NORTH ESSEX LOCAL MEDICAL COMMITTEE



NORTH ESSEX LOCAL MEDICAL COMMITTEE

Minutes of a Meeting of

North Essex Local Medical Committee

held over MS Teams

on Thursday 11th March 2021 at 1.15 pm

PRESENT: Dr H Casey (Chair) Dr E Field (Vice Chair)

Drs Ahmed, Ali, Benson, Cunningham, Dhawan, Harrod-Rothwell, Hodgkinson, Hooper, Ipakchi, Kandasamy, Killy, Kumar, Melamed, Omar, Parikh, Raja, Roberts, Sweeney, Taylor (H), Tiwari, Wijekoon, Mr Fuller and Mrs Pedder.

PART ONE

APOLOGIES FOR ABSENCE

Apologies for absence had been received from Drs Balmer, Gunatillake and Taylor (S).

Having established that there were no matters to be taken in Part Two, the Chair proceeded with the agenda.

DECLARATION OF INTERESTS

Drs Ali, Tiwari and Taylor (H) declared that they were now employees of NHS England in their capacity as Medical Advisors.

MINUTES

The minutes of the meeting held on 11th February 2021 were confirmed by the Committee and agreed for publication to the website.

MATTERS ARISING

3.2 MSE Population Health Management – Dr Harrod-Rothwell asked that the minutes from 2020 be checked to determine the expiry date of the data sharing agreement and whether it is within the period covered by the COPI notice which expires at the end of March 2021.

3.4 Conference of UK LMCs 12-13th May 2021 – The Chair asked the office to ensure that the May LMC meeting did not clash with the Conference. It was subsequently confirmed that the meeting of North Essex LMC is scheduled for 6th May. Expressions of interest were also sought to attend the virtual conference - Drs Casey, Field and Tiwari requested a place.

DISCUSSION TOPICS

1. White Paper Integration & Innovation: Working Together to Improve Health & Social Care for All

Members received a press release providing some background to the publication of the White Paper, (the full document is available at ) A further copy of the LMC response to the recent ICS consultation was also received for reference.

There were no specific comments on the White Paper at this time but Dr Taylor had heard anecdotal reports that West Essex would be re-aligned with Essex. The office was not aware of any plans to change the current STP alignment of either North East or West Essex but will make enquiries and advise members accordingly at the next meeting. Dr Raja was due to attend the Suffolk and North East Essex STP Board meeting on 12th March at which further information may become available.

2. Primary Care OPEL (Operational Pressures Escalation Levels)

2.1 Members received the framework and metrics, together with comments from Beds and Herts LMC. Members concurred with the views of Beds and Herts LMC, particularly in relation to the high percentage levels used as a marker of pressure and the benchmark number of contacts per day. It was also difficult to define all patient contacts, given the move to remote working, total triage and tasks coming in from various sources.

Members were of the view that General Practice had no spare capacity before Covid and had already been under pressure from additional workload transfer from secondary care. Whilst practices may be able to cope at each level in the short term, sustaining safe working for longer periods was not seen to be feasible.

Dr Raja will feedback to Joanne O’Connor as follows:-

• Appointments in General Practice do not account for the hidden work that goes unnoticed; ie: admin, informal patient contacts, lab results, letters etc.

• Workload transfer from secondary care needs to also be factored in while quantifying workload.

• Unlike secondary and community care, there is no spare capacity in General Practice.

• GP workforce absenteeism figures used for the metrics is way off target.

• Short term and long term impact of absenteeism need to be differentiated as often the practices struggle to manage when even a single GP or staff is absent for more than 2-3 days.

• OPEL 3 & 4 rating focusses only on Secondary Care’s ability to cope. It is Primary Care’s ability to cope that should be the criteria for all OPEL levels.

3. North East Essex CCG Constitution

3.1 E-mail correspondence between the office and Dr Hasan Chowhan, Chair North East Essex CCG, was received. The CCG is seeking LMC support for its draft new Constitution which is based on the NHS England model. Dr Chowhan had given assurances that there are no changes to the composition of the Governing Body or its Committee structure and that he did not foresee any significant change to the powers of the Accountable Officer/Chief Executive.

3.2 Members had no objections but did question the need for this exercise given the current consultation on Integrated Care Systems and the expectation that these will become statutory bodies by April 2022. However, NHS England appears to be driving the process and the office expects to see similar requests from CCGs across Essex.

3.3 Given that NHS England expects the CCG to transition to the new Constitution in April 2021 members were happy for the draft to be circulated to member practices as soon as possible.

4. Revisions to Two Week Wait Pathway for GI Cancer

4.1 A letter from Dr Liz Towers and Dr Deepak Kumar dated 23rd February 2021 relating to changes to the pathway in the MSE area was received and discussed, together with a draft template referral form. Several concerns were raised by members:-

• Who should follow-up missing FIT test results when a patient has been referred?

• Does the Lab at MEHT have capacity to meet demand for this additional testing?

• Expected backlog of testing following the pandemic.

• Why can’t patients be given the option to return their FIT test to the practice if the practice is happy to include it in their usual lab run? There have been ongoing issues with Royal Mail during the pandemic and this could build in dangerous delays.

• The letter refers to compatibility with SystmOne and EMIS but there is no mention of Vision.

• The requirement for practices to provide results/request bloods.

