ࡱ> [@ p4bjbj44 $ViViH,'*******>bbb8L>H"HHHHHHHIR/LfH*Z%Z%Z%H**H)))Z%**H)Z%H)))YB/**E b%,DHH0HDbL&(NL4E>>****EL*0EPl)E!$i"HH>>$bt)X>>b MINUTES OF THE Somerset PCT and Somerset LMC meeting held IN THE LMC MEETING ROOM, CROWN MEDICAL CENTRE Thursday 13TH SEPTEMBER 2007 10.30 AM Attendees Judith Brown Somerset PCT Jan Hull Somerset PCT Donal Hynes Somerset PCT David Slack Somerset PCT Ian Tipney Somerset PCT Berge Balian Somerset LMC Sian Hanson Somerset LMC Barry Moyse Somerset LMC Harry Yoxall Somerset LMC Jill Hellens Somerset LMC Apologies MINUTES OF THE LAST MEETING 12th July 2007 These were agreed as a true record Matters Arising 3.1 Ambulance Turnaround at Trusts HY said that he had had no further report that GPs were being put under pressure by ambulance controllers to allow admissions to be delayed but the LMC will keep a watching brief IT said there is some scepticism in A&E Departments about the GP Acute Care PBC proposal some of the PBC proposals and asked GPs to let the PCT know if there are any problems arising out of this 3.2 Counselling Taken under 4.8 Mental Health Services 3.3 Communications The LMC felt the recent briefing to practices had been well received and was a good start, particularly the 72 hours response commitment reply .The information on financial processes was helpful, although there are still some unresolved matters How the PCT complaints process worked is unclear but IT explained that this is dealt with by Phil Brice directorate which included a dedicated manager. A rigid time scale is adhered to and IT signs all complaint letters, complaints statistics are reported to the board. It was agreed that a separate meeting should be held on this issue. The LMC added they were exploring a possible mediation process to link local and external complaints IT noted that communications between Practice Managers has dropped off, and needs to be reestablished. BB said that the LMC had established formal links with practice managers and had helped set up the county group. 3.4 Prescribing Scorecard Elements of this have been developed within the DES , but the PCT wish to develop a wider tool, it was agreed has to be seen to be useful rather than just a performance management tool, and a way to rate external agencies as well. 3.5 Overarching strategic framework of PCT Taken under PCT Item 4.5 PCT ITEMS General Update IT has met and agreed an approach with trade unions and the PCT are going out to consultation on a new structure for provider services. Primary Care Premises A paper will be going to the board confirming PCT commitment to development of 9 schemes using 11 practices There will be a review of the longer term needs of primary care over the next 5 