January 2013/December 2013

1. January 2013/December 2013 Index Acknowledgements Page 1 Overview of 2013 Page 2/3 Views of a new LMC member Page 4 How the NHS Changes have affected Primary Care – a personal view Page 5 Joint Update from Barking & Dagenham CCG and Havering CCG Pages 6/7 Joint Public Health Overview London Borough of Barking & Dagenham/ London Borough of Havering Page 8/9 Update from Havering Health & Wellbeing Board Page 10 GP ICT & Innovation Team – Developments & Updates Pages 11/13 Local Pharmaceutical Committee The view of a Co-opted Member Page 14 Update from Local Dental Committee Page 14 Medicines Management Report Page1 15 LMC Members and other Committees Page 16 LMC Accounts for 2012/2013 Page 17 Barking & Havering Local Medical Committee

2. Acknowledgement This year has been another tempestuous year of changes. There has been the announcement of contractual changes to the GP contract in April 2014 with the named GPs for the top 2% at risk and slashing of QoF. These top 2% will be expected to have dedicated access to the practice and proactively managed. Locally we have seen changes to our community providers, with new contracts to providers outside, but ironically employing local staff and in some cases stopping services altogether. Our hospital remains under scrutiny with heavy monitoring and a Pan London fragmentation of services all in the name of improved outcomes for our patients. Regardless. our colleagues in BHRUT struggle on in these pressured times in spite of their hard and sometimes innovative work. Further to this we have seen issues within our OOH services and NHS111 services but through negotiation between CCGs, LMCs and our GP workforce we have seen constructive dialogue. Also there has been further forging of relationships with CCGs, Local Authorities, Public Health, Local Pharmaceutical Committee (LPC) and the Local Dental Committee (LDC) and we hope to strengthen this further  Overall, It has, and will, affect our GP workload pushing further pressure on GPs. Questions will be asked on the ability of core GP values of continuity, access and chronic care. NHSE England (NHSE) rhetoric in London seems to suggest GPs should concentrate on chronic care and leave emergency care to others..... Regardless, I know Primary Care is delivering . A recent meeting suggested that data over a 10 year period showed that A&E attendances increased by 10 million. Over the same period GP contacts increased by 94 million!!!!! So well done all!!!! We need to acknowledge the hard work which officers and members do for the Committee on behalf of all GPs. May we also thank our co-opted members, Dr Hemant Patel of LPC, Som Hirekodi of LDP, Dr A Chaudhuri, Mr G Dawidek, Councillor S Kelly of London Borough of Havering, both CCGs and Public Health for their contribution to this report and for giving their time to attend LMC meetings. Thank you to Mr Neil Roberts, Primary Care Director at NHSE for contributing to our Annual Report. Our thanks also go to Medicines Management and ICT for their contribution. I would like to thank Madhu Pathak for all her hard work during a very difficult 2013. It is greatly appreciated. Thanks also go to Sue Elliott and the rest of the LMC administration team for their support throughout the year. Dr Jagan John, Chairman 1

3. Overview of 2013 2013 has been a very challenging year for LMC. We were used to working with the PCTs and had only just started working with CCGs, NHSE and the Local Authorities. LMC’s first quarter was spent adapting to the changes in our working environment, having moved from St Georges Hospital to King George Hospital. We had to work with new IT system and in transition lost some of the information. At the same time we had new telephone numbers and new email address making it difficult for practices to communicate and that caused some confusion. LMC did its best to inform all the GPs about the changes but it took time for practices to get used to it. We are pleased to say that this was all resolved by the end of March. We have now been at King George Hospital over a year and work goes on as normal. We have had two “Working Together” meetings this year, one in May and one in December. These were attended by GPs, Consultants, CCG representatives and Public Health. We had good exchange of ideas and information with presentations from GPs. Consultants and CCG Chairs. There was a consensus among attendees that these meetings are a good platform for discussions with Secondary Care colleagues and Public Health. A new Consultant-to-Consultant Referral Policy was discussed, agreed and finalised and is now in use. The monthly LMC meeting is now being held at Havering Town Hall on the first Thursday of each month as there is no meeting room available at King George Hospital, which means each month we have to transport all the paraphernalia required for the meeting. Our bi-yearly elections were held in June. A list of the current members and the other committees they represent, can be found on page 16. In August we appointed Leela Pendle as Primary Care Director on a consultancy basis to represent this LMC at some of the meetings held in Victoria with NHSE when members cannot attend. This has allowed our views to be represented at most of the meetings held by NHSE. Before working for us Leela was a Senior Industrial Relations Officer with the BMA. Suzy Iskander, our Administrative Assistant, left us at the end of August when she moved to Watford and Hayley Hart joined us on a part-time basis. Continued/…………….. 2

