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NEWCASTLE AND NORTH TYNESIDE
LOCAL MEDICAL COMMITTEE
(www.nntlmc.co.uk) (email: )
Chief Executive Officer Executive Officer Executive Officer
Dr. George Rae Dr. David Black Dr. Ken Megson
Beaumont Park Surgery 2 Betts Avenue 29 Beverley terrace
Hepscott Drive Benwell Cullercoats
Whitley Bay Newcastle North Shields
NE26 9XJ NE15 6TQ NE30 4NU
Tel: 0191 2514548 Tel: 0191 2743767 Tel: 07803 989960
Minutes of the meeting of Newcastle and North Tyneside Local Medical Committee held on Tuesday 5th September 2017.
17.52 PRESENT
Dr G. Rae (Chair) Dr K. Megson
Dr D. A. Black Dr M Chaudhary
Dr C. Doig Dr A. McCubbin
Dr H. Minney Dr N. Morris
Dr C. Pandilwar Dr. A. L. Ramshaw
Dr G. Reissmann Mr J. Snaith
Dr S. Summers Dr M. Wright
17.53 INTRODUCTIONS/APOLOGIES FOR ABSENCE
Apologies for absence were received from Drs Cookey, Flint, Graham, Moore, Pearson, Podogrocki, and Mr Smith.
17.54 DECLARATIONS OF INTEREST
There were no new declarations of interest.
17.55 GP COMMISSIONING
i) Individual Funding Requests (IFR)
Several practices had raised issues around IFRs and who completes these. In several instances these had been bounced back and forth between primary and secondary care, and that some clarification was needed around this issue.
Clearly if an IFR was known to be required then the GP should complete it before the referral is even made. Questions were asked around the issue of diagnostic uncertainty, and whether consultants should complete the IFRs in these cases. It was said that this is possible, but that there is a need to avoid the hospital doing unnecessary work, and that if this work was all done in secondary care, this would have the potential to reduce capacity to see patients. It was mentioned that the IFR website suggests that a letter is sent to the patients GP in cases of diagnostic uncertainty. It was felt by some that VBC vouchers are straightforward, and that this doesn’t take long to complete but others suggested that this takes longer than thought, and that the implications of this added time are significant. It was felt that if supportive letters are sent to GPs, they are happy to action IFRs in these circumstances. It was asked whether logins for the system are unique to GPs or to practices, and it was said that generic logins for practices are in use.
ii) Complex wounds
Several practices in Newcastle had experienced issues around their nurses undertaking complex wounds, as that this was not a part of GMS. It was asked whether this was a part of the enhanced services but it was confirmed that simple wounds was but not complex ones. There was an issue about the criteria for complex as opposed to simple though.. Practices have asked if they can stop providing this service and practices may well give notice on this issue. The CCG agreed to investigate the matter.
17.56 ACUTE TRUST BUSINESS
i) Changes to NHS Standard Contract
The trust had met with the CCG recently around the above, and that this had been useful to helping reach a position of understanding around the contract. It was said that the trust now feel that they are largely happy with the contents of the contract, but that there a still a couple of small issues. DNA policy was mentioned as one of these, and it was said that the trust is currently working on a procedure for this that will provide more clarity.
Fit notes were also mentioned as an issue, and that the trust is being asked to provide a time specific fit note upon discharge, which is not felt to be optimal for patients. It was felt that this could cause unnecessary referrals back to General Practice, but that if timescales for recovery were included on discharge letters to GPs, this would be extremely helpful.
Pain management was also mentioned, and it was said that there are some issues around tertiary pain management, and the requirement for these patients to be referred back to GPs for management. Consultant to consultant referrals were mentioned, and it was felt that this has had already had a good procedure in place for several years. With regard to tertiary pain management it was noted that a GP is more likely to have a better holistic view of the patient’s history, and may in these instances be the best person to manage this issue. The North East as a region is one of the highest prescribers of opiate medication. Although there was no suggestion of a link to pain management clinics there may be an unintended consequence arising from medicines management policy as non opioid alternatives have been restricted.
It was felt that there is a lot that a patient’s GP can do a lot towards pain management, which can circumvent the long waiting times for pain management clinics.
There were some questions around discharge letters, including whether letters to patients with GPs copied in are counted and it was confirmed that they are. It was also asked whether a letter was needed to be sent where the same GP system is used between the two services.
17.57 GP FEDERATIONS UPDATE
i) North Tyneside
A draft of the improved access plan had been sent to the board of Tynehealth prior to finalisation. Tynehealth are aiming to have four hubs on stream before the end of September, including one in Whitley Bay. It was mentioned that the federation is using the extended hours online system to advertise vacant duties in North Tyneside. Also a shareholder meeting will be held at the end of the month. There were some questions around recent IT issues that had been experienced, and it was said that a decision had been taken to go with MIG, as opposed to smartcard access. The MIG was briefly explained. There some questions around prescribing, and it was said that the CCG have specified urgent prescribing in North Tyneside for Tynehealth, and non-urgent for practices. It was asked whether the service is manned from North Tyneside practices, and it was said that the federation wants local workforce to staff the service.
ii) Newcastle
An email had been received from the Newcastle federation representative, which detailed the finalisation of admission of practices from the west end of Newcastle following the dissolution of their federation. It was said that several practices have not yet joined, and that they are welcome should they wish to. It was mentioned that Christian Townend is now working full time for the federation, and that this has added a significant boost for the organisation. The federation remains eager to develop close working relationships with other local organisations, and are looking at the potential of supporting the emergency contract at Grainger Practice from December 2017.
