HARINGEY LOCAL MEDICAL COMMITTEE MEETING
To be held from 1.00 pm to 3.30 pm on Friday 4 October 2013 at The Muswell Hill Methodist Church, 28 Pages Lane, N10 1PP Sandwich lunch available from 12.30
PART ONE LMC members only
AGENDA
1.0 Welcome and apo logies 1.00 – 1.05
2.0 Declarations of interest 1.05 – 1.05 2.1 Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate
3.0 Minutes and matters arising: 1. 05 –1. 15 3.1 Minutes from Haringey LMC Part one meeting on 7 June 2013 (pages 3-9) 3.1.1 Inappropriate transfer of work (minute 5.1 refers)
4.0 Members reports of meetings attended 1. 15 – 1. 25
4.1 Dr Julie Sharman/Greg Cairns to feedback from Joint Chairs Meeting with NHS England 25 September 2013 4.2 Dr Constantinos Stavrianakis to feedback from Medicines Management Committee meeting on 20 March 2013 4.3 Members reports of other meetings attended
5.0 Local issues 1. 25 – 1.4 0 5.1 CCG update 5.1.1 To co-opt Sherry Tang as new Chair in non-voting capacity 5.2 EMIS web and Docman 5.3 PMS issues 5.4 Sessional GP issues – to raise any sessional GP issues 5.5 North Middlesex Hospital issues – to raise any issues (also see item 5.0 in Part 2) 5.6 Whittington Hospital – to raise any issues 6.0 LETB update 1.4 0 – 1.5 0 To receive an update 7.0 Part 2 agenda – to discuss the part 2 agenda 1.5 0 - 2. 05
8.0 Items to R eceive 2. 05 – 2. 20 8.1 Process for responding to GP queries (pages 1 0 – 12)
8.2 Division of responsibilities (pages 13 – 14)
The professional voice of general practice in Haringey Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. [email protected] www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage 1 8.3 Practice Manager Representative following Lesley Mayo’s retirement
8.4 GPC News 20 September 2013 This can be accessed via the following link: http://www.lmc.org.uk/visageimages/newsletters/GPC/News%202%20-%20September%202013.pdf
8.5 To receive a list of the forthcoming LEAD events http://www.lmc.org.uk/visageimages/Events/annual%20calendar%201314%20(updated%20August%202013).pdf
9.0 Date of the next Meeting
6 December 2013, Rooms 4 & 5 Hornsey Central
10.0 Any Other Business 2.2 0 - 2.30
2 Draft minutes of the Haringey Local Medical Committee Part One meeting held from 1.00 to 2.30 pm on 7 June 2013 in Group Rooms 4 and 5, Hornsey Central, 151 Park Road, London N8 8JD
CONFIDENTIAL
Present: Dr Abida Ansari Dr Gino Amato Dr Christiana Aride Dr Mohssen Dabirikhah Dr Sue Dickie Dr Mohamed Jurangpathy Dr Sarah Larkin Dr Martin Lindsay Mrs Marion Lombardelli Mrs Lesley Mayo Dr Kanagaratnam Nagarajah Dr Helen Pelendrides Dr Dineshwar Prasad Dr Imtiaz Sardar Dr Costi Stavrianakis Dr Ana Stuttard Professor Darshan Suri
Visitors: Mr Gerald Alexander, LPC
Londonwide LMCs: Mrs Jane Betts, Director of Primary Care Strategy Dr Tony Grewal, Medical Director/LMC Secretary Miss Nicola Rice, Senior Committee Liaison Executive
Item Action Organisation/ no. person responsible 1.0 Welcome and apologies for absence:
Apologies for absence were received from Dr Devrim Beyzade, Dr Neil Manttan and Dr Eleanor Scott.
2.0 Declarations of interest
There were no new declarations of interest.
3.0 Minutes and matters arising:
3.1 Minutes of Haringey LMC Part one meeting on 5 April 2013
The minutes of the LMC Part 1 meeting on 5 April 2013 were agreed as a correct record.
