DAC Practice Managers Meeting Thursday 13 th September 2012 2.45pm 4.15pm YMCA, Derby Attendees: Sue Altoft Wilson St Surgery Jenni Brailsford Derby Open Access Centre Sarah Chalmers Alvaston Medical Centre Elaine Gibbs Wellside Medical Centre Anne Hutchinson Friar Gate Surgery Lesley Hutchinson Park Lane Surgery Judith Kirkland Charnwood Surgery Sarah Morcom Derwent Medical Centre Jan Peach Brook Medical Centre Uzma Rani Shamim Sadiq Hollybrook Medical Centre Stephanie Shepherd Mickleover Surgery Sue Threadgould Macklin St Surgery Lisa Wain Nicola Willis Clarence Rd Surgery In Attendance: Lee Doyle (part) General Manager, Community Services Keith Mann (part) Head of Primary Care, PCT Dita Bukovacova (minutes) Apologies: Cathy Jones, Mike Kelly, Iffat Khan, Sue Knott, Mike Newbold, Suzanne Rigbye, Robert White Welcome Action Uzma welcomed the group, round table introductions took place. Uzma gave an update on the following areas: QES currently has two types of arrangements in place for the delivery of enhanced services Quality Enhanced Services (QES) in Derby City PCT and Basket of Services (BoS) in Derbyshire County PCT. These arrangements are currently being reviewed, with a view to possibly align the two in the future. Linda Hunter (Assistant Chief Finance Officer) is presenting a paper on the future of QES/ BoS at the Clinical Commissioning Committee on 14 th September. The paper proposes that a Working Group be put together to start reviewing any future arrangements. Currently, the QES is made up of DESs and LESs. Whilst certain LESs may well stay with CCGs, DESs such as Health Checks, Smoking Cessation will go to Public Health and it needs to be decided how these services will be unpicked; i.e. whether Public Health are happy for the CCG to commission these services on their Page 1 of 5
behalf or if they want to take this responsibility on themselves. Keith Mann, Head of Primary Care has called for a meeting with the Chief Operating Officer from the four CCGs in Derbyshire to discuss the future of enhanced services, The meeting will be taking place in October, following which, there will be an update to the PMs. Capital Grants Applications will be reviewed on Tue 18 th September 2012 by a panel; Practices will be notified within a week 1.3mil available in the City to help Practices fulfil CQC requirements. Priority areas which will be rewarded are e.g. automatic access, reception areas, disabled access facilities, clinical treatment rooms. There may be an opportunity for re-quote but dependent on time There is a tight deadline by when the grant needs to be spent (March 2013) Innovation monies There will be an Innovation budget for practices within the CCG. Details are yet to be confirmed but Practices are encouraged to speak to either one of the DAC Leads or Uzma Rani if they have any proposals in mind. Post meeting note: The budget available per locality currently stands at 40k. Prescribing The next DAC locality meeting, which will be taking place on 11 th October, will focus on the Prescribing External review. Practices can re-use the information they submitted to the Medicines Management Team in June 2012. Post meeting note: As Practices have already submitted their prescribing action plans to the Medicines Management Team (MMT), it was decided at the DAC strategic leads on 18 th September that this was sufficient and there was no need for Practices to conduct the external review. The agenda for the next locality meeting will be confirmed shortly. GP involvement in Commissioning Any GPs considering getting involved in commissioning should contact one of the DAC Leads to discuss further. GPs can decide on the time commitment as well as the areas of work to suit their own circumstances. The CCG s agreed payment rate is 80/hour. Unplanned Care Whilst at the last meeting it was reported that there has been an increase in urgent admissions, the latest figures show that the numbers were down in DAC by 3% between April June 2012. Lee advised that data from RDH showed that the activity for July September was also down for the first time in almost seven years. The group was advised that certain East European communities tend to go directly to A&E without contacting their GPs first. To address this issue, close collaboration between localities and various local community groups will be required. Uzma had recently been in contact, amongst others, with NC Fusion Partnership, which is a Voluntary organisation set up to help new entrants in the city. NC Fusion provide a wide range of services including English Lessons, advice and guidance on jobs, food Microsoft PowerPoint 97-2003 Presentation Page 2 of 5
parcels, housing advice etc. The organisation has agreed to build a section on Appropriate use of NHS Services into the English classes they host. They also agreed to give out any Leaflets/Posters the Locality/ CCG wished to share. Sue Altoft shared a poster which has been developed by Wilson St Surgery for their patients, detailing steps to take to get an appropriate medical help (attached) which could be used as one of tools in tackling this issue. Sue advised that she was happy for the poster to be amended and shared with NC fusion. If practices wish to refer anyone to NC fusion, they can do so by ringing 01332 344582. DAC Team Timeout The timeout was held on 4 th September. It was agreed here that the December DAC locality meeting would be used as an AGM, for reflecting back on the past year and discuss future plans/priorities. It was also discussed that minutes from the Strategic Leads meetings, as well as Agendas would be available on the DAC section of the CCG website and if practices had any items they wanted to be picked up at the DAC strategic Leads meetings, they could contact Sue Knott, Mike Newbold or Uzma Rani. Community Matrons / District Nurses It was agreed to move