Local Medical Committee Meeting 5 November 2013

MINUTES OF THE COUNTY DURHAM AND DARLINGTON LOCAL MEDICAL COMMITTEE HELD ON TUESDAY 5 NOVEMBER 2013 IN THE BOARD ROOM AT APPLETON HOUSE

Present:

James McMichael Chairman – Chester-le-Street David Robertson Secretary

Fiona McConnell Chester-le-Street Richard Harker Darlington Rob Cowley Derwentside Anne Holmes Durham Francis Whalley Durham Donna Boyd Durham Dales Nari Pindolia Durham Dales Kamal Sidhu Easington Norbert Dielehner Sedgefield John McGuire Sessional Heather Prestwich Sessional Robin Wade Sessional

Claire Elder LMC

Invited:

Stewart Findlay DDES CCG David Graham ND CCG Frank Moore Specsavers Tim Mitchison Specsavers Steven Hayes Specsavers Elspeth Aspinall GP Lead – Safeguarding Children Sue Nuttall Adult Safeguarding Senior Manager Paul McGoran Community Alcohol Service Claire Sullivan Consultant in Public Health

Number Item

L13/107 Apologies for Absence

Tanya Johnston (Durham) Nari Pindolia (Durham Dales) K V Reddy (Easington) Sanjay Gupta (Sessional) Mike Spence (Sedgefield – Practice Manager)

L13/108 Minutes of the Meeting held on 1 October 2013 – members accepted

Private and Confidential Local Medical Committee Meeting 5 November 2013

the minutes with the following amendment and one additional paragraph:-

L13/96

'Concern was expressed that funding for IT support may eventually be withdrawn and practices may have to find the costs themselves'.

L13/100.04

FW expressed concern about the communication from CCGs to ordinary GPs. JC & DG outlined the range of options available to GPs to keep up to date with CCG developments and assured the committee that they would welcome suggestions about how communications could be enhanced.

L13/109 Matters Arising

Work Creep

FW confirmed that he has received a report regarding cervical smears that is creating a lot of work, the Secretary asked that he forward this to him to add to his list.

Medicines Management

Further discussion involving Medicines Management, CDDFT, LPC and LMC are planned in in response to guidance on MCAs.

The LMC had learnt from Prof Gray, Medical Director, CCDFT that he anticipated the introduction of electronic FP10s for patients being discharged from hospital (possibly by December 2013) and this should allow the FT to liaise directly with local pharmacies when MCAs were needed for patients.

NHS Complaints

Representatives from the NHS Customer Care Centre had visited the Regional LMC in October and had been frank in admitting that the introduction of this new service had not gone well. Subsequently significant efforts had been put in to improving the Customer Care Centre although it remained to be seen how even significant improvement would benefit primary care as the essential role that PALS played in mediation had been lost

Care.data

An update on the care.data programme had been circulated to practices. The BMA had clarified the responsibilities of GP practices as there was a potential conflict between two pieces of legislation with serious implications for practices. As a result of this work:

 Additional guidance has been developed  The rollout of Care.data has been deferred until Spring 2014  There will be a nationally co-ordinated public information campaign

Call to Action

DAR had drafted a response online for the consultation that members agreed could be submitted on behalf of the LMC. There was still the option for committee members to respond individually if they so wished.

L13/110 Safeguarding Adults

Elspeth Aspinall and Sue Nuttall attended to update the Committee on the Safeguarding Adults department. The team (hosted by North Durham CCG ) includes experienced nurses and social workers. They provide support and advice (eg to Care Homes where there are many vulnerable adults) and training. Sue Nuttall also acts as the Mental Capacity Lead.

Named GPs were in post in North Durham (Dr Elspeth Aspinall) and Darlington (Dr James Carlton), but there is still a post open in DDES.

The team hope to survey Practices on issues relating to safeguarding adults and in future EA and SN are hoping that each Practice will have a named GP Lead.

Members raised issues with regard to information storage within Medical Records about Domestic Violence Reports. CS agreed to take the matter up and bring back some guidance to the LMC.

L13/111 Adult Hearing

Frank Moore and Colleagues (Tim Mitchison and Steve Hayes) attended the LMC and advised the Committee on how AQP for hearing aids impacts on GPs. The Committee was advised that they will need to re-refer patients after the three years. Stewart Findlay (DDES CCG) confirmed that the CCG is looking at this contractual matter to make the issue as simple as is possible.

