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ISLINGTON LOCAL MEDICAL COMMITTEE

Part 1: (LMC members only)

Wednesday 27 August 2014

1:30pm – 3:00pm (sandwich lunch available from 1:00pm)

Islington CCG Offices, 338-346 Goswell Road, London EC1V 7LQ

AGENDA

1.0 Welcome and Apologies 2.0 Declarations of Interest

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 3.1 Minutes from the Part 1 LMC meeting on Wednesday 18 June 2014 (pages 3-7) 3.2 Matters Arising not elsewhere on the agenda 4.0 Members Reports of Meetings attended as LMC representatives 4.1 Draft minutes from the Chair and Vice-chairs meeting with NHS E LAT (pages 8-14) on Wednesday 16 July 2014 4.2 CEPN Steering Group – feedback on meeting held on 11 July 5.0 Items for discussion 5.1 Everyone Counts: Planning for Patients (£5 per vulnerable patient) 5.2 Co-commissioning (Please see paper on Part 2 agenda) 6.0 Part 2 Agenda 7.0 Health Education NCEL update 8.0 Items to Receive 8.1 GPC News: June 2014 – Issue 17 8.2 GPC News: June 2014 – Issue 18 8.3 GPC News: July 2014 – Issue 1 8.4 GPC News: August 2014 – Issue 3; Issue 3 Appendix - dementia extraction - opt-out form (click on link and see under

‘GPC News - August 2014 (3)’) 9.0 Newsletter Items 10.0 Any Other Business

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http://www.lmc.org.uk/visageimages/newsletters/GPC/News%2017%20-%2012%20June%202014%20-%207th%20interim%20update.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%2018%20-%2020%20June%202014.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%201%20-%204%20July%202014%20-%20with%20appendix.pdfhttp://www.lmc.org.uk/visageimages/newsletters/GPC/News%203%20-%208%20August%202014%20-%209th%20interim%20update.pdfhttp://www.lmc.org.uk/article.php?group_id=11392

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11.0 Date of Next Meetings Wednesday 22 October Wednesday 17 December

Venue: Islington CCG Offices, 338-346 Goswell Road, London EC1V 7LQ

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Islington Local Medical Committee

Minutes from the Part 1 meeting held at 1:30pm on Wednesday 18 June 2014 at Islington Clinical Commissioning Group Offices, 338-346 Goswell Road, London EC1V 7LQ

Present: LMC Members: Dr Robbie Bunt (Chair) Dr Simon Hazelwood Dr Antonia Lile Dr Anita Nathan Dr Catherine Steven Dr Clifton Woolf In Attendance: Londonwide LMCs Greg Cairns, Director of Primary Care Strategy Sarah Martyn, Assistant Director of Primary Care Strategy

1.0 Welcome and Apologies

The meeting started at 1:40pm.

1.1 Dr Robbie Bunt welcomed everyone to the meeting. Apologies were noted from Dr Paddy Glackin, Bernadette Edwards and Dr Vicky Weeks (Londonwide LMCs).

2.0 Declarations of Interest

2.1 There were no new declarations of interest.

3.0 Minutes and Matters Arising

3.1 Minutes of the meeting held on Wednesday 23 April 2014 3.1.1 The minutes of the meeting held on 23 April 2014 were agreed as a correct record, subject to the

following changes: Paragraph 4.3.1: the word “practices” in the third sentence should be changed to “premises”. Paragraph 5.1.1: the sentence should be reworded to read “Dr Hazelwood advised that

Mitchison Road Surgery were discussing options.” Paragraph 10.3: the first sentence should reworded to read “Concern was raised that

practices had been paid 50% for the work upfront but were unable to complete the work due to an unworkable computer system.”

3.2 Matters Arising 3.2.1 Membership of the LMC: Greg Cairns advised that this had been followed up and Dr Glackin

had promised to get back with a decision. It was agreed to follow this up again and bring back to the next meeting.

ACTION: to follow up with Dr Glackin his position and bring back to the August meeting.

LLMC

3.2.2 Christmas Opening Update: Dr Bunt advised that the GPC were now taking this up formally so

there was little point looking at this locally, but asked that an update on the latest position was obtained.

ACTION: to circulate the latest GPC position on the Christmas Opening Hours.

