Wellbrook Medical Centre

WELLBROOK MEDICAL CENTRE

PATIENT PARTICIPATION GROUP

TUESDAY 24TH JANUARY 2012

1.  Present Chair: Ann Bennett, Vice Chair; Bob Illing, Joan Adams, June Hatch, Jenny Wood, David Lindop. Visiting Clive Gerrard.

From the practice: Cathy Jones, Dr Sue Ruddle

2.  Apologies: Sarah Hough, Jill Crosby, Martin Cocker, Christopher Cook.

Brenda Cowley had advised that she may attend later as she had other commitments that day. However,

she did not appear for the meeting

Alyson Horton resigned from the group prior to the meeting.

3.  Ann opened the meeting by advising that Dr Ruddle and Cathy Jones were joining us for a practice update. It looked like a lengthy meeting with lots to discuss and as such Ann has allocated approximate time slots to guide us through.

The minutes from the meeting of 11th October were accepted.

Ann advised that she had been approached by Catherine Baraniak of the Chellaston Practice, who is a member of the Derby Commissioning Network Strategic Lead Board, regarding a meeting to be held in Pride Park Derby on Wednesday 8th February, to which we were invited. The meeting is to raise patient and general public awareness of the commissioning process that is taking place. Ann Bennett, June Hatch, Sarah Hough and Jenny Wood all agreed to attend on behalf of the PPG. Bob Illing said he might also join in the representation.

Action: Ann to inform Catherine of the attendance numbers.

Short discussion followed on follow up Foyer Duty. It was agreed that the following would be arranged: -

·  Ann will liase with Heather to confirm what clinics will be taking place (to enable the PPG to cover a spectrum of patients in such duties)

·  Arrangements would be made for the following times

Joan Adams & Ann Bennett – 14th March 32012

Jenny Wood & June Hatch – 23rd February – afternoon session

4.  General discussion took place regarding costs incurred by the members and in general Ann Bennett, on behalf of the PPG. Incidental costs are incurred on an ongoing basis. It was agreed that the PPG would approach the surgery for a float of £20 to cover incidental costs such as stamps, paper, telephone costs and miscellaneous expenditure.

Action: Practice to consider if this is acceptable

5.  Quick discussion commenced regarding the feedback from previous foyer duty done by the PPG. Ann had compiled a list of points raised and compliments collated. Ann suggested that this could be discussed during the meeting when Dr Ruddle and Cathy arrived.

6.  Dr Ruddle and Cathy arrived and were aware of the lengthy agenda and had further matters to discuss with the PPG.

Dr Ruddle commenced with a staffing update: -

Doctors: -

Dr Mohammed is leaving at the end of June. The recruitment process will commence in February to replace Dr Mohammed with a full time partner.

Nursing Staff: -

Following a thorough review of nursing staff and Practice requirements several changes have

taken place.

a) Gill Wood (Nurse Practitioner) had left the practice on 20 January 2012. The outcome of the nursing review had been a reduction in Nurse Practitioner hours. Gill had been offered alternative options but had chosen redundancy.

b) Sarah Toon will continue in her Nurse Practitioner role and will see most minor illnesses, which is expected to take up the major part of her week. The Doctors will make up any shortfall of hours.

c) Kath Doolan and Eleanor Meadows who have already left will be replaced by Jackie Moore - (Band 6 Practice Nurse). Generally, concentrating on Chronic Disease Management Jackie will be working 30 hours per week.

d) Julie Green who left last October/November will be replaced by Sarah Webster (Band 5 Practice Nurse) who will start in post on 19 March 2012. The number of hours for this post has been increased from 24 to 27hrs.

Now that the recruiting process has been finalised, Dr Ruddle advised that nurse locum cover would cease shortly.

Reception: -

A new receptionist Angela Drozd has been appointed, replacing Melanie Clarke.

·  Appointment system

Due to the staffing changes the Doctors’ had revamped the current appointment system. There have been significant changes in this respect. These began last week.

a)  The booking period will be extended to 1 month. Appointments will continue to be released in staggered amounts.

b)  For all non-urgent medical conditions there will be general appointment time at 11.30 am daily – called “11.30 and wait”. Calls, booking an appointment should be made before 12 noon.

All patients will be given the same appointments time of 11.30 and will then be seen by a doctor when their turn in the queue arrives.

All doctors on duty will be available for these appointments but a specific doctor cannot be requested.

Morning clinic for pre booked appointments now ends at 10.30am.

c)  The afternoon appointments ‘on the day’ will be reserved for urgent appointments; patients will be offered an appointment initially with the Nurse Practitioner or with the Duty Doctor if deemed necessary.

Dr Ruddle pointed out that the main difficulty was that the demand for appointments at Wellbrook outstripped availability. NHS budgets allowed on average for 2 appointments per patient per year.

d)  Dr Ruddle asked if we knew if patients were aware of telephone appointments as she felt that these could be promoted further. She pointed out that few Practices offered this facility. Dr Ruddle confirmed that these appointments could be pre booked and were a very convenient way for the doctors to keep in touch with patients and establish continuity of care. It was confirmed that it took up as much time as a consultation and as such was appointment time allocated. The PPG advised that we felt patients knew of Saturday morning appointments. It was confirmed that there were 15 Saturday morning appointments each week.

·  Repeat dispensing

The group raised the topic of repeat dispensing. The question of the Pharmacy fulfilling all items on the prescriptions, when sometimes they weren’t all required, was the issue in question. Dr Ruddle advised that only items required should be dispensed and if items were not always needed they should not be on repeat dispensing but obtained by repeat prescription. It was felt that proper use of repeat dispensing, if a patient always used the same pharmacy, worked well. It was also hoped that, with the help of the Pharmacies, its use could be extended and with the Enhanced Service in this area (Pharmacists ensure medicines are not dispensed unnecessarily) costs could be cut.

