Grosvenor Medical Centre

GROSVENOR MEDICAL CENTRE

PATIENT GROUP MEETING

4 March 2015

11.30 am – 1.30 pm

Purpose of the meeting: To review the outcomes of the 2014/15 3 key survey areas and actions taken to date. To provide the panel with an update of current developments within the practice.

Present:

Dr A Spooner – Partner, Grosvenor Medical Centre

Rachel Patrick – Service and Patient Participation Group Administrator

Caroline Harley – Practice Manager, Grosvenor Medical Centre

Trish Vickers – Senior Practice Nurse

Trevor Gomersall – Patient Panel Representative

Kevin Larkin – Patient Panel Representative

Colin Yoxall – Patient Panel Representative

Catherine Edwards – Patient Panel Representative

Neville Layhe – Patient Panel Representative

Lynne Jones – Patient Panel Representative

Maggie Shaw – Patient Panel Representative

Apologies

Nino Mastroianni – Patient Panel Representative

Michelle Bromhead – Patient Panel Representative

The meeting commenced with the welcoming of three new panel members. The practice is absolutely delighted that the number of panel members is increasing with each panel member bringing different skills and knowledge.

1. Key priority areas for 2014/15 Survey update

At the September 2014 meeting the patient panel agreed 3 key priorities for surveying patients in 2014/15. These were:

1. Sexual Health services for young people – the panel agreed to support the practice’s decision to support Cheshire East Council’s local survey for young people by the practice promoting the survey at the Young Person’s Clinic starting in October to capture views from attendees who will be Grosvenor Medical Centre patients and patients from other practices. It was important to engage this age range in their views as current users of services and influencers of future services. Unfortunately the number of young people attending the clinic has not been as many as expected and certainly not significant to undertake a survey. A small number are attending each week, which the practice has been informed, is not unusual at the start of a new service. Until word gets around to young people and they become confident in the confidentiality of the service numbers will be slow to pick up. The service provider is comfortable with the slow up take so the practice is happy to continue to provide the room for the service and to advertise the service. As there were insufficient numbers to promote the East Cheshire’s Council’s survey the practice quickly made the decision to survey practice patients at the second Flu clinic on what they liked about the practice and an aspect of the appointment system. The practice continuously looks to making improvements on the appointment system and one of the areas difficult to predict in what is an acceptable length of time for a patient to wait for a non-urgent appointment. At some stage in 2015 when the service numbers pick up the practice will work with the Sexual Health service for young people to undertake a relevant survey.
2. Appropriate Local District Nursing Service Provision – To ensure the stability of the current provision particularly continuity of care and access to staff with the right skill mix to provide services to patients who cannot get to the practice premises. The panel felt continuity of care was valued along with the appropriate number of senior staff who can make decisions and associated staff who can provide holistic care
3. Convenient Hospital Services – Can more hospital services be provided locally for ease of access for patients and can specialist services be in a hospital or local surgery that is the most convenient to South Cheshire patients?

All three areas with the agreed questions were surveyed at the 2014 Flu Clinics using the kiosks loaned to the practice from the South Cheshire Clinical Commissioning Group (SCCCG). Colin Yoxall, Catherine Edwards and Kev Larkin, panel members, assisted patients with using the kiosks. Becky Barber, a Practice Engagement Manager at the SCCCG also assisted the practices at the Flu Clinics. She brought with her the Cheshire East Councils ‘House of Hazards’ a useful display board of hazards in the home and there were council leaflets available for patients to take away included the Be Steady Be Safe brochures. Their help was pivotal to the success of the surveys and also to the smooth running of the flu clinics. The practice thanked the Panel members for their valuable support, help and enthusiasm on the day. The Fire Brigade also supported the practice at the Flu Clinics with their Kitchen Fire display and again helpful leaflets for patients to take home. The SCCCG gave the practice two boxes of free 2014/15 Calendars advertising helpful hints and tips on disease and medicines management for patients to take if they wish.

