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					Swindon and Wiltshire LPC
Minutes of OPEN session held on 17 th July 08 at Urchfont
Manor, Devizes

Present: Shaun Hill, Alison Kidner, Rob Townsend, Jon Phillips, Paul Hedge, Michael Orchel, Gerald Lloyd

In Attendance: Fiona Castle (Secretary), Paul Clarke (Swindon PCT), Chris Phillips (Wiltshire PCT),

                 Maggie Thornton and ?Sue (Wiltshire PCT Stop Smoking Team) for Item 4 only

       Minute                                                                            Action by
1      Apologies
       Ian Wood, Nick Jephson, Ray Jephson, Cathy Jones
2      Declarations of interest:
       No new declarations made
3      Minutes of Previous meeting:
       These were accepted as a true record and signed by the Chairman
4      Matters Arising:
       Falls Audit – still only 13 pharmacies have expressed interest and therefore
       the project will run on that number. Timescale proposed to be late
       September, running through October and into November. Agreed that this
       fitted in with pharmacy workload, and that data collection should be
       completed before Christmas rush started in late November. Additional
       pharmacies can still get involved.
       The Wiltshire Falls Strategy is published on the PCT website.

       Pharmacy White Paper – Chris Phillips is dealing with GP reaction to the
       proposals in it concerning dispensing doctors. He referred us to Current proposals would affect 9 out of 23
       dispensing practices in Wiltshire
5      Smoking Cessation through Community Pharmacy
       Maggie and Sue joined the committee for a discussion of the experience of
       the current service in the South and potential to expand the service across
       the county.

       The smoking cessation service has been disappointed by the numbers of
       quitters achieved through pharmacy for the investment in training of staff by
       the service. The service appears to work best where it is lead by a trained
       technician/counter assistant supported by a trained pharmacist. Turn-over of
       trained staff was an issue.
       Promotion of the service through pharmacy was discussed. Individual
       pharmacies are not listed on Stop Smoking Service posters and leaflets, just a    Contractors
       reference to “some pharmacies”. Maggie explained that they could not list
    every provider (eg GP surgery, pharmacy, health trainers at leisure centres)      Contractor
    due to sheer numbers. She confirmed that when a client phoned the service         engagement
    for details of services that names of particular pharmacies were included in      subcommittee
    the options given to the client.
    She would like to see pharmacies do more to recruit patients, for example         Communications
    offering the counselling service to those purchasing NRT.                         subcommittee

    There is one funding model for one-to-one support to quit, whether it is
    delivered through GP surgery, trained advisor in leisure centre, or community
    pharmacy. In the community pharmacy model there is also reimbursement
    for NRT supplied. In all the other models, prescriptions are generated for NRT.

    In Swindon the payment level for pharmacy is higher than that offered to GP
    surgeries since there is some overlap with payments to GPs for their core
    contract (eg identifying smokers)

    Additional advisors are being recruited to the service in target areas –
    Trowbridge, Chippenham, Calne, Bemerton, Tidworth, Westbury, Durrington
    and Amesbury.
    A timetable of training dates and locations was given to the LPC, and
    information from this will be circulated with the next LPC newsletter             FC
    Bespoke “brief intervention” training may be available for groups of
    pharmacy staff to assist in recruitment. This training may also be used as an
    initial step in identifying potential advisors – concern was expressed that
    some immature counter assistants had been sent for advisor training who did
    not yet have the social skills to be successful stop smoking advisors.
    Qualification as an advisor is not recognised until the trainee has delivered 5
    quitters, in recognition that this is not an academic qualification, but a
    vocational one and requires practice of the skills following training.
    Wiltshire PCT Stop Smoking Service will recognise Level 2 advisor training
    achieved with other Stop Smoking Services, and will not require candidates to
    repeat the 2 day training course. A member of the service will visit to discuss
    local paperwork and update on any recent changes to guidance.

    It was noted that there is now a National Template for the Stop Smoking
    Monitoring Form. This may facilitate its inclusion into pharmacy PMR

    22.5% of the population are smokers – there are plenty to recruit!
6   Wiltshire PCT
    Departmental Organisation and Contacts
    The director of Finance, John Williams is to retire in September. His successor
    Charlotte Moar starts shortly with the PCT. This position is one of the most
    influential in the PCT.
    Links to Community Pharmacy are within the Directorate of Primary Care and
    Commissioning. The director – Debra Elliot is leaving shortly and recruitment
    is underway for her successor.
The department of Primary Care is headed by Jo Cullen, to whom Chris
Phillips reports. His responsibility is for Pharmacy, Out of Hours and
Dispensing Doctors with some work on the GP lead Health Centres
Liz Edwards, a support worker, has recently been recruited to the department
and will be giving support to Chris (and others). She may be looking at the
claims/payments procedures for enhanced services.
Chris noted that he receives late claims for payments to pharmacy – he had
recently received one which included claims backdated to November 07. It
will not be paid as money from the last financial year has now gone. There
had been a problem with payments for Quarter 4 payments to pharmacy,
where the finance department had stamped claims as if paid, but had not
transferred payment. Only 1 pharmacy had noticed and complained. The
scale of the problem was noticed on investigating that complaint. Members
of the LPC noted how difficult it was for contractors to reconcile claims and        Finance sub-
payments. A discussion followed regarding claim reference numbers which              committee
could relate to payments. This should be followed up in any review of the            CP
claims system                                                                        LE

