Ellesmere Port GP Locality Network Meeting am Thursday 03 December 2015, Civic Hall, Ellesmere Port Chair: Chris Ritchieson

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1 Ellesmere Port GP Locality Network Meeting am Thursday 03 December 2015, Civic Hall, Ellesmere Port Chair: Chris Ritchieson Unapproved Draft Attendees: David Thorburn Nigel Wood Simon Powell Chris Steere Claire Baker Alison Daly Emily Morton Richard Martin Chris MacDonald Tim Goldsborough Sue Roberts In attendance: Laura Marsh Sarah Murray Laura Jones John Glover Nick Thompson Director of Commissioning, West Cheshire Clinical Commissioning Group Programme Manager Primary Care (WCCCG) Locality Support Manager (WCCCG) Cheshire Care Record Membership Support Officer (Minutes), (WCCCG) Practices not represented by a GP: Neston Surgery / Westminster Surgery Key Points to Communicate to your Practice Cheshire Care Record See below for details Item 3. Prime Ministers Challenge Fund Update See below for details Item 4. Primary Care Cheshire Update See below for details item 5. Elective Referral Analysis See below for details item 7. New Services See below for details item 8. Agenda Agenda Item No 1. Welcome & Introductions The Chair welcomed the members to the Network meeting, explaining that he would be stepping in to Chair duties in Jeremy Perkins absence. Action Apologies for Absence Sandra Moss Claire Westmoreland Jeremy Perkins Minutes of E Port & Neston GP Network by 1 Date: 03/12/2015

2 Declarations of Interest Nil The Chair reminded the Network that the CCG has requested that all new declarations of interest be reported to Diane Taska Code of Conduct The Network members were reminded of the meeting s Code of Conduct. 2. Minutes of the previous meeting The minutes of the previous meeting were approved with minor amends including: It was felt that the suggestion that Ellesmere Port North feed back on their experiences with the Year of Care pilot in February would be too soon following a January start. It was agreed that feedback be given in April. The Network also requested confirmation on a point from the previous meeting s discussion around the Extended Hours service that patients who don t opt in to sharing their data will not be permitted to use the Extended Hours service. It was stated by CCG representatives that this was the case and that the reason for this is that once the system moves over to EMIS Web, GPs will not be able to access the records of opted out patients and as the Extended Hours service is not considered emergency provision, it is not considered safe for a GP to review a patient in a routine setting without access to their full records. It was argued by the Network that they frequently see patients in a routine setting without access to full records when reviewing new or temporary patients and therefore opted out patients could be seen on that basis. Laura Marsh explained that she will discuss this point with clinical colleagues and feed back before the next meeting. Previous Action Points Echo Forms Work is ongoing regarding the cardiologist opinion following echocardiography. Lesley Appleton is meeting with Professor John Somauroo to discuss the clinical benchmarks that will be decided as requiring cardiologist opinion. Action: Feedback decision at next meeting Flu Update The Network heard that flu arrangements have reached a stalemate. Primary Care Cheshire informed the Network that the funding being offered for the service is not enough to cover the cost of the service. It was felt that no more could be done on the matter this year; practices would continue with their individual informal arrangements for immunising their own patients and an earlier look at the situation should be adopted next year so that an agreement on how to deliver the service can be reached sooner. Some alternative suggestions for next year were discussed including limiting vaccination to residential and nursing home patients who might be at more risk or making this one of the CQUIN components. There was also discussion around prophylaxis. The Network heard that GPs are currently being paid 18 per patient paid on prescriptionof tamiflu, but there was uncertainty regarding best practice of patients lacking capacity. It was felt that there should be some guidance in place and the Network heard that this issue would be picked up at LMC. It was highlighted that there was a difference in advice Minutes of E Port & Neston GP Network by 2 Date: 03/12/2015

