NORTH ESSEX LOCAL MEDICAL COMMITTEE

Minutes of a Meeting of North Essex Local Medical Committee

held atthe Boreham Village Hall, Main Road, Boreham

on Thursday 14thJanuary 2016at 2.15 pm

PRESENT:Dr J Hodgkinson (Chairman)

DrsAhmed, Casey, Chowhan, Dabas, Guille, Harrod-Rothwell, Kandasamy,Melamed, Muir, Obisesan, Oliver, Onuorah, Roberts, Strowbridge, Taylor, Wier and Wijekoon,Mr Bradshaw and Mrs Pedder.

PART ONE

APOLOGIES FOR ABSENCE

Apologies for absence had been received from Drs Balmer, Basra, Faerestrand, Ipakchi, James and Johnston.

The Chairman began by askingif there were any matters members wished to take in Part Two. There being none, she proceeded with the agenda.

DECLARATION OF INTERESTS

There were no new declarations of interest.

MINUTES

The minutes of the meetings held on 12th November and 10th December 2015 were confirmed by the Committee and agreed for publication to the LMC website.

MATTERS ARISING

There were no matters arising that were not included in today’s agenda.

DISCUSSION TOPICS

  1. Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

1.1Members received and considered the joint document prepared by NHS England, NHS Improvement, Health Education England, NICE, Public Health England and CQC.

1.2Whilst members acknowledged the need for transformation, they considered that general practice in Essex first required a period of stabilisation, given the extreme workforce and workload pressures currently faced by practices in the county.

1.3Whilst the obvious political drive towards seven day access remained evident, members welcomed the reference on page 8 to “improving access to primary care at weekends and evenings where patients need it …” The document does, however, go on to reaffirm the goal for 100% of the population to have access to weekend/evening routine GP appointments by 2020.

1.4Experience of demand for seven day access varied amongst members, but Dr Taylor reported that take up for the weekend service currently being offered by Stellar Healthcare in West Essex was good and appears to be increasing.

1.5Members were interested to know how the vanguard sites had performed. Dr Harrod-Rothwell advised that this will undergo evaluation but due to variances in demographics, the data may not provide a comprehensive picture.

  1. Support for Vulnerable GP Practices – Pilot Programme

2.1Members received a letter from NHS England dated 7th December 2015 setting out how the programme will be delivered and looking at how best to identify and support the most vulnerable GP practices.

2.2The criteria to be used to identify practices –CQC ratings of “inadequate” or “requiring improvement” and local intelligence – should be used with caution. There is a risk of prejudice if the number of complaints received by a practice is taken in isolation. Practices may be struggling to maintain a high quality service as a result of recruitment or workload issues.

2.3Members were of the view that the funding available was grossly insufficient and questioned how many practices would apply given that they are required to match the funding contribution at 50%. The practices that do benefit from this programme are not likely to be those that would instinctively be considered as vulnerable.

2.4The office will check whether APMS practices are to be included in the programme.

  1. PMS Review Process

3.1Members first considered the draft criteria prepared by NHS England for the use of freed up PMS Premium monies which followed national guidance. Members’ attention was particularly drawn to item (b), below:

Secure services or outcomes that go beyond what is expected of core general practice or improving primary care premises. There should be no premium funding that is not tangibly linked to providing a wider range of services, or providing services to higher quality standards or providing services for a population with specific needs that are not adequately captured by the Carr Hill formula. Funding could also be used to support improving the quality of primary care premises, for example, to support delivery at scale.

3.2Mr Bradshaw had negotiated tirelessly with NHS England to ensure that freed up PMS monies are reinvested fairly in general practice. Members were aware that the proposals currently being put forward replicated criteria that were contained in the national guidance issued in September 2014. Unfortunately the situation in Essex has deteriorated rapidly since then to the point whereby general practice has become increasingly unsustainable in parts of the county.

3.3Given the current crisis, and the lack of any plan or resources at a national level to address this, members were strongly of the view that the first call on any locally freed up PMS monies and/or Transformation Funds should be to support practices in the continued delivery of high quality core services in line with current contractual arrangements.

3.4It was noted that all locally freed up monies had now been devolved to CCGs. It therefore seemed sensible that CCGs should in the first instance assess the sustainability of general practice with a view to prioritising the future use of freed up monies.

3.5Anything over and above core services should be funded via alternative budgets, DES/LES payments, and not from the Transformation Fund. The Committee’s comments will be fed back to NHSE and CCGs.

3.6There is, however, no simple definition of what services are core. Mrs Pedder had done a great deal of work over the past few years to identify services that have, at any time, been commissioned as an enhanced service and guidance has been issued to practices. Ultimately the decision of whether to continue to dounresourcedwork remains with practices, and the Committee recognised that patient satisfaction is a huge factor. The office will review and update the guidance on enhanced services and circulate to practices and will also seek advice from GPC as to the definition of what constitutes core services. Members were reminded that template letters are included in the LMC Managing Workload resource packs and the office will review these periodically to ensure they remain current.

