The professional voice of general practice in Enfield 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

ENFIELD LOCAL MEDICAL COMMITTEE MEETING

To be held at 1.30 pm to 3.30 pm on Monday 17 December 2012 in the Edward Beale Room,

West Lodge Park Hotel, Cockfosters Road, Hadley Wood, EN4 0PY Lunch available from 13.00

PART ONE

(LMC Members only) 1.30 pm to 2.45 pm

AGENDA

1.0 Apologies

2.0 Declarations of interest Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate

3.0 Minutes and matters arising not listed elsewhere on the agenda: 3.1 Minutes of LMC meeting on 29 October 2012 (pages 3-9) 3.1.1 Vacancies on the Committee (minute 3.5) –members to feed back 3.1.2 Co-option of a practice manager (minute 3.6 refers) - ongoing 3.1.3 Meeting format and schedule for 2013 (page 10) (minute 5.0 refers) – to receive and

discuss proposed meeting dates for 2013 3.1.4 Christmas and New year opening (minute 13.1) – Dr Grewal to update 3.2

Draft and unconfirmed minutes of the NCL Cluster and LMC Chairs meeting on 30 October 2012 (these are reproduced under item 2 on the part 2 agenda)

4.0 Register of interests To discuss the suggestion that a Register of members’ interests be sent out with each agenda

5.0 Chair and LMC members to report on any meetings attended as LMC representatives including: Meeting on 29 November 2012 between the LMC and the Local Authority and public health representatives

6.0 Items for discussion: 6.1 Enfield Primary Care Strategy Implementation – members to discuss their views about

how the strategy is being rolled out in the borough

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6.2 Enhanced services (these are reproduced under item 7 of the part 2 agenda) – to discuss:

• Matrix of schemes

• COPD LES

• Enhanced Access LES • DVT LES

• Anticoagulation LES • Minor Ailments Scheme

To note Dr Sadhu’s comments on the above enhanced services (pages 11-12) 6.3 GP workforce Development – proposals for Clinical Associate posts (reproduced under

item 6 of the Part 2 agenda) 6.4 Audit of GP referrals (reproduced under item 6 of the part 2 agenda) 6.5 Co-ordinate my Care – Dr Grewal to update 6.6 Request to use GP2DRS system to extract practice registers for diabetic eye screening

(pages 11-26) Please note that at the time of sending out this agenda an Enfield specific paper had not been forwarded to the office)

6.7 PMS issues – to raise any PMS issues 6.8 Sessional GP issues – to raise any sessional GP issues 6.9 LMC Annual Conference on Thursday 23 May 2013 and Friday 24 May 2013 (pages

29-30) To nominate two representatives to attend the Annual Conference

• To confirm whether the representatives wish to attend the Annual Conference dinner on 23 May 2013

• To confirm whether the representative (s), if a BMA member, wishes his/her name to be put forward to attend the ARM in Edinburgh from 23 to 27 June 2013

7.0 Part Two agenda

To discuss any items on the part 2 agenda not already discussed 8.0 Items to receive: 8.1 GPC News 4 November 2012

http://www.lmc.org.uk/visageimages/newsletters/GPC/News%204%20-%20November%202012.pdf

8.2 Londonwide LMCs Honoraria policy (pages 31 - 45) 8.3 LEAD (pages 46-47) – to receive a list of the forthcoming events 9.0 LMC newsletter items – members to identify newsletter items 10.0 Date of next meeting: 28 January 2013 (LMC members only) 11.0 Any other business

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Minutes of from the meeting of Enfield Local Medical Committee held at 1.30 pm 29 October 2012, in The Edward Beale Room, West Lodge Park Hotel,

Cockfosters Road, Hadley Wood, Herts EN4 0PY

Part one Confidential

Present: Dr Niel Amin Dr Olanrewaju Durojaiye Dr Sarit Ghosh Dr Richard Harris Dr Sinnappo Karthikesalingam Dr Manish Kumar Dr Tathagata Sadhu Dr Pavan Sardana Dr Ujjal Sarkar Dr Jonathan Warren In attendance: Mrs Jane Betts, Director of Primary Care Strategy, Londonwide LMCs Ms Gracie Edevbie, Committee Liaison Executive, Londonwide LMCs Dr Tony Grewal, Medical Director, Londonwide LMCs Miss Nicola Rice, Committee Liaison Executive Londonwide LMCs

Item no.

Action Organisation / person

responsible 1.0 Welcome and apologies

Apologies for absence were received from Dr Sharma.

2.0 Standing orders of LMC and roles and responsibilities of LMC members

2.1 Standing Orders The Standing Orders were adopted.

2.2 LMC members roles and responsibilities The members roles and responsibilities were adopted. Dr Grewal advised members that if they were approached by the media for a quote on a news item as an LMC member they might wish to contact the Londonwide LMCs communication team for advice before speaking to the press.

3.0 Membership

3.1 Members Terms of Office The membership terms of Office were noted.

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3.2 Drawing of lots to determine terms of office

The following members drew lots to determine who would serve for two years or four years: Dr Niel Amin – term of office to end 31 August 2014 Dr Lanre Durojaiye – term of office to end 31 August 2014 Dr Sarit Ghosh – term of office to end 31 August 2016 Dr Manish Kumar – term of office to end 31 August 2014 Dr Tathagata Sadhu – term of office to end 31 August 2016 Dr Ujjal Sarkar – term of office to end 31 August 2016.

3.3 Election of Chair Dr Manish Kumar was elected unopposed to serve as Chair until 31 August 2014

3.4 Election of Vice Chair Dr Ujjal Sarkar was elected unopposed to serve as Vice-Chair until 31 August 2014.

3.5 Vacancies on the Committee It was noted that there was 1 vacancy in Edmonton and 2 vacancies in Southgate. Dr Grewal asked members to talk to their colleagues in the respective areas to see who might be interested in being on the Committee.

LMC members

3.6

3.6.1

3.6.2

3.6.3

Co-options Co-option of a practitioner representing a particular class of experience It was agreed that Dr Ron Singer should be invited to be co-opted onto the Committee by virtue of his long experience as a former LMC member and interest in medico legal politics. Co-option of a Practice Manager It was agreed that an item would be included in the next Enfield newsletter inviting practice managers who would be interested in being co-opted onto the Committee, to send in a statement. It was also agreed that the Practice Manager group would be informed of this course of action. Co-option of a Practice Nurse representative It was agreed that this would be kept under review.

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4.0 Local LMC priorities

4.1

Local LMC priorities Dr Grewal explained that the priorities listed on the agenda were suggestions only and invited the LMC members to consider them

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4.1.1

4.1.2

4.1.3

and any other priorities they could identify. The LMC members agreed that while the introduction of LETBs would be important to consider they considered that in Enfield the main priority areas would be in relation to sources of practice funding, improvement and development of premises and better engagement with the CCG and the CCG Board. The members were particularly concerned about the impact which the PMS review and the possibility that LESs would be put out to procurement would have on practice funding. Local Enhanced Services Dr Grewal reminded members that LESs would be commissioned by CCGs or the local authority via public health and advised members that the LMC would need to continue to ensure that they were fit for purpose and that the LMC was consulted with appropriate timescales to respond. He suggested, therefore that the LMC might wish to consider forming an enhanced services group which would look and comment on LESs with support from the LMC office when required. Dr Ghosh understood that the CCG was in the process of developing a committee to look at LESs and considered that there should be LMC representation on that group also. The LMC agreed to Dr Grewal’s suggestion and it was agreed that the following members would form the Enhanced Services Group to which draft LES specifications would be sent for comments: Dr O Durojaiye Dr S Karthikesalingam Dr Tathagata Sadhu It was noted that the some enhanced services had or were about to be rolled out to practices without them formally having been passed to the LMC for comments. It was agreed that a letter would be sent ot the CCG and the Health and Wellbeing Board reminding them of the need to formally consult the LMC about local enhanced services. Engagement with the CCG It was agreed that the LMC needed to work more closely with the CCG and that a meeting should be arranged for Dr Kumar and Dr Sarkar to meet with the CCG Chair. Members expressed concern about the possibility that CCGs would be performance managing colleagues to which Dr Grewal responded that this was outwith their authority and would be inappropriate as they had no training or experience in this. He considered, therefore, that CCGs would be putting themselves at risk in taking on such responsibilities. Premises The LMC agreed that there was a need to be supportive of any single-handed practices particularly when it was known that a single-handed practitioner was due to retire. Dr Grewal asked LMC members to advise any single-handed practitioner who was due to retire to contact either him or Ms Vicky Ferlia at the LMC office. Dr Sardana queried what was happening in relation to leases for PCT owned premises. Dr Grewal advised that this issue was due to

