GLOUCESTERSHIRE
LOCAL MEDICAL COMMITTEE
ANNUAL REPORT
2011 - 2012
LMC CHAIRMAN’S INTRODUCTION
Looking back over last year is always a chance for reflection on evaluation of work done and
outcomes achieved. Our tireless and hard-working LMC office team have continued to work
effectively to deliver what I hope you will agree is a vital service to all practices and all this done
without increasing the LMC levy for the year. Mike Forster has once again proved to be an
excellent appointment to lead the team and I’m sure you will agree with me that his efforts, his
skills and his diplomacy have won us great respect with all practices and also with the new upand-coming agencies spearheading the future of NHS delivery.
This has been a significant time of change in the health community and with change comes
turbulences. The LMC has the value of a long and distinguished institutional memory and this has
served us well in holding the current health organisations to account in its statutory responsible
role to be consulted on the changing developments and the delivery of the NHS White Paper
reforms. We have made good progress in forging new relationships with these organisations but
have had to engage in a more complicated dance between PCT, shadow CCG and the emerging
and (some would say) staggering changes in the organisation of Gloucestershire Care Services.
As an organisation the LMC will always remain true to its core function of supporting and
representing general practitioners and their practices within the County. We have therefore
reviewed our own organisation to make it fit for purpose for the future. We have embraced the
challenge of changing style and image to help us mould new health care delivery while protecting
our members from the increasing pressures of reform, budgetary restraint and increasing
demand.
It is my belief that the current executive now in place, with the support of all the committee (now
rejuvenated by the energy of newer members) are fully up to the challenges facing us. A war is
not won by one battle alone but by consistent small victories which leads to a winning campaign.
Hearts and minds and changing attitudes are just as important in this task as waving weapons.
We will continue to build our relationship with the CCG and at all times remind them that they are
accountable through their own constitution to their practice membership. Leaders are accountable
to their followers and this will be a strong theme for negotiators in the months and years to come.
We’re still in the very early stages of change. It is not for the LMC to resist this but more to
influence the changing horizons and to embed and strengthen the core values and importance of
primary care to the system. Indirectly we continue to encourage GP provider activity, uniting and
helping to align practice interests and trying to provide value for money through our buying group
initiative, contract advice and pastoral care support.
The LMC should be there for its membership. Our emphasis for the future will be to strengthen
unity among practices, find answers to practice issues and to protect the interests of the individual
against the force of institutional pressure.
Once again may I thank all the committee this year for your hard work supporting General
Practice and in particularly for your enthusiasm, professionalism and ability to speak up when
those around you in our profession find it difficult to do so.
Dr Phillip Fielding FRCGP
LMC chairman
2
SECRETARY’S NOTES
Impact of national changes in the NHS
The Coalition Government, following their White Paper (issued in July 2010), published a Health
and Social Care Bill which has dominated health politics ever since and has just been enacted.
The main intent is for GPs to take over much of the responsibilities currently vested in Primary
Care Trusts (PCTs) to commission health care from all except primary care. PCTs would cease to
exist by April 2013 at the latest. The contracts for GP practices would be held by a new NHS
Commissioning Board. While the idea of GPs bringing common sense to the commissioning
process was generally welcomed the possibilities of any willing provider coming in to underbid for
healthcare contracts was opposed. Locally the effect has been that:

PCT employees have sought alternative work, which has led to PCTs clustering with
others – in our case Gloucestershire PCT and Swindon PCT now share one Executive
team.

A Clinical Commissioning Group (CCG) (what the White Paper had called the ‘GP
Commissioning Consortium’) has been set up in ‘shadow’ form as a sub-committee of the
PCT (as it has to be while the PCT remains in control of the funding). Three LMC
members resigned to take up posts in the Shadow CCG, which only goes to show that
there is a limited number of GPs in the county interested in medical politics. At least with
just one CCG to cover the whole county (other CCGs have a much smaller patient base)
the Gloucestershire CCG will have a stronger financial standing and negotiations will be
easier. Unfortunately the main internal PCT and CCG meetings also have taken place on
Thursdays, thus making attendance at LMC main meetings very difficult. The LMC was,
however, delighted to welcome the whole CCG to one of the LMC meetings.

