Advisory Group Meeting
Thursday 17th April 2014 10.00am-12.00pm
Room 3 Beaumont House
Mile End Hospital
Agenda
/Time
/Lead
1
/Welcome, introductions and apologies
/10:00-10:05
/ Chair Angela HancockBusiness Items
2 / Minutes of the meeting of meeting 25 February /10:05-10:15
/ All3 / GP patient information pack /
10:15- 10:35
/ Kristina ValentinoNELCSU
4 / GP boundaries /
10:35-10:45
/ Dr George FarrellyGP/CCG
5 / Assistive Technology /
10:45-11:10
/ Steve Nye & Masum Ahmed LBTH6 / Barts Health
· response to Healthwatch patient experience report
· Quality Account
· Advocacy and Interpreting Service /
11:10-11:35
/ DiMyra Garrett
7 / Transforming Services – Changing Lives’ Programme /
11:35-11:45
/ David Burbidge8 / Priority setting and Enter and View programme /
11:45-11:55
/ Di9 / AOB /
11:55-12:00
/ AllCCG = Clinical Commissioning Group
NELCSU = North and East London Commissioning Support Unit
LBTH = London Borough of Tower Hamlets
Date of next meeting: 10 June 3pm-5 pm
Healthwatch Advisory Group Meeting
Thursday 17th April 2014 10.00am-12.00pm
Room 3 Beaumont House
Mile End Hospital
Attendees
David Burbidge / Myra GarrettAngela Hancock / Daniel
Shahanur A Khan / Kristina Valentino
Thufayel Islam / Dr. George Farrelly
Shamyl Saigol / Steve Nye
Masum Ahmed
Staff: Dianne Barham
Apologies:
Chair: Angela Hancock
1. Welcome, introductions and apologies (Chair Angela Hancock)
2. Minutes of the meeting of 25 February 2014 (All)
3. GP Patient Information Pack (Kristina Valentino, NELCSU)
Member: A pilot is being run by Age UK, Housebound Project on teaching people how to use Skype. The problem is these organisations are not linking together especially from the community perspective.
Dianne went for a second interview with Social Action for Health, the second interview was successful. A key concern regarding Social Action for Health:
· They don’t just use Social Action for Health groups.
There are three different types of group leaders
· The mums groups, maternity services liaison committee
· People who are already in user groups, e.g. the older people’s reference groups, the diabetes groups, womens health etc.
· Individuals who have a particular interest in certain health groups or services (impassioned individuals).
Action: HWTH should work together with GPs to bring together a group of patients that reflect the make-up of the borough. Also could be done by bringing in the people who took part in the GP Equality event.
4. GP Boundaries (Dr. George Farrelly, GP/CCG)
Contact Details:
Dr. Farrelly is a GP who is on the board for the Quality and General Practice Program. Key concerns presented:
· How do we make General Practice in TH sustainable in these difficult times?
· How do we keep professionals morale up, including good communication with patients?
· And also how do we keep practices financially viable?
The GP pack information (has not been developed yet) the idea is to give existing and new patients some kind of information pack on how to help them use the practice optimally. This makes providers think about what they are actually trying to provide, how to do it efficiently. The pack is for GPs to inform patients on what they do and how patients can access these services, and what they DON’T do.
Dr. Farrelly wanted the board members views on this package.
Member: We thought of putting something together by getting patient input first to make sure we are creating a high level template, we wanted to also make sure it wasn’t something being imposed upon patients.
Myra: One of the things we struggle with is the telephone system and one of the ways of getting around it is to use the bookings online. But the registration of getting online is impractical; you have to go into the surgery to sign up. But once you sign up, it makes life so much easier for the patients. What they are doing now with every new patient is offering this online access.
David: What I would like to see is more cooperation of how we could actually use the system, to the advantage to the patients, GPs, nurses and even pharmacies.
We could have an online version of this.
Shahanur: Couple of concerns:
· Patients groups are not run by patients any more, its dictated by the practice
· The GP practice systems is not that good (i.e. appointment call backs are too long)
· Not everyone is digitally aware (especially the vulnerable)
Member: It is very important to get clear information and signpost patients. There are real issues about technology, there seems to be a technology divide.
David: GPs and hospitals don’t want leaflets because it creates clutter, so how are we going to put this package across? Putting information on leaflets to give out to patients will not be an option in the next twelve months.
Dr. Farrelly: Although leaflets are useful, but they can be a problem. We can get lots of them and it is difficult organise and stock them.
Dr. Farrelly expressed concerns about the GP Boundary the government wants to get rid of the boundaries and allow patients the choice of where to be registered.
From his perspective as a provider this doesn’t work. If patients move from the geographical boundaries the system breaks down. Accessing patients who leave far will be a problem and take up time of GPs and impacts on the practice service and other patients. There are a lot of hidden problems with scrapping the GP boundary. It’s not about patient choice it’s about merging care. It’s better to raise standards of GPs rather than have patient’s leave their practices.
Group discussion on GP Boundary:
Dianne: There seems to be not enough GPs in TH and it feels like we are attacking the GPs. What should HealthWatch be doing? Who should we lobby for this?
George: With a growing population we need to increase the number of GPs or GP practices. Lobby for this to NHS England and tell them the system is struggling.
