Securing the future

of general practice

Annual Report 2007-08

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Message from Dr Stewart Kay, Chairman of the Board of Directors

If this year has taught us anything, it is that the wheels of the NHS grind exceedingly

slow.

The full horror of polyclinics has not been visited upon us, and given the economic

climate, and the late embracing of the federated model by the centre, may not be.

GP led health centres are another matter entirely. Our colleagues are becoming

increasingly adroit at tendering for these, and at Londonwide LMCs we are

encouraging a cooperative locality model which avoids tensions and competition

between neighbouring practices.

More pressing issues for London may be contractual and fiscal, with PCTs seeking

to bring PMS remuneration more in line with nGMS, and alterations to the QOF

formula.

Organisationally we hope to increase further our direct links with NHS London and

the mayor's office, as policy decisions ebb further away from PCTs.

A quiet year of clinical practice and contemplation would be nice, but this seems

increasingly unlikely.

Dr Stewart Kay

Chair of the Governance Board

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Message from the Joint Chief Executives

Londonwide LMCs and the individual LMCs across London have worked tirelessly

during the year to secure the future of general practice. This year has seen the

threat of polyclinics, commercialisation, GP-led health centres, QOF prevalence and

increased scrutiny of practices by their PCTs, to name a few of the issues we have

been addressing.

For most of our constituents, the issue of commercialisation and polyclinics/GP-led

health centres have caused the most concern. In response to this Londonwide

LMCs has used a number of tools to support its practices, including: our very

successful Keep My NHS GP Local campaign; followed swiftly by our Self

Assessment Toolkit; our first major conference, Securing the Future of General

Practice in London and the launch of our new education and development pilot

scheme Londonwide LEAD (Learning Education And Development).

To help GPs and practice teams keep up-to-date with emerging issues we have

substantially increased our communications and guidance to you. We hope you

have found this useful. Where ‘centrally imposed’ government initiatives are

concerned, we have taken decisive action to ensure that your voice is heard and

provided practical solutions wherever possible. However, we have also looked to

you, as masters of your own destiny, to fight your own cause. We have urged GPs

and practice teams to scrutinise their own practices to identify any potential

weaknesses and improve them, for the good of their patients. It is imperative that

you defend yourself against the critical eye of your PCT.

This year has seen a whirlwind of changes following the Darzi review and

Londonwide LMCs has worked hard to ensure that GPs and practice teams received

the support and advice they needed during this challenging time. Now that the dust

has momentarily settled and the economic climate has led to the temporary retreat of

the commercial sector it would be easy to become complacent. Be assured

Londonwide LMCs and your LMC are not. We will continue to approach the year

ahead with vigour and determination to represent general practice across the capital.

Challenging and interesting times lay ahead.

Dr Michelle Drage Dr Tony Stanton

Joint Chief Executive Joint Chief Executive

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Successes and challenges during the year

This year has proved to be a challenging one for general practice, with the effects of

privatisation, GP led health centres and polyclinics dominating the agendas of most

LMC events and meetings. During this period, Londonwide LMCs has worked

diligently to ensure that all LMC members, constituents and their patients are kept

fully informed of the changes that are happening across the capital and the potential

impact it will have on them. Key to this process has been our first practice and

patient-focused campaign: Keep My NHS GP Local.

Keep My NHS GP Local Campaign

Londonwide LMCs is proud to have been the one of the first organisations to run a

dedicated awareness campaign regarding the potential changes brought about by

the Darzi review, even beating the BMA to the starting line.

The first stage of the Keep MY NHS GP Local has been a real success, amongst

practices and patients. The local media has been dominated by coverage of our

poster launch, survey results and petition, and our growing voice in the medico-

political arena has also led to increased interest from the national media.

“We signed this petition

and we are here today

because we highly value

our neighbourhood GP.”

(Linda Critchley, mother of

twins)

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Listening to the voice of the capital’s GPs

Listening to the voice of the capital’s GPs was our formal response to Healthcare for

London’s consultation on wide-sweeping healthcare reform across London. By

commissioning an analysis of Healthcare for London’s polyclinic plans undertaken by

Professor Jones, Dean at the London Deanery, our response was both detailed and

rigorous.

Each of our LMCs discussed, in detail, their own response to the consultation and

these were included. This ensured that Healthcare for London were left under no

illusions as to the views of the capital’s GPs.