The LMC has had to convert from a bilateral relationship with the PCT to what is
becoming a tripartite relationship to include the CCG, but this is further complicated by
the existence of Locality-based Commissioning Groups. A number of minor incidents
indicated that the PCT was not considering consulting the LMC as early in planning as
they should.

The PCT decided not to attend the main LMC meetings, but to continue with negotiations.
This may have been as a result of the changes going on.

Gloucestershire Care Services were to have been set up as a social enterprise but a legal
challenge prevented that. The situation is still unclear as we move into the future.
LMC Organisation
With so much change going on it was felt appropriate to review the LMC’s role and ways of
working. A survey of constituent GPs’ opinions showed that there was:

An unwillingness to increase the levy.

A general concern that the link between members and their constituents was weak.

An appreciation of the work of the LMC office, especially its newsletter.

A feeling that the LMC was not sufficiently representative.
Following on from that the LMC held a special meeting, led by the Vice-Chair, in December to
decide how to take things forward, and agreed:

To reduce the number of full meetings to 4 a year, at least as an experiment.

To publish a list of practices which each member represented.

To modify the way in which the Newsletter was sent out and to revise the website to
attract more readers.
The potential use of modern communication methods (e.g. Facebook & Twitter) remain to be
decided upon.
Hails and Farewells
The quadrennial elections to the LMC in Feb/March left us with a vacancy in N Cotwolds and two
vacancies in Gloucester City. Proportionately this is not so bad a result as elsewhere in the
3
country (e.g. Birmingham). Perhaps it is an opportunity to co-opt salaried GPs in order to
improve the balance on the committee between partners and salaried GPs.
We say farewell to Dr Richard Gale (Freelance GPs), Dr Andrew Seymour and Dr Steve Steinhardt
(Gloucester City), and Dr Andrew Rigby (Tewkesbury). Dr Chris Morton and Dr Jeremy Welch had
already resigned during 2011 to take more part in the CCG.
We welcome onto the committee Dr Sanjay Shyamapant (taking the Tewkesbury seat), Dr Andrew
Sampson (Freelance) and, by co-option, Dr Hywel Furn-Davies (N Cotswolds).
The Executive committee remains largely unchanged, but we welcome Dr Tom Yerburgh as the
new Negotiating Officer and wish Dr Steve Alvis a successful 2 years as Treasurer vice Dr Steve
Steinhardt.
Activities and Achievements

The CCG. The year has involved ongoing discussions with and about the CCG, which
continue. A significant cause of concern is that the CCG should be democratically elected
and that all GPs should be involved in the election. The GPC has directed that LMCs
should ensure democratic engagement. The Chair and Vice-Chair of the Shadow CCG
were appointed by the PCT. (Although the LMC had had an observer at the selection the
LMC had no say in the outcome.) There were too few candidates for the other posts in
general to warrant any elections but there was an election in the South Cotswold Locality
and Dr. Malcolm Gerald was duly appointed to the CCG.
We are currently being consulted over the CCG Constitution. Is the Shadow CCG truly
democratic? Will the CCG that takes over from the PCT be democratic?
GP Provider Unit. As early as May there were discussions on the need for practices to federate to
provide services, along the lines of the ‘GP Care’ company in Bristol. Those discussions continue.
The LMC cannot properly set up such an organisation but is doing all it can to help others do so.
We called a briefing meeting at which a firm called ‘About Health’ explained the challenges of
forming such a unit, and how the risks might be minimised. We have held meetings since for
those interested in taking the idea forward.
NHS Shared Business Services (SBS). Family Health Services (FHS) currently administer the GMS
contract. A firm called NHS SBS applied to take over the work which would have involved losing
the local knowledge of the current FHS staff and also making them redundant. The LMC opposed
this strongly and was instrumental in achieving a public meeting to set the key performance
indicators for the new contract. Under the final plans some at least of the current staff will be
taken over by NHS SBS.
Choose & Book. The LMC was able to persuade the PCT of the general unpopularity of the Choose
and Book implementation and to continue the LES for the year.
Specialisation v Generalisation. Specialists tend to believe that their speciality is the most
important aspect of medicine and that everyone needs to be trained and tested regularly.
Generalists, on the other hand, say they have been doing the work successfully for years, and
(with minor exaggeration for effect) that if they took all the training the specialists demand then
they would not have the time to do their usual work. Child protection training and cervical
cytology training were both quoted during the year as being ‘mandatory’ and the LMC spent time
persuading everyone that it was not, and that there were other ways of achieving the laudable
ends of keeping children safe and taking successful smears. The LMC prompted the GPC into
ruling that Registrar GPs were adequately trained in cervical cytology and did not need to take
locally approved training.
IT – The Summary Care Record (SCR). The PCT put considerable pressure on practices to upload
patient data to create summary care records. While the theory was good, in practice the limited
bandwidth available, the frequent automatic updates, and the need to use smart cards meant that
the system hurt GP practices more than it would necessarily aid patients. The LMC therefore
advised practices against involvement in the SCR, and was generally listened to.
Care Quality Commission (CQC) registration. CQC registration was still far off in time, the
standards required were still not yet set, and the GPC’s guide to registration was still in the offing.
For these reasons the LMC tried to persuade practices not to buy expensive software to help them
achieve CQC registration. Some practices listened, but many did not, especially in Cheltenham.
4
Revalidation.
Revalidation continues to progress despite lack of clarity from the GMC or the Royal College as to
its implementation and delivery. The current existing appraisal system which has been in place
for 10 years is intended to be revamped by the medical director of the cluster and we can only
hope that this will not derail the hard work that our county appraisers have achieved and the
benefits that have been gained to fellow GPs by dealing with an educational and developmental
focus to the policy.
Child Protection.

