Items in normal text – for consideration / items in italics – for information / * indicates additional papers
Jane Westlake from Chiesi supported this meeting through the purchase of virtual stand space and gave a short presentation prior to the meeting
Adult Mental Health Services
David Roberts (Director for Mental Health and Learning Disabilities), Richard Maggs (Medical Director) and Malcolm Jones (Service Manager) joined the meeting to provide an update on service provision and discuss concerns raised by the LMC.
It was recognised that waiting times had for one quarter failed to reach the WG target of 26 week waiting time. Dai Roberts shared that the service believe the 26 weeks needs to be revied and there is an ambition for this to be set at 13 weeks.
Medical vacancies have been a significant issue across the department but these have been filled with only 6 consultant vacancies remaining. A shift has been made to find ways to free up consultants time so that they can be more front facing by employing Advanced Nurse Practitioners and qualified Pharmacy Prescribers.
Richard Maggs acknowledged that there have been historical issues around the data management of anti psychotic medications. Work has been undertaken to create centralised databases to tackle this issue. Other areas under review included:
Single Point of Access (SPOA)
The ambition was to simplify the pathway but it was recognised that access is complex and the departments have had to respond to these complexities. Open access 24/7 will be provided via one number across the whole of SBUHB. There is currently a discussion around whether this will be via 111 or via an open access dedicated number. To date the SPOA has received 400 referrals – 75% were direct GP referrals. Only 21 were identified as being Category B – Crisis (to be seen within 4 hours).
Work is underway to expand the mental health and well-being provision and the service are working with Wales Risk Research Network (WARRN) to support suicidal thoughts and suicide attempts.
Q: AR asked about the location of MH nurses moving forward.
A: Malcom confirmed that there was no intention to remove MH nurses that are practice based. New appointments, funded via cluster transformation funds, would reflect local need.
Q: AS stated that GPs are already relying on the provision of support from the charity sector for the less serious cases, due to no capacity within the NHS to support. He asked about the capacity of the service going forward and whether the open access and the Wellness Centre would create a greater surge.
A: Malcom stated that the pilot work currently taking place within OOH on Friday, Saturday and Sunday would suggest this is not the case. Most cases are being triaged at the point of initial contact and not being redirected to MH Services.
Q: Rhydian welcomed the SPOA but found that the advice numbers sitting behind this were not staffed and not being answered. The fact that the service were still using paper referrals was criticised due to the delays and subsequent failings in appropriate communication. RT asked that WCCG was used as this was auditable and transferred directly into patient notes.
A: Malcom/ Richard shared that there is a plan to move to WCCG and it was acknowledged that administrative management was a concern. A business manager has been appointed to specifically tackle these issues.
Q: GPs are seeing patients again 24 hours after being discharged by MH Services.
A: Richard Maggs said that specific cases would be needed in order to comment upon this.
Q: It was stated that practices need broad MH skills that are above and beyond anxiety and mood swings. A: The service is working on co-developing Job Descriptions with Clusters to tackle this, supporting local need.
A discussion was had around MH secondary care requesting tests to be undertaken by GPs such as ECGs. Richard Maggs shared that there are increased mortalities with MH patients compared to the rest of the population which need be appropriately managed. This was supported but members flagged that they were receiving requests that were not directly related. A further conversation was deemed necessary to be clear about the management of physical health alongside mental health and the difference between tests to be undertaken prior to the commencement of a drug regime v’s the management of comorbidities.
Q: Anjula Mehta asked for clear guidance on communications around why drug regimes were commenced and what the follow up should be. Patients are being started on drugs with no follow-up and they fall into the cycle of repeat prescriptions.
A: Richard Maggs acknowledged that there was a historical tendency to trial drugs with no clear outcome measure – in essence prescribing off-licence. This has been a particular issue within NPT and an area that the service intend to resolve.
PC closed the Q&A and thanked the guests for their valuable time and contributions.
