ࡱ> [@ 4>bjbj44 hViVi6-*******>bbb8TL>\hFF"hhhCCCi\k\k\k\k\k\k\$R^R`f\*%CC%%\**hh\)))%X*h*hi\)%i\)))X**[h: nwbs%Z*U\\0\ [ a&@ aT[>>**** a*[lC &)""*CCC\\>>$b_)d>>b minutes of the Somerset PCT and Somerset LMC MEETING HELD at CROWN MEDICAL CENTRE Thursday 12TH JULY 2007 11.00 AM Attendees Jan Hull Somerset PCT Donal Hynes Somerset PCT David Slack Somerset PCT Ian Tipney Somerset PCT Berge Balian Somerset LMC Harry Yoxall Somerset LMC Jill Hellens Somerset LMC Apologies Drs Dolman, Hanson and Moyse MINUTESOF THE LAST MEETING 10TH May 2007 Agreed as a true record Matters Arising 3.1 Health Promotion Information A new health promotion catalogue has been produced and the service will be based in the Chard PCT office .A letter has been circulated to all practices. BB commented that there was still little general PCT communication with practices, and most contacted David Slack with questions about contract issues. IT suggested that a wider communication was needed and the PCT will re-circulate an updated copy of the PCT structure. 3.2 CPD Payment for Trainers The CPD payment had been clarified as the responsibility of the SHA, it would be paid for 06/07 only. 3.3 Ambulance Turnaround at Trusts IT had met with Ken Wenman and T&S Trust to discuss the problems around Taunton, and the working relationship between A&E and the ambulance service. The PCT needs to be seen as the facilitator and will set up further meetings to see how to improve matters. A list of concerns is to be established and worked through. There are not the same problems at EST.HY raised concerns from colleagues that had come under pressure to state 3-4 hours was an appropriate time for a patient to wait for an ambulance although the GP had requested that the patient be seen quicker. Specific instances to be sent direct to Ian Tipney. ACTION: HY 3.4 Counselling The PCT have a draft consultation paper on mental health services from which they will re-shape the primary care service. The consultation will probably last for 3 months due to the number of interested parties. Where practices have immediate problems the PCT will endeavour to put in a short term solution, and some new counselors had been recruited to vacant posts. The LMC will have a key role and will be asked for comment. 3.5 Communications BB reported that it is still unclear on the financial statements sent to practices what each item refers to although this had been previously sorted with the individual PCTs. ACTION:PCT PCT ITEMS General Update The PCT reorganisation is now complete, Susan Davies has been appointed as the deputy director for primary care. There were a very small number of redundancies. Currently there are 13 vacancies within the management structure. Management savings have been delivered and will be re invested. PEC appointments IT was pleased to have appointed Dr Donal Hynes as PEC Chair, Other members as follows: Dr Caroline Gamlin Interim Director of Public Health Paul Goodwin Director of Finance and Performance Jan Hull Deputy Chief Executive/Director of Strategic Development and Partnerships Alison Kyle Dietician Dr Harvey Sampson General Practitioner Dr Geoffrey Sharp General Practitioner Ian Tipney Chief Executive Julie Vale Nurse The PEC will be developed over the summer months and will look for good clinical engagement. The PCT are currently reviewing provider services, IT is planning to visit all community hospitals. There is some pressure to establish a separate Community Foundation Trust to run the provider services, but currently the PCT felt there was no reason to set up a different organisation. There is a need to sort out provider services, and to negotiate capital funding with the SHA. BB congratulated Donal on his appointment and the PCT on appointing clinical members of the PEC of a high caliber. He asked whether the provider arm of the PCT has to have a separate clinical governance and performance management from the rest of PCT, and requested reassurance that there is no intention to remove provider services from the public sector. IT saw provider services as staying within the NHS, although the private sector may be involved, for example through PFI funding. A mechanism for engagement needs to be established with secondary care as a development priority IT stated that all clinical matters will need to go through the PEC and decisions made in a very structured way. DH has already set up meetings with the directors of the acute trusts and he felt that the PEC has a strategic vision for the next few years. He added that PEC minutes and correspondence will be open to everyone. The PCT is trying to be more visible this year and keen to visit practices. A discussion followed on the prioritization of this. Primary Care Premises The previous PCTs commitments have been clarified, so although there had been no board level agreement, expectations had been raised and therefore existing schemes prioritised. 9 Schemes will to go to the new board for initial consideration, with a rolling programme thereafter. IT is working on this with DS and practices and the proposal will have a significant investment attached. This will be worked up through the summer, but no formal announcement will be made until September. IT discussed the boards wish to establish a performance framework for Primary Care. The LMC expressed reservations about the long term validity of any markers to be included within this, and the need to avoid duplication with QOF and limit any additional workload. HY commented that the current prescribing scorecard does not appear to be a validated performance tool and any performance criteria should be evidence based DH said the PCT would like to engage with LMC on that. ACTION DS/HY GP Appraisal Steve Holmes paper on GP appraisal is going to main LMC today; there will be a need for discussion between the LMC and PCT regarding payment arrangements in due course. Prescribing Budgets DS reported on the Paper to be presented to the PEC. This recommends that budgets are set largely based on ASTRO PU. A third of practices were within budget for 06/07.An uplift of 7% has gone into budgets for this year, which gives a good opportunity to keep within budget for many. HY asked how outliers at either end of the prescribing spectrum would be regarded. The LMC is also concerned about how practices can make the right prescribing changes when pharmaceutical prices are both erratic and bizarre. GMS/PMS Contract Issues 5.1 QOF 5.1.1 Medicines Management The LMC had met with the PCT and the matter concerning in reference to practice MM audits has been resolved. This would be communicated to practices ACTION: LMC 5.1.2 Denominator for Microalbuminuria Testing (Matter Arising) BB stated that the agreement in Somerset needs to be revisited, currently when a practice is efficient and patients are on the appropriate medication, the cohort remaining are the most difficult group and therefore the target is too high. BB suggested an e mail conversation with DS in order to resolve this. ACTION: BB 5.1.3 Post Payment Verification The 5% random check will be done in one practice in each of the former PCT areas in September and the LMC will be involved in the selection process. Aspiration payments Mendip have historically been paid differently to other areas and as practices have planned their cash flow on previous arrangement this may result in problems for some practices. DS would be happy to be contacted by practices who were experiencing cashflow problems as a result. 