Myra: Could you touch on the issues of Jubilee Street practice in regards to the increase of the population in TH?
George: In 2004 there was a new contract, which had a complex model on how much each practice would get per patient per year. Smaller practices were going to lose around £30,000 per year as a result of this new contract. In England 70% of GPs were going to lose money. This was a non-starter. So they introduced something called MPIG (Minimum Practice Income Guarantee). This meant that you were going to lose out; they guaranteed we would at least stay even, so we all signed up. What they are now doing is removing the MPIG, so some practices such as Jubilee Street practice will be going under because they have a big MPIG. They are removing the subsidy. If we don’t find a fix for that the Jubilee street practice will go under.
Myra: Can they be bought?
George: Yes, like ATOS who bid for St. Pauls Way practice, they just wanted to make money so they cut costs and then they walked away from the contract.
Member: So what we are looking at is a similar occurrence with another organisation which may not ultimately sustain or provide the same service?
George: That’s right; Jubilee Street will get behind this, NHS England will be looking for a way to sustain this practice.
David: From the NHS England’s point of view the money goes with the patient but the patients’ vote with their feet; if they don’t like a practice they go to another one and take the money with them, that’s what the whole concept is.
Dianne: If people are happy we should write a letter to HealthWatch England saying as patients we don’t understand the system, our GPs are struggling and we can’t carry on hassling them.
Member: As patients do we express our views through HealthWatch?
George: Just say you like your GPs (if you do) and you don’t want them to close down.
Shahanur:
· How are you going to manage patient’s opinion? For those who live close to the boundary.
· Some patients might feel more comfortable with a certain GP that they have been seeing for a long time and they would like to continue with this doctor
· How are we going to adjust to new patients moving in to the area?
· How much money does the government give per patient?
Member: It varies from patient to patient.
George: We roughly estimate a £115 per year per patient that’s all our income, this includes visits, and health provisions etc. everything you get from your GP is roughly included for a £115 a year. Give or take £10. In terms of money it’s not a large amount. We (GPs) do 90% of NHS contact and 10% by hospitals. The 10% is the most costly. The actual amount the GPs get is not a large amount. It does vary from practice to practice.
Member: There are also additional allocations depending on the types of populations and that’s were jubilee street practice is coming into problems.
George: yes, that’s the problem. GPs are told ‘this is what we are giving you because this is your population’. TH overall has lost money, TH is a younger population. But that young population gets sicker 10 years earlier.
Shahanur: We heard a few voices from the providers and patients that increasing the size of practices is potentially compromising patient care. So what do we as an organisation who are representing patients need to do?
David: We need to put forward patient opinions of what we collect as an organisation we cannot have a political opinion about the number of GPs to supply. We can comment on the fact that we think that there are fewer GPs then there should be, but we cannot campaign to get more GPs or to alter the system against the government decision, HealthWatch will not be backing any campaigns.
Action: HealthWatch Tower Hamlets should draft a letter to HealthWatch England, raising concerns about GP funding in Tower Hamlets.
5. Assistive Technology (AT) (Steve Nye & Masum Ahmed)
Contact details:
Steve Nye The AT team want work with professionals to increase the use of AT and get people connected with technology. AT works in partnership with Telecare, the Telecare team provide a 24 hour response service, which includes alarms that are activated when risk of danger or when there has been an accident. The AT team are looking at the wider application of AT and how to extend the use of Telecare and AT support systems in Tower Hamlets. The AT team are also looking at trying to get people connected with technology like Skype and how to reduce social isolation with AT. We are also running a pilot to see how AT can support disabled children at home. AT also supports carers and every member of the family not just the person that might need immediate help.
In regards to Dr. Farrelly’s statement about service users taking up 10% of hospital resources, AT will be a way to prevent these resources being taken up. Towards spring/summer there will be a large survey project that is going to be a control study on how AT has affected quality of life indicators, how has it prevented people from using up more resources from the council as well as health.
Clients who need AT can access the products through social workers and other health professionals who will carry out assessments and reviews, and through signposting. We want to make links with community groups and raise awareness.
Member: Some people might be embarrassed of receiving help (relying on AT)
Masum: We are working with groups who may be afraid of stigma
Myra: We need to raise awareness to the carers.
Steve: In most cases it depends on carers/people to assist patients.
Dianne: Majority of people want to remain independent, so changing people’s attitude in AT has been an empowering thing, rather than be a stigma. The Housebound project will try to keep a list of people who might be interested.
Member: Is confidentiality going to be protected?
Masum: In terms of privacy there’s guidelines on the ethical use of AT.
David: Three concerns:
· All the un-used technology is costing money (from those who have been re-assessed for AT and no longer require it)
· Can pharmacies deliver to local services rather than local authorities having a centralised store
· A lot of the people who use this technology for emergencies end up waiting longer for the emergency services because the call needs to go through a call centre which than makes the ambulances turn up at the call centres and not to the patients house. This delays ambulances for up to 40 minutes.
Masum: In regards to the first question, we are separate from the Telecare team, recycling is in their remit but we can take these issues forward.
In regards to the second question we are trying to look for some pilot partners who are interested in AT, we do want pharmacies to be engaged in AT.