Doncaster Local Medical Committee Ltd s1

1 PRIVATE AND CONFIDENTIAL DONCASTER LOCAL MEDICAL COMMITTEE LTD (Company Reg No: 6775496)

MINUTES OF THE OPEN MEETING HELD AT 7.30 PM ON MONDAY 10TH MARCH 2014: DONCASTER GOLF CLUB, 278 BAWTRY ROAD, DONCASTER DN4 7NY

Present:

Dr P D Wilson (Chairman) Dr K Lee (Treasurer) Dr D Eggitt (Secretary) Dr M Sheikh Dr A Bray Dr J Saddler Dr D MacKenzie Dr E Njoku Dr R Shah Dr R Nayar Dr A Oakford Dr K Rowell Dr A Zaidi Dr A Khan Dr V Rehman Dr R Dachtler Mr E Emovon

In attendance:

Dr N Tupper, Chairman, Doncaster CCG Mr C Stainforth, Chief Officer, Doncaster CCG Mrs M Coulman, Head of Strategy and Delivery, Doncaster CCG Dr Pat Barbour, SE Locality Lead.

Mrs J Reynolds, Lay Secretary

2014.26 CHAIRMAN’S ISSUES

 The Chairman welcomed the Committee and DCCG representatives to the meeting. Dr Pat Barbour, SE Locality Lead, was also welcomed, together with Sarah Ritchie, Medical Student at Dr Sheikh’s practice.  Apologies for absence had been received from Dr Rupert Suckling and Dr Trish Edney  The Committee were requested to lodge any new declarations of interest with the Lay Secretary.

2014.27 MINUTES OF THE LAST LMC MEETING

Following slight amendments, the minutes of the last meeting held on 3rd February 2014 were approved as an accurate record.

2014.28 MATTERS ARISING FROM THE LAST LMC MEETING

2014.17 Shared Care – Bariatric monitoring

Dr Eggitt updated the Committee. Monitoring protocols for patients who have undergone bariatric surgery have now been received from the DRI. Dr Eggitt will look at these in terms of impact of work on primary care, and will present his views at the next meeting. It was noted that some bariatric work is done at DRI and some through the Sheffield Teaching Hospitals.

Action: Dr Eggitt to report back at the next meeting on the bariatric monitoring protocols. 2

2014.19 Neo Natal Dried Blood Spot/Hepatitis B update

The Area Team have been contacted regarding the roll out of this Public Health Screening and Immunisation pathway, and what plans are in place for the training of practice nurses to undertake the dried blood spot sampling at the same time as the 4th dose for all at risk infants. We have been advised that training on taking the DBS will be available electronically and will also be incorporated into the annual immunisation training updates. Training materials will be available to primary care as an e-learning course from Public Health England.

2014.18.4 Winter Pressures funding

Following discussion at the last LMC meeting, when the DCCG had confirmed that additional ‘in hours’ surgeries could not be undertaken as part of the Winter pressures funding as this would, in the opinion of the DCCG, be a duplication of GP core work. The LMC requested clarity from the DCCG on how this sits with the Doncaster 8-8 Centre, which, it is understood, is offering additional ‘in hours’ surgeries to both registered and non registered patients. Chris Stainforth stated that he believes a mistake has been made with the 8-8 Centre, in terms of the commissioning arrangements for their registered population by the Area Team. When the overall contract for the 8-8 Centre was devolved from the Area Team to the DCCG, it was not made clear that the winter pressure monies would only be available for the non registered population. Dr Oakford believed that this was clearly specified.

Dr Eggitt sought clarity on whether this was not a duplication of the core contract, as the Doncaster 8- 8 Centre were already being paid for registered patients. At the last meeting Dr Edney had advised that additional ‘in hours’ surgeries were being run in Sheffield GP practices. However, post meeting Martha Coulman had consulted with the Area Team and it had been confirmed that this was not allowable. However, the Doncaster 8-8 Centre had not been mentioned specifically. It is understood that it was never the intention that the winter pressure monies were to be used for registered patients. Services for the registered population at the Doncaster 8-8 Centre are commissioned by the Area team, whilst general non-registered patients are commissioned by the DCCG as part of the 8-8 Centre’s APMS contract which is a split contract. The winter pressures funding would be a contract variation of the original contract, as occurred a year ago under the PCT.

