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),
S Perman (SP), P Ramkumar (PR), A Rayani (AR), M Rickards (MR), N Shah (NS),
A Stevenson (AS), R Thomas (RT), K Wallis (KW), H Wilkes (HW)
LMC Secretariat: M Liddell (Executive Officer)(ML)
SBUHB/PCCU: H Dover (HDo), A Mehta (AM)
PRACTICE MANAGERS: C Boland (CB), L Flowers (LF), C Jones (CJ)
REGISTRARS: R Spacie (RS)(Swansea)
Dyfed Powys LMC: Dr P Horvath-Howard
Dr Hlaing welcomed all to the meeting and confirmed that the meeting was being recorded to which there were no objections. Dr Visha Krishnamoorthy was introduced and welcomed as a new member representing the Sessional / first five constituency. Mrs Sandra Kiley had stepped down as the Practice Manager representative for Swansea and Mrs Caroline Jones and Mrs Lorraine Flowers, who would share this position, were introduced and welcomed.
Dyfed Powys LMC: Dr L Williams
Registrars: Dr L Parkinson
SBUHB: Dr K Reid, Dr H Kemp
A small number of forms remained outstanding and had been requested.
Full LMC Tuesday 12th May 2020 – The Minutes were agreed and signed by the Chair.
1(iv)/ 2(ii) Transformation Funds: HD informed members that WG had brought forward the timeframe and all transformation monies had to be spent by 31st March 2021. There would be no carry forward of funds.
2(i)/3 Dementia Drug Prescribing in Primary Care: Following discussion at the Liaison meeting when the LMC had informed SBUHB that LMC members did not agree to taking over the prescribing of dementia drugs, a letter had been received from Dr Richard Maggs in which he provided reassurances that prescribing for patients would not involve additional work for GPs.
Members were asked if the reassurances provided would convince them to make the decision to take over prescribing and there followed a lengthy discussion from which it was clear that confidence in the way Mental Health Services generally communicated with Primary Care was very low. This was mainly due to poor and in some cases a lack of timely communication related to patient management and members felt that until these issues were addressed it was unlikely that all GPs would want to take over the prescribing of dementia drugs. This remained an individual choice for GPs.
AM said she shared the frustrations of LMC members and much work had been done pre-covid in trying to improve communications from Mental Health Services. Meetings had now restarted with another scheduled for 23rd July 2020 when the messages she was receiving from the LMC meeting would be passed on. NS pointed out that MH service managers may not be fully aware of the areas of concern that GPs have and AM agreed that a summary of the ‘pinch points’ would be helpful to encourage engagement. This would be provided by the LMC.
AM confirmed that neither of the field hospitals were being use for admissions. Llandarcy was not currently being used for any other purpose and Bay Studio was being used for antibody testing.
The draft minutes had been circulated with the agenda. No questions were raised.
5.2 FEDERATION OF LMCs: SH confirmed that the Exec team had met with officers of DPLMC and NWLMC to discuss federation but did not want to consider this at the present time. An option paper prepared by DPLMC and NWLMC would be shared with MLMC for comment.
Phil Cox had agreed to manage the website which was in the process of being updated to make it a more flexible and useful resource for GPs/practices. A wellbeing section for GPs had been added. Phil invited feedback and suggestions from members. No increase in annual costs was anticipated.
The Chair’s report had been circulated with the Agenda
HDo commented that the speed of response of practices to the covid crisis was remarkable and the way practices had stepped up was unprecedented. WG advice had changed frequently including in relation to funding. The message at the outset was to do whatever was necessary to ensure that covid didn’t stop services but more recently this had changed with spend having
to be accounted for and the decision making process identified. This was the reason for the review and scrutiny of costs. The costs which had not been approved had been considered inappropriate or were not within the criteria limits which had been set. It was agreed that the criteria would be shared with the LMC and a small group would be established to identify themes emerging from the reports from practices of declined expenses. These would be discussed with the Health Board to determine whether the action taken had been appropriate.
HDo reported that the reactivation of secondary care services was a difficult process because of the impact on other services and the Quality Assurance requirements. The reactivation group was meeting fortnightly and the LMC would be kept abreast of service updates via the weekly LMC/HB skype meetings.
Cluster leads were now heavily involved in looking at how best phlebotomy could be provided in each cluster recognising that one model would not fit all clusters. The opportunity was also being taken to look at combining phlebotomy with other services such as BP and CD monitoring, Flu Jabs and housebound visits. A steering group led by Primary care was taking this forward.