Initial Health Assessments for Children in Care. The PCT had received an adverse
OFSTED report that these inspections were not being adequately carried out, and
therefore appointed Hadwen Practice to do all these assessments for the whole county.
Hadwen needed information about the patients from the patients’ own practices. The LMC
took the view that full information should be provided but that the practices should be
paid for doing so. The PCT refused to pay and suggested that Hadwen would be content
with the sort of information obtainable through a C&B process at no effort to the practice.

Attendance at Child Protection Conferences. The LMC recognised the importance of these
conferences but considered that GPs should be paid to provide backfill while they were
away. No progress on this either.
QoF – QP – Telehealth. The PCT had not discussed with the LMC the hiring of some 2000
Telehealth equipments. Having entered into the contract they suggested it could be used to fulfil
the requirements of QP8 and QP12. As an easier way to achieve those QoF points many practices
accepted this, but the LMC remains to be convinced that Telehealth is a good use of taxpayers’
money, in that the £4.5m spent on the contract could have been used to benefit many more
patients in other ways.
Community Hospital Admissions. The LMC formed a working party to formulate views on the
suggested way ahead and made suggestions and comments.
Support to GPs. The Severn Deanery set up a mechanism for training certain GPs to support
others. The LMC had appointed Drs Chris Good, Michelle Hayes and Tom Morgan to be the ‘LMC
Advocates’ in this scheme. Somerset’s web-based ‘GP Safe House’ was considered but at £13,000
was deemed too expensive to implement. Nevertheless, there remains concern that perhaps not
all GPs and practices in trouble contact the LMC.
HepB Inoculations for potential medical students. The universities were now demanding proof of
HepB inoculation before students were offered a place. This was an occupational health matter
but until a place was offered there was no occupational health liability. The LMC negotiated with
the PCT, unsuccessfully, for a LES to administer the inoculation. Agreement was reached,
however, that where there was adequate documentary proof of the need then NHS stocks of
vaccine could be used to give the inoculation, although the practices could not be paid for giving
it.
Albumin:creatinine ratio urine testing. After extensive discussions it was eventually agreed that,
as the two testing bottles now being used for this test were too small to take the sample, the
acute trust would provide a pipette in the sample pack to enable the patient (rather than the
practice staff or the hospital laboratory staff) to decant their urine from the sample-gathering
bottle into the two testing bottles. Though small, this sensible solution demonstrates the value of
liaison with the Acute Trust.
Federation of LMCs Buying Groups. There has been a steady increase in the number of practices
