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FEDERATION MEETING}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par 
\par MINUTES}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581\charrsid1932205 
\par 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 THURSDAY 07 APRIL 2011}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581\charrsid1932205 
\par 
\par }\pard \ltrpar\qj \fi-1440\li1440\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1440\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581\charrsid1932205 Present:\tab Dr }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid5125581 {\*\xmlopen\xmlns2{\factoidname PersonName}}Ed Ford{\*\xmlclose}, Dr John Higgie, Dr Alan Nelson, Dr Maggie Wilson, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581\charrsid1932205 Lesley Struck, }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid6556550 Janet Hewlett, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 Georgina {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Langley{\*\xmlclose}{\*\xmlclose}, }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid5125581\charrsid1932205 {\*\xmlopen\xmlns2{\factoidname PersonName}}Sharon Rowe}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 {\*\xmlclose}.
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5264 
\par 
\par Guest speakers: Amanda Smith, Senior Locality Manager \endash  Somerset
\par Community Health (covering the Community Nursing teams and Community
\par Hospitals), Teresa Bradley \endash  Children & Young Peoples\rquote  Services, Jenny
\par Thompson \endash  Children & Young Peoples\rquote  Services (covering the Health Visitor
\par teams).
\par 
\par Teresa explained that they were here to discuss a model which would be
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5264 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5264 introduced for the community nurse and health visitor teams in {\*\xmlopen\xmlns2{\factoidname 
City}}{\*\xmlopen\xmlns2{\factoidname place}}Somerset{\*\xmlclose}{\*\xmlclose}.  She said that the reason for the changes were due to the QIPP (Quality, Innovation, Productivity, Prevention) agenda, which required providers to be more \lquote savvy
\rquote  with their resources.  She said that QIPP also required operations at federation rather than GP level.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3886962 Teresa thought that practices within the West Somerset Fede
ration would probably notice very little difference due to the way that the health visitors work as they have already been working as a geographical \lquote {\*\xmlopen\xmlns2{\factoidname place}}Exmoor{\*\xmlclose}\rquote 
 team in a similar way to the proposed model.  Teresa said that there would be some subtle differences with regards to the District Nursing team as they would be working more geographically.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5264 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3886962 
\par Ed asked how the case loads would be split up for the health visiting team and raised the point that Williton is currently part of the Bridgwater Federation a
nd queried how this would work.  He said that there had been some concerns regarding the proposals from both GPs and health visitors.
\par 
\par Teresa said that it had been a surprise to them that Williton had federated with Bridgwater but that this was being taken into consideration.  She said the {\*\xmlopen\xmlns2{\factoidname place}}Exmoor{\*\xmlclose}
 team consisted of Williton as well as the West Somerset Federation areas.  The {\*\xmlopen\xmlns2{\factoidname place}}Exmoor{\*\xmlclose} team had raised concerns about Williton\rquote 
s status.  The advice from the GP involved on the working group was to maintai
n federation boundaries as far as possible.  However, Teresa said that this was a consultation exercise so this was not cast in stone.  She reported that there were similar issues in other parts of the county and reiterated that this was a consultation pr
ocess and the model was a suggestion at this stage.
\par 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8807099 Ed said that a major concern was how case loads would be allocated to health visitors.  He said that if health visitors had mixed case loads across a range of practices that it could be confusing.  At the
 moment a health visitor is allocated to a practice and there are clear lines of communication when GPs need to liaise regarding child protection issues, for example.  He questioned how GPs would know who to speak to if caseloads were mixed across practic
es.  Ed said that if the allocation of cases was left up to the team that would seem reasonable as they are currently managing themselves well, but if case load allocation was dictated from above it could be problematic.
\par 
\par Amanda explained that there would be a link health visitor for each practice but that there would not necessarily be one health visitor dealing with that practice\rquote s case load.
\par 
\par Ed said that clear lines of communication would be required to ensure child protection and raised the point that we so often hear of cases in the media where agencies have failed children because of poor communication.
\par 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6363236 Teresa exp
lained that currently health visitors meet twice monthly for child protection supervision when they discuss all issues in all practices so that all members of the team are aware of all cases.  Teresa said it was likely that Irnham Lodge would still have 
{\*\xmlopen\xmlns2{\factoidname PersonName}}Sheralynn Bigwood{\*\xmlclose} as its }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid270462 name}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8660625 
d health visitor.  There would be more health visitors available to answer queries so we should, for example, experience a three-for-one situation with better availability of staff.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8807099 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8660625 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid270462 Ed said that it would be better if the model were able to be adapted locally and the team here were able to allocate caseloads and work as they felt was needed.}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid8660625 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid270462 
\par Amanda said that over the next month or two the model would be out for consultation and how it will be delivered would be }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852 discussed and agreed with the staff on the ground.}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid270462 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\cf6\insrsid3485852 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid270462 
Ed said that practices would like closer links to the community nurse and health visitor teams but that it was re-assuring to know that the intention was to enable them to decide how best to work together rather than it being dictate
d by management and Amanda said that was absolutely the case.
