WALSALL LOCAL MEDICAL COMMITTEE An open meeting of the Walsall Local Medical Committee was held in the Lecture Suite, Manor Learning and Conference Centre, Manor Hospital, Walsall on Monday 7 th January 2013 commencing at 7.45pm, which was attended by 31 people. PRESENT: Dr.A.J.Desai Dr.H.S.Syed Dr.U.Ahmad Dr.F.Mahmood Dr.A.T.Askey Dr.A.D.M.Bligh Dr.R.T.Cheriyan Dr.A.Ghosh Dr.A.S.Gill Dr.A.S.Khan Dr.R.Kumar Dr.R.Mandal Dr.R.Mohan Dr.L.S.Nambisan Dr.A.S.Suri Dr.S.J.Vaid Chairman Medical Secretary Asst.Secretary Treasurer Also present: Dr.N.S.Sahota Associate Medical Director/ Black Country Cluster Dr.Barbara Watt Consultant in Public Health Medicine/ NHS Walsall Dr.S.Yuen Consultant Paediatrician/ Walsall Healthcare NHS Trust Anne Baines Director of Strategy & Transformation/ Walsall Healthcare NHS Trust Alan Turrell ` Asst. Director Contracting & Procurement/ NHS Walsall Lawrence Brazier Head of Procurement/Walsall Council David Sheldon Procurement Officer/Walsall Council Dr.S.Handa Black Country Regional GPC representative Dr.K.M.Amiruddin Dr.J.Chandra Dr.I.Majid Dr.D.C.V.Nair Dr.B.C.Pal Dr.R.Suri Dr.H.Vitarana 1
Minute Secretary Carolyn Andrew LMC Executive Officer The meeting was opened at 19.45 hours by the LMC Chairman, Dr.Ajit Desai, who welcomed speakers, guests and members to the first Walsall LMC meeting of 2013 and wished everyone a Happy New Year. WELCOME: Dr.N.S.Sahota Dr.Barbara Watt Alan Turrell Anne Baines Lawrence Brazier David Sheldon Dr.S.Handa 1) APOLOGIES: Dr.Nick Hall Dr.A.Iqbal Mr.Amir Khan Dr.S.Manthri Lindsay Shields Changes to Published Agenda The LMC Chairman notified some changes to the published agenda: (i) The item on the Early Access Service had to be withdrawn due to the sudden illness of the presenter, Lindsay Shields. (ii) The item in Any Other Business concerning Sexual Health in Primary Care had been withdrawn as there was no-one available to present it. The Chairman apologised for any inconvenience caused by the withdrawal of the above items. 2) Transition of Public Health Contracts to Local Authority: Including Local Enhanced Services Dr.Barbara Watt/ Alan Turrell/David Sheldon/ Lawrence Brazier Dr.Barbara Watt: Consultant in Public Health Medicine/NHS Walsall Alan Turrell: Asst.Director Contracting & Procurement/NHS Walsall Lawrence Brazier: Head of Procurement/Walsall Council David Sheldon: Procurement Officer/Walsall Council Dr.Barbara Watt stated that GPs and Public Health had always worked very closely together. She added that this was a very important subject and she welcomed the opportunity to discuss it at LMC. She advised GP colleagues that neither the Public Health Department nor the Local Authority had all the answers as yet but that questions would be welcomed at the end of the presentation and they would do their best to answer them. Barbara reminded colleagues that with effect from April 2013 local government will have a new role in improving public health and commissioning public health services. The CCG will also have a role in commissioning services, as will the NHS Commissioning Board. It is vital that fragmentation of public health services during the transition is avoided. 2
New Commissioning Responsibilities: Where services sit CCGs: Non-specialist Acute, Community Mental Health Services NHS Commissioning Board: Primary Care Specialised Services, including HIV Public Health Screening and Immunisation Services Children s Public Health Services 0-5 years e.g. Healthy Child Programme (until 2015) Health services for armed services Health Services for offenders in institutional settings Local Authorities: Social Care All other public health (excluding Public Health England Services) Children s public health services 0-5 years e.g. Healthy Child Programme (from 2015) Services to be Commissioned by Council Includes: Drugs and Alcohol misuse, prevention and treatment Smoking Cessation/Tobacco Control Nutrition, physical activity and obesity Children s public health services 5-19 (0-5 to follow) Comprehensive Sexual Health Services (excluding HIV treatment) NHS H ealth Checks Workplace health Alan Turrell took over at this point to talk about the role of CCGs in Primary Care, saying that they had a role to develop primary care services in their patch. He informed colleagues that a team had been set up within the CCG to look after primary care development. The CCG would also be responsible for commissioning LESs renamed Community Based Services in future based on AQP model. The CCG would also be supporting the capability of primary care as providers e.g. response to procurements. Local Authority Governance Arrangements David Sheldon referred to the comment made by Barbara about public health services being new to local authorities but in actual fact they were responsible for them in the 1970 s so things had come full circle. David continued, saying that the Health and Wellbeing Board has representation from GPs, CCG members and officers of the council. The council has recognised how important this is and the Portfolio Holder in the interim is Councillor Mike Bird, Leader of the Council. The Director of Public Health is yet to be appointed but once the appointment is made they will report in to Jamie Morris, Executive Director/Neighbourhood Services. 3
