WIRRAL LOCAL MEDICAL COMMITTEE
Minutes from the meeting held on Monday 5 September 2016
In the Lairdside Suite, Royal Standard House
PRESENT:
ALSO PRESENT:
Dr R Williams
Dr A Adegoke
Chair
Hon. Secretary
Dr B Ali
Dr G Francis
Dr L McGrath
Dr R Millard
Dr F Newton
Dr K Cooke
Dr S Jalan
Dr A Mantgani
Dr J Mottram
Dr M Smethurst
Dr M Coupe, WUTH
Mr P Edwards, Wirral CCG
Ms H Harrington, Wirral CCG
Ms S Hennell, Wirral CCG
Mr P Lear, Wirral LDC
Mrs S Lepts, Wirral LMC
Mrs S Thelwell, Wirral LMC
55.
Welcome
The Chair welcomed members and visitors.
The Chair introduced Mrs Sarah Lepts, who had been appointed to succeed Mrs Thelwell
as Office Manager and would take up her duties on 19 September 2016. Mrs Lepts was
attending this meeting as an observer.
56.
Apologies
Apologies were received from Dr Blackie, Mrs Carrol, Mr Develing, Ms Howell, Dr
Quinn, Mr Stewart and Dr Syed.
57.
Declarations of Potential Conflicts of Interest
Dr Newton declared that he is on the GP-Fed Board.
58.
Minutes from Previous Meeting
The minutes from the previous meeting were noted to be a true and accurate record and
were proposed by Dr Newton and seconded by Dr Smethurst.
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59.
Matters Arising (1)
Phlebotomy Service
The Chair summed up that there had been a review of the phlebotomy service a couple of
months previously. Neither local GPs nor LMC had been involved in the input of that
reorganisation. The new phlebotomy service was launched and there had been
considerable unhappiness and dissatisfaction from GPs with the new service. A number of
meetings had been held and because of the dissatisfaction of GPs, the provider (the
Community Trust) decided to put the reorganisation on hold and revert back to the previous
service provision, pending further discussions with GPs, practices and the LMC to try and
plan a service which would suit.
Mr Edwards agreed with the Chair’s summing up. He also said that the Community Trust
had tendered for the service some time ago and were now saying that they did not have
enough resources to run the service as they would like. The CCG had argued that the CT
had tendered for the service at a price and should be able to deliver it for that price.
Discussions would take place over the next few weeks on how to move forward and agree
a model.
A member asked about provision of a paediatric service and was advised that CT did not
have the resources to deliver this service. The member said that this was a major issue.
Another member said that a paediatric service had been set up temporarily based on a few
sites. She continued that there were a lot of issues with the original service specification
and with the way the new changes were brought in, especially the very short notice and
that some practices were greatly disadvantaged over the number of sessions, with at least
one practice losing over 50% of its sessions.
Members discussed recent events, the resources available and whether these resources
could sustain the service. The sum paid per patient to the CT (£2.50) was compared to the
sum paid per patient to practices (£1.82) providing their own phlebotomy service. A
different model of service was needed. There was a suggestion that practices should be
able to withdraw from the contract if the new specifications did not meet their
requirements. There was a view that practices had signed up to the original model but this
had been changed 3 months later; this should not have been allowed to happen and the
tenderer should have provided the service as specified. The LMC role should be to help
practices who were not happy with the new specification to get them the option to take
their money out and provide their own service. The CT had not met its requirements and
if a practice or groups of practices wanted to get together to provide their own service, they
should be allowed to do so. Another member pointed out that if 1 of the 11 practices which
had not used the CT and had continued to provide its own service had failed to do so, it
would have lost its contract and had it awarded to someone else.
Mr Edwards explained that the CT had come to the CCG with proposals and then had
implemented the proposals without them having been approved by the CCG; the first time
the CCG became aware of this was when they received a letter from the CT that the system
had changed. The CCG had responded that they were not happy with this and the CT had
to revert back to the previous system until this was resolved. Mr Edwards agreed that if
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someone had tendered to provide a service at a given price, they should be held accountable
if they did not do so.
Mr Edwards went on that various options were being looked at to resolve the situation. A
member pointed out that there was nothing special about phlebotomy and practices could
provide their own service; GPs should be given this choice.
