Download Minutes 1st Patient Group Meeting

Inaugural Minutes Meeting – Wednesday 17th September 2013
Duke of Edinburgh Hotel
Present:
Dr Simon Harvey
Maxine Baron & Members of Patient Group
Dr Harvey thanked everyone for coming to the meeting, the department of health suggest that general practice
meet with their patients in a group and invite them to feedback on service provision, to help develop patient
services within the surgery. This is new to all of us and something that some practices have already adopted
and some are in the process of adopting. The philosophy behind the process is to involve patients in the
development of services provided in general practice. There are a lot of services that were originally offered in
secondary care now being moved to primary/community based settings.
We wrote to patients inviting them to the meeting on a voluntary basis some accepted and some declined. We
have a few ideas that we want to make you aware of – surgery website and ordering your prescriptions
electronically. NHS background and what we do in general practice.
We run as a business and are funded via the CCG and NHS England, we provide services to our local
population and are funded on a capitation basis per patient - which is currently £66 - from this income we run
our buildings, pay the staff, buy consumables to be used in the surgery (bandages, vaccinations, scalpels,
sutures etc.), pay ourselves. We are given more money for children and the elderly and people who have a lot
of long term conditions. For the young and healthy we are not paid as much. There are other additional income
streams that we can earn extra income called enhanced services we offer additional services such as sexual
health, minor surgery, vaccination programmes (flu, shingles, pneumococcal, warfarin clinics). We are also
given a medicines budget estimated on what we should spend each year on our population estimated on size
and patient comorbidities. An average of 10% over budget is what we were spending but in recent years we
have come in on budget or under budget. Our prescribing is overlooked by advisors who tell us where we need
to go or where we are going wrong. We doctors do not necessarily have this at the back of our minds when we
are prescribing.
We have many reviews on our services, how we work and what medical activities we offer. We are inspected
for health and safety, infection control, prescribing, how many patients attend Accident & Emergency, how
many of our patients attend CHOC (out of hour’s service) and how many referrals we make to the hospital. This
performance is reviewed locally, county wide and nationally. KC asked why this was done, Simon explained the
reasons behind PBR (performance by results), and referrals need to be appropriate if we are out of line we will
be investigated further by CCG. “Why do they monitor A&E attendances you can’t be held responsible for that”
– if someone attends during our core hours (8.00am to 6.30pm) they want to know why they haven’t been to the
doctors surgery first if the patient says that they couldn’t get an appointment to be seen then they will document
this and monitor how frequently patients say it is because they cannot get an appointment with their GP.
Access to your doctor is monitored – do we offer enough during our core hours? We have no more capacity to
increase our current workloads.
Background on Primary Care - all doctors surgeries are run as a small businesses, we are self-employed
business people who employ our own staff - we offer consultations, medications, referrals for second opinions,
in-house clinics such as antenatal, diabetic, respiratory, sexual health, warfarin clinic and acupuncture (people
with severe pain).
Historically in Cumbria - Barrow, Whitehaven and Carlisle are the highest users of all NHS services Barrow is
the highest user in Cumbria and LHS is in the middle in Furness locality. Within the Lake District their figures
are different as their populations are different and they have a lot of holiday makers who use the services.
The function of the group is to meet four times a year, canvas opinion about service provision reviewing
services to introduce and services to stop. There is a National Survey run by central government and in the
feedback from that Liverpool House scores very highly compared to national standards on patient satisfaction –
the group felt that the surgery should be rewarded 11 out of 10!. Some areas we need to review in-house
ourselves – same day prescriptions (we meet this nowhere else in Cumbria offers this service) the CCG feel
that because of the potential for error we should change, we have resisted this but this there is always pressure
on us. We are also the only surgery in Cumbria who takes requests for medication over the telephone but
again there is potential for error – not everyone remembers what their medications are called and we don’t
necessarily know what that “little yellow pill” is either. You can order your prescriptions in other ways too via our
website, email or at your local pharmacy. The website functionality is for repeat medications (medications that
you are on regularly) we can advise you & show you how to do this – this can be done even when we are
closed. The computer has safeguards to stop people over ordering or requesting medications that are not
routinely prescribed for them. We as Partners feel that this is a good service but the CCG don’t feel that it is a
safe service and is open for medication errors. Our current prescribing is satisfactory but there is a huge
volume of work with on the day demand and pressure on the team – we will continue to resist for now.