In relation to Area 1 the comments from patients around what they liked about the practice are captured in the following document:

As the patients were using free text to record their responses there was quite a wide variety of answers. However the answers with a reasonable level of responses were:

Friendly staff/Friendly 16 responses

Very good/caring 12 response

Friendly and helpful 9 Responses

Very/always helpful 6 Responses

Very efficient/efficient 5 Responses

Good 5 Responses

Overall the responses were very positive and indicative of the hard work of the GPs and practice staff. It was delightful to get so many commendable comments. A couple of GPs also got a mention. Patients inevitably did note the difficulty sometimes in getting an appointment and this is something the practice is continually reviewing.

The practice also asked what did patients feel was an acceptable length of time for a patient to wait for a non-urgent routine appointment? The current appointment system has a percentage of appointments available to book in advance up to 6 weeks, a further percentage for 2-3 weeks ahead with the remainder of appointments being available in 2-3 days and on the day. The current system is set up as a result of a large number of patients not planning their care which is not ideal and it was unknown as to if this meet the need of the patients. The results of the survey were:

On the whole a large percentage of patients felt that it was acceptable to wait less than 2 weeks to book a routine appointment demonstrating that not many forward planned their care. This will be fed into the next review of the appointment system.

In relation to Area 2 the panel felt it was important to ascertain patients’ knowledge of what the District Nursing service provides along with what was important to them from the service. Prior to the survey the District Nursing Service had been significantly compromised as a result of cost improvements made by East Cheshire Trust. Staff were so stretched that they were challenged in delivering the core services to which they were contracted to provide. The questions for the District Nursing Service were only undertaken at the first flu clinic so that the outcomes could be taken into account promptly and fed back appropriate to the review. The core services were identified in Question 1 to ascertain if patients were aware of these core services.

Q1 – What services do you think the District Nurse Provide?

a) Palliative Care

b) Care to the frail and elderly

c) Post-Surgical Care

d) Day to day care for housebound patients

e) Seeing patients at the surgery

Please tick as many of the above options that you feel are correct – A-D are services provided by the District Nursing Service. District Nurses work solely in the community and do not see patients at the surgery. The results of the survey were as follows:

There was a spread of responses through A-D indicating that most patients were aware of the core services. However a third of the respondents did indeed believe that the District Nurse saw patients at the surgery. It was quite clear that potentially unless patients or their relatives had received visits and treatment from the District Nurse the wider practice population may not realise the importance of this service to housebound patients. Therefore supporting this service to ensure that it is funded appropriately would not necessarily be a priority for the practice’s patient population.

Q2 – What would be most important to you when seeing a District Nurse?

a) Continuity of Care

b) Trust in their skills and knowledge

c) Just to see the same person

d) For the Nurse to know and work with the:-

i) GP

ii) Physiotherapist

iii) Social Worker

Please tick as many of the above options that you feel are correct and which are the most important. The results were as follows:

All of the options are relevant to a District Nurse. Prior to the survey the Practice was unsure if patients knew that the District Nurse could directly work with other disciplines (sub-section d of the question). The 43% response rate was more encouraging than expected. As Dr Spooner was involved in the work to discuss and agree the Key Performance Indicators (KPIs) for the District Nursing Service the findings from the survey will be fed into this process.

Area 3 involved the convenience of hospital services. It had been acknowledged that care closer to home that is convenient and easy to access was very important to patients both for treatment and referrals for hospital services. Also although specialist services have to be provided in dedicated centres of excellence was felt important that these are located in specialist hospitals that are easy to get to with good transport links. The results of the surveys were as follows:

The survey results were very encouraging in that patients wanted first out-patient appointments at a local surgery. This is inevitably for convenience and ease of parking. Trish advised that the practice had already discussed potential options e.g. a pre-op clinic but this would have to be resourced from the monies saved by the hospitals not undertaking this work. An x-ray facility in the community was felt to be a good option if this was feasible. This is something that the practice can feed into the commissioning process and the practice is keen to support the initiative. With respect to specialist services, although Manchester and Liverpool are the providers for the North West, it was quite clear that due to the location of Crewe being in the most southerly part of the North West patients from the practice prefer to travel to North Staffs Hospital in Stoke. It is important that this is fed into the North West commissioning process via the local Clinical Commissioning Group as North Staffs is part of the East Midlands area and not normally viewed geographically appropriate for the North West.

The panel in January 2015 were also involved in undertaking a questionnaire for the GP Alliance. The GP Alliance had identified areas of priority for the PM Challenge Fund’s Bid and wanted to ascertain from Patient Panel members if these were indeed the appropriate developments. The questionnaire – as below

was sent at short notice to Patient Panel members who did endorse the developments proposed.

