ࡱ> wyv[@ 5bjbj44 `ViVi-dxxxxxxx4448l4t[Mh  "BBBBBBLLLLLLL$NRQfLxR&BBR&R&LxxBBL z)z)z)R&xBxBLz)R&Lz)lz))R5IWxx4LB pw4&KL4M<[MK{Qz'{Q<4Lxxxx{Qx4L\B2 bz)!"BBBLLdD)^ MINUTES of THE Somerset PCT and Somerset LMC meeting held at Lyngford House Conference centre Thursday 15 March 2007 Attendees Jan Hull Somerset PCT Donal Hynes Somerset PCT David Slack Somerset PCT Mr Ian Tipney Somerset PCT Berge Balian Somerset LMC Sian Hanson Somerset LMC Harry Yoxall Somerset LMC Jill Hellens Somerset LMC Apologies Drs Moyse and Dolman Minutes of the previous meeting 11.01.07 The Minutes were agreed as a true record Notes from the informal meeting 28.02.07 The notes were agreed as an accurate reflection of the meeting. BB stated the need to set timescales on action points that arise from the meetings. A time frame of 4 weeks was agreed Matters Arising 3.1 Interim PEC arrangements The LMC have tried unsuccessfully to arrange a meeting with the PEC as there are various clinical issues to discuss. BB asked what process the PCT had in place for setting its work programme. DH said that currently such a policy has not been formulated.. The PEC awaited a national decision on PEC structures following the recent consultation. He hoped to get full PEC as soon as possible this depended on guidance being issued. HY said that patient pathways are a priority in order to make PBC work and the PEC will be central to agreeing these. DH stated that patient pathways will be dealt with under the PBC umbrella. This will involve a changing relationship with providers and commissioners. Clinical pathway questions raised by practices could be relayed to the PEC by the LMC in the interim, though eventually clinicians would be asked to contact the PBC group. JH said that any clinical changes to pathways would be ratified through the PEC. HY gave an example of the inappropriate referral of a TIA patient that presented at A&E back to their GP, due to local interpretation of the PCT instruction on stopping consultant to consultant referrals. DS will discuss the potential problems with HY. ACTION:DS 3.2 Health Promotion Information The PCT plans to have a central service in Chard, if there are particular areas of immediate concern practices should inform the PCT. HY requested a list of the information leaflets currently available. ACTION:PCT 3.3 Choose and Book Directory of Services HY reported on a constructive meeting with T&S, EST and the RMC to make the DOS more precise. The trusts seem keen to make this Work. 3.4 IT Support The LMC had met with Neville Roberts to discuss the various IT problems in Somerset practices. The PCT has identified funding to upgrade stock in Mendip and South Somerset, as they had fallen behind on the rolling programme. 3.5 Smoking Cessation BB stated that smoking cessation had become an issue for both PCT and GPs. DH said the PCT were working on a simpler mechanism to extract information from the practices. The process will change next year, but practices already include smoking cessation in their everyday work the payments are primarily for data collection rather than intervention BB asked if providing smoking cessation through a formal in-house structure was this considered to be a core or enhanced service? DS suggested a meeting with the LMC in order to go through the various issues. IT recognised that practices are struggling to hit the