4. We continue to represent on LPC and LDC and the Area Prescribing Committee (APC). We were a bit disappointed that the APC’s new terms of reference did not include LMC as one of the voting members but we continue to be represented. We do not want issues to be decided for GPs at APC without LMC presence there. As colleagues know, the LMC has spent many months in negotiation with PELC helping to mediate and resolve the crisis that happened between the PELC working GP members and the PELC management. Hopefully most of the issues have been resolved. In September we held our Annual Dinner, which was attended by nearly 200 GPs and guests and was a great success. LMC took the decision to recognise the good work done by our colleagues in Primary Care and consultant colleagues who have been very proactive in working with GPs for a number of years. The following certificates were awarded. Dr Abdul Jabbar in recognition of Long Service to LMC (25 years) Dr Gurdev Saini in recognition of Exceptional Service to LMC Dr Jitendra Kakad   to recognise Excellence and Achievement in General Practice Dr V Goriparthi to recognise Excellence and Achievement in General Practice Dr Jayantha Mannakkara  in recognition of Continuing Support and Services to GPs Dr Honer Kadr  in recognition of Continuing Support and Services to GPs Thanks to all the colleagues who put above names forward. We very much hope to have your continuing support next year for future nominees. The award ceremony was greatly appreciated. During the last year we have made donations of over £300 to the Cameron Fund by transferring our Buying Federation profits to them. This is instead of the £100 donation we used to make from the LMC budget. Christmas is here again and we are all looking forward to working with you all in the New Year. Madhu Pathak 3

5. Views of a New Member Joining the LMC has been a good learning experience for me. I was invited to join by Dr Ann Baldwin who was already a member of the LMC. The atmosphere at my first LMC meeting was very relaxed. I was encouraged to participate in the ongoing discussions. The experience and knowledge that come from these discussions has given me better insight into the past and hopefully will help me contribute more meaningfully to future issues. The LMC performs a very important role for the local GP community; it gives a united voice for the local GPs, negotiates on behalf of the local GPs, help to design and agree on shared care pathways and act as a bank of information and advice for local GPs. One of the great achievement of the LMC this year was the role it played in helping to mediate and resolve the crisis that happened between the PELC working GP members and the PELC management. The role of the LMC in the CCG era is even more important as the LMC is not saddled with the conflict of interest that the CCGs are faced with. Maintaining this unique role will be one of the challenges of the LMC in the future. Dr David Derby, GP in Havering 4