·  Non attendance rate

It was hoped that with the new appointment software that the non-attendance rates would drop. This was the case for the first month but numbers have reverted to around 100 per month. This is disappointing. The reminder service does not work on landlines and there is no typical defaulter. This will continue to be monitored and letters issued to patients who miss appointments.

·  A & E attendance

Misuse of A & E attendance has continued despite Saturday opening and extended appointment time. Discussion took place as to how this could be tackled and it was agreed that the PPG would look at producing a pamphlet to inform the patients on the services available and appropriate usage. The surgery wish to correct the process before 1st April as a direct charge will be taken from the surgery budget.

Action: The Group to meet to discuss how to proceed

Jenny Wood advises that the drop in centre does not always have a prescribing nurse on duty and this gives rise to patients being referred to A & E.

Dr Ruddle concluded her talk with the changes that have taken place in the last 12 months as follow: -

1.  Minor Illness information has been produced within the surgery and distributed.

2.  The appointment services have been reviewed with the advances booking services being extended to 1 month.

3.  A review of Secondary Services. The PPG were asked to review feedback from services provided in the past 12 months. Due to some misunderstanding of the areas to be reviewed and how to achieve it this has not been fulfilled.

Dr Ruddle requested that we obtain feedback from experiences from Outpatients, Scans Hearing clinics etc that the doctors’ don’t generally hear about, i.e. value for services provided.

Ann felt that it would be difficult for the PPG alone to access sufficient patients who had received secondary care. The limited number of patients seen at Foyer duty would not provide realistic results.

Action: The group to meet and discuss how to tackle this.

4.  Cathy Jones and Dr Ruddle then spoke about the visits that the PPG made to Tynefield . Court – Etwall and Bearwardcote Hall, Etwall – both Nursing Homes

These visits were made to give the patients representation and to fulfil the criteria of the DES. They were undertaken with the full consent of the Practice: a letter from the Practice introducing the PPG to the Homes having been sent prior to their visits.

It appears that some ambiguity arose following submission of the reports, following each visit and the Practice and a Nursing Home were upset. This came as a surprise as both nursing homes seemed happy with the visits and had asked the PPG members back. Ann advised that so far as the PPG were aware the Nursing Homes were very happy with the services provided by the surgery and explained that the reports were provided to the surgery with a view to the doctors’ being aware of any minor points that were raised during discussion. In no way were the reports meant to be criticism.

Ann provided Dr Ruddle and Cathy with the list of points raised during Foyer Duty and pointed out that there were suggestions and also praise for the G P’s within the list.

Ann suggested that Dr Ruddle/Cathy could discuss the list at the next practice meeting.

Dr Ruddle left the meeting at this point and Cathy remained.

·  Jenny Wood asked Cathy if there could be occasional PPG representation at the Practice meetings. Cathy advised this would not be appropriate.

·  The PPG and Cathy discussed the use of the room in the surgery at different times to allow for younger members or working members to attend evening appointments. Cathy is in agreement to an evening meeting on a late surgery night – Thursday. The room will need to be vacated by 7.45 pm at the latest. Cathy was advised that we had a potential new member who was currently working.

Action: Ann to approach the new member and feed back to the group in due course.

·  Jenny asked Cathy if the surgery ran any “Well man” clinic as she had concerns in this respect. A patient has requested such a check from the surgery and had been refused. Cathy advised that this was not a service that was currently provided, although it anyone had concerns about their health then they could always make an appointment to discuss this.

·  We discussed future meeting dates and advised Cathy that we would probably have a meeting in February, as we had not fulfilled all items on our Agenda.

1. Matters Arising: A request had been made to change the venue of one of next year’s flu

clinics, from Etwall Village Hall to Hilton. This had proved not to be viable, as there was no

suitable venue available.

1. Following a report regarding overspending at the Royal Derby Hospital Ann asked if there was any pressure on the Practice to minimise referrals to the Hospital.

Cathy responded that we were constantly reviewing referral rates and appropriateness of referrals made; also that each referral received a second opinion before being actioned. She did point out that most doctors would support their colleague’s referral being made.

Cathy left the meeting at about 4.15pm and the meeting continued.

9.  Due to time restraints, Ann asked Jenny if her talk on her work within the Hospital Trust could wait until the next meeting and Jenny agreed this was fine.

10.  The meeting proceeded with an update from David Lindop.

NHS Updates - Providing information on things that are happening now or about to be introduced and raising awareness of things that will come in the future.

The NHS- the bigger picture
The NHS is currently in a transition stage where some old structures are still in place whilst the new structures are being developed.
Some current organisations are morphing into new organisations; e.g. The Local Involvement Networks (LINKS) will become Health Watch.
Most of the changes will be in place by April 2013.

Clinical Commissioning Groups
Over time the CCGs are being handed responsibility by the Primary Care Trust so that eventually they will:
Strategically Plan (access need, review current provision, decide priorities
Procure Services design services, shape the structure of supply, planning capacity and managing demand)
Monitor and Evaluate (support patient choice, manage performance, seek public and patients views)
This is known as commissioning and means they will be responsible for the finance and deliver these activities.

Derbyshire CCGs
North Derbyshire- middle of the north of the county.
Hardwick Health-north east of the county.
Southern Derbyshire- The entire south of the county, including the city, except for
Erewash.
High Peak – not now going forward as a separate CCG.

CCG Progress
Identifying and working on their priorities.
Holding public meetings to discuss the priorities and get patients involved.
Working towards authorisation for CCG status.
Leading on projects to improve services.
Reviewing contracts with organisations that provide services.