Dr Shah asked who is accountable for the Doncaster 8-8 Centre, and why GPs are still see patients in A/E who have already been seen by a clinician at the 8-8 Centre? He suggested that the service provided by the 8-8 centre does not appear to be an effective use of resources. Dr Tupper stated that this will be a question to ask when the DCCG do a review of unplanned care in May. Chris Stainforth agreed to send dates and time of this meeting to the LMC office.

A question was raised on why one provider is allowed to offer a service and not another, and how does this sit with competition law. Chris Stainforth stated that he would be willing to look for a way around this, but would need to see what Sheffield has done. However, in view of the lateness of the season, the opportunity to bring extra winter funding into Doncaster GP practices has now been lost.

A brief discussion took place on out of hours work, ie Saturdays and Sundays. Dr Eggitt clarified that whilst this had been pursued as a good use of winter pressure monies, it was purely for those GPs who had expressed an interest, and not mandatory for all GPs. Dr Bray stated that non recurrent winter monies versus a GP Practice’s regular ongoing commitment are two very different scenarios.

Action: Chris Stainforth to let the LMC office know of the date and time of the May meeting on Unplanned Care.

2014.29 DCCG UPDATE – Dr N Tupper

Use of winter pressures money on care for the elderly and vulnerable adults

Dr Tupper stated that this winter service is proceeding very well, and lots of activity is taking place. £160,000 has been invested. We await the feedback in May to decide whether the use of winter 3 monies this year has been effective and whether this experience can be used in shaping or forming part of future work in Primary Care.

In addition, all Practices have received a letter offering a £2,000 non recurrent amount for the purchase of equipment, (from a specified list).

North West locality

A ballot is underway in the North West Locality, following the receipt of two applications for the position of Locality Lead. Closing date 18th March.

Named GP for over 75s.

Dr Tupper stated that details are still awaited, but confirmed that money has been allocated within the budget to facilitate this.

Annual General meeting of DCCG 27th March.

This is open to all localities, but unfortunately there is no backfill funding.

Children’s Trust

Chris Stainforth gave details of this new Children’s Trust for Doncaster, which is in the process of being formed and will be the first in the country. It will be a non profit making independent Limited Company and will be chaired by Colin Hewitt, who has been appointed by The Secretary of State, with some other national figures on board. The recruitment process for Chief Executive and other members of the team is ongoing. Details are still sketchy on how it is to be configured, but some of the current children’s services, eg CMARAS and the Integrated Family Support Services, will be put into this new provider. Initially there was some resistance from the DCCG due to concerns around lack of clarity, but now things are moving quite rapidly and the Council have worked closely with the Dept of Education and agreement has been reached. It is perceived that this new private provider – the Children’s Trust, will provide constructive change to a system which had not been working well previously. The core Council services are being put into place first, with further development on the health side.

Future contracting arrangements with GP Practices

Dr Tupper confirmed that a letter had been sent out to all Practices in mid February.

Consumables

It was confirmed that the DCCG have agreed to pay GP Practices for consumables (phlebotomy needles) as part of the Treatment Room enhanced service. 4

2014.30 PUBLIC HEALTH UPDATE

No report available – Dr Suckling on annual leave.

2014.31 REPRESENTATIVE REPORTS OF MEETINGS

2014.31.1 Smoke Cessation Service

Dr Eggitt updated. The LMC had met with David Ramsey (SWYPFT) and Simon Lister (RDaSH) ON 6.3.14. SWYFT will be the new provider of the Doncaster Smoke Cessation Service from 1.4.14, but the service is still under development, with data gathering taking place, and may not be ready for full roll out until 1.7.14. In the interim period, SWYPFT will honour existing arrangements with practices who are signed up to the Smoke Cessation LES. For those Practices who do not subscribe to the Smoke Cessation LES, patients will be seen by SWYPFT, although the offices in East Laithe Gate will close at the end of March and further premises are being sought. Practices will be notified of new contact arrangements.