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4.1.4

4.1.5

be discussed at the meeting between the NCL LMC Chairs and Cluster the following day. He explained that initially it had been proposed that a London agreement be reached but then there had been a move to have a national lease. However, a national agreement was still to be reached and he considered it likely that the leases would move back to being discussed locally. IT issues Dr Warren noted that ISOFT would no longer be providing practices with integrated web support and asked if the LMC could offer any support to practices. Dr Ghosh noted that the Cluster IT support were eager to help practices integrated onto any system of their choice and noted that the transfer from ISOFT to EMIS without data loss had been proven. Dr Durojaiye understood that some advice had been given that practices might wish to delay the implementation of EMIS web as it might affect their QOF points. It was agreed that the LMC office would contact Mr David Thomas to establish if this was the case. Workload issues as a result of the BEH Clinical Strategy Dr Ghosh considered that another of the LMC’s priorities should be to support practices’ increased workload as a result of the walk in centre in Edmonton being closed during the week.

5.0 Schedule and format of meetings for 2013 Dr Grewal reminded members that the current meeting pattern with an LMC Part one and Part 2 meeting every two months had been suggested by the LMC office in response to the transition and as a result of the PCTs delegating their authority to the Cluster. He suggested that the LMC might wish to review this structure once it became clearer who the LMC would be likely to meet with in the future. Dr Sarkar proposed that in view of the constant changes the LMC would need to meet more often and LMC members agreed with this approach. It was agreed that the LMC would continue to meet in even months with Part 1 and Part 2 meetings but that LMC member only meetings should take place in the alternate months on the last Monday of the month. This meeting schedule would commence from January 2013. Dr Sardana undertook to contact Forest Road Group Practice to see if it was possible for meetings to be held there. It was agreed that a list server for Enfield LMC members should be set up to enable LMC members to have an online forum to discuss issues between meetings.

PS

6.0 Minutes and matters arising:

6.1 Minutes of Enfield LMC Part 1 meeting on 25 June 2012 The minutes were agreed as a correct record.

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6.1.1 Scriptswitch (minute 3.1.1 refers)

It was noted that a decision had been taken to continue to use Scriptswitch for the current financial year. It was agreed that any discussions about Scriptswitch in the future should take place during Part 2 meetings.

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6.2 Draft and unconfirmed minutes of the Enfield LMC Part 2 meeting on 25 June 2012 Noted.

7.0 Members reports of meetings attended

7.1 Sub-Committee of the health and wellbeing Board meetings in August, September and October A report of issues discussed at the meetings by Dr Durojaiye was tabled. Dr Grewal thanked Dr Durojaiye for attending these meetings on behalf of the LMC. Dr Durojaiye explained that this group had considered proposals relating to the DVT LES, Access LES, Anticoagulation LES and MAS and it was agreed that a letter should be sent to Mr Sean Barnett to advise him that the LESs must formally be forwarded to the LMC office for consultation. Dr Durojaiye also referred the Committee to the discussions which had taken place with regard to proposals around GP workforce development which would involve four clinical associate GPs being recruited and to offer existing Enfield GPs the opportunity to access training in the borough. One of the anticipated outcomes of this would be to improve patient access by providing an additional 17, 472 appointments capacity per annum. Dr Sardana queried how it would be decided which practices would have access to these posts. Dr Grewal undertook to look into this and clarify with Dr Lennox.

7.2

7.2.1

Members reports of meetings attended Prescribing sub committee Dr Durojaiye confirmed that he had attended the Prescribing Sub Committee the previous week where it had been confirmed that Scriptswitch would continue to be used. He further advised that a proposal had also been tabled relating to the use of Medman to identify errors in scripts. Dr Grewal suggested that this proposal be resisted.

8.0 Enfield issues

8.1 PMS issues Dr Sarkar advised the Committee that an NCL Cluster PMS review group had commenced in May 2012 to consider the PMS review and confirmed that there were LMC members from the five boroughs on

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the group. He advised that the group had met on a monthly basis and at the meeting the previous week the Cluster had indicated that it wished to propose that PMS contracts had a baseline of core funding with additional KPIs which were still to be discussed. He reminded members that joint cluster/LMC workshops had been held in each of the boroughs and that the LMC had arranged a meeting for Enfield PMS practices in which it had been agreed that leads would be identified each representing high, medium and low earners to lead on the negotiations on behalf of the borough. Mrs Betts reported that LLMCs was arranging a meeting for all the PMS negotiating leads on 15 November 2012 to review the current state of play and to decide the next steps.

8.2 Sessional GP issues No sessional GP issues were raised

9.0 NCL Cluster and LMC Chairs Group meeting:

9.1 Minutes of NCL Cluster and LMC Chairs meeting on 26 June 2012 Receive.

9.2 Draft and unconfirmed minutes of NCL Cluster and LMC Chairs meeting on 28 August 2012 Received.

10.0 Londonwide LMCs update

10.1 LETB briefing Dr Grewal urged members to read the briefing and noted that Mrs Andy Michaels and Ms Leah Benson at the Londonwide LMCs office had been working hard on this. He advised that it would remain on future agendas.

10.2 LEAD Reference Group Dr Niel Amin agreed to be on the LEAD Reference Group.

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11.0 Items to receive

11.1 GPC News – July 2012 Noted

11.2 GPC News – September 2012 Noted.

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12.0 Date of next meeting:

17 December 2012

13.0 Any other business

13.1 Christmas and New Year opening hours Dr Grewal referred to the letter which the NCL Cluster had sent to practices suggesting that they could not close early on Christmas and New Year’s Eve. He advised that this was not appropriate and the LMC office would be contesting the letter vigorously.

13.2 Register of interest Dr Sarkar suggested that the register of interest of LMC members be sent out with the LMC agendas. Dr Grewal noted that no other LMCs did this and was not sure that it would be appropriate to include such information. It was agreed that this issue would be a substantive agenda item on the next LMC agenda.

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Proposed meeting dates for Enfield LMC meetings in 2013 Last Monday of the month

Venue: Forest Primary Care Centre Time: Part one – 13.30 to 14.45

Part two – 14.45 – 15.30

28 January 2013 (LMC members only)

25 February 2013 (Part one and Part 2 meetings)

25 March 2013 (LMC members only)

29 April 2013 (Part one and Part 2 meetings)

20 May 2013 (LMC members only)

24 June 2013 (Part one and Part 2 meetings)

29 July 2013 (LMC members only)

19 August 2013 (Part one and Part 2) – do members wish this meeting to go ahead?

30 September 2013 (LMC members only

28 October 2013 (Part one and Part 2 meetings)

24 November 2013 (LMC members only)

23 December 2013 (Part one and Part 2 meetings)

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Dr Tathagata Sadhu

Comments on the proposed LES

1.GP workforce planning- Clinical associates to be recruited are working in ONE practice the locality

and how will they engage in the network/ locality and how the network will benefit? It is likely the

practice where the CAs are based will benefit the most which is against the spirit of working in a

network.

Consider placements in multiple practices for clinical associates.