The issue of re-referral is a nationwide problem and FM asked that GPs keep in mind that a number of patients feel they are presently in limbo as there has been much confusion on re-referral back to Specsavers.

Members mentioned problems that patients had experienced with Specsavers, FM was asked that members feed these problems back to him and he would have the matters looked at and investigated.

FM also confirmed that if Members wished his colleagues would be happy to attend further meetings as they would have insight with a local flavour.

L13/112 Alcohol Primary Care Contract

Drs Paul McGoran and Claire Sullivan attended and set out some options for a Primary Care Alcohol Related Harm Reduction Scheme – County Durham. CS reported that research had shown:  Patients expect to be asked about their alcohol consumption whereas health professions believe that they do not!  Giving a simple leaflet is as effective as more extensive interventions in reducing alcohol consumption in patients who are not already heavy drinkers

CS had developed four proposals for the committee to consider. A lively debate concluded with a narrow majority voting for option 4: to mirror the Directly Enhanced Service for screening with GP Practices being paid £2.38 for each screening and brief advice. This would allow each GP Practice to screen 26% of their eligible population each year. This would ensure all of the eligible population could be screened over the 4 years period.

This Model would be aimed at males in the 16-39 age group. Questionnaires could be handed out at the Reception desk when patients checked in for their appointments with the leaflet given to patients during the consultation where this was indicated.

Audit packs, posters and leaflets would be supplied to Practices.

L13/113 Clinical Commissioning Groups

North Durham – David Graham

DG asked the Committee to consider giving permission for the CCG to take raw immediate data ie number of patients seen, how many nurse triage appointments, etc. It was thought that on the collection of such raw data it could aid in tackling winter pressures and keeping the Trust up to date on potential flu epidemics.

Members wanted it to be seen that there is incredible increase on workload in Primary Care and anything that helped this could be useful.

Concern was expressed about coding for such a data collection.

DDES – Stewart Findlay

SF explained that there has been a restructuring of staff within the CCG as the present structure was not working out quite as anticipated. There had also been several key staff who had resigned including Dinah Roy and Satinder Sanghera. Some vacancies existed for GPs within the CCG for will be 2 – 4 sessions per week.

SF confirmed that ND had agreed to weekend opening but DDES had put together a slightly different proposal for its member practices.

SF expressed concerns over Winter Pressures and confirmed that he was having weekly meetings with the Trust Chief Executive. SF hoped that weekend opening may reduce admissions to the Trust.

Discussion about 111 proceeded – see L13/114.02

L13/114 General Correspondence

114.01 LMC Rep on the Performance Screening Group

Kamal Sidhu reported that he had attended a meeting of the PSG as an observer. It was felt vital that the LMC should be represented at the PSG and that this representation should be remunerated.

114.02 Speak to GP within 1 hour dispositions from 111

JM outlined the problems that arose in CDD when urgent care doctors were handed cases where the 111 disposition was ‘Speak to GP within 1 hour’. JM noted that this was out of step with neighbouring areas where the patient’s practice was phoned to provide this service and he asked that the LMC reconsider its position to fall in line with the rest of the region. DAR and JM explained that this arose from the pilot phase of 111 where the LMC had been adamant that practices could not be bound by the decisions generated by 111. The secretary pointed out that there was no contractual agreement to provide this care based on decisions made by a non-clinical third party.

Although the committee was sympathetic to JM’s view it agreed to adhere to its existing position but that it would be happy if the disposition was changed to ask the patient to contact their own general practice that could then make a decision about how best to help and in what timeframe.

SF reported that the CCG was working on a system of instant ring back for paramedics. LMC members felt that this could not be guaranteed. Much discussion was held about 111 Service.

It was felt by SF that a 7 day working week was on the horizon and was available within the Trust and therefore Primary Care services would have to change. However DAR pointed out that the BMA would fully commit to this system only if it was backed up with support staff and other Health Care professionals also, ie Nurses, etc. that in the present climate seemed unaffordable.

Members expressed concern that within County Durham there would be a significant challenge in recruiting and retaining GPs within the next few years as 25% will be of pensionable age and unresourced expansion of services might exacerbate this problem.

114.03 LMC Meeting Dates – 2014

No Meeting in January 4 February 2014 4 March 2014 1 April 2014 6 May 2014 3 June 2014 1 July 2014 No Meeting in August 2 September 2014 7 October 2014 4 November 2014 2 December 2014

Date, Time and Place of Next Meeting

3 December 2013 @ 19.30 in the Board Room at Appleton House

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