3 regarding flu prophylaxis between the current NICE guidance and a recent Cochrane review. Action: Update at next meeting 3. Cheshire Care Record The Network received a presentation on the Cheshire Care Record from John Glover, Senior Responsible Officer. The Network heard details of updates regarding the development of the Cheshire Care Record. The Network heard that it has been difficult to attain data from primary care level as the records at primary care level are often more complete in paper form than electronic. There has however been a quality control group put in place to monitor the data output of various streams to increase two-way dialogue and encourage contributing figures to be accountable for the information they generate. There has been an increased focus on end of life information. The Caldecott Group is now in place as part of the establishing of the governance structure. The Network also heard that the Cheshire Care Record had been unsuccessful in a bid to expand into Wirral and a similar product is now being introduced in that area but work is underway to ensure a strong link between the two to enable Arrowe Park data to be available through the Cheshire Care Record. The Network heard about slight changes to the consenting process with the introduction of a 24 hour consent option. The full presentation is attached to these minutes. 4. Prime Minister s Challenge Fund The Network heard updates on the various Prime Minister s Challenge Fund projects: e-consult Initially e-consult was proposed on the basis that it should be all practices adopting the system or not at all, however the Network heard that the CCG has since decided to provide the service to those practices interested in trialling it and not to those who don t. There have been 16 practices who would like to take it up, 7 that have said no, and the remaining practices have not answered. The Network wondered whether it would be possible to stop using the service if a practice took it up but realised some way into using it that the workload generated is too much. It was stated that that would be possible. Extended Hours The Network heard that the Extended Hours service was expected to commence on 14 December however due to a range of factors including lack of EMIS training, it was felt that this go live date should be delayed until 6 January. Data Sharing The Network heard that the data sharing agreement is thought to be as robust as possible thanks in part to challenges from some practices. EMIS Mobile/Anywhere The Network heard that the intention regarding EMIS Mobile and EMIS Anywhere is Minutes of E Port & Neston GP Network by 3 Date: 03/12/2015

4 to give individual clusters a choice between the two systems depending on which would suit their needs best given the various connectivity levels across the CCG patch, and a rollout of the chosen system is planned for January. Bromley-by-Bow The Chair provided the Network with some feedback following a recent visit to the Bromley-by-Bow Centre in east London attended by a group of CCG staff, GPs and practice managers. He explained that the element of the centre that stood out to him most was the focus on providing alternative services to seeing a GP. He argued that there is a tendency in traditional general practice to push back when the demands on a GP s time because too great. He felt that rather than doing that, the Bromley-by-Bow Centre is able to divert some of the demand to more appropriate avenues as opposed to simply pushing back. The Network also heard about a number of other features of the centre that were thought to be significantly different to conventional GP set-ups. In particular, an absence of signage or a formal reception and instead encouraging visitors to loiter with intent and interact with staff freely. CCG representatives explained to the Network that funds were available through the Primary Care Infrastructure Fund to look towards establishing similar reception area formats and that any practices interested in working towards any of the ideas promoted by the Bromley-by-Bow Centre could make bids for this funding. It was also explained that any more substantial developments, related more to building work as opposed to redesign, could potentially be funded through NHS England provided the proposals align with Primary Care Estates Strategy. The Network also heard that the Sir Sam Everington of the Bromley-by-Bow Centre will be attended a Rolling Half-Day event at on 28 January. 5. Primary Care Cheshire Update The Network heard from David Thorburn on behalf of Primary Care Cheshire. He explained that the intention of Primary Care Cheshire is to become more proactive; there is currently a newsletter circulated to update practices about developments relating to PCC although it was noted from members of the Network that this is not being received. He also stated that the PCC website is currently being upgraded. PCC also hopes to begin visiting practices directly to discuss the role of Primary Care Cheshire in detail. 6. CQUIN Developments The Network heard an update regarding developments in the CQUIN for. This update is attached. 7. Elective Referral Analysis The Network discussed the data presented to practices directly recently related to referral levels. There were some concerns regarding the validity of this data noted as there were a number of referrals from all practices attached to named GPs who either no longer worked at the practice or in some cases never did. It was felt that it is difficult to put too much stock into the data with such inaccuracies. It was suggested by CCG representatives that although the data may not be completely accurate, it provides a basis to begin understanding where outliers in the patch s referral practices may be. The Chair also added that he had recently attended a Musculoskeletal clinic at the Countess of Chester Hospital and was surprised to see the often very low quality of the referrals being received from GPs in the West Cheshire area. It was felt by the Network that an area of importance to address is the Minutes of E Port & Neston GP Network by 4 Date: 03/12/2015

5 communication of commissioning. It was argued that that community based services or initiatives designed to reduce admissions are being introduced but GPs are not always told about them and therefore cannot use them. It was suggested that this topic be discussed at the next Secretaries Forum. 8. New Services The Network was provided with a brief update around new services for ophthalmology and DVT: Ophthalmology Modest savings so far of 20k (over 4 months). No quality issues highlighted at the current time and any early datixes were managed and learnt from. A full service review due to take place in January (after the service has been operational for 6 month) which will look at the impact on Trust demand, patient satisfaction and how the pathway functions overall. Any comments from networks will be gratefully received. If there are queries Mediscan s main point of contact is Zeeshan Humayun (Zeeshan.Humayun@nhs.net). DVT Again modest savings of 7.5k between April and August. There remain a number of issues in the system including spoke sites not referring to hubs appropriately and with the supply of Tizaparin for patients who test positive. The CCG are working with PCC and the Countess to work through these issues. The Countess numbers do not currently seem to be reducing despite a positive deflection rate from the service and an audit is underway to determine where the remaining patients are coming from and their appropriateness. Following a review of the pathway there will be a re-launch of the service in December in line with a Rolling Half Day focussing on the correct pathways for PE patients. It was requested by the Network that the DVT pathway be investigated as D-Dimers are being repeated at Trust level. Action: An update will be made in January. 9. Any Other Business It was noted by the Network that patients are arriving at GP practices for postoperative dressing as the Countess of Chester Hospital Dressings Clinic is overcapacity. Patients are also using Out of Hours clinics for dressings and some are being sent to the walk-in centre in Eastham. The CCG provided some preliminary information about the situation: The CCG does contract and pay for services from Wirral Community Trust for the OOH unit at Eastham. The Wirral CT contract is paid on a block basis, so is not incurring extra costs. In previous years the dressing service has notified the CCG of capacity issues. Previous years solutions have included asking the Urgent Care Unit to receive the overspill. A separate project is being established to evaluate the prescribing of dressings products. Minutes of E Port & Neston GP Network by 5 Date: 03/12/2015

