DRAFT Minutes of the Meeting of the GP
Sub-Committee of Lothian Area Medical Committee held at the Holiday Inn,
Edinburgh on 16 June 2008
Dr R J Williams in the Chair
Visit from Dr Simon Mackenzie re investigations at the interface
Following correspondence regarding
concerns about the increasing number of incidents of poor communication from
the acute services at time of patient discharge, Dr Simon Mackenzie (Associate
Medical Director, LUHD) kindly agreed to attend this meeting to address these
issues. Dr Mackenzie had already
received a number of anonymised examples forwarded to the Committee by Lothian
GPs, and numerous further examples were discussed.
There is a significant level of
despair in general practice as regards the frequent episodes of poor interface
communications, which seem to be increasing.
The Committee was heartened by Dr Mackenzie’s acknowledgement of the
difficulties, and would welcome contact from any of the LUHD Clinical
Directors, formally or informally, to discuss matters that impact on GPs in
Lothian.
Dr Williams thanked Dr Mackenzie
for attending and patiently listening to the Committee’s gripes, and welcomed
his stated intent to take steps to address these.
1. Apologies - Drs Alexander, Beamond, Hardie, MacCallum,
Milne
Absent - Dr Lang, Prof Weller
2. Minutes of the last
meeting
The minutes of the meeting of 12 May 2008
were approved and signed by the Chairman.
3. Matters arising
3.1 Pre-op tests
Further to discussion at 12 May GP Sub, Dr
Haigh informed the Committee that Dr Alan Mulvihill (Consultant Ophthalmic
Surgeon, Princess Alexandra Eye Pavilion) is taking forward the issue of
inappropriate requests from the PAEP for pre-op urine screening prior to eye
surgery.
3.2 Alcohol Services
An enhanced service for alcohol is being
negotiated with the PCCO, with the LMC proposing reasonable payment for a
reasonable amount of work. The PCCO
are expected to come back with a firm offer in the next week or so.
ACTION: DM
In the interim, any Committee member
involved in CHP discussions re this enhanced service was requested to bring
this to GP Sub.
ACTION: ALL
4. GP Sub-Committee
Information Sheet
The Committee noted and discussed the
information sheet, circulated with the agenda papers. The following issues were raised:
4.1 Notes from Chairman’s Group of 26 May
2008
A Visit
from Alison McCallum
Redrafted guidance on confidentiality issues
is awaited from Dr McCallum, in her role as Caldicott Guardian for NHS
Lothian. As agreed at the Chairman’s
Group meeting, Dr Williams has sought advice from the BMA regarding the release
of patient-identifiable data. An LMC
representative is required for Lothian data sharing partnership.
ACTION: RJW
Dr McCallum also suggested an LMC
representative be invited to join the child protection/school nursing
group. Further information on this
group is to be obtained.
ACTION: RJW
B Sexual
Health meeting report
It was noted that the specialist view is that
chlamydia targets (300 tests per 1,000 patients) are excessive and unworkable,
however, there is strong central direction behind this.
C Paediatric
Asthma QIS - Enhanced service?
One of the outcomes of the QIS review of
Paediatric Asthma Services was a suggestion of additional data recording by
practices. It was recommended that this
be taken forward as an enhanced service.
D MUST
tool
The implications of implementing the
Malnutrition Universal Screening Tool in general practice in Lothian are
enormous. GPs are already aware of
increasing requests for referral to dieticians, following community nurses’ use
of MUST. The Committee is conscious of
the dearth of community dieticians in Lothian, and does not believe that this
tool could be implemented in general practice until such time as the dietetic
service is fully resourced.
Dr Williams agreed to write to Lynne Douglas
(Associate Director of Allied Health Professionals, NHS Lothian).
ACTION: RJW
E General
Nursing Services
See item 7 below.
4.2 Medical
Secretary’s Business
A Back pain meeting
attended 20 May 2008
Noted.
B Challenging Behaviour Practice
meeting attended 20 May 2008
See item 9 below.
C Discipline committees
Two consortia are being formed from the east
and west coast health boards. These
consortia include all members of SGPC, training is to be provided.
D Managed Server
Noted.
E Investigations at the
interface
Further to Simon Mackenzie’s visit above,
specific examples re wax check prior to appointment, VSL//3, and chasing up MRI
scans were discussed.
F Bed Bureau
Edinburgh CHP letter of 4 June noted.
G Extended hours / medical
insurance
It was noted that MPS members will be asked
on an annual basis to declare the number of hours worked as this will determine
their contribution and may affect their indemnity. This is the result of the European Working
Time Directive as, if the number of hours worked exceeds a certain amount,
members will not be covered by MPS.
MDDUS have no plans to ask members to disclose this information.
5. Area Medical Committee
Minutes - 16 April 2008
5.1 Clinical
Board (item 4.3 on page 4)
With regard to the treatment of patients with
long term conditions, the Committee did not agree with the consensus that
resources were being used inappropriately.
