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  1. 1. PROFESSIONAL EXECUTIVE COMMITTEE MINUTES OF THE MEETING HELD ON WEDNESDAY 13 JUNE 2007 – BLEASDALE SUITE GARSTANG GOLF CLUB Present: Dr J Gardner - Chair of Professional Executive Committee Ms J Aldridge - Nurse Lead Dr D Bradley - General Dental Practitioner Ms C Lewis - Allied Health Professional Lead Dr A Maddox - Director of Education Dr J Marriott - GP Representative, Lancaster/Morecambe Mr S Mackey - Pharmacy Representative Mr K McGee - Director of Commissioning Mr B McPherson - Director of Community Services Lancashire County Council Mr K Parkinson - Director of Finance/Deputy Chief Executive Dr P Rees - GP Representative – Fylde Dr M Spencer - GP Representative - Wyre In attendance: Ms S Beattie - Commissioning Manager (for agenda item 4) Ms H Fordham - Head of Commissioning (for agenda item 5) (Unscheduled Care) Mrs P Hulme - Commissioning (for agenda item 6) Mr P Hargreaves - Head of Estates Planning (for agenda item 7) Mrs G Carey - PA to Dr Gardner/Administrator Dr Gardner opened the meeting by welcoming Kevin McGee, Director of Commissioning and Sean Mackey, Pharmacist Lead, to the meeting. The Professional Executive Team is now complete. 1. Apologies 1.1 Apologies were received from Mr I Cumming, Mrs S Parnaby, Dr F Atherton and Mr P Hutchence.
  2. 2. 2. Minutes of the last Meeting – 9 May 2007 2.1 The following amendment was requested: Item 6.3 (6.3.1) Vascular Surgery – That the words “an altercation” be changed to “difficulties”. 2.2 Following the above amendment, the minutes of the meeting held on 9 May 2007 were agreed as a correct record. 3. Matters Arising 3.1 Diabetes Structure - Update 3.1.1 It was reported that dates of meetings had been circulated and key members had been identified. Mark Spencer had agreed to be the Chair of this group. It is hoped that draft ideas on the way forward would be circulated by August. 3.2 Strategic Direction 3.2.1 The Executive Team are working on a document to support a widespread engagement process. The engagement is to be with all stakeholders, including patients, clinicians, Local Authorities, Academia, other professional bodies and charities. The planned launch date for the document is 9 July 2007. 3.3 Teaching Bids 3.3.1 Members were informed that this was ongoing and Directors were confident that it would be successful. 3.4 Vascular Surgery 3.4.1 Members were informed that the paper is not available at the moment. An urgent meeting is to be arranged with a view to reaching a conclusion. 3.5 Academy for Health Leadership 3.5.1 Blair McPherson informed members that Lancashire County Council Social Services have established a Leadership Academy. They would be interested in exchanging information on this with North Lancashire Primary Care Trust. 4. Coronary Heart Disease 4.1 Dr Gardner welcomed Sarah Beattie to the meeting. Sarah presented a paper on Coronary Heart Disease. 4.2 The main focus of this paper was to provide information to assist the PEC in its role of advising North Lancashire PCT as to how it can facilitate continued improvement and change for the Coronary Heart Disease (CHD) agenda. The PEC was asked
  3. 3. to consider the paper and provide advice on the best way to take planning and commissioning forward for CHD services across the North Lancashire footprint. 4.3 Sarah explained that the Coronary Heart Disease (CHD) agenda was quite complex but that the model agreed for Diabetes services appears to also fit for CHD services i.e. with one strategic group for the PCT and two locality groups. 4.4 Issues highlighted and discussed were as follows:  Strategic Group would need to be setting standards.  Strategic Group would need to influence providers including the tertiary providers.  PCT would clearly need to liaise with the Cardiac Network.  Strategic Group must ensure that it maintain links into other groups.  Strategic Group should take responsibility for ensuring clinical pathways are right and evidenced based. 4.5 It was noted that Primary Care prevention of Cardio Vascular Disease is not currently commissioned by the PCT. Dr Gardner informed members that Emer Coffey, Locum Consultant in Public Health was working on this issue and he would invite her to present a paper to the July PEC meeting. 4.6 It was agreed to approve the formation of a PCT-wide Strategy Group for CHD, with locality implementation groups, based on a PBC footprint. 