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Bundle Hdduhb Primary Care Applications Committee 18 November 2019

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Bundle Hdduhb Primary Care Applications Committee 18 November 2019 Bundle HDdUHB Primary Care Applications Committee 18 November 2019 1 10:00 - Governance 1.1 Welcome and Introductions Presenter: Chair 1.2 Apologies for Absence Presenter: Chair 1.3 Declarations of Interest Presenter: All 2 10:10 - General Medical Services (GMS) Contract changes 2.1 Future of General Medical Services at Mariners Surgery, Ferryside Presenter: Anna Swinfield PCAC Mariners Surgery Ferryside SBAR November 2019 FINAL Appendix 1 FINAL Ferryside public engagement plan ISSUED Appendix 2: Ferryside EqIA Oct 2019 3 11:20 - Any Other Business 2.1 Future of General Medical Services at Mariners Surgery, Ferryside 1 PCAC Mariners Surgery Ferryside SBAR November 2019 FINAL PWYLLGOR CEISIADAU GOFAL SYLFAENOL PRIMARY CARE APPLICATIONS COMMITTEE DYDDIAD Y CYFARFOD: 18 November 2019 DATE OF MEETING: TEITL YR ADRODDIAD: Future of General Medical Services at Ferryside Surgery TITLE OF REPORT: CYFARWYDDWR ARWEINIOL: Jill Paterson, Director of Primary Care, Community & LEAD DIRECTOR: Long Term Care SWYDDOG ADRODD: Anna Swinfield, Head of General Medical Services - REPORTING OFFICER: Sustainability Pwrpas yr Adroddiad (dewiswch fel yn addas) Purpose of the Report (select as appropriate) Ar Gyfer Penderfyniad/For Decision ADRODDIAD SCAA SBAR REPORT Sefyllfa / Situation Meddygfa Minafon has been a Health Board Managed Practice since 2015, and currently operates over three sites. In June 2019 the Primary Care Applications Committee made the decision to support a proposal to consider the consolidation of the delivery of General Medical Services to the population of Meddygfa Minafon over two of the three sites, namely Kidwelly and Trimsaran. This paper outlines the work undertaken on patient engagement regarding the future of the third and smallest site, Mariners’ Surgery in Ferryside. This has included working with the Community Health Council (CHC) on a public engagement plan, patient and stakeholder feedback and a public engagement event in Ferryside. Cefndir / Background Meddygfa Minafon currently operates over three sites, serving a total population of approximately 8,315 (October 2019): Meddygfa Minafon, Kidwelly – main site (serving approximately 5333 patients) Derwendeg Surgery, Trimsaran – branch site (serving approximately 2082 patients) Mariners’ Surgery, Ferryside – branch site (serving approximately 900 patients). All registered patients are eligible to use the General Medical Services provided at all sites and whilst many patients prefer to use the Surgery most convenient to their home address, many already travel to access a particular service at a particular time due to the lack of availability at their closest or preferred location. This is particularly the case with urgent appointments with a GP due to patient demand and appointment availability. The PCAC paper (June 2019) contained considerable detail relating to the background and history of the Practice and context for review of the future provision of General Medical Services across the three sites. Page 1 of 12 Figure 1. Map showing Meddgyfa Minafon practice boundary and patient distribution GP provision at Meddygfa Minafon has stabilised since 2018 with regular locums working at the Practice alongside a WTE Clinical Lead GP, and another salaried GP. However, there are still significant challenges and risks in delivering general medical services safely and effectively over three Practice sites, and in particular at The Mariners Surgery in Ferryside. Premises The Mariners Surgery in Ferryside sits within a complex of buildings at Calon Y Fferi at the southern end of the village and is in the ownership of Ferryside Social Enterprise Group (FSEG). The Calon Y Fferi complex includes extensive community facilities including a café/restaurant with Post Office, Men’s Shed, launderette, community centre and community garden. The premises is occupied under a five year lease which expires imminently on 4 January 2020. The rent is £9, 900 per annum. The Health Board as tenant is responsible for non-domestic rates and utilities. Running costs in addition to rent for 2018/19 were £8,989.77 bringing the total costs associated with the building to £18,889.77 for the year. The building is a small ground floor area comprising one consulting room, two treatment rooms, small reception and waiting area, a former dispensary now used as storage, and a small staff kitchen area. Toilet facilities are sited in the neighbouring area adjacent to the Surgery and staff have to let patients in and out through the adjoining door to access this area. Disabled facilities are limited. Page 2 of 12 Services Since 2015, General Medical Services at Mariners Surgery have been limited by shortages of locum GPs and other clinical staff, and as a result patients have travelled increasingly to Kidwelly or Trimsaran to see a GP or for nurse-led chronic disease monitoring. The services which remain at Mariners Surgery are limited and not fully utilised with unused appointments. Figure 