Private & Confidential]

GLASGOW AREA MEDICAL COMMITTEE

General Practitioner Subcommittee

MINUTES of the MEETING of

the COMMITTEE held on 28th July 2008 in the Committee’s offices at 40 New City Road Glasgow G4 9JT

SEDERUNT	Drs Colin Brown, Georgina Brown, Malcolm Brown, Douglas Colville, Mark Fawcett, Murray Macpherson, John McLauchlan, Keith McIntyre, Kathryn McLachlan, Anne Mullin, John Nugent, Iain Robertson, Paul Ryan, Petra Sambale, Maureen Smith, Ian Struthers, Alastair Taylor, Andrew Townsley, Barbara West and Peter Wiggins.
CHAIRMAN	Dr Paul Ryan, Chairman of the Committee chaired the meeting.
APOLOGIES	Apologies for absence were received from Drs Donald Blackwood, Dallas Brodie, Peter Cawston, Brian Clegg, Bill Doak, John Dudgeon, Norrie Gaw, Ian Gordon, Richard Groden, Gary Hamilton, Kevin Hanretty, Michael Haughney, John Ip, Robert Jamieson, Derek Logan, Gerry Lynas, Neil Mackay, Jim MacKenzie, Alan McDevitt, Chris McHugh, Robert Mair, Patricia Moultrie, Michael Mutch, Jim O’Neil, Nigel Pexton, Alex Potter, Andrew Power, Arun Rai, James Ward and Raymund White.
ATTENDING	Mrs Mary Fingland, Secretary of the Committee.
REVISED AGENDA	The Committee received the Revised Agenda.
MINUTES 09/022	The Committee received the Minutes of the meeting held on 16th June 2008. The Minutes of the 16th June 2008 were approved and signed by the Chairman.
BUSINESS ARISING 09/023	(a) Multi Agency Public Protection Arrangements (MAPPA) Members were told CH(C)P Clinical Directors had recently received a presentation on the MAPPA process and a further meeting on MAPPA was planned. Dr Wiggins wondered whether patients could be referred into the scheme by their GPs and heard it was hoped in the coming year that such referrals would be possible. Members heard minutes of MAPPA meetings should be restricted to those attending the relevant meetings however, whilst occasionally a GP may receive a copy regarding a patient, it had been made clear the minute should not form part of the patient’s clinical record. Dr Nugent told members it was also possible for GPs to request more information on a patient who had been through the process. (b) Area Drug and Therapeutic Committee (ADTC) Non Medical Prescribing Subgroup – Deputy Dr West indicated that she may be able to attend the ADTC Subgroup meeting on Friday 8th August.
CLINICAL ISSUES 09/024	(a) Dermatology Services at the Royal Alexander Hospital (RAH) Members were told the RAH Dermatology department was no longer accepting GP referrals for the removal of benign asymptomatic lesions. The department had stated it would be happy to see such referrals where there was diagnostic doubt however, the removal of these lesions would only be offered on medical not cosmetic grounds. Members were told restrictions were also now in place in the Dermatology departments at the Victoria and Western Infirmaries. Members heard under the current Plastic Surgery protocol, these procedures were no longer carried out by Plastic Surgeons and GPs were now referring such cases to Dermatology. Dr Smith told members Dermatology departments across Glasgow and Clyde were experiencing an increased workload as a result. Members discussed the possibility of setting up additional minor surgery provision in General Practice to alleviate the problem. Dr West told members she had already corresponded with Dr Kevin Fellows, CH©P Minor Surgery Lead, on this issue. Members also heard during earlier discussions on increasing primary care minor surgery provision it had been suggested that secondary care was funded to carry out these particular procedures and lack of resource should not therefore be an issue. Members heard there was also no mechanism as yet for GP to GP referral for the removal of these lesions to practices providing minor surgery as an additional service, or for the removal of the cap on the number of procedures that can be carried out by primary care contractors. Members were also concerned that some of these lesions can be (or are) found to be melanomas and wondered who or what justified what was or wasn’t clinically appropriate. Dr West told members that for a relatively small amount of resource transferred to primary care providers, positive outcomes could be achieved fairly quickly and waiting times could be vastly reduced in other areas as a result. It was agreed Dr Smith would take this issue to the Waiting Times Planning and Improvement Referral Group. Action: Dr Smith to raise the issue of treatment of Benign Skin Lesions at the Waiting Times Planning and Improvement Referral Group. (b) Merit Educational Meeting – Diabetes Type 2 Members noted the agenda for the Merit Educational Meeting on the Treatment and Management of Type 2 Diabetes in Primary Care. Members noted the programme would be offered by Community DSNs to practices interested learning more about managing patients on insulin. Members further noted the course was sponsored by Novo Nordisk and followed the ABPI Code of Practice. (c) Changes to SCI Gateway Referral Templates The Committee received documents detailing proposed changes to SCI Gateway Referral Templates, copies of which were emailed and tabled. Members questioned whether SCI developers understood GP IT Systems or the way in which Primary Care worked, as a number of changes worked against the GP practice. These included:- · Missing information on drug allergies. · The lack of ‘high’ or ‘medium’ filters which would be more practice specific. · Appropriate information failing to be passed on because of changes to screening. Members once again raised the issue of only being able to refer as ‘urgent’ or ‘routine’ and suggested the inclusion of ‘soon’ as a category would be very helpful. However, in response members were told the decision to omit such a category had unfortunately been taken at a national level and could not be changed locally. Dr West thanked those members who had already highlighted issues with the revised templates and she will forward these directly to Alastair McCall.
NOTES AND REPORTS OF MEETINGS (FOR INFO) 09/025	(a) Oral Report of the AMC Committee meeting held on Friday 18th July 2008 The Committee received an oral report of the Area Medical Committee meeting held on Friday 18th July 2008. Cardio Thoratic Transfers to HCI The Committee heard transfer arrangements to the new unit at the HCI are to be further clarified. Managing Medical Careers The Committee was told concerns about MMC were once again being raised. Camglen The Committee heard a meeting between GP representatives and Alan Lawrie, Director South Lanarkshire CHP and Nic Zappia, General Manager Primary Care Support had taken place. Members were told agreement has almost been reached on Camglen’s nGMS contracts remaining with GG&C but being managed under the auspices of South Lanarkshire CHP via a Service Level Agreement (SLA). It was proposed the SLA would cover Enhanced Services and QoF amongst other items. A significant amount of work was also being undertaken which was looking closely at the range of GG&C services and resources currently enjoyed by Camglen GPs and how these would be incorporated in the SLA. Members queried whether anyone had actually costed this exercise to the NHS and Primary Care and whether it was value for money. (b) Report of the SCCRS Group meeting held on Tuesday 17th June 2008 The Committee received a report on the SCCRS Group meeting held on Tuesday 17th June 2008, copies of which were emailed and tabled. (c) Report of the Primary Care Mental Health Interface Group meeting held on 3rd April 2008 The Committee received a report on the Primary Care Mental Health Interface Group meeting held on 3rd April 2008, copies of which had been emailed and tabled. Members heard this was a new group looking which might help develop a Primary Care and Mental Health Interface. Dr Smith wondered if the group had a remit and heard one was currently being developed.
AOCB 09/026	(a) Planned Care Improvement Plan DNA Workgroup – Deputy required; Tuesday 19th August at 3:30pm in Gartnavel General Hospital Unfortunately no member attending was able to act as Deputy. It was agreed to email details to absent members.