2. Project Initiation of minor ailment scheme (MAS)-

It is a good concept in principle, but details of the project and how to engage the stakeholders are

not clear. This will need engagement of GPs, pharmacies, hospitals, OOH and local population to

succeed as shown elsewhere in the country.

3. Enhanced Access-

Proposals are very difficult to implement.

31% of payment dependant on Network GP satisfaction survey.

Payments linked to network performance and not individual practices.

Payments for enhanced access8.40 *6 = 50.40 pounds/ hr and difficult to get locums below 75-80

pounds/ hr. so to implement this scheme will possibly result in financial losses for practices.

4. COPD LES-

Proposals are detailed and workable. However payments linked to network performance and will

unfairly penalise practices spending more effort to achieve the targets.

Details of Pulmonary rehab not clear from the proposals.

5. Anti Coag LES-

More details needed as multiple proposals are being recommended, but not sure which one is the

preferred one.

6. DVT LES-

Again good concept. Not sure if clinical input and costs needed to run this service in GP surgery(

doctor/ nursing staff) will be covered by the payments.

Details of the DVT LES which was sent out from the PCT earlier showed a different payment scheme

from the one submitted to the LMC.

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Costings

A&E Attendance (including MFF) £134.40

Follow up £134.40

Anticipated patient numbers for service

Total number of suspected DVT patients 227

Approx number of patients to be referred to the cluster GP practices 159 (70%)

Anticipated number of patients for no further action (from 159) 95 (60%)

Anticipated total number of Patients referred to A&E for treatment (on average 3 x appts) (from

159) 64

Anticipated patients that will not attend the cluster (referred straight to A&E from the GPs) 68

Savings as a result of A&E attendances avoided through no further action (95 patients) £51,072.00

Total savings of primary care based DVT testing hubs £51,072.00

The savings calculated may not be achievable and pts with low risk of DVT are not followed up in A &

E anyway.

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From: Corcoran Stephen (BARNET PCT) [mailto:stephen.corcoran@nhs.net] Sent: 30 November 2012 01:15 To: Nicola Rice Cc: Saldanha Yvette (BARNET PCT); Kumar Manish (ENFIELD PCT); Chalmers-Watson Claire (CAMDEN PCT); Martin Lindsay; Robbie Bunt Subject: Approval needed from 5 North Central London LMCs to switch on the GP2DRS system to extract practice registers for diabetic eye screening. Dear Ms Rice, I'm sorry for bothering you but I would be grateful for your help with our urgent problem. I am a Barnet GP working for the newly-commissioned NCL Diabetic Eye Screening Programme (NCL DESP) one day per week as a GP Liaison. We invite people with diabetes for annual eye photos in order to detect sight-threatening disease requiring treatment because it is usually too late by the time the affected person notices. To do that we collate a screening register from the diabetes registers of around 250 practices in North Central London. We need to update this screening register regularly to ensure that everyone with diabetes is invited, because we cannot rely on everyone being referred individually by their GP, even though the GP could be held responsible if they omitted to refer to screening a person who subsequently lost their sight as a result of delayed detection. There can be marked differences between the register we hold for a practice and the register size recorded for the Quality and Outcomes Framework. If our register is not up to date, we risk causing distress by inviting people who have died and failing to screen people because they have moved or changed their GP. We can overcome these issues with regular but cumbersome batch tracing against the central NHS Spine but we will not know about new additions to a practice register if we are not informed. It is incredibly labour intensive to process lists received in different formats from practices. In addition, contacting practices about patients who don't respond to make sure they have not moved without our knowledge can be protracted and time consuming. In an attempt to get standardised and inclusive registers, we continue to try to get practices to run a set of MIQUEST searches but practices frequently have difficulty running these queries because they are unfamiliar and fiddly with lots of pitfalls. Last year because no alternatives were available, and to stay out of the way during a commissioning process, I cycled around Enfield and visited nearly every practice to run the MIQUEST queries myself, but derived additional benefit by using it as an opportunity to meet and understand practices and to point out the built in searches that list patients who probably have diabetes that practices had not diagnosed or coded - thus boosting prevalence. Unfortunately with a tight budget NCL DESP can ill afford such inefficient methods.

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Recognising the problem, the National Diabetic Eye Screening Programme has commissioned a service called GP2DRS which works with the major GP system suppliers to extract the contact details of people with diabetes to a national server which then re-distributes them to local programmes (phase 1). Phase two will share selected diabetes information such as Hba1c and blood pressure with the eye consultant only if the practice manually adds a Read code for consent to a patient's record. Because we desperately need this service, NCL DESP has signed up to be an early adopter. If the LMCs approve on behalf of their practices we can switch it on and immediately get registers from EMIS LV practices which agree to participate. The other GP systems will come on stream in turn. This would mean getting more registers in before the end of December 2012 which is the cut off in terms of responsibility for the screening service to screen patients before the end of the following March. Therefore there is a clear benefit to be had by practices as well as NCL DESP if the service is switched on as soon as possible. I enclose a formal application to Barnet LMC and a brief guide to the proposed service. I am very happy to prepare similar submissions to Enfield, Haringey, Camden and Islington LMCs. As I am aware of the LMC meeting dates in December, I am writing to see if would be at all possible for each LMC to consider and recommend the service to it's constituent practices as requested in our application, or for the five LMCs to act as a group when making this decision. I am very happy to ask questions and make more expert advice available if requested. We would also be very happy to set up the system in an LV practice in Barnet which members could review. I hope this email is in order and I would be grateful if you could give it your consideration. Many thanks Stephen Corcoran MB MRCP(UK) General Practitioner, The Speedwell Practice, 16 Torrington Park, London N12 9SS GP Clinical Lead, NCL Diabetic Eye Screening Programme, North Middlesex University Hospital, London N18 1QX Mobile 07768 497 579

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Page 1 of 4

North Central London Diabetic Eye Screening Programme

General Practice to Diabetic Retinopathy Screening

(GP2DRS)

Guidance for Practices

1. Introduction The purpose of this document is to inform GP Practices associated with the North Central London

Diabetic Eye Screening Programme (NCL DESP) about the GP to Diabetic Retinopathy Screening

(GP2DRS) system, the Programme’s plans to implement the GP2DRS system and the implications for

the current processes used to maintain patient registers. The document provides GP Practices with

details of:

• an overview of the GP2DRS system;

• the benefits of the GP2DRS system to GP Practices and the importance of GP Practices

signing up to GP2DRS;

• the Programme’s plans to implement GP2DRS;

• the implications of implementing GP2DRS;

• who to contact at the Programme with any questions about GP2DRS.

2. GP2DRS

The principle aim of GP2DRS is to automate the sharing of data between GP Practices and local

Programmes across England in order to keep patient registers up-to-date.

The National Diabetic Eye Screening Programme (NDESP) has been working with GP System and

screening management system suppliers to develop a system that will:

• automatically extract patient data from GP Systems to a central Database;

• subsequently transfer patient data automatically to Programme DR Systems from the central

Database;

• flag any queries and discrepancies against current Programme patient registers

• in the future, automatically return screening results to GP Systems.

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Page 2 of 4

The GP2DRS system will enable the collection of both demographic data and (optionally) key clinical

risk factor data on patients aged 12 and over who are recorded by their GP as having been

diagnosed with diabetes. The demographic data will be available to programmes on an opt-out

patient consent basis once agreement has been obtained with each GP Practice to activate the data

extraction service. The clinical data will be available to Programmes on an opt-in patient consent

basis. Consent from GP Practices is also required for the extraction and transfer of data from their

GP Systems.

GP2DRS is developed and delivered in three phases:

• Phase 1 of GP2DRS will provide Programmes with web based access to patient records from

all their local GP Practices that have signed up to the service via the Database User Interface.

This will enable individual Programmes to manually reconcile these patient records with the

existing patient records held on their screening management systems. Phase 1 will provide

Programmes with more timely and accurate patient register updates from participating GP

Practices and will significantly reduce the associated workload for both Practices and

Programmes.