2: Table of services currently provided at Mariners Surgery, Ferryside Monday Tuesday Wednesday Thursday Friday AM AM AM AM AM Reception Reception Reception CLOSED CLOSED Phlebotomy clinic PM PM PM PM PM Reception CLOSED CLOSED CLOSED CLOSED Nurse – Treatment Room Frailty Clinic/ Physiotherapist (alternate weeks) Mariners Surgery is currently open for a total of 18.5 hours per week, including periods of lone worker cover by a Receptionist. This has been recently been reviewed and risk assessed under the Health Board Lone Worker Policy in response to staff concerns about being alone on the premises after dark (5-6pm) and having to lock-up and secure the building alone in a comparatively remote location. As a result the closing time on Tuesday afternoons has been revised from 6pm to 5pm to allow the sole receptionist to lock-up at the same time as the Practice Nurse leaves. The opening time on Tuesdays has been brought forward from 1pm to midday to maintain the same level of access. No GP sessions at The Mariners Surgery have been provided since mid-2016 when it was decided to withdraw GP appointments due to a shortage of locum GPs across the three sites in order to provide safe and effective clinical services to the registered population. To maintain clinical input and relationships with the Ferryside community it was agreed to establish a GP-led Frailty Clinic and an Advanced Physiotherapist clinic, running alternate weeks. An activity analysis carried out in January-March 2018 demonstrated high levels of vacant (not booked) appointment slots, as well as a percentage of patient DNAs for pre-booked appointments: Clinic % Vacant slots % DNAs Phlebotomy 24.4% 13.39% Practice Nurse – Treatment Room 26.97% 5.57% Physiotherapist 40% 4.17% The number of vacant slots for Practice Nurse clinics has continued to increase since this audit and these clinics were subsequently reduced from four sessions to one session per week. Data Page 3 of 12 from October 2019 shows that, even with running a single session per week, vacant slots with Practice Nurse clinics continue at a rate of between 13 - 21%. Whenever a patient asks for their phlebotomy, treatment room or physio appointment to be at Ferryside, staff will offer this. In March 2018, dispensary services at Ferryside Surgery were suspended pending a formal decision on their continuation, due to concerns raised about the clinical safety of the service. An interim arrangement was established with a local Community Pharmacy (Kidwelly Pharmacy) to deliver dispensed medication to Mariners Surgery for collection by patients. This temporary collection service was made possible because the Receptionist based in Ferryside had a dispensing qualification; however this Receptionist retired in August 2019 and it was no longer possible to staff this interim arrangement. As a result of this the collection of medication has been suspended until further notice. All patients affected by this were informed in writing and given a number of choices of alternative ways to get their medication including home delivery by Kidwelly Pharmacy, collection direct from any named Community Pharmacy and collection of the prescription from Minafon Surgery to take to any Community Pharmacy. Public engagement Considerable public engagement has been undertaken with the patients of Minafon Surgery since 2015, including public meetings and drop-in events in Kidwelly, Trimsaran and Ferryside. A public engagement plan was agreed with the Hywel Dda Community Health Council (CHC), see Appendix 1, and this engagement is ongoing. Early engagement has taken place internally with Practice staff and meetings have taken place with FSEG, St. Ishmael’s Community Council and the Patient Participation Group (PPG). Letters were sent to all patients in Ferryside and the surrounding area to inform them of the review and proposal to relocate services to Minafon and Trimsaran. Patients were asked to feedback their views to the Health Board and/or the CHC and were invited to attend a public engagement drop-in event in Ferryside on 15 October 2019. Public engagement drop-in event, 15 October 2019 Approximately 105 people attended the event held at Three Rivers Hotel in Ferryside (2-7pm), representing approximately 7% of those patients who had received a letter. The event was staffed by the GMS team with support from Community Pharmacy and Minafon Practice staff who were also able to take bookings for flu clinics at the event. All feedback was captured via record sheets and feedback has been compiled (along with that received by telephone, email and post) by theme as indicated in Figure 3. All feedback has been shared with the CHC. Page 4 of 12 Figure 3: All patient feedback by theme (187 responses compiled from telephone, email, post and in person at drop-in event) Services at Meddygfa Minafon – 29% of responses raised concerns over services at Meddygfa Minafon. These included specific references to delays answering the telephones, lack of disabled parking bays and lack of continuity with locum GPs. Telephones: during the peak period of 8.30am - 9.30am over 200 calls can be received at Meddygfa Minafon.
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