Pre covid funding would remain and transformation funds would not be utilised in bringing the service back to pre-covid levels. Cost efficiencies would be identified through using phlebotomy staff more effectively. Pump priming monies would be available to make the service more efficient for Primary care. Schemes involving transformation funds would have to be completed and evaluated by 31st March 2021 with the exit strategy looking at;
RT commented that returning to pre covid levels of work could be problematic because of PPE and social distancing requirements. AM confirmed that this had already been recognised in Primary Care and the identification of suitable venues from which to provide phlebotomy services was essential to maximise workload.
HW raised a concern about the service in NPT where most phlebotomy was provided in NPT hospital. Previous attempts by her cluster to provide the service had failed and she was
concerned that if an alternative model was not in place by 31st March 2021 no service would be provided.
AM provided a reassurance that the phlebotomy service currently provided on acute sites would not stop but this was an attempt to make the current service better. If a cluster solution were not possible there may be an option to look at a practice solution. There had never been a plan to reduce the service but ideally patients should not attend acute sites for blood tests. The
assurance given by AM about Acute sites continuing to provide a phlebotomy service was welcomed by HW.
The draft minutes had not been circulated with the Agenda and ML apologised for the oversight. SH provided a brief summary of issues discussed.
Details of queries raised between March – June 2020 had been recorded in thematic form and circulated to members.
(b)Enhanced Services: requirement for f2f consultations:
LF requested guidance around ES where there was a requirement for f2f examinations for some patient groups. Eg Learning Disabilities. AM advised that examinations would be clinician initiated if not reassured by phone /video consultations. She would be happy to look at any examples forwarded where some further clarity was required.
CB raised a concern about late payments and cited the example of an employee who had been appointed by the practice on behalf of the cluster but for whom only one payment in 12 months had been received leaving the practice out of pocket. AM was unable to comment on the example given but would speak to the Primary Care Manager involved.
HD confirmed that red and green zones were still operating but the number of patients with covid symptoms had reduced. The shift fill rate was currently very good.
No new issues were reported
Phil Cox (PC) represented the LMC on this SBUHB group which wanted to promote positive messages in the media about General Practice to reassure patients that they were still ‘open for business’. PC asked members to let him have tweet sized messages to reflect this. It was also hoped that the benefits of technology could be promoted with the experience of two patients being highlighted. If anyone could identify patients who had positive experiences in using ‘Ask my GP’ and who would consent to their experience being written up please contact Phil directly
This would remain on the agenda as a standing item.
PH-H confirmed that;
NS informed members that, as a result of a delay in the BMA’s Annual Representative Meeting (ARM) there was a also a delay in elections for GPC Wales representatives for Morgannwg LMC. Although no longer members of MLMC, Ian Harris, Charlotte Jones and Jerome Donagh continued as the current MLMC reps and would attend the GPC Wales meeting on Thursday 16th July 2020. NS would be attending as Chair of Welsh Conference / Sessional GPs rep and SH and AR would attend as observers.
had accepted MLMC invitation to be a co-opted member and would be attending future meetings.
PR reported that there did not seem to have been much publicity around the launch of the 119 number and although some members were aware of it, not all had been notified.
Details of the consultation had been circulated to elected members and responses were required by 20th July 2020. AR commented that a lot of it was unworkable and made demands of GPs which would be impossible to achieve without additional resources. The LMC would be submitting a response but AR suggested that GPs should also respond individually as it was the type of document that would gain momentum if not challenged.
PH-H confirmed that GPC wales was collating responses from LMCs in Wales and expected them to be in alignment following comments made on the list server. PH-H asked GPs to copy their responses to GPC Wales.
GPC Wales had arranged to meet the Chair of the All Wales Medical Committee in August when concerns would be made very clear
PH-H reported similar issues as discussed by MLMC. There had been difference in approach to funding of PPE and covid expenses across the two HBs. DPLMC was looking for a soft-touch sensible approach to the restarting of services in terms of using clinical acumen and judgement and constituents were being reminded of the importance of documenting clinical decisions.
PR informed members that the sessional group had been meeting more regularly to support each other, discuss changes in working practices and share knowledge. Locum shifts had reduced significantly and many GPs preferred to work from home. PR confirmed that the group also included some members who worked in NPT.
Details of changes to the SBUHB MPL between April-June 2020 had been circulated to elected members with the Agenda
HD informed members that Tracy Myhill, CEO of SBUHB had announced that she would be retiring in December 2020 . The LMC had been made aware and SH had contacted her directly on behalf of the LMC.
LMC Executive Committee: Tuesday 11th August 2020
LMC Full Meeting: Tuesday 8th September 2020– arrangements tbc