BRIG ROYD SURGERY Minutes of Patient Group Meeting Tuesday 18th September 2012

Present: Patients: Melvyn Cross (Chair), Keith Stott, Charlotte Brady, Gerald Williams, Rosalind Denton, Judith Shea and Behrooz Bashi GP: Dr Ben Wyatt Practice Manager: Sue Rosborough Reception Manager: Angela Goulden Apologies: Rachel Key (submission by e-mail), Mark Spriggs (submission by e-mail), Cherelle Clarke-Broadbent and Roy Greenwood and Practice Nurse Vanessa Starsmore

Welcome and Introductions

MC extended a welcome to everyone and the group members introduced themselves for the benefit of new member Behrooz. MC also explained the reasons for the patient group to Behrooz.

Review of Actions Taken from Patient Group 2011

Sue thanked the group for helping to determine our priorities for the last 12 months, which we then shared with the wider practice population and put into practice. She confirmed the actions taken as follows:

1. For the practice to undertake a major publicity campaign to relaunch www.brigroydsurgery.co.uk – which provides practice information, health advice on the site and in links to other health promotion sites, and SystmOnline.

Action completed and ongoing – see under point 2.

2. For the practice team to provide fliers to patients to take away for the website in general and for SystmOnline. For these to be available in the waiting room.

Action completed and ongoing – fliers re website and online services printed, posters printed, all displayed in waiting room, large notice board in waiting room used from March to August, and notice board along GP corridor still in use. Waiting room display will return after flu season.

3. For a tailored “help guide” to using SystmOnline to be uploaded to the website.

Action completed – printed guide in hard copy format and uploaded to website immediately above Online Services icons.

4. For the practice to encourage all receptionists to promote the website as a health promotion resource and to promote online services to patients and to offer to register them when they are in the practice if possible and appropriate. Action completed and ongoing – receptionists taking the opportunity to promote online services via website, and registering patients at the reception desk, providing assistance in the interview room if required, but more reticent advising patients to use the website for clinical aspects.

5. For the practice to encourage partners to promote the online facilities where they feel it is appropriate, especially when patients are requesting prescriptions in consultations.

Action incomplete – general feeling that time would not permit conversations with patients about online services by GPs in consultations. Role delegated to reception team.

FIGURES TO SUPPORT ABOVE ACTIONS:

Patients registered for SystmOnline, shows 51% increase over 12 months

Sept 2011- 1339, May 2012 - 1745 and Sept 2012 - 2025

Patients booking appointments via SystmOnline, showed 28% increase but has dropped back to last year’s level. Highest usage is for appointments on Mondays.

Sept 2011- 128, May 2012 - 162 and Sept 2012 - 126

Patients requesting prescriptions using SystmOnline. About 10% of total requested prescriptions per day are made online. The highest online requesting is over the weekend, for us to action on Mondays. The highest number of online requests has been 29 in one day.

There was discussion regarding each of the above related points. Charlotte was pleased to see that awareness of the online facilities had been raised and Melvyn confirmed that it was important to offer both online and telephone options for patients. All agreed that patients are happy with the service and that it reflects well on the practice, with Angela’s reception team praised for their speed of response over the phone. Ros advised that it is “just as quick to ring as it is to request online”. Gerald asked if there are any differences in online usage according to patient age and Sue will assess this in the forthcoming patient survey.

Ros asked if appointments for Practice Nurses could be added to the online service. Dr Wyatt explained the difficulties with the variety of appointment lengths for different procedures and the varying skills of our Nurse team.

6. For the practice to install new speakers in the waiting room.

Action completed – new speakers installed in April. No complaints received. All members of the group agreed the sound quality is greatly improved and that no further action is required. 7. For the practice to make the Comments and Compliments book and Suggestion Box more obvious, placing the book on a stand on the table near the check-in screen and producing signage to promote.

Action completed – “Patient Involvement” table created and stand purchased to display Comments book and Suggestion Box. This has generated many more comments than previously. Currently also displaying flu leaflets but will return to Patient Involvement on its own after flu.

8. For midwife follow-up appointments to be made available to be booked online.

Action completed – all midwife appointments can now be booked on-line – not major usage (4 in August), most ladies book at the desk as they leave each appointment.

Charlotte advised it is sometimes difficult to book ahead and Angela will ensure a minimum of 4 weeks appointments are displayed online for the midwife.

Review of patient complaints 2011-12

Sue reported the practice had received two complaints in the last 12 months.