years. DS stated that the PCT would wish to engage the LMC in the review. There is an increasing revenue commitment of 500,000 pa over the 5 years, and the PCT would like practices to reach their performance targets, as there is no central money for premises and this is therefore a big commitment from the PCT. The LMC view was that was reasonable so long as the performance measures used are the same as the rest of the practices. It was also important that practices know that this is a rolling process. GP Appraisal The LMC are happy with the PCT proposal on GP appraisal although appraiser terms and remuneration remain to be discussed Prescribing Budgets Practice budgets had been calculated using methodology improved from last year by including some morbidity data. Presently a 3 million deficit is forecast for end of year. 20 practices are within budget and some 20 practices project a m ore than 8% overspend. Many have done a lot of work, and formulary compliance can still lead to big savings, interestingly in low cost as well as high cost practices. HY said that once the practice complies with the formulary, further savings are much harder to achieve. The commissioning forum may need to become more involved with practices that are significantly overspending.. BB was not surprised at overspend, noting that patient demand and external pressures are not always considered by prescribing advisors . It was agreed that the timescale for change in the pharmaceutical market, notably for category M products, is faster than prescribing change recommendations could be made and implemented SH suggested looking at practices that have made savings for comparison. IT stated that the budget has to be tight but reasonable. Strategic Framework JH thanked the LMC for comments on the strategic framework, 50 replies had been received, with a wide range of responses about priorities. These will be collated by the end of November, after which a summary will be issued Provider Services Review Judith Brown joined the meeting to give a presentation on the future of the PCTs provider services . The PCT will be launching their proposal on 20th September and the consultation will close on 10 December. South Petherton Community Hospital Consultation The PCT considered the options in February and a consultation will start on 25th Sept and close on the 4th Dec The draft will be finalised at the PEC next week, and the LMC will be consulted. The capacity will include 16 stroke ( and other neurological rehab) beds, 8 GP step up step down /long term condition management beds, and space to relocate the specialist mobility (wheelchair) service from thereby creating a much more efficient and comprehensive