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Making an impact with the media

We have seen a significant increase in the quantity and range of positive media

coverage of a wide range of issues raised by Londonwide LMCs and individual

LMCs. This is testament to the attitude of LMC Chairs and members and the

professionalism of our in-house press office. News is a serious business. We take

our continued success at creating positive coverage and damage limitation seriously.

Open and honest communication coupled with good working relationships with

journalists is a prerequisite for all our media relations work.

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Another great year for LMC successes

Often, so much of what LMC members do on behalf of constituents is about ensuring

that general practice is high on a PCT’s agenda for all the right reasons. Yet, so

much that is done behind the scenes will never be seen as it is about getting clarity,

achieving consensus or the reversal of a potential decision before it impacts on the

patient or practice staff. LMC members, supported by a team from Londonwide

LMCs comprising of a medical director, director of primary care strategy, committee

liaison executive and committee administrator are mindful of the need to engage,

cajole, negotiate and work with PCTs to achieve a desirable outcome that puts the

patient first. And this happens day in day out. Where PCTs get it right, we are full of

praise. Joint working and cooperation are a must. It pays dividends in the end.

North West

Overview and scrutiny committees - Brent, Hillingdon and Kensington and

Chelsea LMCs have been proactive in developing good working relationships with

the chairs of their local overview and scrutiny committees.

Enhanced Services - Hillingdon LMC successfully negotiated a GP-friendly

extended hours LES that included flexibilities not contained in the DES used as a

model in other areas.

North Central

Camden and Islington GP trainee curriculum - At this year’s LMC Annual Conference, Camden and Islington LMC’s motion for the GP Trainee curriculum to include an introduction to medico-political issues and the role of the LMC and a requirement that GP trainees attend at least one LMC meeting in their area as an observer, was successfully passed. Review of the blue badge application process - Following Haringey LMC’s request that the Teaching Primary Care Trust (TPCT) review the process for assessing blue badge applications, the TPCT developed a joint proposal with Haringey Council whereby blue badges and freedom passes will be assessed by occupational therapists. This proposal will help to maintain consistency of assessments and will reduce GP workload. Barnet LMC has had similar discussions with Barnet PCT during the past year and the PCT is currently liaising with Barnet Borough Council about employing occupational health therapists to undertake the assessments of blue badges and freedom passes.

North East

List cleansing LES – City and East London LMC successfully negotiated with the

three PCTs in the sector for a list cleansing LES. In addition, the Family Health

Service also provided a NHS e-mail address specifically for queries about the

process and any specific cases they felt needed to be reviewed.

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South West

Achievements in Merton, Sutton and Wandsworth have centred around negotiating

the least damaging way over the introduction of extended access.

Diversity - The LMC has been successful in attracting new members, reflecting the

greater diversity of GPs. It has reorganised its working arrangements to involve all

LMC members in face-to-face meetings with their respective PCTs. This has led to

much better engagement and consultation, particularly in Wandsworth.

South East

A Picture of Health - One of the major challenges has been responding to the

consultation over A Picture of Health, the reorganisation of hospital services in

Lewisham, Greenwich, Bromley and Bexley, and the knock-on effect for Guy's,

Thomas's and King's. The LMC has been robust in fighting for the best possible

services for patients.

Extended access LES - Southwark LMC devised a flexible LES for extended

access which has been welcomed by the PCT and adapted and adopted in other

PCTs. And open meetings for GPs and practice managers in Bexley, Lewisham and

Lambeth have been a very useful way of listening to the concerns of practices and

responding to them.

Bromley

Choose and Book LES - Following removal of the DES, usage of Choose and Book

fell to 17% in the summer. The LMC successfully negotiated a LES which offered

practices a flat fee per booking.

Performance Management Tool - Members of the LMC worked closely with the

PCT to agree a local process for implementing the PCT’s planned Performance

Monitoring Tool. The LMC ensured that every item in the tool was either a statutory

requirement or based on solid evidence. The final result was a much shorter, useful

and evidence-based performance tool.

Educational events and our first landmark conference

During the year, Londonwide LMCs has expanded the services it provides to GPs

and their practice teams, in particular, looking at the provision of a broader range of

education and training opportunities. Earlier this year, Londonwide LEAD (Learning

Education And Development) was established, a pilot initiative focused on providing

non-clinical training for GPs, practice managers and practice nurses across the

capital. The feedback has been exceptionally positive. So much so, that we hope to

mainstream the provision of education and training services during 2009.