• Phase 2 of GP2DRS will enable Programmes to receive patient data directly in their screening

management systems where functionality is provided to enable the reconciliation of this

data with their existing patent records. Phase 2 will assist individual Programmes in

matching and updating patient records and will further reduce the Programme workload

associated with managing patient registers.

• Phase 3 of GP2DRS will provide GP Practices with quick and accurate access to screening

results. Phase 3 will provide participating GP Practices with more timely notification of

screening results and will significantly reduce the associated workload for both Programmes

and GP Practices. Phase 3 comprises two sub-phases, Phase 3a and Phase 3b, Phase 3b is

currently out of scope but may be included in the future.

The GP2DRS phases are represented diagrammatically in figure 1.

The following GP system suppliers are participating in GP2DRS:

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Page 3 of 4

A small number of GP Practices are not serviced by the above systems.

3. Benefits of GP2DRS The main benefits of GP2DRS include:

• data is collected automatically, without intervention required by the Programme or GP

Practices. This saves the both the Programme and GP Practices significant time and effort

and minimises the scope for error in identifying the cohort to be screened;

• data is collected more frequently than using the manual approaches. This improves the

quality of the patient cohort collected, reduces the number of ‘missed patients’ and also

reduces the risk of sending screening letters to patients who have died or moved away;

• data is accurate in so far as data in GP System is accurate. All patients coded as being

diagnosed with diabetes become known to the Programme, thereby minimising risk of sight

loss through administrative error;

• GP Practice and programme workload is further reduced due to the automatic transfer of

screening results when GP2DRS Phase 3 is implemented.

The Programme can only maximise the benefits to be realised from implementing GP2DRS where a

high proportion of the local GP Practices also sign up to the service. Failure to achieve a good GP sign

up rate will mean that the Programme will continue to run old, labour intensive and error prone pre-

GP2DRS and new, post-GP2DRS processes in parallel. However, it is recognised that some Practices

either cannot or will not be able to participate, for example because they implement GP Systems

that are not within the current scope of GP2DRS.

GP System Supplier GP System

(CSC (Computer Sciences Corporation)) iSOFT Premiere

(CSC (Computer Sciences Corporation)) iSOFT Synergy

EMIS (Egton Medical Information Systems Limited) LV

EMIS (Egton Medical Information Systems Limited) PCS

EMIS (Egton Medical Information Systems Limited) Web

In Practice Systems Limited LAN

In Practice Systems Limited VES

Microtest Limited Microtest

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Page 4 of 4

4. Programme Plans to Implement GP2DRS In order to implement GP2DRS the Programme is required to produce and execute a detailed project

plan with guidance and support from the NDESP. Key project activities include:

• The production of a business case seeking approval and funding from the Primary Care Trust

(PCT);

• The production of a Local Medical Council (LMC) submission to seek:

o Area-wide GP Practice consent to participate in GP2DRS;

o Agreement on the GP2DRS consent model;

o Support for GP Practice engagement.

• Managing the change from the current processes to the new ways of working with GP2DRS.

The Programme plans to implement GP2DRS Phase 1 from December 2012.

5. Implications of Implementing GP2DRS The implementation of GP2DRS will increase both the effectiveness and the efficiency of maintain

patient registers.

The implications of implementing GP2DRS to GP Practices include:

• Processes will be agreed to continue to receive new referrals and updates to existing patient

records from those GP Practices that are unable to participate in GP2DRS;

• Differences identified in GP System and DR System patient data will need to be investigated

and resolved. An agreed process and clear responsibilities must be established to deal with

data quality issues and to ensure that corrective action is taken and errors are not repeated

with every GP System extract;

• GP Practice coding practice should be reviewed, for example to:

o Avoid the use of Read codes that are not mapped to the GP2DRS data set;

o Ensure the accurate and timely recording of patient consent to the transfer and use

of demographic and clinical data.

6. Who to Contact at the Programme with GP2DRS Questions GP Practices should use the following contact details for GP2DRS related questions:

GP2DRS Manager: Buki Asanbe, Email: buki.asanbe@nhs.net, Telephone: 020 8887 3714

Technical Support: Ronan Corcoran, Email: ronan.corcoran@nhs.net Telephone: 020 8887 3803

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Page 1 of 10

North Central London Diabetic Eye Screening Programme

General Practice to Diabetic Retinal Screening

(GP2DRS)

Submission to Barnet Local Medical Committee

28th November 2012

Introduction: General Practice to Diabetic Retinal Screening (GP2DRS) is a national system for the automatic electronic transfer of patient data from GP Systems to Programmes’ Diabetic Retinopathy Systems (DR Systems). The GP2DRS system is overseen by the NHS Diabetic Eye Screening Programme (NDESP). The North Central London DESP wishes to implement this system and seeks support from the Barnet Local Medical Council (LMC) for the project and agreement on the

associated patient consent model.

The main issues covered by this paper are:

o Inaccurate identification of the diabetic eye screening cohort, particularly

the failure to identify people diagnosed with diabetes, is still thought to

be one of the largest risks to implementing a successful Diabetic Eye

Screening Programme;

o Present methods for maintaining patient registers and their limitations;

o An overview of the GP2DRS system and the benefits to GP Practices;

o An outline of the preparatory work required;

o The proposed consent model for GP2DRS which has received Patient

Information Advisory Group (PIAG, now NGIB) approval;

o The NCL DESP wishes to sign up to the GP2DRS service.

Clinical Director Susanne Althauser, Consultant Ophthalmologist

Programme Manager Ali Askari

GP Clinical Lead Stephen Corcoran (stephen.corcoran@nhs.net)

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Page 2 of 10

1. Background

Local Diabetic Eye Screening Programmes (DESPs) use specialised software for cohort management, invitation, diagnostic analysis and results / outcomes management (DR Systems). Digital Healthcare Limited (DHC) supplies this software to NCL DESP and to the majority of English Programmes. GP computer systems hold the most complete summary healthcare record available, including patient demographics, data on chronic disease management and summaries of acute care episodes. These records are the optimal source of patient information for DESPs wishing to keep their own patient registers accurate and up to date. There is an average of 295 people diagnosed with diabetes per GP practice, assuming 8,500 practices nationally.

2. Maintaining Accurate Patient Registers

It is an NHS target that 100% of patients diagnosed with diabetes are offered annual screening for the early detection and treatment of diabetic retinopathy. This must be offered as part of a systematic programme that meets national standards. Eye examinations provided by opticians or optometrists do not count towards this target (unless the optician is also accredited to screen patients as part of the national screening programme). The only way this objective can be fully met is if the local DESP holds an accurate database of patients with diabetes in their area. The National DESP (NDESP) has released a Standard Operating Procedure (SOP) to assist Programmes in maintaining accurate databases. All Programmes should follow the SOP in order to meet national quality service objectives. The SOP includes regular validation of a Programme’s database against electronic data extractions from each associated GP practice system.

3. The Approach used up to now

The North Central London Diabetic Eye Screening Programme (NCL DESP) commenced on 1st July 2012 and presently receives new referrals to the service and updates to existing records via the following methods. o Manual referrals and updates via post, fax and email.

o Electronic data extraction from each GP System using the results searches

performed by each practice. This was the case with the decommissioned

Barnet Diabetic Eye Screening Service.

o Electronic data extraction from each GP System using a set of 12 MIQUEST

queries have been used in Camden Islington Enfield and Haringey, to enable a

standardised search and report format, facilitating more electronic analysis and

handling.

o Manual validation of existing patient files against the National Tracing Service

to identify people with diabetes who had moved, changed practice or deceased

There are a number of concerns with these existing approaches

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o The content of manual patient data submissions from GP Practices is variable,

and includes the risk of data transcription errors, with the consequence that

patients diagnosed with diabetes may not invited for screening. Practices can

sometimes fail to notify the DESP about patients whom they consider to be

unsuitable or cared for elsewhere. All people aged 12 years and older should

be counted, even if they are unsuitable or refuse screening.

o A QOF register will not include people aged between 12 and 16.

o The frequency of updates from GP Practices can be variable. This may cause

a delay in people being notified to the DESP

o The process of manually requesting and reconciling data from each GP

Practice is very time-consuming, both for GP Practice and Programme staff.

