Download Open Evening for Patients August 2013

The Mandeville Practice
Open Evening for Patients
Wednesday 7th August 2013
The open evening for patients of the Mandeville Practice was held to talk about
services at the surgery and inform patients of new developments. We also wanted to
encourage feedback from our patients on what are their main concerns, which issues
are important to them and how satisfied they are with services at the practice in
general.
The evening was publicised on the website, in posters around the surgery, on
prescriptions and details emailed to members of the patient reference group. Written
invitations were posted to patients in the patient group without access to email.
Refreshments were provided on the evening and the event was attended by sixteen
patients, seven GP partners and two members of the management team.
Dr Kevin Suddes opened the evening with introductions from the doctors and
explained that Dr Colin Kennedy was absent from the meeting due to his planned
retirement at the end of the month. He went on to thank everyone present for
showing an interest in the practice and giving up their time to attend.
Dr Paul Vogwell went on to describe the plans for the building development which is
now due to be finalised in October 2014. The practice had hoped this would have
been completed sooner but it was explained that delays were due to matters outside
our control. The extension will include a pharmacy which will be contracted to open
100 hours per week, and until this is built, the pharmacy will operate from a
temporary portacabin situated close by. Parking spaces will be increased, two new
consulting rooms added, notes storage provided so that patient notes can be stored
on-site, and the waiting room will be restructured.
Changes in the NHS which were introduced in April of this year were outlined by
Dr Suddes who has an executive role in the local commissioning group (Aylesbury
Vale Clinical Commissioning Group). He explained that the purpose of CCGs
(commissioning groups) is to deliver services and to make sure that hospitals and
other secondary care organisations give us best quality care. Previously, these
services had been delivered by central government – a ‘top down’ approach. Now
the emphasis has been changed so that local people, councils and doctors will be
working together to build new services and get the best value out of the services we
all use.
Aylesbury Vale CCG holds patient engagement meetings around four times a year
and patients are invited to let the surgery know if they would like to attend. Dr Beck
urged patients to become involved as this presents a real opportunity for the public to
influence the direction of healthcare in the area.
1
Denise Skidmore
D:\769832404.doc
Dr Suddes talked about the recent Keogh report which has resulted in Stoke
Mandeville Hospital being put into special measures. He explained that this is a
positive move because experts will be brought in to make sure that changes happen
to improve the standard of care in every area of the hospital.
He went on to discuss NHS 111 which, up until now had been managed locally by
NHS Direct. Although they have delivered a good service in our area compared to
many, financially they cannot continue to function and the CCG are now looking at
other providers. Nationally, NHS 111 calls have led to an increase in A&E
attendance, calls to surgeries and ambulance requests. This is thought to be due to
the cautious ‘risk-averse’ nature of the advice given out by call-handlers. The
doctors all gave their support for the 111 service and agreed that it should work in
principle.
Patient feedback during this discussion revolved around press irresponsibility and
their tendency to present a negative view of some very complex situations. The
doctors agreed with this observation, saying that change is already happening
around us and there are a lot of encouraging developments in the new NHS.
Denise Skidmore, Operations Manager talked about IT developments in the surgery.
Text messaging to remind patients about their appointment booking had been
introduced a year ago and has had some impact on the number of missed
appointments. The electronic prescription service has been in place for under a
month and is already proving very successful. Patients who have regular repeat
medication are encouraged to ask their pharmacy about signing up to the service.
The impact on this service should result in greater efficiency and fewer paper
prescriptions.
Patients are already able to book appointments at the surgery themselves, at any
time of day or night, via the automated option on the phone. In September this will
be extended to an on-line booking facility for patients who have access to a
computer.
The summary care record was introduced nationally earlier this year and all of us will
have received a letter explaining what this is. In the event of a medical emergency,
anywhere in the country, the hospital will be able to check the patient’s medications
and allergies and reactions. To opt in to this service, patients were not required to do
anything and only complete and return the form if they wanted to opt out. There are
some concerns that this had been misunderstood and many patients may have
opted-out in error.
Another aspect of the operation manager’s role in the practice is that of dealing with
complaints. The surgery has an excellent reputation and is proud of the service it
provides. However, things do not always go to plan and if something has gone
wrong, the surgery needs to know. In this way services can be reviewed and lessons
can be learned. The practice receives very positive feedback from patients every
day in the form of words, cards and messages and patients are encouraged to leave
good written feedback on the NHS Choices website.
2
Denise Skidmore
D:\769832404.doc
The Mandeville Practice is a training practice and Dr Zoe Rogers and Dr Angela Hart
are the GPs responsible for training new doctors. Dr Rogers explained that
sometimes this means asking a patient if they would mind a second doctor sitting in
on their consultation or the consultation being recorded for training purposes.
