / Description / Who to action / Completed5 / To obtain details of Hillingdon COPD service / HP
6 / To send the details of the Hillingdon COPD service (transformed to a C&H version) to Richard Bull with a view to getting the CCG to commission. / HP
RR urged contractors to get their Health Champions to register the number of interventions made.
RR reminded that CP is bad at recording interventions.
PO warned that he would not want CP to deliver a COPD service for free, as this would set a precedent for future services.
Prescribing Program Board -Report from HP of September 2016 meeting:
Previous Action: SE to use PSNC data to come up with the names of the contractors who were not currently performing well re. delivering MURs -
Action no. / Description / Who to action / Completed7
Previous action / To visit the C&H contractor who has not carried out an MUR or NMS with a view to finding out what his/her challenges are. / RR
8
Previous action / To phone up the C&H contractors who are currently underperforming wrt. MUR numbers with a view to finding out what their challenges are. / HP
Action no. / Description / Who to action / Completed
9
Previous action / To set up NMS workshop YOUTUBE video for contractors (including a practical demonstration element). / HP
HP stated that he would be able to monitor how many people would have watched it.
Previous action –HP to make “opportunities from the JSNA meeting” – report from NP, an agenda item at the next meeting:
Action no. / Description / Who to action / Completed10
Previous / To send a link to the “2016 Health and Wellbeing section” of the JSNA when it becomes available to all LPC members. / NP
NP stressed how important the JSNA document currently is and he added that the LPC should use it more to pick up the health and wellbeing needs in C&H.
NP stated that “section- 7: Health and Environment” of the JSNA is “coming soon”.
NP stated that he had pulled up details of the 2014 Health and environment section of the JSNA and he highlighted to the meeting the many headings that could be used to help get CP services commissioned in the future.
SE asked when the PNA would be updated.
HP stated that the PNA is currently being updated and it would be updated using the current JSNA.
NP stated that the JSNA is incredibly useful because it asks the patients whether they are currently happy with a service.
SE state that the JSNA should be gone through with a fine-tooth comb.
HP suggested that committee members should divide up the JSNA document to digest and comment on.
SE suggested that a sub-committee could be set up to examine the JSNA.
Action no. / Description / Who to action / Completed11 / To include and divide up sections of the JSNA to the LPC work stream spreadsheet. / HP/NP
NP stated that the “unmet needs” are actually documented in the JSNA.
SE also suggested that LPC members should be paid to carry out detailed work on the JSNA.
RR asked the FAC to factor this suggestion into the budget.
STP:
Action no. / Description / Who to action / Completed12
Previous / To send the members a link to Hemant Patel’s CP plan “Indispensible” / HP
HP stated that he and Hemant would be meeting a few members of the STP board in the near future.
Hackney Public Health:
Action no. / Description / Who to action / Completed13 / To add CEPN to the LPC work stream spreadsheet. / HP
New services – discharge medication service:
Action no. / Description / Who to action / Completed14
previous / To follow up on the development of the new PharmOutcomes discharge medication service. / HP
Meeting with Sotiris Antoniou -
Atrial fibrillation Program:
HP stated that he had talked about this at the prescribing board meeting and they had said that this program is well in hand and that CP could not help with this service.
DOACs:
Action no. / Description / Who to action / Completed15
previous / To ask Sotiris Antoniou whether the UCL partners could help with an independent evaluation of CP services (such as MOS). / HP
RR wondered whether a summary action sheet be included with the agenda.
SE stated that he preferred the fact that the meeting actions are littered amongst the minutes to give context.
RR proposed that another box “completed” be added to the action boxes in the minutes.
Action no. / Description / Who to action / Completed16
previous / To add another box “completed” be added to the action boxes in the future meeting minutes. / SB
4. NHS E updates
SCR
HP stated that there was nothing to report.
Enhanced Services Update MOS & MAS
HP stated that NP would be attending a meeting with NHS E and he would report back on matters re. MOS and MAS during the next few weeks.