4. GP2DRS Solution

4.1. Overview

The principle aim of GP2DRS is to automate the sharing of data between GP Practices and local Programmes across England, in order to keep patient registers up-to-date. The NDESP has been working with GP System and DR System suppliers to develop a system that will: o automatically extract patient data from GP Systems to a central Database; o subsequently transfer patient data automatically to Programme DR Systems

from the central Database; o flag any queries and discrepancies against current Programme patient

registers; and o in the future, return screening results to GP Systems.

The GP2DRS solution will enable the collection of both demographic data and (optionally) key clinical risk factor data on patients aged 12 and over who are recorded by their GP as having been diagnosed with diabetes. The demographic data will be available to programmes on an opt-out patient consent basis once agreement has been obtained with each GP Practice to activate the data extraction service. The clinical data will be available to Programmes on an opt-in patient consent basis. Information on the consent model is available later in this document. GP2DRS is developed and delivered in three phases: o Phase 1 of GP2DRS is designed to provide Programmes with web based

access to patient records from all their local GP Practices that have signed up to the service via the Database User Interface. This will enable individual Programmes to manually reconcile these patient records with the existing patient records held on their DR Systems. Phase 1 will provide Programmes with more timely and accurate patient register updates from participating GP Practices and will significantly reduce the associated workload for both Practices and Programmes.

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o Phase 2 of GP2DRS is designed to enable Programmes to receive patient data

directly in their DR Systems where functionality is provided to enable the reconciliation of this data with their existing patent records. Phase 2 will assist individual Programmes in matching and updating patient records and will further reduce the Programme workload associated with managing patient registers.

o Phase 3 of GP2DRS is designed to provide GP Practices with quick and accurate access to screening results. Phase 3 will provide participating GP Practices with more timely notification of screening results and will significantly reduce the associated workload for both Programmes and GP Practices. Phase 3 comprises two sub-phases, Phase 3a and Phase 3b, Phase 3b is currently out of scope but may be included in the future.

This GP2DRS phases are represented diagrammatically in figure 1.

4.2. What are the benefits and drawbacks of GP2DRS?

The main benefits of GP2DRS are as follows : o The data is collected automatically, without intervention being required by the

practice. This saves the practice significant time and effort and minimises the

scope for error in identifying the cohort to be screened;

o The data is collected more frequently than using the manual approaches. This

improves the quality of the patient cohort collected, reduces the number of

‘missed patients’ and also reduces the risk of sending screening letters to

patients who have died or moved away;

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o The DESP’s demographic data is as accurate as the practice’s. All patients

coded as having diabetes will become known to the DESP, thereby minimising

the risk of sight loss through administrative error.

The information held by GP Systems about people diagnosed with diabetes is not always accurate and sometimes the most up-to-date details will be held by the local Programme. The NDESP has been working with suppliers to ensure that data inconsistencies are flagged to Programme and GP Practice staff so that the GP System can be updated and brought into line with the DR System. One obvious limitation of GP2DRS is that:

• GP2DRS will not detect people with diabetes that a practice has not diagnosed or coded correctly or people whom the practice should be regularly re-testing because they at high risk of developing diabetes. There are ready-made data quality reports available in GP systems but analysis of QOF returns and visits to practices with unexpectedly low prevalence support the NCL DESP view that these are used inconsistently. NCL DESP favours a collaborative audit to make better use of these reports and increase prevalence figures.

4.3. Which GP system suppliers are involved in GP2DRS?

Listed below are the software systems and suppliers that are participating in GP2DRS: Th

The central Database has been developed by the Database Contractor, Quicksilva Ltd.

4.4. When will GP Practices be able to use GP2DRS?

GP2DRS is being introduced in three phases:

GP System Supplier GP System

(CSC (Computer Sciences Corporation)) iSOFT Premiere (CSC (Computer Sciences Corporation)) iSOFT Synergy

EMIS (Egton Medical Information Systems Limited)

LV

EMIS (Egton Medical Information Systems Limited)

PCS

EMIS (Egton Medical Information Systems Limited)

Web

In Practice Systems Limited LAN

In Practice Systems Limited VES

Microtest Limited Microtest

DR System Supplier DR System & Version Number

Digital Healthcare Limited Optomize 3.7 and above

Health Information Systems (UK) Limited Any

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o Phase 1: only those GP Systems that have satisfied rigorous Connecting for

Health (CFH) quality assurance processes and been given Full Rollout

Approval (FRA) are able to participate in GP2DRS. The majority of participating

GP Systems have now attained FRA, which means that Programmes will be

able to access data from GP Practices implementing these systems via the

central Database. In particular, the central Database will provide demographic

updates when a new patient is diagnosed with diabetes, when the contact

details of a patient change, and when a patient should be removed from the

programme’s register. Initially this will be provided in a printable and electronic

format. It is anticipated that Programmes will phase the implementation of GP

Practices.

o Phase 2: when implemented in early 2013 data can be sent automatically from

the central Database to Programmes’ DR System databases. This will use an

automated tool, the Data Reconciliation Tool to compare the data collated from

GP Systems with the data already stored in Programme patient registers.

Queries and discrepancies will be flagged to Programme users within their own

DR System for resolution.

o Phase 3: Phase 3b is currently out of scope therefore there is currently no

scheduled date by which programmes will be able to transfer screening results

from their DR Systems to patients’ GP Systems.

4.5. What preparatory work will be required?

In the long run, GP2DRS has the potential to save GP Practices a considerable amount of time by automating the transfer of data to local Programmes. Depending on the current processes in use by each GP Practice, the initial reconciliation between the GP System and local DR System can be expected to result in a number of discrepancies that will need resolving. Thereafter, these should be minimal. To ensure patients are accurately identified to the local Programme and any data queries are resolved promptly the NDESP recommends the following: o A review of current referral processes to ensure that referral is only via

GP2DRS once active and all other routes are discontinued;

o Agreement between each GP Practice and the local Programme of how patient consent to the transfer of clinical data will be recorded on the patient record;

o A review of local coding practice at each GP Practice, including the coding of diabetes to ensure that patients with diabetes are coded in line with Quality and Outcomes Framework (QOF) business rules;

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o Agreement between each GP Practice and the local Programme of a pathway for the management of queries arising from GP2DRS, including named contacts in each practice and a method of keeping this contemporaneous.

5. GP2DRS consent model

5.1 Introduction

Consent to the transfer and use of patient data must be managed on a per patient basis. In defining the patient consent model, the NDESP has sought the advice of the Patient Information Advisory Group (PIAG), now the National Information Governance Board (NIGB), which is the statutory body responsible for governing the management and transfer of patient information in the NHS. In consultation with the PIAG, the National DESP has drawn a distinction between demographic data and clinical data:

o Demographic Data: broadly this is the information necessary to enable a

patient to be contacted as part of screening call/recall. It includes NHS number, patient name, date of birth, sex, contact details, GP details, preferred language, and diabetes status.

o Clinical Data: this covers relevant and appropriate clinical data. Data included

directly supports the diabetic retinopathy screening, assessment and treatment process and includes medical history relating to risk factors for diabetic retinopathy such as duration of diabetic condition, HbA1c levels, blood pressure, microalbuminuria levels and smoking history, but excludes sensitive information.