4.2 The Chair had already raised some of these concerns at the Mid Essex Trouble-Shooting Group and will report back to members in due course. Drs Kandasamy and Taylor were able to report that a similar pathway was working well in West Essex.

5. CQC Consultation

1. The latest consultation from CQC was received which members agreed contained insufficient detail apart from stating that there will be a move away from on-site inspections, except in cases where there is information about significant risks to patient safety. Mrs Pedder had joined a recent webinar on the consultation which had provided no further useful information.

2. Members were concerned about the quality and limitations of data that may be used to determine ratings, particularly in respect of remote feedback, such as Google reviews. These are often unfairly biased to a negative viewpoint and not reflective of the general patient view.

3. The consultation closes on 23rd March 2021. Any further comments for inclusion in the LMC response should be sent to Mrs Pedder by Friday 19th March 2021.

6. Institute of General Practice Management

1. Members considered a letter to LMCs seeking support for this newly formed body. Mrs Pedder advised that Practice Managers in Essex have good communication channels and she regularly attends Practice Manager locality meetings and also chairs the LMC Essex Practice Manager Group. However, this level of engagement is not necessarily reflected in other areas of the country and the IGPM would be a mechanism by which Practice Managers could develop and feel valued. Were the LMC not to support the IGPM it would send a bad message to Essex Practice Managers. It was noted that the IGPM is in discussion with the BMA and has received support from Dr Richard Vautrey, GPC England Chair.

2. Following lengthy discussion members voted on the five questions posed in the letter:-

Q1. Does your LMC support the concept of the IGPM?

Yes

Q2. Will your LMC be willing to provide some of the set-up costs?

No

If yes, can you provide a figure for this?

N/A

Q3. Would your LMC be prepared to help with local elections?

In principle, to advertise – Yes but to run - No

Q4. Would your LMC be willing to add an IGPM page to your website?

Yes, we would include a link to the IGPM website.

Q5. Would your LMC be willing to promote the IGPM to its practices?

No

3. This matter will be considered by South Essex LMC at its meeting on 25th March and a response will be sent following that.

7. Tenure of GP Leads

1. Members received a letter from West Essex CCG dated 3rd March 2021 requesting the support of the LMC to extend the tenure of all elected GP Board members until 31st March 2022. The deadline to respond to the CCG had been extended to 17th March to allow time for consideration at today’s meeting. There were no objections to what was being proposed.

8. Chief Executive’s Report

8.1 Covid-19

• Movement of Vaccine - Members received a decision support tool that had been designed to aid PCNs in regard to the safe movement of vaccine. Correspondence between Dr Raja and Vicky Cline was also received. Dr Raja confirmed that use of this tool is voluntary, practices do not have to discuss movement of vaccine with the lead pharmacist and they do not need to advise the CCG.

• Population Risk Assessment Tool – Members received for information the joint NHS England/DHSC letter dated 15th February 2021 which provides information on the additional cohort of patients identified at increased risk from Covid-19, and the implications for their vaccination, support and advice. No action is required by practices, patients will be automatically added.

• Vaccination of JCVI Cohorts 5-6 & Additional Funding for Vaccination in Residential Settings – Members received the NHS England letter dated 13th February 2021 which included guidance on cohorts 5-6 and details of the £10 supplementary payment for each vaccination administered to eligible residents and staff in care homes for people with learning disabilities or mental health problems. Concerns were raised regarding the supply of Pfizer vaccine in Mid Essex for 16-18 year olds. Dr Raja asked that details be shared with him in order that he can request a formal pathway from the CCG.

• Covid Vaccination & Learning Disability Healthcheck Enhanced Service - The final draft NHS East of England Template Agreement was received for information. The aim of the service specification is to support the reduction of health inequalities by maximising the number of people with a learning disability to receive both a Covid vaccination and an LD Annual Health Check. Dr Balmer and Dr Christine Moss (West Essex) had been consulted on the initial draft and their comments incorporated into the final template which had been formally published last week.

• A letter of thanks to the profession from Dr Richard Vautrey dated 15th February 2021 was received for information.

• Vaccine Allocations – NHS England FAQs were received for information. Members felt there was a two tier system for local and mass vaccination sites.

8.2 NHS Property Services

Members received for information an update on the BMA legal challenge and a template letter for practice use.

8.3 Green Book

The Green Book has been updated to reflect recommendations for the use of Covid-19 vaccines. Chapter 14(a) was received for information and includes detailed information on priority and clinical risk groups.

8.4 Contract Agreement 2021/22

Members received for information a guidance document that had been produced by Karl Fuller. The document summarises the upcoming changes to the GP Contract for 2021-22 and had already been shared with practices. It was agreed this would be very useful for practices and members asked that their thanks be passed to Karl for producing the document.

5. Corporate Clinical Offence Legislation

A guidance note commissioned by GPDF from Mazars was received for information.

6. Applications/Renewals of Bus and Lorry Driving Licences

An update from DVLA was received for information.

7. GPDF Newsletter February 2021

The February newsletter was received for information.

9. Any Other Business

1. PCN Support

Dr Hooper sought LMC support for PCN Clinical Directors who CCGs are expecting to represent GPs on ICS Boards. Dr Raja advised that the LMC is working up a scheme and he hopes to bring a paper to the next meeting. The LMC monthly meetings for CDs were paused at the start of the vaccination programme but it is hoped these can be reinstated shortly.

10. Date of Next Meeting

The next meeting will be held at 1:15pm on Thursday 8th April 2021 via MS Teams.

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