service. Mental Health Services JH said the PCT are aware of the concerns in primary care about counselling provision Next week she is to brief the board on the mental health agenda after which a discussion paper will be circulated. Short term arrangements have been put in place to create a holding strategy until the consultation process is over. GMS/PMS Contract Issues 11.15 5.1 QOF Post Payment Verification Process The random selection of the 5% practices has been carried out via the LMC, although the chosen practices have not yet been informed. 5.1.1 Medicines Management This has been resolved 5.1.2 Denominator for Microalbuminuria Testing DS to write to BB to accept the LMC proposal. ACTION: DS 5.2 PMS Agreement-Updating HY suggested it would be helpful to have a meeting of all PMS practices DS agreed that following the locality meeting in South Somerset a wider view taken. Yvonne Vigar is currently looking at PMS budgets and enhanced services overlap. 5.3 Enhanced Services 5.3.1 2007/08 Agreement The agreements have now been distributed to practices 5.3.2 Leflunomide This has been accepted as part of the NPT ES 5.3.3 Smoking Cessation Although the template for non EMIS practices is not yet ready, the PCT has hit their 1st quarter target for the first time ever. BB said it would be helpful to send non EMIS practices an e mail about appropriate coding . ACTION: PCT 5.3.4 GP Access Survey The results for Somerset were good and better than the national averages . DS said that when all access plans are returned the PCT will discuss the results with practices. they are aware that in some cases there are incidents where patients are offered several appointments that may not be convenient and it is difficult to adjust for this . There is more work involved than just looking at the raw results. The PCT will discuss this matter with the county Practice managers group. ACTION: PCT 5.3.5 Negotiations for 2008/09 The first negotiating meeting will take place on Thursday 11th October. 5.4 PCT Information Cascade The LMC asked if the PCT could prioritise information distributed through the cascade. Whilst it was appreciated that these had to be sent, may of the circulars were of little interest to GPs and the more important really should be flagged as such. Commissioned Service Issues 6.1 Out of Hours BB LMC met with Norma and the WAST Director of Finance, to look at working conditions and remuneration for OOH GPs. Other elements were considered including district nursing. The LMC will report on subsequent developments to the next meeting. 6.2 Somerset Partnership 6.2.1 Drugs and Alcohol Service New 5 years contract The selection will made at the end of November. There is a now a shortlist of 6 organisations tendering. 