6 Action: A further update will be made in January Next meeting 08.30am on Thursday, 07 January 2015, Ellesmere Port Civic Hall Rural & City Network Minutes November 2015 City Network Rural DRAFT Minutes UNAPPROVED Minute pdf Key: Outstanding Actions NB: Actions will be taken off the table upon completion Current Overdue Complete Date initiated Action By Whom Due Date 03 December Established thresholds for consultant opinion on JP January 2015 echocardiography November 2015 Update around flu arrangements December November 2015 Ellesmere Port North Cluster to feedback on Year of Care model February 03 December 2015 Update on prophylaxis guidelines following LMC JP January 03 December December 2015 Update around new Ophthalmology and DVT services, including issue of D-Dimers being repeated at Trust Dressings Clinic arrangements to be discussed in January January January Minutes of E Port & Neston GP Network by 6 Date: 03/12/2015

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9 Ellesmere Port GP Locality Network Meeting am Thursday 07 January, Civic Hall, Ellesmere Port Chair: Jeremy Perkins Vice Chair: Chris Ritchieson Approved Minutes Attendees: David Thorburn Chris Ritchieson Nigel Wood Simon Powell Chris Steere Claire Baker Alison Daly Emily Morton Jon Stringer Chris MacDonald Tim Goldsborough Sue Roberts Anna Commander Sandra Moss Cathy Bedford In attendance: Huw Charles-Jones Laura Marsh Sarah Murray Tanya Jefcoate-Malam Laura Jones Philippa Robinson Dale Vimalchandran Nick Thompson GP Chair (WCCCG) Director of Commissioning, West Cheshire Clinical Commissioning Group Programme Manager Primary Care (WCCCG) Primary Care Manager (WCCCG) Locality Support Manager (WCCCG) Director of Turnaround (WCCCG) Countess of Chester Hospital Membership Support Officer (Minutes), (WCCCG) Practices not represented by a GP: Westminster Surgery Key Points to Communicate to your Practice Prime Minister s Challenge Fund Update Order for e-consult for those practices electing to take it on will be made in the coming weeks. Commencement date for EMIS Web within Extended Hours has been postponed to 1 Feb. MPLS and VDI projects are progressing but not expected to be in place until the end of next financial year. Primary Care Cheshire Update PCC would like a stronger response to a request for feedback on the DVT service. CQUIN Two year programme Preparation for Vanguard funding Funding models intended to align with The West Cheshire Way. New Colorectal Pathway A new pathway to relieve demand on colorectal service and improve access for patients. Opportunity for communication between GP and Specialist Minutes of E Port & Neston GP Network by 1 Date: 07/01/

10 Network Involvement in West Cheshire Way Networks to focus on individual aspects of The West Cheshire Way; Ellesmere Port and Neston will focus on Being Well. Subject to be discussed at each meeting. Elective Care Analysis Referral data flawed but paints a picture of high referral rates. CCG financial position worsening. Agenda Agenda Item No 1. Welcome & Introductions The Chair welcomed the members to the Network meeting, in particular Anna Commander as the new Practice Manager of Willaston Surgery. Action It was also acknowledged at the beginning of the meeting that there had been problems with regards to circulating meeting papers. The cause of this is unclear but papers were eventually distributed prior to the meeting and a trial is to be sent out to try and identify and resolve the problems. Apologies for Absence Richard Martin Claire Westmoreland Declarations of Interest Nil Code of Conduct The Network members were reminded of the meeting s Code of Conduct. 2. Minutes of the previous meeting The minutes of the previous meeting were approved with minor amendments: It was noted that the minutes of the previous meeting stated that GPs were currently receiving 18 per patient for prophylaxis whereas in actual fact that 18 per patient was the amount proposed. It was also noted that the previous minutes stated that Laura Marsh would feedback to the network further discussions around opted-out patients accessing the Extended Hours service. It was stressed that the decision that these patient would not be able to access the Extended Hours service has already been made, however she will feed back the concerns to the Steering Group. The minutes of the previous meeting will be amended to reflect these points. There was further discussion around the Extended Hours service and concerns amongst the Network that patients who have not opted-in will not be able to access it. There is concern from the Network that this approach is exclusionary and unfair on those patients who might wish to use the service but not wish to share their data, on the basis that GPs frequently see patients during in-hours clinics without access to their notes and could see patients in Extended Hours service on the same basis. It was also noted by the Network that some feedback from patients on receipt of the recent letter sent from practices explaining the situation has been that patients feel they are being blackmailed. It is argued by the CCG however Minutes of E Port & Neston GP Network by 2 Date: 07/01/