5. The Role of North Lancashire PCT Medicines Management Team 5.1 Dr Gardner welcomed Hilary Fordham to the meeting. Hilary presented the paper which proposed changes to the Medicines Management structure in the light of changes to the PCT’s function and the development of Practice Based Commissioning. The PEC was asked to consider the paper as a starting point for discussion on how the structure would develop. 5.2 The Medicines Management Team is still operating under a structure largely inherited from the previous Fylde Wyre and Lancaster and Morecambe PCTs. With the move towards PBC, the Medicines Management team proposes a transition toward a smaller, more centrally governed approach. This will enable engagement with the PCT’s priorities in commissioned services, patient pathways and governance. A structure has been proposed that will enable optimal skill mix to deliver these objectives. 5.3 Issues highlighted and discussed were as follows:  Moving more Pharmacists to work in Practices  Prescribing support on site in a trusted relationship  How prescribing support can be funded – equity across the PCT and between practices.  Budgetary arrangements for practices
  4. 4. 5.4 It was accepted that this was the start of discussions with PBC Consortia on how the Medicines Management Structure would support commissioning (both PCT and PBC) and provide support to practices. 5.5 It was acknowledged that the Medicines Management capacity at PCT level would be likely to become smaller and more concentrated as Prescribing Support Pharmacists do more work for practices involved in PBC. 6. Dermatology Services 6.1 Dr Gardner welcomed Pippa Hulme to the meeting. Pippa presented a paper on Dermatology Services. The PEC was asked to consider the paper and approve the procedures for management within Primary Care by GPs and to note the ongoing discussions with regard to Intermediate Dermatology procedures. 6.2 Members were informed that at the present time the Dermatology department at Blackpool Fylde and Wyre Hospitals are receiving around 2,000 referrals more than they have the capacity to deal with. In addition, the department has also recently been undertaking extra clinics to deal with a backlog of minor procedures. 6.3 A GP with special interest in Dermatology has recently undertaken an audit of 2 weeks worth of referrals. His conclusion was that a large majority of these referrals could be dealt with either by GPs within their practices or via a GP with a specialist interest. 6.4 Discussions have been held with Consultants in Blackpool and it is clear from discussions with the University Hospitals of Morecambe Bay that there are similar issues with capacity. The University Hospitals of Morecambe Bay have previously issued referral exclusion criteria and it is proposed that this is reinforced with GPs at the same time as any communication with GPs in Wyre and Fylde locality to ensure a consistent approach and policy across the PCT. The process needs to be in place for 1 July 2007. Blackpool PCT have already informed their GPs of the changes to referral policy for Blackpool Victoria Hospital. 6.5 The PCT in Partnership with the LMC is currently undertaking a review of all Enhanced Services including Minor Surgery. It is the PCT’s intention to lift any cap on minor surgery procedures in general practice, providing they are undertaken in line with approved guidelines. 6.6 Following discussion the following areas were highlighted:  Look at cryotherapy provision. The evidence base for this therapy is no more effective than alternative treatments for warts and verrucas. Storage of liquid nitrogen is making it increasingly unattractive.  Not an embargo on activity – looking at alternative ways to manage these conditions. 6.7 The PEC agreed with the exclusion list and approval was given for a letter to be sent to GPs in North Lancashire Primary Trust that with effect from the 1 July 2007 the Dermatology Department at Blackpool, Fylde and Wyre Hospitals Trust
  5. 5. will no longer accept referrals for conditions which are, in any case, classified as Additional Services. It was agreed that a paragraph re Dermatology Services be inserted into the Chief Executive’s report to the Board. 7. Primary Care Centres – Briefing Paper 7.1 Dr Gardner welcomed Phil Hargreaves to the meeting. Phil presented a paper on Primary Care Centres. The PEC was asked to consider the report and provide any recommendations for presentation/adoption to the PCT Board. 7.2 Members were informed that the paper had been to a number of committees and followed a robust and transparent process. It gives a briefing on the Primary Care Centres recently built, those on-site and those planned for the future. North Lancashire PCT does not have an Estates Strategy at the moment but work on this is being progressed. 