Mr Edwards said it was clear that there was dissatisfaction with the phlebotomy service
and recognised that what the CT had done was not right; this was why the CCG had told
the CT to revert back to the previous system whilst the CCG worked in conjunction with
the CT, practices and federations to resolve it.
A member suggested that when discussions took place with the CT, and federations were
invited, it was important to invite an LMC representative as the federations represented
GPs as providers, not all practices belonged to federations and the LMC represented all
GPs across Wirral.
The Chair said that there was an awareness that LMC needed to be involved and had been
involved in some discussions and comments. Currently, LMC was waiting for a date to be
set for the next meeting.
The Hon. Secretary declared an interest in that his practice did their own phlebotomy; they
had foreseen this problem. He said that CT had been at LMC two meetings ago and had
just mentioned in passing that they were going to redesign phlebotomy. The Hon.
Secretary had specifically requested for LMC to be involved but the next thing to happen
had been that every practice was written to by CT with the redesigned service. This was
wrong and he wanted to put this on record. Secondly, if the CT had not worked to the
specification that was given to them, then every practice should be given the right to decide
to pull out of the contract. This was a very important point as there were so many things
that had been wrong with the current phlebotomy service with changing goal-posts all the
time. Thirdly, the CCG, through their mechanism for monitoring contracts, should be able
to sanction the CT because they had caused a lot of disruption to services on Wirral.
Mr Edwards said that the impact to the reputation of practices over the past few weeks
must not be underestimated and a good working solution should be put in place as soon as
possible.
The Hon. Secretary said that his last point was that the CCG needed to make the next
meeting happen soon as the longer it was delayed, the more problems would result. A
member suggested that there needed to be something in the contract that the CT could not
impose changes to the contract in the way that they had.
The Chair agreed that in essence there had been a unilateral change in contract, without
any input from LMC, GPs, practices or patients and the CT just could not do this.
ACTION: CCG to ensure LMC is involved in Phlebotomy discussions.
7 Day Access
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The Chair reminded members that LMC had voted not to support 7 Day working, that the
CCG had asked for expressions of interest from all Wirral practices and federations, and
this was a work in progress.
CCG Chair
The Chair advised members that Dr Naylor had resigned as CCG Chair and the election
process had started to find a replacement. LMC would have some input to the election
process.
LMC Levies/ Capita
The Chair reminded members of a discussion at the June meeting concerning the LMC
bank reserves when potential late payment of levies was raised by the office manager due
to the takeover by Capita from COM.
This forecast had materialised and Wirral LMC had not had any levy receipts since the end
of May 2016 and were currently owed over £30,000. Fortunately, the LMC bank reserves
should allow the LMC to continue to function whilst this was being resolved. A number
of strong emails had been sent to NHSE.
The discussion moved on to the problems being faced by GPs and practices following the
takeover by Capita including payments, medical records collection, retainer scheme
payments, performers list updates etc. Members agreed that this was a major pressure on
practices who had to chase up payments. NHSE had to be made aware that this was slowing
down general practice.
The Hon. Secretary said that a lot of practices were struggling; some practices were being
overpaid in error and were now being asked for refunds whilst others were not being paid
at all. He suggested that LMC write to NHSE to say that the situation is not acceptable and
copy the CCG into correspondence. It was acknowledged that this was a national issue
and Dr Barnett, Liverpool LMC Secretary and GPC representative had had discussions
with representatives from NHSE.
Mr Lear offered email contact details for Capita. It transpired that LMC already had and
had used the same contact details for Capita.
It was suggested that something should be put in the newsletter to practices that LMC was
aware of the issues with Capita and was alerting NHSE and the CCG to the difficulties
being experienced by practices.
ACTION: write to NHSE and Capita. Newsletter item.
60.
CCG Updates
PLCP: Procedures of Lower Clinical Priority
Ms Hennell and Ms Harrington gave a short presentation on PLCP. See appendix 1a.
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This was still a ‘work in progress’ with a launch date of 14 September for the online PLCP
referral process. The tool had been designed to be as user-friendly as possible with an
immediate decision; if a patient met the criteria, a reference number for referral would be
generated immediately. An up to date list of PLCP had been sent out to practices the
previous week. The list was not national and was Cheshire, Merseyside with some Wirral
variations. PLCP had been around for a long time but this was the first attempt by Wirral
CCG to enforce it. The CCG had looked at other areas and found that in some areas, PLCP
had been applied correctly whilst in others, over 50% had gone through which did not meet
the criteria.
