CEG 8th March 2016 Orsett Hall
Present: Dr L Grewal Chair, Chafford hundred Medical Centre
Dr L Joseph The Grays Surgery
Dr Cheema Rigg Milner Medical Centre
Dr Yadava East Thurrock Road Medical Centre
Dr R Yadava East Thurrock Road Medical Centre
Dr Bhat Sai Medical Centre
Dr Mohile Chadwell Medical Centre
Dr V Deveraja Sorrells Surgery
Dr Chandran Stifford Clays Medical Centre
Dr Kallil The Surgery, Orsett
Dr Jagadish Sai Medical Centre
Dr N Raj Purfleet Care Centre
Dr Wendorff Dell Medical Centre
Dr Jayakumar Pear Tree Surgery
Dr Pattara The Surgery, Horndon-on-the-Hill
Dr Abeyewardene Dell Medical Centre
Dr Obabori The Shahadeh Medical Centre
Dr K Masson Milton Road Surgery
Dr Ajayi St Clements Health Centre
Dr Sharma Neera Medical Centre
Dr Cheung Ash Tree Surgery
Dr Shahadeh The Shahadeh Medical Centre
Dr Gurjar Neera Medical Centre
Dr Hamilton Derry Court Medical Centre
Dr Kadim Prime Care Medical Centre
Dr M Roy Southend Road Surgery
Dr Yasin The Health Centre, South Ockendon
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Dr Bellworthy Santa Maria Centre
Dr Rabih Wassel Derry Court Medical Practice
Mr Qaiser Malik BTUH
Mr Russell Vine Hassengate Medical Centre
Mr Davinder Masson Dr K.K. Masson Surgery
Ms Katie Webb Derry Court Medical Practice
Ms June Mason The Health Centre, South Ockendon
Ms Emma Walsh St Clemnts Medical Centre
Ms Fiona Ryan BTUH
Ms Jo Howard BTUH
Mr Sam Marlton The Grays Surgery
Ms Sharon Hogarth College Health (Essex) Ltd
Mr Steve McKenna Neera Medical Centre
Ms Marilyn Spires East Thurrock Medical Centre
Ms Lynn Heath Balfour Medical Centre
Ms Sharron Carter Primecare Medical Centre
Ms Carol Shahadeh Shahadeh Medical Centre
Ms Gift Sithole Shahadeh Medical Centre
Mr Anil Iwnah BTUH
Ms Kim James Thurrock HeathWatch
Ms Kate Woolterton BTUH
In Attendance: Mr Rahul Chaudhari Thurrock CCG
Mr Kishor Pardki Thurrock CCG
Ms Gemma Curtis Thurrock CCG
Ms Joy Joses Thurrock CCG
Ms Lesley Buckland Thurrock CCG
Ms Christine Celentano Thurrock CCG
Ms Alana Stokes Thurrock CCG
Ms Ria Walsh Thurrock CCG
Ms Urszula Pucilowska Thurrock CCG
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1. Welcome & Apologies LG welcomed all to the meeting and asked if there were any declarations of interest that were not already on the register. There were no apologies to be noted.
2. Minutes of the meeting held on 9th February 2016 and Action Log Minutes of the previous meeting held on 9th February 2016 were reviewed and agreed as an accurate account.
Action Log – please see Appendix 1 3. PET CT Mr A Kumar (AK) introduced himself to the Committee and shared the PET CT Scan presentation.
The NHS PET CT Diagnostic Imaging Service is part of a national contract procured by the Department of Health to provide greater access to PETCT for patients in England. Committed to delivering outstanding patient care and clinical excellence, with patients being seen within seven days of the referral and reports following two days later. The service has been designed to meet the needs of 11 cancer networks and integrate fully with local clinical pathways and protocols. The service is provided from the following locations: Basildon, Bournemouth, Cambridge, Canterbury, Colchester, Leicester, Maidstone, Northampton, Norwich, Nottingham, Portsmouth, Plymouth, Poole, Sawbridgeworth, Southampton and Taunton.
PET Scan nationally has been provided in different ways, last year it was nationally reviewed. Various parts of the country bid for the contract and the plan was to use imperial scanner for the first 2 months,. NHSE has been requested to review the decision on providing CT Scanner for Basildon Hospital. PET CT is cardiac and dementia screening.
A question was asked regarding availability of the screening for lung cancer referrals. AK replied that there are several reporters working in different arrears. Scans get reported in my absence in other sites. Radiotherapy is not funded at the moment and cardiac scanning is already approved nationally. It provides efficiency and accuracy.
A question was asked how long the contract is as lung cancer screening is predominant. Is there a possibility that fix scanner will be placed for the next 10 years? LG stated that CCG recommendation to the Board and HOSC will be required. LG requested to vote which location is more suitable in opinion of the Committee. Thurrock has got more voices. KJ suggested involving the PPG in this consultation. LB offered to discuss that further on the next Clinical Reference Group Meeting on 24th March 2016 – Action LB.