11 that the intention of the Extended Hours service is to provide a full GP service beyond the usual clinic hours and as such it is crucial that consulting GPs have full access to the medical records of the patient they are meeting as opposed to offering the service as an additional urgent care provision. It was also noted by the CCG that the Extended Hours service is not a mandatory service to be provided, it is an additional service and as such it is not felt that the access to primary care of patients who have elected to opt-out of data sharing is being limited. There was discussion around a point discussed and minuted from the previous meeting around practices who might decide to take on the e-consult service but later decide it is not suitable for them and decide to stop using it. The Network asked for clarification on this point as it is felt that with the substantial financial outlay involved in a practice deciding to commence e-consult, the implications on NHS spending should a practice decide to abandon the service should be acknowledged. The Network also asked for an update around EMIS Anywhere/Mobile, and heard that practices have been contacted to ask which option (Anywhere or Mobile) they feel would be most appropriate for them and the next steps are pending Kerry Winsland s return from annual leave. Previous Action Points Echo Forms Developments around establishing thresholds for consultant opinion following echocardiography are ongoing. Work was in progress between Lesley Appleton and the Trust but as Lesley Appleton is now on maternity leave this work will have to be picked up by someone else in her absence. Action: JP to establish who this work has moved over to. Flu Update There was further discussion around flu jab arrangements as although it is accepted that the time to affect arrangements for 2015 has passed, it is imperative that plans for are made much further in advance than this year. It was agreed that NHS England would be invited to attend the LMC meeting to begin the ball rolling as soon as possible. Action: NHS England to be invited attend LMC Meeting to discuss flu jabs. Prophylaxis It was agreed that no update on prophylaxis is required. Ophthalmology/DVT Update Update on new ophthalmology and DVT services to be circulated via . Dressings Clinic The discussion on dressings clinic will be moved to February due to staff sickness. Action: Discuss at next meeting 4. Prime Minister s Challenge Fund The Network heard updates on the various Prime Minister s Challenge Fund projects: Minutes of E Port & Neston GP Network by 3 Date: 07/01/

12 e-consult There are 17 practices planning to use the e-consult system. The order for the product is expected to be placed in the next week or two and from then discussions will take place about the logistics of commencing the service. Extended Hours The Network heard that due to a number of factors, the commencement of the Extended Hours service has now been postponed from 6 January to 1 February. There was also further discussion about the decision that patients who have opted out of sharing their data would not be able to access the Extended Hours service. The Network heard that this decision will be discussed at the Primary Care Working Group. MPLS A contract for the MPLS service is due to be signed in the next few days and the CCG is in the process of procuring hardware to accompany the VDI, however it was stressed that work on these systems is not expected to be completed until towards the end of the next financial year. The Network enquired as to whether funding for Physio First and the Wellbeing Coordinators would be continued. It heard that they would be funded into next year using non-recurrent funding, then pending a formal procurement and recommissioning process and the development of a sustainable model for both projects, would be expected to be funded on a recurrent basis in the longer term. It was noted by the Network on the subject of the Wellbeing Coordinators that practices would like to receive more feedback about caseloads, providing practice managers with an overview of the kind of issues they are dealing with. Sarah Murray also noted that she attended a national Prime Minister s Challenge Fund event recently and was struck by how much further on in the process West Cheshire appears to be in relation to other areas of the country and it was felt that this is a result of discussions and plans made in meetings such as this one. 5. Primary Care Cheshire Update The Network heard an update from Primary Care Cheshire: It heard that practices had been contacted recently to request feedback on the DVT service but only one practice had responded. It was stressed that ideally they would like a stronger response. The Network was also reminded about Sir Sam Everington s visit to the CCG for the Rolling Half-Day on 28 January. The value to hearing Sir Sam Everington s insights was stressed. The agenda for the day is attached with these minutes. 6. CQUIN The Network was provided with an overview of the /17 CQUIN. It heard that the intention of the /17 CQUIN is to build on strong results from 2015/16, current funding remaining as recurrent funding and moving to a two year scheme to give Practices stability. Interventions already commenced around vulnerable older people should continue, but with each Network area providing a focus, prototype and development area in one programme to start with. As per the Network Involvement Paper, this will be as follows: Minutes of E Port & Neston GP Network by 4 Date: 07/01/

