MINUTES

Drs. I Harris (IH) (Chair), S Hlaing (SH), J Kletta(JK), E Rees (ER), N Shah (NS),
Mrs M Liddell (ML), Executive Officer, Mrs E Harris(EH) (Sec. Assistant)

Dr A Rayani

• LMC Executive Committee Meeting on Tuesday 14th August 2018 were ratified by the Committee and signed by the Chairman.

nil reported

A nomination form had been received in respect of Dr Phil Cox, Locum GP, to represent the sessional/first five constituency. Expressions of interest had also been received from two GPs in Swansea and both would attend the next LMC meeting.

The course organisers for the Swansea VTS had been contacted again to arrange a date to speak to trainees about the role of the LMC. The vacancy for a Swansea rep had not yet been filled.

Issues raised at recent cluster meetings were discussed including the Diabetes DES. The Exec team was concerned about the number of practices which had taken up the DES but were not submitting claims.

26th September 2018: IH provided an update from the meeting which had been attended by Tracy Myhill, ABMU CEO. Ian had been asked by cluster leads to write to WAST about the possibility of replicating the Cwm Taf off-loading policy in ABMU to avoid a build up of Emergency ambulance vehicles outside ED.

A solution had still not been agreed for practices in NPT. ER commented that the geographical alignment of the Upper Valleys cluster practices contributed to the difficulty in finding a solution.

As discussions around Heads of Lease issues were still ongoing at National level local issues remained unresolved.

27th September 2018: Attended by AR

A summary of expenditure to 30th September 2018 was tabled and reviewed. No queries were raised.

GPDF – WORKSHOPs: Three workshops were being organised during November 2018 to enable direct input from LMCs about future GPDF activities. IH would attend one in Reading as the MLMC delegate and ML would attend if a second place were available. AR would attend as a GPDF rep.

The Exec discussed GP representation in Wales. Due to ongoing discussions the structure of GPC Wales post April 2019 was not clear and it was hoped that the workshops would provide some clarification.

IH had attended a discharge summary group meeting on 25th September 2018 and was disappointed that there had been little improvement in performance which had plateaued around 55%. This was a performance management issue which would be raised with the new ABMU MD.
The LMC would write to practices and cluster leads to request that missing discharge summaries be reported via Datix lite.
IH advised that MTeD (Medicines transcribing and electronic Discharge) would be piloted in 6 wards in Morriston Hospital in November 2018 resulting in a discharge summary being required before take-home medication could be prescribed.

The draft minutes had been circulated.

IH had had a productive meeting with NPT Mental Health & Learning Disability Managers about concerns about the service in NPT. Practice managers would be asked to contact the service directly to provide examples of downgraded referrals, inappropriate advice about antipsychotic prescribing and any other issues.
A shared care agreement for antipsychotic prescribing would be progressed and also the introduction of a single point of access in NPT and Swansea which was working well in Bridgend.

This continued to be progressed

JK would review the Cwm Taf paper and prepare a draft for ABMU GPs.

The bids drawn up by Cwm Taf and ABMU HBs had not included proposals for Bridgend resulting in a separate bid for Bridgend being submitted.

The draft minutes had been circulated. The Exec discussed the usefulness of the Liaison group in relation to secondary care issues and agreed that it may be more effective to make direct contact with secondary care departments when problems arose. This would be discussed further at the next Liaison group meeting.

Clarification would be sought as to whether the Bridgend cluster would be included in the ‘Tower Hamlet’ pilot. An update of progress being made with the process for prescribing insulin when patients were not being monitored by secondary care would also be requested.

A request for data about service provision in the last six months would be made including information about closed sites and the impact of rota gaps. It was believed that this was having a knock-on effect on in-hours workload.

The primary care escalation process was still under discussion. The LMC wanted to ensure that it was not a complicated process with which practices would not want to engage.

The LMC Exec was pleased that the proposal for NWIS to act as DPO for Welsh practices was being progressed.

Urgent clarification would be sought from the UND about reports that DNs would no longer vaccinate housebound patients even if they were currently on their caseload. The LMC believed this to be a retrograde step.

IH would meet with Judith Vincent to clarify the process and agree rules of engagement before changes were implemented. Examples of recent inappropriate changes included the use of cling film as an alternative to lidocaine patches and additional work required around the use of food thickeners.

A pathway document had been forwarded to the LMC for approval but it was felt to be very complicated and clarification would be sought as to how it had evolved and been agreed.

Constituents had reported delays in CXR being read, receiving requests to repeat CXRs up to 3 times before a CT scan was agreed and scans not being arranged. IH would speak to Sian Phillips and practices would be asked to submit as many examples as possible.

The LMC had been informed that a Diabetic OPD list had been deleted on the retirement of a consultant. The head of the OPD booking office would be contacted to ascertain whether the list had been reinstated.

ER would undertake a review of the website. ACTION

IH would attend as a GPCW rep. AR/HW/SH/JD/ER/CW(Reg)/BR(Reg) would attend as LMC reps with voting rights. ML would attend as an observer. IH would allocate and circulate the motions well before the conference.

14th December 2018: BMA House, London: AR/ML would attend.

Tuesday 19th (pm) and Wednesday 20th March 2019: SH / NS / JK would attend as LMC reps. AR would attend as GPDF rep.

• Full LMC Meeting – Tuesday 13th November 2018 – The Mercure Hotel, Swansea
• LMC Executive Committee: Tuesday 11th December 2018 – BAR 44, 44cHigh St, Cowbridge