Changes to the service:

 The service specification will be changing to become more focused on non face to face support (telephone and website) and will essentially target high risk patients and those in the deprived socio economic groups.

 GPs will signpost into the service (cards, leaflets, posters, will become available for GP Practices). The patient will then receive telephone triage, as per an algorithm. Those falling into the high risk or deprived groups will be referred back to the GP Practice (if signed up to the Service Specification) to be seen by a nurse or HCA for face to face smoking cessation advice and consideration of nicotine replacement therapy.

 FP10s will be replaced by a voucher scheme (one for NRT and one for Champix). Those patients falling outside the identified categories will be expected to purchase their own NRT.

 The Practice Nurse or HCA will complete the voucher (which is merely a letter of recommendation to a pharmacist).

 There will be an SLA with Pharmacies who will make the decision to prescribe. There will be a PGD for Champix. Work is currently ongoing between SWYPFT and the LPC.

 Data on patient outcomes (ie those who have set a quit date, not quit, become lost to follow up etc) will be forwarded to Practices on a quarterly basis.

 Systm One and Emis Web have a Unit to Unit referral system (Task – which pre-populates the form, making referral easy is the practice chooses to refer rather than signpost).

All Practices will be receiving full details of the new service in writing, within the next few days. 2014.31.2 Gender Reassignment – meeting with Professor Wylie 6.3.14 5 Dr Eggitt had met with Professor Wylie in Sheffield to discuss future monitoring of gender reassignment patients within primary care. Dr Wylie confirmed that gender reassignment is now nationally funded, and is operated throughout 7 centres within the UK (Sheffield and Nottingham being our closest). Numbers of patients being referred into the service have increased rapidly in the past year, and there are currently 200 patients on the Sheffield Clinic books. Patients are seen within 3 to 4 months.

Dr Wylie explained that there is a desire for Primary Care to take on the prescribing and monitoring of patients post treatment, but there will be no requirement for drug titration. It is also envisaged that GPs will be involved in medical screening prior to a patient commencing a treatment pathway. National protocols are expected within the next 6 to 8 weeks.

Dr Wylie agreed to send these across to Doncaster LMC for perusal, following which a further meeting with Professor Wylie will be arranged. Dr Eggitt confirmed to Dr Wylie that any screening undertaken by GPs, which has been approved by the InterCollegiate documents, will require a local contract.

2014.31.3 Vacc and Imms

Dr Khan will update the Committee next month.

2014.32 CORRESPONDENCE

Nil received.

2014.33 CORRESPONDENCE FOR INFORMATION ONLY

2014.33.1 Community Paediatrics Service re-design – launch event 25.3.14. 2014.33.2 APC Minutes 30.1.14. 2014.33.3 LMC minutes: January 2014 – Sheffield, Barnsley, Rotherham

2014.34 OFFICERS’ ACTIONS

2014.34 FORTHCOMING MEETINGS: The Lay Secretary was supplied with information on forthcoming meetings.

2014.34 ANY OTHER BUSINESS

Service redesign – DRI. 6

Dr Shah asked for an update from Mr Emovon on information he had heard regarding a major structural change at DRI. Mr Emovon confirmed that a redesign of departments at DRI is underway. The plan is for Divisions, with a Group Director for each Division, and clinical leads for various specialties within the divisions. It is planned that there will be 6 Divisions and the target date for completion is 6th July. This is in line with national trends. There is some work being done on looking at care pathways within each Division, in the hope of becoming more efficient, improve patient care and reduce costs. The changes to the structure should have no impact on Primary Care.

There being no further business, the meeting was closed at 8.30 pm.

It was agreed to meet again on TUESDAY 15TH April at 7.30 pm at Doncaster Golf Club.

SIGNED ………………………………………………… (Chairman)

DATE ……………………………………………………