The professional voice of general practice in Lambeth Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. info@lmc.org.uk www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage

LAMBETH LOCAL MEDICAL COMMITTEE MEETING

To be held at 1.00pm on Tuesday 23 October 2012 at

Room ST01 & 2 ground floor, 2-8 Gracefield Gardens, Streatham London SW16 2ST

AGENDA

1.0 1.1

Welcome and Apologies: To welcome new members and receive apologies

2.0 Standing Orders of the LMC and Roles and Responsibilities of LMC Members 2.1 To formally adopt the Standing Orders (page 3-7) 2.2 To receive and adopt the LMC members Roles and Responsibilities (page 8-10)

3.0 Membership 3.1 To receive members’ Terms of Office (page 11) 3.2 To elect a Chair to serve until 31 August 2014 in accordance with the attached Roles and

Responsibilities and Nomination (page 12-14) 3.3 To elect a Vice-Chair to serve until 31 August 2014 (page 15)

4.0 Local LMC Priorities 4.1 To discuss the LMC’s local priorities and to identify objectives:

Suggested priorities could include the following (this is not exhaustive and may not be relevant to your local area)

• Education and training

• Sources of practice funding • Improvement and development of premises

• Engagement with CCGs and CCG Boards

• Communications and Newsletters

4.2 To discuss how the committee will lead on and support the agreed objectives

4.3 To discuss co-options: • Co-options into vacancies (where relevant)

• Co-options representing a particular class of experience

• Co-option of a Practice Manager as an observer (page 16-17) • Co-option of a Practice Nurse as an observer

5.0 Meetings for 2013 Format of meetings for 2013 5.1 To discuss the proposed schedule/ format of LMC meetings for 2013 (the committee may wish to

discuss the structure/format of meetings for 2013 particularly post April as a result of any discussions which take place under item 4.0.

5.2 To receive the proposed dates of meetings for remainder of 2012 and 2013: (These meetings will continue to be in two parts – part one for LMC Members only and part two with the BSU/CCG)

• Tuesday 26 February 2013

• Tuesday 23 April 2013

• Tuesday 25 June 2013 • Tuesday 20 August 2013

• Tuesday 22 October 2013 • Wednesday 17 December 2013

Meetings are scheduled to take place at 2-8 Gracefield Gardens, Streatham, SW16 2ST

5.3 Londonwide LMCs office contacts (page 18)

6.0 Minutes and matters arising 6.1 Minutes of previous LMC meeting on 21 August 2012 (page 19-23 6.2 Notes of the BSJLC (part 2) meeting held on 21 August 2012 (page 24-28)

7.0 Reports of meetings attended by LMC members as LMC representatives 7.1 Londonwide LMC update

• To receive an update from the LMC office • LETB briefing (page 29-36)

7.2 To receive an update from the Chair including: • SE Cluster meeting held on 2 October - actions attached (page 37-38)

7.3 To receive updates from LMC representatives attending local meetings:

• GP Contract Steering Group (GPCSG) • Practice Manager Forum (PMF)

• Medicines Management Committee (MMC) • Lambeth Clinical Commissioning Collaborative Board (LCCCB)

8.0 Items for discussion: 8.1 Coordinate my Care (page 39) 8.2 Medicines Management communications Campaign (page 40-41) 8.3 Sessional/Salaried GPs issues

To discuss any issues

9.0 Items to receive: 9.1 • GPC News September 2012

http://www.lmc.org.uk/article.php?group_id=6099

9.2 LEAD: To receive a list of forthcoming LEAD events (page 42)

10.0 LMC newsletter To identify items for the next newsletter

11.0 Dates for the next meeting: 11.1 • Tuesday 18 December 2012 (part one) - 1.00 pm - 2.30 pm

(part two) - 2.30 pm - 4.00 pm

12.0 Any other business: At least 24 hours’ notice should be given of matters to be raised under this item

STANDING ORDERS LAMBETH LOCAL MEDICAL COMMITTEE Nothing in these Standing Orders shall override conditions in the Committee's Constitution or of Contracts of Employment. OFFICERS 1. The Officers shall be elected members of the Committee and shall consist of a

Chair and a Vice-Chair. 2. The Committee at its first meeting after the biennial election shall proceed to elect

the Officers who shall hold office for the next two years, provided that they remain elected members of the Committee.

3. In the event of the resignation, death or removal from office as hereinafter

mentioned of an Officer the Committee shall as soon as may be appoint a member of the Committee in place of such resigned, deceased or removed Officer.

4. An Officer may be removed from office by a resolution to that effect carried by

two thirds of the members of the Committee present and voting at an extraordinary meeting of the Committee summoned for that purpose.

5. No officer may hold an appointment as a member of the Board of the Lambeth

Primary Care Trust or NHS London or of their successor bodies, and no Officer shall serve as Chair of the Professional Executive Committee or the successor body.

DUTIES OF THE OFFICERS 6. The Chair shall preside at meetings of the Committee and, if absent, the Vice-

Chair shall preside. In the absence of both, the members present at the meeting shall appoint someone of themselves to act as Chair for that meeting. The Vice-Chair shall also act in the absence of the Chair in all other matters where responsibility is given to the Chair in these Standing Orders.

FUNDING OF THE COMMITTEE

7. The funds of the Committee will be consolidated in the accounts of Londonwide

LMCs Ltd. OFFICIALS OF THE COMMITTEE 8. The Secretary of the Committee shall be the person holding the relevant Contract

of Employment with Londonwide LMCs Ltd.

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9. The Secretary shall be responsible in respect of these Standing Orders for (1) The issue of notices summoning meetings of the Committee and of any

sub-committees. (2) The keeping of the minutes of all meetings. (3) The safe custody of books, registers and documents. (4) The conduct of all correspondence. (5) Receiving and bringing to the notice of the Chair all requisitions by

members. (6) Such other matters as the Committee may, from time to time, decide. 10. In the absence of the Secretary the above duties may be assumed by other staff

members of Londonwide LMCs Ltd. 11. The Committee's accountant shall be the accountant appointed by Londonwide

LMCs Ltd to examine the accounts. MEETINGS 12. The Committee shall agree an annual schedule of meetings. If the Chair deems

there is insufficient business, a meeting may be cancelled and the members be notified of the decision.

13. An extraordinary meeting of the Committee shall be summoned on the direction

of the Chair or on the requisition in writing to the Secretary of not less than a quorum of the members of the Committee stating the business to be discussed at such extraordinary meeting.

14. An extraordinary meeting shall transact only the business for which it is

summoned. 15. Agendas will be sent to members seven days before a meeting and supporting

papers and minutes of the preceding meeting, whenever possible, shall accompany the agenda. A notice shall be presumed to have been served one day after posting.

A member desiring a matter to be included on an agenda shall make her/his

request in writing to the Chair or Secretary, at least 10 days before the meeting. Requests made less than 10 days before a meeting may be included on the agenda at the discretion of the Chair or Secretary.

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PROCEDURE AT MEETINGS 16. At each ordinary meeting of the Committee the minutes of the last ordinary

meeting together with the minutes of any extraordinary meeting of the Committee held since the date of the last ordinary meeting shall be submitted for approval.

17. No seconder shall be required for any motions or amendments of which prior

notice has been given in writing or in connection with the presentation of a report of a sub-committee. All other motions or amendments after being proposed must be seconded.

18. If an amendment to an original motion has been moved and where necessary,

seconded, no second or subsequent amendment shall be moved until the first has been disposed of.

19. If an amendment is carried, the motion, as amended, shall take the place of the

original motion and shall become the question upon which any further amendment shall be moved.

20. Every question at a meeting of the Committee (other than for which a two-thirds

majority is required) shall be determined by a majority of the votes of the members of the Committee present and voting, and in the case of an equal division of votes, the Chair of the meeting shall have a second or casting vote.

21. Every vote shall be taken by show of hands unless a resolution to the contrary is

moved and where necessary, seconded and supported by a majority of members of the Committee in which event the vote shall be taken by ballot in such manner as the Chair of the meeting may determine.

22. No motion to rescind a resolution which has been passed within the preceding six

months shall be proposed until after the expiration of six calendar months from the time when it was originally or last proposed and no motion which has been rejected shall, except on the recommendation of a subcommittee, be again proposed until after the expiration of six calendar months from the time when it was originally or last proposed.