The process for obtaining patient consent is different for each type of patient data (see the sub sections below), although for either case, the patient can withdraw/refute their consent at any time. Patient’s consent to the transfer and use of both demographic data and clinical data are separately recorded in GP Systems using Read Codes. In practical terms, this means that Programmes may only extract/use a patient’s data to the extent that these Read Codes indicate that the required level of patient consent has been given. In addition, as these Read Codes are the key source for determining whether a patient has given consent to the extraction/use of their data, it is vital that a Programme asks the patient to notify their GP Practice if they indicate to the Programme that they wish to withdraw/refute their consent. This allows GP Practices to maintain an accurate record of each patient’s consent status by updating these Read Codes accordingly. Where a patient’s Read Codes are updated to indicate that he/she has withdrawn his/her consent to the transfer of his/her demographic data, the Programme should ensure that the record of that patient is deleted from the central collated Database of extracted data. For the avoidance of doubt, this does not require the Programme to delete any demographic data stored in its DR System, and relevant data retention regulations would still apply.

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Page 8 of 10

Where a patient’s Read Codes are updated to indicate that he/she has withdrawn his/her consent to the transfer/use of his/her clinical data, the Programme should ensure that any clinical data which has been extracted from the GP System regarding that patient is deleted both from the collated Database of extracted data and from the Programme’s DR System. For the avoidance of doubt, this does not require the Programme to delete any clinical data stored in its DR System which was not originally extracted from a GP System.

5.2 Demographic Data

The NDESP approached PIAG for advice as to whether or not it was necessary to make an application for under Section 60 of the Health and Social Care Act 2001 (now Section 251 of of the NHS Act 2006) for the transfer of patient demographics. In December 2004 PIAG advised that there was no requirement to apply for Section 60 support. This decision was made by PIAG because consent to sharing the data required to contact people diagnosed with diabetes could be implied from the common understanding that some aspects of diabetes care cannot be delivered directly by the patient’s GP, provided that information about the use of the data by the local Programme and details of the right to opt out of the process are provided to the patient. In practical terms, if a Programme is an NHS body, this means that it is implied that a patient has consented to the extraction, transfer and hosting of demographic data by that Programme. Programmes are required to ensure that a process for dealing with consent is in place prior to the extraction of any data. In order for a Programme to operate according to PIAG’s advice, all patients should be informed that the data transfer is taking place, who has access to the data, and what they have to do to opt out of this data transfer.

This requirement is being addressed in two separate ways:

1) GPs inform the patient they can expect to be given annual diabetic eye

screening by the Programme. The reasonable assumption is that in order for the screening service to offer this service, they must be aware of the patient’s demographic details and their diabetic condition.

2) A letter will be sent to patients inviting them for screening and informing them of this data transfer, who has access to their data and what they have to do to opt out of the process.

It is important to note that the legal risk of avoidable blindness as a result of a patient’s details not being transferred to the screening programme is the responsibility of their GP to manage. The automatic process to transfer patient demographic data has been designed to assist GPs with this responsibility.

26

Page 9 of 10

Note that implied consent does not generally extend to non-NHS bodies. In such cases, the NDESP takes the view that patient consent must first be obtained/inferred from the patient’s words or conduct, save where the non-NHS body is simply acting as a ‘mere conduit’ for the NHS body. If a patient wishes to withdraw their consent to the transfer of their demographic data (and hence clinical data), the patient should contact their GP to record their withdrawal. As a failsafe, where a Programme subsequently receives notification from a GP Practice that a patient has withdrawn consent to the transfer of their demographic data, they should: o contact the GP Practice by telephone to confirm that this is correct; o if the GP Practice provides confirmation, then the Programme should send the

patient a final letter which: o warns them that this means that they will no longer be invited for

screening, i.e. that they have effectively also opted out of screening as the Programme is unable to function without access to their demographic data

o explains the risks of this action, and o explains how they can opt-back in to screening by contacting their GP.

5.3 Clinical Data

The NDESP approached the PIAG in 2006 for advice as to how to obtain consent to transferring relevant and appropriate clinical data. Consent to the transfer and use of clinical data (whether to NHS or private sector bodies) must first be obtained/inferred from the patient’s words or conduct. Therefore, in order for a Programme to comply with this advice: all patients should be informed before the transfer of clinical data takes place of what data will be transferred, who has access to the data, and what they have to do to opt out of this data transfer.

The patient’s consent can be inferred by the Programme indicating in the patient’s invitation to screening that it intends to obtain the patient’s clinical information from the patient’s GP, with a clear explanation of which organisations will have access to the clinical information, how it will be used, and how to opt out of its transfer; and the patient’s consequential attendance for screening, or accepting an appointment for screening, unless at any time the patient indicates to their GP or to the Programme that he/she wishes to opt out of the transfer of clinical information. Programmes must ensure that no clinical data is extracted from a GP System in respect of a patient until that patient has confirmed or attended his / her first screening appointment after receiving this information. Following attendance at screening, the Programme will advise the GP Practice that the patient has consented (unless the patient opts out). The GP Practice can then record the patient’s consent in the GP System, enabling clinical data to be transferred.

6. Submission

27

Page 10 of 10

The Local Medical Committee is requested to: o Formally approve the GP2DRS consent model; o Provide area-wide consent to GP Practice participation in GP2DRS;

o Provide support in GP Practice GP2DRS communication and engagement. The LMC is asked to note the following: o GP2DRS has already been shown to work effectively in a number of pilots

implementations using EMIS, iSoft, In Practice and Microtest GP Systems.

o The NCL DESP is seeking to implement GP2DRS Phase 1 followed by Phase 2.

o Because of the particular difficulty of implementing MIQUEST searches in

Barnet and because it has applied to be an early adopter, NCL DESP would like to start rolling out GP2DRS to interested GP Practices using EMIS LV from December 2012 and other practices at a later stage. With this in mind, our GP Clinical Lead will be communicating further details to GP Practices.

o Further information regarding GP2DRS can be obtained from our GP Clinical Lead, Dr Stephen Corcoran.

Barnet LMC is asked to provide a response and any comments to stephen.corcoran@nhs.net as soon as reasonably possible.

28

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30

 

Name of Policy Honoraria Payments Policy

Authorising group Board of Directors

Effective date 22 November 2012

Latest Review Date December 2014

Version number 1.0

Policy Owner/Author Company Management Team/ Paul Tomlinson, Director of

Resources

Staff Reference group Sue Broome, Michelle Drage, Julie Freeman, Tony Grewal,

Theodora Kalentzi, Gill Rogers, Joni Wilson-Kaye, Helen

Musson, Punam Sood.

Register of amendments Date

31

2 

 

Honoraria payments policy

1.0 Introduction

1.1 This policy covers payments of honoraria by Londonwide Local Medical Committees

Limited (LLMCs), referred to in this document as the company, to constituent LMC

members.

1.2 Londonwide LMCs is the professional voice of General Practice, representing LMCs

in 27 boroughs across the capital. Representation is important at a number of levels:

1.2.1 LMC members reflect the thinking of practices in the area and relate to

their needs and issues

1.2.2 LMCs discuss and act upon issues relevant to their area, consider pan

London and National issues and relate this to local issues and opinion

1.2.3 At all levels where decisions are made with impact upon general practice -

eg National Commissioning board, Clinical Commissioning Groups etc.,

Local Authorities and Public Health

1.3 GPs are not contracted, or otherwise funded for representative activity outside of

practice. Engagement with the representative activities means time away from work

and creates a financial and workload impact for the doctors and practice staff

concerned.

1.4 As a membership organisation, Londonwide LMCs receives statutory and voluntary

levies which are deducted from practice income at source, to create a pooled fund to

resource activities that will support representatives in discharging their statutory

functions.

1.5 The statutory levy is capitation based and covers all the GPs working at the practice

as well as sessional GPs working in that CCG area

1.6 The voluntary levy, also capitation based, which, inter alia, covers payments to the

GP Defence Fund, GPC and charities (The Cameron Fund, Royal Medical

Benevolent Fund, BMA Charities, Sick Doctors Trust). This levy does not fund

honoraria payments

1.7 Londonwide LMCs holds the levy funds on behalf of members. The Board of

Directors agree an annual budget to support representation by paying honoraria to

GPs and practice staff who take time away from work to support LMC business.