6.2.2 CAMHS This is a key area in the previously discussed mental health services review 6.3 ATOS origins service The ATOS service in Somerset has been shelved. HY asked if this had created long waits at Trusts as the extra capacity had anticipated from april.. IT said that T&S Trust thinks radiology waits will be down to 2 weeks shortly, but they admit there is currently a backlog. SH reported that there is confusion amongst clinicians on where to refer for imaging and the 4 Possible routes for so doing., The LMC thought it would be helpful if a single point of access be established. DH undertook to look at this. ACTION: DH 6.4 TOP pathway The new service from Marie Stopes was welcome. However, waits at T&S were still 6 weeks and some women, especially teenagers cannot easily travel. DH asked SH to join the group looking at TOP service configuration including the , option of having a Marie Stopes clinic within the county . ACTION: DH/SH 6.5 Primary Care Physiotherapy Physiotherapy will be part of the provider services review; therefore there will be no resolution of the known problems for a while. It was noted that there are some pilots of direct access in Sedgemoor. Practice based commissioning 7.1 Trust Envelopes for 2007/08 & Commissioning Flexibility DS will let the LMC know in the next ten days whether there was to be any continuation of the envelope arrangement for EST and TST . BB said it was important to form a joint group of PCT LMC, Board and PEC, and asked how the various groups current link together and integrate. DH agreed that a formal practice based commission group will need to be formed, and the setting up of this will be shared with the LMC. ACTION: DS/DH ANY OTHER BUSINESS Recycling Disposable Instruments The majority of instruments are not being recycled, although the waste contractors claim that a proportion of the metal is recycled after incineration . JB will raise This matter with the Decontamination Group. ACTION:JB TOP service waiting time Taken above Locum Reimbursement for Salaried GPs The LMC was concerned that the PCT had informed a practice that discretionary funding for salaried doctors maternity leave was not made, although such doctors were medical providers on the List. The LMC will send details to DS who agreed to look into the matter. ACTION LMC/DS Chlamydia Screening 74 practices have signed up to act as distribution/collection centres , but some report that their nurses felt they had come under a certain amount of pressure to undertake more formal screening. The PCT agreed to make inquiries. ACTION: PCT DATE OF NEXT MEETING Thursday 8th November 07     PAGE  PAGE 4 >EWkluwyҹĹ{pĉeWNCNh5_*h5_*CJaJh5_*5CJaJhMh5_*5;CJaJh&y5;CJaJh=5;CJaJhMhU^)5;CJaJhZ5;CJaJhh5;CJH*aJhht5;CJaJh Q5;CJaJh5;CJaJhMh>5;CJaJh5_*5;CJaJh5_*5;CJaJh>5;CJaJh56jh56UEl $ % B ^ z & F U"gd$hgd#$a$gd5_*gd5_*$a$gdh$a$gd5_*gdI? '&#$/H4o4B ^ z " Ϳqh_TITAh5_*CJaJh>5;CJaJh5_*5;CJaJh$h5CJaJhl5CJaJhh5CJH*aJh5CJaJhj5CJaJhZ5CJaJhMh 5CJaJhMh 5;CJaJh$h5;CJaJhMh>5;CJaJh5CJaJh5_*5CJaJh5_*6CJaJh CJaJh~dCJaJh5_*CJaJ " # 3 Y  * + J J #^gd$h$a$gdYRgd= $8^8a$gdYR8^8gd= & Fgd>h^hgd5_* & FgdZh^hgd " # 2 3 4 8 X Y [    - . 8 9 < @ R e h u Ļtldlh=$jCJaJhF OCJaJhw}hw}CJaJhw}h5_*CJaJhLGCJaJh6CJaJh5_*CJaJhqVCJaJhCJaJh>5CJaJh:5CJaJh#K5CJaJhMh 5CJaJhMh>5;CJaJhMh 5;CJaJh5_*h5_*CJaJ'  ) * + 6 7 I M [ ĻyĻpg__WWWhpRyCJaJhKCJaJhK5CJaJh:5CJaJhKhCJaJhCJaJh5CJaJhw}h:5CJaJhw}h:5;CJaJhw}h=5CJaJh=5CJaJhl5CJaJhhCJaJh6CJaJhLGCJaJh=$jCJaJh5_*CJaJhCJaJ"     7 I J M Z l t  3MNQg!&,;CDLMSUX·路؟hecCJaJhpRyCJaJh=$jCJaJh|CJaJhw}h9FCJaJhw}hw}CJaJhw}hCJaJh9FCJaJhLGCJaJh6CJaJhCJaJhKCJaJ;X\{   !"$%-.JXY^fwyǾ}tlllhLGCJaJhc 5CJaJh:5CJaJh:5;CJaJh=5;CJaJhl5;CJaJh$h5;CJaJh#Kh#K5CJaJh$h5CJaJh=5CJaJhECCJaJhpRyCJaJhc CJaJh9FCJaJh6CJaJhecCJaJ*"IJMefgkqz{úti]QH=hw}hnCJaJh@5CJaJhMh 5CJaJhjhj5CJaJh$h5;CJaJhj5;CJaJhMh 5;CJaJhk:h6CJaJh=CJaJhk:CJaJhk:5CJaJhEC5CJaJh5CJaJha$5CJaJh#Kh=CJaJh=5CJaJh6CJaJhECCJaJhc CJaJhF OCJaJJfg{,5%z{*\ $8^8a$gdYR8^8gdUp^pgd} $p^pa$gdYR & F gdlp^pgdn & F gdj & Fgd*gd=(+,-3;DHIlx|}!%35?LMU`Ź{{{{{{{sh{^CJaJh}CJaJhw}CJaJh^vMCJaJh|CJaJhaQCJaJhw}h}CJaJhw}h^vMCJaJh}hm5CJaJhj5CJaJhm5CJaJhnCJaJhw}hw}CJaJhw}hnCJaJhw}h@LCJaJ-`co $%Xjln +4NPwh6CJaJhUCJaJh#iCJaJhUh*5CJaJhj5CJaJh*5CJaJh}hM~CJaJhM~CJaJh-CJaJhyAOCJaJhGrCJaJhw}CJaJh{^CJaJhaQCJaJh^vMCJaJ2wz{(AOSaejv)*,/9BξξƾƾξξξƮΛζƈƈƀxhw}CJaJhR1 CJaJhfCJaJhIhUCJaJhBCJaJhIhfCJaJh>kCJaJh6CJaJhUCJaJhICJaJhaQCJaJhUhl5;CJaJhl5CJaJhUhaQCJaJh#iCJaJ/+78SV_co~LO[\^ak57IJRT[ظظ؎؎؎h$CJaJh$hWe5;CJaJhWe5CJaJhfh$CJaJhlCJaJhbCJaJh6CJaJhUCJaJh>kCJaJhBCJaJhICJaJhfCJaJhw}CJaJ7\_018^8gd@p^pgdIp^pgd $p^pa$gdYR^gd$ $^a$gdYR & F gdl8^8gd^ $8^8a$gdYR5J]^_py|~!*-@umemmhICJaJhCJaJhIhWe5;CJaJhh[s;CJaJh6$^h6$^CJH*aJh[sCJaJhCJaJhBCJaJhhWe5;CJaJhWe5CJaJhWe5;CJaJh6$^h6$^CJaJh$CJaJh6CJaJhCJaJh6$^CJaJ'@ILNSdfhmx  $%8;<HJWaex !%&'+12JRS]Ļԥԥԥԥh\ICJaJh2qCJaJh2qhWe5;CJaJhWe5CJaJhn/CJaJhCJaJhq"CJaJhCJaJhIhICJH*aJhICJaJhBCJaJ>]`aos'*/01HWXY]`ȵvmd[ShWCJaJh75CJaJh>5CJaJh`35CJaJhMh>5CJaJhMh>5;CJaJh$h5;CJaJhMh 5;CJaJhMh 5CJaJh\Ih2qCJaJhn/CJaJhN CJaJhkzCJaJh6CJaJhw}CJaJhq"CJaJh\ICJaJh2qCJaJ 1X  4 O P ~ B!!!!-"e"y"""#H#x## h^`hgdq" h^`hgd`3gd*8^8gd> & Fgd>   1 3 4 8 N O P ^ !7!A!B!D!G!¹𱥙˙˹|pdpXhf h76CJaJhMh>5CJaJhMh 5CJaJhf hf 5CJaJhf CJaJhW6CJaJh=0#h*5CJaJhWhf 5CJaJh7CJaJh76CJaJh*6CJaJh=0#5CJaJh*5CJaJh7hWCJaJhkzCJaJhWCJaJhq"CJaJ"G!N!T!w!y!