6. Joint Update from Barking & Dagenham CCG and Havering CCG Both Barking and Dagenham and Havering CCGs were authorised with conditions on 1 April 2013. We operate as statutory bodies responsible for the commissioning of a range of local acute, community and mental health services. Barking and Dagenham CCG became fully authorised in June when its six conditions, which largely related to the development of robust QIPP and financial plans, were lifted. Havering CCG has three conditions remaining, related to its QIPP and financial plans and hopes these will be removed in the Dec/January submission to NHS England. The first few months of the new organisation have been challenging as we have taken the lead on commissioning local services and transitioned from a PCT into one of three main new commissioning organisations for health, the other two being NHSE England and the Local Authority. The new landscape remains a real opportunity to demonstrate the benefits of clinical commissioning. Given we work in the most challenging health economy, bar none, in the country; we have perhaps more opportunity than most to really make a difference. GP members remain at the heart of our CCGs with eight Clinical Directors representing practices on the Governing Body and six clinical champions who provide additional clinical support to the CCG work. Member practices meet once a month after the Protected Time Initiative and in six locality groups, led by a Clinical Director. As well as the PTI and cluster meetings, Havering CCG has a formal Members Committee once a quarter where the CCG leadership reports back to members on progress and members can hold the leadership to account over key issues. The Barking and Dagenham, Havering and Redbridge CCGs are collaborating in a number of areas where we have a mutual interest whilst maintaining independence to focus on borough focus specific issues. We work closely with health and social care partners through the Health and Wellbeing Board to improve health and social care outcomes for our local populations. We have made a number of achievements in the short time that we have been in operation which have been supported by the hard work and enthusiasm of local practices. Urgent care The biggest challenge for the BHR CCGs is to improve urgent care and the performance of our local hospitals trust, BHRUT. Havering CCG leads on the performance management of the BHRUT contract and is applying a rigorous approach to contract management and quality improvement. This year we became the first CCGs ever to commission their own independent, clinical review of local A&E services. Senior management at both the Trust, and at our mental health and community services provider, NELFT, are in no doubt that we are new organisations, working in new ways. Setting up, and chairing the local urgent care board, has given us an opportunity to get all of our health and social care partners around one table. Here we test our systems and procedures, plan a joint approach to the challenges we face and hold each other to account. Crucially, together, we have also started to make real improvements to urgent care for our populations. Continued/..................... 5

7. Steps should be taken to continually improve patient’s experience of integrated care, while also empowering communities to test new approaches. Good models of integrated care can and will look different in different areas. • Patients and service users need to see that agencies are working together for their benefit, this demonstrated through culture and behaviour as well as every day practice. Care and support of children Barking and Dagenham has a very young and ethnically diverse population. Havering is perceived as being generally older and less diverse but the recent census has demonstrated a rapid growth in the number of children in the borough and changing ethnic structure. Both boroughs have common concerns about the general health of children not least high levels of obesity; vulnerable young people and their families are a common concern as are safeguarding issues. As such the needs of children are a higher priority than ever before. To address this priority we must: • Be clear who is responsible for safeguarding vulnerable children: Previous failings in safeguarding show the dangers of a disconnected system and unclear procedures. With the reorganisation of the NHS there is an imperative to ensure all organisations and their staff understand both the individual and the system responsibility for safeguarding. • Enhance the involvement of children and young people in their services: We need to do more to ensure young people are consulted on how their healthcare is provided, and that they have access to information on health, illness and services. • Continue to improve primary care for children and young people: We need to support plans for extra training for GPs about child health and ensure inclusion of key elements of the Healthy Child Programme, improving awareness in primary care about public and population health. • Maintain children’s mental health as a priority: During the year we will be assessing the progress made on this important priority. • Ensure the children and young people have access to good sexual health services: GPs have a key role to play. The commissioning of sexual health services as a whole forms part of Councils’ wider role to protect the health of the population. Protecting people’s health The new public health responsibilities of Councils include the requirement to protect people’s health, which covers planning for and responding to emergencies, and ensuring protection from communicable and non-communicable diseases including through immunisation and screening programmes. Meeting these responsibilities will need effective working between Councils, and the new health system organisations, including Clinical Commissioning Groups, GPs, Public Health England and the NHS Commissioning Board. We, and our respective Councils are looking forward to a continuing strong and professional relationship with our colleagues at the Local Medical Committee and in General Practice to improve the health of our residents and access to good quality health care. Matthew Cole, Director of Public Health, LBBD Dr Mary E Black, Director of Public Health, LBH 6