5.2 PMS Agreement-Updating HY has met with Susan Davies to discuss PMS, and the LMC are talking to PMS group in order to resolve any outstanding issues. 5.3 Enhanced Services 5.3.1 2007/08 Agreement The PCT are waiting for the LMC decision on the smoking cessation and PBC agreements, and then will send out all specifications to practices. ACTION: LMC 5.3.2 Smoking Cessation BB said that this is an area where no agreement has been reached, although the template developed is excellent. There is a lot of resistance from practices to weekly monitoring, and practices will need individually to decide on participation in the LES as the LMC is unlikely to endorse it if weekly monitoring is required DS stated that the PCT will accept no less than monthly reporting if practices are not in a position to report weekly. 5.3.3 Access Survey Currently still embargoed. 5.3.5 Negotiations for 2008/09 BB would like to create a timescale for negotiations and proposed October for a preliminary meeting, and a second in early January That would then allow two months for any national adjustments. ACTION: BB &DS 5.3.6 End of year adjustments payments/Data All the payments have gone out, although dispensing is still to go. There are still some discrepancies that the PCT are aware of. 5.3.7 DMARD The PCT agreed in principle that Leflunomide will be considered for inclusion in this ES. 5.4 PCT Information Cascade Janet Ashworth, Associate Director for Patient Safety, will in future have the co-ordinating role in approving the distribution of material through the cascade. Whilst the LMC recognises that the PCTs hands are tied and that they are required to cascade most of what comes out, most of what is distributed is of extremely limited value. HY proposed that perhaps significant items could be prioritized and it was agreed the LMC should discuss this with Janet Ashworth. ACTION: LMC Commissioned Service Issues 6.1 Out of Hours A meeting has been arranged for the 25 July with WAST to discuss the terms and conditions for the OOH Doctors Social Services have released a proposal for the OOH emergency to be relocated to Wellington house, and their plans to have only one social worker on duty in the evening have raised alarm. HY will send Jan Hull a copy of the LM letter. ACTION: HY 6.3 Somerset Partnership 6.3.1 Foundation Application (Matter Arising) Edward Colgan attended the last LMC county meeting to give a presentation on the foundation Trust and Jan Hull is to meet with the LMC next week in order to give an update on the DAAT. IT has agreed a two year SLA, raising issues on the risk management of patients. CAMHS A triage system needs to be put in place in order to assess. There are significant concerns that the CAMHS service is to be confined to serious mental illness, alternative provision needs to be commissioned to deal with mild to moderate mental illness in children and adolescents. 6.3.2 Drugs and Alcohol Service (Matter Arising) Taken Above 6.4 ATOS origins service There is no further Progress to report an outcome is awaited. HY reported that access is still a problem at MPH, sometimes a patient will wait for 6.5 months ahead, HY will send relevant information to Judith Newman. ACTION: HY 6.5 TOP pathway The PCT is reviewing the whole sexual Health agenda and needs to make a commissioning statement, the sexual health paper will go to the PEC, after which they will pick up TOP in the autumn. Primary Care Physiotherapy HY reported that the service is unevenly spread and reliant on trusts that are not primary care focused. Karen Lashly a practice manager in South Somerset has raised specific issues in a letter to Judith Brown DH said the PCT is to review the whole service and the inequalities, and he is meeting with Judith Brown in the next two weeks. Practice based commissioning 7.1 Prescribing update 7.1.1 Practice Prescribing Budgets for 2007/08 Taken under 4.4 7.4 Practice Indicative Budgets for 2007/08 and activity information DS hoped the finalised budgets would be available at the PBC day on July 13th at Haynes, it has been a complex process and the PCT remains unsure over the quality of data. All practices have been invited to further Ardentia training HY said practices hesitate about spending a lot of time on this until data quality is assured. DS acknowledged this concern and said that a limited amount of data validation would be undertaken jointly with practices as part of the LES. Trust Envelopes for 2007/08 & Commissioning Flexibility IT stated that reconciling the Trust envelopes has been difficult but has ensured financial stability whilst PBC plans are developed. HY added that Somerset practices were increasingly committed to the consortium model and outside West Somerset, where there were legitimate different priorities; all but two practices were now signed up. The LMC asked for clarification on the prescribing element of the DES. If payment required achievement of all the targets a number of practices would feel in not worth attempting. DS agreed to consider some form of scaled payment for this section. . ACTION: DS & LMC ANY OTHER BUSINESS 8.1 Social Services Out of Hours cover Taken under 6.1 8.2 After a tendering process, the contract for running the renal dialysis satellites in Taunton and Yeovil, and establishing the new one in Frome, has been awarded to B Braun Avitum who will take over from Fresenius next year. Existing staff will transfer to the new company, and patients should notice very little difference in the service. 8.3 Overarching strategic framework of PCT. A draft to be developed by September, and will feed into LDP, this will look at the whole portfolio of PCT services. 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