South Essex Local Medical Committee

SOUTH ESSEX LOCAL MEDICAL COMMITTEE

Minutes of the Annual General Meeting of South Essex Local Medical Committee held at Rayleigh Parish Centre, Rectory Garth, Rayleigh on Thursday 26th May 2015 at 2.15 pm

PRESENT: Dr M Sharma (Chairman) Dr P Chisnell (Vice Chairman)

Drs Aderonmu, Aung, Barusya, Deshpande, Dhanjal, Harrod-Rothwell, Hunt, Khan, Kittle, Morgan, Moss, Okoi, Porter, Raja, Ramoutar, Srivastava and Waiwaiku, Mr Bradshaw and Mrs Pedder.

PART ONE

The Chairman began by providing members with a brief verbal update on the LMC Annual Conference held on 19th and 20th May, and in particular on the motion put together by the GPC on undated GP resignations. GPC will issue a full report shortly on the Conference and motions carried.

The Chairman then asked if there were any matters members wished to take in Part Two. There being none, she proceeded with the Agenda.

APOLOGIES FOR ABSENCE

Apologies for absence had been received from Drs Balmer, Butler, McMahon, Nanda, Siddique and Tayo.

DECLARATION OF INTERESTS

The Chairman asked members present to declare any new interests in respect of the discussion items. There were none.

MINUTES

Following correction of a typographical error on Page 3, the Minutes of the General Meeting of the Committee held on 28th April 2016 were confirmed and approved for publication on the LMC website.

MATTERS ARISING

P3 Our Urgent Prescription for General Practice: The office will be re-opening discussions with Local Authorities and Education Departments and will draft template letters for use by practices. Dr Porter will share an example letter with the office for information. The template letters previously 2

produced by the office in respect of secondary care work and included in the LMC “Managing Workload” Resource Packs will also be reissued to practices.

P3 Standards for the Communication of Patient Diagnostic Test Results on Discharge from Hospital: Dr Barusya confirmed that Southend CCG will be contacting the LMC office to discuss this issue.

P3 Firearms Licensing Process: The new process continues to be the subject of national concern and a motion was also debated at last week’s LMC Annual Conference. As a result, GPC will be conducting an urgent review of the process and will seek clarification on fees and the medico- legal implications for practices. The LMC had already shared guidance with practices but is currently preparing a series of template letters for the use of practices. In the meantime, practices should be reminded that they can legally refuse to provide information but they must notify the Police of their intention not to comply with the request within the 21 days.

P5 Diabetic Eye Screening: A letter from Dr Harrod-Rothwell to practices dated 23rd May 2016 was tabled. The letter confirmed that the LMC had now received the necessary legal assurances that the Data Sharing Sign-Up Agreement from Health Intelligence contains nothing that would render it unsafe for practices or patients. Health Intelligence had taken all the comments raised by the LMC on board, with the exception of indemnifying practices against fines from the ICO.

P5 Anticoagulant Medication: Mrs Pedder had sought clarification from Basildon and Brentwood CCG but to date no response had been received. Mrs Pedder will follow-up. Members remained of the view that the monitoring of Warfarin is not the responsibility of the GP.

DISCUSSION TOPICS

1. Annual Election of Chairman, Vice Chairman and Co-Opted Members and Review of Sub- Committees and Standing Orders

Nominations had been received from Dr Manjeet Sharma and Dr Paul Chisnell for the roles of Chair and Vice Chair respectively. Members agreed unanimously to accept these nominations and Dr Sharma and Dr Chisnell were duly elected to serve for a further year.

In accordance with the Constitution of South Essex LMC, up to a maximum of three practitioners can be appointed as Co-Opted Members representing a particular class of experience not otherwise represented on the Committee. One nomination had been received from Dr Kate Barusya which was unanimously supported by Members. Dr Barusya was therefore duly appointed to serve for a further year.

If Members are aware of any colleagues that are interested in becoming involved in the LMC and who have special experience not otherwise represented on the Committee, they are asked to contact the office.

At this point Members would usually consider the membership of sub-committees and the Standing Orders. However, given the fast changing environment within which primary care is now operating, it was agreed that the Secretariat would undertake a review of the sub- committees and bring back a suggested model to a future meeting of the Committee.

2. General Practice Forward View

Following publication of the “General Practice Forward View” (GPFV) and subsequently the Kings’ Fund report “Understanding Pressures in General Practice”, Dr Balmer had produced a draft localised action plan looking at the implications and opportunities for Essex LMCs. The 3

paper considers how the LMCs can ensure that the changes proposed in the GPFV can be implemented locally. Members commented on the individual chapters as follows:- . Investment: Members welcomed LMC engagement with Health and Wellbeing Boards to increase awareness of the GP crisis and ensure this is taken account of when Better Care Fund Plans are signed off. . Workforce: It was important that the LMC continues to work with HEE and EPIC to ensure that local funding is identified and used to the best advantage of general practice in Essex. The benefits of the GP Retainer Scheme were recognised by Members, but unfortunately there were currently no GP Retainers in Essex. . Workload: The LMC office is drafting guidance on safe working levels and as part of this work is looking at what might constitute a safe working model. There is currently no formal “Safe Working Model” but the following figures obtained from the BMA were tabled and Members’ views were sought. o Minimum appointments required per week 72/1000 patients (NHSE via McKinsie, but widely accepted) o Average list size per GP = 1600 approx (2014 NHS/HSCIC figures) o Therefore required appointments per GP per week = 115 o 115 appointments at 15 minutes each = 28.75 hours (previous NHS recommendation was 26 hours “contact time” per week) o 115 appointments over 9 sessions is 13 face to face per session o 13 appointments at 15 minutes each gives a clinic session of 3.2 hours (BMA contract suggest 9 sessions of 3.5 hours) Following discussion, Members’ confirmed that they would be happy for these figures to form the basis of an Essex model. . Practice Infrastructure: The NHSE Estates and Technology Transformation Fund is discussed under Agenda Item 3. . Care Redesign: Members felt it was important that care redesign should be driven by GPs not secondary care and questioned whether the new models of care would deliver the continuity of care that is a priority for so many patients.