LLMC

3.2.3 Child Protection: it was agreed that Dr Vicky Weeks would be asked to follow this up on behalf

of the LMC as there had been a number of issues outstanding for some considerable time.

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ACTION: to follow up on the child protection issues with Sarah Humphreys

LLMC

4.0 Member Reports of Meetings attended as LMC Representatives

4.1 It was noted that the meeting on 11 June had been a Learning and Development Session for the Chairs and Vice Chairs. It was agreed that the notes of the Chairs and Vice Chairs meeting with the NHS England London Area Team on 10 April 2014 would be circulated. The meeting with the London Area Team planned for 16 July would be put on the Part 2 agenda for the August LMC meeting.

ACTION: to circulate the minutes from the Chairs and Vice Chairs meeting with the NHS England London Area Team on 10 April 2014.

LLMC

ACTION: to put the minutes from the 16 July 2014 Chairs and Vice Chairs meeting with the NHS England London Area Team on the LMC Part 2 agenda for the August 2014 meeting.

LLMC

5.0 Items for Discussion

5.1 Membership and Vacancies 5.1.1 Dr Bunt advised that Bernadette Edwards was talking to the Practice Managers’ Forum about a

representative for the new term. It was noted that the CCG were having a similar problem in recruiting new Board members as the LMC were attracting new members and it was just felt that GPs just do not have the time to take anything new on.

5.2 Londonwide LMCs Areas Sector Team Changes 5.2.1 The LMC noted that Dr Vicky Weeks was the new Medical Director and the team were carrying

two vacancies for Committee Liaison Executives.

5.3 Commissioning a LCS for Abnormal Liver Function Test Pathway 5.3.1 Dr Bunt asked the LMC whether it would like to ask the CCG to consider putting together an LCS

for supporting the clinical pathway. The LMC agreed that the question should be asked at the Primary Strategy Meeting.

5.4 CEPN Steering Group – Appointment of a Deputy to attend the meetings on 11 July and 12 September 2014

5.4.1 It was agreed that Dr Catherine Steven would deputise for these meetings.

6.0 Part 2 Agenda

6.1 Minutes of the meeting: Paragraph 6.1.2 should be deleted as this was repeated. Alison Blair had agreed in principle that an LMC representative would sit on the Contract

Monitoring Group, however, this had not yet been confirmed. This would be followed up in Part 2.

The LMC noted that the Mental Health Primary Care/Secondary Care Interface Agreement had been through the CCG Governing Body.

The information on population increases in the south locality had not been received. The LMC noted that Public Health had been involved in working on a premises needs

appraisal in South Camden and there had been some conversations with Islington practices. There had been a big population growth and there were some new developments, with money attached).

ACTION: to check out what was happening with the premises needs appraisal in South Camden.

Greg Cairns

6.2 Co-commissioning of Primary Care: Greg Cairns advised that the expression of interest was

due in on 20 June and Islington were part of a North Central London proposal. LLMCs paper had

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not been attached to the papers and it was agreed that it should be circulated in time for the LMC members to consider it before the next meeting.

ACTION: to circulate LLMCs Co-commissioning paper to stimulate the conversation at the August meeting.

LLMC

6.3 Locally Commissioned Services: Dr Bunt asked if practices had been written to regarding

Locally Commissioned Services (LCS) for 2014/15. Dr Woolf had seen the NHS contract changes and has spoken to Paul Trevethick regarding practice boundaries the details of which are awaited.

6.4 Clinical Commissioning LCS: Dr Bunt advised that the funding for the LCS had increased for

2014/15 but noted that there were two figures and these needed to be clarified in Part 2 with the CCG. In terms of the new components that the LMC would be happy with – 1, 2, 5 and 6 – though there was concern that bits of Component 5 were above and beyond the core contract. A new part of the specification was that the referrals and reflections work on QP markers were no longer in the contract but now in this LCS.

6.5 Clarity was required around Component 4.4 and general practice would need read codes and an

incentive to use them. It was noted that the CCG would only be able to monitor this if they knew which patients were being referred. The time allocated and money seemed fair but it needed to be made clearer about what GPs were being asked to do. It was noted that there was no incentive in the contract to look at referrals. The funding only equated to one GP session and there was an additional £50 per 1,000 patients, but would depend on the precise detail.