Endless Street GP Dispensing to patients from Ford – letter/spirit of
A contractor had passed to FC a copy of a letter from the GPs at Endless
Street to their patients in Ford indicating that they could collect dispensed
repeat medication from the surgery at Endless Street. FC expressed the
opinion that this was in contravention of the terms of their consent to
dispense to these patients only from Winsley. Advice had been sought from
PSNC who had raised the matter with Peter Dunleavy at the DoH. The
nuances of what constituted dispensing and where dispensed medicines
could be handed out to patients, when dispensed at another location was
FC agreed to forward the response from Peter Dunleavy to Chris Phillips. The         FC / CP
matter would pass through the Contracts Applications Panel

Public Health Campaigns
In Wiltshire the Public Health Department had been asked to propose
subjects. The initial list includes
Skin Cancer – July/August
Lung Disease – September
Sexual Health – December
Heart Disease – February
Chris Phillips expressed surprise that they had not included Smoking for
The difficulty of co-ordinating the acquisition of relevant leaflets etc and their
distribution to pharmacy was raised. No work had yet started on co-
ordinating a Skin Cancer campaign.
Swindon PCT had worked on only one campaign last year, and had not
discussed anything yet for this year. Issues in Swindon include Hip Fracture         FC
rates and poor HbA1c control (blood sugar).
    Both PCTs would be keen to discuss any LPC proposals for interactive rather
    than leaflet based public health campaigns

    Swindon PCT
    Pharmacy QoF
    Letters have gone out to pharmacy with details of the scheme as approved by
    Swindon PCT PEC.
    The medicines management team are encouraging GPs to put Warfarin onto
    Repeat Dispensing Scheme and pass over control in line with NPSA guidance
    to community pharmacists

    Contract Monitoring
    All pharmacies on both Swindon and Wiltshire will receive full self assessment
    forms for completion and return to the PCT. Wiltshire will visit the remaining
    half of pharmacies which were not visited last year using same format as last
    year. In Swindon monitoring visit will concentrate on Intervention Recording
    and Learning from Errors. FC to meet with Fredo Ebtahaj to discuss                 FC

    Dressings Supply
    Following the submission of PSNC advice on the legality of the NHS supplies
    proposed scheme in Swindon, and the NHS supplies response, the PCT is
    going ahead with the scheme. The initial pilot will affect pharmacies serving
    Eldene and Highworth.
    Further advice from PSNC is expected. Both PCTs have asked to be kept
    informed of any developments.                                                      FC

    Building local pharmacy involvement/links with GPs
    A general discussion was held, especially pointing out the problems in towns
    of linking several pharmacies and several GP practices, however no resolution
    or way forward was determined.
7   Salisbury LIG – Urgent Care Meeting
    The issue of Clexane supply in the community was discussed. Some GPs are
    using it, and adjusting prescriptions to supplies available in the community. It
    was agreed that it would be better to have supplies readily available taking
    prescription guidelines into account. This should be formally rather than
    informally commissioned. It would also be useful for pharmacists to know
    where patients with suspected DVT should be directed if community services
    now exist.
    It was noted that if Nadine Fox was suggesting an informal arrangement with
    the Co-Op pharmacy in Salisbury, then it was likely that any service was
    through Three Swans Surgery
8   Meetings to be attended on behalf of the Committee
    The committee look forward to the outcomes of the meetings listed

    Chris Phillips suggested that the committee should be represented if possible      FC
    at the Visioning Events for Out of Hours and Urgent Care, prior to the services
    going out to tender. FC agreed to attend.
     With relation to the proposed meeting with Nicola Gregson, it was suggested
     that preliminary discussions with Henryk ? (provider arm pharmacist) and           FC
     Mary Collier (CSCI pharmacist) may be beneficial regarding MDS and Carer
9    South West Regional Pharmacy Conference
     The proposal for the conference was introduced to the PCT representatives,
     and suggestions for potential invitees were invited. Names/positions
     suggested included
     Maggie Rae (Director of Public Health, Wiltshire)
     Pauline McDonald (Deputy Director of Commissioning, Swindon)
     Directors of Finance
     Directors of Commissioning
10   Any other business
     Chris Phillips advised that following the consultation process, it had been
     decided that the Primary Care Centre for Devizes should be sited in Green
     Lane. Timescale is likely for completion in 2010. Further details are on the PCT
11   Date and Time of Next Meeting
     Thursday September 18th, 10am, Urchfont Manor

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