Items in normal text – for consideration / items in italics – for information / * indicates additional papers
The invited speakers from the Mental Health and Learning Difficulties Directorate had been unable to attend this meeting.
LMC MEMBERS: Drs R Beynon (RB), T Cufflin (TC), H Dean (HD), P Evans (PE),
I Harris (IH), S Hlaing (SH)(Chair), S Karupiah (SK), J Kerrigan (JK), S Perman (SP), P Ramkumar (PR), M Rickards (MR), N Shah (NS), A Stevenson (AS), R Thomas (RT), H Wilkes (HW)
LMC Secretariat: M Liddell (Executive Officer), E Harris (Secretarial Assistant) (EH).
SBUHB/PCCU: H Dover (HDo), Dr A Mehta (AM);
PRACTICE MANAGERS: M Haynes (MH),
REGISTRARS: L Parkinson (LP)(NPT)
OBSERVERS: Dr B Chisholme (BC), Dr Heather Cowie (HC)
Dr Hlaing welcomed Drs Heather Cowie and Ben Chisholme who attended as observers and also thanked the Sponsors who had supported the meeting.
LMC Members: Drs P Cox, J Donagh, C Jones, R Jones, K Mellin, A Rayani, K Wallis, P Williams
Dyfed Powys LMC: Dr P Horvath-Howard, Dr L Williams
Practice Managers: C Boland, S Kiley
Registrars: Dr J Shah, Dr R Spacie
no forms completed
• Full LMC Tuesday 14th January 2020 – The Minutes were agreed and signed by the Chair.
The draft minutes had been circulated with the agenda and were noted.
Nominations received had not exceeded the number of seats and an election had not been required. ML confirmed the names of the LMC Committee members, 15 of whom were current members. New members included Dr Duncan Williams and Dr Heather Cowie.
ALL TO NOTE
Morgannwg LMC had been allocated 3 places at the Conference in York. AS and PR expressed interest in attending and further details would be sent to them.
HDo confirmed that the National Escalation tool had been rolled out with a mixed completion rate. IH advised that it would be an on line tool and would be relatively easy to use.
HDo advised that a number of clusters had asked that transformation funds be rolled forward and this had been agreed and actioned. There was an underspend on some lines and approval to roll forward to 2020-21 was awaited.
Clusters were now moving forward to the consolidation phase.
Attended by SH who provided a brief summary of the issues discussed.
The Draft minutes and Action log had been circulated with the agenda.
WOUND CLINICS: Lack of capacity in the Wound clinic in NPT was resulting in patients being directed to Primary Care which was not appropriate if practices were not participating in the Wound Care LES. Examples should be forwarded to Anjula Mehta but it was possibly something for discussion at Cluster level. The LMC requested reassurance around what should happen if the Wound Clinic was unable to deal with patients. This would be discussed in the Liaison meeting. (ML)
WARFARIN: RT highlighted an SI which had occurred as a result of the non availability of daily INR checks during weekends. This would be discussed at the Liaison meeting. (ALL TO NOTE)
WCCG (Cardiology): HW highlighted that Cardiology (Bridgend) patients had been waiting for up to two months to be prioritised. This issue had been raised previously and was thought to have been rectified. IH requested details which would be taken up with Cardiology. He was disappointed that it had happened again and suggested that members should check the situation in respect of their patients. (IH/HW)
ML / ALL TO NOTE / IH/HW
Attended by IH. The draft minutes had been circulated with the agenda and were noted. IH confirmed that 6 seats in Bro Taf LMC had been allocated for Bridgend GPs and 3 had been filled by Ian Harris, Peter Evans and Sarah Medlicott.
The updated schedule (Aprl19-Feb 20) of queries raised had been circulated. No new issues were raised.
MH queried the supply of PPE to practices – see item 6 (i)
HD confirmed that the fill rate for evening, weekend and overnight shifts remained good. AM commented that the robust leadership arrangements which had been put in place had helped the service.
AM confirmed that the introduction of the SPOA for Swansea /NPT was imminent. It was anticipated that this would help fix the issue of face to face consultations being required prior to patients being accepted.
Anjula Mehta confirmed that DNs were involved in a NEWS(2) (National Early Warning System) pilot. IH said that this was of concern for the LMC as it is not validated for use in primary care and a close watch would be kept.
IH commented that issues around the prescribing of medication remained the biggest issue under discussion at the Liaison meeting. The use of a MAR chart was the anticipated solution but would take some time to be implemented nationally. In the meantime issues of concern should be fed back to Tanya Spriggs who could investigate them on an individual basis.
ALL TO NOTE
Anecdotally the situation seemed to have improved but it wasn’t clear if this was as a result of patient demand having fallen due to Covid-19. HD commented that AGPU GPs had made an impact on the ambulance stack and having a GP in ED in Morriston since December 2019 had also helped. The request to release ambulances for red calls had improved but delays were still being recorded in respect of Amber calls.
IH requested that the HB clarified the availability of ambulances to transfer patients on ventilators during the current Covid-19 outbreak.
IH would attend the first meeting of the Ambulance Task force in a few days as would a member of the Welsh Consultant committee.
LMC Members agreed that now was not the appropriate time to raise issues in the media but could reserve the right to look at the situation again. AM commented that it was difficult to predict what would happen but that ED would look very different as a result of covid-19
no new issues raised
The review was ongoing.
IH confirmed that, as directed by the LMC Exec and members, he had argued strongly to maintain the current position of representation and that MLMC should have 3 seats and this had been agreed. All LMCs would have a minimum of 3 seats but Bro Taf would increase to 4. Further discussions would be held in view of the outcome of the Romney Report and quotas introduced to ensure that GPC Wales remained truly representative. The election for the 3 MLMC seats would be in July 2020.
The management of the current Covid-19 outbreak was discussed extensively and members expressed a high level of concern about the current proposals for managing it in Primary Care. The Standard of PPE issued to Practices was not fit for purpose and offered little protection against the virus.
A Business continuity template had been circulated to practices by the LMC and IH advised that the safety of GPs and their teams was paramount. Cluster working should be considered and the LMC was advising GP Partners to register on the All Wales Locum list to enable them to work in neighbouring practices should the need arise. The link to the Locum list would be circulated to all practices.
The Public Health Website was probably the best for patient information and most work was now being done on a 4 nation basis.
Guidance was being updated on a daily basis
Attended by IH. Covid-19 had been discussed. Dr Peter Horvath-Howard had been appointed as Medical Advisor. There continued to be concerns about the OOH service in Hwyel Dda.
PR reported that the local locum list had been closed down and there had been some discussion about the use of the All Wales Locum list to advertise shifts. This had not been agreed and LMC advice was that this should be avoided.
The List of MPL changes between November 19- February 20 had been circulated to elected members with the agenda.
AGM(s): Tuesday 31st March 2020 ( rearranged from 14th April 2020 due to Easter School Holidays): The Great House, High St, Laleston, Bridgend CF32 0HP
LMC Executive Committee: Date and venue to be confirmed
LMC Full Meeting: Tuesday 12th May 2020: The Mercure Hotel Swansea SA7 9EG