targets and there is a need to review how to approach smoking cessation, the PCT will work positively with practices, particularly with the introduction of the smoking ban in July offering a useful milestone. ACTION: PCT 3.6 Public Health Representative on LMC BB had written to JH and DS asking for a named individual who would be invited to attend the LMC county meetings. DS said in principle the PCT are happy to do this, and suggested Dr Harry Yoxall speak to Caroline Gamlin. ACTION: HY PCT Reorganisation 4.1 General Update The PCT Management structure has been published and all first phase interviews are complete, the PCT are now in the process of managing employees who do not have a future role. SHA Staff are in a similar position and have been issued with redundancy notices. The PCT are currently interviewing for Phase 2, which will be completed by March 27th. Further appointments should be made by the first week of April when a management structure with more names attached can be published. There will then be roughly 20-30 vacancies to fill. The PCT will then have completed the process according to Commissioning a patient Led NHS, The PCT HQ is centralised in Yeovil, the plan is to move all staff out of Express Park and Wellsprings Road as soon as possible. They are not decided on the future of Wells premises. There will be a small number of redundancies, overall the management savings will be 1.8M. IT said the PCT will be happy to share the names and structure with the LMC . 4.2 Staff Appointments Covered under 4.1 4.3 Communications DS agreed to produce a list of the PCT structure for each practice. ACTION: DS Locality Arrangements It was explained that although the first part of the reorganisation has been about savings, as soon as the process is complete a review of provider services will begin. The programme is to be discussed at the beginning of April, but the PCT have a firm commitment to rebuild community hospitals in Minehead, South Petherton, and Bridgwater. IT said it was their intention to base all management in Yeovil, but the PCT will still need to provide a local service and presence. David Slack advised that part of the Primary Care Development directorate would be based in the West of the county to facilitate working with practices in this area. FITNESS FOR PURPOSE JH reported that the SHA driven Fitness for Purpose work was nearly complete, the board to board meeting had taken place. The PCT was pleased with their overall performance, and it had proved to be a useful process for looking at policy. She added that the first aim of the health community was to achieve economic stability throughout the South West. GMS/PMS Contract Issues 5.1 QOF BB asked what the PCT plan was for this years QOF verification process. DS said that all QOF visits have been completed and they are not rushing into random checks. Payments will be made by the end of April. 5.2 PMS Agreement-Updating HY asked if the PCT are planning to have a named individual to negotiate with PMS practices. DS said that initially negotiations will be handled by the locality representative, but the PCT are looking for an expert in PMS overall. 