Items in normal text – for consideration / items in italics – for information / * indicates additional papers
LMC MEMBERS: Drs R Beynon (RB), P Cox (PC), T Cufflin (TC), H Dean (HDe),
S Hlaing (SH)(Chair), R Jones (RJ), J Kerrigan (JK), V Krishnamoorthy (VK),
S Perman (SP), P Ramkumar (PR), A Rayani (AR), N Shah (NS),
A Stevenson (AS), R Thomas (RT), K Wallis (KW), D Williams (DW), H Wilkes (HW)
LMC Secretariat: M Liddell (Executive Officer)(ML), E Harris (EH)
SBUHB/PCCU: H Dover (HDo), A Mehta (AM)
PRACTICE MANAGERS: C Boland (CB), C Jones (CJ)
REGISTRARS: R Spacie (RS)(Swansea) L Zamen (LZ)(NPT), W Slater (WS
OBSERVERS: A Verechinsky (VTS Sx)
SH opened the meeting and welcomed all including Wendy Slater, Liza Zamen (NPT VTS reps) and Alissa Verechinsky, GP Registrar in Harbourside surgery).
SH advised that, at the request of members there would be a closed session at the end of the meeting.
LMC Members: Drs H Cowie, S Karupiah, K Mellin, M Rickards, P Williams
Dyfed Powys LMC: Drs P Horvath-Howard, L Williams
SBUHB: Dr K Reid,
Five forms remained outstanding.
Full LMC Tuesday 14th July 2020 – The Minutes were agreed and signed by the Chair.
The draft minutes had been circulated with the agenda.
The Chair’s report had been circulated with the Agenda
1. HUBS & FIELD HOSPITALS
HD confirmed that the Health Board had pulled out of the field hospital at LLandarcy which would revert to a Sports Centre. The Bay Field hospital would be available should activation be required and was currently being used for Phlebotomy, Antibody testing and by Swansea University for teaching. Plans to use it for mass covid / flu vaccinations were also being considered.
AR asked if there were capacity issues currently in Morriston Hospital and HD advised that although both Morriston and Singleton were currently operating at level 4 the field hospital was not being considered for use as this would only come on line at super surge ( when all other beds across the Health board had been used) If there were a surge in admissions which required the field hospital to be used for admissions it would be staffed by the ‘closing down’ of non essential services. AM confirmed that practices would not have access to the field hospital for vaccination purposes as there were other opportunities in the community which could be explored first. She also stated that the vaccination of the 50-65 year age group is not expected to fall to primary care and options for this group were being considered subject to vaccinee availability expected November/December 2020.
CB and CJ stated that practices were having to field queries from patients about the unavailability of Covid-19 tests in Wales with patients being advised by the 119 service to attend as far away as Tetbury / Mountain Ash / Aberystwyth. Neither HD or AM were aware of local difficulties with test availability and would seek advice. Any problem with the availability of test kits would be outside the control of the HB but there should not be a problem with capacity for testing. AM would provide feedback asap.
TC asked if patients could arrange tests directly via the SBUHB as advertised on the website. AM advised that logistically this would not be possible and patients should be advised to use 119 as advertised on WG Website.
2. Reactivation of Primary Care Services:
With the reintroduction of Enhanced services from 1st July 2020 SH asked if written guidance would be issued re remote consultations replacing f2f where necessary. AM advised that cases should be looked at on an individual basis and would depend on clinical judgement.
AM would check and confirm the timescales for the completion of the CCSAT and IT toolkit
3. Phlebotomy Services:
The project steering group which included the cluster leads, was continuing to work on the development of a robust and sustainable phlebotomy service in which the use of hospital sites would be reduced and which would include an enhanced digital platform. An evaluation of future demand would be undertaken by clusters to include work currently undertaken in secondary care to help inform the business case and funding requirements.