1. Mis-diagnosis by GP Registrar, subsequent correct diagnosis by Dr Pool but late in the day when the patient had been in pain for two days and a visit request had remained unallocated. Written response to the patient by Dr Pool, and action taken by the practice to move all requests for visits from a paper- based system to one within our clinical system, with an improved system for visit requests which are made late in the day.

At Melvyn’s request Angela clarified the visit request and allocation process with which the group members were happy, and Dr Wyatt explained the supervision and debriefing of GP Registrars within the practice, including the use of “safety netting”.

2. Complaint regarding care plan and lack of diagnosis made by patient’s parents followed up with change of GP for this patient with complex needs.

Review of Patient Feedback in last 12 months

Sue had compiled a list of patient feedback from the last 12 months which was shared with the group. Sue advised that the team was very pleased to receive such positive comments which reflect the care and skills of our team.

“We are so lucky, fantastic service.”

“I had an appointment with Lee at the non-smoking clinic. She was brilliant, really made me want to keep motivated and carry on. Her explanation of everything was fantastic” “I think this Doctors’ surgery is absolutely fab, you can get an appointment quickly, nurses and doctors are helpful and never make you feel you are wasting their time. I have been at a few surgeries in Huddersfield and have been amazed at how much better it is here. You can get through on the phone, get same day appointments, doctors will go out of their way to be helpful and the receptionists are always pleasant and helpful. I have two children under 5 and the nurses are always patient and kind at immunisation time. A prompt appointment has averted a potentially very serious medical situation, thank you for the same day appointment.

Keep up the outstanding work. Everyone is quick to moan about the NHS but you provide a first class service here – this is a sentiment shared by my Mum and sister who have recently relocated to Ripponden. 10/10!”

“As a visitor I gave admired the outside of this building but on my first sight of the interior I was overwhelmed. The light aspect, soothing colour scheme and wonderful floor.”

“ Came in late afternoon surgery and requested for nurse to see my 9 year old daughter’s cut knee. Was delighted that she was seen in 20 minutes. A caring practice. Thank you to the receptionist and the nurse”

“ My husband and I think the doctors, nurses and everyone in the team here are absolutely fantastic. Nothing is too much trouble and we feel very fortunate and privileged to be patients of such a wonderful practice. Fantastic!”

“A fantastic doctors’ practice. Dr Richardson is an excellent practitioner, empathetic, pragmatic and supportive. Having seen a ‘specialist’ at Huddersfield Royal I had got nowhere. Dr Richardson has helped me feel there is hope and a light at the end of the tunnel on a clear day. Thank you so much.”

“I recently suffered from a very unpleasant vital attack which left me badly debilitated resulting in me having to request an urgent appointment. My regular GP was unavailable that day and I was seen by Dr Pickles. My condition was dealt with extremely sympathetically and professionally by Dr Pickles and Care Assistant Lee. Over the next few days my condition was monitored regularly and the level of care afforded to me meant that my recovery has been faster and less stressful than I would have otherwise expected. I would simply like to express my gratitude to both these medical professionals. Thank you.”

Melvyn summarised the above feedback by advising that “This says it all”.

From NHS Choices in the last 12 months

Sue reported there had been no postings since May 2011

Patient Suggestions in last 12 months

Sue read out the 3 suggestions received from patients in the last 12 months: “ If people who miss their appointments are serial offenders, perhaps you should display their names, bearing in mind that 174 missed appointments equates to 29 man hours approximately”

All members of the group felt this was not an action to be taken. Sue advised that a text message reminder facility was available to patients who give their consent and Angela explained the action taken. There was discussion regarding “blanket texting” to all patients with an appointment and our stance on the issues of consent. Group members agreed with the actions taken by the practice at present.

“Music could be a little more upbeat. What I heard today was rather depressing” “Music too loud, not really suitable for a waiting room”

There was discussion regarding music in the waiting room with Dr Wyatt reminding the group that the main reason for the music was to assist with patient confidentiality as the practice wishes to operate in an open environment without cubicles and screens. Dr Wyatt reminded the group that the private interview room is available for staff and patients to use if required. Sue and Angela reported its use in the last 12 months. The group members expressed no concerns with the music and no action is required.

Determining our Priorities for the next 12 months

Sue asked the group for assistance in developing the practice’s priorities for the next 12 to 24 months. She outlined the closer working with other local practices which is developing through GP Commissioning and advised the group of the six priority areas determined by the GP Commissioners in Calderdale. Sue also reported on the Practice Development Plan which the practice had submitted to Calderdale for the next 2 years, advising that we had reflected on everything this group helped us to do last year and would include the priorities agreed for the next 2 years in future plans.