\par 
\par Ed raised the point that the Dulverton practice was extremely worried about the impact on them.  The geographical distance of the practice from any central hub was of concern and there was a worry that they would lose their practice-based services.
\par 
\par Amanda said that she thought that Dulverton would remain absolutely the same as at present.  Amanda said that the model aimed to provide a single point of access }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8721334 and that there would be a hub and spo
ke approach.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid270462 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8721334 
\par Teresa said that the aim was to provide a model which was sustainable, improved access and removed the need for travel.  She said that there was no intention of \lquote throwing the baby out with the bath water\rquote  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid11146491 and that the health visiting team were already working in a similar way.  Teresa said the team in {\*\xmlopen\xmlns2{\factoidname place}}West Somerset{\*\xmlclose} were 90% of the way there.  {\*\xmlopen\xmlns2{\factoidname City}}
{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose} queried the remaining 10% and asked what changes would need to be made to achieve this.  Teresa replied that it was about making ind
ividuals think about assisting colleagues in other areas where required.  For example if Angela was working in Porlock and a patient registered at Irnham Lodge but living in Porlock needed a visit, it would be about asking Angela to do this rather than it
 having to be Sheralynn.  Teresa said that the team would be able to sort out their caseload themselves.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8721334 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11146491 
\par Amanda said that in terms of the community nurse team, there would again be a link nurse with each practice.  Investigations were being made into the p
ossibility of one or two staff working in rapid response roles, which the team have wanted for a long time.  Amanda said that there were vacancies in this patch and they were considering if staff would need to be pulled from 
{\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Taunton{\*\xmlclose}{\*\xmlclose}, for example, as there may be skills which could be shared.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid27004 
They were also investigating if one team member could be responsible for visiting nursing homes rather than different nurses going into the same home.  Amanda said that there was a very good community team in 
the area but they do become de-motivated when they are over-worked.  The model had been designed to bring benefits to patients and their families as problems with access and the time lag in g}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852 
etting a response to queries have}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid27004  been raised as problems.  Amanda said that an administrator was needed to take the call and refer it on to generate a response in a timely manner.}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid11146491 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid27004 
\par Lesley said that the community nursing team here had Gerri}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852 ,}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid27004  and Amanda replied that they may morph her role.
\par 
\par {\*\xmlopen\xmlns2{\factoidname City}}Sharon{\*\xmlclose} queried what the impact would be on resources in West Somerset if Williton are treated as part of the Bridgwater Federation as the {\*\xmlopen\xmlns2{\factoidname place}}Exmoor{\*\xmlclose}
 team would lose health visitors.
\par 
\par Amanda said that resource implications would need to be considered if this were the case.
\par 
\par John raised the point that it was possible that Federations may in fact need to be much larger }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14040930 
and until the legislation was released it may not be worth worrying about the impact of Williton on the model as it may need to change again.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid27004 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par Ed thanked Amanda, Teresa and Jenny for shortening their one hour presentation and they left.
\par 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \b\f1\insrsid5536783\charrsid5536783 Agenda
\par }\pard \ltrpar\qj \fi-1440\li1440\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1440\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid5125581 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 Apologies
\par }\pard \ltrpar\qj \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13709296 {\*\xmlopen\xmlns2{\factoidname place}}Exmoor{\*\xmlclose} Medical Centre \endash  Dr David Berger & Kathryn Kyle, Dunster Surgery}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5264  \endash 
 Dr David Davies, Porlock Medical Centre, Dr Ian Kelham}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 .
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid5536783 \hich\af1\dbch\af0\loch\f1 2.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 Minutes of the last meeting \endash 
 The minutes of the last meeting were agreed and signed off by the chairman.
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid5536783 \hich\af1\dbch\af0\loch\f1 3.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 Matters Arising:
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid5536783 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\qj \fi-720\li1440\ri0\widctlpar
\jclisttab\tx1440\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1440\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 West Somerset Health Forum \endash 
 the first meeting will be held on Tuesday 17 May at 6.30pm in the Large Seminar Room at {\*\xmlopen\xmlns2{\factoidname PlaceName}}{\*\xmlopen\xmlns2{\factoidname place}}Minehead{\*\xmlclose} {\*\xmlopen\xmlns2{\factoidname PlaceType}}Hospital
{\*\xmlclose}{\*\xmlclose}.  {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose}
 reported that she had not had a response with regards the objectives of this forum.  Ed said that he did not think that he would be able to attend.  No one else stepped forward.  {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place
}}Sharon{\*\xmlclose}{\*\xmlclose} will request the minutes.
