SELF Minutes of meeting 18.01.18
South East Locality Forum (SELF)18 January 2018, 10.00 – 12.00Wallingford Medical Centre
Present / Name / Organisation / PPG / Name / Organisation / PPG
John Reid, Chair / JR / Mill Stream (Benson) / Maggie Winters / MW / Benson
Jeremy Hutchins / JH / Goring and Woodcote / Andy Mayes / AM / Thame Rycote
Monica Waud / MWa / Morland House, Wheatley / Peter Woolsey / PW / Sonning Common
Janet Waters / JW / The Bell, Henley / Neil Topping / NT / Watlington and Chalgrove
Anne Lankester / AL / OCCG / Ed Capo-Bianco / ECB / LCD
Veronica Barry / VB / Healthwatch Oxfordshire / Nicola Perrett / NP / Healthwatch Oxfordshire (minutes)
Welcome and Introductions
John Reid welcomed Nicola Perrett to the meeting. The group introduced themselves.
Apologies
GeoffBraham (Goring and Woodcote)
JulianBrooks (Bell,Henley)
Maureen Norton(Wallingford)
JR remarked that the number of active members in PPGs is small.
JW said Henley PPG has created a patient voice category to keep people involved in the PPG who cannot make a large contribution
The group discussed involvement and succession planning.
Chair’s Annual Report
JR suggested the group make further contributions over the week to expand the current working document. JR sends the annual report to the CCG. JR and the group discussed the requirement/purpose of the annual report. JH suggested sharing the report with the rest of the PPG members as an open document. The group agreed this would be a good idea.
Appointment of Chair and Vice-Chair for 2018
JR advised he is willing to continue as chair but others could put themselves forward. ECB chaired the group temporarily to ask whether anyone would like to make the commitment to being Chair or Vice chair. PW said that the group functions as well as it does because of JR/JH. He proposed that this arrangement continues.NT seconded the proposal. JW agreed and suggested that JR/JH could swap roles. JH would prefer to continue as vice chair. JH said succession planning for the role is critical for future. ECB suggested members identify PPG members to do some shadowing of meetings to familiarise other members with the work.
JR suggested that someone could attend LCSG meetings to help with the workload. MW offered to attend these. AL supports this group and will add MW to the mailing list
ACTION: JR to send MW details of the LCSG meetings. AL to add MW to the mailing list
Matters arising from the minutes of meeting 23 November 2017
- JR suggested the need formore robust election processes within the terms of reference for PPGs. Goring PPG would be considering whether the whole patient body should have a vote. AM said that he has read the terms of reference for groups; the variation between them is in the election of officers. He suggested a maximum length of stay to encourage new people.JW changed their terms of reference to allow members to be reelected on an annual basis once their term is finished. The group discussed variation between PPGs whether members stay onthe PPG but are inactive, or whether members change regularly. NT said that it is hard to involve people from Watlingtonand people under 60 in general. AL asked about HWO role in developing PPGs. VB/NP confirmed that this is a planned piece of work. JH’s view is that the LF/PPGs know their people best and do not want to have a view imposed. VB suggested the sharing of good practice and JR agreed that this is the reason why he is involved. JWsuggested more engagement with people. MW said that coming to meetings is not the only way to be involved and PPGs need to be creative about how to get others including younger people involved egbeing proactive going out to mother and baby groups. NT suggested fundraising as a way of involving a wider range of people and to energise others. JR brought the conversation back to the question of electing people when a member has stood down and questioned the motivation of some people who attend. AM is encouraging local schools to send a teacher or involve a parent and is using school as an HR recruitment function to target likely members.
- MW has shared the MSK issue which has had a positive outcomeie an immediate referral to the Nuffield Orthopaedic Centre for assessment. Healthshare had a large waiting list -AL advised this has reduced from the 12,000 backlog they took on. ECB advised the list has reduced but is not at the point yet when patients can self-refer. JH added this was raised with the CCG before Christmas – the comms people have agreed to put out more information about self-referral. AL advised that information has been sent to GPs to know what the pathways are. JH would like to see more information for patients.
Locality news and update (Ed Capo-Bianco) including
- Feedback from consultation meetings in Wallingford and elsewhere, and development of PCF
- Sustainability of primary care (general practice)eg succession planning for GPs. There are county wide initiatives looking into using clinical pharmacists and mental health workers in practices. GPs in the South East can see the benefits of Clinical pharmacists rather than mental health workers and the balance of funding is to be adjusted to reflect this.While there is the possibility of having a link worker from MIND rather than a community psychiatric nurse most GPs would still see the benefit from a pharmacist. NT advised the pharmacy has doubled in size in Chalgroveand told the group there is information in the window listing mental health conditions and wonders how this would be addressed/followed up. ECB expects this would be referred back to the GP. JH questioned the governance especially as being encouraged to see a pharmacist. PW suggested PAGBmight be open to discussion about working practices that are mutually beneficial to pharmacists and GPs. JW also suggested the pharmaceutical regulator though they are currently working on strategy. PW said that the pharmacists would be happy to work with GPs especially giventhe increase in the online medication market. AM said that the funding for clinical pharmacists and mental health is non-recurrent and limited – practices are concerned about taking it on if it won’t continue. ECB advised this could be done under contract so practices wouldn’t be further burdened. JH said the sustainability issue was raised two years ago but thinks it is good to get experience of whether clinical pharmacists in practices work – he is also aware of the commercial issues between the GP pharmacy and commercial pharmacies which can be a barrier. PW advised the practice dispenser does not provide information in the same way as a pharmacy. JH said the dispensary at the practice generates income that pays for GP services and that GP pharmacies are governed by national rules.
