Minutes of the Meeting of the Powys Subcommittee of Dyfed Powys Lmc on Tuesday 10Th May
MINUTES OF THE MEETING OF THE POWYS SUBCOMMITTEE OF DYFED POWYS LMC ON TUESDAY 10TH MAY 2011 AT BUILTH WELLS SURGERY
Present
Dr Doug Paton, Crickhowell
Dr Antony Lempert, Knighton
Dr Chris Nevill, Newtown
Dr Peter Howard, Haygarth
Dr Howard Christley, Builth Wells
Dr Eleri Gittins, Caereinion
Dr Simon Currin, Montgomery
Dr Sara Lampert, Welshpool
Mrs Ros Gittoes, Practice Manager, Haygarth
Also present
Dr Brendan Lloyd, Medical Director
Mr Andrew Cottom, Chief Executive Officer
Mr Gerry Davidson, Senior Partnership Manager
Apologies
Dr Mark Thompson, Rhayader
Dr Huw Evans, Llanfyllin
Dr Chris Breese, Llanfyllin,
Dr Andy Raynesford, Llanidloes.
Dr Paul Metcalfe, Brecon.
1. Setting the Direction
Mr Gerry Davidson made a presentation detailing the work of Dr Chris Jones entitled “Setting the Direction”, the key message of which was the design of integrated health and social care pathways for elderly people in particular. Dr Jones identified that currently patients are pushed in and out of hospital based care as a result of the lack of appropriate resources, and this needed to be replaced by a pull system of care. The design of services would require strong clinical leadership, based around locality working, building the capacity of local services with good communication.
The model being developed in Powys is pre-emptive, with the identification of risk, early intervention, good quality information and a range of local supportive services. There was a focus on GPs identifying risk and managing the care supported by extended community nursing including rapid response and a range of care home beds.
There were a number of challenges to the service transformation required –
- financial, there is no new money to facilitate change
- need to share across sectors
- need to engage communities in the process
- adopt a co-operative behaviour.
Dr Nevill identified issues around secondary care discharges. It was acknowledged that primary care was well developed and the GPs role needed to be surrounded with services offering support.
Among the obstacles to the design identified by the GPs were the lack of time within GP practice to allow them to engage with the organisation, although it was also suggested that some regulatory issues in social services made GPs cautious about engagement. In addition, the cumbersome reporting lines in both health and social care do not encourage GP involvement. Difficulties with getting indicative budgets and commissioning data were also highlighted, although it was suggested that most practices could extract referral data through their docman systems.
2. Minutes of the previous meeting
The minutes of the meeting held on Tuesday 11th January were agreed as a correct record.
MATTERS ARISING
3. LHB/LA merger
Mr Cottom reported that while formal merger was no longer of the cards, both he and the CEO of the County Council was committed to a process of greater integration of which “Setting the Direction” is a subset.
There has been discussions with Hwyel Dda LHB about closer working, particularly in respect of Bronglais Hospital where Powys patient were a key component of future work. It was noted that there were important links with English hospitals and this didn’t always sit well with WAG strategy. While the transport infrastructure encouraged cross border referrals if was not feasible to refer patients to Wrexham. Dr Pete Howard reported that he had been invited to a working party on cross border issues with WAG next week, he indicated that this was multidimensional, with possible consequences for practice lists if there were changes to the existing commissioning arrangements in England and Wales in light of the White paper in England.
4. Engaging in the quality agenda
Dr Lloyd once again highlighted the importance of evidencing the quality of work undertaken in general practice. The Faculty of Quality Improvement had been established and documentation can be found on the LHB website and Dr Lloyd urged general practice to get engaged and Breder Worthington is able to work with practices.
Dr Lloyd indicated that the map of medicine can still be accessed through my health online, although this would be without local editing facility.
5. Sexual Health Services
There have been some meetings, however the accreditation criteria had not changed.
6. Shrewsbury/Telford
It was noted that the plans proposed in the consultation document had been approved, however there continued to be concerns about access to Wrexham services as an alternative, as the public transport network feeds towards Shrewsbury.
7. Section 12/2
GPs reported that psychiatric services were at an all time low. There are huge problems accessing specialist out of hours services in S.E. Wales and it was reported that specialist care is north Powys out of hours was almost nonexistent. GPs suggested that better services could be commissioned from across the border in England.
It was agreed to ask Chrissie Hayes to update the LMC.
NEW BUSINESS
8. Quality and Productivity Indicators in QOF
The new quality and productivity indicators in QOF covered 3 distinct areas - prescribing, referrals and emergency admissions. Dr Lloyd indicated that the LHB would be looking at Statins, ACE inhibitors and PPIs as areas for action under the prescribing indicators, and these would be in addition to three different prescribing indicators identified under medicine management. It was confirmed that the existing locality structures would be utilised for the new QOF processes.
There would be no specific targets around for referrals and emergency admissions, it was suggested that these indicators were to promote engagement between practices and with the LHB. Dr Lloyd indicated that the care pathways was likely to concentrate on orthopaedics and ENT, while the issues for the emergency admissions is likely to focus on falls, COPD and end of life care.
Dr Lloyd indicated that there could be issues around the provision of the commissioning data from England. GPs highlighted that they would have commissioning data on their computer system which could be extracted using the doc-man system, it was suggested that an enhanced service could be established to assist the data collection.
9. Report from GPC Wales
Dr Pete Howard, Powys Rep to the GPC Wales advised the subgroup that the Welsh Assembly Government had made a made an administrative error in the calculation of last year’s global sum, it has been confirmed that any overpayment will not be reclaimed, although this year’s payment had been adjusted to reflect the position had the overpayment not been made. Dr Howard also confirmed that the PE7&8 will be adjusted for 2010/11 to reflect the grounds for appeals in 2009/10.
10. LMC/LHB meeting
Dr Doug Paton indicated that most issues had been covered in the meeting. In addition however there had been a suggestion that the Lifestyle LES would be reviewed with a view to making the scheme more encompassing. The group were reminded that while the LHB might wish to discuss the clinical governance toolkit at the QOF visit, the toolkit was voluntary and practices could chose not to participate.
.
11. Date of next meeting
The date of the next meeting is Tuesday 13th September.