23. Subject to the provisions of these Standing Orders, all questions relating to the

procedure at a meeting of the Committee shall be determined by the Chair of the meeting whose decision shall be final.

MINUTES 24. Action Minutes of the proceedings at every meeting of the Committee and of

every general meeting of the electorate and a record of the attendances at such meetings shall be kept by the Secretary.

25. Unless and until the contrary is proved every meeting where-of the proceedings

are recorded in the minutes as aforesaid shall be deemed to have been duly convened and held and all the members present as such meetings shall be deemed to have been duly qualified.

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GENERAL MEETING OF THE ELECTORATE 26. A General Meeting of the Electorate shall be held if the Chair so decides, or the

Committee so decides, or on a requisition in writing to the Secretary of one half of the elected members of the Committee, or on requisition in writing to the Secretary of not less than 25 members of the electorate, stating in each case the business to be transacted at the meeting and such meeting shall be held at a time and place to be determined by the Committee.

27. Notice of a General Meeting of the Electorate will be circulated to all members of

the Committee and the Electorate giving the time, date and place of such meeting of which not less that 21 days' notice will be given. The agenda, which shall include all motions of which notice has been given as hereinafter mentioned, shall be circulated to the Electorate not less than seven days before the day of such meeting.

28. At least 14 days’ notice in writing shall be given to the Secretary of any matter

which a member of the electorate shall desire to be considered at a general meeting of the Electorate.

QUORUM OF A MEETING OF THE COMMITTEE 29. One third of the members of the Committee, or if one third is not a whole number,

the next whole number above one third, shall form a quorum of the Committee provided that at least three-quarters of the members present shall be elected representatives of practitioners on the list and, where relevant, elected (or co-opted) representatives of practitioners on the general ophthalmic list.

30. In the event of the Committee assembling to a meeting that is called and the

assembly does not form a quorum, it may discuss the business to be transacted but no decisions reached shall be considered decisions of the Committee until ratified by a subsequent meeting of the Committee at which a quorum is assembled.

URGENT BUSINESS TO BE CONDUCTED BETWEEN MEETINGS OF THE COMMITTEE 31. The Chair shall be given powers to make decisions on behalf of the Committee in

matters of urgency where there is no early meeting of the Committee at which such business could be considered. The Committee itself will determine from time to time how it will ratify and require reports under such "Chair's Action".

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SUB-COMMITTEES 32.1 The Committee shall set up such sub-committees to deal with items of business

as it so determines. The decisions of such sub-committees shall not become the decisions of the Committee until such time as they are ratified by the Committee, except in such cases where the Committee gives prior leave for the sub-committee to act on behalf of the Committee.

32.2 In relation to paragraph 32.1 of these Standing Orders, the Committee gives

specific prior leave for the members elected by the Committee to the Standing Joint Committee with Lambeth Primary Care Trust to act on behalf of the Committee in all matters falling within the remit of the Primary Care Trust concerned.

AMENDMENT AND SUSPENSION OF STANDING ORDERS 33. No amendment of or addition to these Standing Orders shall be made unless

notice of the proposed amendment or addition has been included in the notice of the meeting of the Committee at which it is to be considered and a resolution in favour of the amendment or addition is carried by not less than two thirds of the members of the Committee present at the meeting and voting.

34. Any Standing Order may be temporarily suspended at any meeting of the

Committee by resolution to that effect carried by not less then two thirds of the members present at the meeting and voting and with the consent of the Chair of the meeting.

35. Any member who has interest, pecuniary or otherwise, in any matter under

discussion by the Committee shall declare that interest. 36. Nothing in these Standing Orders shall prevent the Committee from agreeing to

work together with members of other Local Medical Committees in the area covered by NHS London or its successor body or bodies.

1 September 2012 – 31 August 2014

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LMC Committee Members Roles and Responsibilities

Title: LMC Committee Member

Accountable to: Constituent GPs and practice teams, the LMC Chair,

Committee and the Medical Director/LMC Secretary and Chief Executive of Londonwide LMCs.

Attendance at Meetings Members are expected to attend regularly at full meetings of the LMC and, if appointed to any additional group as required by the LMC. Non-attendance at three successive meetings (any combination of full and liaison meetings) without good reason may result in the member being asked to stand down. Role of Committee Member

1. Members are elected by constituents and are expected to:

represent them make themselves available to them

listen to and seek their views ensure that those views are fairly represented

agree to use emails as their main form of communication.

2. Members must be aware that, by their election, they have a mandate to make decisions on behalf of their constituents.

3. LMC members are expected to read all relevant papers prior to a meeting and come prepared to discuss all agenda items. The office will ensure, wherever possible, that papers are sent out seven days before a meeting either by post or in electronic format.

4. Members are expected to respond promptly to all relevant communications, including

organisations within the specified timeframe.

5. mainly be in electronic format.

6. Members of the LMC are expected to follow established LMC policy and to fairly

7. If members express a personal view, rather than LMC policy, this should be made

clear in any discussion. Responsibilities of Committee Members

1. Members are expected to ensure punctual arrival at all meetings and to stay for the

duration of the meeting in order to receive full reimbursement.

2. Members are expected to ensure that all communication devices are set to silent

mode and any urgent calls are taken outside of the meeting.

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3. Members are expected to keep themselves up to date with local policies, proposals and processes, including any identified LMC priorities, affecting their constituents and to be aware of national issues affecting the whole profession and the impact locally.

4. Members are expected to work and behave in an inclusive and collaborative manner

and to be respectful of their fellow committee members, the committee Chair, and the

LMC secretariat, both at meetings, and in all their communications in their capacity

as LMC members.

5. Members are expected to adhere to the minuted outcome (party line) of the meeting,

in their LMC capacity, once it has been agreed.

6. Members are expected to adhere to confidentiality where appropriate.

7. Members are expected to use email as their primary method of communication outside of committee meetings.

8. Members must the policy of Londonwide LMCs and must their interests.

9. Members must declare any pecuniary or other interest in any matter under discussion.

10. Members are not expected to raise issues relating to them personally, or to their practices, unless using the issue to introduce or illustrate a point. If they do, the LMC Chair reserves the right to correct the member/s and revert to generic principles.

11. LMC members, who are also PEC/CCG members, should make it clear in which capacity they are acting when involved in discussions or attending meetings. Once stated it is expected that a member will represent the views of that organisation during any meeting or ensuing discussion. Any member who feels unable to avoid a conflict of interest should withdraw from that discussion or meeting.

12. If contacted by the media for an LMC viewpoint, LMC members should first contact the press office at Londonwide LMCs to discuss the request and their proposed response.

13. Diversity and

Equality Policy.

14. Londonwide LMCs is incorporated as a Company Limited by Guarantee. This means the liability of individual LMC members is limited to £1 as long as each LMC member, member:

Completes fice.

Accompanies all written communications in their capacity as an LMC member with

the Company disclaimer.

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Honoraria for Attendance

1. Honoraria for attending LMC meetings are notional flat-rate payments, inclusive of expenses.

2. The level of the honorarium will be determined by the Board of Directors of

Londonwide LMCs on an annual basis.

3. By signing the attendance register members are deemed to be making a claim for honoraria.

4. Members are expected to attend for an entire meeting unless prior notification has been received by the office.

5. Members arriving after the start of a meeting or leaving before the end of the meeting and who have not previously notified the office may be paid a reduced honorarium.

6. Members are responsible for ensuring that information relating to honoraria is

accurate and up to date. quarterly basis net of tax and national insurance directly into a bank account nominated by the LMC member. Members are required to provide the office with their national insurance number and bank account details.