8. How the NHS changes have affectedPrimary Care – a Personal View 1st April 2013 saw the biggest organisational change in the structure of the NHS since its inception in 1948.  NHS England is a single national organisation and responsible for, amongst other things, the direct commissioning of primary care services.  Practices will have noticed that many former PCT colleagues have moved on, with a resulting need to forge new working relationships within a new and  “slimmed down” organisation. Different services delivered by GPs are now being commissioned by and paid for, through different organisations.  NHS England cannot have the same approach to supporting practices as GPs would have experienced via PCTs and so we know they are having to look elsewhere – or internally – for that support. And of course GPs are playing their part in the commissioning of healthcare services through their work with CCGs. The teething problems associated with the reorganisation are almost resolved.  The patience of GP colleagues whist these problems have been worked through really is much appreciated.  In all our work in NHS England, and particularly in the development of a range of single standard operating models for the commissioning of primary care, we make every attempt is to keep the following principles in mind: Wherever possible to enable improvement of primary care To balance consistency and local flexibility Alignment with policy and compliance with legislation, including the Equality Act 2010 A realistic balance between attention to detail and practical application A reasonable, proportionate and consistent approach We now look forward to the exciting challenges of the next few years as we listen to the reaction to the Case for Change for GP services across London and we think about, and then start to deliver the work we need to do together to achieve the necessary changes.  That way, we will keep  London’s GPs motivated and continuing to innovate giving us a primary care system fit for the next 50 years delivering the kind of services patients demand and deserve and which GPs will want to provide.   Neil Roberts, Head of Primary Care, HNS England 7

9. Public Health OverviewLondon Borough of Barking & Dagenham and the London Borough of Havering Our two boroughs differ from one another in many respects. However, we have chosen to focus on what we have in common, not least the challenges and opportunities arising from the transfer of the public health function from the NHS to top tier local authorities on 31 March 2013. Much has been achieved already, but the pace of change can only accelerate as our respective Councils take on the challenge of addressing their new responsibilities to improve the health of the populations they serve. Although change and challenge is a fact of life, some things remain constant. The need to prioritise improvement in the health and wellbeing of the population, to work to reduce inequalities, to ensure equity in resource distribution, and to work in partnership with relevant organisations continues in both boroughs. Our respective Health and Wellbeing Boards are the forum for debate and challenge between partners, ensuring agreement and shared commitment to achieve change and improvement. We believe it is vital that we work with the Local Medical Committee and General Practitioners if we are to deliver population health improvement; with Councils and their respective Clinical Commissioning Groups investing jointly to achieve the industrial scale change needed to reduce mortality (death) and morbidity (illness). Industrial scale change is about doing things that we know can have an impact on the health, wellbeing and future life chances across the whole life course on a scale that gives all our residents the opportunity to benefit. The winds of change are now focusing on the future vision for primary care and General Practice with negotiations around the GMS contract, new standards for primary care, seven day working etc. Within all these new developments it is important for us in public health and General Practice to build on the strengths of community medicine. The key strategic messages which the Council and General Practice need to work on in partnership are: Supporting people to stay healthy • There is a shared need to shift focus and resources to prevention and early intervention. This applies across the life course. • The greatest health gain for the population is not in the improvement of acute care, necessary though that is, but in optimising the health of people with long term conditions through self-management and effective primary and community care. Consistent quality standards are fundamental to ensuring that the impact of illness is minimised. Integration of care • The financial and demographic challenges facing health and social care make integrated care an urgent necessity, as well as being in the best interests of patients. At the heart of an integrated model of out-of-hospital care must be the aim to improve reablement and recovery outcomes for all, whilst recognising the conflict between people’s rights under the NHS Constitution to a universal service, and the eligibility criteria that are a consequence of the pressure on social care. • Continued/………………… 8