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Securing the future of general practice, the title and theme of our landmark

conference exclusively for GPs and practice managers provided attendees with an

insight into the views of external speakers from the King’s Fund, NHS Confederation,

BMA Law, Social Enterprise Coalition and GPC. Sparking debate and thought

provoking questions, the afternoon masterclasses provided an opportunity to revisit

these and much more as practices from across London learnt that no change for

general practice is not an option. We anticipate much of our work next year to

continue on this theme.

“LMC is now running workshops

covering a good range of hot

topics. Continue in the same

vein. Excellent.” (Event

participant)

Tailored GP and practice team support

It has been an incredibly busy yet highly rewarding year for the team. With external

scrutiny by the NHS and its agents increasing year on year, we anticipate 2009 to be

just as busy. Just some of the interventions include:

Assisting GPs approaching their retirement to leave their practice with the

approval and support of the PCT, thus protecting the GP’s credibility and

dignity

Supporting practices faced with Remedial Notices – 9 currently, with 4

successful outcomes and a further 5 ongoing

Proactively helping practices to prevent partnership dissolutions

Facilitating the successful merger of two practices

Providing peer assisted learning to a number of GPs involved in following

through their personal development plans

The provision of intensive support to help those practices struggling to establish

sound organisational structures around administration, employment and contractual

obligations, remains a key priority for the team.

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Diversity – GP election success

Make your voice heard, an innovative campaign to encourage more under-

represented groups of GPs (female, younger, salaried and sessional) to stand for

election was a great success. Resulting in a 33% increase in GMS/PMS salaried

GPs, a 50% increase in the number of sessional GP and the number of female LMC

members also increased by 15%. Londonwide LMCs also saw the first-ever

sessional GP, (Dr Annouska Hari, Westminster LMC) elected as Chair.

Following the success of our first induction day for new LMC members, it is planned

to maintain momentum by providing more updates, along with diversity training

across all our LMCs. Phase two of implementation of this strategy will focus on

embedding awareness and improving and maintaining knowledge and understanding

of human rights and equal opportunities for all our constituents, including practice

managers and practice nurses. This will be incorporated with the training and

education programme (LEAD) set out previously.

Finance and Governance

Delivering value for money to the practices and GPs supported by our London-based

office and individual LMCs continues to be a key priority and much of the

achievements touched upon in this report are testament to that. The LMC

administrative levy per patient per annum for 2007/08 was 40.6 pence per annum.

Our elected Board of Directors, supported by the Joint Chief Executives, have

continued to focus on setting the strategic direction for securing the future of general

practice, reviewing progress against objectives in the business plan and formulating

policy. As practicing GPs and LMC Chairs they provide insight, experience and

influence both internally and across the wider health economy.

For information on the staff contacts please see the appendix. For contact details at

Londonwide LMC, please log onto our website at: www.lmc.org.uk

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Appendix

The team at Londonwide LMCs Joint Chief Executives and LMC Secretaries Dr Michelle Drage assisted by PA Sary Davies and Dr Tony Stanton presently supported by Marie Vassallo Medical Directors/LMC Secretaries Dr Paddy Glackin Dr Tony Grewal Dr James Heathcote Medical Directors/ Assistant LMC Secretaries Dr Eleanor Scott Dr Bob Button Directors of Primary Care Strategy Julie Freeman (SE/SW) Andy Michaels (NW) Gill Rogers (NW) Mazzie Sharp (NC/NE) Committee Liaison Executives Nicola Rice (NC) Lesley Williams (NW) Jenny Foley (SE) Ariadne Siotis (SW/NW) Helen Musson (NE) Jackie Peake (Bromley) Ann Ayamah Leah Benson Marian Morrison GP Support Team Jean Hassell, Executive Director of GP Support Services Nora Breen, Manager of GP Support Services Communications Team Sue Broome, Director of Communications Jonathan Ashby, Communications Executive Hannah Millard, Public Relations Executive Supporting the Whole Organisation Lee Prince, Executive Director of Corporate Affairs and Company Secretary Nicola Loney, Administration Manager Eashrat Mahmood, Corporate Team Administrator Marie Vassallo, Corporate Team Administrator Karen Cooper, Corporate Team Administrator Zack Okeoma, Finance Executive

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Annual Report 2007-08 Feedback form

Please feel free to send this form back anonymously Name_______________________________________________________________ LMC________________________________________________________________ Contact details_______________________________________________________ ___________________________________________________________________ Please let us know of anything you would like to see in the annual report or if there are improvements you would like to suggest: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Fax back to 020 7383 7442 or email your comments to hannah@lmc.org.uk