Please note that these roles and responsibilities are subject to periodic review

Reviewed August 2012

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LAMBETH

LOCAL MEDICAL COMMITTEE

TERM OF OFFICE FROM 2012 Lambeth Constituency

Elected LMC members

Members until 31 August 2014 (6 places) (Term of office 2010-2014)

GP Contractual Status

Members until 31 August 2016 (7 places) (Term of office 2012-2016)

GP Contractual status

Dr Arun Gadhok

PMS GP Principal Dr Azhar Ala

GMS GP Principal

Dr Nigel Konzon PMS GP Principal Dr Malcolm Artley

PMS GP Principal

Dr Jenny Law PMS GP Principal Dr Samuel Chu

Sessional GP

Dr Emma Rowley-Conwy PMS GP Principal Dr Himanshu Patel

PMS GP Principal

Miriam R Ish-Horowicz Freelance GP Dr Neil Vass

PMS GP Principal

Dr Lee Winter GMS GP Principal Dr Penelope Jarrett PMS GP Salaried

Vacancy

Co-opted member until 31 August 2014 (A practitioner representing a particular class of experience not otherwise represented on the committee) The number of co-opted members should not exceed a quarter of total number of elected members. (Maximum of 3 co-opted members)

Name Reason for Co-option

Observers until 31 August 2014 (No voting rights on the committee, can include Practice Managers and Practice Nurses)

Name

Last updated: 1 September 2012 Version 1.0

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LMC Committee Chair Role and Responsibilities

Title: Chair Accountability to: Constituent GPs and practice teams, in association with the Local

Medical Committee and the Medical Director/LMC Secretary and the Chief Executive of Londonwide Local Medical Committees Ltd

Role of the Chair

1. To attend and preside at all meetings of the Committee, in accordance with the Constitution and Standing Orders of the LMC. If the Chair cannot be present, the Vice Chair will preside. It would be expected that the Chair and Vice-Chair will liaise to ensure that one or other is present at all Committee meetings to provide consistency with proceedings.

2. The Chair will be an ex-officio member of all sub-committees, where these are

appointed by the LMC.

3. The Chair will work with Londonwide LMCs to set the agenda for all LMC, Liaison and other meetings as appropriate.

4. To fulfil the role of being a point of contact for local GPs and practice teams, and

liaise with the Londonwide LMCs’ office on a regular basis on all matters to provide consistent support and information to constituents.

5. Chair support to be provided to Londonwide LMCs in dealing with local issues.

6. To demonstrate leadership through:

• chairing and leading meetings of the LMC • securing the active involvement of elected members in pursuit of LMC policy

with the PCT/or successor organisations, working closely with the Sector Team at LLMCs

• Overseeing effective two-way communication with constituent GPs and practice teams to ensure appropriate gathering of ‘grass roots’ intelligence to inform LMC policy.

7. To agree the priorities for the committee; to act as a resource for the LMC where

there is a need to comment on specific local issues; and to provide professional representation at local, sector and Londonwide level.

8. To work closely with the Communications and Sector Teams on local media coverage, newsletters and other communications as appropriate.

Responsibilities of the Chair

1. The Chair will be responsible for the approval of the draft minutes and action notes of meetings of the committee where attended.

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2. The Chair will ensure that the LMC team is fully informed of any discussions and decisions taken outside of the meeting schedule.

3. Communication from the Londonwide LMCs’ office will mainly be in electronic format and Chairs are expected to use email as their primary method of communication outside of committee meetings.

4. The Chair is expected to attend identified and relevant training in order to maintain skills required in performing the role of Chair (e.g. Effective Chairing/Negotiating skills).

5. The Chair will behave in an inclusive manner both at LMC meetings and in all

communications in their capacity as LMC Chair.

6. The Chair will encourage the development and involvement of elected, potential LMC members.

7. The Chair will adhere to the LLMCs Equality and Diversity Policy.

Strategic Responsibilities of the Chair

1. The Chair will lead the representation of GPs and practice teams by forging and maintaining sound working relationships with the PCT or successor organisations and other local statutory organisations.

2. The Chair will work collectively with other LMCs within Londonwide Local Medical Committees Ltd to better the interests of London’s practices.

3. The Chair may be asked to participate in a reference group from time to time to assist Londonwide LMCs’ strategic priorities.

4. The Chair and Vice Chair of each LMC hold the proxy votes for the election of

the Board of Directors for Londonwide LMCs Ltd and Londonwide Enterprise Ltd and at company Annual, Extraordinary or Adjourned General Meetings.

5. The Chair is expected to maintain a political and strategic awareness of matters affecting the LMC both locally, regionally and nationally.

6. The Chair is expected to attend the national UK LMC Conference or otherwise to

ensure that the LMC is properly represented. Honoraria for attendance

1. Chairs are entitled to receive honoraria payments over and above what is outlined in the LMC Members roles and responsibilities. The Londonwide LMCs Honoraria Policy will follow with further details.

Reviewed August 2012

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Lambeth Local Medical Committee

Nomination Form Chair of the Committee

TO BE COMPLETED BY THE CANDIDATE I wish to stand as Chair. (BLOCK CAPITALS PLEASE) I am an elected member. Statement of Intent Please provide in no more than 100 words a brief statement outlining your aims for the direction and working of the LMC in the forthcoming year.

I have read and understood the LMC Chairs Roles and Responsibilities and if elected I am willing to serve until 31 August 2014. Signed: PLEASE PRINT NAME: TO BE COMPLETED BY THE SECONDER

I have read and understood the LMC Chairs Roles and Responsibilities. I support the above nomination. I am an elected member of the LMC.

Signed: PLEASE PRINT NAME: Please return this nomination form to the LMC Secretary not later than the start of the meeting at which the appointment is to be made.

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Lambeth Local Medical Committee

Nomination Form for LMC Vice-Chair

TO BE COMPLETED BY THE CANDIDATE I wish to stand as Vice Chair.

(BLOCK CAPITALS PLEASE) I am an elected member. I have read and understood the LMC Chairs Roles and Responsibilities and if elected I am willing to serve until 31 August 2014. Signed: PLEASE PRINT NAME:

TO BE COMPLETED BY THE SECONDER I have read and understood the LMC Chairs Roles and Responsibilities. I support the above nomination. I am an elected member of the LMC. Signed:

PLEASE PRINT NAME: Please return this nomination form to the LMC Secretary not later than the start of the meeting at which the appointment is to be made.

Guidance for Practice Managers and Practice Nurse Representatives at LMC meetings

The LMC may in its absolute discretion invite a Practice Manager and a Practice NurseRepresentative to attend the whole or any part of any committee meeting as an observer.

Attendance at Meetings

If a Practice Manager/Practice Nurse Representative is invited to attend an LMC meeting, and is unable to attend that meeting for any reason, they need to inform the Londonwide LMCs office before the meeting.

Role

1. A Practice Manager or Practice Nurse Representative would normally be invited to speak and take part in the debate but would not be entitled to vote.

2. Representatives are encouraged to read all relevant papers prior to a meeting. The office will ensure, wherever possible, that papers are sent out seven days before a meeting either by post or in electronic format.

3. Representatives are encouraged to respond promptly to all communications, including emails, from the Londonwide LMCs’ office, and wherever possible, within five working days.

4. Communication from the Londonwide LMCs’ office will mainly be in electronic format.

5. Practice Manager/Practice Nurse Representatives of the LMC are expected to follow established LMC policy and to fairly represent the LMC’s views to outside organisations.

6. If Representatives express a personal view, rather than LMC policy, this should be made clear in any discussion.

Responsibilities

1. If unable to attend a meeting, representatives are expected to give their apologies to the Londonwide LMCs’ office before a meeting. Non-attendance at three successive meetings (any combination of full and liaison meetings) without good reason may result in therepresentative being asked to stand down.

2. Practice Manager/Practice Nurse Representatives are expected to keep themselves up to date with local policies, including LMC portfolios, proposals and processes affecting their colleagues and to be aware of national issues affecting the whole profession and theimpact locally.

3. Practice Manager/Practice Nurse Representatives are expected to use email as their primary method of communication outside of committee meetings.

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4. Representatives are expected to declare any pecuniary or other interest in any matter under discussion.

5. Representatives are not expected to raise issues relating to them personally, or to their practices, unless using the issue to introduce or illustrate a point. If they do, the LMC Chair reserves the right to correct the representative/s and revert to generic principles.

Once stated it is expected that a representative will represent the views of that organisation during any meeting or ensuing discussion.

Any representative who feels unable to avoid a conflict of interest should withdraw from that discussion or meeting.