3.1.1 North Middlesex Hospital prescriptions (minute 3.1.1 refers)
It was noted that a response had not been received from Professor Okolo. NR Miss Rice undertook to follow this up.
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3 3.1.2 Whittington Hospital access to patient records trial (minute 4.1 refers)
The email from Mr Chris Giles setting out an update with regard to the Whittington Hospital access to patients’ records trial was received.
Mrs Mayo advised that she had been invited to attend Whittington Health to see what the GP portal looked like in relation to the integrated electronic patient record system which Whittington Health was currently implementing. Mrs Mayo reported that it could be beneficial. In response to her query as to whether a patient would need to give consent in order that GPs could look at the records on the Whittington Health system, Dr Lindsay confirmed that consent would need to be obtained by Whittington Health as the data controllers.
Dr Grewal noted that the position in relation to data extraction and consent was changing and that LLMCs was preparing a summary of the many sets of guidance and principles around data sharing.
3.1.3 CQC access to patient records (minute 4.3 refers)
It was noted that the GPC had confirmed that CQC had the legal right to see patient records.
4.0 Members rep orts of meetings attended:
4.1 Meeting with Dr Fiona Wright and Cllr Bernice Vanier on 23 April 2013
Dr Lindsay reported that his meeting with Dr Wright and Cllr Vanier had gone well. Cllr Vanier confirmed that the LMC would be involved when appropriate.
Dr Pelendrides reminded the LMC that she was vice-Chair of the Health and Wellbeing Board and noted that there were 4 CCG members on the Health and Wellbeing Board. Dr Pelendrides assured the LMC that these members would highlight those issues which needed to be considered by the LMC.
4.2 Feedback from the North Central London Joint Formulary Committee on 25 April 2013
The notes of the meeting provided by Dr Tathagata Sadhu, an Enfield LMC member who represented the five NCL LMCs on the Committee were received. Dr Stavrianakis noted that he also attended this meeting in his capacity as a member of Haringey CCG’s Medicines Management Committee. Dr Stavrianakis advised that it was proposed that the formularies across the five NCL boroughs be standardised across the sector
It was noted that the issue of medications being initiated in secondary care but continuing to be prescribed by GPs was discussed and the LMC agreed that secondary care physicians should be responsible for the drugs they prescribed.
Mr Alexander noted that no community physicians attended these meetings and it was agreed that Miss Rice would send him a copy of the letter which the LMC office had sent to the Chair requesting representation and the relevant contact details. In the meantime Dr Stavrianakis undertook to bear in mind NR
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4 the difference between community and hospital pharmacists should relevant issues arise.
4.3 Feedback from North Middlesex Drugs and Therapeutics Committee on 29 April 2013
Professor Suri advised that at the meeting on 29 April 2013 he raised the issue of only 3 days antibiotics being prescribed following attendance at A&E. It was agreed that this would be looked at.
4.4 Meeting with Ms Julie Lowe, Chief Executive of North Middlesex University Hospital
Dr Lindsay advised that he had held a helpful meeting with Ms Julie Lowe and she had undertaken to come to the next LMC meeting.
4.5 Enfield and Haringey Child protection meeting with CCG, Social Service and child protection team on 1 May 2013
Dr Lindsay advised that these meetings had been arranged to look at how communication between the child protection team and Enfield and Haringey GPs could be improved as different forms and thresholds existed for different boroughs. He reported that it had been a positive meeting and it was good that people were working together to avoid duplication of work. He advised that there would be named Health visitors linked to practices and there would be links to the Child Protection team.
Dr Pelendrides noted that if a Haringey practice had a child registered but who was an Enfield resident liaison with the health visitor in Enfield liaison would take place by telephone. However if a Haringey practice had a large number of children who lived in Enfield then the health visitor would attend the practice.