The Committee felt that this work demonstrated that there were very few
cases where a change in clinical management would have prevented admission. There was debate around whether this work was
intended to reduce admissions.
5.2 Inter-consultant
Referrals vis-à-vis Externally Sourced Referrals (item 5.3 on page 6)
Following concerns raised by a GP asked by
one consultant to make a referral to another consultant, it was noted that the
situation was accepted as being more complicated than simple preferential
treatment of certain groups of patients.
It was also fully accepted that the referring clinician should be
whoever knew most about the patient’s case, regardless of whether that was
their GP or consultant.
5.3 GP
Sub-Committee (item 6 on page 7)
It was noted that the Committee was commended
in opposing the proposal to introduce the DATIX system in primary care.
6. Primary Care Joint
Management Group Minutes - 8 May 2008
6.1 Extended
Hours (item 26 on page 2)
Approximately 25% of practices in Lothian
having signed up for the Extended Hours DES, the Scottish average is 16%. Dr Storrie informed the Committee that the
DES has had no impact on LUCS attendances.
6.2 GMS
(Appendix 1 on page 6)
It was noted that a further investment of
1.5% on total allocation is speculation until actual allocation is known.
7. General Nursing
Services
In light of a district nurse refusing to see
a non-housebound patient in what would appear to be a move away from a flexible
team approach, concerns were raised over the proposed restructuring of
community nursing services in Lothian.
The Committee is of the firm belief that community
nurses should be part of practice-based teams and is convinced that any move to
geographical allocation will have the effect of impairing communications
between GPs and nurses, and community nurses and practice nurses.
It would be a great disservice if the current
flexibilities that exist between the nursing teams were to be lost. Experienced district nurses are highly valued
members of the primary care teams, and the Committee would continue to ask for
increased numbers of hands-on nurses, with generalist skills. The Committee is not convinced that any
proposal to increase the number of higher grade nurses at the expense of the
other grades will be of benefit to patient care, and have yet to be convinced
of the benefits of the suggested “skill mix”, and use of lower grade staff to
perform tasks currently performed by skilled and trained nurses.
Dr Williams agreed to write to Dr Heather
Tierney-Moore (Director of Nursing, NHS Lothian) to clarify the
responsibilities of district nurses, and to confirm the strong support GPs have
for their nursing colleagues, particularly in terms of the distress endured in
the face of Agenda for Change and the apparent unfairness of the regrading
outcomes for many. This letter will be
copied to all practices in Lothian.
ACTION: RJW
8. Vaccine shortage for
Hib catch-up campaign in Lothian
A copy of Dr Lorna Willocks’ (Immunisation
Co-ordinator, Consultant in Public Health Medicine, NHS Lothian) letter of 6
June regarding the reduced availability of Pediacel® and implications
for pre-school booster for Hib catch-up cohort was circulated with the agenda
papers for information. The letter is a
risk assessment of the options, however, opting out of the national programme
recommendations was not thought to be acceptable. The Committee queried whether practice nurses
or health visitors would be administering the vaccines, and whether NHS Lothian
resources have been found. It was felt
that the routine schedule is far too complicated and clinically dangerous, an
accident waiting to happen.
9. Challenging Behaviour
Practice - discharged patients audit - May 2008
The above audit was circulated with the
agenda papers for information. The
Lothian service is to be commended, with many patients having been reintroduced
to mainstream general practice.
There are still issues to be resolved, e.g.
patients with a West Lothian address have experienced problems accessing the
service. Dr Libby Morton (GP at the
Challenging Behaviour Practice) is researching other Health Board areas with a
view to developing alternative ways of providing this service.
10. GP appraisal:
arrangements for agreeing the dates for interviews
The Committee noted the letter from Dr Peter
Berrey (GP Appraisals Adviser, Lothian and Borders). The proposal is to allocate each GP a fixed
quarter of the year within which they must undertake their appraisal
interview. This issue has arisen as
there are over 600 GPs to appraise, and it seeks to address a number of GPs who
continually avoid setting an appraisal date, some who slip a whole year.
The Committee agreed with the proposal and
this will be fed back to Dr Berrey.
ACTION: RJW
11. AOCB
11.1 LUCS
Concerns were raised regarding the lack of
special notes for palliative care patients.
Dr Shishodia agreed to include a reminder in ‘GPs Only’ that special
notes should be kept up to date.
ACTION: PS
A GP Sub-Committee representative is invited
to sit on the LUCS Board.
ACTION: RJW
11.2 Retiral
of Patricia Cripps
It was noted that this was Patricia Cripps’
last Committee meeting before her retiral at the end of June. On behalf of general practice and Committee
members past and present, Dr Williams thanked Miss Cripps for all her support,
advice, encouragement, knowledge, wisdom, enthusiasm and skills during her 21
years in post.
12. Date of next meeting - Monday 11 August 2008, 7.30pm at the
Holiday Inn, Edinburgh
[NB -
no meeting in July]