1.8 This policy will aim to set out the circumstances where honoraria will be paid, the

responsibilities and expectations associated with payments and arrangements for

claims.

2.0 Equality Impact Assessment

2.1 The language and intent of the policy have been reviewed carefully to ensure that in

supporting the policy principles there is no detriment to any group or individuals for

any reason including anyone with a protected characteristic as described in the 2010

Equality Act. The company welcomes feedback on its policies as it seeks to

continuously improve, please notify the Director of Resources if you have any

suggestions on how to improve the inclusivity of this policy or if you believe there are

any areas of detriment that can be redressed.

3.0 Aims of policy

3.1 This policy aims to provide clarity in the following areas

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3.1.1 To set out governance arrangements around honoraria for

Londonwide LMCs

3.1.2 To ensure transparency and equity of expectations of claimants and

the levels of claims

3.1.3 To ensure that appropriate members are identified to attend key

meetings and that those individuals contribute and feed back

3.1.4 Manage meeting attendance and claims to maximise the value of

representation within the resources available

3.1.5 To provide a framework to identify where local determination is

appropriate and the scope of decisions that can be made

3.1.6 The types of activity for which honoraria will be paid

3.1.7 The roles and responsibilities expected of members who receive

honoraria

3.1.8 Arrangements for claiming and receiving honoraria payments

4.0 Definition of an honorarium (pl Honoraria)

4.1 An honorarium is a payment made by Londonwide LMCs to an LMC member for:

Being Chair of an LMC,

Being a vice-chair of an LMC or borough subcommittee within an overarching multi

borough LMC,

Attending LMC meetings

Performing tasks on behalf of the LMC,

Other purposes as determined by Londonwide LMCs, in accordance with the

schedules in section 5

4.2 Honoraria payments are not intended to specifically relate to the actual cost of

attendance or provide full backfill payment for the member. They are a notional payment

based on the criteria outlined for each type of payment.

4.3 The levels of the honorarium will be determined by the Board of Directors of Londonwide

LMCs from time to time. The board will also set out the responsibilities attached to an

honoraria claim. This policy is agreed by the board.

4.4 Payments do not create a contract of employment between the company and the

individual claimant. To comply with HMRC requirements, appropriate taxation is

deducted from honoraria prior to payment to individuals.

 

5.0 Types of payment

5.1 Honoraria payments can be separated into two categories:

Fixed payments for LMC chairs

Attendance honoraria for members (including chairs) who attend agreed

meetings or undertake other events/activities agreed by Londonwide LMCs.

5.1.1 A list of rates correct at the time of writing is included in Appendix 1 at the end

of this policy. Details of the types of payment made are shown in the

schedules below.

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4 

 

5.2 Chairs Honoraria (including locality chairs)

Description A fixed annual payment to cover the roles and duties of LMC Chairs

or locality chairs

Payment £8,000 for one LMC responsibility

£4,000 payment for each additional LMC under chairs control

£4,000 for a locality or subcommittee chair where they do not have

full chairs responsibility. Apportionment of payment will depend on

precise cirumstances and will be determined by Londonwide LMCs

in collaboration with the overall LMC chair.

Fixed chairs payment may be paid to vice chairs who are providing

extended cover for the chair e.g. vacancy or extended absence.

Responsibilities

included in

payment

Preparation for LMC meetings e.g pre-meetings and reading papers

Managing LMC related e-mail

Phone calls from constituents

Calls/meetings with LLMCs

Handling membership enquiries

Meeting prospective members at constituent practices

Attend Chairs/Vice Chairs meetings

Participate in appraisal/peer review

Development of members

Engaging in pre-meetings and planning activity

Engage strategically

Ensure the operational effectiveness of their LMC

Ensure appropriate participation and inclusion of members

Identification of members to represent others at external meetings

including encouraging members to represent the LMC outside the

committee.

Travel time and costs

Meetings where

additional

Honoraria may be

paid/claimed (if

not paid by host)

where attending in

LMC capacity

LMC meeting (Automatic payment through attendance list)

Cluster meetings (Automatic payment through attendance list)

Health and Wellbeing Boards

Clinical Commissioning Groups (CCGs)

Clinical meetings e.g. Medicines Management

Safeguarding Children meetings

LMC local working groups (e.g. enhanced services, PMS, premises)

Local Educa

LMC conference

LLMC AGM

Board meetings (if a member)

Approved Media engagement

 

 

 

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5 

 

Quality Outcomes and Measures for LMC chairs

Chair role and responsibility

Main aspect of the quality standard

Quality Outcomes Measures

Leadership Represent all LMC members

All LMC members involved including those in the minority at meetings and through communications outside of meetings

Through yearly appraisal accessing relevant available information

Balanced view presented that precludes individual interests

Through yearly appraisal accessing relevant available information

LMC views are represented at meetings outside of committee meetings

Participates in meetings outside of the LMC. Attendance record and written feedback to LMC meetings

Operational Effective LMC meetings

LMC meetings are presided and attended by the chair

Attendance record

Development and management of LMC meetings is actively led by the chair

Responds to outputs of LMC meetings eg agenda, actions and minutes. Feedback from Londonwide LMCs

Local priorities delivered Objectives set at the beginning of the term begin to be realised through reflection at end of the two year term. LMC members aware of local priorities and aims of committee during two year term. Chair regularly reminds members at meetings and included in minutes

Communication Effective relationships

All communications to constituents is relevant and timely

Lead on and ensure that all LMC members contribute to local news. Regular news sent to constituents

Key stakeholder organisations consult with the LMC at an early stage to share information and knowledge

Leads on and has key working relationships with influential individuals in key stakeholder organisations. Through yearly appraisal accessing relevant available information

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6 

 

Development Acquisition and maintenance of relevant skills

Demonstrates o Leadership skills o Negotiation/

influencing/ facilitation skills

o Time management o Communications/medi

a skills o Chairing skills

Identified learning needs through yearly appraisal. Attend/complete relevant training

Keeping up to date

Fully briefed and able to use and share information appropriately

Through yearly appraisal accessing relevant available information

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5.3 Attendance honoraria

Description Payment made to LMC members for attending LMC meetings

or other meetings in an LMC capacity as directed and approved

by the chair of the meeting

Payment Hourly rate for meetings as detailed in Appendix 1

(£82 per hour in November 2012)

Responsibilities

included in payment

Read papers and prepare for meetings in advance

Engage with and contribute to meetings

Represent colleagues

Travel time and costs

Meetings where

additional Honoraria

may be paid/claimed

(if not paid by host)

where attending in

LMC capacity as

directed by LMC

Secretary/ Medical

Director

Cluster meetings (Automatic payment through attendance list)

Health and Wellbeing Boards

Clinical Commissioning Groups (CCGs)

Clinical meetings e.g. Medicines Management

Safeguarding Children meetings

Local LMC working groups

LMC conference

LLMC AGM

Approved media engagement

Vice chairs to receive an additional 1 hour honoraria payment

to cover preparation time when chairing an LMC meeting on a

one-off basis.

Outcomes/ Quality

measures

Feedback to LMCs

Representation of constituents and two way engagement with

them.