5.3 Enhanced Services 5.3.1 Current areas for negotiation BB Questioned if there had been any feedback regarding the access survey. DS had not heard but would confirm the timescale for this. ACTION DS Choose and Book Choose and book was a one year DES and there has been no confirmation of a further incentive scheme for next year. HY said that C&B compliance will drop significantly without such a scheme as CAB carries significant costs for practices. Many practices will disengage if payments cease. IT said that it would be a shame to lose C &B as Somerset is the top performer in the country. ACTION: PCT Enhanced service Negotiations BB requested confirmation from the PCT on any outstanding issues from the negotiations as he would like to write to practices in early April. DS said the urology consultants had agreed to prescribe triptorelin so this matter was now resolved. SH said that brief guidance was needed on changing patients from existing alternatives, and when it was still more appropriate to use goserelin. ACTION: DS 5.3.2 Inflationary uplift DS confirmed that the DDRB Review had recommended 0% for GP pay for 06/07. IT had received advice that it may not be the end position, and as the PCT want to support enhanced services, a local agreement may be needed. 5.4 CPD payment for trainers Item still outstanding, for next agenda ACTION: DS Commissioned Service Issues 6.1 Out of Hours The LMC are aware of some areas of risk in the OOH service. 6.2 Acute Trust Services 6.2.1 Rheumatology LMC HY reported on the shortage in provision of rheumatology appointments which is particularly difficult for long term patients who may need a follow up appointment. DS said the PCT are aware of the issues, but the county wide commissioning group have asked why Rheumatology is secondary care based, and are talking about reconfiguring the service. This is a commissioning issue rather than a capacity one. HY wondered if an intermediate level service would be appropriate. IT said that a letter had been sent to T&S Trust requesting a full review of Rheumatology there. 6.2.2 Ambulance unloading delay PCT This item had not yet been followed up by PCT ACTION: DS JH said a piece of work had been conducted on turnaround times which she would forward. ACTION: JH 6.3 Counselling JH Reported that the PCT is concerned about a number of matters in relation to mental health services in the county. Mental Health provision in primary and secondary care is to be reviewed. At primary care level three PCTs have GP practice based counselling services, but some of the counselors have left due to the fragmentation of the service and concerns about their future job security and this needed to be looked at as a high priority. JH agreed to share some information on the scope of the review with LMC.. ACTION: JH ATOS origins service DH reported that the ATOS service for an alternative provider of more complex investigations would largely be made up of ultrasound and X ray services .Referral will involve a tick box e-form handled by the RMC. DH confirmed guidance would be issued on GP access to higher level investigations like CT scanning. ATOS will become a new diagnostic choice within Choose and Book and the patient will then be contacted by the RMC and offered a suitable appointment HY had concerns that a large commissioned area is EEG, and it would be difficult for primary care to use this investigation effectively. DS said that the PCT are talking to secondary care about this. Practice based commissioning 7.1 Prescribing update DS is aiming to have a meeting with the LMC