3.7A summary update on the PMS Review Process in Essex together with Dr Balmer’s letter to practices dated 11th December were received for information. All PMS practices are entitled to return to GMS arrangements at any time as legislated for in the PMS Regulations. Mr Bradshaw had recently produced guidance for PMS practices on this right of return to GMS arrangements. A copy of this guidance, together with the covering e-mail to practices dated 8th January, was also received and considered by members.

  1. Mid Essex CCG – Proposed Changes to Healthcare Services

4.1Members received a consultation document circulated by Enable East on behalf of Mid Essex CCG. The document had been shared with the LMC by a Mid Essex practice. The consultation closed on 28th December but the CCG had subsequently apologised for omitting the LMC from the list of stakeholders and had confirmed that any comments from today’s meeting would be accepted.

4.2Members had a number of comments and concerns:-

  • Prescriptions for Gluten-free foods: Whilst this should not pose a problem to the majority of patients, the most vulnerable could be affected by the increase in costs.
  • Hearing Aids for mild hearing loss:Changes being proposed to the hearing aid service will have a significant and detrimental effect on an already vulnerable group. Changes of this nature will widen health inequalities as opposed to reducing them.
  • Vasectomy and Female Sterilisation: It is imperative that where appropriate equality impact assessments associated with these proposed changes are based on the couple rather than one party which does not have appear to have happened in the case of proposed changes to contraceptive services. From a clinical perspective there appears to be no justification for withdrawing the Vasectomy Service which is the lowest risk and most effective method of contraception available to couples and that does not expose either partner to the risks of exogenous hormones.
  • GP Accessed Physiotherapy: The workload implications of these proposed changes on general practice appear to have been completely overlooked. Those proposed for Physiotherapy will result in an enormously increased and un-costed demand on general practice.

4.3Whilst the financial climate for CCGs is very difficult and the proposals are well intentioned, members were of the view that the time and effort involved in this consultation exercise, and the significant angst that would be caused to patients as a consequence of the changes, were disproportionate to the projected level of savings when taking into account the overall financial deficit in the local health economy. The office will respond to the CCG accordingly.

  1. Chief Executive’s Report

5.1Avoiding Unplanned Admissions DES

Members received LMC e-mails to practices dated 15th December and 6th January, together with a letter from NHS England to Dr ChaandNagpaul dated 30th December. LMCs have been pressing NHS England to make an interim payment on account to practices and following a teleconference last week, NHS England has now issued details of a process by which practices should be able to enter data manually in order to expedite payment.

5.2Essex Golden Hello Scheme

Members received a letter from NHS England dated 23rd December advising that, to ensure an equitable approach across the NHS East region, the Golden Hello Scheme will no longer be supported with immediate effect. Whilst only four new GPs had received funding under the scheme, the termination of the scheme would certainly not help the current workforce crisis. It was unfortunate that equity could not be achieved by extending the scheme to the rest of the Eastern region.

5.3Learning Disabilities (LD) Healthcecks

Members received an e-mail from Elaine Roe, NHSE, seeking the Committee’s view on the LD Healthcheck DES and the interpretation of the 2012 Directed Enhanced Services Directions, namely if a contractor has signed up to provide the LD DES but has not undertaken the required health checks, could this be deemed as “not capable” based on previous performance. Members were asked to consider two options, the wording of which had been taken directly from an e-mail from Ms Roe dated 22nd December 2015:-

a)NHSE agree with the LMC that practices are deemed as “not capable” if they have signed up previously but did not offer or undertake any health checks; or

b)Seek the support of the LMC to press upon contractors to only sign up to the DES if they are fully committed to providing the service.

Members unanimously supported option (b). Mr Bradshaw will report back to Elaine Roe accordingly.

5.4GPDF

Members received a letter from the GPDF Treasurer confirming that a rebate of the levy paid for 2015 (approximately 22.5%) will be made to LMCs.

5.5Motions to Special LMC Conference and Annual Conference

Members received for information details of the motions submitted to the Special LMC Conference which will be held on 30th January. Any suggested motions for the Annual Conference to be held in May should be e-mailed to the LMC office.

5.6LMC Professional Indemnity Forms

All members were asked to complete and return the declaration to the LMC office by 1st February 2016.

5.7LMC Elections

The following constituencies are due for re-election in 2016:-

  • Colchester
  • Epping
  • Tendring
  • Ophthalmic Medical Practitioner.

Nominations will be sought towards the end of January. Existing members in these constituencies were reminded that they are required to seek re-nomination.

5.8EPIC Newsletter

The December edition of the EPIC Newsletter was received for information.

  1. FOR INFORMATION

a)GPC News 18th December 2015(Received)

  1. DATE OF NEXT MEETING

The next meeting will be held at 2:15pm on Thursday 11th February 2016 in the Goodwin Room, Boreham Village Hall.

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