5.4 Honoraria for Board Members

Description Attendance payment to elected and co-opted board members

Payment £304 per meeting

Responsibilities

included in payment

Attendance at all board meetings

Responding to enquiries in role as a board member

Attendance at AGM

Preparation for board meetings

Engagement with business issues

Contact with Londonwide LMCs

Additional payments External meetings where attending in role as LMC director

Additional extraordinary board meetings or away days

Outcomes and Quality

measures

Stability and progress of the company

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5.5 Honoraria for Observers e,g. Practice Nurses and Practice Managers

Description Payment made to Non GP LMC members, who attend meetings

or support LMC Work

Payment Half honoraria rate of GPs

Responsibilities

included in

payment

Read papers and prepare for meetings in advance

Engage with and contribute to meetings

Represent colleagues

Provide consultative advice as required

Meetings where

additional

Honoraria may be

claimed (if not paid

by host) where

attending in LMC

capacity as

directed by LMC

Chair

LMC meetings

Other meetings or activities as directed by the chair

Outcomes and

Quality measures

Provide feedback to LMC meetings

Represent colleagues in their professional group

5.6 Other situations

5.6.1 There are some circumstances where LMC members convene a meeting

endorsed by LLMCs but the meeting is not serviced LLMC staff, e.g. locality

meeting. Where it has been agreed with the LLMC office that honoraria will be

paid to LMC members, the chair of the meeting must take an attendance

register of those who attend and submit it to the LMC office with a brief written

update regarding the meeting and any outcomes. The chair should forward

the attendance list to the LLMC office who will process payments

automatically for those who have signed in.

5.6.2 An honorarium based on a daily rate will be paid to those LMC members

attending the two day LMCs Annual Conference as the nominated LMC

representative. Claims for attendance at the Annual Conference should be

submitted to the LMC office using the honoraria claim form. Expenses such

as travel and accommodation may be paid where appropriate by the BMA in

accordance with their reimbursement of expenses policy which will have been

sent to the LMC Annual Conference representatives.

5.6.3 The GPC convenes meetings twice a year on average to provide an

opportunity for LMC members to attend the GPC/LMC negotiating meetings.

The LMC will pay an honorarium to those LMC members who attend such

meetings. An attendance register will be taken at the meeting and payment

of honoraria will be paid accordingly.

5.6.4 On occasions Londonwide LMCs may convene meetings which take place in

the evening in relation to which honoraria payments are not made but a hot

meal is provided instead. In these circumstances this will be clearly explained

in any communications to LMC members inviting them to such meetings.

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Honoraria Payments for such meetings will only be made where they have

been agreed by the company.

5.6.5 If an LMC member attends a LEAD event as a speaker they should comply

with speakers arrangements. Often this is the Honoraria rate but speakers

should check the agreement and claim accordingly.

6.0 Claiming honoraria

6.1  Londonwide LMCs aim to process all honoraria claims in a timely and accurate way.

Members are responsible for ensuring that personal information relating to honoraria

payable to them is accurate and up to date. Honoraria are paid by Londonwide

LMC

bank account nominated by the LMC member. Members are required to provide the

office with their national insurance number and bank account details. Members are

also required to provide their date of birth to the office, as this is now required in

6.2 Payments are processed automatically when members attend an LMC meeting. If

they attend an external meeting or undertake other LMC work, they will need to make

a specific claim using the form shown in appendix 2.

6.3 Claims should be submitted as soon as possible after the honorarium becomes

payable, members should aim to submit their claims within 6 weeks of the activity.

Unclaimed honoraria represent hidden cost and therefore risk for the company which

it needs to manage. The company therefore reserves the right to decline claims that:

Relate to activity more than 12 months ago

Relate to activity that is not in the current financial year. To allow for processing

of claims for meetings near to the end of the financial year, the company will

accept claims 3 months after the end of the financial year for the previous

financial year

Represent claims for activity covering 12 months or more (which may be very

large claims)

6.4 By signing the attendance register members are deemed to be making a claim for honoraria. Members are expected to attend for an entire meeting unless prior notification has been received by the office. Members arriving after the start of a meeting or leaving before the end of the meeting and who have not previously notified the office will be paid a reduced honorarium proportionate to attendance. Proportionate payments will be agreed between the chair, the Medical Director and the Director of Primary Care Strategy. Londonwide LMC staff will process payments.

6.5 To be eligible for honoraria payments, LMC members are expected to follow defined roles and responsibilities which will be updated periodically.

7.0 Budget

7.1 The board of directors will agree the budget for honoraria each year

7.2 A notional budget will be provided for each LMC showing their expected budget

for honoraria use. .

7.3 Each LMC will need to plan their meetings, membership and honoraria claims to

make best use of resources. Budget pressures must be identified and addressed,

extra resource may be available where there are constitutional reasons for the

additional expenditure.

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8.0 Appeals and queries

8.1 This policy aims to set out a clear and fair claims process for LMC members that is

applied consistently. Should you feel that you have a claim that has been wrongly

declined or if you are aware of inconstant application of the policy, please contact the

Director of Resources or the Chief Executive who will review the situation.

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Appendix1

Honoraria rates from 1 October 2012

Attendance honoraria

(based on a notional £82.00 per hour)

From

1 Oct

2012

LMC meeting (standard length of 2 hours) £164

LMC Executive/SJLC (2 hours) £164

GPC Negotiat £205

£246

Attendance honoraria

Practice managers, Practice nurses or other observers £41 per

hour.

(based on an annual honorarium of £8000)

Whole time rate £2,000

Half time rate £1,000

Additional LMC responsibility £1,000

LMC Board Members

Meeting Rate £304

Attendance at LMC Conferences

Annual LMC Conference (per day) £478

Special Conference (full day) £478

Notes:

1. Bromley attendance rates are higher for historical reasons. They are therefore to be maintained at current levels until they fall in line with the rest of Londonwide LMCs.

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2. Maximum payment/ meeting length- 3 hours

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Appendix 2

Honoraria Claim Form (for meetings other than LMC meetings) Please submit your honoraria claim as soon within 6 weeks or the event so that we

can process your claim in time.

Please e-mail your claim to CLE (e-mail address) Or post it To: CLE Name Londonwide Local Medical Committees Limited Tavistock House North Tavistock Square

London WC1H 9HX

Date of the

meeting

Name of the meeting Time/ Duration Approved

(Office use

only)

By signing this form, I confirm that:

I attended the above meeting(s) on behalf of the LMC

And I have attached a report/feedback from each meeting attended (where relevant in accordance with the honoraria policy).

.....

Date............................................. LMC

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Upcoming Londonwide LEAD Events January 2013

Wednesday 23 January 2013

Practical guide to risk management workshop

GPs & practice staff

Venue Hamilton House Meeting and Conference Centre Cost £75 (inclusive of VAT) for attendees from Londonwide

practices £90 (inclusive of VAT) for attendees from practices from other areas

Contact kcooper@lmc.org.uk

February 2013 Wednesday 6 February 2013

Health and safety seminar Practice Managers

Venue Woburn House Conference Centre Cost £75 (inclusive of VAT) for attendees from Londonwide

practices £90 (inclusive of VAT) for attendees from practices from other areas

Contact kcooper@lmc.org.uk

Date to be confirmed

Patient registration and new patient checks seminar

GPs & practice staff

Venue To be confirmed Cost £75 (inclusive of VAT) for attendees from Londonwide

practices £90 (inclusive of VAT) for attendees from practices from other areas

Contact kcooper@lmc.org.uk

March 2013 Tuesday 5 March 2013 (am)

Increase your patient consultation effectiveness workshop

GPs

Venue Woburn House Conference Centre Cost £99 (inclusive of VAT) for attendees from Londonwide

practices

£119 (inclusive of VAT) for attendees from all other areas Contact mvassallo@lmc.org.uk

Please turn over for more events

46

March 2013 (continued) Tuesday 5 March 2013 (pm)

Enhance your telephone consultations skills workshop

GPs

Venue Woburn House Conference Centre Cost £99 (inclusive of VAT) for attendees from Londonwide

practices

£119 (inclusive of VAT) for attendees from all other areas Contact mvassallo@lmc.org.uk

Date to be confirmed

General practice nurse workshop: mental health/dementia

General Practice Nurses

Venue To be confirmed Cost £59 (inclusive of VAT) for attendees from Londonwide

practices £71 (inclusive of VAT) for attendees from practices from other areas

Contact mvassallo@lmc.org.uk

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