In Association with Appletree Medical Practice

Appletree Patient Participation Group In association with Appletree Medical Practice Duffield, Derbyshire

Appletree Patient Participation Group (PPG) Minutes of the 18 th meeting, 25 th July 2012

Attendees: Jenny Humphreys, Terry Kelly, David Greatorex, Maxine Cheesbrough, John Raw, Dr Mark Browne, John Beavis, Margaret Raw, John Rowlands, Martin Thorne, R E Hague, Elaine Evanson, Linda Adey, Philip Mucklow, April Morton, Lianne Burke, Yvonne Greenwood, Marian Chesters, Ken Donovan, Sonia Rafferty, Wendy Palmer.

Apologies: Stephen Leather, Ann Martin, Elena Whinfrey, Betty McKeggie.

1. Presentation from Amber Valley Community Transport. Mrs Maureen Graham kindly attended the meeting to provide an overview of the Amber Valley Community Transport services available. These comprise Dial-a-Bus, Group Travel, Dial-a-Ride and the Community Car Scheme. Dial-a-Bus will take people to the shops who would otherwise struggle to achieve this without help; it also helps people attend some social events and prevents isolation for many of its users. A £2 return charge with a Gold Card applies. Group Travel will take community groups such as school groups and Brownies and Guides but will also take informal groups out for trips such as social lunches at affordable rates. Dial-a-Ride will help individuals attend doctor/dentist appointments, hairdresser trips etc. The service is charged (68p per mile, minimum charge £5) but at a considerably lower rate than a taxi service and is much more affordable whilst providing physical help with the needs of the trip and not requiring a second appointment for the return journey. Thirty drivers undertake approximately 180 trips a month, provide help with wheelchairs and will wait while the passenger attends their appointment so as to be there for the return journey.

Overall these schemes provide a fantastic service, valued highly by users, and they rely on volunteers.

A question was raised about the issues of insurance when acting as a volunteer for the services. Mrs Graham reassured those present who might be thinking of volunteering their time that as long as the insurance company knows it is not a business service and not profit making (as mileage rates only cover expenses) there is not a problem, but it is important to inform the insurance company of the arrangement.

For minibus volunteers it was asked that those over 65 years of age do not apply to help as there is a time and cost implication in training and putting necessary paperwork in place which does not have time to pay off by 70 years which is the age limit for driving this type of vehicle.

A brief discussion with Dr Browne ensued in which it was agreed that the services could provide invaluable help in bringing groups of people to the flu clinics and other

of 6 05c2496bc632de25543e8dc4af4cab6a.doc Appletree Patient Participation Group In association with Appletree Medical Practice Duffield, Derbyshire similarly run clinics or events at the surgery. Some cost would be incurred by the practice but the health benefits would hopefully override this by reaching a greater proportion of target patients than without the transport service being provided.

Since Amber Valley Community Transport provides such an excellent service for otherwise housebound patients it was agreed that word should be spread around the practice community as far as possible. To this end, several copies of two leaflets were and distributed and copies left at the surgery. A contact number for Amber Valley Community Transport Services is 01773 746652 and there is a website www.derbyshirect.co.uk

It was enquired whether the scheme is oversubscribed with demand outstripping supply, to which it was explained that although there are peak periods when booking some degree in advance is required (early morning and 3 pm), there are also times when there is no problem obtaining a car (Saturdays and the middle of the day).

The point was also made that Amber Valley does not cover all the areas of residence for patients of Appletree (e.g. Little Eaton); Mrs Graham responded that there is some flexibility in the areas covered by the schemes.

Mrs Graham was thanked for her informative talk and the generosity of her time.

2. Update on the implementation of SystmOne Lianne Burke, the practice IT Data Manager, spoke of the changeover from EMIS to the new clinical system SystmOne. As a windows-based rather than Dos-based system it provides more sophisticated functionality and is a superior system. For the patients of the practice it has been quite a smooth transfer and the information itself has transferred successfully. Staff have found the changeover quite stressful with much learning on the job required. By Christmas the staff expect to be more fluent in the use of the new system.

