Making Connections in DGS October 2014

Kent Local Medical Committee
8 Roebuck Business Park, Ashford Road Harrietsham Kent ME17 1AB
Tel: 01622 851197 Fax: 01622851198
Email [email protected]
Medical Secretaries: Dr M Parks
Dr J Allingham
Mrs Di Tyas
Making Connections in Dartford Gravesham & Swanley CCG
October 2014
Drs Prav Kasinathan, Jill Kent, Ian Jones,
David Lawrence and Saijit Shetty joined
Liz Mears and Kelly Brown at the recent
liaison meeting with DGS CCG. Drs
Bhaskar Bora, Balaji Chalapathy, David
Woodhead, Liz Lunt, Mr Mike Gilbert, Mrs
Patricia Davies and Jabeen Egan attended
on behalf of the CCG.
Flu Vaccinations (Housebound)
The CCG reported that flu vaccinations
for housebound patients are now part of
Therefore all housebound patients,
including those not on the community
nursing caseload, will be offered a flu
vaccination by KCHT. The LMC thanked
the CCG for making this important
contract change.
It is anticipated electronic reporting will
be fully implemented following a short
trial period to highlight any potential
issues. Anyone experiencing problems
should contact David Woodhead.
Concerns were raised around suspicious
xrays and the 2 week wait pathway, with
abnormal results being returned directly
to GPs without being coordinated or
picked up by MDT. The CCG agreed to
escalate concerns.
It was noted that the responsibility for
PwSI accreditation currently sits with the
Area Team, but that a further update was
anticipated from NHS England. It is the
LMCs understanding that PCTs accredited
PwSI’s for a three year period, enabling
PwSI’s to continue for a maximum of 3
years following the demise of the PCT. It
was noted that Dr Biernacki is currently
the only PwSI in DGS.
Frequency of Phlebotomy Collections
Darent Valley are keen to introduce twice
daily collections, and have requested an
estimate of practices interested in
utilising this service. It was noted that
the service currently costs approximately
£11 per month, which would potentially
double should practices decide to opt for
a twice daily collections. Bhaska Bora
agreed to discuss with practices, it was
suggested it be put to a vote at the next
District Nursing & Community Contract
There remain serious concerns with the
current provider of the DN Service. The
CCG are working closely with KCHT, who
they have placed on a rectification plan
to manage quality and performance
issues. It was noted that their remained
disquiet amongst DN staff, exacerbated
by the 17% vacancy and 8.7% sickness
rates, equating to almost 1/3 of the
The CCG reported that work undertaken
by Julie Hunt to move DN into GP cohorts
is going well, and that it is anticipated
that workshops will be set up to bring
practices and DN together to develop
good working relationships from 1st
October 2014.
The CCG will be discussing with its
governing body a mandate to go out to
tender for this service. The importance
of the specification and the need to focus
on creating greater synergies was
There were discussions around the system
in place in A&E from 8am-8pm whereby
navigators are the first point of call
before escalation to either a registrar or
consultant. It was noted that the system
is in its infancy and that issues are being
addressed fortnightly to ensure a robust
system is in place. Anyone experiencing
retirement, whilst giving consideration to
deprivation and an expanding community.
It was noted that following approval for
the Garden City at Ebbsfleet and the
anticipating the highest level of
accelerated growth.
Queen Mary’s Hospital
Anxieties were expressed at the lack of
information available regarding changes
at St Mary’s hospital. It was noted that
Darent Valley are currently managing
elective work at QM, and urgent care is
currently run by the Hurley Group on
behalf of CCG.
It was noted that
inpatient services will move in December.
The Primary Care Strategy Group have
approved the strategy as the direction of
travel, but anticipate changes to reflect
local feedback. DGS have organised a
workshop on the 15th November to look at
the future of local primary care.