13 City Starting Well Rural Ageing Well Ellesmere Port and Neston Being Well (Long Term Conditions) The CQUIN for next year will also build on positive results of clustering seen in 2015/16. The overarching aim for next year s CQUIN is to Primary Care to redesign the local health system via The West Cheshire Way. It was noted that some existing LES specs do not align with The West Cheshire Way so while the funding will be ringfenced for Primary Care, the requirements to achieve these payments will change to relate to the aims of the West Cheshire Way more closely. Specifically, this will include: The Diabetes LES The Spirometry LES The Nursing Homes LES A letter has been drafted setting out the CCGs intentions. This is currently with the LMC for review and feed-back. In order to develop and roll-out this new way of working, additional funding will be available on a none recurrent basis to pump-prime the setting up of these services. It is hoped that this shift in activity will in turn change the contracting and financial models we use with our providers to give sustainability. Finally, it was stated that this discussion was only intended to be an overview at this stage and more detailed discussion would take place at a later date through funded cluster leads meetings. Updates on developments will be included on Network agendas each month going forward. 7. New Colorectal Pathway Dale Vimalchandran, Consultant Colorectal Surgeon from the Countess of Chester Hospital to discuss work that is underway around streamlining the colorectal outpatient pathway, principally by trying to avoid unnecessary trips to hospital either by way of telephone consultations, specialist nurse-led appointments, or straight to test appointments. Presentation slides are attached. The Network was largely enthusiastic about the plans but had a number of points to raise. It was stated that GPs will sometimes be contacted by patients who have been to the colorectal service and are awaiting rest results and will assume that their GP has them (or have been directed to their GP), or in some cases may receive test results and/or discharge by letter and visit their GP for more further information while the GP may not feel best placed to advise on colorectal conditions. The Network heard that the planned changes, although likely to create an initial delay, will speed up processes across the whole service including the time in which a patient has to wait for their results, which should relieve some of that pressure from GPs. Also, that discharge by letter patients will be provided with a contact number to reach colorectal clinicians to discuss any questions they might Minutes of E Port & Neston GP Network by 5 Date: 07/01/

14 have following discharge. It was noted by the Network that the proposed 30 minute section in consultant clinics would be extremely useful to GPs as patients that fall between routine and admit categories are often most difficult to deal with, whereas this 30 minute section for urgent appointments would be ideal for those patients. There was discussion around a mechanism to track failed calls, so that patients unable to answer the phone when the clinician calls are not forgotten. It was explained that although there is not currently a formal process for this, it is something those involved in designing the service are aware of and are working on. It was also confirmed that GPs would receive a letter following a telephone consultation. 8. Network Involvement in the West Cheshire Way The Network heard that alongside the CQUIN, it has been decided that individual Networks will focus on one of the three component parts of the West Cheshire Way: Chester City Starting Well Ellesmere Port and Neston Being Well Rural Aging Well. Specific areas of work within these overarching themes would be decided based on appropriateness by Helen Ashcroft, James Duckers and Patricia Parker. It was suggested that a more detailed look at Being Well and the projects within that during the February meeting. 9. Elective Referral Analysis Action: Being Well to be added to next agenda Philippa Robinson, Turnaround Director for West Cheshire Clinical Commissioning Group, attended the meeting to discuss the elective referral data recently circulated to practices and how the Network might wish to proceed with addressing certain issues. She began by acknowledging the concerns around the accuracy of the data. A number of errors have been highlighted where large numbers of referrals traced back to specific practices have been linked to doctors who have not worked at the practice in some time. She explained to the Network that on investigation this appears to be due to two main factors: in the case of Choose and Book referrals, administration staff at the Trust end are not necessarily ensuring they attach a referral to the actual referring GP but rather in some cases attaching that referral to any GP listed as being a member of the practice. In cases of non-choose and Book referrals, Trust administration staff are often attaching referrals to GPs who no longer work at the practice. In both cases she explained this is due to NHS England outsourcing their GP database (which is used by Trust admin staff when assigning referrals to a 3rd party company and it is accepted at NHS England level that the data is no longer current and up-to-date, therefore referrals are being attached to doctors who no longer work at the practice in lieu of the actual Minutes of E Port & Neston GP Network by 6 Date: 07/01/