The changeover has been a generally positive step and over the next few months patients should be able to receive SMS text message reminders of their appointments should they wish to, and at some point in the future be able to use SystmOne for online appointment booking, with a limited proportion of appointments available to book this way. Some trial and error will be needed in reaching the right balance of appointments to be booked via the internet or over the phone/at the reception desk.

The new system is considered more secure in ensuring the correct identity of repeat prescription recipients. Extra checks in this system also mean it will not be possible to order a repeat prescription more than 14 days in advance of the end of the previous supply, so for holiday planning a phone call to the surgery will be required and the reception staff will ensure the prescription is signed on time. Similarly, if hand delivering a prescription, please make a note explaining why the advance

of 6 05c2496bc632de25543e8dc4af4cab6a.doc Appletree Patient Participation Group In association with Appletree Medical Practice Duffield, Derbyshire supply is required and when the prescription is needed for. An annual review is performed for most patients on repeat prescriptions for which the patient will be called to the surgery to see either a doctor or specialist nurse.

With photo ID and a utility bill for example as proof of address, it will be possible to register for repeat prescription ordering on SystmOne (and in turn online appointment booking when made available). If already registered with EMIS, the same password will carry over for the use of SystmOne.

When asked, Lianne estimated that the practice has valid email addresses for approximately 10% of their registered patients and a greater proportion of mobile phone numbers (the practice made a push to get patients to provide mobile numbers in the run up to the changeover to SystmOne).

Emails can not be used to discuss personal matters with the practice as this is not sufficiently secure; however the practice will reply to acknowledge emails and explain that medical issues can not dealt with by email. It was noted that in some cases emails from Appletree Medical Practice may go into recipients’ spam boxes. Email communication has the potential to be used to communicate Appletree news to patients however it is not currently used in this way.

It was enquired whether the presence of a pharmacy in the surgery would reduce the turnaround time for obtaining repeat prescriptions. The answer was no, however the benefits would be felt in obtaining a prescription for an acute illness such as antibiotics for an infection, to save having to go elsewhere to find an open pharmacy. The limiting factor on repeat prescription turnaround time is that the doctors have to check and sign about 200 prescriptions a day; this will not be reduced by a pharmacy on the premises. Dr Browne discussed how perhaps in the future there may be developments in how doctors can authorise prescriptions safely without physical signing, for example by authorising larger periods of supply being made available at a time (for ‘safer’ medications). However there are currently legal restraints making this impossible.

Another advantage explained for SystmOne is that medical records can be electronically transferred to another practice if a patient moves area, rather than having to be manually inputted which can introduce human error. However, patients are reassured that only the patient’s currently registered practice has access to records at any time. One exception is that the Royal Derby Hospital may be given access to a patient’s records by their GP when being referred for treatment but only with consent and signature of the patient.

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3. Review of Action Plan Progress i) Care and Quality John Beavis presented a summary of this group’s activities and focus and provided the following notes:

1. Care The PPG is to host Local Carer Events in conjunction with the Practice Carer Champions and Area Carer Association representatives. Due to the previous low take-up, we will find out their needs and views at the next event.

2. Communication Analysis of the 2012 Independent Patient Survey indicates dissatisfaction amongst patients, in particular in the following areas: • Reception • Test result feedback • Hospital result feedback • Continuity of medical care

The PPG asks what steps the Practice is taking to address these issues.

3. Patient Services • The availability and flexibility of services provided by the practice, in particular on Saturday mornings and weekday evenings. • Practice policy on Home Visits for the seriously ill. • Practice policy on the doctor-of choice issue.

The PPG [Care and Quality group] asks for clarification on these issues of service. ii) Environment Terry Kelly presented the following overview of this group’s key issues:

1. Wall Mounted Notice Boards/Free Standing Information Boards. Appletree: A start has been made in giving the wall mounted notice boards headings denoting that the information is about the Practice, NHS, PPG or other. The free standing notice boards are used to display details of the Pharmacy Development, Summary Care Records and the new computer system. Could such boards also be utilised to highlight health topics such as diabetes, pregnancy, anti-flu injections, travel clinic, obesity and so on?