6.6 Concern was raised around how the buddying arrangement would work. If the payment per

practice was £1,200 per practice it would equate to just over one reflection per 1,000 patients. Dr Antonia Lile advised that locum GPs were signed up to this piece.

2:20pm – Dr Catherine Steven entered the meeting.

6.7 Dr Bunt advised that it was not clear how Component 5 would work and queried if a YoC DES template should be updated each year. He felt the process was over-complicated but the main aim was to get money into primary care. Component 5.1 was the enhanced version of the DES specification, and it was noted that the CCG had requested permission to use an adapted YoC template for DES purposes. In Component 5.2 it was noted that there was also some additional work for Children MDTs.

6.8 Closing the Prevalence Gap: there was concern that the letter was not correct and there were

implications for practices in that unless a final solution was found the money would be clawed back at the end of six months.

6.9 Long Term Conditions: concern was raised that that the paper was now saying that the

amalgamation of the existing workstreams was delayed for another six months because (1) of the risks of going live with an untested template; and (2) failure of EMIS core components continued to hamper additional work on the heart failure component and the second phase of the ‘Closing the Prevalence Gap element. The LMC noted that the CCG had been asked for 50% funding up front with an inflationary uplift. In addition they had been asked to commission for a longer period though there had been no response as yet. The LMC asked for the embedded specification to be circulated.

ACTION: to email the embedded document to the LMC. LLMC

6.10 Avoiding Admissions Enhanced Service/£5 vulnerable elderly funding: Dr Bunt noted that

there was another template to be completed and assumed it was accessible, and printable, on EMIS. There was concern that the £5 per elderly patient that was supposed to support over 75s was being directed to community health services.

6.11 Patient Access to Records Roll Out Plan: concern was raised that GPs would need to be more

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cautious when writing patient notes. 6.12 Everyone Counts: Dr Bunt advised that the paper was a first stab at how the money should be

spent but it did not make it clear whether the money could be negotiated. There would be an iterative process by member via the forums. He proposed that the LMC suggested what services it would like to see commissioned from GPs and alternative providers. It was agreed to offer the use of Task Force groups as a way forward. There was concern that the CCG did not have sufficient resources to produce all the new services and that the LMC would offer its help.

6.13 Primary care Prescribing Budget Setting: Dr Bunt advised that the LMC, as a representative of

practices, needed to be careful and clear about what the changes were. Dr Woolf wished to emphasise that it be clinically led and that the team should continue to be mindful of that. Dr Bunt asked the LMC if they accepted the statistical model that had been modelled by public health. Dr Steven advised that the changes needed to be discussed as well as the route for flagging up issues. The changes had been capped and practices would not be penalised if they did not come in on budget. Dr Woolf explained that this was clinically led and noted that the team were mindful of that. He asked that if patients were on expensive drugs would it be moderated if necessary. Dr Bunt asked if this was not already taken into consideration and how it could be challenged. There was huge amounts of work some of which was not relevant to practices as there was no money to be made out of it. He felt it was pretty nebulous to say that the formula could not be changed as practices still came in on budget. There were also questions around the markers and whether the list was reasonable given the things that could affect prescribing costs.

6.14 Developing Services in Islington: it was noted that a letter had gone out after the

announcement of Prime Minister Challenge Fund bids. Dr Bunt advised that he had pointed out the COI and equity for practices that had been invited in for further discussions.

6.15 Public Health: Dr Bunt felt that the relationship with public health was faltering as Dr Steven was

to have been the LMC representative working with them and felt that the documents should be discussed with a LMC representatives rather than the whole committee having to wade through long documents. It was noted that these could have been commented upon via the listserver. He was particularly concerned with the sexual health LCS and the fact that tests would only be paid for if they were was positive.

6.16 It was noted that the Smoking Cessation LCS had been put on the listserver and Dr Bunt felt that

there should have been a covering sheet detailing the differences. It was felt that the long term follow up was made much more difficult as there was a 30% turnover of patients. The document did not contain any financial information either and Dr Bunt felt that there should be an 1% uplift at a minimum. He also suggested that for the following year Public Health were asked to produce a short covering paper detailing all the changes.