15 referring doctor as that doctor may not be on the out of date NHS England database. It was suggested by the Chair however that although such inaccuracies cannot be ignored, the data in terms of quantity of elective referrals per practice should not be affected and this data will therefore give a relatively accurate picture of referrals levels by practice. She stressed however that irrespective of the reasons behind anomalies, the data as a whole presents a picture of a referral volume that when considered in relation to other CCGs in the country has to be addressed. The Network was also updated on the financial position of the CCG and its local turnaround status. It heard that by end of Month 8 it is now 400k further behind. The Network heard that City and Rural Networks have begun analysing their own data and discussing potential courses of action. She explained that as there have been ongoing discussions about whether the Network meeting in its current format serves its original purpose and is the best use of time, perhaps it would be a better use of the experience around the table for something else, perhaps to analyse Ellesmere Port and Neston data. It was felt by the Network that such an approach has been attempted before but with little effect, and it is felt that high referral rates are the result of not enough community alternatives. 10. CCG Updates The Network heard that due to the Christmas break, the majority of regular CCG meetings which would useful make up the update to the Networks did not take place so a full update will be provided in February. 11. Any Other Business It was noted by the Network that payment for attendance at safeguarding conferences cases has been ceased which is felt to be inappropriate. Feedback to be given to Safeguarding team. Action: Nick Thompson to feed back to Safeguarding Team The Network enquired about seniority payments. This is to be taken up with NHS England. Action: Laura Jones to follow up with NHS England Great Sutton offered to provide the Network with feedback on their time spent using the Dragon Dictate system. Action: David Thorburn to feedback on Dragon Dictate Next meeting 08.30am on Thursday, 04 February, Ellesmere Port Civic Hall Rural & City Network Minutes December 2015 Minutes of E Port & Neston GP Network by 7 Date: 07/01/

16 2. City Network draft Minutes 10 DEC.pdf 2. Rural DRAFT Minutes pdf Key: Outstanding Actions NB: Actions will be taken off the table upon completion Current Overdue Complete Date initiated Action By Whom Due Date 03 December 2015 Established thresholds for consultant opinion on echocardiography HA to feed back at meeting. JP February November 2015 Ellesmere Port North Cluster to feedback on Year of Care model April 03 December 2015 Update around new Ophthalmology and DVT services, including issue of D-Dimers being repeated at Trust January 03 December 2015 Dressings Clinic arrangements to be discussed in January - Delayed until March March 07 January NHS England to be invited to attend LMC Meeting to discuss flu jabs LM to feed back at the meeting. LM February 07 January Being Well to be added to next agenda LM February 07 January Follow up with NHS England re: seniority payments LJ February 07 January Feedback on Dragon Dictate on agenda DT February 07 January Nick Thompson to feed back to Safeguarding Team regarding ceased payments Sarah to update. Considered part of core service by NHS England NT February Minutes of E Port & Neston GP Network by 8 Date: 07/01/

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19 Ellesmere Port GP Locality Network Meeting am Thursday 04 February, Civic Hall, Ellesmere Port Chair: Jeremy Perkins Vice Chair: Chris Ritchieson Unapproved Minutes Attendees: David Thorburn Chris Ritchieson Nigel Wood Simon Powell Chris Steere Claire Baker Alison Daly Emily Morton Jon Stringer Chris MacDonald Claire Westmoreland Richard Martin Tim Goldsborough Tracey Bowes Cathy Bedford In attendance: Huw Charles-Jones Sarah Murray Tanya Jefcoate-Malam Catherine Wall Helen Ashcroft Dave Hobday Trish Parker James Duckers Nick Thompson GP Chair (WCCCG) Programme Manager Primary Care (WCCCG) Primary Care Manager (WCCCG) Clinical Lead for Diabetes (WCCCG) Head of Commissioning (WCCCG) Interim Clinical Commissioning Manager (WCCCG) Commissioning Manager (WCCCG) Clinical Commissioning Manager (WCCCG) Membership Support Officer (Minutes), (WCCCG) Practices not represented by a GP: Nil Key Points to Communicate to your Practice Prime Minister s Challenge Fund Update Six practices will be using e-consult and a GP from Runcorn who uses the system will present his experiences to that group of practices. Patients who have opted out of sharing their data will now be offered access to Extended Hours through EMIS Web but on a very limited basis. BT are beginning work on MPLS. Wellbeing Co-ordinators and Physio First will continue to be funded at least in the short term. Primary Care Cheshire Update A meeting to further discuss the DVT service has been arranged. CQUIN The nature of the CQUIN for /17 is being reassessed to ensure it is as productive for all involved as possible. Joint Provider Meeting Invitation to contribute primary care-related ideas Minutes of E Port & Neston GP Network by 1 Date: 04/02/

