WIRRAL LOCAL MEDICAL COMMITTEE
Minutes from the meeting held on Monday 2 October 2017
In the Lairdside Suite, Royal Standard House
OPEN SESSION
2.15pm – 3.15pm
PRESENT:Dr R Williams Chair
Dr B Quinn Vice Chair
Dr A Adegoke Hon. Secretary
Dr B Ali Dr K Cooke
Dr G Francis Dr S Jarvis
Dr L McGrath Dr A Mantgani
Dr R Millard Dr J Mottram
Dr F Newton Dr M Syed
ALSO PRESENT: Dr Stephanie Gallard – Wirral Community Trust
Mr David Hammond – Wirral Community Trust
Ms Nesta Hawker – Wirral CCG
Mr Iain Stewart – Wirral CCG
Dr David Rowlands – WUTH
Mr Stewart Kennedy – GP Trainee
Mr Peter Lear – Wirral LDC
Ms Claire Ashley – BMA
Mrs S Lepts, Wirral LMC
64. Supporting GPs with Further Medical Evidence Presentation
Ms Lindsey Ollerheadintroduced herself as a healthcare practitioner with a nursing background, who provides medical advice for DWP. She gave a verbal presentation which enhanced knowledge of her role and the GPs role in providing further medical evidence (FME). (See appendix 1d).
Main points:
- FME is integral part of the process and negates need for face to face appointment
- FME requires a consistent and confirmatory statement from the GP about function only but GPs can comment on risk factors and red flags can help.
- Only 1/3 of a large number of FME requests were returned in 2016. If FME cannot be returned within 5 days it is still helpful to receive even 2 weeks later.
- Due to a departmental change, more mental health patients are being called in for assessment.
Ms Ollerhead summarised it is a contractual requirement to complete the FME request and is integral to her role; preferably within the timescale.
Members asked a few questions to which Ms Ollerhead responded:
- DWP does not advise patients to ask GPs for letters to strengthen their case but all sources of evidence are processed. Function is the main focus but a letter can be helpful if it raises a red flag. It is the GP’s decision whether to write a letter or not. GP can tell the patient they will be notified by DWP at some point to provide information so the patient does not require a letter
- A short computer printout is helpful if it details recent consultations regarding mental health but for functionality it is not. The ESA113 form needs to be competed in detail but a printout can be attached.
- It takes roughly 13 weeks for the FME to be processed but extends beyond that due to demand.
- If a GP knows that a patient is not entitled then they should contact the independent fraud company.
There were no further questions and the Chair thanked Ms Ollerhead for coming. He summarised that the presentation was very helpful and willbe disseminated to members, GPs and uploaded to the Wirral LMC website.
Ms Ollerhead left somebusiness cards and leaflets with the Office Manager and asked for an email to confirmthe number of GPs present at the meeting.
ACTION:
- LMC Office Manager to email presentation to LMC members, GPs and upload to LMC website.
- LMC Office Manager to email number of GPs present at meeting to Ms Ollerhead.
65. CCG Update
The Chair informed visitors that MSK was discussed in the closed session and anemail communication received from Dr Paula Cowan confirming a pause in the introduction of the service; to allow for further discussion involving primary care and Wirral LMC. He added LMC do not want to appear negative but have not been included in the preparation and want to make sure that the service is a success, everyone is happy and to be more specific that some of the contract involves the opportunity for primary care to deliver.
Ms Hawker confirmed there will be a pause in the service and the start date will be in December 2017. She added that the service model requires a prime provider but there is 30% within the agreement to sub contract to other providers, although difficult to state who that will be at this stage.
The Chair asked if a month’s pause is long enough and Ms Hawker replied that the piece of work and engagement so far has been 2 years in the making. It is currently getting to the stage of absolute detail of how to phase up from December and from then the need to recruit etc.
A member commented that it was 2 years in the making that LMC knew nothing about and requested LMC be made aware of future redesigns so proactive views can be put forward for consideration.
The Chair added it is CCG statutory requirement to involve the LMC and they should have involved LMC at an earlier stage but that an apology has been received by the CCG. The Hon. Secretary added that procurement law was given as an excuse but it is important for LMC to be involved with service redesign and at the onset, not when problems arise.
Ms Hawker agreed but asked if LMC were talking as members or primary care providers and stated that procurement law is a challenge when there is an integrated system. She added she would look for clarity within the CCG as to when and what the CCG can engage on in future.A member replied that LMC is not a provider organisation and represents commissioners as well as providers.
The Chair stated concern that if GPs are not on board or confident with the service they could potentially decide to refer everything. This could completely swamp the service and cause it to fail and he added it required further thought and discussion with LMC and maybe other stakeholders. The Chair asked how much discussion there has been with patient groups about the service.