7.3 The process outlined would be applied across the PCT. Members of the PEC felt that they would like, as a group, to feed into the Estate Strategy and that it would be useful for them to see what future agendas look like. It was acknowledged that PBC also needed to be taken into account. 7.4 The PEC approved the process for presentation to the PCT Board. 8. GP Appraisal Policy 8.1 Dr Maddox presented the GP Appraisal Policy. Annual appraisal is a contractual obligation for all GPs and the PCT is required to ensure that an appraisal system is in place. The paper represented the final draft of the North Lancashire PCT GP Appraisal Policy which had been developed by the Appraisal Committee and had been brought together from the Policies of the three previous PCTs (Fylde, Wyre and Morecambe Bay). The PEC was asked to approve the Policy for immediate implementation. 8.2 The question was asked if there were enough appraisers. Dr Maddox informed members that at the moment there were 21 but ideally we would need 25 – 30 and recruitment was ongoing. Each appraiser would appraise a minimum of 6 GPs each. 8.3 Information from appraisals would be used by the Clinical Director of Education and the Medical Director to plan educational programmes. 8.4 The GP Appraisal Policy was approved for immediate implementation. 9. Chief Executive Items 9.1 Structures Kevin Parkinson, on behalf of the Chief Executive, informed members that all PCT staff would receive letters about their on-going employment before the end of June.
  6. 6. 10. Chairman’s Items 10.1 Individual Meetings with Members 10.1.1 Dr Gardner reported that individual meetings with members had commenced and the following had been agreed: Dr P Rees To chair the Clinical Governance and Effectiveness Committee Dr S Spencer To chair the Diabetes Strategy Group. To join the Independent Sector Review. Dr J Marriott To lead on Enhanced Services and Independent Sector Mr P Hutchence To liaise with Claire Wild with a view to moving forward the role of Community Optometrist 11. Any Other Business 11.1 Health Visitors – Pathways of Care for Children 11.1.1 Claire Lewis informed members of two issues that Health Visitors had brought to her attention regarding pathways of care for children. i) Paediatric Outreach Clinic – In the Fylde area patients used to be slotted into outreach clinics quickly. It seems that as a result of Choose and Book, families have to travel increased distances to clinics as it is not possible to book into the nearest. ii) Neonatal Outreach Service – As a result of Choose and Book, parents who make the choice to have a delivery in Preston are not receiving an outreach service if they live in the North Lancashire PCT area. 11.1.2 Kevin Parkinson advised that both of these concerns were commissioning issues. Claire to approach Margaret Bode, Assistant Director of Commissioning or David Brown, Head of Commissioning for Children regarding the above issues. 11.2 Prescribing Budget Dr Rees informed members that he had been advised of an uplift in his Prescribing Budget but he had not received the actual figure yet. Prescribing Budget figures have not yet gone out to practices across North Lancashire Primary Care Trust. 11.3 Community Services for Eating Disorders 11.3.1 Dr Rees informed members that Psychiatry Services are not, with the Fylde area, providing services for patients with Eating Disorders. Patients were being referred elsewhere and the question was asked if this service was commissioned locally. 11.3.2 This work should happen through Specialist Commissioning and Dr Gardner would look into this and the question would be answered at the next PEC.
  7. 7. 11.4 Community Out of Hours 11.4.1 Duncan Selbie’s (Department of Health’s Director of Commissioning) letter of December 2006 brought PCT’s attention to communication issues within General Practice Out of Hours Services. 11.4.2 Members were informed that North Lancashire PCT’s three Out of Hours Service Providers have all been checked and the PCT is satisfied that their communications systems are fit for purpose. Hilary Fordham has been closely involved in drafting a new SLA with Baycall, who provide Out of Hours services for Lancaster/Morecambe/Carnforth. The new Service Level Agreement contains additional quality markers. Hilary will be looking at the other Out of Hours Service Level Agreements sequentially. 12. Date and Time of Next Meeting Wednesday 11 July 2007 – 2pm Grasmere Room Wesham