GP Les Contracts are a valued element of Public Health provision and the local authority is aiming to continue in a similar form separate council contract with each GP practice. There has been no financial settlement as yet, an announcement was expected to be made in December but it is now expected on 11 th January 2013. There are issues of residency vs registration, the figures are very close but the council may want to look at this to decide whether services should only be provided to residents of the borough. Out-of-area patients may involve invoicing other authorities but this may not be cost-effective, more information will follow on this. Next Steps: Maintain continuity of services subject to financial allocation Dialogue with new commissioners Agree new arrangements LES contracts and financing The team agreed to take questions, saying that if there was anything they could not answer straight away they would report back at a later date. Questions: Dr.H.Vitarana What about information sharing, will the systems of the local authority link with GPs clinical systems? B.Watt This is a really important point and there is a work stream in the Transition Board that looks at information flows and datasets. There will be a memorandum of understanding between LA - CCG and LA-NHSCB. Linking up information has been looked at but there are issues around governance that have to be satisfied. D.Sheldon CDR Intell will remain with the CCG BUT Public Health and Local Authority will have access to it. Dr.A.S.Suri Two important points (i) Allocation of LES s and (ii) Monitoring of LES s. Is the list of LES s directed from the top or will they be locally agreed? Swine flu for example how will the LA decide who will deliver it? Dr.A.J.Desai When LES s are commissioned will stakeholders still be involved e.g. LMC, as has always been the case in the past? A.Turrell The list is based on what has been laid down as the commissioning responsibilities of the new organisations. There is scope for organisations to work together there is room for manoeuvre. The LMC Medical Secretary, Dr.Haris Syed, commented that historically there were some LES s commissioned by others (different areas had different LES s). Certain functions are being transferred to the Local Authority but nothing is set in stone, there will be discussion and the transition period is the time to have that discussion. The LMC Chairman, Dr.Ajit Desai, cautioned that from April it will be more difficult for GP practices if there are problems with a LES, given that three different organisations will be commissioning services. He asked how would practices know whom to contact? Dr.R.Kumar CCG will take responsibility for how services will be commissioned in the future. A GP practice has to plan for the long term and needs to know exactly what staff it will require to deliver the services it is contracted to deliver. D.Sheldon The Local Authority is looking for continuity, we do not know about funding as yet but are taking the longer term view. 4
A.Turrell LES s up to now have been implemented on an annual/biennial basis but in future are likely to be on a longer term basis. Choice and Competition will apply to LES s as much as to any other services. The LMC Chairman felt that there should be consultation with GP providers on this. Dr.Raj Mandal commented that, according to the handout that had been provided, the CCG has no role in commissioning. The LMC Medical Secretary added that GPs used to know whom to approach at PCT if there were any payment issues but unfortunately this was not the case currently. Dr.Narinder Sahota, Associate Medical Director for Black Country Cluster, enquired when the Director of Public Health was likely to be appointed? Dr.Barbara Watt responded that the appointment was expected the following week and that interviews were being held on 8 th January 2013. Dr.Amrik Gill, Walsall CCG Chair asked to make the following points: (i) The division of areas is mandatory, not a local decision. It is mandated in the Health and Social Care Bill. (ii) Why give Public Health back to the local authority? Obesity is not just a medical issue it is a lifestyle problem. CCGs and Social Services will need to work together to provide integrated care. (iii) As we go forward the NHSCB will expect CCGs to develop new LESs (iv) AQP I do not personally like this, it is not a good way to run the health sector, but it is law and we have to work with it. Dr.Raj Mohan said that he understood about AQP and stated that it would be necessary to look at providers in the past and to investigate sustainability