BRIG ROYD SURGERY
Minutes of Patient Group Meeting
Tuesday 29th March 2016
Present: Patients: Melvyn Cross (MC) (Chairman)
Brian Sutcliffe (BS), Carol Short (CS), Tabitha Peacock (TP) and Paul Hitchen (PH)
GP: Dr Louise Knowles (LK)
Practice Manager: Sue Rosborough (SR)
Practice Nurse: Karran Eames (KE)
Apologies: Patients – Gerald Williams, Mark Spriggs, Roy Greenwood, Diane Fairbairn, Pauline Jones, Charlotte Brady, Rosalind Denton
1. Opening Remarks
MC welcomed everyone to the meeting, accepted apologies as above and welcomed TP and PH to their first meeting. Thanks were also expressed to CB for the newsletters which have been well received and help to get important messages to patients, SR and LK also thanked members for their overall support.
2. Chairmanship of PRG
MC agreed to serve for another year and was unanimously elected Chair until Spring 2017. SR advised that MS was willing to continue in the role of Deputy Chair for meetings if MC was unable to attend.
TP commented on the importance of involving patients and carers in the running of the practice.
3. CQC Report
SR thanked PRG members for their support before CQC visited, on the day itself and on receipt of the initial and subsequent reports. There was discussion regarding the bland nature of the initial report and the improvement in the final report. MC highlighted the references to the PRG in the final report which had been missing initially. CS felt that the approach from the Inspectors had been too structured.
All accepted the grading awarded - a “good” practice with “outstanding” responsiveness to patients. SR reminded members that the full CQC report was available on the practice website whilst KE stressed the width of the “good” banding.
4. Review of Action Plan for 2015-16 and items brought forward from last meeting
To maintain the quality of our service – ensuring patients are treated in a friendly, professional and caring manner – “to treat patients as we would like to be treated ourselves”.
SR highlighted that patient feedback confirms we continue to provide friendly and professional care.
To maintain the level of access to GPs and the nursing team.
There was discussion of recent increases in our list size due mainly to issues at other local practices. SR advised that many of these patients have complex health needs and that the whole practice team is feeling under pressure. SR advised that a meeting has been arranged with the CCG Primary Care Team to discuss the current issues. LK informed that a practice can close its list in agreement with NHS England and that the aim of the meeting is to exert pressures on others to improve. LK hopes that Meadowdale will pick up some patients.
MC asked if additional GP sessions were required and LK advised that this is an option to consider later in the year when there may be changes in the number of sessions worked from the current partners. All sessions reduced by the current partners with at least as many sessions from a new partner.
SR informed that the nursing team is fully staffed once again. Vanessa has returned to work, Michelle has taken a post in the hospital and KE – with us this evening for her first meeting – is now with us as Practice Nurse Lead on a permanent basis. SR advised that Dr Emma Cole finished her GP training in March so we are back to a normal level of two GP trainees.
To continue to respond to patient demand as flexibly as possible as at present.
We continue to see all patients who need to be seen urgently “on the day”. Our increasing list size is putting the system under pressure but we continue to ensure demand is met, appreciating that in the majority our patients do not abuse the appointment system and request appointments appropriately. Our telephone call back system works well and provides the opportunity for patients to have a chat with their GP which may indeed be all that is needed. In response to a question from MC LK advised that calls are allocated to the patients Usual GP or if they are not in to the GP on call. CS advised that the service is “brilliant” and PH commented that patients know they can be seen if they are ill so try to self-manage initially. LK stressed the importance of patient education in maintaining access.
To maintain the highest standards of clinical care.
SR advised that no complaints had been received in the last year regarding clinical care, advising members of the annual review of “significant events”. All clinical events were reviewed in November and lessons learned and shared across the team, including changes to clinical protocols and procedures.
To use members of the team in the most suitable way to deliver care including prescribing pharmacist support.
SR advised pharmacist prescribers continue to be employed from the practice budget. LK confirmed this has reduced GP workload and reminded members of the role undertaken by the Prescribing Pharmacists. KE stressed how helpful the nursing staff found the system. SR advised that team development is ongoing – Alice will train in giving vaccinations later this year, Lee is learning ear-syringing, and the Practice Nurses continue to develop their knowledge of the management of chronic diseases.
SR also advised on the increasing complexity of administrative roles, including both managerial and reception roles. An assessment of the time required for the admin team to undertake their role above and beyond the “basic” reception duties is underway.
To continue to work closely with our patients and the members of the Patient Reference Group to enable us to deliver this action plan.
SR confirmed the practice is fortunate that the PRG members support the practice as do the majority of patients.
SR provided details of a meeting with the Immunisation and Screening Co-ordinator from NHS England at which there was discussion regarding the key role this group has had in promoting the screening and prevention agenda. SR provided details of the uptake of screening as follows:
Bowel screening figures - 65% (the third highest in Calderdale) – there is a reminder within patients records who have not responded to their first invitation with GPs and PNs encouraging patients to request a testing kit. CS commented how good this was and LK advised that the practice receives a letter from the screening team to advise if a patient has not opted into the screening programme.
Cytology (smear) figures – 87% (the highest in Calderdale). KE advised that the nursing team are now asking patients “shall I do your smear while you are here?” which is increasing uptake.
To continue to communicate with patients effectively and transparently and to provide information about local events in our community which may have a positive impact on the health and well-being of our patients.
