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
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,
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
Dr P Rees - GP Representative – Fylde
Dr M Spencer - GP Representative - Wyre
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
1.1 Apologies were received from Mr I Cumming, Mrs S Parnaby, Dr F Atherton
and Mr P Hutchence.
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
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
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
Budgetary arrangements for practices
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
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
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
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
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
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
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.
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
Dr S Spencer To chair the Diabetes Strategy Group. To join the Independent
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.
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