4.6 Medicines Management Committee on 8 May 2013
Dr Stavrianakis confirmed that Ms Efa Morty was still working on liaison with community dieticians but this was making slow progress. Dr Lindsay hoped that this would be resolved in the near future as GPs appeared to be doing all the work yet had no ownership of the problems and considered that the work should be passed back to the dieticians. Dr Pelendrides responded to advise that there were technical reasons why the budget could not be stopped and explained that there were no contractual levers in place at the moment to do this unless something was put in next year’s budget. Dr Lindsay noted that at the moment the services being provided were coming out of GPs budgets and this needed to be resolve. Dr Pelendrides undertook to take the LMC’s concerns back for consideration.
Dr Stavrianakis further advised that a Food First policy was due to be circulated in relation to frail and malnourished patients.
Dr Grewal reported that LLMCs had asked NHS E to clarify who would be responsible for producing PGDs for immunisations for example and the indemnity arrangements.
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4.7 LMC Annual Conference on 23 and 24 May 2013
Dr Lindsay advised that Dr Laurence Buckman had given a dramatic speech as his last Conference as GPC Chair and noted that four people had openly stated their intent to stand as GPC Chair.
He noted that there had been an emergency session regarding Mr Jeremy Hunt which had been quite lively and confirmed that the Haringey motion regarding EMIS web, indemnification and patient consent had been passed.
Dr Amato asked whether there was any sense from the GP leaders that anything could be done regarding the current situation and whether anybody from NHS E or the government was listening to GPs’ concerns. Dr Grewal advised that there was genuine desperation among GPC leaders as it was apparent that the government was not listening. He noted that LLMCs would be undertaken a campaign to raise the profile of general practice and if it resulted in sufficient patients saying that they valued general practice then it might be possible to get politicians on the side of GPs.
4.8 MMR update
Dr Grewal noted that there was no panic in London and that all of the 1500 practices bar 3 were actively engaged in the catch up programme. He clarified that the three practices all had valid reasons for not participating.
5.0 Local issues:
5.1 CCG update
Dr Pelendrides confirmed that since April 2013 the CCG had signed 3 of the main acute contracts. Block contracts had been agreed with North Middlesex Hospital and Whittington Hospital and a contract with the BEH Mental Health Trust was signed and sealed. There was still much work to do in relation to agreeing contracts with Royal Free Hospital and UCLH but Dr Pelendrides noted that 50% of the contract with UCLH had gone to specialist commissioning.
Dr Pelendrides advised that 2 conditions around the CCG’s authorisation were outstanding in relation to information governance and risk sharing but noted that the five CCGs had reached an agreement on the risk share arrangements the previous week which was due to be considered by the Board the following week. It was hoped that by September 2013 no conditions would be in place.
Professor Suri expressed concern about the quality of the discharge letters provided by A&E at the North Middlesex Hospital and noted that GPs were often asked to do initiate investigations for patients. Dr Amato advised that the CCG was taking a two pronged approach to the discharge letters with him leading on the quality side and Dr Simon Caplan leading on the contractual side. He advised that work needed to be done on agreeing what should be in discharge summaries and asked for any volunteers to help work on this.
Dr Amato advised that he had asked the MDU for advice regarding the need to follow up investigations and had been advised that it was the GPs
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6 responsibility. Miss Rice advised that Barnet LMC was in the process of drafting a letter to be sent to Trusts regarding inappropriate work being transferred to primary care and undertook to share it with the Committee when it was available.
5.2 Emis web and Docman
Dr Lindsay advised the following:
The GPC had taken up the issue of GPs being indemnified by Emis web
Widescreens were due to be rolled out to practices although it was not clear when this would happen
N3 upgrades would take place over the next few months which should increase line speed
The GPC had taken up the issue of the batch dispensing problems those with EMIS PCS were experiencing.
He understood that in some areas hospitals had met some of the costs of Docman for practices and he asked whether the CCG could enter into a dialogue with the Whittington Hospital to persuade it to provide funding assistance for Docman in the future. Dr Pelendrides undertook to take this away for consideration.