HP stated that the National NHS E team and the local NHS London team have arranged two important meetings (the CP Future meeting and LPC NHS meeting) which will now clash on the same day.
PURMS & PRE-REG payments
HP stated that he had sent out a survey to all London contractors to discover the extent of the payment issues for these two services. HP added that 59 contractors responded to the survey and 11 had been from the Hackney area. HP stated that the survey results will be sent to NHS E who now has a dedicated person assigned to resolve these payment issues.
NUMSAS
HP stated that only those contractors who currently operated a shared NHS mail account could apply for the NUMSAS service. HP stated that NHS E’s records are in a mess and there is much confusion over this issue.
HP recommended that all contractors simply send an email to NHS E expressing an interest in delivering the NUMSAS service.
Flu Service update
HP stated that as of last week C&H had delivered the following:
- 340 vaccines on the London service.
- 132 PPV vaccines.
- 6411 on the National service.
HP stated that a thousand more vaccines had been delivered this year. HP added that PPV numbers had been down on last year.
HP reminded the members that there had only been two complaints from GPs wrt. double jabbing patients with PPV vaccines.
RR stated that access to the enhanced SCR would solve these double jabbing issues.
Market entry
HP stated that KS’s application for a relocation had been approved.
RR stated that a Tower Hamlets contractor had contacted him concerning the impact of an internet pharmacy. RR stated that although this contractor was from Tower Hamlets, his pharmacy bordered the Hackney area.
Action no. / Description / Who to action / Completed17
previous / To send details of Internet Pharmacy application – highlighted by Tower Hamlets contractor to SE. / RR
5. prescribing program board
OOP expenses
HP stated that the medicines management team had shared a list with him of ten contractors who had claimed the most in terms of out of pocket expenses. HP stated that he had phoned all the people on this list, and there has a been a huge reduction in these claims.
KS reminded the meeting that provided these contractors have evidence for these claims then they were breaching no regulations.
HP stated that medicines management were trying to encourage contractors to buy better.
SE stated that he had broached this subject with the PSNC and they had sent him a response. SE then read out this response:
1. You have acted in accordance with the rules set out for claiming in the drug tariff.
2. Pharmacy contractors do not dispense products on cost grounds alone. They also take into account brand continuity, patient preference and availability of the product within the market at the point of dispensing, which may result in costlier products being supplied.
3. There is huge variation in purchase prices and discounts within the marketplace. This is accepted practice. Community Pharmacy remuneration is based on a system of “swings and roundabouts” – all contractors have a set rate of discount applied to their NHS payment, therefore they will lose on some products and gain on others. These gains constitute £18 million of purchase profit, which contractors are allowed to earn.
SE stated that there are no rules being broken, and SE stated that he would share this response with HP.
Over ordering of prescriptions
HP stated that Rozalia’s team at medicine’s management keep emailing him with incidences of this and HP has replied back to them stating the protocol for dealing with it. Which is currently:
-The CCG medicines management team should facilitate a practice meeting with the GPs and CPs involved and a protocol should be agreed between them.
HP stated that if after this, problems still persist, then he should be informed of specific examples of this and then he would visit the offending Pharmacies and he would reiterate the importance of following the agreed protocol.
EOLC – New Service Update
HP reminded that this is a new service, and that a training meeting will take place on the 31st March 2017. HP reminded that this is the first service the CCG has commissioned from CP. HP hopes that this service will be delivered well.
6. Devo Hackney/STP
RR reminded that he currently sits on the hackney healthcare and social transformation board.
RR stated that this board is currently concentrating on four areas:
- Unplanned care.
- Planned care.
- Child and young people’s health.
- Prevention.
RR stated that he would update the meeting members with any outcomes from this board.
HP stated that he had attended a Communication and engagement leadersevent on the 26Th January 2017 where he presented to 40 PR people on the subject of CP’s vision, concerns and aspirations. HP stated that the presentation had been received well.
RR stated that new services need to have some kind of patient feedback factor built into them.