~!!!!!!!!!!!!!!!!!!!! " """"("+","-"/"="d"e"m"y"{"|"ɽɴɴɫ}tkhf 5CJaJh`35CJaJh_Eh7CJaJh CJaJh75CJaJh 6CJaJh$h5CJaJhZ5CJaJh=0#5CJaJhMh>5CJaJhMh 5CJaJh7hf CJaJh6CJaJh7CJaJhf CJaJhq"CJaJ)|""""""""""""""""""##########/#7#F#G#H#I#L#]#m#x######ȿڮړ|tttth_ECJaJh_Eh(vdCJH*aJh_Eh(vdCJaJh=$jCJaJhF OCJaJh_Eh7CJaJhf CJaJh 6CJaJh=0#5CJaJhZ5CJaJh`35CJaJhq"CJaJhf h7CJaJh[(CJaJhf hf CJaJ*################$$$$$&$($.$9$=$^$c$h$p$q$u$y$$$$$޺}}umum}m}e}e}em]hLWCJaJh6CJaJhfCJaJh95 CJaJhq"CJaJh[(CJaJhVCJaJh&CJaJh[(5CJaJh&h[(CJaJhV5CJaJhZ6CJaJhq"5CJaJh`35CJaJhZ5CJaJh=0#5CJaJhk:hV5CJaJh[(h[(5CJaJ$###($%%&[&\&|&y'{'''((( )<)8^8gda$8^8gd> & Fgd> h^`hgd  $p^pa$gdYR8^8gdj $8^8a$gdYR8^8gd=0# h^`hgd`3$$ %%%%%$%0%A%B%]%i%l%%%%%%%%%%%%%%%%%%%%&&&&O&Q&[&༳znhfhfCJH*aJhf5CJaJhx5CJaJh`35CJaJhZ5CJaJh=0#5CJaJh hKM$5CJaJh)"5CJaJhfhf5CJaJh&CJaJhKM$CJaJh)"CJaJhfCJaJhq"CJaJhLWCJaJh6CJaJ'[&\&x&{&|&&&&&&&w'x'y'z'{'''''''''''''''Žͽ|qee\SKKhCJaJh[DK5CJaJh6CJaJhMh 5CJaJh$h5;CJaJh/5;CJaJhMh>5;CJaJhMh>5CJaJhMh5CJaJh[DKCJaJh6CJaJhi\CJaJhdCJaJhk:CJaJhjha$6CJaJha$5CJaJh`35CJaJhfhf6CJaJ'(( (L(O(Y(b((((((((((((()) ) )))$)+)<)?)I)P)Y)\)^)v)w)x)؀wll؀`h[DKh[DK6CJaJh h CJaJh 5CJaJh h[DKCJaJh[DK5CJaJha$6CJaJha$5CJaJhi\5CJaJh=5CJaJh5CJaJhMh 5CJaJh[DKh CJaJh CJaJh6CJaJhi\CJaJhCJaJh[DKCJaJ%<)x)))))(**++,&,,I-_--X.Y..I/ & Fgd>gd* h^`hgd2{$h^`ha$gdYR h^`hgd#K $p^pa$gdYR $8^8a$gdYR8^8gda$x))))))))))))))))*****%*'*-*>*Q*\*c*u*v*y****yph]h]h]]]U]Uh6CJaJh[DKh[DKCJaJh9CJaJh95CJaJh9h9CJaJh9h CJaJha$6CJaJha$5CJaJh5CJaJhMh 5CJaJh[DKhi\CJaJh[DKCJaJhi\CJaJh CJaJh h CJaJh 5CJaJh[DK5CJaJh`35CJaJ!************ +++++,+6+I+U+Z+f+g+j+o+r+++++++++++,,,,,%,ޞʱ撄{r{h5CJaJhx5CJaJh#Kh[DK56CJaJh9h95CJaJh=$jCJaJh=$jhi\CJaJh!,rCJaJhGrCJaJh[DK6CJaJh[DKh[DK6CJaJh6CJaJhi\CJaJh9CJaJh[DKCJaJh[DK5CJaJ*%,&,',+,;,?,@,G,H,v,|,,,,, - - ---!-G-P-V-Z-]-^-_-a-b-~--------¶֪{peph@x5hw}CJaJh@x5huCJaJh%Kh*CJaJhu5CJaJhj5CJaJh5CJaJhx5CJaJh#Kh[DK5CJaJh2{hw}5CJaJh2{h2{5CJaJh!,rCJaJh2{CJaJh3=-CJaJhCJaJhi\CJaJhx6CJaJ%------.. ..!.%./.2.W.X.Y.u.~.....ڿʷtfZNBhMhiQ5CJaJhMh>5CJaJhMh 5CJaJhMh>5;CJaJh$h5;CJaJhMh 5;CJaJhMh*5CJaJh h*\CJaJh@x5h*\CJaJh!,rCJaJhw}CJaJh@x5hw}CJaJhGCJaJhi\CJaJh@x5huCJaJh@x5CJaJh@x5h@x5CJaJh%KCJaJ......... //G/H/I/N/k///////////////00020E0N0j0k0s0z000000ܸ̰̰̰̰԰̨̨̨̜䐇{rh$h5CJaJhMh5CJaJh`35CJaJh%Kh5CJaJh%Kh%K5CJaJhCJaJh<CJaJh%Kh6CJaJh!,rCJaJh%KCJaJhGCJaJhKCJaJh%K5CJaJha$5CJaJh5CJaJ+I//k000011111112333 4 4 $^a$gd7` $^a$gdG^gdYR $^a$gd\` $ & F a$gd%k $^a$gd $ & Fa$gd%k8^8gd> $8^8a$gdYR000000000111U1V1W1Y1_1d1e1f1z1{1|1111111111111;2Z22233ԼܬĬĴĴĴ䴊ĬĂymhGhG5CJaJhG5CJaJh7`CJaJh\`hGCJaJhhGCJaJh!,rh!,r5CJaJh!,rCJaJh\`CJaJheCJaJhGCJaJhw}CJaJhCJaJh%KCJaJh%k5CJaJh#K5CJaJhc 5CJaJ(333&343_3j33333333 4 4 4'48494;4D4G4H4I4K4L4N4O4Q4R4T4U4V4ǻ}qieieieie^Zh0 h=$jh0h}mjh}mUhMhm5CJaJhm5CJaJhh5CJH*aJh5CJaJh 5CJaJh$h5CJaJhMh5CJaJhGhG5CJaJhG5CJaJh7`CJaJhGCJaJhw}CJaJh#Khw}CJaJh#Kh$h5CJaJ! 4H4J4K4M4N4P4Q4S4T4U4V4_4`4a4l4m4n4o4p4h]hgdEC &`#$gdECgd=$j $ & Fa$gdmV4W4]4^4_4a4b4h4i4j4k4l4n4o4p4hMhm5CJaJh}mh00JmHnHuh0 h00Jjh00JU":pn/. A!"