Sue presented the following summary of the Practice Development Plan:

1. Increasing the number of specialist clinics hosted here – Healthy Weight, Alcohol Support, Epilepsy Nurse led sessions, AAA screening and Continence clinics. 2. Provision of NHS Health Checks 3. Maintaining access to GPs 4. Air conditioning in GP rooms (subject to external funding being secured) 5. WiFi access in the waiting room (subject to securing funding) 6. Developing the role of Healthcare Assistants to enable Practice Nurses to in turn develop their roles. Sue advised the group of changes to the Nurse team with MB on maternity leave for a year, MC retiring, AP appointed and JS covering maternity leave.

There was discussion regarding these plans as follows:

1. The group expressed an interest in further developing the services delivered here including Physiotherapy, Mental Health and Paediatric Clinics. Being seen in familiar surroundings and without a long journey and/or lengthy wait at the hospital would greatly improve the experience for patients. Sue agreed to follow this up. Dr Wyatt advised that there are costs involved in providing such facilities away from the hospital and members acknowledged this. 2. Patient numbers. Dr Wyatt advised that moving to the new building has increased the number of registered patients and our resources must respond to this. Charlotte asked how many “non registered” patients there were in our practice area. Dr Wyatt advised that there is no way of knowing who was not registered but it was assumed that those who were not registered were probably well. 3. Telephone Access to a GP. Dr Wyatt clarified that the practice was not intending to run a telephone triage system and the patient group agreed that this was the correct course of action from the patient viewpoint. All present acknowledged how useful GP advice calls were – these can avoid unnecessary attendances and appointments. 4. Melvyn asked if the practice used Nurse Practitioners and Dr Wyatt advised that there were none at present and no plans to change the roles of our nurse team. 5. Ros and Gerald had attended the Calderdale Health Forum and identified that patients at other practices were running self-help groups for long-term conditions such as Diabetes and Stroke. All agreed this would be beneficial and it was agreed that we should ask the wider practice population if they would be interested in running and/or attending groups of this nature, and for which conditions. Ben advised that the practice would be unable to run the groups but would be able to provide support and host the groups if feasible.

In addition Ros asked about progress in a system to send prescriptions directly to the pharmacy. Ben advised on the requirement for patients to choose where their prescriptions were dispensed and Sue advised that Calderdale has been chosen as a pilot site for Electronic Prescribing in the near future. The procedure regarding repeat and acute prescription requests was clarified by Angela, as was the process for patients to request their prescriptions be sent to any of the local pharmacies.

Sue outlined work being undertaken with neighbouring practices including:

1. Reducing inappropriate A+E attendances 2. Ensuring patients “Choose Well” – working with our other local practices to personalise this and make it more local. 3. Ensuring adequate access to GPs – there is a suggestion of providing information on self-management of certain conditions on patient notice boards. This is working in other practices.

There was discussion regarding how neighbouring practices may operate differently to Brig Royd with their responses having to meet the needs of their own populations.

Points raised by the group were as follows:

1. Charlotte – the advice from NHS Direct when contacting them regarding a child is to attend A+E. 2. It was acknowledged that the majority of our patients attend services appropriately. Ben reported that the practice has the lowest level of antibiotic prescribing in Calderdale and that GPs address inappropriate attendances for minor illnesses when patients present. 3. The group was not in favour of leaflets for the self-management of illnesses in the waiting room but asked Sue to ensure that this information was available on the practice website and within the practice leaflet. 4. The group was happy for the practice to produce a quarterly newsletter if the wider population showed interest. Charlotte agreed to help with this.

Melvyn summarised the discussions by concluding that the freedom of our reception team to provide personal and prompt service to patients ensured they were directed to the correct service. These excellent lines of communication ensured the high standards of care delivered at the practice.

Care Quality Commission Registration

Sue advised the group that the Practice has registered with CQC and is currently working through self-assessment of compliance with Essential Standards of Care.

Calderdale Health Forum and Calderdale Commissioning Group

Ros and Gerald explained the 6 priorities for the Commissioning Group in this current year and advised that patient involvement was to be sought in determining priorities for future years.

Ben explained the role of the Board of the CCG and assured the patient group that all practices were represented through a Practice Lead GP who attended monthly meetings, not of the board, but with colleagues from all practices.

Ben explained the role of the Commissioning groups and the purchase of secondary care services.

Ben also advised that in response to the CCG priority “preventing premature death” he was pleased to report that our team had assisted at a cardiac arrest in the car park and used our defibrillator with a very successful outcome.

Date of Next Meeting

This will be held in January, Sue to arrange via Melvyn on completion of the analysis of the patient survey.

The meeting closed with thanks to all for attending.