Members also received an update on the GPFV from Dr Chaand Nagpaul and a recently published BMA “Focus On” document which summarises some of the key potential opportunities for general practice and provides a steer for LMCs and practices on maximising its potential to deliver change locally.

3. Estates and Technology Transformation Fund (Primary Care)

Members received and considered NHSE guidance for CCGs on submitting recommendations for funding from the Estates and Technology Transformation Fund. The aim of this three year programme is to help practices establish infrastructure which enables extra capacity for appointments in hours and at evenings and weekends to meet locally determined demand.

The intention is that revisions will be introduced to the NHS Premises Costs Directions from September 2016 to fund up to 100% of the costs of premises developments to improve affordability for GPs and reduce recurring costs. Members were therefore keen that as many practices as possible benefit from this significant additional investment and asked that the LMC office e-mail practices encouraging them to submit an application to their CCG. 4

Applications, which must support CCG local plans, will be reviewed by CCGs and those selected will be submitted to NHSE between 2nd and 30th June. Whilst Members recognised the timeframe was extremely short, it was understood that the initial application process for practices was fairly simple.

4. PMS Reviews

Members received a letter from Ros Roughton, Director of NHS Commissioning, NHSE, regarding the management of funding changes resulting from the recent national PMS Review Process.

The letter sets out the key principles aimed at ensuring that funding changes are managed in a way that does not risk destabilising general practice and confirms that commissioners will need to ensure that:-

. CCGs have published proposals for reinvesting the funding potentially released from PMS Reviews in line with national principles, and; . No funding is released from PMS practices facing reductions until reinvestment proposals have been confirmed.

The review of PMS practices has concluded in Essex and it was agreed that the LMC office will contact all Essex CCGs to seek clarification on their proposals for reinvestment of the funds that have been released as a result.

A BMA “Focus On” document was also received for information.

5. Chief Executive’s Report Delivered by Mr Bradshaw

5.1 Mid and South Essex Success Regime

The latest progress update was received for information.

5.2 Specialist Prescribing

Members received for information a letter from Dr Chaand Nagpaul to Professor Terence Stephenson, Chair of Council, GMC regarding GPs being able to prescribe safely within their limits of competence.

5.3 Local Enhanced Service for Sexual Health

Members received for information recent e-mail correspondence with Provide. Following a meeting of North Essex LMC on 12th May, Mrs Pedder had sought clarification on a number of issues and a response from Paul Hooper, Provide, was tabled. Mr Hooper’s e-mail confirmed:-

. Claims are required to be submitted within 7 working days of month end. . Whilst Provide are legally within their rights to withhold payment for claims made outside of the 7 working day window, they will act reasonably and consider late submission in the event of unforeseen circumstances. . Provide will not send any patient identifiable data to ECC. However, Mr Hooper’s statement refers to Provide as a provider of NHS services. On this occasion Provide act as a commissioner and Members therefore asked that the office seek further clarification that this statement is supported in law and that no Information Governance issues remain. 5

5.4 Support for Vulnerable GP Practices: Pilot Programme

A letter from NHSE dated 21st April 2016 was received for information.

5.5 Primary Care Support Services

A letter from Dr Chaand Nagpaul to NHSE dated 6th May 2016 highlighting the significant national concerns over the service provided by Primary Care Support England (PCSE) under contract to Capita was received for information, together with an update from PCSE. The LMC office continues to monitor the ongoing problems faced by practices, particularly with regard to records movement and ordering/delivery of supplies.

5.6 Essex Practice Manager Conference 2016

Members received an evaluation report of the conference held on 10th May 2016. Mrs Pedder provided details of the speakers and topics covered.

5.7 Report of the GPDF Treasurer to Conference

Members received for information Dr John Canning’s report to Conference.

5.8 EPIC Workforce Development

Members received a flyer for the inaugural Essex Primary Care Careers Fair which will be held on 11th June 2016 at the Post Graduate Medical Institute in Chelmsford. The Careers Fair is aimed at promoting career opportunities in Primary Care in Essex. Dr Porter provided details of some of the workshops that will be held during the day and encouraged Members to attend and also to inform colleagues of the event. The LMC will be represented along with most of the Essex CCGs. A copy of the April Newsletter was also received for information.

6. ANY OTHER BUSINESS

Employees as Patients: Dr Dhanjal asked if there was any guidance on patients being registered at the practice where they work. Whilst Members felt this was not good practice, they did recognise that on occasions it is unavoidable. In these circumstances, practices should have safeguards in place and a clear policy to identify the potential risks. The practice should contact the GMC for further clarification.

7. FOR INFORMATION a) GPC News 22nd April 2016 (Received)

8. DATE OF NEXT MEETING

The next meeting will be held on Thursday 23rd June 2016 at Rayleigh Parish Centre, Rectory Garth, Rayleigh at 2:15pm.