Patricia Davies reported that workforce
issues were discussed at the research and
innovation hub, in particular thinking
encouraging consolidation of training and
encouraging GPs to stay longer term,
There were discussions around the
potential impact with diverts of nonelective work from south London, causing
additional activity and internal capacity
The Ophthalmology Service at QM is
currently provided by Kings College, and
both Kings and Moorfield provide a
service at DV. It was noted that DGS are
looking to develop an integrated
There were discussions around the
benefits creating specialist general
practitioner roles to offer a more
attractive option for GPs. A collaborative
approach was agreed as the best way
Patricia Davies reported that COTs will
provide 3 options (Fawkham Mannor,
Maidstone or Medway). David Lawrence
commented that the service provision is
excellent and suggested it should include
Domiciliary Visits. It was agreed that a
fully integrated service is required with
clear signposting for referrals.
Upskilling Practice Nurses in minor
injuries or prescribing was suggested in
the interim to help nurse practitioner
recruitment problems. Concerns were
raised around potential issues around
The Primary Care Workforce Facilitator
role will be key along with closer links to
It was suggested that an update be
provided on DXS. There were discussions
around communicating using the intranet
or DXS. David Woodhead commented
that the DXS system costs around £40k
per year, and is only currently utilised by
less than 1/3 of practices. It was noted
that the DXS system does not allow users
to amend details. The CCG are keen to
ascertain the best way forward and are
considering options.
DGS and Swale CCGs have submitted a
Cocommissioning of Primary Care Services
utilising the template provided by NHSE.
DGS see the template as a trajectory to
be worked through. The need to mitigate
potential conflicts of interest was
discussed. The Government anticipates
that a pilot would run in October 2015.
The CCG commented that they value the
opinion of the LMC and are keen to
involve them in further discussions on
receiving further guidance from NHSE.
Primary Care Strategy - Workforce
The CCG are working closely with the
LMC and HEKSS, who are carrying out a
survey to give a more detailed
understanding of the attrition rate and
figures regarding GPs coming up for
Enhanced Services Update - LARC
specification to its members, feedback
from which highlighted concerns around
pricing, and indicated an inclination to
withdraw from providing the service.
The LMC wrote to Public Health detailing
the concerns raised following extensive
feedback from LMC reps, who have
subsequently agreed to extend the
current contract until 31st March 2015 to
facilitate further consultation and
address concerns. It was noted that the
final specification and prices will be
shared in January 2015, prior to the new
service commencing from April 1st 2015.
initiate/prescribe and amber indicating
shared care.
It was agreed that
consultation with the LMC should take
place where red or amber lights are
safeguarding and the difficulties in
contacting the safeguarding team on the
number advertised. The importance of
ensuring contact details are regularly
updated was highlighted. The CCG will
ask Geoff Wheat, Chief Nurse to update
and re-circulate information.
LMC Annual Conference
Liz Mears extended an invitation to all
attendees to come to the LMC Annual
Conference on the 12th November 2014.
The event is free to attend – anyone
interested please email [email protected]
Shared Care
Concerns were raised round the shared
care for Denosomab/Aricept.
Egan confirmed that the CCG are still in
the process of evaluating this as part of
their review, but have not currently
agreed to additional funding for shared
Date of Next Meeting
The next meeting will be held on Tuesday
6th January 2015 at DGS CCG Offices Floor
2 Gravesham Civic Centre DA12 1AU.
There were concerns where work from
secondary care shifts to primary care
without associated resources.
There were discussions on clinical
monitoring and the introduction of
additional Primary Care Mental Health
Specialists (CPNs) and dementia nurses to
support GPs in delivering this service. The
CCG reported that they have received
positive feedback on the CPNs service. It
was noted that there are two Primary
Care Mental Health Specialists (CPNs) for
patients with stable, enduring mental
health conditions requiring short-term
intervention, and they are keen to
engage with practices:
Manjit Gill [email protected] 07880
404478 for Gravesend
Jacqui Langford [email protected]
07879 812379 for Swanley and Dartford
Issues around areas of responsibility and
the assumptions with shared care were
discussed. Jabeen Egan agreed to forward
an update of shared care agreements to
the LMC for information.
There were discussions around the
introduction of a traffic light system, red
indicating the GP are unable to