6.17 Dr Bunt was concerned that there had been not LMC representative on the NHS Healthchecks

Steering Group but noted that it was a well written and precise specification. There had been some changes with a decrease in money if it was electronic. If it still required a paper form to be filled in the old rate should be continued to be paid.

7.0 Health Education NCEL Update

7.1

This was not discussed.

8.0 Items to Receive:

8.1 The LMC noted the GPC News for April 2014 (two editions) and May 2014.

8.2 The LMC noted the BMA “Your GP Cares” Campaign.

9.0 Newsletter Items

9.1 There were no items identified for the newsletter.

10.0 Any Other Business

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10.1 There was no other business.

11.0 Date of Next Meeting

11.1 The next meeting was noted as Wednesday 27 August 2014 at Islington CCG Offices, 338-346 Goswell Road, London, EC1V 7LQ.

The meeting ended at 3:10pm

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North Central and North East London Chairs and Vice Chairs

Meeting with NHS England Local Area Team

Thursday 16 July 2014 2:00pm – 4:00pm

in Woburn House Conference Centre, 20 Tavistock Square, London WC1H 9HQ

Present: LMC Members: Dr Jackie Applebee (Tower Hamlets Vice-Chair) (arrived 1420; items 2 to 11)

Dr Robbie Bunt (Islington Chair) Dr Claire Chalmers-Watson (Camden Chair) Dr Martin Harris (Barnet Vice-Chair)

Dr Simon Hazelwood (Islington Vice-Chair) Dr Clifton Marks (City and Hackney Vice-Chair) Dr Saidur Rahman (Newham Vice-Chair)

Dr Fiona Sanders (City and Hackney Chair) Dr Ambrish Shah (Redbridge Chair) (arrived 1500; items 4 to 11)

Dr Sella Shanmugadasan (Tower Hamlets Chair) (chaired the meeting) Dr Constantinos Stavrianakis (Haringey Vice-Chair)

NHS England Local Area Team Alan Keane, Assistant Head of Primary Care Commissioning Londonwide LMCs Greg Cairns, Director of Primary Care Strategy Dr Tony Grewal, Medical Director Steven King, Committee Liaison Executive

The meeting started at 2:00pm

1.0 Welcome and Apologies

1.1 Dr Shanmugadasan welcomed everyone to the meeting. Members introduced themselves.

1.2 Apologies were received from Dr Surendra Dhariwal (Newham Chair), Dr Michal Grenville (Waltham Forest Vice Chair), Dr Manish Kumar (Enfield Chair), Dr Martin Lindsay (Haringey Chair), Dr Yvette Saldanha (Barnet Chair), Rylla Baker ,Fiona Erne, and Neil Roberts (NHS England North Central and East London), Sarah Martyn and Dr Vicky Weeks (Londonwide LMCs), Dr Madhu Pathak (Barking, Dagenham and Havering LMCs)

2.0 Minutes of meeting held on 10 April 2014

2.1 Minute 2.0: Practice Payments Update Dr Bunt asked why there had been delays in payments. Dr Hazelwood reported that that practices had had problems reconciling payments which had been made and payments which had been deducted. Dr Bunt said that after a GP had left a practice payments had been deducted incorrectly from the practice in relation to that GP. Mr Cairns reported that there were a number of cases where practices were owed money where NHSE had referred them to the CCG which in turn had referred them to the legacy team, which no longer existed, so there was no one to talk to. There was also a matter of the inaccuracy of remittance advice.

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Dr Grewal said that there were a number of sanctions which practices could take up against NHSE in relation to practice payments. These included legal actions, requesting interest on late payments and resignation. Dr Chalmers-Watson said that practices were concerned that payments systems had not been embedded in the new structures, leaving the possibility that they might be put out to tender. Mr Keane said that NHSE was developing a specification setting out the terms and conditions to provide the service with a view to moving towards open procurement resulting in the most efficient way to deliver the service. Dr Grewal was concerned that LLMCs had not been invited to contribute to the specification for the service. Dr Shanmugadasan said that when the payment problems had arisen, LLMCs had provided members with a contact telephone number at NHSEL and had negotiated the resolution of the problem. There remained the issues of was this a matter for NHSE or the people running the finances and who would take over the running of the finances. Dr Shanmugadasan said that members who were having problems with receiving payments could e-mail pay@lmc.org.uk for assistance.