4. NICE Cancer Guidance Kishor Padki (KP) introduced himself and shared NICE Cancer Guidance presentation and highlighted that using one part of improving picture of cancer outcomes (BMJ 17 October 2015) more cancers now diagnosed through FTR.
KP informed that NICE Guidance has been introduced last year and it is available to download from Thurrock CCG website. It gives an overview on not only diagnosis but talks about the screening. Fast track referrals process transformed the process and survival rate. It is also not deprived localities.
A question was asked what the current risk assessment process is. KP informed there are electronic acute cancer digital referrals. That was a national pilot project, which showed that GPs are referring more patients. KP asked to be contacted if any of the GP Practices are still using digital referral system.
KP presented a referral form and encourage to check this for which will be in use from the 1st of April 2016. More importantly this form compares all of the necessary details, NICE Guidance and 3
flow chart that can be used for electronic referrals.
5. Practice Concerns Laptops for mobile working The significant reduction in the GPIT budget since the inception of the CCG (2016/17 funding will be less than half of the budget in 2013/14) due to NHS England's revised national allocation formula for this area of spend necessitated a review of items funded by the CCG and laptops and vpn keys were no longer supported. NHS England is current updating the GPIT Operating Framework for 2016/17, and recent intelligence suggests that "mobile working at the point of patient care" is likely to become a core requirement. Accordingly, the CCG in conjunction with other Essex CCGs have submitted a bid for the purchase of mobile equipment from the national Sustainability and Transformation Funding pot that NHS England holds as part our 2016/17 Operational Plan. The outcome is by no means certain, and we will arrange appropriate action and inform Practices once we have further information. In the absence of guarantees of a successful outcome, I will advise Practices that have an urgent need for such equipment to fund this from their Prescribing Incentive Scheme Reward monies as they currently do. The CCG Board has been apprised of the current position.
LG introduced Ms Kate Woolterton (KW) Project Manager BTUH/ GP Collaboration Project to refer last meeting practice concern regarding pathway and procedure for DNA referrals – a new helpline available for amendments and cancellation by patients.
A question was asked how often we refer the patients to on call. KW stated that her responsibility lies between Primary and Secondary Care around Basildon Hospital. It is very difficult pathway to refer the patients. Recently there were no beds and AMU Team has got concerns in terms of registering process. Information has been passed to refer patient through A&E instead through register system. To update further by KW on referrals on call within next 3 months on the CEG Meeting – Action LG.
A question was asked regarding communication. Patients are receiving different letters during the treatment - from GP Practices and Hospitals in terms of the same pathway. It is difficult to cope with the fact that reports are also coming from different sources. There is no clarity about the letters. LG responded that Dr Raja is looking into that already.
A question was asked concerning patients discharge process with medication prescribed by the hospital. LG advised that every case depends on the Discharge Junior Doctor. Further advice supposed to be forward to the patient’s GP Practice if the treatment remains.
A question was asked regarding patients referred to their GP after being discharged from the hospital. KW promised to standardised letter and makes sure that some further actions will be included in format of the letter. LG gave an example of a patient, who requested for 24h ACG without prior knowledge what is conceivable.
LG and KW answered the following questions: 1. Long time waiting for gastro referrals – BTUH is struggling with all referrals within 18 week guidance. It was suggested to send another letter; those referrals will be booked in first instance. The prompt appointments are offered by Choose and Book system. If form is to be posted or faxed, the hospital Appointments Team will need to input them manually, which can cause delays. If there are no available appointments, system will offer the one after the standard expectation time. The way to arrange it sooner is to make a call after a month of booking in order to query any cancellations. 2. What is the procedure if hospital Consultant requests GP to prescribe the medication? If you feel that you are not comfortable with the medication please contact Medicine Management Team at Thurrock CCG to discuss. First prescription should be issued by the hospital. 3. I have a patient requested medication to lightening the skin. I have contacted Medicine 4
Management Team and as result I refused to prescribe anything. LG responded there is no identified lightening skin procedure and a cream that you buy over the counter is not necessarily medically approved and could permanently damage your skin. 4. There was a problem with cancellation hospital appointments by patients. KW informed that she has spoken with Patient Team and they are preparing a simple procedure chart flow. It will be circulated to the practices and PALS. KW requested all of the remaining questions to be directed to Thurrock CCG practice concerns email address.
6. AOB – Update Constitution sign off LG reminded about sending signed Updated Constitution to CCG and thanked Joy Joses for her engagement and impact in the CCG Communication Department.
Date of Next Meeting 12th April 2016 at Orsett Hall
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