Little Eaton: Suggestions have been made too the Practice on fitting headed notice boards. There is no PPG notice board or display of minutes.

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2. Appletree Surgery Furniture and Play Area The seating has been arranged in both waiting areas to make access to and egress from back rows easier. Two high backed chairs are located in each waiting area. The play area has been located on the back wall and contains notices with respect to parental responsibility.

3. Appletree. Bare Walls Some small colourful children’s wall decorations have been positioned near to the play area.

4. Appletree. Signage The Gents toilet now has a sign but observation has shown that the signs for treatment room 1 can be difficult to find for a patient unfamiliar with it. iii) Communication Wendy Palmer summarised this group’s main issues: ‘ Communication’ applies to the communication from the practice to the patients and back and also the communication in wider sources of information relating to health education.

A was noted that on occasion the reception staff could be more welcoming and helpful. Also, that providing results of medical tests over the reception desk is not always well received by patients and this practice may deserve review.

The ongoing fact that the website is an accessible source of information yet not necessarily viewed by patients was acknowledged, but a solution remains elusive. Similarly the unresolved issue of how to reach non-attending patients in outlying villages remains.

Many health resources are communicated by specialist nurses at the practice and the website posts many useful connections for people seeking information on their health. How can patients be signposted to these resources? iv) Access The absence of John Meggitt was addressed by Martin Thorne who summarised the group’s activities as had been agreed at the January AGM. Work has been done addressing their first priority – access to Appletree in terms of the appointments system and telephone system. An overlap with the work of the communications group has been noted – getting information to patients about the wider access to NHS healthcare services – there is a need to clarify the complicated landscape. However this group recognises that the practice is understandably tied up with the transfer to the new SystmOne clinical system and is prepared to wait for responses to the work done so far by the PPG. Maxine Cheesbrough expressed frustration that work she has done has not received attention from the practice and is wondering whether to cease attending meetings. Martin expressed the view that after the

of 6 05c2496bc632de25543e8dc4af4cab6a.doc Appletree Patient Participation Group In association with Appletree Medical Practice Duffield, Derbyshire holiday season and more time for staff to become familiar with SystmOne there will be more time for Appletree staff to review work on PPG issues.

4. Discussion arising from the action plan key issues review. A heated discussion followed, with various members of the group expressing anger at a perceived lack of engagement by the partners of the practice and a desire by certain PPG members to obtain specific feedback on which issues the doctors would like addressing.

The chair invited Dr Browne to respond on behalf of the doctors; however he was frequently cut short by more views from PPG members, some of which were new members. He did express a significant degree of irritation at the negativity of the approach by the PPG. He was disappointed that PPG members have opted to request action by the practice staff, based on negative comments from the survey, despite the fact that the survey verifies that the majority of patients find the service at Appletree excellent – he would rather see action and initiative from PPG members on what they can do to help the practice. The PPG should be in the spirit of cooperation and working together.

Some new members present, not familiar with the history of the work done putting together the action plan and deciding on a method of working (that of sub-groups pursuing the four key areas), were critical of meetings held between PPG members and the practice manager Steve Leather, implying non-inclusive working arrangements. This position was strongly defended by Martin Thorne on behalf of several members of the PPG as an effective and open approach to tackling the action plan, with frequent report back meetings to the wider group.

Margaret and John Raw beseeched Dr Browne to engage the partners to help the PPG prioritise their actions, asked for transparency from the practice in their plans going forward and asked for clarity on how the doctors see the role of the PPG. There was a strong sentiment that if the requests of the PPG were engaged with, the practice could raise its standards.

It was noted that the secretary role was being handed down by Jenny Humphreys so volunteers for this role by the next meeting are invited please. Thanks were extended to Jenny for her minute taking and was this met by spontaneous applause.

Finally, Margaret Raw raised the suggestion that the alternate monthly business meetings are not proving satisfactory to her and other PPG members and a show of hands was requested as to whether to alter this arrangement (which had been decided at the AGM in January). The show of hands was not decisive so it was suggested that this issue be debated to conclusion as the first item on the agenda of the next (August) meeting.

Date of next meeting is Wednesday 29th August, 7 pm, Duffield surgery.

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