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MINUTES OF PROCEEDINGS OF THE HEALTH, SOCIAL SERVICES AND PUBLIC
SAFETY COMMITTEE Present: Apologies: In Attendance: Dr Hendron took the Chair at 2:10 pm.
Private Session 1. Chairman's Opening Remarks i. The Chairman reported briefly on the presentation by Diabetes UK in the Long Gallery on Monday, 11 June. ii. The Chairman reported on the successful Men's Health Event in the Long Gallery on Tuesday 12 June and advised that he would write to the Minister in support of a request by Dr Ian Banks for her to meet with the Men's Health Forum. iii. Following the Westminster and local government elections, members were advised that they must declare any new interests in accordance with the Guide to Rules Relating to the Conduct of Members. iv. Following receipt of a letter from Professor Bob Stout enquiring whether anything more can be done to promote the full implementation of the recommendations of the Royal Commission on Long Term Care of the Elderly - particularly in relation to personal care - the Chairman will write to advise the Minister of the Committee's intention to raise the matter at its forthcoming meeting with her to discuss the Departmental Budget bid. 2. Minutes of the Last Meeting The minutes of the last meeting were agreed. 3. Matters Arising The Committee meeting scheduled for Wednesday, 20 June will be held in the Boardroom of Musgrave Park Hospital and will be followed by visits to the Rheumatology and Orthopaedic Departments. 4. Subordinate Legislation Question put and agreed to: That the Health, Social Services and Public Safety Committee has considered the following Statutory Rules: - No. 217/01 - The Medical Act 1983 (Approved Medical Practices and Conditions
of Residence) and General Medical Services (Amendment No. 3 ) Regulations (Northern
Ireland) 2001 and, subject to the Examiner of Statutory Rules being satisfied as to their technical correctness, is content with the Rules. Public Session 5. Presentation by the Royal College of General Practitioners Northern Ireland Panel Members: Dr Peter Colvin, Chairman The Chairman welcomed the panel to the meeting at 2:20 pm, after which Dr Colvin spoke to a presentation paper that had been copied to members in advance. This was followed by a question-and-answer session, which is summarised in Annex 1. The Chairman thanked the panel, and they left the meeting at 3:25 pm. Mr Kelly left the meeting at 3:25 pm.
Private Session 6. Synopsis of the Departmental Response to the Committee's Inquiry into Residential and Secure Accommodation for Children in NI Agreed: The Committee will revisit the response after the Clerk has prepared a brief paper outlining the Department's action taken/planned against each of the Inquiry's 36 recommendations. 7. AOB i. The Department has advised that it will issue the Committee with a paper on its Budget bids immediately after the Finance Minister's speech to the Assembly on 19 June 2001. Agreed: The Chairman will contact the Permanent Secretary to enquire whether the Minister could meet with the Committee to discuss the bids on an alternative date prior to the suggested one of Monday, 2 July 2001. ii. There will be a press launch of the Report by the Acute Hospitals Review Group on Wednesday, 20 June 2001. Arrangements are being made for the Committee to receive advance copies in advance with a strict embargo. iii. The Committee declined a request from the Department for a copy of the briefing paper on rheumatoid arthritis prepared by the Assembly Researchers. iv. Agreed: The Committee will meet informally in the autumn with the Chair of the Learning Disability Steering Group, Mr John Richards, to discuss the development of the Learning Disability Strategy. v. Agreed: The Committee will meet informally in the autumn with the Chest Heart & Stroke Association to discuss a new strategy on the commissioning of stroke services. vi. Agreed: The Committee will decline a request from Transfusion 'C' Positive for a meeting as it has already heard representations from the UK Haemophilia Society in support of Hepatitis C sufferers and has written to the Minister on their behalf. vii. Agreed: The Committee will meet informally with the Lisburn Support Group of Fibromyalgia to discuss how sufferers of the illness are treated. viii. There will be training courses for Assembly Members and staff on government finance on 6 and 12 September 2001. Further information will be issued later.
8. Date and Time of the Next Meeting The next Committee meeting will be at 2:00 pm on Wednesday, 20 June 2001 in McKinney House, Musgrave Park Hospital.
The meeting ended at 4:15 pm.