5.3 PMS issues
PMS appraisal payments Mrs Mayo advised that she had been informed that the one off payments for appraisals would be per principal. However, members noted that the payments had not yet been made.
5.4 Sessional GP issues
5.4.1 Pathology results Dr Stuttard noted that sessional GPs did not always receive communications from hospitals even if they were the referring doctor. Dr Lindsay acknowledged that this was a problem and noted that it was not unusual for his practice to receive a letter from hospitals addressed to a former GP partner who had deceased. He reminded members that this was a national issue which seemed to be difficult to resolve. He noted however that sessional GPs should have their own path code and suggested that Dr Stuttard contact Mr Geoff Benge about this.
5.5 Housing letters regarding new regulations about moving patients whose homes have spare rooms
Noted.
6.0 HE NCEL (formerly LETB ) update
Dr Aride provided feedback in relation to the HE NCEL Members and Stakeholders Council which she attended on 23 May 2013. Dr Aride advised
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7 that the group had discussed what engagement techniques worked well and how patients and communities could be empowered through the work of UCL Partners and HE NCEL. Suggestions which had been put forward included the involvement of patients groups in the redesign of pathways, established patient groups to be encouraged to influence other patients in their assertive role in their care, regular links with community groups, feedback from patients and carers, peer health promotion in schools, peer group support for mental health issues. The meeting also heard of a 2 year project at UCH and Barts Health aimed at changing the relationship between pregnant women and clinicians by looking at how information was delivered and making antental care services more personal.
7.0 Part Two agen da
8.0 Received items:
8.1 GPC News 9, April 2013
Received.
8.2 LEAD events
Received.
9.0 Date of the next meeting
4 October 2013
10.0 Any other business
10.1 Delays in payments
Mrs Mayo noted that many payments being made through Exeter were late and although read receipts were sent in relation to email queries fuller responses were not forthcoming and it was not possible to talk to anybody in person.
Dr Grewal advised that Londonwide LMCs colleagues had met with the leads of the three NHS E Area Teams and had highlighted the problems in relation to payments. It was acknowledged that a problem existed and the Area Teams agreed to work with Londonwide LMCs so a small working group had been set up comprising an Associate Director from each Area Team, Mrs Lesley Williams, Primary Care Strategy Executive from LLMCs and another representative from LLMCs.
Dr Grewal explained that it had been agreed that practices would receive reimbursement for rates in monthly instalments and that they would be made near the time their accounts were due to be debited.
Mrs Mayo noted with concern that seniority payments would now be made on a quarterly basis in in arrears. Dr Grewal undertook to look into this. Mrs Mayo observed that Mr Keith Denford who worked in the payments team was TG equally frustrated with the new system.
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8 10.2 Retirement of Mrs Lesley Mayo
Dr Lindsay noted that this would be Mrs Mayo’s last meeting as she would be retiring at the end of the August. Dr Lindsay thanked Mrs Mayo for her input and noted that Mrs Mayo often kept the Committee informed of what was happening and highlighted many issues about which the LMC members were unaware. The LMC joined Dr Lindsay in wishing Mrs Mayo a long, happy and healthy retirement.
