Items in normal text – for consideration / items in italics – for information / * indicates additional papers
1. Professor Hamish Laing: Executive Medical Director ABMU HB:
Hamish confirmed that he would leave the NHS at the end of July 2018 to take up post as Professor of Enhanced innovation, Engagement and Outcome at Swansea University. His NHS career spanned over 30 years and he hoped to continue involvement with LMC colleagues through his new role which involved work on value based healthcare to ensure that monies were being spent in a way which would ensure the greatest impact on healthcare.
Hamish had enjoyed his interaction with the LMC and was particularly impressed and encouraged by the support offered to GPs and practices across ABMU including assistance in helping with difficult performance issues. He recognized the valuable input of all LMC members and the importance of having Practice managers and GP registrar representation at meetings. Hamish also made particular reference to the input of individual Executive Team members and thanked them.
Ian thanked Hamish on behalf of the LMC for his commitment and relationship over many years. Issues raised had always been taken very seriously and his many achievements were to be congratulated especially his drive to improve the quality of discharge information.
2. Hilary Dover (PCCU Service Director), Alastair Roeves (Interim AMD) and Jason Crowl (Unit Nurse Director) gave a presentation entitled:
‘If Primary Care and Community Services ran Unscheduled Care and Diabetes Services at ABMU HB, what would it look like?’
The aim was to look at how services could be provided differently in order to achieve beneficial outcomes in terms of activity. A schedule of proposed schemes was made available to LMC members and explained by Alastair and Jason.
Alastair asked GP members to provide comments and to prioritise schemes. There was a tight timescale but deemed necessary if any changes were to be achieved by next winter. Hilary pointed out that there were staffing opportunities although it would not mean new staff but more a rebalancing of the system from secondary to primary care.
The general feeling of members was that it would be difficult to vote/comment without further details being provided and this was acknowledged by Alastair.
Alastair also spoke about the development of an ABMU integrated diabetes model which would see a seamless flow of patients between secondary, primary and community care and with an appropriate shift of resources. Further details were being worked up in a business case with the expectation that a solution would be available from April 2019.
Ian thanked Hilary, Alastair and Jason for the presentation and asked members to try and complete the schedule of bids as a matter of urgency. He was pleased that the Health Board was engaging with the LMC in the change process.
LMC MEMBERS: Drs P Evans, I Harris (IH) (Chair), S Hlaing (SH), C Jones (CJ),
R Jones (RJ), J Kletta (JK), S Karupiah (SK), K Mellin (KM), P Ramkumar (PR), A Rayani (AR), E Rees (ER), M Rickards (MR), A Stevenson (AS)
A Stevenson(AS), R Thomas (RT), K Wallis (KW), H Wilkes (HW), P Williams (PW)
LMC Secretariat: M Liddell (Executive Officer) (ML), E Harris (Secretarial Assistant) (EH).
DPLMC: Dr L Williams
ABMU/PCCU: Dr S Bassett (SB), Mrs H Dover (HD), Dr A Roeves (ARo),
PRACTICE MANAGERS: C Boland (CB), S Kiley (SKi)
REGISTRARS: Dr A R Evans (AE)
Drs T Cufflin, J Donagh, L El-Sharkawi, H Hunt, N Shah, R Thomas, K Wallis, H Wilkes, J Williams, P Williams
Dyfed Powys LMC: Dr P Horvarth-Howard
Registrars: B Roberts (Bridgend), C Williams (NPT)
Practice Managers: M Haynes
ABMU: Dr S Husbands
PHW: PHW representatives would attend meetings when public health issues were on the agenda and would continue to liaise with primary care mainly through clusters.
• Full LMC Tuesday 8th May 2018 – the Minutes were approved and signed by the Chairman
Tom Watkin had notified the LMC that he would be unable to continue as an elected LMC member following a move to North Wales.
IH welcomed Ainsley Rees-Evans to the meeting as the Swansea VTS representative.
The VTS programme directors were supportive of LMC/ABMU involvement in induction sessions for new trainees.
AR / ML
The newsletter had been circulated on 27th June 2018. IH was congratulated on the content and quality.
AR had attended a sustainability panel on 26th June 2018. HD was appreciative of the on-going support being received from the LMC.
GPC Wales would be asked to consider using RAG (Red/Amber/Green) ratings to standardise the BMA heat map information across Wales.
Despite the WG view that unspent cluster funds could be ‘reprovided’ the following year the Health Board view was that there could be no carry forward of funds.
The meeting on 30th May 2018 had included presentations from cluster leads about initiatives considered to be suitable for mainstreaming. Further work was required around this prior to the next meeting on 25th July 2018 which would be attended by the CEO. IH would attend.