7. training update
NP stated that there was currently nothing to update.
HP wondered whether videos/webinars should replace training meetings/pharmacy forums.
SE stated that webinars would enable CPs to have more of a life.
HP wondered whether live or recorded webinars should be favoured.
HP added that live webinars would cost money and there may be I.T. challenges with setting up and running a live webinar for lots of people.
Action no. / Description / Who to action / Completed18 / To trial making the next couple of training events into recorded webinars. / HP
HP stated that 50 C&H contractors had signed up to the C&I LPC’s organised health Champion training event – held in Camden.
8. CEPN update
HP stated that there was no update on this.
HP reminded the meeting that the GP confederation has won funding from the CEPN to train nurses to undergo vaccination training. HP stated that he is trying to link into this training for CPs.
RR wondered why CP wasn’t accessing these funds just as the GP confederation currently was.
SE stated that CP isn’t physically putting in bids for this funding. SE asked how many bids had been put in by CP.
HP replied that the only bid had been for Health Champion training.
RR stated that he didn’t know why CP didn’t have a rep. on the CEPN board.
RR suggested that the LPC add “making bids for CEPN funding” to the LPC work stream spreadsheet.
Action no. / Description / Who to action / Completed19 / To add “making bids for CEPN funding” to the LPC work stream spreadsheet. / HP
HP stated that he currently has no capacity to put together and submit multiple bids for CEPN funding.
RR suggested that funding be obtained to train more Independent prescribers.
The members discussed their interest in becoming IPs and all members except RR and NP 9already an IP) stated that it was currently too much of an undertaking (time and effort wise) to study to become an IP.
SE and NP highlighted the risks to employers re. allowing their pharmacists to train to become IPs – employers would get no quick return for their investment and they may lose their IP employees to GP surgeries once trained.
Action no. / Description / Who to action / Completed20 / To ask Sanjay Ganvir about the state of regional funding for IP training. / HP
9. pharmacy london
ERD
HP stated that Ashik Rai (Senior Implementation Manager at NHS DIGITAL) gave a presentation on activity and support for ERD (electronic repeat dispensing).
AR spoke to a PowerPoint presentation and highlighted the following points:
•Despite some pharmacists using ERD frequently AR has found that they are not using it properly.
•The main issue is the question of “when should Pharmacists marks items as dispensed”.
HP stated that AR had stated that Pharmacists must mark a prescription as dispensed when the patient collects the items and NOT when the items are simply put on the shelf at the Pharmacy.
HP added that AR had stated that half of all pharmacies he had visited are repeating the above mistake. HP stated that AR had added that this is causing big problems when a GP cancels or changes an item in a prescription.
RR stated that this change of marking a prescription as dispensed when a patient collects the prescription will cause a lot of extra work.
HP stated that if a prescription is marked “with dispenser”, it cannot be cancelled by the GP.
RR stated that ERD is causing a lot of confusion amongst GPs and CPs.
HP drew the meeting’s attention to the following links:
•NHS England ERD Guidance
•CPPE e-learning has been updated
•ERD Toolkit for Dispensers
•eRD Toolkit for Prescribers
HP stated that he would produce a webinar video on the ERD toolkit.
HENCEL
HP highlighted the following points:
•HENCEL – are having another round of budget cuts – 70% this time.
•HENCEL and HENWL LETBs are going to merge to make a North London LETB.
oAny bids made by Pharmacy to this new LETB for funding will have to be of a higher quality as more people will be bidding for this money.
NUMSAS
HP stated that there are currently 500 Pharmacies signed up to the PURM service, and 338 of these have invoiced for the service, therefore these 338 will be switched over to NUMSAS. HP added that this transfer will take place in June 2017.
New PL CEO – Amit Patel
HP highlighted the following points:
- Amit is not a Pharmacist.
- He has had 10 years of medical education experience (via HEE and the Deanery).
- He has helped with the management of large scale transformation across Primary care.
10. Hackney Public Health