ACTION: NHSE to advise on why there had been delays in making payments.

Mr Keane

2.2 Minute 5.4: Minor Surgery DES Dr Grewal reported that LLMCs had asked NHSE to exclude infection control in a DES but NHSE had said that they would retain the DES in its present form. The matter could be taken up with CCGs at borough level. – I think he said exclude?

ACTION: Seek infection control DES from CCGs.

LLMCs

3.0 Patient Participation DES

Members raised a several concerns about the implementation of the DES. These included:

some practices had had their claims rejected but had not been informed of this

some practices had been informed that their claims had failed but they had not been told why

when practices had previously provided information on age, sex and ethnicity of their Patient Reference Group (component 1) were not required to provide this information again, but some of these practices had failed on component 1

the success and failure of practices had been mixed and differed between boroughs

the timescales had been unrealistic. They needed a further month or two. The Chair said that the DES had been implemented with national guidance and there is a process to ensure compliance. Dr Sanders expressed concerns that practices which were not approved for the DES might be wary about signing up to other DESs. The Committee agreed that it was the patients who suffered as a result of these problems. NHSE should undertake an audit of the DES and report the findings (the figures and what practices had achieved) to the Committee.

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Dr Grewal said that if practices failed in their appeals they could resort to litigation. He said that NHSE would have to ensure that its process was robust in order to defend any claims adequately. NHSE should provide practices which had failed with confirmation that they had failed, the reasons for the failure and the evidence upon which it had been based, and reasonable time to allow them to prepare a response. Dr Grewall suggested that less than one month’s notice would not be reasonable, two to three months’ notice might be reasonable. NHSE should also inform practices about the dispute resolution procedure. Dr Marks said that the dispute resolution process was time consuming. He believed it could have been avoided had NHSE handled the process differently. Mr Cairns said that a key failure in the process was that there had been no dialogue between NHSE and LMCs, in particular in relation to the application procedures and in relation to issues which could have been allayed through informal discussion. Mr Keane addressed the points which had been raised. He said that practices could apply for dispute resolution up to 20 July. Dr Shanmugadasan requested that there should be a LMC representative as an observer on the dispute resolution panel and that the Committee should receive a report on the outcome of disputes which had been adjudicated by the resolution process.

ACTIONS:

Investigate failures in communications with practices

LMC representative to attend the dispute resolution panel as an observer

NHSE to inform the Committee of the outcome of disputes which had been adjudicated through the resolution process

NHSE to undertake an audit of the DES and report its findings to the Committee.

Mr Keane

4.0 PMS Reviews

Dr Grewal reported that LLMCs was monitoring the PMS reviews but it was not a priority for NHS E at the present time.

5.0 MPIG

Dr Shanmugadasan reported that practices were losing a lot of income as a result of MPIG. Dr Applebee said that nothing practical was being done to support them. If nothing was done some practices might be forced to close. The MPIG formula should be renegotiated as a matter of urgency, but this was unlikely to happen before the end of September. There were 22 practices at risk in East London. If they were forced to close, thousands of patients across the area would be without a GP. Something practical and sustainable had to be done. Dr Applebee expressed further concerns that NHSE had not written to practices to inform them that they were at risk through loss of payments under MPIG. She believed that the survival of the NHS was at stake. GPs were the gatekeepers of healthcare. If GPs were not able to provide services it would result in problems for secondary care. Dr Sanders read from the letter written by Neil Roberts, Head of Primary Care, NHSE (London Region, North, Central & East) setting out the support which was being offered to practices which would lost funding under MPIG. The Committee agreed that none of the support being offered addressed the essential needs of practices which would be put at risk due to the withdrawal of MPIG funding. Dr Sanders added that the problem did not rest solely with the MPIG funding, the problem lay predominantly with core funding, which should be addressed. Enhanced services did not make up the money which practices were losing because they involved a lot of work. Dr Roberts said that NHSE should be campaigning on behalf of practices. She believed that there

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were many systems for which NHSE was responsible which could save work and costs if they were addressed. Dr Chalmers-Watson said that LMCs had difficulty in dealing with this matter as it was not clear who was dealing with different aspects of the MPIG policy. She asked if NHSE could clarify to LLMCs who owned which issues relating to MPIG. Mr Keane said he would follow up the matters which had been raised.