17.58 MINUTES OF THE LAST MEETING
Apart from one minor correction, the minutes of the meeting held on 6th June 2017 were confirmed as a true record.
17.59 MATTERS ARISING FROM THE MINUTES
i) Item 17.42 ii) – LMC succession plan
There were some issues around timescale for the individual in line, as he had experienced issues around recruitment to support their practice, which is causing delays in the shadowing process. It was reiterated that the execs would not be leaving at the same time. It was also mentioned that the dates for the LMC conference have changed, and that this had originally been stated as a finishing point for support for the new occupants of the roles. It was stated that support would continue towards the end of the medical political year in May/June 2018.
ii) North Tyneside Procurement – Legal Challenge
The above was mentioned, and it was said that there were no further updates.
17.60 GENERAL DEBATE SESSION – Motions for Conference – deadline 18th September
The deadline for submission of motions is the 18th of September, and the committee was asked to submit ideas. A letter will be sent to members prior to submission. It was mentioned that the organisers have specified that they would like constructive motions to be submitted.
17.61 CHAIRMAN’S BUSINESS
i) LMC Open Meeting 2018
It is hoped that a further open meeting for GPs & PMs will be held in early 2018, to try and promote the LMC and attract new members.
ii) Support for Colleagues
The LMC had supported a practice with their bid for around development funding, but the outcome had not been successful. The practice in question has had to fund their own development, which is causing difficulties for them.
iii) Healthwatch Trustee North Tyneside
Healthwatch North Tyneside had attempted to recruit a retired GP to interview for the role as trustee. The individual who had been asked had felt that they were too long retired to hold any relevant views on the current medical landscape. It was asked whether any committee members had any individuals to suggest for this.
ACTION NEEDED: Item in newsletter advertising this.
iv) LMC History
It was briefly mentioned that the history of the LMC is important, and it was felt that this needed to be recorded for posterity perhaps as page on the website. It was also mentioned that the chair of the LMC had been asked to speak at a honorary dinner for Chaand Nagpaul.
It was also felt that some discussion is needed around ‘looking after our own’ without being preferential, i.e. how to raise awareness in care of medical professionals being treated. In addition it was noted that the LMC needs to discuss ACOs/ACSs in the future.
17.62 SECRETARY’S BUSINESS
i) LMC Annual Conference delegates
The LMC has 3 delegate places to attend the England LMC conference in November. One of the potential delegates needed to confirm whether they will be able to attend, and the committee was asked to nominate possible reserve delegates.
ACTION NEEDED: Letter to committee members asking for reserve delegate nominations
ii) Pharmaceutical Needs Assessment- Newcastle
LMC had been contacted by the local authority with regards to the above, and that the LMC would compose its response after consultation with colleagues on the LPC when required.
iii) Ponteland Rd/Grainger Road Consultations
After discussion it was felt that for Ponteland Road, closing the practice would put too much strain on the surrounding practices, due to the high levels of deprivation in the area. It was stated that the current contract with Freeman Clinics is coming to an end, and that a risk assessment is required for the contract.
The LMC had also been asked to comment on the Grainger Medical Practice consultation, and it was felt that it would be more practical to operate this practice over one site, due to the logistical issues of operating across two sites. It was suggested that the two sites could run as two separate practices, and but this was not an option in the consultation document.
17.63 TREASURER’S BUSINESS
Some discussions with NHSE had been held around the issues with the levy payments. It had been discovered that levy payments had not been collected from several practices in the area for some time and the treasurer is currently looking into this. It was mentioned that one practice are conscientious objectors to the LMC levy payment, and it was suggested that this practice could be approached to see whether they would like to change their minds.
17.64 PRACTICE MANAGERS’ ISSUES
There were no Practice Managers’ issues.
17.65 SESSIONAL GP ISSUES
One of the sessional representatives would be attending a meeting for Locum GPs the following week, and it was asked whether sessional GPs see the LMC/GPC news. It was said that the news is uploaded onto a website that sessionals have access to.
17.66 ANY OTHER BUSINESS
A member mentioned that the police may have key codes for patients houses in Newcastle, which could be helpful in situations where doctors are struggling with this as an issue. Useful as last resort as may require Police to attend in person
17.67 GPC NEWS
There were no matters arising from the GPC news.
17.68 DATE AND TIME OF NEXT MEETING
The next meeting will be held on Tuesday the 3rd of October 2017 in the Board Room at the Freeman hospital at 6:45pm.