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Proposed process for responding to GP queries
Clinical Queries Non -Clinical Queries i.e. patient-related, consultant advice, i.e. administrative matters, contacts, IT, appointments, urgent information etc general information etc
GP / Practice to contact departments GP / Practice to email all non -clinical directly via telephone, fax or email queries to a dedicated email address nmu- address provided in the directory of [email protected] or telephone services on the GP Extranet line – 0208 887 3624 nww.northmid.nhs.uk/OurServices.aspx
Please note: Emails or faxes should not Head of BD to monitor mailbox daily and be used for urgent queries forward queries to the nominated leads for the area/specialty for investigation (with a copy to GM) If the query has not been resolved in reasonable time, or the GP is still unsatisfied with the outcome, escalation Nominated lead to compile a response route should be used via Head of with an outcome of investigation and Business Development via dedicated send it back to the Head of BD (It would email [email protected] be expected that this will be within a or via dedicated telephone line maximum of 48 working hours and where not possible, the reasons should be clearly stated along with expected Head of BD to escalate to the relevant time of response ) GM/ Clinical Lead for investigation
Nominated lead to compile a response with an outcome of investigation and GM/ Clinical Lead to compile a response send it back to the Head of BD and send it back to the Head of BD
Head of BD to forward the response to Head of BD to forward the response to the GP and log it on the “GP queries log” the GP and log it on the “GP queries log” and send a copy to CEO and Medical and send a copy to CEO and Medical Director – GP queries summary to be director - GP queries summary to be presented on a regular basis at the presented on a regular basis at the relevant forum (TBC) relevant forum (TBC)
10 Responding to GP Queries: CBU nominated leads & contact information for Non-Clinical/ Non-urgent GP queries
CBU1 Specialty Nominated Lead Job Title Telephone Fax Email address A&E & UCC Mark Channell A&E manager 3501 [email protected] ICU & Critical Care Vikki Howarth ICU matron 3658 [email protected] Diagnostic Imaging Neil Sorby Head of Service 2229 [email protected] Clinical Site Management Hamed Harb Head of Site ? [email protected]
Escalation Route General Manager CBU1 Jonathan Gardner GM 2454 [email protected] Clinical Director CBU1 Eddie Lamuren CD 2558 [email protected] CBU2 Specialty Nominated Lead Job Title Telephone Fax Email address Acute Medicine Natasha Black Service Manager 07436 039 210 [email protected] Respiratory & Cardiology Penny O'Hara Service Manager 3008 po'[email protected] Care of the Elderly Natasha Black Service Manager 07436 039 210 [email protected] Renal & Diabetes/Endocrine Penny O'Hara Service Manager 3008 po'[email protected] Gastroenterology /Endoscopy Penny O'Hara Service Manager 3008 po'[email protected] Therapies Brian Somerville Head of Therapies [email protected] Discharge Planning Helen Joyce Matron 2355 [email protected]
Escalation Route General Manager CBU2 Jonathan Gardner GM 2454 [email protected] Clinical Director CBU2 Maurice Cohen CD 2858 [email protected] CBU3 Specialty Nominated Lead Job Title Telephone Fax Email address Oncology & Radiotherapy
HIV & Haematology Stroke, Neurology, Dermatology & Rheumatology Pathology OPD
11 Pharmacy Infection Control
Escalation Route General Manager CBU3 Clinical Director CBU3 CBU4 Specialty Nominated Lead Job Title Telephone Fax Email address
Anaesthetics & Pain Management
General Surgery Trauma & Orthopaedics Urology Ophthalmology Theatres Admissions
Escalation Route General Manager CBU4 Clinical Director CBU4 CBU5 Specialty Nominated Lead Job Title Telephone Fax Email address Women’s Children’s EPAU Reproductive Medicine Child Protection Associated OPD Services
Escalation Route General Manager CBU5 Clinical Director CBU5
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LMC Members – Responsibilities
No. Representative (Dr/Practice Interest & Responsibility Manager/other) CCG 1 2 Claims & communication with NHS England (practice visits, CMC & other CCG initiatives) 3 CQC & Non Principal GPs
4 Data Sharing
5 DES & LES 6 Educational Training & Public Health 7 Enhanced Services
8 H&WB 9 IT & QOF
10 IT, CEG , Enhanced Services
11 Liaison Committee 12 LPR/locality meetings 13 Mental Health
14 Mental Health & Access
15 Networks 16 OOH 17 Patient Participation 18 Practice Manager Liaison 19 PM rep Practice Manager’s Forum, SBS, Advocacy & Interpreting Estate issues 20 Practice Nurse Liaison 21 Premises 22 Prescribing
The professional voice of general practice in Haringey Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. [email protected] www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage 13
23 Salaried GP scheme
24 Secondary Care (excluding Ment al Health), PMS & SBS 25 Workload (from secondary care)
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