#$%_Dd6w \0  # AbeWd/ЌA1<DneWd/ЌA1AFTuԟDO^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*CJH@H ] Heading 2$5$7$8$9D@&H$CJL@L ] Heading 3$5$7$8$9D@&H$>*CJP@P ] Heading 4 $5$7$8$9D@&H$^CJb@b ] Heading 5.$$p5$7$8$9D@&H$^p`a$5CJDA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List HB@H ] 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 eKHeader  !4 @B4 eKFooter  !HRH  $ Balloon TextCJOJQJ^JaJ.)@a. EC Page Numberp, El $%B^z"#3Y*+JJ# J f g {   , 5 % z { *\_01X4OP~B-eyHx([\|y{ !?A \1#<)I/ 4p4%*.37=@o4 ")!!8@0(  B S  ?$k&%Ol&%4m&%@n&%L$o&%d@!p&%ѻq&%Gr&%l1s&%1t&%m)u&%,n)v&%D)w&%)x&%4o/y&%to/z&%,1{&%4ϻ|&%l1}&%,/~&%λ&%I'&%I'&%ڽ&%T3&%3&%K.&%LMUUZl { A T e s hzDS&GShqx'_h !#!""##% %%%&&'(H)V)v))))H,H,J,J,K,K,M,N,P,Q,S,T,n,q,333333333333333333333333333333333333333]y<<Rugx |  $!$!####)) ,H,H,J,J,K,K,M,N,P,Q,S,T,n,q,H,H,J,J,K,K,M,N,P,Q,S,T,n,q,user $[} dpb  7PP;j=nAAzz@LT`d#.\TPfPii>u*808^8`0o( ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.88^8`o(pp^p`o(.  ^ `o(..^`o(... ^`o( .... PP^P`o( ..... `^``o( ...... (#`(#^(#``o(....... `'``'^`'``o(........ ^`hH ^`hH.  0 ^ `0hH.. \ 0\ ^\ `0hH... HH^H`hH .... ^`hH ..... `^``hH ......  <`<^<``hH.......  (#(#^(#`hH........ >^`>hH >^`>hH.  0 ^ `0hH.. s0s^s`0hH... ^`hH .... ^`hH ..... `^``hH ......   ` ^ ``hH.......  &&^&`hH........0^`0o(0^`0o(.p0p^p`0o(..@ 0@ ^@ `0o(... xx^x`o( .... HH^H`o( ..... `^``o( ...... P`P^P``o(.......  ` ^ ``o(........^`o(.hhhhhhhh 88^8`o(pp^p`o(.  ^ `o(..^`o(... ^`o( .... PP^P`o( ..... `^``o( ...... (#`(#^(#``o(....... ((^(`o(........ 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........ 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........ fPi4 P;j= >u̘ 7 d@LT} #.\pAAP8Tj30;41PLTj30;41PLTj30V;41PȝTj30;41pHu@ ^`OJQJo( b        ЯZBp,\kX9 9f 4NL$zy @ @y"{o BaQ}N 11 R1 95 y =+ c gdWZ ^qVI>sx q"=0#KM$&[(U^)5_*"+R+3=-H/n/@x5bE65e6k:;vA[AEC~]DF9FHCI\IJ#K%K[DK eK@L^vMF O"OyAO QU/Y4$[*\_\i\"T]6$^(vd~dWef"!g#i!fij=$jk>kl\Qlm n2q!,rGr[shtUx&ypRy}y2{I?**\w`3X#Iz_E6E#Cf\`LW(dYR%%kQg&/::$FGux#h]{^& a$56lXLGUS-bU#w}=9HjKe|+-0M~w$h iQnkzI} ~ 9x yGQ7`f KZec=}mc $Vl8KMj4TQ7<j)"=Nf$@G,q,@p,@UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma"h5B&Af˹F%P%P!xx4d2,2,2QHP ?]K:\Templates\LOGO.DOT useruser4         Oh+'0h   $ 0 <HPX` ssuserfser LOGO.DOT userDOT7erMicrosoft Word 10.0@^в@P~@V&? @Fړ%՜.+,0 hp  Somerset HealthP2,{  Title  !"#$%&'()*+,-./0123456789:;<=>?@ABDEFGHIJKLMNPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuwxyz{|}Root Entry FpǰData C_1TableOLWordDocument$SummaryInformation(vDocumentSummaryInformation8~CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q