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid5536783 \hich\af1\dbch\af0\loch\f1 4.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 Constitution \endash 
 Copies of the draft constitution which was obtained from the LMC model were circulated to all members ahead of the meeting.  Ed said that there were a few areas which our federation may need to adapt to suit us.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid5536783 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\qj \fi-720\li1800\ri0\widctlpar
\jclisttab\tx1800\wrapdefault\aspalpha\aspnum\faauto\ls1\ilvl1\adjustright\rin0\lin1800\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 Voting \endash 
 it was agreed that this would be on the basis of one vote per practice according to whichever representative could attend the meeting.  Practices will be able to vote by proxy if they cannot send a representative.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid5536783 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Vice-Chairman \endash  Ed said that he had discussed this with {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}
Sharon{\*\xmlclose}{\*\xmlclose} and it was felt that it would be useful to have a Vice-Chair in the case of Ed\rquote s absence at a meeting.  Ed proposed Alan as Vice-Chairman, seconded by Maggie and motion carried.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid5536783 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Secretary \endash  Ed had again discussed this with {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon
{\*\xmlclose}{\*\xmlclose} and the view was that for continuity purposes someone would need to undertake the task for a year at a time.  Ed said that rather than a voting procedure, perhaps practice managers could share this on an annual rota basis.  
{\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose} said that she would be happy to continue this for this year \endash  agreed.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid8208916 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8208916 Elections and AGM \endash 
 Ed said that the constitution stated October for re-elections but in line with the official formation he proposed that we do this in February.  John said that this was a good idea and would fit well with the financial year. Agreed.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid8208916 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Voting quorum \endash  Ed highlighted that the original quorum said 4 member practices should be represented.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid2955817 Alan proposed that given the size of our federation 3 would be enough.  Agreed.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8208916 
\par }\pard \ltrpar\qj \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2955817 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817 
\par {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose} will re-circulate the final version of the constitution for member practices to sign.
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2955817 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid2955817 \hich\af1\dbch\af0\loch\f1 5.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid2955817 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817 Future Venues \endash  {\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}
Sharon{\*\xmlclose}{\*\xmlclose}
 said that Lesley had suggested previously that we rotate venues for the meeting.  Lesley said that this would be less onerous on those who have to travel into Minehead and fairer given that lunch was supplied.  Agreed.  Harley House will be the venue for
 the next meeting.
\par }\pard \ltrpar\qj \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid2955817 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid2955817 \hich\af1\dbch\af0\loch\f1 6.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid10435696 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817 GP Admissions Project Update \endash  Ed updated on the presentation he gave }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid3485852 in March}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2955817  to a group which included representatives from Somerset PCT, Yeovil DGH, Frome and Somerset Community Health.  Unfortunately the representatives 
from Taunton & Somerset NHS Trust who had been due to attend had cancelled that morning due to a crisis situation.  Ed said that the general consensus was that the best way to manage admission}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7093767 
s in the future was to go along the lines of the proposal from the West Somerset GP Federation, i.e. to give GPs acce}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852 ss to more diagnostic equipment and}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7093767 
 nursing resources.  Ed said that everyone will have seen the email to say that the nurses at {\*\xmlopen\xmlns2{\factoidname PlaceName}}{\*\xmlopen\xmlns2{\factoidname place}}Minehead{\*\xmlclose} {\*\xmlopen\xmlns2{\factoidname PlaceType}}Hospital
{\*\xmlclose}{\*\xmlclose} had never stopped administering IV antibiotics.  Ed said that it will be interesting to see how nurses respond to the proposals.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10435696 
The next step will be for Ed and Andy Hill (who works for Somerset PCT in commissioning services from Somerset Community Health) to meet with representatives from
 Taunton & Somerset NHS Trust to work out the logistics of operating the system.  There is a need to carry out x amount of tests per year to ensure the diagnostic equipment is reliable but the number is unknown.  Ed and Andy will meet with representatives
 from pathology and clinical leads at T&ST to discuss the safety issues.  Ed said that if we cannot have the diagnostic equipment on site at {\*\xmlopen\xmlns2{\factoidname PlaceName}}{\*\xmlopen\xmlns2{\factoidname place}}Minehead{\*\xmlclose} 
{\*\xmlopen\xmlns2{\factoidname PlaceType}}Hospital{\*\xmlclose}{\*\xmlclose}, an alternative urgent results service would be investigated.  There was a 
finance representative present from Somerset Community Health at the presentation who was extremely positive about the proposals.  Sue Balcombe was also present.  The finance representative queried why Band 5 nurses were doing HCA work.  Alan said that th
i
s was a concern because Band 5 nurses at the hospital were leaving because of this.  Ed said that there would be the possibility of Band 5s being used to support the diagnostic service but warned that this was likely to be a long and drawn out process due
 to the detail involved.  