Appointment service – Liverpool House has a robust system with good access apart from during our holidays
but occasionally we need further help so we employ a regular locum Dr Akbar (many of you may have met him
already) he works at the surgery every Tuesday afternoon and some Wednesday’s to help with demand. Every
day we have an hour long emergency session for emergencies on the day we can see anywhere between 4-14
people in this hour (this is not always achievable). Having this service between 4-5pm helps to capture the sick
children from school but also enables us to offer appointments to workers who are unable to get out of work
until after 5pm. We offer appointments from 5.00-6.30pm every day and late evening appointments on a
Tuesday with Dr Akbar. We also offer 7.30am appointments for shift workers all 3 GP’s do this and so does
Jeannette our Healthcare Assistant (this is publicised in-house). Our routine day we offer appointments from
8.00am until 10.00am then from 10.30 to 11.45am at 10-minute appointments, we then have 2-hours in which
time we do our house calls, paperwork, sign prescriptions (anything from 100 to 160 a day but we now have
digital signage and electronic prescribing), telephone patient’s back who have queries. Home visits can be
unpredictable you may have anywhere from one to five a day from Biggar Village to Roa Island to visit. We will
then start afternoon surgery at 2.00pm until 4.00pm at 10-minute appointments then go straight into the
emergency appointments from 4.00-5.00pm then start evening surgery at 5.00pm until 6.30pm. On our nonduty doctor day we will work from 1.30-4.30pm then when we stop seeing patients we will catch-up on
paperwork, referrals, pathology results, meetings in-house etc.
When our waiting times for an appointment started to increase we employed Dr Akbar to help us as we have no
extra capacity in the day.
In the national patient survey there were lots of comments about the surgery reopening on a Saturday morning
– none of the Partners want to go down this road again (Karen felt that this is what the Out of Hours service was
for). We were one of the last surgeries to stop offering the Saturday morning service in Cumbria but we will not
be offering this again. Saturday morning surgery is okay for the bigger practices to offer but is more difficult for
the smaller practices. Other areas commented on are pick-up times for prescriptions increasing this - using EPS
(electronic prescribing system) solves that.
Premises – CQC (Care Quality Commission) will start inspecting general practice in the very near future; we
will need to meet certain standards. CQC also inspect hospitals, they are different as they are purpose built,
and most general practices operate out of terraced housing. We do not meet their criteria for certain people –
disabled – we don’t have a lift for people to access upstairs. We don’t have an issue with this but we are
discriminating against patients accessing all areas. We have recently revamped the treatment room as we
didn’t meet certain criterion replacing floor coverings – we need to replace the woodchip wall paper, replace the
fabric chairs. At present CQC are not coming down hard on general practice as we are all in the same situation
but they will do eventually and they expect us to pay for the renewal and updating of our premises.
There are plans for a new purpose built medical centre in Barrow for a number of practices to move into – there
is something bubbling under the surface which we have shown an interest in. We wouldn’t go onto the Alfred
Barrow Site if we were amalgamating into one big practice we would remain individual practices (like Ulverston
Health Centre). Our current list size is 5.500 which is more than we should have and we often have people
requesting to join the practice because of our reputation. We were closed for a long time but we have to take
people on now. New patients can be very complex, you need to get to know them and in the early days are
often heavy users of the service.
Not everything goes right all the time and we do receive complaints one or two a year, pressures will change
this in the future with list sizes growing and access becoming more difficult to achieve. We are also audited
regularly for infection control, minor surgery, long term conditions care etc.
Next Steps
We will need to publicize the minutes of the meetings on the practice website – these will be non-identifiable.
We would also like you to help us design a patient survey for use in-house use – we will then hand this out in
the waiting areas, collect the results and collate the information feeding back to yourselves. We then as a
group discuss the findings and review if we need to change or improve areas and produce a report then
advertise the results in-house and on the practice website. We agreed that we would change the format each
time to ensure that people are asked a variety of questions not the same thing every time.
Everyone was happy with the choice of venue we will change the day to a Wednesday and lunchtime was
agreeable. All contact with the surgery was to go through Maxine our Practice Manager Email address –
[email protected]
Date and time of next meeting: – early to mid-December.
Prescribing – the computer based prescription service monitors overuse, underuse and safeguards early
ordering alerting us. If a patient wants extra because they are going away we can achieve this but need notice.
Emis (our computerised database) is designed to help stop the wastage of medications in the NHS. We also
have a pharmacist at the surgery who we often refer people to for a review of their medication. All people on
regular medications need to have their medications reviewed annually.
Referrals – there is a cost/tariff for each referral to the hospital and the hospital is paid for every outpatient
appointment, if people do not attend the hospital still receives money but the CCG is charged. Patient has a
choice of where they want to be seen but the GP may wish to refer you to a centre of excellence for a hip
replacement – all the hospitals whether a centre of excellence or local district hospital receive the same tariff for
their services. The hospitals are in competition with one and other which is good as it ensures that they raise
their standards.