this agenda item to an earlier slot of the agenda as Lee Doyle needed to leave early due to other meeting commitments. Lee introduced himself and his role General Manager for Community Services, currently based at Cardinal Square, however in the process of moving to the London Road Community Hospital s premises. Lee provided the following updates: Community Matrons Structure to be reviewed over the next few months Looking at various skills mix Interviews held recently, some very good candidates and couple of appointments made Nursing homes: provide more support; some work already done in Derbyshire County share best practice and findings. District Nursing Team structure Going through a difficult period there were no student district nurses last year, there are several retirements coming up this year which could potentially lead to a 36% reduction in Band 6 workforce. A number of options are being considered (i.e. employing retired personnel on a part time basis, Band 5 support on a fixed term contract; recruitment of new District Nurses) Considering the possibility of moving DNs back to Practices (individual needs and resources available to be looked at) Sue Cox to retire, her post will not be replaced Helen Jones overseeing Intermediate Care A GP might be sought to join the team (approx. 2 sessions) Lee provided his contact details if there are any questions or issues Practices may Page 3 of 5
need to raise: lee.doyle1@nhs.net or mob: 07585 966150. Lee advised that he is on annual leave for the next two weeks. Discussion ensued around SystemOne and district nurses. One Practice Manager cannot access notes done by District Nurses. Lee advised to email him and he will look in to it. Some Practice Managers felt that District Nurses are not using SystemOne to its full potential. Lee admitted that is something which needs to be addressed, i.e. by providing training etc PCT / NCB Update Keith Mann updated the group on following: PCT / NCB National Commissioning Board (NCB) is not a statutory body yet. At the moment they are employing personnel to look at ways of how services will be dispensed in the future One operating model will be applied across the country Transition period from April 2012 to 2014 There will be 32 Local Area Teams across the country. In East Midlands there will be one regional team for Derbyshire and Nottinghamshire. Currently not known how many locations they will operate from (likely two). Derek Bray has been appointed the Managing Director. Interviews are under way for the posts of 5 directors. No further structures are known yet Contractual arrangements will fall under NCB local area teams. Clinical Commissioning Groups (CCGs) will act as commissioners. Local Professional Networks (LPN) for Dental, Pharmacy & Optical services are being set up. They will work alongside CCGs and the Health and Wellbeing Boards on strategy and planning etc. CCGs are responsible to do the same for GPs. Outer boundaries LES / QES Keith advised that there hasn t been any further guidance apart from the letter shared with Practices. It was part of GP Choice process. Guidance can be found on DH website, under GP Choice information. Practices do not need to establish outer boundaries but if they decide to do so, they need to contact the Primary Care Team who will then issue a contract variation. A discussion took place with regard to the guidance. Practice Managers said that the document read like there had to be exceptional circumstances for not establishing an additional outer boundary area. LES will operated by the CCG QES is tied up with LES so should be under the remit of CCGs Any qualified provider (not only GP practices) will be able to apply for provision of certain services Finance Team The majority of finance functions are in the process of being moved to Scarsdale. This may cause some delays in responding to queries. Practice Managers said that they were not aware of this. Uzma will contact the team and share with Practices their new contact details etc. Page 4 of 5
Access Uzma asked if Practices have introduced any new ideas in order to improve access. One Practice increased the number of telephone appointments. Another example was a flyer advising on repeat prescribing. The flyer was produced by their PPG, not the practice. Patients perhaps relate to the information better as comes from fellow patients. Uzma advised that a Practice in Ripley area is testing Productive General Practice model and asked if the group would like to find out more. It was agreed to invite a speaker to learn more about this model. Uzma CQC Practice Managers briefly discussed the topic. Practices have been advised that a visit is likely to take place within first 2 years of registration. Feedback following a visit elsewhere was given apparently it was very intense, focusing predominantly on safeguarding. General Purposes Sub-group Mike Newbold is a member of this group. Terms of reference were circulated (& attached to this email). Any comments on this document should be sent to Mike; michaelnewbold@nhs.net Item 5 Finance Working Group draft T Any other business Uzma advised that new HealthWatch organisation will replace Derbyshire LINk; Healthwatch will be the new consumer champion for both health and social care. It will exist in two distinct forms local Healthwatch, at local level, and Healthwatch England, at national level. The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality. Practice Managers were asked if they would find this a useful topic for discussion at a future meeting and it was agreed that Uzma would invite the Local HealthWatch lead to the next DAC PMs meeting It was felt that 1 hour is not sufficient time to cover all topics and it was agreed to extend the next meeting to 1.5 hours. All Date of Next Meeting 11 th October 2012 3.00 4.30pm YMCA, London Road, Derby Page 5 of 5