ACTIONS:

NHSE to write to practices to inform them of the sums of money they would lose each year under MPIG. NHSE to provide a copy of the letter to Dr Grewal

NHSE to update the Committee on the concerns which it had raised at the next meeting, on 22 September

Mr Keane

6.0 Co-Commissioning of Primary Care

Mr Cairns reported that all CCGs had submitted expressions of interest. It was not clear how these would be evaluated and what would happen thereafter. Mr Keane said that there were four categories of expressions of interest: A: Greater CCG involvement in primary care commissioning. B: Joint commissioning C: Delegated commissioning management , which would require legislation D Other forms of co-commissioning. EOIs had been rated as ready now, soon or later. NHSEL’s evaluation criteria would include:

clarity in respect of governance to ensure that there were no conflicts of interest

consistency across London

patient flows

targets should be achievable not simply currently achievable targets

support improvement in services Mr Cairns said that in some areas CCGs had not engaged with local stakeholders or GPs. In one area, to his knowledge, even members of the GGC governing body had not been informed of the processes. Issues had been raised which had not been reflected in EOIs. NHSE had not set out its strategy to inform stakeholders in relation to co-commissioning process. Mr Keane said that the process had been peer led. Whoever had submitted EIOs should have had input from peers to inform the EOI. He believed that failures to engage peers in the process would be identified at the evaluation stage. Dr Grewal said that if NHSE claimed that EOIs had been made on behalf of CCG members, they were likely to be challenged where CCG members had not been engaged in the EOI process. He suggested that NHSE should ask for further and better particulars from CCGs in relation to their EOIs. Dr Chalmers-Watson said that NHSE failed to prioritise matters according to their importance and urgency. The letter seeking EOIs had been issued in May with 20 June as the closing date for EIOs to be submitted. She did not believe that the EOIs were urgent compared with some other matters so they should have been given a more realistic timeframe. Dr Shanmugadasan asked how practices could be expected to undertake more work without

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additional resources.

ACTIONS:

Clarify to LLMCs how EOIs would be evaluated and the co-commissioning process thereafter

Inform LLMCs of the outcome of the evaluation of EOIs

Mr Keane

7.0 Issues with CQRS

Dr Grewal reported that NHSIT had acknowledged that CQRS as it had been originally introduced had not been fit for purpose. He believed that things were improving. The Committee noted Dr Grewal’s report and acknowledged the work that NHSE had done in improving CQRS.

8.0 Choice of GP Practice

Mr Cairns requested an update on this matter. Mr Keane reported that from October all practice would be able to register patients from outside their boundaries. In doing so they would not be required to provide home visits. NHSE was awaiting proposals. When they had received them they would send the proposals to LLMCs. Dr Grewal said that NHSE was responsible for providing general medical services or primary care for any patients under the scheme. There was no information regarding how patients were to be informed about the scheme so that they could make an informed choice. In particular, what they would do if they could not attend their practice. Dr Grewal believed that practices should be allowed to refuse to see patients for immediate necessary treatment if they were registered elsewhere under the scheme. He expressed concerns that if an unwell patient contacted a local practice, the practice would have to make an assessment regarding whether to see the patient. If the practice refused to see patients because they were not registered with the practice, the GP could be liable to a claim for impairment of fitness to practice. It was therefore imperative that NHSE informed patients and practices what they would be required to do under the scheme. Dr Shanmugadasan said that the proposed scheme could have an impact on the commissioning budget if practices referred patients who were not registered with them. He asked if patients would be permitted to register with their local practices for emergency visits and what would be the impact on budgets for secondary care and drugs. Dr Bunt asked what would happen to locally commissioned services and local pathways in relation to these patients. The Committee agreed that there was little information in respect of the proposed scheme. It requested NHSE to provide more information. Dr Applebee requested the results of the pilot scheme, although she appreciated that the results of the pilot would be skewed by the enthusiasm of the participants.

ACTION: NHSE to provide LLMCs at the next meeting with the following information in respect of the proposed scheme:

the specification

the responsibilities and rights of the GP and patient

payments

the timescale for its introduction

pilot scheme results

Mr Keane

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9.0 Any Other Business

9.1 Patient records – receiving records of newly registered patients Dr Shanmugadasan reported problems with receiving records of newly registered patients from their previous practices. He provided a list of 170 patients in this position to Mr Keane, who said he would look into the matter.