10. Care and support of children The rapid growth in the number of children in the borough and the changing ethnic structure, as well as concerns about the general health of children as demonstrated through obesity levels and their vulnerability and safeguarding needs makes the needs of children a higher priority than ever before. To address this priority we must: Be clear who is responsible for safeguarding vulnerable children: Previous failings in safeguarding show the dangers of a disconnected system and unclear procedures. With the reorganisation of the NHS there is an imperative to ensure all organisations and their staff understand both the individual and the system responsibility for safeguarding. Enhance the involvement of children and young people in their services: We need to do more to ensure young people are consulted on how their healthcare is provided, and that they have access to information on health, illness and services. Continue to improve primary care for children and young people: We need to support plans for extra training for GPs about child health and ensure inclusion of key elements of the Healthy Child Programme, improving awareness in primary care about public and population health. Maintain children’s mental health as a priority: During the year we will be assessing the progress made on this important priority. Protecting people’s health The new public health responsibilities of the Council include the requirement to protect people’s health, which covers planning for and responding to emergencies, and ensuring protection from communicable and non-communicable diseases including through immunisation and screening programmes. Meeting these responsibilities will need effective working between the Council, and the new health system organisations, including Barking and Dagenham Clinical Commissioning Group, GPs, Public Health England and the NHS Commissioning Board. The Council is looking forward in continuing a strong and professional relationship with our colleagues at the Local Medical Committee and in General Practice in improving the health of our residents and access to good quality health care. Atul Aggarwal, Chairman of Havering CCG Dr Waseem Mohi, Chairman of Barking & Dagenham CCG 9

11. Havering Health & Wellbeing Board Update In its first year, the Board was set up with 12 members from across the Health and Social Care spectrum.  We are rapidly becoming a reviewer of the strategic situation with particular reference to the interfaces between health and social care. 20 assorted projects have been started ranging from COPD to reablement housing at Royal Jubilee Court to Tele Care and Tele Health.  These are just beginning to show major returns.  For example, the number of falls going to Queens dropped by 30% this year.  Our first year achievements are in planning rather than in doing, but this will be delivered in future years. We are working closely with the CCG and it is beginning to show real improvements and joint working, particularly around respect and consideration for the patient.  It is also been a year where we have greatly increased contact with the medical profession, for which I can only thank you for your help.  We need to continue to improve the health care in the borough and I am sure together that we can make great strides in this area. Councillor Steven Kelly, LBH, Chairman of Health and Wellbeing Board 10

12. GP ICT & Innovation Team Developments and Update Paperlight & Data Quality Accreditation This was a pre-cursor to submitting summary care records and other initiatives such as GP to GP. It involves ensuring that policies and best practices are in place and reviewed regularly within general practice on issues of information and data flows. For example ensuring all practices are entering data into a clinical IT system contemporaneously and having systems in place for business continuity in case of any disaster. It also concerns the data that is input by staff and monitoring of the quality of that data and use of read codes. This was, and still is, a requirement from Department of Health. Data quality All practices should have their data assessed against the quality standards regularly to ensure practice data is fit for sharing. As more and more practices use GP2GP and other electronic movement of data such as EPS, (electronic prescriptions) it becomes more important for the data to be of a high standard. Hardware Refresh (Printers & Scanners) GP Surgeries where offered additional scanners for their practices. The scanners offered could be used for clinical and non clinical scanning. As all the scanners are the same make and model this additional equipment will provide extra resilience in the event of a scanner failure. We had a good response to this offer. This is a rolling project which annually refreshes the older printer models across the Borough’s printer estate. This program provides the practices with latest model printer equipment which is covered by a 3 year manufactures warranty which is especially important as printing issues are the majority of fault calls that the GP IT Department have to deal with. As part of the programme we are actively moving from multiple manufactures to a single manufacture supply of printers. National Programme Projects SCR The Summary Care Record (SCR) is a secure electronic summary of key health information sourced from a patients GP record and held on the National Spine. Authorised healthcare staff can access the SCR to help with the care they provide to patients in urgent and emergency situations, where access to this information can be otherwise difficult or impossible to obtain. EPS2 EPsr2 enables prescriptions to be sent electronically from the GP to the dispensary of the patient’s choice. Over a billion prescription items were issued in 2012 and about 70% of prescriptions are for repeat medication. Key Benefits Patients – EPSr2 gives patients the flexibility to collect their medication from closer to where they work, shop or live. Patients need to nominate a pharmacy of their choice. A nomination isn’t a binding contact and they can change their minds at any time. Nomination can be set at the pharmacy or at their GP practice Continued/……………… 11