taking advantage of the savings available from the suppliers approved by the Federation of LMCs
Buying Groups. This had the further minor benefit that a small amount of the commission made
by the Federation was returned to the LMCs.
LES v Core. The LMC again reiterated that just because a LES ends it does not mean that the
work originally covered by the LES becomes part of the core contract.
LMC Finances
Despite all that went on this year the LMC was able, again, to hold the statutory levy at the same
level. Dr Steve Alvis has taken over as Treasurer from Dr Steve Steinhardt.
5
TO THE TRUSTEES OF THE
GLOUCESTERSHIRE MEDICAL BENEVOLENT TRUST
FOR THE YEAR ENDED 31ST DECEMBER 2011
We have independently examined the accounts of the Trust as set out on pages 2 to 3 as required
by the Charities Act 1993.
The Trust has elected both to prepare the accounts on the receipts and payments basis and to
subject its accounts to independent examination rather than audit.
Our responsibilities are to:
 Identify whether or not proper accounting records have been kept;
 Check that the Trust accounts agree with the account records;
 Check that the accounts have been properly prepared in accordance with the Charities Act 1993
insofar as these apply to the receipts and payments basis.
Where matters arise from this examination that give cause for concern it is our duty to report it.
Our report:
No matters have arisen during the course of our examination where we have to give an adverse
report.
L BEAVEN
GRIFFITHS MARSHALL
Chartered Accountants
Beaumont House
172 Southgate Street
Gloucester
GL1 2EZ
February 2012
6
GLOUCESTERSHIRE MEDICAL BENEVOLENT TRUST
RECEIPTS AND PAYMENTS ACCOUNT
FOR THE YEAR ENDED 31ST DECEMBER 2011
2011
2010
£
£
INCOME
Dividends received
Bank interest received
74
73
5
6
79
79
-
-
EXPENDITURE
Accountancy fees
NET RECEIPTS FOR THE YEAR
£
7
79
£
79
GLOUCESTERSHIRE MEDICAL BENEVOLENT TRUST
BALANCE SHEET
31ST DECEMBER 2010
2011
2010
£
£
ACCUMULATED FUNDS
Balance as at 1st January 2011
Net receipts for the year
Balance at 31st December 2011
£
11,274
11,195
79
79
11,353
£
11,274
Represented by:
INVESTMENTS
1,100 25p ordinary shares in Foreign & Colonial Investment Trust plc
1,026
1,026
10,327
10,248
(Market value £3,173 - 2010 £3,300)
CURRENT ASSETS
Balance at bank: Lloyds TSB
£
8
11,353
£
11,274
GLOUCESTERSHIRE LOCAL MEDICAL COMMITTEE
ACCOUNTS’ REPORT
FOR THE YEAR ENDED 31ST DECEMBER 2011
We have prepared the annexed accounts from the books and records of the Gloucestershire Local
Medical Committee, and from the information and explanations supplied by the Treasurer.
We have not carried out an audit.
L Beaven
Griffiths Marshall
Beaumont House
172 Southgate Street
Gloucester
GL1 2EZ
9
GLOUCESTERSHIRE LOCAL MEDICAL COMMITTEE
RECEIPTS AND PAYMENTS ACCOUNT
FOR THE YEAR ENDED 31ST DECEMBER 2011
2011
Voluntary
£
2010
Statutory
£
Total
£
£
EXPENDITURE
Donations:
Royal Medical Benevolent Christmas Fund
Cameron Fund Christmas Appeal
General Medical Services Defence Trust