6. Diversity and Equal Opportunities.All representatives will be expected to abide by Londonwide LMCs’ policy of not toleratingsexual harassment or any other form of harassment, victimisation, bullying or other unfair discrimination on any grounds including age, disability, ethnic or national origin, race or colour, gender, religion and belief, marital status, responsibility for dependants, sexual orientation, or because a person intends to undergo, is undergoing or has undergone gender reassignment.

Honoraria for Attendance at LMC meetings

1. Honoraria for attending LMC meetings are notional flat-rate payments, inclusive of expenses.

2. The level of the honorarium will be determined by the Board of Directors for Londonwide LMCs on an annual basis.

3. By signing the attendance register Practice Manager/Practice Nurse Representatives are deemed to be making a claim for honoraria.

4. Practice Manager/Practice Nurse Representatives are expected to attend for an entire meeting unless prior notification has been received by the office.

5. Practice Manager/Practice Nurse Representatives arriving after the start of a meeting or leaving before the end of the meeting and who have not previously notified the office maybe paid a reduced honorarium.

6. Practice Manager/Practice Nurse Representatives are responsible for ensuring that information relating to honoraria is accurate and up to date. Honoraria are paid by Londonwide LMCs’ office on a quarterly basis net of tax and national insurance directly into a bank account nominated by the Practice Manager/Practice Nurse Representative. Practice Manager/Practice Nurse Representatives are required to provide the office with their national insurance number and bank account details.

Reviewed August 2009

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Londonwide LMCs’ Office Contacts

• Main office telephone number: 020 7387 2034

• Main office fax number: 020 7383 7442

• LMC website: www.lmc.org.uk

Your LMC team

LMC Medical Director

Dr Theodora Kalentzi x 245 tkalentzi@lmc.org.uk

Director of Primary Care Strategy Julie Freeman x 234 jfreeman@lmc.org.uk

Primary Care Strategy Executive Lesley Williams x 221 lwilliams@lmc.org.uk

Together responsible for all LMC issues and matters requiring negotiation with PCTs and South East London Cluster

Committee Liaison Executive

Jenny Foley x 222 jfoley@lmc.org.uk

For queries relating to LMC and Borough Standing Joint Liaison Committee meetings. Corporate Team Administrator

Marie Vassallo x 257 mvassallo@lmc.org.uk

For all queries relating to office administration including LMC members’ honoraria and changes to the database regarding GPs and practice contact details.

General Londonwide LMCs’ contacts Chief Executives Dr Michelle Drage

PA Joni Wilson-Kaye jwilson-kaye@lmc.org.uk

GP Support Services

Vicky Ferlia, Director of GP Support Services x 260 Nora Breen, Manager, GP Support Services x 241

vferlia@lmc.org.uk nbreen@lmc.org.uk

For queries relating to all types of GP contracts, performance issues, patient complaints, partnership issues, employment issues and NHS changes affecting your practice.

Corporate Affairs Paul Tomlinson, Director of Resources x 224

ptomlinson@lmc.org.uk

For queries relating to organisational matters, LMC elections and levies.

Communication Team Hannah Millard, Communications and Marketing Executive x 239 Laura Quirke, Communications and Marketing Executive x 238 Jonathan Ashby, Communications Executive x 228

hmillard@lmc.org.uk lquirke@lmc.org.uk jashby@lmc.org.uk

For media coverage and advice, website and newsletter production.

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LAMBETH LOCAL MEDICAL COMMITTEE MEETING

Part I

Held at 1.00pm on Tuesday 21 August 2012 at Gracefield Gardens, Streatham, London SW16 2ST

LMC Members: Dr Azhar Ala Dr Arun Gadhok Dr Tyrrell Evans Dr Miriam Ish-Horowicz Dr Jenny Law (Chair) Dr Himanshu Patel Dr Emma Rowley-Conwy Dr Neil Vass Ms Lyn Eustace

Observer: Dr Katrina Whalley

Londonwide LMC Representatives

Dr Theodora Kalentzi Mrs Lesley Williams Mrs Jenny Foley

MINUTES

1.0 Welcome and Apologies 1.1 To receive apologies

Apologies were received from Dr Aitken, Dr Patel and Dr Winter. Dr Law welcomed Dr Theodora Kalentzi as the new Medical Director/LMC Secretary. Dr Law formerly thanked Dr Tyrrell Evans for all his sterling work and contributions as Vice- Chair of the LMC and wished him well for the future.

2.0 Declarations of Members’ Interests 2.1 Dr Rowley-Conwy declared that she was the Chair of SELDOC and had an

interest in the bid for the OOH contract. Dr Rowley-Conwy also declared that she held an enhanced services contract for the walk-in services at Gracefield Gardens.

3.0 Minutes and maters arising

3.1 Minutes of previous LMC meeting held on 26 June 2012 were agreed as an accurate record.

3.2 Matters Arising: Item 10.1 - Octenisan skin wash The committee noted that the Medicines Management team had begun to work with Kings renal team around communicating with GPs over prescribing matters.

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4.0 Reports of meetings attended by LMC Members as LMC representatives 4.1 Londonwide LMC update

Dr Kalentzi gave the following updates:

• GP Contract Performance Management requirements Dr Kalentzi informed the committee that Londonwide LMC recognised that there had been a number of anxieties including the recent communication to practices regarding the results of the 2011/12 contract compliance process, and that she would be writing to Cluster. Dr Kalentzi indicated that the LMC should feel reassured that their issues and concerns were being dealt with and asked that any further individual issues were directed to her at the LMC office. She also pointed out that GP support was available to help with any issues.

• LETB Dr Kalentzi informed the committee that the key issues were to note that there would be three LETBs across London. The structure would be different in each area.

• LEAD Reference Group Dr Kalentzi informed the committee that LEAD was trying to set up a reference group and asked for volunteers to join the group. She explained that membership of the group would not be onerous as all information would be shared by email with a maximum of an hour a month for this purpose. Anyone interested in volunteering should contact the LMC office.

• South London Healthcare Trust (SLHT) – Trust Specialist Administrators (TSA)

Dr Kalentzi informed the committee that a series of workshops had been arranged to discuss the financial difficulties the Trust was facing. The following dates for future workshops were noted: - 6 September

- 25 September - 6 October

Dr Ala pointed out that he had attended the first workshop meeting on

9 August. He agreed along with Dr Vass to attend the other TSA

workshops.

Dr Ala/ Dr Vass

Appraisal and Revalidation Dr Kalentzi informed the committee that Cluster was looking for volunteers to be appraised. Dr Kalentzi reported that she had worked on the appraisal and revalidation guidance and that if anyone had any concerns they should let her know.

4.2 To receive an update from the Chair including: Chair and Vice-Chair

Dr Law and Dr Gadhok formally asked the committee for their approval to attend the next SE Cluster meeting on 2 October as Chair and Vice-Chair. The committee gave their approval.

5.0 Reports of meetings held by LMC members at LMC representative 5.1 LETB

This was discussed under item 4.1.

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5.2 SE Cluster meeting held on 17 July Dr Gadhok highlighted the following issues that were discussed at the last Cluster meeting held on 17 July 2012:

• GP Registration Concerns about how the principles would be disseminated were raised.

• Enhanced Services Responsibility for enhanced services would move to the CCGs.

• List Maintenance PCTs were working towards using QMS to allow practices to be able to view flags.

• Lease and contract updates All practice leases and agreements needed to be in place by 31 December ready for transfer to NCB.

• Improvement Grants A working group had been set up to look at improvement grants.

• Outer Borough Boundaries A number of practices had not yet submitted their boundary plans. Any issues or concerns should be raised directly with GP support at Londonwide.

Dr Kalentzi informed the committee that Londonwide had managed to extend the timelines for submitting information to Cluster.

5.3 GP Contract Steering Group (GPCSG) The notes from the GPCSG meeting held on 10 July were noted.

5.4 Practice Managers Forum (PMF) There was no update.

5.5 Medicines Management Committee (MMC) Dr Law gave the following update on behalf of Dr Aitken:

• Medicines Management LES 2011/12 and QOF 2011/12 Appeals.

Fourteen practices had submitted appeals for consideration by the

Committee. The appeals broadly fell into either missed prescribing

targets or appeals on the budget setting. Seven out of the fourteen

practices had part or all of their appeals denied and they would be

receiving letters explaining the reasons.