2. Practice Nurse Update

Trish Vickers introduced herself to the new members. This is the Senior Nurse at the practice and is also the Lead Nurse for South Cheshire Clinical Commissioning Group (SCCCG). Trish is responsible for the Practice Nursing Team which comprises of 4 Nurses and a Health Care Assistant (HCA). The practice HCA (Ella) is currently training to be an Assistant Practitioner. An Assistant Practitioner is a Qualified HCA which is one step under a Qualified Nurse. It is a two year course linked with the University of Chester. Ella is the first HCA in the Cheshire area to undertake this course. When she has qualified she will be able to undertake new procedures e.g. Ear Syringing and Circulation assessments. Trish advised that as from the 1 March 2015 all new Health Care Assistants have to have achieved a number of competencies before they can undertake the role. Existing HCAs should be reviewed against the competencies to ensure that they are competent to continue to work in this role. Suitably qualified HCA’s will free up Nurse time for the nurses to undertake Chronic Disease Management – the management of long term conditions (LTC). The workload with respect to LTC’s is increasing with rising numbers of patients going onto disease registers. These patients require input to assist with the management of their disease. All of the Grosvenor Practice Nurses are trained in chronic disease management, treatment room work, wound care, immunisations, cervical cytology and more recently the management of oedema – swollen legs. For oedema the Practice Nurses have recently received training from the Tissue Viability Nurse as part of a pilot project to see if this service can be delivered as a clinic in the community.

As Lead Nurse for the SCCCG Trish had recently spoken at a local pensioner group and took a number of points raised back for further discussion at the SCCCG. One of the points was in the feasibility of a ‘drugs amnesty’ – patients being able to safely return unused medicines. Trish is also very active in work that is involved in identifying vulnerable elderly patients. She has piloted this in Grosvenor Medical Centre and due to the success of the project this has now been adopted by other local practices. It has also resulted in a ‘Single point of Access’ service being created where practices can refer patients to for a number of services – e.g. support at home thereby maintaining their independence in their own home. Trish is now looking a patients’ with diabetes and engaging with these patients in lifestyle changes rather than just monitoring the disease.

3. Update on the CCG/ Connecting Care

Dr Spooner advised that SCCCG at present was on target, despite financial pressures, to meet the 2014-15 requirements. Funding pressures have created difficulties as South Cheshire is an underfunded area with deprived patients but SCCCG hopes to be in financial balance at the financial year end. It has been nationally noted that the SCCCG has been underfunded and the CCG is due to receive some additional monies for 2015-16. The monies will not be enough to do all the things which other organisations would like the CCG to fund. This just adds pressure for the future and creates the need for General Practice to be stable and able to develop new services and to link with all existing services so that all parties work together. Dr Spooner explained that the SCCCG holds the budgets for the local providers – Mid Cheshire Hospital, East Cheshire Trust, the Local Authority, Cheshire and Wirral Partnership Trust, with set outcomes for these organisations to come up with ways of working to deliver what is required in the community to meet patient needs.

One of the initiatives East Cheshire Trust (ECT) undertook was to re-organise the District Nursing services which caused problems that were discussed at the September 2014 Patient Panel Meeting. This was pivotal in the use of a question around this in the surveys undertaken at the flu clinics. The survey results were fed into the later discussions ECT that acknowledged that ECT needs to be aware of specific local issues, outcomes required and appropriate quality markers i.e. all organisations using the same computer system to input patient information.

Cheshire East Council did receive some monies from the Better Care Fund for new initiatives. Kev Larkin raised the concern that often new monies are not ring fenced by the Local Authority and therefore may not be invested in the projects to which the initial intention was for. It was raised that is it always difficult to establish from the Local Authority how monies have been utilised particularly with local residents see valuable respite facilities being reduced or closed. These facilities are often for patients who need rehabilitation services. Maggie Shaw asked if research can be commissioned around outcomes for patients to demonstrate how important step down provision is compared to a patient being stuck in hospital. Dr Spooner responded that locally research is done by Liverpool Research Centres where funding is not easy to obtain. Although Keele undertakes a lot of research Cheshire does not fall in their Deanery Research boundary.