The roll out of GPTR (electronic test results) would be of great benefit for practices and give them access to the same system as secondary care. HW confirmed that a pilot was underway in 2 Surgeries ( Dr H Wilkes and Partners, BFHC) and Mount Surgery and was working really well although at present paper forms were still required.
4. Reactivation of Secondary Care Services
Workload transfer from secondary care continued to increase but without examples being reported via diet datix it was difficult for the HB to take action. The LMC had agreed to organise
a two week pilot to capture data from 2 practices in Swansea and 1 in NPT and SH had designed a simple excel template. AM advised that these concerns had already been highlighted to secondary care but it was essential that examples were reported. SH asked for a volunteer practice from NPT to assist with the collection of data. AR said that practices should continue to send in email examples as the more information available the better.
AM confirmed that the Reset and Recovery group which had been established was attended by all units including PCCU to discuss the speed and services to be reactivated. A Quality Impact Assessment of was undertaken of proposals and primary care was able to feed in comments of the impact of any changes in service referral or discharge pathways. HD confirmed that LMC concerns should be fed back to Sharon Miller. Most services had reactivated and a review was being undertaken of those which had not.
5. Communication with patients
PC reported that the message from the PC Communications Group had changed as a result of delays in waiting times for secondary care appointments. Patients were now being advised to monitor symptoms and report any changes to their GP. He encouraged GPs to let him know if there were any other messages they wanted to get across to patients via the media.
6. FLU Vaccination
CJ asked if the District Nursing service would be involved in the vaccination of housebound patients and AM confirmed that they would continue to vaccinate patients on their current caseload who they were already visiting.
RT asked PR (sessional GP group rep) to remind sessional GPs that they could be vaccinated at the surgery at which they were registered.
AM confirmed that a flu guide was being prepared by the HB for practices and the issue of PGDs was imminent.
RT asked that members adhered to the PPE guidance for flu to keep pollution to a minimum
7. Appointment of Executive Officer /Company Secretary
ML confirmed that a new Executive Officer / Company Secretary had been appointed and would take up post on 5th October 2020.
The Draft Minutes of the meeting had been circulated with the agenda.
2.1 Allergy service
NS requested an update about the referral pathway for Allergies and stated that it was becoming embarrassing that the arrangements for this service could not be clarified for constituents. AM advised that she was waiting for confirmation from the service directors in Morriston and Singleton Hospital and would make it a priority to notify the LMC.
4.2 Mental Health Services
HW requested an update from the HB meeting with Richard Maggs on 22nd July 2020. AM advised that all issues of concern had been raised at the meeting. A significant backlog of Outpatient appointments was a contributory factor and steps were being taken to resolve this and support the service. Further meetings were being arranged and AM would attend.
A SPOA (Single Point of Access) service had been established in SBUHB and mirrored the successful service already working in Bridgend. Referrals could be made by telephone or email. SH asked why referrals were not being made via WCCG. AM advised that this should be possible and would be explored.
HW asked if the plans for a Mother and baby unit at Tonna hospital were going ahead with cover during OOH from the SBUHB OOH Service. AM advised that she was not aware of any discussions with the PCCU but would find out.
5.1 Patient Registration(GMS)
RT asked for clarification as to whether patients were required to have an address in the practice area as stated in the Minutes as there was a mechanism for registering patients of no fixed abode. This would be raised at Liaison and with NWSSP.
The record of themed issues raised had been circulated with the agenda. Inclusion on the LMC website would be considered at a later date.
(a) Schools – Covid-related letter requests
CJ advised that Practice managers were reporting an increasing number of letter requests from parents of children being sent home from school with minor cold symptoms and letters to support home schooling and asked if guidance could be issued. HDo confirmed that School nursing would be asked to have a look into this issue.
(b) Electronic Prescribing
CJ requested an update in respect of the implementation of electronic prescribing. AM confirmed that NWIS was working on a national roll out. There was no indication of the timescale.