- Care home initiative. Half of the care homes in the locality are signed up for GPs to visit on a weekly basis. CCGs are trying to make this more appealingegchanging the requirement to care for 50% of patients or for practitioners other than GPs to visit. JR advised from experience that this can work well and reduce admissions. JW advised that with the number of new care home developments this could not necessarily be further supported by GPs. ECB gave the example that patients with high needs could have funding for a weekly visit weekly but there is a need to bid for funding. JW is concerned about the number of new care facilities planned and the impact on GP services especially new elderly people moving into the area with complex needs. MW told the group about a scheme in Scotland whereby a GP is dedicated to working only in nursing and residential homes. ECB suggested the federation could have a GP to focus on this area of work. PW said Sonning recognises that planning consents have been given for the future and recognises that there will be further growth in more expensive housing that only older people can afford. The group discussed neighbourhood development plans.
•Plan on page – 2 votes
•Pictorial layout – 4 votes
•Booklet – 3 votes
The group discussed the options including:
- PW said that there has been feedback about access to internet services.
- AM suggested a one page format with key issues is good.
- The group queries whether the one page format in A3 or A4 as it seems very busy to be A4.
- JWsuggested it could go on TV screens in surgery and said in a surgery patients who are waiting are looking at screens and not at leaflets.
- MW said that the one page visual summary works well as it gives a good summary about how services are organised.
- JH suggested it shouldindicate what is going to change with timescales but not with any detail as this is available in the full plan.
- JR reminded group that the question is about the format rather than the content.
- JR referred to information from Anita Higham about readability and would the public understand the terminology eg ‘keeping surgeries open’ rather than ‘sustainability of primary care’.
- MW does not like the walking stick graphics to depict elderly people
- AM does not like the text on coloured backgrounds
- JR would like clarity about the size
- MW commented that the LF is not a good focus group to comment as they are already informed. She has tested it on her husband and said that the language needs simplifying.
- PW suggested having less content in a very focussed way. It could be better to have less information that people would be likely to read eg a picture and a sentence.
ECB commented that in the South East there are fewer proposals than elsewhere as patients can access services. The recommendations are about trying different skills mixes to support GP pressures and so support practice such as continuity with a named GP. NT acknowledges that a GP surgery is a business and there are fewer partners/board members – he has raised this as an issue but there is no easy answer.The south east is lucky to have been able to recruit GPs which is not the case in other areas.
Questions on reports from PPGs on their recent activity
In addition to the written reports:
MW (Benson)
In addition the PPG asked the regional manager from Lloyds pharmacy to come to a PPG meeting – due to a broken arm the manager cannot attend the meeting but has agreed to answer PPG queries.MW will circulate the responses.
JH (Goring and Woodcote)
- JH recommends the new practice website saying it is very effective. The same site has been offered to other practices and rejected. JR suggested that it would be good if one practice ‘has a good go at it’. The online consultation facility was discussed – patients can log on and enter online non-urgent queries eg about test results. The response is through emailie it is not a skype consultation. The aim is to reduce phone traffic into the surgery. ECB advises that this is available in some surgeries. JH said they have never adopted an email system whereas this system has better governance/confidentiality. The cost of the new website is higher than standard GP site. PW commented there are other web options developed outside the UK.
- AL commented there are sites identified for parking which could take pressure off the surgery.JW said this is a live and public issue especially with disabled parking, staff parking and fines
- JW brought a leaflet for the next carersbut as not that many carers are attending it has been deferred to 20th March. The next audiology talk is fully booked with a waiting list. There will be other talks in future; a series is planned for 2019 including neurology/respiratory. This requires minimal effort for surgery and there is funding from Townlands for refreshments and the talks are promoted in the local press. The group commended the work.
- The group wants to monitor waiting times at hospital clinics as there arenow some problems getting appointments for various reasons.
- The practice has signed up to district nurse mentoring programme. This involves 84 hours of GP mentoring which means the district nurse can then prescribe and the practice has the nurse for 1 year.
- JH advised Go active has changed to Go active health for diabetes support.