of staff. Dr.Vitarana pointed out that his main concern was the NHS Health Checks as this will produce a very heavy workload for practices. The LMC Medical Secretary, Dr.Haris Syed, commented that those services that have been commissioned locally have been delivered by GP practices. One of the CCG roles is to support practices to develop services. Alan Turrell reminded colleagues that the local authority is not bound by AQP and said that the CCG has the opportunity to review which services to commission and may package some services for AQP. He acknowledged that there is a perceived threat to GP practices from AQPs coming into the marketplace but he encouraged GPs to also look at it as an advantage and an opportunity to develop their practices so that they can demonstrate to their patients that they are able to compete. Members asked what if the AQP fails would GPs be expected to pick up the pieces? They also pointed out the potential for fragmentation of services. David Sheldon underlined the fact again that local authority has it s own rules and tendering processes it has to go through but it is not bound by AQP or AWP and the LMC Chairman added that everyone must work together on this. Dr.Suri said that although they are not bound by these restrictions today, they might be tomorrow. GPs have historically provided cost-effective, efficient services that have been strictly monitored. Alan Turrell responded that some of these issues and difficulties are the upside of GPs having more commissioning responsibilities. The downside is that some things have had to be moved. The LMC Chairman acknowledged that there were lots of questions still to be answered but GPs have to be heavily involved in this. 5
The Chairman thanked Barbara Watt and colleagues for the information they had provided and he invited Dr.Sudhir Handa, GPC Regional Representative for the Black Country, to discuss the DH consultation on the proposed contract imposition. 3) DH Consultation on Proposed Contract Imposition Dr.S.Handa Dr.S.Handa: GPC Regional Representative for Black Country Dr.Handa had listened carefully to the debate around transition of public health contracts to the local authority and the future of enhanced services but he urged colleagues to keep things in proportion, reminding them that the work involved in LESs is huge whilst the financial rewards are relatively small. Contract Imposition The GPC negotiates on behalf of GPs and there are 7 negotiators drawn from 89 GPC members. Negotiations take place in advance of the new contract and 5 months of negotiations had been going well until Jeremy Hunt intervened (Secretary of State for Health, new in post with questionable knowledge of the health service and how it works). He stopped the negotiations and advised that the government intended to impose changes to the contract. Barbara Hakin, Richard Armstrong and Ben Dyson were involved in this and a letter from Barbara Hakin dated 23 rd October 2012 gave details: 1.5% uplift 1% average Bringing about equality over 7 years getting rid of MPIG Changes to QOF The letter stated that if these changes could not be agreed then the government would bring in DDRB. Dr.Handa stressed that the most important part of this as far as GPs were concerned are the changes to QOF. Threshold/workload changes are the biggest issues, average practice loss of 31,000 per annum. When the government tries to impose a contract they are obliged to go through a consultation period beforehand. The consultation period for the proposed contract changes commenced from the date of Richard Armstrong s letter in December 2012. Dr.Handa urged colleagues to respond to the consultation LMCs to write to their local MPs and individuals to Jeremy Hunt and David Cameron and to make their views known. The GPC Negotiators are putting on a series of Roadshows across all four countries and there is one date for West Midlands (in Birmingham) so far, although GPCWM have asked for a further date for West Midlands as it is such a large area. These roadshows need to be well attended. 4) Any Other Business (i) Intermediate Care Beds/Parklands Court Dr.H.S.Syed The LMC Medical Secretary advised members that there had been an issue just before Christmas concerning 25 intermediate care beds purchased at Parklands Court as part of winter pressures. The issue was around who had responsibility for visiting patients taking up the beds, as there was no contractual obligation on their own GP to visit if Parklands is outside their practice boundary, and an interim arrangement had subsequently been made for Badger to cover them up until 31 st March 2013 when the arrangement ends. 6
5) Date of Next Meeting Monday 4 th February 2013 commence 19.45 hours Lecture Suite, MLCC, Manor Hospital, Moat Road, Walsall WS2 9PS The main meeting was closed by the LMC Chairman at 21.05 hours. Committee members were asked to remain for the In-Committee session. 7