• Prescribing Budgets in 2013-2014. The options for how the budget would be set were:

- 100% fair shares - List size based - By ASTRO-PU - Using some other deprivation/long term condition weighting

Both the MMC and the LMC agreed that the option that would be the best one would be where most practices fell within a bell shaped curve. Mr Phil Cokayne from Finance would be working on some modelling, and would keep the MMC and LMC updated.

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5.6 Lambeth Clinical Commissioning Collaborative Board (LCCCB) Dr Law informed the committee that she had attended the last LCCCB meeting and pointed out that there was a large volume of paperwork to read and that it was not reasonable to expect people to have read them. Dr Law reported that the substantive item on the agenda was about awarding the talking therapies to SLaM and that low intensity counselling would be provided by ‘trainees from 1 November. Dr Ala pointed out that no one had picked up the Equality Impact Assessments which had delayed the process. A petition had started to support the talking therapies service. Dr Law pointed out that the main aim was to have a single point for counselling using the trainees because of costs. Concerns about the GPs being responsible for trainees providing counselling services had been raised and Dr Law confirmed that SLaM would be responsible for the trainees. Dr Law suggested taking a calm approach to these arrangements and wait to see how they will work.

6.0 Items for discussion

6.1 Sessional/salaried GPs issues No specific issues were raised.

7.0 Part two agenda 7.1 The agenda for part two was discussed and concerns about the following items

were raised: Finance paper

• Main issue was the huge deficit in SLHT and the effects for South East London. There were concerns that Lambeth would be expected to contribute.

• Section 6.3 - acute services. • Section 7.1 - Expenditure position – Client Group Services.

LCCCB update

• Intermediate care.

• Day Care services. • DMARD LES.

• Virtual Wards – Home Wards now part of integrated care. • 111 and OOH.

• CCG constitution.

• GP Delivery Scheme.

8.0 Items to receive:

8.1 The following items were noted: • GPC News – July 2012

http://www.lmc.org.uk/article.php?group_id=5334 • GPC News – June 2012

http://www.lmc.org.uk/article.php?group_id=5067

• General Medical Council (GMC) publishes doctors’ child protection responsibilities http://www.lmc.org.uk/article.php?group_id=5292

• Making your voice heard - The results of the 2012 Londonwide LMCs' election are announced http://www.lmc.org.uk/article.php?group_id=5224

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8.2 LEAD The LEAD scheduled was noted.

9.0 LMC Newsletter

9.1 No specific items were identified.

10.0 Dates for future meetings

10.1 The date for the next meeting on Tuesday 23 October was noted.

11.0 Any other business There was no other business.

23

LAMBETH LOCAL MEDICAL COMMITTEE (LMC)/ BOROUGH STANDING JOINT LIAISON COMMITTEE MEETING (BSJLC)

Part II

Held at 2.45 pm on Tuesday 21 August 2012 at Gracefield Gardens, Streatham, SW16 2ST

LMC Members: Dr Azhar Ala Dr Arun Gadhok Dr Tyrrell Evans Dr Miriam Ish-Horowicz Dr Nigel Konzon Dr Jenny Law (Chair) Dr Himanshu Patel Dr Emma Rowley-Conwy Dr Neil Vass Dr Duveken Voors Dr Lee Winter Ms Lyn Eustace

Londonwide LMC Representatives

Dr Theodora Kalentzi Mrs Lesley Williams Mrs Jenny Foley

Other Representatives BSU/LCCCB Ms Therese Fletcher Dr Adrian McLaughlin Cluster Ms Rylla Baker

ACTION NOTES 1.0 Apologies

1.1 Apologies were received from Dr Aitken, Dr Winter and Ms McGrath from the BSU. Dr Law agreed to chair the meeting, but asked that the committee revert to the original arrangement for rotating the chair from the next meeting on 18 December. In the meantime arrangements would be made to deal with any urgent business.

2.0 Declarations of Members’ Interests

2.1 Dr Rowley-Conwy declared that she was the Chair of SELDOC and had an interest in the bid for the OOH contract. Dr Rowley-Conwy also declared that she held an enhanced services contract for the walk-in services at Gracefield Gardens.

3.0 Action notes and maters arising

3.1 The action notes from the previous meeting held on 26 June were noted.

3.2 Matters arising: Item 5.1 – PMS contract review Ms Baker informed the committee that all practices had signed their contracts with the exception of one practice where the GP was retiring. That practice list was less than 1200 patients and that the Primary Care Decision Making Panel had agreed that the list would be dispersed to GPs within a 1.5 mile radius.

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Ms Baker also reported that she was still working on a number of the schedules and would circulate the revised schedules to practices as soon as they were ready.

Ms Baker

Outstanding actions: Item 3.2 – Training for liquid base smears Ms Baker still had to follow up the outstanding action and discuss the training requirements with Gillian Holdsworth. Ms Baker confirmed that she would not expect breach notices to be issued for practices where the only issue was that GPs had not completed/attended specific training courses for taking smears.

Item 7.1 – Zero Tolerance Ms Baker agreed to undertake a review of the violent patient DES schemes across LSL to try and agree one scheme and hoped to be able to agree the terms of a zero tolerance approach within that review.

Ms Baker

Ms Baker

4.0 Business Support Unit (BSU)/ Lambeth Clinical Commissioning Collaborative (LCCB)

4.1 BSU Finance In response to Members concerns in the Finance update, Ms Fletcher agreed to the following actions: Action: Section 6.3 – acute services Ms Fletcher agreed to clarify the forecast overspend of £3.299m for King’s College Hospital.

Section 7.1 – Expenditure position – Client Group Services Ms Fletcher agreed to clarify the following:

(i) What is the investment for community services (ii) Will there be a review of the community services (iii) What is the ‘other’ category referred to in the table

Ms Fletcher

Ms Fletcher

4.2 LCCCB update Running costs and commissioning support LMC Members raised concerns that the IT services support for primary care would be delegated to CCGs but it was not yet clear what the financial arrangements would be. Dr McLachlan shared the LMCs concerns. Ms Baker indicated that there was not one IT process in the South of London for all the Boroughs. Intermediate Care LMC Members indicated that there had not been any consultation on intermediate care. Dr McLachlan informed the committee that there had been brief discussions at the LCCCB. Currently there were two wards that were not being used effectively. Dr Rowley-Conwy asked if this was because of Home Ward and Dr McLachlan agreed that it was partly because of this. Dr Law stated that this was an important change which she would like the LMC to be consulted on and given the opportunity to contribute to the discussions as it was part of the wider integrated care review.

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Action: Dr McLachlan agreed to provide further information to the LMC on the consolidation of beds at the Pulross and the development of Lambeth Community Care centre as an amputee rehabilitation unit. Day Care Services LMC Members asked about the review of Day Centres and particularly about the Eamon Fotrell Day Centre to the LMC. Action: Ms Fletcher agreed to provide information about the Eamon Fotrell Day Centre to the LMC. Nursing /Residential/Extra Care Homes LES Dr Law raised concerns about the review of the Nursing/Residential/Extra Care Homes LES that had been completed and the proposal that the new arrangements would be sent out shortly pending ratification at the LCCCB Board meeting to be held on 5 September. She asked how this could be happening as none of the LMC members had been consulted. Ms Fletcher explained that the working group with Clinical Commissioners and GPs Leads had met a few times. Dr Law explained that LMC Members could not attend the working groups because of the timing and short notice of the meetings. Dr Law suggest that this was considered at the GP Contract Steering Group. Action: Ms Fletcher agreed to circulate the proposals for this LES to the LMC for comments. DMARDS LES LMC Members asked about payments for this LES. Action: Ms Fletcher agreed to clarify when the payment would start and when they would be made. Gracefield Gardens Walk in Centre (WiC) – review of services Dr Rowley-Conwy indicated that SELDOC had not been consulted about the review of the WiC. Action: Ms Fletcher undertook to ensure that SELDOC was consulted about the review of WiC.

Dr McLachlan

Ms Fletcher

Ms Fletcher

Ms Fletcher

Ms Fletcher

4.3 GP Patient Registration The Committee noted the guidance for GP Patient Registration and the operating principles which Ms Baker confirmed had been updated to reflect the new guidance.