DR J HENDRON June 2001 Q. The role of GPs seems to be changing within primary care, particularly in relation to management responsibilities. Do doctors see benefits in this and view it as the way forward? [Mr Berry] A. There is an increasing teaching and research input to undergraduate education, with a big move to train doctors to be more sensitive to the changing role of primary care, where GPs manage increasingly complex medical problems. There should be encouragement for GP research to be done at the coalface, not at centres of excellence. Research GP practices are being set up in GB, but there are none in Northern Ireland. Primary Care has sought a little of the R&D budget, but so far, the silence from the Department has been deafening. Managerial responsibility is an inevitable consequence of the increasing prevalence of multi-professional teams within the modern health service, and is important to ensure clinical governance. But this places further time constraints on GPs, who are hard-pressed to give quality time to patients and to triage those priority cases that require longer consultations. Q. While the concept of the way forward is of multi-disciplinary health care teams, can you comment on the anecdotal evidence that not all GPs are comfortable with the changes? Can you also comment on the BMA's recent call for strike action in relation to GPs' contracts? [Mr McFarland] A. We accept that some GPs find it difficult to work in the new team environment, but, as an educational body, we believe that the delivery of primary health care can be facilitated by multi-professional strategies and shared ownerships and perceptions. But teams do not happen just by bringing individuals together; the developmental needs of the health care professionals, which have been poorly funded by the HSS Boards, must be met. Effective teamworking can be achieved through different management structures at the coalface, but the success can be tempered somewhat with poor IT communication and professionals having to work from different buildings. In terms of GPs' contracts, we are not the negotiating body: the BMA General Practitioners' Committee has ownership. But the wrangle is an expression of frustration by highly committed GPs about the lack of quality time they have to spend with patients, the increasing waiting lists, and inadequate access to secondary care, nursing staff and support services such as the paramedics. The public demand a first-class health care service, and their rising expectations are justified. But this requires additional investment. Q. Does the panel believe that the best way to proceed is through investment in R&D, as opposed to a proportionate funding increase for GP practices? It is recognised that co-ordination generally within primary care practices, particularly in relation to IT systems, should be improved. Does this need to happen centrally with a template to follow? Are there any good models of GP practices that we can learn from? Are there any good examples of multi-professional training in health care, or is this still theoretical? [Ms McWilliams] A. We are not advocating a pro rata funding system. But there are several individuals who want to carry out research in primary care and are crying out for funding. A small amount of resources for research, with attendant parameters, would be very useful. There are wide variations across primary care practices as health care professionals prioritise different areas. Certainly funding is vital to put in place standardised IT systems, because if we do not have accurate, up-to-date data, we cannot determine need. IT from the better primary care practices should be the benchmark used to help bring others up to speed. It is important to support and encourage people to develop rather than being draconian and stifling innovation. The Royal College has two initiatives: the Quality Practice Award, which a number of practices are working towards, and the Quality Team Development Fellowship Award, which can be granted for improvements in auditing practices or technology, for example. A particularly good example of multi-professional education in primary care is the Target Scheme in Doncaster, which has been running for two years and has an attendance rate of 97%. The project sets aside one morning per month for the primary care group to meet and promote greater awareness of health care issues, discuss protocols of care, and agree objectives. The scheme's success lies in the fact that it has protected time, the professionals own the process, and it is genuinely multi-professional. There are proposals for such a scheme to be established in the NHSS Board area, but this will require resources. We feel that there are real benefits to be gained from such an approach, which should eventually be extended throughout Northern Ireland. Q. What is your organisation's link with the BMA? How can the nature of our health care system, which is overly bureaucratic, be simplified so that energies are devoted to front-line health care needs? How can we improve communication between patients and the health care professionals? [Mr Kelly] A. The BMA and the Royal College of General Practitioners (RCGP) both represent doctors. However, the RCGP is a voluntary organisation and is not empowered to negotiate on GPs' terms and conditions within contracts. Primary care pilot schemes here have brought about benefits for patients in, for example, cardiac rehabilitation and the treatment of diabetes. The success of these pilots has lain in the empowerment of patients in assessing their priorities and engaging with the primary care professionals in a transparent way. Health care professionals need to learn how to engage better with patients and vice versa. There are some models of good practice being established locally with a good network of patient-participation groups. Again, more investment is needed to develop this groundwork. Q. Given the research that you quoted which states that areas with increased access to GPs have a healthier population, I am concerned that some rural areas in Northern Ireland, such as Fermanagh, suffer from inequality insofar as they have a poor out-of-hours GP service. What is the present policy on this service? A. The introduction by central government of the out-of-hours GP service was a response to concerns from the profession about doctors' stress. We think it contributes to better fitness of GPs to practise. We need evidence from as wide a base as possible, though it is accepted that the quality of service in some areas could be improved. There seems to be an improving pattern in the service delivery of the GP co-operatives in relation to response times and satisfaction ratings. Such co-operatives are working effectively in the Republic of Ireland, Denmark and Holland. However, there is room for better co-ordination of out-of-hours health care, and cross-border comparisons can be made here to facilitate patients' access to GPs. One problem is that patients do not always access primary care at the best point, which leads to considerable duplication of services. We would support an initiative to see how primary care services can be better integrated and so maximise use of scarce resources. |
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