13. GP Practices – Reduce the number of paper prescriptions being printed and reduce the footfall in the practice. No more lost prescriptions. This gives GPs the flexibility to sign prescription electronically in between patients and not having to wait until the end of surgery. Greater efficiency and control over an electronic prescription as it allows GP to cancel prescriptions up to any point before the prescription has been dispensed. • Note: GP practices that are on EMIS LV will need to migrate to EMIS Web as EPSr2 isn’t available on LV. • GP2GP • GP2GP enables patient electronic health records to be transferred directly from one practice to another. • There are about 9,000 GP practices in England. They each currently deal with an average of 500 patient record transfers each year. • GP2GP electronic transfers will be more accurate, secure and much faster than the current paper based approach which can take weeks to complete. • Key Benefits • Improve the quality and continuity of care. • Improved safety • Clinical time savings • Administrative time savings • Infrastructure N3 NGA Upgrades • The New Generation Access project is a nationwide project to provide each GP practice with a higher bandwidth N3 connection. We are working with BT N3 to identify alternative network upgrades for sites that were originally considered as out of scope for the new NGA service. • Windows 7 & Active Directory (Pilot) (PC Hardware Refresh) • We have a further hardware refresh project identified to refresh PCs and to roll out Windows 7 and Office 2010 suite of software. We are currently developing a new desktop and server image and should have pilot testing work completed in November and potential to start upgrades in January 2014. • Patient On Line Access (DES 2013/14) • The aim of this directed enhanced service is to establish patient online access for booking /cancelling of appointments, requesting repeat prescriptions and registering patients (issuing passwords and using verification practices) to enable patient online access. • The purpose of patient online access can be defined as: • Improved patient choice, where patient will be empowered to choose the appointment date, which will then reduce the number of DNAs.   • To improve patient care by reducing patient journey, especially patients with long term conditions, by offering online services like ordering repeat prescriptions online. • Freed up admin time by reducing foot fall and telephone calls at the practice. • Continued/……………….. 12

14. Year of Care • BHRCCG is one the 7 national sites (Early Implementer Teams) for the Year of Care Funding Model Project. This is an NHS IQ project (formerly DH) aiming to establish a capitation based funding model for patients who have one or more long term conditions covering the cost of their care including social care for a 12 month period. • The first phase of the project was completed in March 2013 we are currently in phase two, shadow testing the personal budget/ currency. The project has been selected as one of the key priorities for NHS IQ and Monitor. • Year 2 ( 2013/14) will focus on shadowing LTC year of care currencies (local) • Discussion as to how the year 2 changes might be reflected in the local plans for the development and commissioning of integrated care • Further develop the commissioning and contracting of the model through testing implementation in a shadow year • Further develop the systems architecture needed to implement the model • Systematise the wider engagement of local stakeholders development of national pricing model and will entail: • Compare the currencies through use in shadow form and provide data and feedback • Provide greater depth of costing data • EMIS Web Upgrades • Overview • Emis Web is a Connecting for Health Level 4 accredited hosted clinical system. Current Emis users have the opportunity to upgrade their system from Emis LV or Emis PCS. The Emis Web project has been rolled out across ONEL for the last 18 months. Engagement with GP practices has taken place to demonstrate the new system and support has been provided to facilitate the go live process. Post go live support is also provided to practices to assist in familiarising them with the new system. Practices on Emis PCS were priority as the system is not compatible with CfH modules (Choose & Book, EPS2, GP2GP) so that the practice can take full advantage of these facilities. • As Isoft is moving away from primary care clinical systems, these sites have the opportunity to migrate to one of the other clinical systems. Those who choose Emis Web have been incorporated into the project and are provided with support from the GP IT team in the same way as existing Emis users. • Current position - Emis Web upgrades 97% • There are 41 practices in Barking and Dagenham. 25 practices are INPS Vision users and 1 site uses TPP System 1. • Currently there are 16 Emis practices within Barking and Dagenham. All sites were migrated to Emis web by the beginning of September 2012. Barking and Dagenham were the first London PCT to migrate all their Emis sites • There are 51 practices in Havering. 39 practices are INPS Vision users. There are currently 12 Emis practices within Havering. 11 practices have migrated to Emis Web to date including the Isoft site, who opted to change to Emis Web. One surgery has yet to engage with the project. • Dave Game, Head of Primary Care IT Services 13