20 Being Well The Network will continue to discuss aspects of Being Well as part of each month s agenda; March will focus on Acute to Community Shift. Agenda Agenda Item No 1. Welcome & Introductions The Chair welcomed the members to the Network meeting. Action Apologies for Absence Laura Marsh Sandra Moss Sue Roberts Declarations of Interest Nil Code of Conduct The Network members were reminded of the meeting s Code of Conduct. It was also noted during the introductions that Chris Ritchieson has decided to resign from his post at Great Sutton (Wearne). He explained that his decision was due to a desire to work closer to home in order to spend more time with his family. It was stressed by the Network that Dr Ritchieson s decision to move from the West Cheshire CCG area and to a practice likely in the Warrington area was a significant loss to the Ellesmere Port and Neston Network, and the West Cheshire Clinical Commissioning Group as a whole. It was also noted that Dr Ritchieson s departure will mean a vacancy at the Vice Chair position. The Chair also used the Introductions segment of the agenda to share his thoughts on the recent visit from Sir Sam Everington. The Network heard that after attending both the morning and afternoon session, the Chair left the event feeling inspired and energised. He noted that he agreed strongly with Sir Sam Everington s suggestion that one of the most significant challenges facing Primary Care at the moment is of redesigning care models without any respite from the current demands. He also noted that although initially he believed he was not one of the older generation of GPs who might tend to be slightly more resistant to change, he actually felt on more honest reflection that he is more resistant to change than he initially thought regarding ideas around innovation and technology, and ways to potentially redistribute demand as emphasised as crucial by Sir Sam Everington, and this is something he would like to challenge. He also reflected on points raised around the importance of federation bodies such as Primary Care Cheshire, as well as a flexible approach to clustering. The Network noted that Sir Sam Everington felt there was a positive energy Minutes of E Port & Neston GP Network by 2 Date: 04/02/

21 around West Cheshire CCG, and that it is important we develop ways to share that energy and experiences around the CCG. It was noted by the Network however that there is some uncertainty about how the bodies Sir Sam Everington is involved with have got from where they started to where they are now. There was also concern that a great emphasis being placed on Primary Care Cheshire could mean a requirement for greater investment, and that GPs could be asked to pay for that greater investment. 2. Minutes of the previous meeting Nil raised, however it was stressed that previous minutes requiring a correction should also be circulated in addition to the current minutes. Action: January minutes to be circulated. Previous Action Points Echo Forms Discussions ongoing between Simon Powell and members of the Cardiology team at the Countess of Chester Hospital, and work ongoing from a number of members of the CCG team. Action: Update in March. Dressings Clinic Work being led by Amanda Lonsdale. A meeting to discuss the future plans for dressings is taking place in the second half of February. Action: Amanda to feed back at March meeting. Seniority Payments Laura Jones has liaised with NHS England around Seniority payments. A full document detailing the arrangement is attached to these minutes. Item complete. Funding for Safeguarding Cases NHS England now considers attendance at Safeguarding cases to be part of core services and as such there is no funding available. The Network felt this decision represents a significant threat to the effectiveness of safeguarding cases as there are distinct inequalities between some practices in the Network and others with regards to the volume of safeguarding work required of them, and the absence of funding represents a significant disadvantage for such practices. The Network felt strongly that this issue should be escalated more formally and discussed at a future meeting, as well as feedback to be requested more urgently than the March meeting. Action: Chair to write to CCG Senior Management Team and ask for feedback on the situation. Action: A member of SMT to attend March meeting with this issue on the Minutes of E Port & Neston GP Network by 3 Date: 04/02/

22 agenda for discussion. 4. Prime Minister s Challenge Fund The Network heard updates on the various Prime Minister s Challenge Fund projects: e-consult There are 6 practices from the Ellesmere Port and Neston Network who will be using e-consult. The plan now is to arrange for these practices to come together and hear from a GP based in Runcorn who has been using the e-consult system. Extended Hours The Primary Care Working Group has reviewed the decision to not allow optedout patients to access the Extended Hours Service through EMIS Web, and will now allow access to these patients but on a limited service basis in the absence of clinical background at the time of review. The Network also heard about a current issue with functionality regarding electronic prescribing through EMIS Web during Extended Hours. All prescriptions are being raised as under Dr Test. It is believed that this is a temporary functionality issue that will be resolved by EMIS, however if that is not the case the suggestion is to make arrangements for all Extended Hours GPs to raise Extended Hours service under Dr Extended Hours and to form a central pot to be paid for by Primary Care Challenge Fund. MPLS BT is beginning work, but they require assurance of the absence of asbestos on the sites of practices built prior to A Survey is underway to confirm this. Wellbeing Co-ordinators/Physio First The Primary Care Working Group has reviewed a paper regarding both the Wellbeing Co-ordinator and Physio First projects and agreed to continue to fund in the short term. It was noted by the Network that the Wellbeing Co-ordinators in particular are an effective admission avoidance facility and as such an argument could be made that money saved in admission avoidance could be used to fund the continuation, and possible growth, of the project. 5. Primary Care Cheshire Update The Network heard an update from Primary Care Cheshire: there will be another meeting held on ***INSERT DATE*** to discuss the DVT service. It was suggested by the Network that PCC collect data regarding the efficacy of the current DVT system in relation to past approaches. Action: CCG to collect historic DVT data The Network also suggested PCC investigate how correctly the protocol is being Minutes of E Port & Neston GP Network by 4 Date: 04/02/