\par }\pard \ltrpar\qj \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid10435696 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10435696 
\par }\pard \ltrpar\qj \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid10160248 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10435696 
Alan queried the terms of reference which had been circulated for Edna Saffin to lead.  He said that he had made enquiries to find out if she had visited the department yet but there did not appear to have been any formal visit f
or this work.  Ed said that }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 
he did not see anything wrong with the terms of reference but did feel that the priority for GPs would be to work with Andy Hill as this would give GPs the opportunity to do more than they are currently able to within the MIU.  
John said that eventually a decision would have to be made as regards GPs working in the MIU as contracts would come to an end.  Alan said that there was no doubt that existing contracts would not be renewed but there would be the opportunity for a new co
ntract which would maintain GP services in the MIU.  He said that the Nurse Practitioners in the unit use the GPs and want to use the GPs and that in the event that this service is removed}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852 
 from the unit everybody will l}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 ose out and patients will not be seen
.  The unit has ground to a halt at weekends because there have been problems securing OOH GP cover.  Maggie queried how the OOH service worked from MIU.  Alan explained that an OOH GP is based there but only if the service could get a GP to cover.  Howev
er there are more gaps in the rota which will get worse as Dr Mackie has retired and fewer GPs are willing or able to cover. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8208916 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10160248 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10160248 \hich\af1\dbch\af0\loch\f1 7.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid10160248 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 Any Other Business
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid10160248 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\qj \fi-720\li1800\ri0\widctlpar
\jclisttab\tx1800\wrapdefault\aspalpha\aspnum\faauto\ls1\ilvl1\adjustright\rin0\lin1800\itap0\pararsid10160248 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 Sip Feeds \endash  {\*\xmlopen\xmlns2{\factoidname PersonName}}Maria Chapman{\*\xmlclose}
, PCT prescribing advisor, has offered to do a report on the use of Sip Feeds for our federation.  She has already done this for the Bridgwater Federation and both Harley House and Irnham Lodge had agreed that she could do this for our practices.  There a
re significant savings to be gained.  Maggie said that }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6556550 
the details would need to be cascaded to nursing homes, community nurses and highlighted that it is always someone else initiating.  Agreed to ask Maria to do the work for the Federation.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10160248 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid6556550 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6556550 Specials prescribed \endash 
 Ed said that Maria had also highlighted the costs of specials and it was suggested that we write to local pharmacists to ask them to contact practices with the cost of the special before they issued this to the patient.  Ed asked if we could writ
e on behalf of the whole federation rather than each practice write individually.  Maggie said that she had very few at her practice because they were dispensing.  Agreed to write to pharmacists on behalf of the federation.  Georgina asked 
{\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose} to include Wares in Porlock and Maggie asked for Quantock Pharmacy in Watchet and Lloyds in Williton to also be included.  
{\*\xmlopen\xmlns2{\factoidname City}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose} will also ask Dulverton about their local pharmacists.
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid6556550 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Butlins \endash  Sharon}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3485852  asked Harley House i}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid6556550 f they had experienced any difficulties in relation to T/R patients from Butlins.  {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname place}}Sharon{\*\xmlclose}{\*\xmlclose}
 reported that security had been contacting Irnham Lodge to try and arrange appointments for patients so the system discussed with Butlins before the closure of the Medical
 Centre did not seem to have been communicated to all teams.  Janet and Lesley were not sure of any specific issues but will check with their reception team and feedback.
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid6556550 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6556550 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid6556550 \hich\af1\dbch\af0\loch\f1 8.\tab}}\pard \ltrpar\qj \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid6556550 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6556550 Date of Next Meeting \endash  Wednesday 6 July 2011, 12.30pm, Harley House Surgery.
\par }\pard \ltrpar\qj \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid6556550 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6556550 
\par }\pard \ltrpar\qj \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5536783 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5536783 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par }\pard \ltrpar\qc \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 Meeting closed.
\par }\pard \ltrpar\qj \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par Minutes confirmed and agreed:
\par 
\par Signed: \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85...
\par 
\par Date: \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..
\par 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5125581 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5125581 
\par }\pard \ltrpar\qj \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid5125581 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5125581 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1773478 
\par }}