Secretary's remuneration
Secretary's expenses, etc.
Catering
Professional charges
Bank charges and interest
Locum fees and mileage expenses
Clerical assistance and office expenses
Corporation tax
Office rent, etc.
Retirement gift
Office equipment
35,749
61,379
526
2,610
2,400
52
112,940
42,479
1,689
11,724
217
38,359
233,406
35,749
61,379
526
2,610
2,400
52
112,940
42,479
1,689
11,724
217
-
300
300
25,355
62,588
554
2,106
2,385
5
105,325
43,528
2,063
11,717
5
271,765
256,231
37,000
226,000
2,168
96
-
35,000
228,056
550
INCOME
Voluntary levy
Statutory levy
Sessional G.P. subscriptions
Other income
Interest received
37,000
226,000
2,168
96
SURPLUS/(DEFICIT)
CASH AT BANK AT 1ST JANUARY 2011
CASH AT BANK AT 31ST DECEMBER 2011
£
5
39,168
226,096
265,264
263,611
809
(7,310)
(6,501)
7,380
15,239
54,309
69,548
62,168
16,048
-2-
10
£
46,999
£
63,047
£
69,548
GLOUCESTERSHIRE LOCAL MEDICAL COMMITTEE
ATTENDANCE BY ELECTED/CO-OPTED MEMBERS*
AT MEETINGS APRIL 2011 – FEBRUARY 2012
NAME:
POSSIBLE:
ACTUAL:
DR. A SEYMOUR (resigned Jan 2012)
9
4
DR. P FIELDING
9
9
DR. S STEINHARDT (resigned Jan
9
7
DR. S ALVIS
9
9
DR. J BAYLEY
9
6
DR. N BOOKER
9
8
DR. S BULLEY
5
4
DR. I BYE
9
8
DR. R COKER
9
5
DR. P FELLOWS
9
7
DR. R GALE (resigned Jan 2012)
9
6
DR. C GOOD
9
8
DR. M HAYES
9
5
DR R HODGES
9
9
DR. W MILES
9
7
DR. T NEHRIG
9
8
DR. C MORTON (resigned July 2011)
4
2
DR. A RIGBY (resigned Jan 2012)
9
7
DR. J ROPNER
9
8
DR. J SALTER
9
4
DR. A SAMPSON
0
0
DR. S SHYAMAPANT
0
0
DR. I SIMPSON
9
7
DR. N SIVA
9
8
DR. J WELCH (resigned July 2011)
3
3
DR. T YERBURGH
9
9
MR D MANN+
9
4
2012)
+(Practice Manager Rep – Dec. 10 ongoing)
10
GLOUCESTERSHIRE LOCAL MEDICAL COMMITTEE
MEMBERSHIP AS AT 31ST MARCH 2012
Constituency and Elected Members
North Cotswolds:
VACANCY
Cheltenham Bishops Cleeve & Winchcombe:
DR. P FIELDING
Royal Well Surgery, St. Paul’s Medical Centre,
DR. R COKER
Overton Park Surgery, Overton Park Road, Cheltenham
Dr. W MILES
The Portland Practice, St. Paul’s Medical Centre
DR. J ROPNER
Berkeley Place Surgery, 11 High Street. Cheltenham
VACANCY
Cirencester, Fairford & Tetbury
DR. I J SIMPSON
DR. K NEHRIG
Phoenix Surgery, 9 Chesterton Lane, Cirencester
Romney House Surgery, Tetbury
Dursley, Wotton-Under-Edge:
DR. T YERBURGH
DR. S ALVIS
Acorn Practice, May Lane Surgery, Dursley
42 The Street, Uley, Dursley
Forest Of Dean:
DR. P R FELLOWS
DR. C GOOD
DR. M HAYES
Severnbank Surgery, Tutnalls Street, Lydney
The Surgery, Drybrook
Yorkley Health Centre, Lydney
Gloucester City:
DR. A SEYMOUR (resigned Jan 2012)
DR. N SIVA
DR. S STEINHARDT (resigned Jan 2012)
DR. J BAYLEY
DR. R HODGES
VACANCY
VACANCY
Heathville Medical Practice, Heathville Road
Quedgeley Medical Centre, Olympus Park, Quedgeley
The Surgery, 5A Brookfield Road, Hucclecote
Rosebank, Stroud Road
Cheltenham Road Surgery,
Stroud:
DR. J SALTER
DR. I BYE
DR. N BOOKER
The Health Centre, Beeches Green, Stroud
Locking Hill Surgery, Locking Hill, Stroud
Prices Mill Surgery, New Market Road, Nailsworth
Tewkesbury:
DR. A RIGBY (resigned Jan 2012)
DR. S SHYAMAPANT
The Church Street Practice, Tewkesbury
The Church Street Practice, Tewkesbury
Non-Principal Rep:
DR. R GALE (resigned Jan 2012)
DR. A SAMPSON
Trainee Representative:
DR. S BULLEY
Locking Hill Surgery, Stroud
Officers of the Committee:
CHAIRMAN:
VICE CHAIRMAN:
TREASURER:
FOURTH OFFICER:
LMC LAY SECRETARY:
DR. P FIELDING
DR. I BYE
DR. S ALVIS
DR. C GOOD
MR M FORSTER
Consultant Representative:
DR. P MOORE
Gloucestershire Royal NHS Trust
Acute Trust Representative
DR. D GOODRUM/DR. S ELYAN
Elected Representatives:
DR. S ALVIS
DR. J BAYLEY
DR. T YERBURGH
11
LMC MEMBER REPRESENTATION TO COMMITTEES
2011 / 2012
G.P.C. Representative
Dr. P Fellows
Annual Conference Representatives 2011/12
Dr. S Alvis
Dr. J Bayley
Dr. T Yerburgh
LMC QOF Assessors
Members:
Dr. P Fielding
Dr. S Alvis
IM&T Steering Group
Members:
Dr. A Rigby (resigned Jan 2012)
Dr. N Siva
Gloucestershire Dispensing Quality Scheme
Member:
Dr. T Yerburgh
Substance Misuse Treatment Shared Care Monitoring Group
Member:
Dr. T Yerburgh
Breast Screening Steering Group
Member:
Dr. C Good
Gloucestershire Controlled Drugs Local Intelligence (GDLIN)
Member:
Dr. S Alvis
Gloucestershire Control of Communicable Diseases Committee
Member:
Dr. S Alvis
Antibiotic User Group
Member:
Dr. S Alvis
County Infection Control Committee
Member:
Dr. S Alvis
Countywide Sexual Health Group
Member:
Dr. R Coker
12
GP Appraisal Steering Group
Member:
Dr. I Simpson
Cervical Cytology Working Party
Member:
Dr. R Coker
Maternity Services Liaison Committee
Member:
Dr. R Gale (resigned Jan 2012)
Teenage Pregnancy Partnership Board
Member:
Dr. J Bayley
Mental Health Shared Care Monitoring Group
Member:
Dr. J Salter
Crisis and Home Treatment Project Team
Member:
Dr. J Salter
Child Protection
Member:
Dr. R Coker
Elderly Care
Member:
Dr. M Hayes
Out of Hours
Member:
Dr. R Gale (resigned Jan 2012)
PMS Contract
Member:
Dr. Bye
Premises
Member:
Deputy:
Dr. Simpson
Dr. Alvis
TB/BCG Management
Member:
Dr. Good
13
TRUSTS
Local Diabetes Services Advisory Group
Member:
Dr. N Booker
Gloucestershire Palliative Care Network
Member:
Dr. N Booker
Executive Committee of the Gloucestershire GP Education Trust
Member:
Dr. P Fielding
LMC WORKING PARTIES & ADVICE
LMC Executive Committee
Members:
Dr. P Fielding
Dr. S Steinhardt (resigned Jan 2012)
Dr. S Alvis
Dr. C Good
LMC / PCT Liaison (Negotiators)
Members:
Dr. I Bye (Chair)
Dr. S Alvis
Dr. C Good (Dep)
Dr. P Fielding
Dr. S Steinhardt (resigned Jan 2012)
LMC Pastoral Support
Dr. P Fielding
Dr. N Booker
Dr. C Good
Dr. A Seymour (resigned Jan 2012)
Dr. I Simpson
Dr. T Yerburgh
Dr. A Rigby (resigned Jan 2012)
Dr. M Hayes
PROFESSIONAL LIAISON
Gloucester Hospital Medical Staff Committee
Members:
Dr. N Siva
Dr. J Bayley (Deputy)
Cheltenham Hospital Medical Staff Committee
Member:
Dr. C Morton (resigned July 2011)
Vacancy
Winfield Hospital Medical Advisory Committee
Member:
Dr. J Bayley
Liaison: Local Intelligence Committee
Member:
Dr. J Welch (resigned July 2011)
14