A 12 week public consultation would start on 19 September relating to the list of restricted
procedures and treatments.
A brief discussion followed relating to the types of procedures on the list including IVF
and the number of cycles that would be funded. There was a view that it would be helpful
for patients to be able to see what was/ was not funded. The list of procedures and
treatments had been compiled from other CCGs’ lists and Wirral CCG’s own leads.
Members noted that it would be on the CCG public website. There was also a view that
the PLCP tool would reduce variations across Wirral.
Ms Hennell and Ms Harrington encouraged members to look at the website and let them
have any feedback on any functionality issues/ problems. It was emphasised that this was
a trial and a ‘step in the right direction’ on what the CCG could or could not do.
CCG Update
Mr Edwards reported that the CCG financial situation was not good. There were a number
of things that the CCG was examining to see if there were any areas where it could lessen
expenditure if there was a lack of evidence. Consultation results were being analysed and
the CCG was trying to look at thresholds rather than stopping services altogether. Some
CCGs had stopped things but Wirral CCG was not in that territory yet; the CCG did not
want to bar GPs from doing things, as there are often clinical exceptions. GPs were
involved in consultations and discussions around sensible thresholds and pathways. NHS
finance was a national problem.
The Chair said that it was very important to keep patients involved and aware of the
financial problems.
Mr Edwards agreed and said that the CCG wanted to give general practice the
tools/guidance to help with patient discussions at consultation level.
The Hon. Secretary said that he intended to include something in the newsletter to let GPs
know about this but would be adding that GPs should always be careful when implementing
policies like this, even if the CCG had given the guidance to do it. GPs always had to
follow the GMC Good Medical Practice; otherwise NHSE PAG would not agree that the
CCG had told the GP not to do it. GPs had to be quite sure and clear in their minds that
they were following the GMC Good Medical Practice policy. The Chair agreed that a GP’s
first responsibility was to the patient.
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Members then discussed a number of points including funding for homeopathy, an appeals
mechanism for patients, making the public aware of the CCG’s financial situation and that
funds had to be spent wisely and giving GPs some freedom to choose. The Chair remarked
that whatever decisions were made about reducing or stopping services had to be done very
carefully.
A member asked how GPs could have input into these decisions and whether LMC had had
input. The Chair said that one method of input/ influence would be the GP Lead for chronic
conditions for the CCG.
Mr Edwards referred to representation on the Healthy Wirral Board and that it would be
re-formatted with more general practice representation. However, there was only one pot
of cash; there was no new money and to negotiate more resources for one service would
mean that another lost resources.
There was discussion about LMC representation on the Board. It was pointed out that the
CCG represented GPs as commissioners and it could be criticised if it invited federations
and not any other provider. Mr Edward responded that a line had to be drawn somewhere
and suggested that general practice, as a provider, had a seat on the board. A member
replied that the LMC was neutral and protected the interests of GPs as providers and
commissioners.
The Chair said that, similar to the phlebotomy situation, there was a very good argument
for having LMC involved and a ‘seat at the table’ to oversee the interests of GPs in Primary
Care. In the past when LMC had not been involved or, at least, had a say, sometimes,
things had gone wrong and phlebotomy was a good example; if LMC had been involved
earlier on, LMC might have had a chance to steer things in a different manner.
Mr Edwards suggested that general practice, as providers, would have seats on the board
and this would either be from LMC or federations. He thought it would be unlikely to have
both, but would ask the question.
The Hon. Secretary said it was bizarre that when Healthy Wirral was being developed,
LMC was strongly representing GPs and he did not know what had changed. He pointed
out that some practices did not belong to any federation and asked how their voices would
be represented as providers. In his view, it was important to have one seat for one
federation, another seat for the other federation and a seat for LMC. Mr Edwards reiterated
that he would ask the question.
A member suggested that LMC should have observer status, at the least. The Hon.
Secretary remarked that he had been attending Healthy Wirral meetings and again asked
what had changed.
The Chair said that this needed to be followed up and thanked Mr Edwards for attending.
ACTION: newsletter item
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61.