(c.) GMS Contract 2020-21
CJ queried the 2.8% uplift for practice staff. NS confirmed that it was in addition to the Global sum and would be backdated to April 2020. AR informed members that monitoring would be undertaken to ensure that the uplift had been applied. A query was raised about the legality of this and NS agreed to raise with GPCW.
HDe reported that ‘Contact tracing’ had had an impact on the service and there were concerns that this could escalate in the coming months. Having access to remote triage kits helped to mitigate this.
No new issues reported
HDo informed members that the Primary Care and Community Unit would include all Therapy services from Secondary care and also Mental Health and Learning Difficulties. This was seen as a positive change and would be phased in over the next few months.
Interim posts were being filled on a substantive basis.
NPT and Singleton Units would combine and Jan Worthing would take over the Service Director role across both sites.
HDo was retiring at the end of December 2020 and Brian Owen had been appointed as Service Director of the Primary, Community and Therapies Unit. Brian would shadow HDo until the end of the year and would be invited to attend the MLMC meeting scheduled for 10th November 2020.
JK had raised the issue of the increasing number of requests from secondary care to monitor patients on an annual basis and asked if there should be an Enhanced Service as there was in other parts of the UK. Following a long discussion it was clear that members agreed that the workload was increasing and would continue to increase as the frail elderly patient population increased. Mixed views were expressed about whether or not the work was within the scope of GPs or should remain with specialists. Further discussion was required with constituents before taking to Liaison.
This would remain on the agenda as a standing item. A date had not yet been agreed to reactivate discussions which had commenced pre-covid and would be requested at the Liaison meeting.
Nimish, Sandar and Helen were congratulated on being elected to the three MLMC seats on GPC Wales
Each LMC could send the Chair, Medical Secretary and up to 5 additional representatives. Members wishing to attend should inform the LMC office. The closing date for registration was 23rd October 2020. GP Trainees were encouraged to attend.
Four themes had been suggested by the Agenda committee.
Workforce, Sustainability, Urgent Care and Enhanced Services
Members were asked to submit details of issues which could be written up as formal motions
There was no representation from PHW and no new issues were raised by members.
PR stated that there was some ambiguity around the number of days GPs were required to isolate following contact with a patient suspected of having Covid-19 and GPC Wales would be asked to seek confirmation of the National guidance.
The LMC was aware of the difficulties being faced by sessional GPs and although the amount of locum work available was now back to pre-covid levels some GPs had suffered financial problems. NS commented that there was no easy solution and that it may be necessary for sessional GPs to consider diversifying to have more of a portfolio type role. In the event of financial difficulties
there were organisations which could provide GPs with financial support, the Cameron Fund being one of them. AS highlighted that Sessional GPs could be eligible for the Government Grant support if they met the required criteria.
HDe asked PR to make sessional GPs aware that shifts were available in the OOH service.
AR had attended the virtual meeting on 3rd September 2020 and advised that issues discussed were similar to those of MLMC and included;
• Concerns about clusters and cluster working including decision making about cluster expenditure. Guidance was being sought
• Disparity around the provision of Health Visiting and phlebotomy services
• Lack of clarity around how the Flu campaign will run in conjunction with the Covid vaccination programme
Details of changes to the SBUHB MPL between April – Aug 2020 had been circulated to elected members with the Agenda.
The report had been circulated with the agenda
HW raised a concern about prescribing for type 2 diabetic patients who were managed by secondary care as patients were not having their bloods monitored. AM advised that during covid virtual consultations were being undertaken in secondary care and although bloods may be taken in a community setting secondary care remained responsible and accountable for the monitoring of results. She would feed back the concerns to the Diabetic team.
HW proposed a vote of thanks for Morag Liddell as this would be the last meeting of MLMC that she would attend.
LMC Executive Committee: Tuesday 13th October 2020 – arrangements tbc
LMC Full Meeting: Tuesday 10th November 2020– arrangements tbc