and LIT To set a realistic uplift to the overall budgets. ACTION: DS 7.2 DES 2 Objectives The PCT have a commitment to a 2007/08 LES at 1.00 per head, the priority areas to include Prescribing 18 weeks wait Implementation of Emergency admission plans 7.3 SPBCG Business Plan Implementation DS stated that Somerset had the one of the first county wide commissioning plans in the country. The PCT had agreed to fund 1.3 million of developments in 2007/8 and the SPBCG were working through the detail of the plan. 7.4 Tariff Unbundling The PCT confirmed that they were looking at unbundling the tariff initially for inpatient work in community hospitals where there are defined patient pathways (e.g. stroke, orthopaedic rehabilitation). 7.5 Activity Information HY reported that practices are not getting much activity data. DS said he was not expecting practices to look at a lot of paper information, but quarter2 and 3 data will be available next week. PBR will not fully operate this year so routine validation to be automated. DH said that the PCT had suggested to the Trusts that coding be done by an independent coder. DECONTAMINATION The LMC have been negotiating with Jenny Fletcher and this is progressing well. ANY OTHER BUSINESS DATE OF NEXT MEETING 10 May 11.30 Venue TBC     Item 13 a LMC County Meeting Thursday 12th April 2007 DRAFT PAGE  PAGE 1 yL g h q r   ? E   ! . c  5  AWúòéhYB*CJaJph3fh,CJaJh/{CJaJh?CJaJhY5CJaJhYCJaJhY;CJaJhY5;CJaJhY6CJaJhYCJaJhY5CJaJhY5;CJaJhYjhYU4yz + I J g h r 8^8F & FEƀ@&$a$ '&#$/55  C ke\P $p^pa$gdr@R$p^pa$p^pF & F Eƀ@&.8^8F & FEƀ@&  Sqr^ $h^`ha$$p^pa$8^8F & FEƀ@& +^ja|28 lopqbdk.7Xhz~ %޷h/{h/{CJaJhY6CJ]aJhYCJH*aJh/{CJaJhY5;CJaJh,CJaJh?CJaJhYCJaJhY5CJaJDij`a|^fp^p h^`h$p^pa$8^8 f !~5  %k~8^8gd/{p^p$p^pa$8^8F & FEƀ@&%s$C */o.|7SY1 P !!!P"h"q"""#$O$%!%B%O%%&&&&&&'1'='A'C'`'r'''I(h(p(((((')h,5CJaJhY6CJaJhY5;CJaJh/{CJaJh,CJaJh?CJaJhY5CJaJhYCJaJI~.SF & FEƀ@&h^h$8^8a$8^8$p^pa$F & F Eƀ@&.  !!!!!+"i"{"""#$/$0$1$O$$B%%%&M&$@ ^@ a$8^8$8^8a$M&&&'1'C'D'`'r'''''(|)) @ ^@ `@ ^@ F & FEƀ@&h^h h^`h8^8$8^8a$')8)L)_)|))))** **.*U**** +!+,,,)-8-C-D-Y---S.X.q....8/AFTuԟDO^Ff'^e{ L X/`}VF 4@7B_ս &h0`uos@K?R_g]ȗg)w_7WܔA  7W@W _#Q~/۫;ޔLw+Џm,^"`=@G@/Ce,^ mΖZr%eO,Q?hfxE‹Ebud̯S(Kޢʰ$QWPeFphg>h DŽbS6{C?(J+*%tPOΧؕN%#ٌF"Ҩ@#(# wRߒV?iw3BLt PRcwlC2JE4G!ep3@b=+aqM wxZp+-1K ]x/&ySGM 1#5]Vך7ܟ։l<XC@t#17 ݿE 7 鮄~U)uX[D5]eGFZ m8w%]6;4DQU|(ޡ9GLtz Qk<4olP|HRM Knߠ5-R*hQ=R[½U&/˄p :4eOVK'Npk䖤ՄLÁ <,&!bl)g DAlh7P&Ů5f+ Ϝ|/7@@'@f*bL8P-#k4ty mx FrR~?({H"DrUvDl< 7))ISuY5~z&bdJHX⩶>B ]^\XqJCڏj%q$ 9̚ri1(.qzbdAU@<递(Qgs XFRs*7 ( J4I!jz׎ a,PD;Ft ?-̣Z]@`ZH0wk  xmHDP2IbD~- =F@fgHP5"; phFK҈ZCX;B(:[Yڗ @ͣ00<!H5iV-Q5.RP}@(Џi϶b.Aw}IpʕC(jw腟dS$Rc;3 ޘ⪀]xse1Dޗht¤Ꞡm8 FFyUCV9]Y)PRY x"k>1HbA1MD/*c,1!9PODU2ֱXAKeW3-khj# *肄 [@ K2C2#OQ\>z-aojv/g71f`V/"!󔚏h$!.ʊԳMZ'X@?DU:Ыx׶1־Q@)!jіPFlv47v&t)_yJk4L l2yI8)Vjn {:~Gփ$MB G"X2rx\RH,Fw(9ϑ x16-/@_EL h^kИɸbE hh2xNf\؟ARLl?C u=n:c4bk[)ݢLQ+F(m/ ౓g>5q% -܄+,)*JQ$/&qh$Ψd|V9Z뤫tΑD< CUS(0fȇ&>0@A6[& lk+\ P̘0F! #*(LʿĈ^ s *PLNVJ3>!4lU~xkU}:`[a 6kW#3_\-so.^= JwX mF{9F(}}瀺y瀂kL'=Nt&@BRoGQ9'Ax\J^]ЖlTQdPh(NQД߹#nUY;H]Zٖ}@Y@89;U^`'ίfDUC9+Ql;!ædn$Qa5U&hKL !~$)62\anH1`t+?[ Ӕ: Sd:nj td[bHG3)j`T\F^U]~yK$z3Vcz!kNCY]9qaR <{+kKZ.9-VuPwbۛNG jZ;bO[/Il t\eW]w `^]1EK}\yVzW y+}#^`x~*뤑9Y}p'پKc6L(Zˢ@4h ZԽrR˰dNpݼSdsgV-W`% mgڢdOF;?2x]@I4.8fԍiZN{v=hҔ6㏒Wǀb'ADi0y 9}Vԝ:nc]1C@gCj(^l 22H͉.OaSz.P3cNEg(1kQd^s2M t22B̳h5"911Dt<拓tBWhZ?0ti8ߗThITS;|7584<5)X~I}j5HٰK{}[X@)MS#68PVde ?3~@}q웬.g.)]L 6vyطM6H3yZ 3nF\XR '͹ -2KfG=9xf:Q QgF@˭$sOh*CJHH Heading 2$5$7$8$9D@&H$CJLL Heading 3$5$7$8$9D@&H$>*CJPP Heading 4 $5$7$8$9D@&H$^CJbb Heading 5.