- PW will pilot an A5 magazine for PPG/health education materialreplicating work done elsewhere.PW believes he can secure funding for this. Each practice will have a free insert to promote practice approved local services. There will be criteria for entry ega butcher will offer support for the elderly – a person takes the leaflet / voucher to access the local support.The same thing will go online with PW providing the material. He will try a 10,000 run ie 1,000 each practice.
- AM has had success after three years engaging with younger people.JW suggested having a young person’s champion and she has a new PPG member in mind. The PPG went to the headteacher to ask for support which has been successful and is being taken further in school
- MW queried about Boots not informing the GP surgery about flu vaccinations.
- JW asked who is doing the self-care video. It will be made by a GP to promote self care.
- PW asked for EBC/AL to write an article for the Henley Standard about PPGs and SELF. JH has concerns about the Henley Standard as they published his email address.
- Maureen and the practice manager hoping to get more people involved
There was a major flood before Christmas at Chalgrove where the surgery was closed for one day.Efforts were made by staff to open the surgery again immediately after Christmas
- With regard to the Matters of Life and Death event being planned with Benson PP, an SODC grant was applied for but the group was advised they were ineligible as they were considered part of the NHS in spite of having own constitution/ bank account. This decision was challenged but was not changed.
- AL advised all surgeries have a business continuity plan.
- The Wheatley group has reviewed its terms of reference but MWa has heard nothing since it was submitted to the practice manager. The PPG has had one meeting but no further dates are planned. The SELF group encouraged her to push further. MWa has been part of a virtual group but has not been consulted at all – she is concerned there could be underlying issues. AL suggested a gentle approach to move things forward and offered to speak to the practice.
Report from the SELF Chair (John)
The PPGs would like to see how the GP practices are doing – a written report from GP awaydays about local initiatives was sent to AL at OCCG. AL advised that information is collected quarterly and on this occasion a one off report has been generated. JH asked if the report could be shared with PPG chairs given that each point is a good discussion point between the PPG and the surgery. JW would like to see the action plan for patient improvement from the awayday in September.PW said he values the contribution AL makes and thanked her for forwarding the information.
Report from the SELF Vice Chair (Jeremy)
- Royal Berkshire – he is not getting a response to questions
- Remote consultations – a number of patients work in London. Push doctor is sometimes used by patients and the work from this comes to GPs with no reference eg to other medication used. JH would prefer one system online. AL said that patient choice needs to be considered
- Online availability of minutes. VB advised approved Locality Forum minutes will be held on the OCCG website. Following a meeting with Sara Price at OCCG work is being done on consistency of navigation and language. Ros from HWO will advise forum chairs about this. JH hopes there will be no delay in publication. MW queried whether back copies of minutes would be available. There will be a link between the HWO andOCCG websites. MW attaches the PPG reports to the minutes. Sara Price raised a query aboutold documents and whether it is possible to archive some. The overall aim is to make navigation clearer for the public.
- Primary Care development – JH expressed concern whether all GPs are engaged with the locality plans. Patients need to have confidence that plans are endorsed by GPs
- The patient advisory group is disestablished. Oxfordshire primary care commissioning committee consists not of patient representatives but public members of the committee – JH said this raises governance issues. There is no good link between PPGs and Oxfordshire primary care commissioning committee.
- Accountable care system/organisation(ACS/ACO)–JH raised concern about the impact on primary care.An ACO is already in place in Bucks. It is possible this can be run by a commercial company – the thresholds for the tendering process for an ACO were discussed. JW queried whether ACOs follow on from STPs and how they fit together. MW reminded members that ACOs/STPs will be subject to judicial review as to their legality and lack of proper consultation. The OCCG is the commissioner.The health and wellbeing board is having a stakeholder meeting next month – JH sees this as being the body that orchestrates the ACO query. Currently it is a talking point.
- Key providers / OCCG staff are meeting to refocus the transformation plan. New models of care are to put people at the centre of health and social care services. The report is not yet circulated. This is a significant piece of work which will be useful moving forward.
- There is a trial with the patients association and NHS England looking at non-confidential data across practices in the CCG. It brings demography / workforce etc on a common basis.
- A survey is being developed for use by CCGs
Report on developments in communications and engagement (Anne Lankester)
Lou Patten has been appointed to work four days a week as CEO of OCCG while her job is backfilled during the transition. She is a district nurse by background. She is aware of boundary issues and the local area.
Developing the role and responsibilities of SELF and PPGs (including making our minutes publicly accessible)
See item 8
Dates for the next two meetings:
- Thursday 22 March at Chalgrove Parish Hall
- Goring May 17th location tbc 10 - 12
Summary of actions
ACTION: JR to send MW details of the LCSG meetings. AL to add MW to the mailing list
ACTION: MW to circulate responses from Lloyds regional manager
ACTION: PW to circulate details of pilot of health education material
ACTION: AL to raise PPG issue with Wheatley practice
ACTION: NT to send directions for Chalgrove meeting
ACTION: VB to pursue putting SELF minutes on CCG website and publicly available
PPG REPORTS TO SELF – JANUARY 2018