ACTION: To look into problems with sending practices old records for newly registered patients.

Mr Keane

9.2 CQC Dr Chalmers-Watson reported that CQC were not doing a good job in relation to inspections. She had arranged a meeting with the LMC to seek to resolve the problems in a timely manner.

9.3 Timescales for Unplanned Admissions DES Dr Sanders asked if practices were required to use the standard template in applying for the DES. She wanted to ensure that practices would not fail on procedural points. This information was urgently required as the deadline for completion of Care Plans was the end of September. Ideally the information should be sent to practices before the end of the week. Dr Bunt said that the scheme should have started on 1 April but this had been delayed because patients’ lists had not been made available to practices until July. Although patients’ lists were provided through local arrangements, Dr Bunt said that NHSE should take this into account in relation to the timescale for the DES. Mr Keane said that there was a standard template but he would seek clarification on whether practices were only permitted to use this template. Mr Cairns said, once again, that issues could have been resolved with better communication between NHSEL and the LMCs. Dr Shanmugadasan reported that secondary care providers were not informing practices for weeks about unplanned admissions, so practices were not able to see patients within three days of them being discharged. Dr Grewal reported that the requirement was to see patients within three days of receiving the discharge summary. – I think this should stay in, it reflects the discussion.

ACTION: As a matter of urgency to

seek clarification on whether practices were only permitted to use a template to apply under the Unplanned Admissions DES or whether the application process was more flexible

ascertain if timescales could be moved to accommodate practices which had received patients’ lists late

send a copy of the standard template to LLMCs

confirm how often (e.g. quarterly) and two whom (CCG or NHSE) practices were to report.

Mr Keane

9.4 Pharmacy Collection Points Dr Bunt expressed concerns that practices were being offered financial incentives to have a

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pharmacy collection point on their premises. This would divert prescriptions to that provider by encouraging patients to collect their prescriptions there rather than go to community pharmacists. Dr Bunt believed that this could lead to the closure of local pharmacies reducing the part local pharmacies would play in meeting the local healthcare strategy. Dr Grewal believed that these schemes could constitute directing patients in relation to dispensing which might result in claims for professional misconduct. He understood that large sums of money were being offered to practices to provide dispensing outlets. Practices might not appreciate that where they earned more than 10 per cent of their income from non-NHS sources the sums would be abated from their notional rent. Providing a pharmacy collection point might therefore give no financial advantage to practices. Some Committee members agreed that the income from this service would be beneficial to many practices where abatement of notional rent in respect of the income would be minimal or even nil. Mr Keane said that NHSE was revisiting this subject and he would seek NHSE’s views on the subject. The Committee requested further advice to be given to members on this matter.

ACTION: Advise members on the following in relation to pharmacy collection points in practices:

Potential claims for professional misconduct in respect of directed dispensing

Abatement of notional rent ACTION: Provide LLMCs with NHSE’s view on the subject.

Dr Grewal

Mr Keane

9.5 Cancer diagnosis case studies in appraisals Dr Bunt said that Dr Henrietta Hughes, NHSE Medical Director for North Central and East London, was seeking cancer diagnosis case studies in all GP appraisals. He was contractually obliged to undertake this for revalidation. Dr Sanders said that it was voluntary but it was being presented as compulsory. Dr Grewal reported that this proposal had probably been superseded by events and LLMCs would advise GPs not to participate in cancer diagnosis case studies are part of their appraisals. GPs were required under their contract to engage with NHSE’s appraisal process but NHSE was obliged to do operate the appraisal process in consultation with the LMC. NHSE could not impose changes on GPs without consulting with the borough LMC.

ACTION: Advise members through the newsletter that it was not compulsory to undertake a cancer diagnosis case study as part of their appraisal.

Dr Grewal

10.0 Date of Next Meeting

10.1 The next meeting with the Area Team meeting was noted as Wednesday 17 Septemnber 2014 at Woburn House Conference Centre, 20 Tavistock Square, London, WC1H 9BD

11.0 Close of meeting

11.1 The meeting closed at 4 p.m.

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