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5.0 Operational Issues 5.1 GP Contract Steering Group (GPCSG)

The briefing from the GPCSG meeting held on 10 July was noted.

5.2 Virtual Wards - update on pilots LMC Members asked for clarification for the term that should

now be used for Virtual Wards which now appeared to be Home Wards. Dr McLachlan agreed that there needed to be clarification of the term. He reported that the Home Ward pilot had been extended to practices outside of the South East locality. He explained that more details on the evaluation were expected shortly.

5.3 Integrated Care Programme (ICP) Dr McLachlan indicated that 27% of practices in Lambeth had signed up to ICP. He also reported that information had been sent to practices by Ms Jill Baker. Dr Law asked for some detailed information about how many pilots were up and running. Dr McLachlan agreed to follow this up with Ms Jill Baker.

Dr McLachlan

5.4 Update on 111 LMC Members raised concerns about the letter that had been circulated to practices from Mr David Sturgeon about opted-in practices and changes to the prices for visits. Ms Baker confirmed that the letter indicated that Cluster wanted to explore prices for visits, such as home visits. It was not the intention to destabilise SELDOC. Dr Rowley-Conwy pointed out that destabilising them was a potential consequence and that clinical commissioners needed to be involved in the consultation as they would be responsible for commissioning urgent care. Action: Dr McLachlan agreed to check the current position regarding opted-in practices following the contract being awarded to the partnership between NHS Direct/Bromley Healthcare & Grabadoc and report back to the LMC.

Dr McLachlan

6.0 Dates for the next meeting: 6.1 The date for the next BSJLC meeting on Tuesday 4 December

was noted. The committee agreed to revert to the original arrangement for rotating the chair between the BSU/CCG and the LMC from the next meeting on 18 December.

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7.0 Any other business 7.1 CCG Constitution –version 12

Dr Law noted that the Constitution was still in the draft stage and asked for the final version to be circulated to LMC Members for their consideration. Dr McLachlan indicated that the Constitution needed to be finalised by the beginning of September. Version 12 was now being worked and would include supporting appendices. He welcomed the LMCs views. Dr Ala asked about the voting process in relation to proportionality. Action:

• Dr McLachlan agreed to clarify the voting process in the Constitution.

• Dr McLachlan agreed to check the timescale for circulating the Constitution to practices for comments.

The LMC office agreed to look at version 12 and inform Dr Law know of any issues of concern.

Dr McLachlan

Dr McLachlan

Dr Kalentzi/ Mrs Williams

7.2 GP Delivery Schemes Dr Ala asked for clarification of about what was required from practices. Action:

• Dr McLachlan agreed to check what was required from practices for the delivery schemes and the deadlines and report back to the LMC.

Dr McLachlan

7.3 Talking Therapies services transferring to SLaM Dr Law asked about awarding the Talking Therapies service to SLaM and about low intensity counselling being provided by trainees from 1 November. Action:

• Dr McLachlan agreed to clarify if the transfer of the Talking Therapies services to SLaM would take place on 1 November.

Dr McLachlan

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Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

1

Date: August 2012 Circulation: LMC Members & Constituents This briefing is designed to:

1. Inform LMC members and constituents on the latest developments relating to LETBs 2. Introduce Academic Health Science Networks 3. Develop an awareness of where there are opportunities and risks for LMCs and GPs 4. Reinforce the need for Londonwide and LMCs to communicate to LETBs and AHSNs

that LMCs are the representative voice for London GPs as providers, and must be strategically involved

Where are we up to? Our February 2012 briefing provided the legislative background and characteristics of LETBs. To briefly recap:

• There are three LETBs in London: South LETB, North West LETB and North Central/North East LETB. All three have now achieved shadow status. A timetable of key events can be found in the Appendix at the end of the briefing.

• The main function of LETBs is to commission education, training and workforce planning for providers and professionals in their area. That education must recognise national priorities but be tailored to local needs – therefore each LETB will evolve differently. High level operational models for each LETB can be viewed here:

o South LETB o NW LETB o NC/NE LETB

• Core functions will include workforce planning and reconfiguration, planning commissioning strategies, contracting with Lead Providers and setting statements of requirements, managing the quality of and relationship with the regulators, working with providers to improve the quality of education and training, developing providers, and strategy.

• Planning and commissioning of education and training will be on a multi-professional basis across care pathways, and will be patient focused. Certain functions will remain centralised with London’s LETBs establishing a shared service for functions that would be more effectively delivered on a pan-London basis. We are awaiting further details as to which functions would be delivered in this way.

• LETBs will report to the new body Health Education England (HEE). HEE will provide

national leadership and oversight of the planning and development of the healthcare and public health workforce, including the allocation of education and training resources. HEE Directions have been published.

29

Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

2

Londonwide and LMC Member LETB activity to influence the developing structures: Londonwide LMCs has been working to establish relationships with the design teams setting up London’s three LETBs, as well as the developing AHSNs (more on those below). We have attended many stakeholder events and secured LMC GP representation at events as well – many thanks to those members who are supporting this work. Because LETB structures are still in formation and the new bodies are getting to grips with their future responsibilities, discussions continue to be at a strategic rather than operational level. Details of size, scale, funding and how funding will be allocated have not yet been developed or shared - what we do know about funding so far can be read in the ‘Funding allocations’ section below. Londonwide LMCs has been outspoken about the need to have GPs in a position of influence within these structures, to ensure the provision of a fit for purpose primary care workforce. GPs play a vital role as employers, employees, providers, commissioners and trainers, and we continue to work to ensure that our voice is being heard. We are also in discussions with the Deanery on how to secure the provision of education, training and workforce planning for GPs and their wider staff, in order to find a solution that protects the interests of current and future GPs and patients. Funding allocations: MPET is the multi-professional education training budget which includes the following different funding streams:

• Medical Service Increment for Teaching (Medical SIFT) for additional costs incurred in providing placements for undergraduate medical students;

• Medical and Dental Education Levy (MADEL) for doctors and dentists in training;

• Dental Service Increment for Teaching (Dental SIFT) for undergraduate dental students;

• Non-Medical Education and Training (NMET) budget for Nursing, Midwifery, Allied Health Professions and Healthcare Scientists.

The DH will be expecting LETBs to reduce running costs significantly, with the expectation that they will not exceed 1.3% of the MPET allocation. This 1.3% equates to approximately £15m for London for 2014/15. Currently, NHS London manages the MPET budget, which stands at £26m for 2012/13 - almost a 40% reduction. Changes to the method of allocation will increase pressure on ensuring and maintaining the essential supply of workforce, and the ability to invest in and develop future training schemes. Broadly speaking, each LETB will be expected to operate with approximately £1.2m for running costs. At the time of writing there are no more specific details on funding allocations.

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Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

3

Pan-London LETB event June 14th: To date, each LETB has arranged stakeholder events including a pan-London event held on 14 June. Slides and a summary of the event are available to download. It was clear from this event that LETB Management Board structures will be made up of a maximum of 14 members, to include one or two GPs, other professional groups and stakeholders. Our analysis of some of the major ‘unknowns’ that Londonwide and members need to address is given on page 4. The new Academic Health Science Networks and their influence on LETB decisions LETBs will not be making their commissioning decisions in isolation. A major influence on the education and training commissioned by LETBs will be the Academic Health Science Networks (AHSNs) which are in the process of being established. As Sir David Nicholson, Chief Executive of the NHS, wrote in his invitation to groups to bid to form AHSNs, AHSNs offer an opportunity “for the NHS and universities to work with industry to not only improve the delivery of innovation but to link this with participation in research, translating research into practice, education and training, wealth creation and service improvement”. The expectation is that there will be a total of 12-18 AHSNs across England, each responsible to the NHS Commissioning Board. What is an AHSN? In order to fully grasp the purpose and function of an AHSN, it might be simpler to explain what an AHSC is. Academic Health Science Centres deliver healthcare to patients and undertake health-related science and research in partnership with universities and hospitals. There are five AHSCs across England with three in London:

1. Cambridge University Health Partners

2. Manchester AHSC 3. King’s Health Partners

4. Imperial College Healthcare

5. UCL Partners.

An AHSC’s prime focus is on innovation and the discovery of new ideas for healthcare, but is less focussed on adopting and translating these innovations for widespread use in practical healthcare delivery settings. That will be a key purpose for AHSNs, which will also have a focus on community based care. AHSNs are designed to be a flexible alliance of the local NHS, universities, local government and industry to promote cross-boundary working in order to identify, adopt and spread innovation and best practice. The challenge for AHSNs is to improve the cross-sector partnership model and accelerate the time it takes from discovery to delivery– that process currently takes up to 17 years. AHSNs will need to set out a formal governance structure showing a clear line of accountability and responsiveness to the organisations that make up the network AHSNs will need to demonstrate the participation of a wide range of organisations including: NHS Commissioners, healthcare providers, higher education institutions, industry, local authorities and social enterprises.