$$p5$7$8$9D@&H$^p`a$5CJN@N Heading 6$$ & F@&a$ 5CJaJDA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List HBH Body Text$5$7$8$9DH$a$CJ^C^ Body Text Indent $5$7$8$9DH$^a$CJ\R\ Body Text Indent 25$7$8$9DH$^CJbS"b Body Text Indent 3 $5$7$8$9DH$^a$CJ4@24 Header  !4 @B4 Footer  !HRH  Balloon TextCJOJQJ^JaJ.)@a.  Page Number- `yz+IJghrCSqr^i j  ` a | ^ f f !~5  %k~. +i{/01OBM1CD`r |!!'"*"."U"""" # #$+%C%D%Y%''''(&(\(((()!)/)[)\))c*d*{*|*Q+R+l++,,,,K-L-_-`-u---------------0@0@0@0@0@0@0@0@0@0@0@0@0@0@0 0@0 0@0@0 0@0@00 0@0@00@00@0@0@0@0@00@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00@0@0@0 0@00@0@0@0@000@0@0@0@0@0@0@0 0@00@0@0@0@0 0@0@0@0@0@0@0@0@0@0@0@00@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00@0@0@0@0@0 0@0@0@0@0@0@0@0@0 @0@0@0@0@0@0@0@0@000@0@0 0@000 0@0@0@0@0@0@0 0 0 0@0@00@0@0000@0@0@0@0@0X 0@0,@0, 0,@0, 0 ,0@0@0@0@0@0@0@0@0@0@0@0@0 0 -->;04<;0 KVcccf%')~255 #'+. ~M&)/!1l3`555!"$%&()*,-/5KRV]_f!!#]{]l ]|$] ]Ʉ]f]ރ]$]]]%]l<](]w]l]"]Lb]]|b]}]]] ]x]t]t ] ]<]]]]] ]=^,=##a<<  ))-----      !"++w  &&DD * ))-----  !"V#*urn:schemas-microsoft-com:office:smarttagsplacehttp://www.5iantlavalamp.com/Z *urn:schemas-microsoft-com:office:smarttags PlaceNamehttp://www.5iantlavalamp.com/Z *urn:schemas-microsoft-com:office:smarttags PlaceTypehttp://www.5iantlavalamp.com/h"*urn:schemas-microsoft-com:office:smarttagsCity0http://www.5iamas-microsoft-com:office:smarttagsg*urn:schemas-microsoft-com:office:smarttagsdate/http://www.5iantlavalampft-com:office:smarttags; *urn:schemas-microsoft-com:office:smarttagsaddress: *urn:schemas-microsoft-com:office:smarttagsStreet 1215200734DayMonthYear#"#"#"#"#"#"##"#"#"## ##"#"# 1+<+-------------------##(%*%-------------------3333h ooshh7r$$$$8%Y%'&())))b*b****+=+@+,,L-------------------------------- ITuser harry yoxall harry yoxall Chris Regan $[0.} p҂ Q>K 7Px8lHAP;j=n!bAƿ@LT0GF#.\TPfPii>u*88^8`o(pp^p`o(.  ^ `o(..^`o(... ^`o( .... PP^P`o( ..... `^``o( ...... (#`(#^(#``o(....... `'``'^`'``o(........808^8`0o( ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h^`OJQJo(hHh  ^ `OJQJ^Jo(hHoh  ^ `OJQJo(hHhxx^x`OJQJo(hHhHH^H`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH ^`hH ^`hH.  0 ^ `0hH.. \ 0\ ^\ `0hH... HH^H`hH .... ^`hH ..... `^``hH ......  <`<^<``hH.......  (#(#^(#`hH........88^8`o(pp^p`o(.  ^ `o(..^`o(... ^`o( .... PP^P`o( ..... `^``o( ...... (#`(#^(#``o(....... `'``'^`'``o(........ >^`>hH >^`>hH.  0 ^ `0hH.. s0s^s`0hH... ^`hH .... ^`hH ..... `^``hH ......   ` ^ ``hH.......  &&^&`hH........0^`0o(p0p^p`0o(.0^`0o(..0^`0o(... ^`o( .... X X ^X `o( ..... `'``'^`'``o( ...... -`-^-``o(....... 2`2^2``o(........^`o(.^`o(.808^8`0o(..808^8`0o(... ^`o( .... ^`o( ..... `^``o( ...... `^``o(....... pp^p`o(........ 88^8`o(pp^p`o(.  ^ `o(..^`o(... ^`o( .... PP^P`o( ..... `^``o( ...... (#`(#^(#``o(....... ((^(`o(........ 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........ 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........ fPi] P;j=] >u^ 7d^ ^@LT} #.\!bA0x8 QP8Tj30;41PLTj30;41PLTj30V;41PȝTj30;41^u@ ^`OJQJo( ?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdeghijklmopqrstuxRoot Entry F3pwzData 1_1Table=QWordDocument`SummaryInformation(fDocumentSummaryInformation8nCompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q