Patients always have the right to say no. In order to be accredited as a training
practice the surgery undergoes a rigorous process which includes official visits and
regular monitoring. Both Dr Rogers and Dr Hart have been commended for their
skills in mentoring and inspiring new doctors and the whole practice team enjoys the
challenge of teaching (and learning!) from these people at the start of their medical
careers.
Because there are fewer doctors entering medicine to become GPs, the practice is
very keen to encourage doctors starting out in the medical profession. Patients at
the meeting wanted to know why it is so hard to recruit GPs these days and it was
felt this is principally due to the workload. It takes 10 years to train as a GP but
currently, 25% of all newly qualified GPs are leaving the country.
Dr Angela Hart talked about the continuing challenge of managing the demand for
appointments in the current environment where it is so difficult to recruit and maintain
new doctors. She explained that the surgery has listened to feedback from patients
and as a result, introduced a triage system whereby anyone has access to speak to a
doctor if they need on-the-day advice or treatment. Many problems can be dealt with
over the phone in this way, without the need for a face-to-face consultation, although
the GP will book an appointment if this is required. She went on to explain that the
balance of appointment availability is monitored and adjusted daily following a
general principle of 60% routine book ahead appointments, 30% book on the day
with a 10% margin for urgent consultations.
Although the availability of appointments is a national problem, Dr Suddes said that
Bucks has the lowest A&E attendance rate of the whole South Central region. This
would indicate that patients are getting good access to their GPs and not just turning
up at A&E inappropriately.
The discussion moved on to the high rate of missed appointments in the surgery and
what can be done about this. Patients receive text message reminders about their
appointment the day before, they have the ability to cancel appointments on our
dedicated cancellation line, using the 24-hour automated option on the phone line
and via the website, yet appointments are still wasted. The surgery always writes to
patients who fail to attend their appointment without giving an explanation. Thoughts
were invited on how this issue could be tackled further and a suggestion by a patient
of conducting an audit of reasons why appointments are missed was thought to be a
good idea.
Anita West introduced herself as the Practice Manager appointed in September
2012, before which she was Business Manager at the surgery. Much of her role she
explained is taken up with reducing expenditure and maximising income for patient
care. She described a recent bid which had been submitted which, if successful, will
provide amongst other things, special treatment chairs for patients, a BP machine for
patients to use and air conditioning for the waiting room. Patients were asked to let
the surgery know if they have suggestions for equipment or improvements.
3
Denise Skidmore
D:\769832404.doc
The continuing problem of the toilets was raised and it was explained that the
pipework for these was badly installed when the building was first built and the
refurbishment of the toilets and waste disposal is an essential component of the
building extension plans. This will mean major work being undertaken over
weekends if possible to cause the least disruption to the surgery.
In response to Dr Beck’s invitation for questions from the floor, a query was raised
about hospital referrals and follow-up. The Choose & Book system for referrals was
explained whereby the patient is able to book their own appointment at the hospital of
their choice, once the referral has been made. Most hospital departments are
included in this service and it is hoped that the outstanding departments will soon
come on board. As not all patients were aware of this facility, it was agreed to put
information about Choose & Book on the website and the TV screens in the waiting
areas.
In answer to a question about whether patient numbers would expand with the
surgery development, it was explained that we have an obligation to take on patients
who live within the practice boundary and that we are unable to close our practice
lists. However the surgery has no plans to extend patient numbers beyond the
17,000 currently registered.
It is hoped that a new doctor will be joining the surgery in September to replace
Dr Kennedy’s sessions. A locum has also been appointed to cover sessions for a
three month period over the autumn.
In response to an issue raised by a patient about the difficulties of speaking to a
specific doctor for advice rather than the duty doctor it was agreed to review the
system of booking a telephone consultation with a doctor in advance.
The question was asked whether the practice had any plans to re-introduce well man
clinics. There are no plans to do this at present although the surgery does carry out
NHS Healthchecks for specifically targeted patients.
In answer to a query as to whether the practice has any plans to recruit more nurse
practitioners, it was explained that these are hard to find and instead the practice has
concentrated on developing a good skill mix of clinicians from health care assistants
and phlebotomists to nurses specialising in heart disease, diabetes, asthma and
COPD. This is based on the principle that good healthcare depends on the patient
being seen by the right person at the right time.
Dr Beck closed the meeting by thanking the patients present for giving up their time
and their continuing support of the practice. Their ideas and suggestions will be
carried forward and will form the basis of the next patient survey.
4
Denise Skidmore
D:\769832404.doc