Items in normal text – for consideration / items in italics – for information / * indicates additional papers
LMC MEMBERS: Drs R Beynon (RB), P Cox (PC), H Cowie (HC), T Cufflin (TC), H Dean (HD),
S Hlaing (SH)(Chair), R Jones (RJ), S Karupiah (SK), J Kerrigan (JK), V Krishnamoorthy (VK),
K Mellin (KM), S Perman (SP), P Ramkumar (PR), A Rayani (AR), M Rickards (MR), N Shah (NS),
A Stevenson (AS), R Thomas (RT), K Wallis (KW), D Williams (DW); P Williams (PW); H Wilkes (HW)
LMC Secretariat: M Liddell (Executive Officer)(ML), E Harris (Secretarial Assistant) (EH).
SBUHB/PCCU: H Dover (HDo), S Miller (SM)
PRACTICE MANAGERS: C Boland (CB)
REGISTRARS: L Parkinson (LP)(NPT), R Spacie (RS)(Swansea)
Dyfed Powys LMC: Dr L Williams (LW)
Dr Hlaing welcomed all to the meeting and advised that the meeting was being recorded to which there were no objections
HD advised that Sharon Miller was attending the meeting in her new role as Interim Associate Director Primary and Community Services. Her role was to ensure that the focus on primary care was maintained during the Covid Pandemic and she would also have a key role in leading a program of work to ensure that essential services were provided through the pandemic.
Dyfed Powys LMC: Dr P Horvath-Howard
Practice Managers: S Kiley
SBUHB: A Mehta
DOI forms had been circulated to all members who were asked by SH to sign and return them to the LMC office as soon as possible.
2(i) Practices at risk / Primary Care Access and Sustainability forum (PCASF): No panels had been arranged since the previous meeting. NS would attend the PCASF on Thursday 14th May 2020 (the meeting was subsequently cancelled due to NWIS being unable to provide data in respect of Access standards which had been submitted by practices)
2(ii) GP Clusters/ Transformation Funds: SH had been advised at the clinical leadership meeting that Transformation funds would not be rolled forward beyond the end of the financial year. HD advised that clarity around this was being sought from WG and full details could not be provided at this time.
SH commented that there was ambiguity around the use of cluster funds for covid related expenses some of which had already been committed but confirmation of reimbursement was not forthcoming. HD advised that, at the start of the covid it had been essential to get services up and running as a matter of urgency but WG was now looking at covid costs across the NHS in Wales and HBs had been asked to provide details of expenses, both committed and proposed. SM confirmed that some of this detail had already been collated from cluster leads and practices through cluster covid spend plans and this could be shared with the LMC. Members agreed that the LMC should contact practices not only to ascertain details of expenses but also to hear of any issues or concerns they have.
2(iv) LMC/SBUHB Liaison Meetings; SH confirmed that Liaison meetings during covid were being arranged on a two-weekly basis and issues such as Wound clinics, 111 and community nursing would be carried forward and discussed at those. No new concerns about these were raised.
6(ii) COVID-19: SH commented that testing in Care Homes had improved but testing of patients in the community was still not available. AR would write to PHW for an update.
No further new issues were raised.
The report had been circulated with the Agenda (copy attached)
1.Communication Channels: SH and AR were attending the weekly Clinical Leadership meetings which included Cluster leads and Health Board managers.
Two-weekly liaison meetings were being arranged between LMC and SBUHB during Covid.
LMC Exec and Full meetings would continue to be held on a virtual basis until face to face meetings, compliant with social distancing guidance, could be achieved.
The LMC also wished to engage with secondary care colleagues and post pandemic it was hoped that LMAG (Local Medical Advisory group would be re-established. AR would write to the Chair of the Medical Staffing Committee.
2.Process for Accessing Urgent Palliative Care Medication in the community during Covid: The LMC had been in discussion with SBUHB about the process which was required during Covid due to the fast deterioration of some patients. Details once finalised would be circulated to practices.
AR reminded members that the process was voluntary and non-contractual and the only responsibility that GPs had was to make an assessment and issue a WH10
WHC 2020 008 Re-use of EOL Medication in Care Homes had been circulated to members and SH confirmed that she and AR would be discussing the process in SBUHB at a meeting on Thursday 14th May 2020.
RT commented that para 12 of the circular made reference to stock for general use being available in Care Homes and this could be a consideration.
3.Dementia Drug Prescribing in Primary Care: The LMC had advised the MMOB that it did not support the prescribing of dementia medication by GPs without a transfer of resources. In response secondary care consultants had stated that there was no additional work required in terms of monitoring and review and that the LMC view was contrary to recommendations in NICE Guidelines for Dementia NG97. Members were asked to comment and following discussion it was agreed that LMC concerns were linked with concerns about wider Psychiatric prescribing issues and these should be looked at together. The LMC would inform the MMOB of the outcome of its discussion and would suggest that further discussion be opened at the end of the Coronavirus pandemic.
4.Communication with Pharmacy, Secondary Care and Community Nurses (Mobile Phones)
SM confirmed that 13 practices to date had requested a mobile phone following the letter circulated on Monday 11th May 2020. The cost of these was being met from Covid-specific funds and SBUHB could not confirm whether the funding would continue at the end of the pandemic. It was important to note that the phones were on a rolling 1 month contract with no ongoing obligations for practices.
5.Verification of Death: SH asked members for comments about the arrangement for verification of death by AHP via the Primary Care Hub. Members commented that it was of great benefit during OOH periods. The requirement to provide a copy of the death certificate to the Primary care hub would be challenged. It was noted that the VOD process had been implemented without prior discussion with the LMC.
The LMC was awaiting a response from the Coroner about the verification of community deaths remotely which was in line with BMA guidance.
NS had been involved in forming a SBUHB policy for the verification of death in Care Homes by care home staff. An on-line training programme was available.
SM advised that a desk top exercise was being carried out to determine the amount of cluster transformation funds not committed in the expectation that these could be utilised to support virtual ward costs. Information would be fed back to the LMC once details were available
: Constituents had reported that changes had been made to the walk in service in SBUHB hospitals which had not been discussed with either the LMC. This had been raised at the clinical leadership meeting and Anjula Mehta advised that she would speak to the radiology dept and involve the LMC in ensuring changes were communicated appropriately.
SH advised of the need to remind practices to continue completing diet datix in respect of breaches of the All Wales Communication standards as Helen Kemp had reported a significant reduction in reports since the start of the covid pandemic.
RJ highlighted an issue in respect of an USC referral made before the start of the pandemic which had been cancelled but not notified to the practice and no follow up appointment arranged. Examples like this must be referred to Anjula Mehta.
Cluster leads had reported that GPs were being asked to do blood tests before and after clinics and this was not appropriate. Diet datix should be completed and Anjula Mehta informed.
: SM advised that discussions about re-opening OPD clinics were at an early stage. WG had issued an operating framework for Qtr 1 and the HB Exec Team would be taking a lead role in looking at the reactivation of services.
The review of ES would continue after the pandemic ended
SH and SM would discuss online registration of students outside of the meeting
The review of ES would continue after the pandemic ended
GPC Wales would be contacted for an update about the introduction of electronic prescribing
SM to check when screening would restart
LW reported similar issues in respect of the way cluster funds may or may not be spent to support primary care.
A shared agreement was in place for prescribing Dementia medication with patients having, at least, an annual review and easy access if deemed to require it. Patients were not being discharged.
LMC Executive Committee: Tuesday 9th June 2020 (virtual)
LMC Full Meeting: Tuesday 14th July 2020 – arrangements tbc