23 used. There was concern that the DVT service just becomes viewed as a reassurance measure. 6. CQUIN The Network heard from Tanya Jefcoate-Malam regarding developments for the CQUIN. She explained that following the discussions during the visit of Sir Sam Everington, developments have been paused while discussions take place to ensure that suggestions for the CQUIN in are as supportive and productive as possible. 7. Joint Provider Meeting She also explained that it is the turn of Primary Care to host the next Joint Provider Meeting Learning Event. Dr Tony Bland from Fountains Medical Practice has volunteered to host the event but members of the Network were encouraged to communicate any additional ideas or cases relating to primary care patients that they feel could be of learning benefit. 8. Dragon Dictate Feedback 9. Being Well The Network heard feedback from David Thorburn around Great Sutton s piloting of the Dragon Dictate software which was the basis of their application to the Innovation Fund. David Thorburn explained to the Network that the system has pros and cons. It is able to transcribe dictation quickly; however its medical terminology is not great. It was noted that when using the software to dictate consultation notes directly into EMIS is useful, but navigating between tabs is difficult to the point of making the facility redundant. It was felt however that the software had changed the roles of practice administration staff and drastically reduced the turnaround time for referral letters. To summarise, the pilot group felt the software had significant benefits, but in order to make the most of the facilities it offered it required a significant amount of investment in terms of time. The group will now formulate a formal feedback report to share their experiences with other members of the Network. Action: Great Sutton to write formal report of their experiences The Network heard from members of the Being Well team from the CCG, Helen Ashcroft, Catherine Wall, Dave Hobday, Trish Parker and James Duckers, around progress of projects under the Being Well heading. Their full presentation is attached to these minutes. The Network then discussed in clusters the work being done around Being Well and gave feedback to those involved in the various projects. It was agreed that going forward, Being Well would continue to make a significant part of the Network Meeting agenda with a specific topic of focus. It was agreed that in March the Being Well focus would be the Acute to Community Shift. Minutes of E Port & Neston GP Network by 5 Date: 04/02/

24 10. CCG Updates A formal summary of the discussions taken place at CCG meetings during December and January is attached to these minutes. The Chair also added that the CCG has begun co-commissioning with NHS England as of 31 January. The Chair also added that the NHS England has formally cancelled its contract with Frodsham Medical Practice. The practice is currently being managed by the Practice Manager and Commissioning Lead of The Knoll as an interim until long-term plans are agreed. 11. Any Other Business The Network asked for clarification around the current arrangements regarding the CCG s Senate meeting. The Chair explained that the meeting has been changed to every other month, with a greater emphasis placed on the importance of preparing a strong agenda. It is believed the success of the meeting relates directly to the strength of the agenda. The Network also asked for confirmation regarding the estimated time frames for EMIS Mobile/Anywhere. It was stressed that we are approaching the end of the financial year and if products are not received before that date the project will not be able to be completed. Action: Project Manager Kevin Carbery to provide practices with an updated estimated timeframe. Next meeting 08.30am on Thursday, 03 March, Holiday Inn (Waterways, Centre Island, Lower Mersey St, Ellesmere Port CH65 2AL) Rural & City Network Minutes January 2. City Minutes 2. Rural APPROVED UNNAPROVED Minutes pdf Minutes of E Port & Neston GP Network by 6 Date: 04/02/

25 Key: Outstanding Actions NB: Actions will be taken off the table upon completion Current Overdue Complete Date initiated Action By Whom Due Date 03 December 2015 Established thresholds for consultant opinion on echocardiography JP February November 2015 Ellesmere Port North Cluster to feedback on Year of Care model April 03 December 2015 Dressings Clinic arrangements to be discussed in March March 04 February 04 February 04 February 04 February 04 February 04 February On agenda Chair to write to CCG Senior Management Team regarding safeguarding payments. Response circulated with agenda Safeguarding funding to be added to March agenda. On agenda CCG to collect historic DVT data to be considered alongside current DVT service. Consider for April agenda Great Sutton GPs to write formal report regarding their experiences with Dragon Dictate. Circulated with agenda Kevin Carbery to provide practices with an updated estimated timeframe for EMIS Anywhere/Mobile. On agenda (Primary Care Update) JP JP NT DT KC March March April March March January minutes to be circulated NT March Minutes of E Port & Neston GP Network by 7 Date: 04/02/

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