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Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

4

So what are the issues for London’s GPs which LETBs and AHSNs need to address? Communication:

• Londonwide LMCs is considering the best ways to support these processes in order to ensure that GPs and their primary care teams are represented, including creating a conduit for views to be fed into the AHSNs and LETBs. We are looking into how this will take shape so that the future of General Practice education, training and workforce planning is protected and enhanced.

Context:

• London has a transient labour market, with intra and inter London movement. Disproportionate migration results in London being a net exporter of its medically trained workforce talent pool. This drain causes high levels of vacancies. Future plans must take into consideration this turnover and its impact on productivity. Data suggest potential oversupply of junior doctors and undersupply of GPs.

National/local policy:

• Changing care settings: planning for integrated care and care closer to home strategies which work across traditional professional boundaries must consider what the training and educational needs will be to deliver this transformational change.

• There is a tension between central direction and local determination which will need to be overcome to ensure that local priorities are not at odds with national plans.

Organisational development:

• The education and training functions of the GP School at the Deanery will need to be protected and hosted somewhere. There continues to be a lack of clarity about where that will be, whether the Deanery will be lifted whole and delivered as part of the shared services function within the LETBs, or whether its work will be divided up.

• Currently, there is considerable variation between the training and education delivered by providers, and there is no national assessment system; there will need to be quality principles embedded into the system.

• Details of how the future primary care workforce will be developed in the short and long term requires investment so that future GPs are fit for purpose in the new world. GPs in future will need to acquire specific skills and attributes and, accordingly, the planning for this needs to happen now; there will need to be a focus on care pathways and multi-professional training. However, little detail is out on how this will be achieved.

• Transition – there is huge concern to ensure that current training programmes and trainees are protected during this transition so the system remains stable. This is made increasingly difficult with the restructuring of several bodies as a result of the Health and Social Care Act which has made it challenging to build and maintain stable and sustainable relationships with people and organisations.

Stakeholders: • CCGs will have significant influence on delivering and shaping future services. The

workforce will be the key enabler to service delivery and transformation, so CCGs will be a major constituent in workforce planning. To get this right needs reciprocal

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Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

5

representation - LETB reps on CCGs, and CCG reps on LETBs. CCGs have a duty to promote innovation, but AHSNs must not be under the illusion that CCGs represent all GPs and practices as providers. It is not clear how CCGs will feed into this process and link with LETBs and AHSNs.

• Conflicts of interest: secondary care representation will dominate LETB and AHSN boards, membership groups and advisory councils and there must be transparency so that all stakeholders’ views and needs are equitably considered and that the system is viewed as a whole.

Next steps: Londonwide LMCs is focussing its attention on this complex agenda. We have established a project team to look at how we will engage strategically with the relevant key players, and keep up the profile of GPs and their practice teams. The next steps are:

• Meeting with GPs currently involved in the LETB arena

• Continuing a dialogue with the Design Leads of the LETBs, Leads of the AHSNs and Deanery

• Meeting with the Deanery to discuss options on how to retain the best provider model of GP education, training and workforce planning

• Continuing to support our current links within the LETB structures

• Continuing to update LMCs and constituents

• Formally seeking a GP representative to sit on the NW LETB Board which will be a live ‘shadow’ Board by 1 October 2012

• Continuing to proactively seek representation in the Board structures for the South and North Central/North East LETBs.

More detail about the development of education and training provision for London is being added to our website regularly. If you have specifics concerns, please contact leah.benson@lmc.org.uk For a quick and easy jargon buster, please view our LETB acronym sheet here.

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Briefing on LETBs and AHSNs Local Education and Training Boards and Academic Health Science Networks

6

APPENDIX: Upcoming key dates for LETBs:

July 2012

LETB development plans in place and LETB geographies agreed and confirmed

From July 2012 LETB Managing Directors appointed

July – September 2012

Self-assessment of LETBs against authorisation criteria

By October 2012

• Independent LETB Chairs appointed • Detailed investment plan for 2013/14 • Detailed description of the ambitions and priorities that the LETB will

address in its first two years, that will form part of the Five-Year Workforce Skills and Development strategy

• Remainder of LETB executive team appointed (ongoing) • Operating model developed and agreed by the LETB shadow board

October 2012 – March 2013

LETB authorisation process

March 2013 Five-Year Workforce Skills and Development strategy available for consultation (to start in April)

April 2013 LETBs established

Upcoming key dates for AHSNs:

Round 1:

20 July 2012 Aspiring AHSNs were invited to submit an expression of interest to formalise its network by the autumn 2012

3 August 2012

Feedback from submissions would be provided and could require further work, and the aspiring network would be issued with guidance on the designation process.

30 September 2012 Supporting application materials will need to be submitted.

October/early November 2012

Panel interviews will take place.

30 November 2012 Announcement of designation decision and would either be designated, designated with conditions or resubmission.

Round 2:

28 February 2013 Resubmission of expressions of interest.

March-April 2013 Panel interviews.

31 May 2013 Designation announcement.

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Acronym Definition

AHSC

An Academic Health Science Centre (AHSC) is a partnership between healthcare providers and universities with the aim of improving clinical and research outcomes. There are currently 3 AHSCs set up in London: • Imperial College Healthcare • King's Health Partners • UCL Partners

AHSP

The Academic Health Science Partnership (AHSP) is built on the same concept as AHCS, but is intended to bring together a broader range of higher education and healthcare providers to speed up the spread of evidence based best practice.

AHSN

Academic Health Science Networks (AHSN) are currently applying to become AHSNs. Guidance on AHSNs is expected to be released imminently. AHSNs will be designated based on a regional footprint and there will likely be from 10-15 or more across the country. This collaboration can strengthen the need to create centres of excellence while pooling scarce resources.

CCGs Clinical Commissioning Groups (CCGs) GP practices will work with other healthcare professionals, in partnership with local communities and Local Authorities to commission local health care services.

CfWI Centre for workforce intelligence (CfWI) provides objective analysis and evidence for the planning and development of the workforce at both national and local levels.

CPD Continuing professional development (CPD) refers to any learning that takes place outside undergraduate education and postgraduate training that helps a person maintain and improve their performance. It covers the development of knowledge, skills, attitudes and behaviours. It includes all learning activities, both formal and informal, that maintain and develop the quality of professional work.

CQC Care Quality Commission CQC is the independent regulator health and adult social care services in England. It also protects people detained under the Mental Health Act.

CHRE Council for Healthcare Regulatory Excellence (CHRE) is an independent organisation that is accountable to parliament. Its main focus is to promote the health, safety and well-being of patients and other members of the public in England, Northern Ireland, Scotland and Wales.

ECQ Education Commissioning for Quality (ECQ) is an enhanced, comprehensive education commissioning system for non-medical and medical staff to support world-class education commissioning.

EOF Education Outcomes Framework (EOF) is the high level strategic workforce planning, education and training framework, providing clear line of sight and improvement to patient outcomes (NHS and Public Health Outcomes frameworks). The EOF sets out the key domains that will be used as a basis for DH to hold HEE to account for the outcomes it secures through the LETBs and its oversight of the commissioning of health education and training services.

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HEE Health Education England (HEE) provides national leadership and oversight on planning and development of the healthcare workforce. It acts as a forum for the interests of healthcare providers, staff professionals and patients.