15. Local Pharmaceutical CommitteeThe View of a Co-opted Member LMC is like a light bulb. Everybody takes it for granted until one day there is darkness. I find that since working with Madhu and her colleagues, the LPC has managed difficult situations better through discussion and developing an understanding of each other's different and changing perspectives. We consider our selves lucky to have Barking and Dagenham and Havering LMC that is clearly ambitious for its members yet sensitive to the changing needs of its partners. I feel it's well thought out ideas to reposition the medical profession locally is good for the people, doctors, commissioners and other partners like pharmacists. I look forward to another year of robust and friendly discussions about improving primary care. Hemant Patel, Secretary Local Pharmaceutical Committee Local Dental Committee The LDC are very pleased that they are being given an excellent opportunity to understand & work more closer together with their GP colleagues. This year has been difficult, I think, both for GPs & GDPs as NHS England is finding its new structure. The LDC is looking forward to strengthen it relationship with the LMC in 2014. Som Hirekodi, Treasurer, NEL Local Dental Committee 14

16. Medicines Management Report 2012/13 For 2012/13 the agreed QIPP Prescribing Savings target for Havering and Barking and Dagenham CCGs were £1,162,000 and £907,000 respectively. These targets were achieved with an additional saving of £1,548,694 and £868,437 for Havering and Barking and Dagenham respectively. Total savings achieved for 2012/13 from prescribing was £2,710,694 for Havering and £1,775,437 for Barking and Dagenham CCGs. Havering CCG successfully demonstrated that for every £0.73 per population head spend on the MMT, saved £11.31 from the primary care prescribing budget. This was similar for Barking and Dagenham CCG where for every £0.92 per population head spend on the MMT, saved £9.11 from the primary care prescribing budget. Key achievements for 2012/13 include being highly commended at the HSJ awards for the Oral Nutritional Supplement Project, achieving the agreed QIPP and unlicensed medicines (specials) targets, practice engagement through Prescribing Forums and collaborative working across the health economy using the Area Prescribing Committee and North East London Medicines Management Network. Further information can be obtained either from the Medicines Management Team or the LMC Office. Belinda Krishek, Medicines Management Chief Pharmacist, Clinical Commissioning Groups 15