BS asked for patients to be informed that the practice is leading the way on screening and immunisation. LK will write a piece for the next newsletter and include an update on infectious diseases including Whooping Cough and Scarlet Fever.
SR has requested marketing materials from NHS England for the next Calderdale breast screening campaign - take up is 62%. SR has also asked for national support of the flu vaccination campaign as take up seems to be dropping nationally and some positive messages may help. SR advised members of the flu vaccination achievements for 2015-16 which were all higher than the West Yorkshire average – pregnant ladies by 20%.
CS said huge credit must be given to the team for these achievements and MC hoped the practice would continue to lead the way in these important areas.
CS and MC will help SR to pull together the next quarterly diary of events. BS advised that people “need a nudge” to join in and how important it is to keep people informed. CB has confirmed to SR she is happy to publish the next newsletter.
It was unanimously agreed to continue with the above as our Action Plan for 2016. TP praised the practice team for its willingness to keep learning and developing.
5. Items from previous action plans (in addition to above):
Health Prevention and Screening:
SR advised the practice will host three clinics for AAA screening in 2016 and the face of AAA screening in Calderdale is a BRS patient. His 10 minute appointment saved his life.
To support patients who may be isolated and feel lonely:
SR advised one Mum has volunteered to help with Stay and Play but we need a couple more. KE is giving out the leaflets at Baby Clinic. MC suggested leaflets be distributed at local Baby and Toddler groups. BS suggested feature in Go Local.
Increase our online offering
SR confirmed the ongoing promotion of online facilities. 3210 patients (32% of practice population) are registered for online services and 2097 patients taking advantage of Electronic Prescribing Service. PH advised how well this system worked.
SR confirmed increasing use of appointment booking – and now cancellation – online. There are an increasing number of prescription requests – and linking these to electronic prescriptions means the patient requests medication at home and picks it up at the pharmacy the next day.
MC asked about charges for text messages and SR advised the practice was running within the limit available from CCG. There was discussion regarding the impact on attendance at appointments with text reminders and SR informed members of the monthly audit of patients who do not attend and its role in our safeguarding procedures.
SR advised that with effect from 31.3.16 there is a contractual requirement for patients to request access to their “detailed coded medical record” online. This will help with patients being able to see their vaccination status online and be able to manage their long-term conditions but records will have to be checked before enabling access – for references to third parties etc – and also access should be available on a proxy basis ie for carers and parents. There are issues with the age at which proxy access should be withdrawn and the potential for coercion for family members to ensure they can see another’s record. SR reported a software glitch has led NHS England to pause to programme at present. SR offered access to all members of the PRG so they are able to see what is available. PH shared the concerns regarding this requirement and stated that the GPs at the practice are very transparent so there will not be any surprises in patients’ records.
KE advised that workload will reduce with patients being able to see the dates of vaccinations and other information without requesting it from the practice.
Spirometry leaflet – in draft. LK will progress.
Yellow lines around Hirstwood – BC advised the order has been signed.
Men’s Health Noticeboard – SR has asked NHS England for some male biased publicity.
School Parkers – issues have reduced as a result of a strongly worded letter from the Head. Less patient spaces used but parents still park on the pavement.
GP Federation across Calderdale - bidding for services from CMBC (Public Health) and CCG who have made it clear they want to offer one central contract rather than 26 individual ones. SR advised the Federation is also heavily involved in the Vanguard programme which covers service redesign in the Upper Valley. Idea is to trial things in the Upper Valley and extend across Calderdale once they have been successfully piloted.
6. Review of decisions taken with PRG in 2015-16
The PRG had been involved in one major decision since the last meeting – to cease funding all dressings for patients. SR confirmed that the practice is now providing the first dressing and issuing prescriptions for anything further. KE and LK explained the quantities issued on prescription. MC asked for each patient to be considered on a case-by-case basis.
SR advised that Dr Ben Wyatt had made presentation to CCG regarding the staff required to deal with the management of complex dressings and leg ulcers in the community and CCG have taken away our thoughts and recommendations.
7. Review of 2016 patient feedback including Friends and Family Test, patient feedback when attending the practice, patient suggestions and complaints:
SR advised that feedback remains outstanding and that feedback was discussed with the full staff team at a training session in November. Staff had also attended a session on how to diffuse difficult patients who may wish to complain, and our April training session is based on dealing with awkward situations – based on our own experiences here at BRS – what happened, what did we do right, and what might we have done better. SR feels this should address some of the issues discussed at the last PRG meeting. The partners want to ensure that all staff can deal with patients who can be assertive or difficult. MC asked for the practice protocol in response to an emergency in a consulting room and LK advised of the alarm system and response required. MC asked if the staff had had any training in reasonable restraint and after discussion regarding the importance of trying to diffuse situations initially, LK felt training may help staff who are concerned by abusive patients.
There was discussion regarding the recording of telephone calls. LK advised that at present the partners do not feel this is required. GPs and PNs make a note in patient records regarding their telephone calls with patients. SR advised that staff now also enter “quick notes” into records of telephone contacts as required. KE ensures that her team summarise a phone call and ensure the patient understands what the next steps are. LK advised that all entries should be made as the call is in progress/completed when the conversation is fresh in people’s minds. MC feels there is balance to achieve and PH felt the use of “quick notes” records any pattern of behaviour or response with patients.