WUTH Update
The Chair invited Dr Coupe, Strategy Director at WUTH to give an update.
Dr Coupe gave a brief update on:
 Press reports on sustainability and transformation plans
 Every trust had to contribute by the end of next month
 5 year plan to implement the 5 year forward view
 WUTH formed part of the Cheshire & Merseyside STP
o Second largest in the country
o To make it more manageable, it was divided into three areas
 4 work streams in place
1. Prevention and improving public health
2. Merger of banking including payroll procurement, clinical support services
3. Organisational arrangements including strategical commissioning
4. Clinical valuation and hospital reconfiguration
 Would like to have the CCG represented
 Would prefer to have the LMC represented
 Running a workshop for medical directors in a few weeks and would like to have
an LMC representative to bring a primary care prospective
The Chair said that LMC would be very interested in attending and keen to contribute
to this. He asked to be informed of the dates/ venue in due course so that he, the Hon.
Secretary or another LMC member could attend.
A short discussion followed concerning the junior doctors’ planned strike action and
arrangements/ advice for patients. Potentially, patients might be advised to see their
GP rather than A&E or secondary care but general practice was working at full capacity
already. There was mention of WUTH’s block contract and what might happen if
WUTH failed to meet targets because of the strike action. Potential increases in waiting
times and cancelation of operations were also discussed.
The Chair reminded members of the GPs and consultants meeting being held on the
evening of Tuesday 20 September 2016 at Clatterbridge Postgraduate Centre.
ACTION:
62.
Matters Arising (2)
Retirement: Office Manager
The Chair advised members of the handover process. Mrs Thelwell would be retiring at
the end of October 2016. Her actual last working date would be 6 October and she would
be on annual leave for the remainder of October, using up unused accumulated annual
leave. Mrs Lepts would be shadowing Mrs Thelwell from 19 September 6 October. Mrs
Lepts would be responsible for meeting arrangements and minute-taking at the next LMC
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meeting on 3 October, although Mrs Thelwell would still be in the office on 4 – 6 October
for a post-meeting handover.
ACTION:
63.
Sub Committee Reports
Cancer Clinical Group: 8 June 2016
Dr Jalan provided a written report from the Cancer Clinical Group meeting on 8 June 2016.
See appendix 1b. Taken as an informational item.
64.
Correspondence
The Chair reported that correspondence had been received about Capita and transfer of
records. A response had been sent.
Dr Millard had raised a query regarding the 2 week rule and whether it was part of PCQS.
The Hon. Secretary had responded that his understanding was that it would not be counted
as part of referral.
ACTION:
65.
Any Other Business
A member raised a query regarding ADHD and a CWP letter with instructions for follow
up by general practice and not by secondary care.
The Hon. Secretary said that this was another example of workload being passed onto
primary care by secondary care with no funding. LMC had had a meeting with CWP and
CCG about transferring patients to general practice and they were supposed to be coming
to LMC to make a presentation about this. There was a suggestion to write to Christine
Campbell about this as it had been clearly stated to CCG that there were things which GPs
would not do and that these requests would be rejected. GPC advice was to reject such
letters and return them. CWP and Christine Campbell had been told that they could not
shift work to primary care until it had been discussed how it should be done. They were
supposed to be coming to LMC next month to present their plan.
The Hon. Secretary advised members that there was a LMC/ CCG mid-month on 22
September and this would be raised then.
Following considerable discussion, it was decided to prepare a standard cover letter or
‘dump’ letter for practices to use when returning such follow up letters, stating that the
practice rejected their letter and would take no action to follow up as it was not part of core
contract. The Hon. Secretary also suggested including GPC advice with the next newsletter
to remind GPs when to ‘say no’ to what does not form part of their core contract.
The Hon. Secretary encouraged members to go to the GP/ Consultant meeting on 20
September as this was part of what was intended to be discussed.
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ACTION: Dump letter and GPC ‘Say no’ advice for practices
LMC Annual Dinner 2016
The Chair reminded members that Thornton Hall Hotel had been booked for the annual
LMC dinner on Friday 18 November 2016. Invitations would be sent out in the coming
weeks.
ACTION: prepare and send out invitations
66.
Date of next meeting
The next LMC meeting is Monday, 3 October 2016, commencing at 1.15pm and finishing
at 3.15pm.
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