LMC MEMBERS: R Beynon (RB), H Cowie (HCo), P Cox (PC) (CHAIR), H Dean (HDe), 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),
LMC Secretariat: H Curtis (Executive Officer)(HC), E Harris (EH)
SBUHB/PCCU: A Mehta (AM)
PRACTICE MANAGERS: C Boland (CB)
REGISTRARS: L Zamen (LZ)(NPT), W Slater (WS) (NPT)
OBSERVERS: Shanti Karupiah, Marged Jenkins, Kasha Aishwarya, Michael Nangalia
GUESTS: David Roberts (Director for Mental Health and Learning Disabilities), Richard Maggs (Medical Director /Consultant Psychiatrist) and Malcolm Jones (Service Manager)
LMC Members: T Cufflin (TC), S Hlaing (SH), K Mellin (KM), H Wilkes (HW), P Williams (PW) Co-opted members: L Flowers (LF), C Jones (CJ)
Dyfed Powys LMC: Darron Smith (Exec Member DPLMC),
SBUHB: Brian Owens (BO), Keith Reid (KR)
PC opened the meeting and explained that he was deputising for Sandar Hlaing and welcomed all, including two registrars observing the meeting to establish if they would like to self-nominate to represent Swansea Registrars.
Minutes were accepted as accurate.
ACTION: SH will clarify when the Outpatient dashboard will be launched at the next Outpatient Group meeting – still awaiting the completion of this.
ACTION: Agreed to close the MGUS issue
ACTION: Run a session to discuss LMC engagement and communications to inform new ways of working – the Exec have scheduled a virtual Away Day May 27th Richard Thomas volunteered to collate ideas from members around how to engage more effectively with practices
ACTION: Supplementary answers to questions raised during the CAMHS presentation were included within minutes and ED/ ADHD referral pathway was sent with the meeting papers. ED is seen to be a growing issue and clear guidelines are paramount. There is a fundamental mismatch of mental health
resources but need to continue to monitor and flag – despite this feeling a highly repetitive approach. AGREED ACTION
AR announced that he would be stepping down as Medical Secretary at the end of the financial year and revert to an Exec role as of April. He shared that he had enjoyed his time as a secretary and was sure that this last year, and all the new ways of working, would enable the LMC to find effective ways to evolve.
Elected Members recognised the substantial and invaluable contribution that AR had made and thanked him for his work supporting GPs and practices. Members were grateful for the insight and perspectives that Dr Rayani had brought and would continue to bring by remaining as an Exec member.
During AOB AR announced that Dr Nimish Shah has been appointed as the new LMC Medical Secretary. Advising that this created a Deputy Chair vacancy which would be filled by an Elected Member self nominating for election. AR and Elected Members congratulated Dr Shah on his appointment.
February 24th 2021 Dr Manisha Rickards resigned from her position as an Elected Member. The LMC have received several EOIs in relation to the vacancy so as a result will have to run a by-election supported by SSP.
Robin Spacie has successfully completed training and as a result resigned creating a Swansea vacancy has for a registrar. The LMC seeks a direct nomination from the Trainees to fill this vacancy.
Draft Minutes and the Action Log were circulated.
RT asked a question as to why the Care Home DES did not have a mechanism to commission services with other practices and potentially other organisations. AM responded by saying that the first call was practice based, followed by a Cluster/Buddy based model. The DES was announced at the beginning of the pandemic and therefore had not had a high uptake. However, practices were still enrolling. 2.3 Issues raised by
Paper circulated by HC illustrating themes and trends. Over 30 enquires were received with the majority being Covid related.
HDe updated the members that OOH had extended its hours by opening at 3.30 and patients needing an appointment were being booked into the urgent primary care centre thereby avoiding being routed to GPs. A Mental Health worker has started working Friday, Saturday and Sunday. OOH had a good fill rate. Swansea Bay wide OOHs will be activated in June which will result in some service changes.