Cover arrangements had not been progressed in NPT. IH advised that the NPT clusters would have to try to replicate arrangements in Bridgend and Swansea.
The Draft Minutes had been circulated for information.
SB confirmed a continuing challenge with the recruitment and retention of GPs and expressed gratitude to those who continued to work OOH. Nursing staff were currently being recruited and there was increasing interest from GPs in remote triage. Some activity data would be provided at the next meeting. It was noted that the Health Board Primary care dashboard included OOH activity data. SB reminded members about the Health professional feedback form which was available on the intranet and reviewed by him. (eg perceived inappropriate prescribing of antibiotics)
meeting. IH reminded members of the necessity to record all such examples in datix for primary care.
ALL TO NOTE
The Datix for Primary Care had been rolled out to all ABMU practices for use where the standards had been breached. Some data would be available at the next meeting.
ALL TO NOTE
PE highlighted two recent extreme examples of delays in responding to 999 calls from the surgery and which had resulted in SEA’s. He also raised the issue of ambulances queuing outside EDs whilst at the same time bed closures were being proposed. The MD of WAST would be invited to the next LMC
Health Boards were looking at a range of options for consideration by GPs.
An updated schedule of issues / queries raised by Practices between April – June 2018 had been circulated.
Single Point of Access (SPA): Concerns had been raised about the introduction of a SPA in NPT without prior discussion with practices. Together with other highlighted relationship issues this suggested a disconnect between DNs and practices that required urgent resolution. Local DN managers had been made aware of the situation which would also be raised with the UND and discussed further at the Liaison meeting.
CB highlighted that the NPT INR clinic was sending patients to their GP to be referred for a scan with the results being returned to MIU. ARo requested that details be forwarded to him.
PE advised that GPs were confused about the types of insurance cover being offered by MDU/MDDUS in light of the state-backed indemnity scheme which would be introduced in April 2019. CJ provided a summary outline and advised that a focus document would be circulated by GPC Wales.
IH paid tribute to DR John Hickey who passed away on 4th June 2018
HD provided brief details of the WG Transformation fund (£100m) for the NHS in Wales. This would be used to fund a small number of programmes that could have the greatest impact in developing and delivering new models of transformed services. Combined Health Board and Local Authority bids were being submitted. Further updates would be provided.
No new update
The minutes of a meeting held with local MH managers would be shared with the LMC once signed off. Issues raised would be discussed at the Clinical Governance Leads meeting.
This item was tabled for discussion at the Liaison meeting on 17th July 2018.
The reticence of non-doctors to complete the forms continued to be a problem and contributed to the poor working relationships with community nursing staff. This would be discussed further at the Liaison meeting.
A transitional Director and Programme manager had been appointed to oversee the process. A clinical lead would also be identified. IH would attend the Bro Taf LMC / Cwm Taf HB Liaison meeting on 18th July 2018.
ARo confirmed the appointment of Dr Helen Kemp who could be contacted at Helen.Kemp@wales.nhs.uk
The BMA legal challenge was ongoing – no further update
IH confirmed that practices could not make a charge for Subject Access Requests or related postage costs. A charge could be made for subsequent repeated requests. IH encouraged members to read the Paul Cundy GDPR blog;
The information in the blog was helpful and although drop box was not accessible on ABMU PCs it could be accessed on phones or non-NHS PCs/laptops.
WG would not provide a DPO service for Welsh Practices. GPC Wales was discussing this option with NWIS.
An update in respect of claims submitted by practices would be clarified outside of the meeting.
No update available
LW provided an update on;
WAST ISSUES: Brendan Lloyd would attend the next DPLMC meeting to discuss issues of concern
OOH: Shropdoc had been awarded the contract although it was unclear what the service included and whether day time services would continue as at present.
DIABETES LES: The HB had modified one of the suites which would be a LES for type 1 diabetics to be looked after in the community.
GP PREMISES – IMPACT OF RATES REVIEWS: The HB has been asked for details of how monies saved as a result of practice rates being reviewed had been reinvested. The LMC view was that any savings should be used for GMS..
The closing date for motions was 17th September 2018. IH asked members to submit motions for consideration.
BMA House London. AR/ML would attend
The list of changes April-June 2018 had been circulated to LMC GP Members.
IH confirmed that the payment uplift and arrears would be paid to practices at the end of July 2018. The DDRB announcement was due in the next two weeks.
ALL TO NOTE
• LMC Executive Committee 14th August 2018 – Venue tbc
• LMC Full Meeting 11th September 2018 – The Mercure Hotel Swansea