17. LMC Members/Other Committees Chairman: Jagan John Joint Vice-Chairs Ann Baldwin Dan Weaver Treasurer: Sickan Subramaniam Barking & Dagenham: Farzana Bhatia Natalya Bila Alex Duodu Venkatarao Goriparthi Raj Kalra Parveen Masud Alok Mittal Syed Pervez Padma Prasad Kanika Rai Tina Teotia Co-Opted Members Mr Gervase Dawidek Consultant BHRUT Dr Abhijit Chaudhuri Consultant BHRUT Mr Steven Kelly Cllr LBH Council Mr Some Hirekodi LDC Mr Hemant Patel LDC Havering: Badi Beheshti Timothy Bland David Derby Ashok Deshpande Birbala Dixit Abdul Jabbar John O’Moore Aarron Patel Pravin Patel Saravanamuthu Poolo Gurdev Saini Maurice Sanomi Kodaganallur Subramanian Sarita Symon Non-Principals Anthony Annan Samia Bushra Uzma Haque Khalid Khokhar Elizabeth Howard Amit Sharma Representation on Other Committees: Policy Making Sub-Committee: Dr Ann Baldwin (Chair Person), Dr D Derby, Dr V Goriparthi, Dr U Haque, Dr J John, Dr P Masud, Dr J O’Moore, Dr G Saini, S Subramaniam, D Weaver Finance Sub-Committee: Dr V Goriparthi, Dr J John, Dr G Saini, Dr S Subramaniam Primary Care Strategy Group Dr J John London Strategy Board Dr J John Londonwide GP Commissioning Council Dr J John NHSE/Londonwide LMC Meeting Dr J John Area Prescribing Committee Dr D Weaver Local Dental Committee Dr F Bhatia Local Pharmaceutical Committee Dr Amit Sharma Public Health Committee for Sexual Health Dr B Dixit IT Leads Dr T Teotia Barking & Dagenham Dr D Weaver Havering LMC Website PLEASE KEEP UP TO DATE WITH ALL THE LATEST POLICIES, GUIDELINES AND GENERAL INFORMATION BY LOGGING ON TO THE LMC WEBSITE: www.barkinganddagenhamlmc.org.uk 16

18. BARKING & HAVERING LOCAL MEDICAL COMMITTEE INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 31st MARCH 2013 • 2013 2013 2012 2012 • £ £ £ £ • Income: • Members subscriptions from levy 144,883 135,834 • Members subscriptions paid in advance (1,588) 143,295 (4,805) 140,639 • _______ _______ • Doctors contributions for annual dinner 2,420 2,394 • Drug Companies contributions for annual dinner 2,400 850 • Drug Companies contributions for meetings 3,000 8,020 450 3,694 • GP Meeting with Consultants 200 - • _______ ________ 151,315 144,333 • Expenditure: • Medical Secretary Salary 74,500 74,500 • National Insurance 9,825 9,883 • Company Secretary Salary Recharge to BDH LMC Ltd 4,188 4,188 • _______ 88,513 _______ 88,571 • Admin Secretary Salary 31,776 30,540 • National Insurance 3,351 3,239 • Admin Assistant Salary 11,208 7,580 • National Insurance 513 307 • Admin Assistant Salary _ 4,688 • National Insurance 93 • Pension Contributions 768 768 • Maternity leave pay claim from HM Revenue and Customs - (3,580) • HM Revenue and Customs PAYE (refund) payment - • 47,616 43,634 • _______ _______ • Postage and Stationery 1,473 2,461 • Mobile telephone 991 529 • Office equipment 623 - • Training meetings - - • LMC Annual Dinner 3,522 3,708 • Locum Cover for attendance at Conference: Dr Weaver 1,000 - • Locum Cover for attendance at Conference: Dr Goriparthi - 350 • Locum Cover for attendance at Conference: Dr John 1,000 500 • Locum Cover for attendance at Meeting: Dr Weaver 1,000 500 • Locum Cover for attendance at Meeting: Dr Bland - 250 • Locum Cover for attendance at Meeting: Dr John - 250 Contributions to charity - 250 • Catering for Meetings 2,203 242 • Accountancy Fees 720 720 • Payroll fees 648 648 • Bank Charges and Interest 156 123 • General Expenses 380 204 • General Expenses - 58 • Internet design - - • Insurance - - • BDH LMC LTD recharge of expenses 810 (1,719) • GPDV Voluntary Levy adjustment 31.03.2012 - 3,034 • GPDF Control Account - 15,186 20 12,128 • _______ _______ _______ _______ • 151,315 144,333 • _______ _______ • NET SURPLUS/(DEFICIT) FOR THE YEAR 0 0 17

19. January 2013/December 2013 This Annual Report is prepared as required by paragraph 8 of the Constitution of the Barking and Havering Local Medical Committee Barking, Dagenham & Havering Ltd. Registration No. 6773489