RT circulated the BMA/GPC England joint badged communication entitled: ‘Sustainable and environmentally friendly general practice – Policy Document’ and asked the LMC to consider a response. RT shared that the Welsh Government has the goal of delivering carbon neutral public services by 2030. The way that healthcare has adapted to the Covid crisis showed that large scale and meaningful change was possible and RT asked that the following proposals in relation to prescribing were considered:
Apply pressure to Welsh Government and NWIS to rapidly deliver Electronic Transfer of Prescriptions from GP surgeries to Community Pharmacies. Build upon the reductions in carbon footprint which
have already been achieved through changes in service provision to deal with Covid (for instance in remote consulting)
Develop and improve mechanisms for safe collection and disposal of medication and inhalers. Many used inhalers are sent to landfill leading to the release of their propellant gases (hydrofluoroalkane propellants) into the atmosphere. If treated appropriately, HFAs can be removed and recycled for refrigeration.
The electronic transfer of prescriptions created a lot of debate with a consensus being that this was a priority for WG and the HB’s.
During AOB RT asked members for their support in sending a letter to the HB to ask to work together on reducing the environmental impact of health care – starting with the exclusion of inhalers and committing to reducing transport. Members acknowledged that there is a need to raise awareness but also position this within the context of the most significant polluters.
• For the LMC to develop with SBUHB a collaborative approach to delivering further reductions in the carbon footprint of healthcare. RT to draft and circulate a letter to the HB
AM advised of the following appointments within Primary and Community Services:
It was agreed that there were mutual benefits in ensuring clear and robust communication channels between primary and secondary care.
The LMC agreed that it was appropriate for all practices to provide a bypass / ex-directory number to be shared with Consultant Connect for rapid Urgent (same day) communication. Acknowledging that this would be monitored for inappropriate use.
The method for Soon (within 7 days) communications using a generic email was not fully supported so the Exec suggested that a generic email was proposed, which is checked twice weekly, and that practices are advised to provide their own individual solution if this was not deemed appropriate. Acknowledging that this process would also be monitored for inappropriate use.
Inappropriate use was a significant concern and therefore the protocol should include a statement that information will be returned unactioned if not deemed appropriate.
Other ideas included the possible use of AskmyGP, or building in a virtual fax system within WCCG to create a pop-up. Both of these would require developments but something for the HB to consider commissioning.
(HW) – to be discussed at the next meeting.
Paper only showing the referral update for ED and ADHD
(standing item): No update
No update from Public Health PC advised that an update how been made to the HB website on the latest vaccine cohorts https://sbuhb.nhs.wales/coronavirus-covid-19/information/vaccine-in-swansea-and-npt/ Practices were encouraged to think about the benefits of including this link within pre-recorded phone messages to minimise the number of general enquires.
PR raised the fact that the Locum Hub Wales requirements were seen as an intrusive process and that there was a the lack of awareness within some GP practices. Members who were sessional staff agreed with these comments stating that there was a disparity in how they were being treated and that some PMs were already being ‘advised’ that they could consider booking sessions via Locum Hub Wales.
NS fed back that this is currently a voluntary scheme to enable locums to receive WG funded indemnity cover. It is still an option for GP sessional staff to take out personal indemnity and not
However, in order to access the WG indemnity cover, as of 1st February 2021, a minimum amount of data is required (it was stressed that not all of the data requested is mandatory). There is a 28 day backdating period to allow sessional staff to retrospectively add data. It is necessary to submit a Nil Return if no sessions are completed. It is not a requirement that practices input data – this remains the responsibility of the locum – therefore it is not paramount that practices are aware of the system.
The indemnity cover is different between England and Wales and this is creating significant issues for practices on the borders who provide care for both English and Welsh patients.
NS shared that BMA and GPC Wales are very aware of the issues and are monitoring After seeking QC advice this current approach is deemed acceptable until such a time that it breaches anticompetitive guidance eg price fixing. NS continues to lobby on this issue focussing initially on making transparent and simplifying the mandatory data entry requirements and requesting that a data export function is built.
Included in sections 1.5 and 2.6 for clarity
AGM – April 13th 2021 7.00 – 8.00pm
Full LMC Meeting – Tuesday 11th May 2021 – arrangements tbc