HENSE Health Education National Strategic Exchange (HENSE) is where senior leaders in health and education including the department of Health, Department of Business, Innovation and Skills (BIS) and NHS employers meet together.

HEI Higher Education Institutions (HEI) such as universities, academies, colleges, vocational schools will work with education providers to tailor education and training programmes to ensure students have appropriate competences.

HIEC

Health innovation and Education Clusters (HIECs) is a formal partnership between the NHS and the higher education sector, industry and other private and public sector organisations. They are responsible for speeding up the adoption and diffusion of best practice, research and development and innovation in healthcare through education and training.

HPR Healthcare Professional Regulators (HPR) the main purpose for this group is to protect the public by keeping a register of health professionals who meet standards for their training, professional skills, behaviour and health.

LETB

Local Education Training Boards are accountable for allocating training and funding received from HEE. They co-ordinate workforce data and workforce plans for the local health economy in response to CCGs strategic commissioning plans.

MADEL Medical and Dental Education Levy (MADEL) Part of the Multi Professional Education and Training (MPET) budget allocation for doctors and dentists in training.

MPET Is the Multi professional Education and Training budget that is issued to strategic Health Authority.

MRC Medical Royal Colleges (MRC) develop curricula for postgraduate medical training and set assessments and examinations in line with standards of the regulator to ensure fitness t practice. The academy of Medical Royal Colleges brings together the Medical Royal Colleges.

NMET Non-medical Education Training (NMET) Part of the MPET budget allocation for Nursing, Midwifery, AHP, Managerial, Administrative, Scientific and Informatic and all other non-Medical or Dental workforces on any Agenda for Change pay banding.

SIFT Service Increment for Teaching (SIFT) is NHS funding to offset the costs to the NHS of providing teaching to undergraduate medical (and dental) students, primarily through clinical placements. It covers both block grants to Acute/MH Trusts and sessional payments to GP practices.

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Actions from South East Cluster Standing Joint Liaison Committee meeting held on 2 October 2012

Item Action Person/ Organisation responsible

completed

3.0 Notes of the meeting held on17 July 2012 Item 3.3 - Olympics

• In the third paragraph to replace ‘allocated’ with ‘issued’.

Item 5.1 - PMS Contract Reviews • The first sentence to read “Mr Sturgeon reported that new contracts would be

implemented from 1 April for Lambeth and Southwark.”

JMF

completed

Matters Arising: Item 3.1 - Minor Surgery

• To defer this item to the next meeting.

Item 5.2 – List Maintenance

• Mrs Betts and Ms Webb to discuss outstanding issues including providing training for QMS outside of the meeting.

• To have local discussions with Bromley and Bexley.

JMF

JB/JW JB/JW

4.1 Enhanced Services • Ms Webb to circulate the LES fact sheet to LMCs through the Londonwide

LMC office.

JW

5.1 Contract Performance Management Tabled schedule of practices receiving breach notices

• Ms Webb to discuss the prescribing issues for Greenwich practices outside of the meeting with Dr Heathcote as soon as possible.

JW/JH

37

5.2 Proposals for approach to 2012/13 NHS SE London GP Performance Management Infection control visits

• Ms Webb to send the proposals that had been circulated to all practices about having infection control visits to Dr Heathcote and Dr Law for their consideration and to decide the best way forward.

JW

5.2 Improvement Grants

• Ms Webb to circulate details of the four options to Dr Kalentzi in advance of the Improvement Grants Panel on 8 October.

JW

completed

5.2 GP Leases (draft letter) • Mrs Betts to send comments on the draft letter to Ms Webb.

JB

completed

5.3 111 and OOH • Ms Webb to share the OOH specifications with SELDOC.

JW

5.5 IM&T • To defer this item to the next meeting on 4 December.

JMF

7.0 AOB 7.1 Opening hours for practices during the Christmas period.

• Ms Webb to circulate the letter to practices as agreed with Mrs Betts and Ms Freeman.

JW

7.2 NES (flu vaccinations for pregnant women)

• Ms Webb to circulate information to practices and cc the LMC office.

JW

38

LSL CMC Communication 1.1

The Gold Patient Care Register is changing…

On 03 December 2012 the Lambeth, Southwark and Lewisham end of life register will be moving

to Coordinate My Care, a London-wide register for patients at the end of their lives. This change is

being made as part of the implementation of the 111 service. Patient details currently held on the

Adastra register will be transferred automatically. The benefits of Coordinate My Care are:

• Ensuring patients’ care preferences are followed: The documentation of patients’ preferences

on a shared register supports the delivery of appropriate care by all services involved.

• Up-to-date information for GPs: Coordinate My Care offers GPs the opportunity to access up-

to-date information on which services are involved in the care of their patients.

• A streamlined process for obtaining logins and password resets: Coordinate My Care offers a

dedicated service for obtaining logins and an automated system for password resets, meaning

an end to the current delays for clinicians wishing to access the system.

• Automatic notification of SELDOC: Coordinate My Care sends an automatic notification to

out of hours services, eliminating the need for making a separate entry on Adastra Special

Notes when patients are added to the system.

• Simplified access for the London Ambulance Service: LAS currently have to operate a number

of parallel systems for the recording of palliative care information, including the use paper

forms as well as maintaining logins for several electronic registers. The adoption of a single

system across London will eliminate the need for this, improving efficiency and reducing the

likelihood of errors.

• Improved measures for preventing duplicates: Coordinate My Care has a mandatory search

function when adding patients and makes use of a complex algorithm for identifying duplicate

patients, enhancing patient safety.

• Integration with 111: Coordinate My Care is fully integrated with the 111 service, ensuring

that palliative care patients contacting 111 will be directed to the appropriate service.

To ensure existing users can continue to access the Register all users will have to attend

Coordinate My Care training. Each training session lasts two hours and will be facilitated by the

Coordinate My Care team from the Royal Marsden. The available dates are:

Date Venue Date Venue Date Venue

Wed

03/10/2012

St Christopher's

Hospice

Thu

25/10/2012

Tooley Street Thu

15/11/2012

UHL

Fri

05/10/2012

Tooley Street Fri

26/10/2012

Waldron Health

Centre

Wed

21/11/2012

St Christopher's

Hospice

Tue

09/10/2012

St John’s Medical

Centre

Wed

31/10/2012

Lower Marsh Fri

23/11/2012

St Christopher's

Hospice

Fri

12/10/2012

Akerman Health

Centre

Fri

02/11/2012

Dulwich Hospital Mon

26/11/2012

Dulwich Hospital

Tue

16/10/2012

Tooley Street Wed

07/11/2012

St John’s Medical

Centre

Wed

28/11/2012

Lower Marsh

Fri

19/10/2012

Kaleidoscope Fri

09/11/2012

Lower Marsh Fri

30/11/2012

Downham Health &

Leisure Centre

Mon

22/10/2012

Lower Marsh Tue

13/11/2012

St Thomas' Hospital

To book a session please complete a booking form and send to mathew.griffiths@nhs.net

39

40

41

Events Calendar

October 2012

Tuesday, 25 Mastering the GP Patient Survey and Improving your Results

Contact: karen.cooper@lmc.org.uk

GPs and practice staff

November 2012

Wednesday, 7 Preparing for Partnership: Business Skills for GPs Seminar

Contact: marie.vassallo@lmc.org.uk

GPs

Wednesday, 14 Alternatives to saying “No” to Patients and Promoting Effective Behaviour Change

Workshop 1 – Alternatives to saying “No” to patients Workshop 2 – Promoting Effective Behaviour Change

Contact: marie.vassallo@lmc.org.uk

GPs and practice staff

Thursday, 15 Practice Manager Seminar: Finance

Contact: karen.cooper@lmc.org.uk

PMs

Thursday, 22 Practice Nurse Event workshop on Cognitive Behaviour Therapy (CBT)

Contact: marie.vassallo@lmc.org.uk

GPNs

Wednesday, 28 Medical records in primary care

Contact: karen.cooper@lmc.org.uk

GPs and GPNs

December 2012

Wednesday, 5 Complaints procedure in general practice seminar

Contact: karen.cooper@lmc.org.uk

GPs and practice staff

All events take place in a Central London venue and charge a delegate fee. Full

details are available on the LMC website (www.lmc.org.uk)

42