Items in normal text – for consideration / items in italics – for information / * indicates additional papers
Dr Helen Kemp, CD for Quality and Safety, PC&CS, SBUHB gave a presentation about the Framework for the Management of Performance concerns in GMP on the MPL in Wales and summarised;
• What is a performance concern
• Why a framework is required
• How the framework was developed
• Stages 0-3 of the Management process and role of LMC
• The membership and role of PAG
Helen had been in post for 18 months and in that time had reviewed 102 (20 inherited) concerns. Exec members were surprised at this number and Helen advised that some were ‘soft’ concerns which hadn’t required further action/investigation. She was asked if she thought that GPs were aware of the support available from the LMC and confirmed that information about support (including LMC) was sent to GPs. She could not make the LMC aware of GPs being investigated but felt that some GPs did find it difficult to seek support.
IH advised that CTMUHB had LMC input at the pre-screening process and asked if this was being considered by SBUHB. Helen agreed to raise this with the HB.
AR asked whether an anonymised report could be made available to GPs as a learning aid. Helen confirmed that his had been one of the recommendations of the Task & Finish group which she had chaired and could possibly be done as a pan-health board exercise.
Drs I Harris (Chair) (IH), H Dean (HD), S Hlaing (SH), S Karupiah (SK), A Rayani (AR), N Shah (NS),
R Thomas (RT),
Mrs M Liddell (Executive officer) (ML), Mrs E Harris (Secretarial Assistant)
• LMC Executive Committee meeting – Tuesday 10th December 2019: The Minutes were approved and signed by the Chair.
6.4 Primary Care Access & Sustainability Forum: The sharing of sustainability data (RAG rating) for inclusion in the BMA heat map had been agreed at the forum but had not been received. This would be raised again at the next meeting and also at the Liaison meeting.
7.2 AGPU (Requests for blood tests to be done in Primary Care): The meeting with Steve Greenfield had not yet taken place. AR and SH would take this forward
NS/ML (6.4) AR/SH (7.2)
Amendments to the LMC Constitution and Articles of Association which were required due to the transfer of Bridgend Practices to Bro Taf LMC had been circulated with the Agenda and were reviewed and agreed. LMC members would be asked to agree the changes at the AGM on 31st March 2020.
As previously agreed a time-out session would be arranged following the appointment of the new Committee to discuss promotion of the role / functions of MLMC
IH confirmed the GPC Wales decision that each LMC should have a minimum of three seats to remain representative but there would be further changes at a later date in line with the Romney review recommendations.
A reminder of the closing date (Monday 17th February 2020) for submission of nomination papers had been circulated to all GPs/Practices.
The Draft minutes which had been circulated with the Agenda were reviewed and approved for circulation.
A summary of expenditure to 31st January 2020 was tabled and discussed. ML informed the Exec that the Voluntary Levy rebate agreed by GPDF for the period Jan-Dec 2019 for Bridgend Practices
would be transferred to Bro Taf LMC. ML would provide details of the projected expenditure for MLMC Ltd for April 2020- March 2021 to inform the discussion at the AGM about the level of Statutory Levy required.
The Draft minutes and action log had been circulated with the agenda. These were reviewed and approved for circulation.
Attended by IH. The draft minutes had been circulated with the agenda.
Attended by IH. The draft minutes had been circulated with the Agenda. The Exec confirmed their view that the re-establishment of the LMAG in SBUHB would be of value.
Attended by NS who advised that the baseline access tool had highlighted concerns including the inability of six practices to have recorded telephony systems.
An ‘Ask my GP’ presentation had been given which NS felt was suited to practices with a large MDT. A disadvantage was that it did not link to the clinical systems. The Exec discussed on-line access to GPs and IH confirmed that CTMUHB practices were being offered e-consult, funded for two years by the CTMUHB.
Attended by SH.
The Exec discussed the additional Transformation monies being provided to clusters and raised concerns about the limitations around the projects which could be taken forward. If not on the HB ‘list’ full business cases had to be written and submitted to the IBG (Investment and Benefits Group). IH re-confirmed the LMC view that practices should not take on the role of lead employer unless there were clear funding arrangements at the end of the transformation funding period.
Attended by HD. A proposal that the purchase of flu vaccines should be a centralised HB role could not be agreed by MLMC and this would be fed back at the next Liaison group meeting.
SBUHB Clinical Services Plan 2019-24: No update provided. SH to confirm details and her attendance at next meeting.
IH confirmed that Bridgend Practices each had a clinical enquiries email address and the Exec agreed that, following the removal of fax machines, this should also be considered for SBUHB practices until WCCG was completely up and running. Clear governance arrangements were required and it needed to be a two-way process with secondary care. The email address should only be used for non-urgent matters with telephone calls being essential for anything urgent. To be discussed at the next Liaison meeting.
Although the view of the LMC and the WG Cerumen Task & Finish group was that wax removal was not appropriate and unsafe in Primary Care the LMC had established that a significant number of practices were still providing this service. As long as this was the case it was unlikely that Health Boards would take over responsibility. For further discussion at the next Liaison Meeting.
SK tabled examples of referrals being rejected / downgraded/ tests requested. Each was discussed by the Exec and advice provided about the best course of action to take. Importantly the HB needed to be made aware of examples in respect of all specialties.
SK raised a query about GPs not being able to refer patients directly for back x-rays and IH confirmed that the LMC had agreed to this.
Historical data in relation to previous levels of uplifts and specifications was awaited from the HB. The LMC would have to agree a list of ‘wants’ to form the basis of negotiations for a better deal prior to meeting again with the HB. Date of meeting to be agreed.
GPC Wales had met with the Chief Ambulance Services Commissioner for Wales who was very aware of the issues which impacted on delays. Efforts were now being concentrated on improving patient flows. There had been agreement that Ambulances would be released for Red and Amber 1 calls and some temporary accommodation had been provided in Gwent to support this arrangement. IH had been asked to join the Ministerial Task Force.
Members of the Exec expressed concern that the above actions might be considered as a deflection and asked if it prevented MLMC from raising awareness of the issues through the media as had been agreed. IH would feed back this view to GPC Wales and report back.
The Exec view was that the document was good and protective of both patients and Health Care Professionals and the guidance should be observed. NS who had been involved in preparing the guidance advised that reception staff could undertake the role chaperone provided they had been trained.
IH highlighted the notice of Elections to the GPDF Board in September 2020 with one of 3 places being linked to Wales. Individuals had to be LMC nominees. The new Committee of would have to give consideration to this.
IH also pointed out the availability of grant funding for LMC projects. If MLMC was looking to federate or collaborate with other LMCs at some time in the future a request for financial support could be submitted for consideration.
ALL TO NOTE
Closing date for Motions 24th February 2020. MLMC had been allocated 3 seats. Exec members were asked to confirm if they wished to attend.
ALL TO NOTE
The Exec members were very supportive of RT’s view that advice circulated for patients should be translated into the languages of the countries most affected. IH would feed this back to GPC Wales.
• LMC full Meeting: Tuesday 10th March 2020
• AGM(s) 31st March 2020 The Great House, High St, Laleston, Bridgend CF32 0HP
• LMC Executive Committee – tbc