Ms Hawker replied there were two recent events. The Chair asked how many patients attended and commented that 2 events was not a lot. Ms Hawker added that these were recent events and that this was something that can be discussed and clarified.
The Chair thanked Ms Hawker for her comments and invited Mr Stewart to give an update. He added that LMC had emailed a couple of times but not received a response regarding the request for an up to date picture of where the CCG is at with bids and funding available regarding GPFV.
Mr Stewart replied he will provide a summary of what is happening now and in the future with GPFV to go out with the minutes and gave an update on:
- Wi-Fi – Egton has been selected as provider and end of October 2017 planning schedule for input. Patient access to Wi-Fi. PM forum next week to provide more detail but there will be minimum disruption fitting of BT line (funded by CCG) and no extra cabling needed.
- Five Digital Bids in EFTT – CCG has been successful on all 5 bids and will receive £3.9m of capital. Will probably not see much change at General Practice level but support and modernisation for the network structure and great news across England as not handed out to every CCG.
- Level 3 Co-Commissioning –Mr Stewart gave members a hand out of all FAQs to date - at GP members meeting on 18 July 2017 an additional 18 questions were sourced(See appendix 1e). They will be reissued again in the weekly email bulletin on Wednesday. There is a secured 45 minute slot on the agenda for the October Member’s Meeting for Dr David Wilson from Halton CCG to give a talk, answer questions, listen to concerns and give his view as Halton CCG have been fully delegated for the last couple of years. Dr Rob Barnett will attend the LMC meeting on Monday, 6 November 2017 to discuss Liverpool CCG who are fully delegated,so members can hear from an LMC colleague. This is all in the build-upfor the CCG to ask if LMC support them for level 3 fully delegated. The deadline for last 2 years for application has been 1st December 2017 with voting in early November but NHSE has brought the deadline forward to 1st November 2017.
The Chair raised concern about the deadline being moved forward and questioned if 4 weeks was sufficient time for GPs to be fully informed of what being level 3 fully delegated means, to make an informed decision, take time to vote and for the CCG to be able to count the votes. Mr Stewart replied there is enough information available but that he has logged concern with Mr Tom Knight at NHSE and asked why the deadline has been moved forward. He added he is still working to the 1st November 2017 deadline but would be happy to draft an email to send on behalf of the CCG and LMC, detailing concerns raised.Members raised no objections.
There were no further questions and the Chair thanked Mr Stewart and Ms Hawker for coming.
ACTION:
- Mr Stewart to email summary re GPFV funding and bids to Office Manager, to be sent out with minutes.
66. WUTH Update
The Chair and the Hon. Secretary attended a meeting 2 weeks ago, at Old Market House, regarding the new hospital contract and the interaction between primary and secondary care. The Chair added Mr Rowlands was cc’d in a draft email regarding a joint LMC/CCG communication to be sent to all clinicians and asked for his opinion or any comments on it before it is sent out. Mr Rowlands responded he could not comment as he did not receive a full copy of the detail in the draft email and requested it be sent to him. He added that the meeting was constructive and contract changes are being progressed with in hospitalbut requested primary care give time for the policies to be put in place.
There were no further questions or update and the Chair thanked Mr Rowlands for coming.
ACTION:
- LMC Office Manager to forward draft copy of new hospital contract joint communication email to Mr Rowlands.
67.CT Presentation
Dr Stephanie Gallard and Mr Hammond were present but, due to the meeting running 10 minutes over, had nothing in particular to report.
The Chair stated he is aware Phlebotomy is a work in progress but asked for an update.
Ms Hawker commented the CCG is hoping a decision about Phlebotomy and how it is going to work going forward will be madeat a meeting tomorrow, which includes discussion with both Federations and GP practices. The Hon. Secretaryexpressed concern that LMC have not been included in this meeting despite repeated requests to be involved. He added it was unacceptable for the CCG to involve the Federations only. He stressed that LMC represents GPs as commissioners and providers and should be invited to meetings as LMC provides neutral opinions and what the average GP wants.
Ms Hawker replied she will share this concern in the meetingtomorrow and will ask Dr Cowan to speak further about it toLMC, as it is difficult for her to discuss it with the present provider of the service in the room.
The Chair requested that the CCG not make a decision in the meeting tomorrow and added that LMC will discuss it further with Dr Wells and Mr Banks at the LMC meeting with them on Thursday 5 October, 2017. Ms Hawker stressed the final decision would not be made tomorrow only an indication of the way forward.
There were no further questions and the Chair thanked all representatives for coming.
68. Correspondence
None.
69. Any Other Business
None.
70. Date of next meeting
The next LMC meeting is Monday,6 November2017, commencing at 1.15pm and finishing at 3.15pm.
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