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1 Patient Participation Group for Chamberlayne Road Surgery - Minutes of the meeting held 15062016 1. Those attending Dr Jyotsna Patel – doctor Adrian Murray Bradley – chairman Sarah Murray Bradley – secretary Magdalene Bailey Ravilal Gorcia – practice manager Jitendar (Jay) Kachela – local pharmacist Anne O’Sullivan Georgina Sarpong Renatta Marakami – health care assistant and receptionist. Malcolm Nash Danielle Degerstrom – receptionist Apologies Ms Nikolett Kadas – Health care assistant Judith Fletcher Dr Kiran Sodha - doctor Kirubai Kohout Mythely Ganeshankugan - receptionist 1 Composition of Meeting – agreement for minutes for the last meeting. The minutes of the last meeting in March 2016 were agreed and have been passed for distribution where necessary. Members of the meeting represent a reasonable cross section of the patient population. The group age range is from 30years to 75 years. The only patient groups not represented are mothers with young children and the 15-30 age group. People in the group represent 7 different nationalities which reflects the diversity of the practice very well. A married couple attends; also parents, grandparents and single people. There is a good mixture of professions and some members of the group are retired, one member is physically disabled, two others have a chronic condition. 2 Matters arising from the previous minutes Item 4, 1st paragraph. The report from the Quality Care Commission inspectors has now been received in its final form and shows that the practice is considered good in all areas. The members congratulated the staff for this excellent result. Item 7, 1st paragraph. The chair reported that there had been an email from Tulip Sidique MP saying that the debate on pharmacy closure had been adjourned. It cannot however be ignored and Jay reported further in his report from Pharmacy. 3 Report from Dr Patel and Mr Gorcia about the practice. Nikolette has had to reduce her hours for personal reasons. She does however cover when the practice is busy. Her enthusiasm and energy is missed by the practice and the meeting wished to thank her for her work so far and wish her well. The meeting was told of a new, extra, level of administration which the clinical commissioning group has inserted between GPs and secondary care. The Brent Optimization Referral Service (BROS) will act as a triage barrier between the GPs and referral of patients to secondary care. This has be contracted out to Bexley Health Ltd (http://www.bexleyhealthlimited.co.uk/about) . Doctor Patel and Mr Gorcia expressed some reservations about the impact that this will have on GP independence and patient choice. This is reflected in an article in Brent Patient Voice (BPV) Newsletter of August 2016 (http://www.bpv.org.uk/will-optimisation-make-things-better-brents-new-referrals-service/) which criticizes the move (and which is reproduced at the end of the minutes). The secretary has, 2 on behalf of the PPG, signed up as a member of the BPV to receive further newletters which may be of concern to the PPG. The move of NHS England, London region, to Skipton House in the Elephant and Castle has disrupted communications for GPs when they need to obtain new patient’s notes, Mr Gorcia told the meeting. The transfer of notes has become a much longer process, making it difficult for GPs to obtain a reliable medical history. This makes it particularly difficult as Dr Patel has recently received an influx of patients transferred from another local GP, Dr Hussein, who has retired. It is hoped that this move will not interfere with the transfer of records on a permanent basis. Dr Sodha is continuing to work on additions to his series on ante-natal care available as a YouTube video channel called `GP tips’. https://www.youtube.com/channel/UCZE6ryik8MrujUAC2Q25PQ/channels . Interested members can have a look via the url or by typing `GP Tips’ into Google. This information would be a useful addition to a newsletter to inform and educate patients about their own health care. The topic is particularly useful in that mothers with young children is just the group that we cannot often get to attend the PPG. 4 Report from Practice Nurse The practice still has not been able to recruit a permanent practice nurse. However, Gracious Calit is the part time nurse who comes between 17:00 hrs to 20:00 hrs on a Tuesday evening. Immunizations, smear tests, dressings and travel vaccinations can be done in surgery during these times. Both Renatta and Nikolette continue to provide Health Care at the surgery. The annual `flu’ injections are about to begin, starting on 19th September. Posters and leaflets are ready for display and distribution. In addition to this, patients aged 73 and 78 will be able to have shingles vaccinations and this will also be offered to any patients over 70 that have missed the opportunity in the last few years. The Pheumovax will be offered to all children in the `at risk’ group between 2 and 4 years and the whooping cough vaccine to pregnant mothers up to 28 weeks into their pregnancy. 5 Report from Reception Nikolette is no longer working full time but is available on occasion. The meeting welcomed Daniella Degerstrom who is the new receptionist. Malcolm pointed out that the `call back’ option on the surgery phone line does not work despite being offered. Ravilal says that he will remedy this. 6 Report from pharmacist – Jay Katchela Jay reported on the progress of the funding situation for local pharmacies. Although a debate has not yet been held in parliament, he is hopeful that the cuts will not be as extensive as feared. He will report on this at the next meeting. He pointed out that although there is apparently a glut of pharmacists there is a dearth of local pharmacies. Possibly this can be accounted for by the growing numbers of supermarket pharmacies which do not offer local services or support local communities. Jay told the meeting of the implementation of the Accessible Information Standards and the way in which these relate to local pharmacies. An article on this can be found on http://psnc.org.uk/wpcontent/uploads/2016/04/Community-Pharmacy_Accessible-Information-Standard_April-2016.pdf but in brief it tells pharmacists that they should implement by 31st July 2016 :1. Ask: as a matter of routine you must find out if a new or returning patient has any information or communication support needs relating to a disability, sensory loss or other impairment (e.g. stroke). 2. Record: clearly and consistently record those needs in the patient’s records (paper or electronic). 3. Alert/Flag: the recorded needs must be ‘highly visible’ - so that it can be seen and acted upon whenever the individual patient’s record is accessed. This should be done in the same way as for any other risk information (e.g. known allergies). 4. Share: you should include information about a patient’s accessible information and / or communication needs at referral and handover, following your existing data sharing processes. 5. Act: make reasonable adjustments so that people get information in formats they can understand. 3 In theory this means that any problems that a patient has in communication should be flagged on their Summary Care Record and thus be available to any qualified health care personnel who needs to treat them and is authorized for access. As Jay pointed out, this will only really happen if there is conscientious continuity of care from a local pharmacist who knows and understands his patients because a patient’s permission is required in order for the pharmacist to access Summary Care Records. Proper access for pharmacists will require better co-operation between GPs and local pharmacists in order that the electronic information can be added to the patient’s records smoothly. Further Information on the Accessible Information Standard is available on the NHS England website. (https://www.england.nhs.uk/ourwork/patients/accessibleinfo-2/ ) 7 Newsletter 9 June 2016 The meeting were told that the Newsletter 9, which is a Special on Patient Transport, will be available shortly. Dr Patel and Mr Gorcia had previously pointed out that there are dedicated GP practices in Willesden, where Dr Burnley at 115 Pound Lane, NW10 2HU Tel: 020 8438 7330 registers homeless patients in the area. In Wembley there is a similar facility at The Wembley Centre for Health and Care, at 116 Chaplin Road, Wembley, Middlesex, HAO 4UZ. Tel: 020 8900 5020 8 Progress on web site improvements. Malcolm pointed out that the practice web site is still not well organized. Neither the minutes of meetings nor newsletters are available and nothing has been done since Nicolette’s first attempts at remedying this some months ago. It is URGENT that the web site reflect the good record from the inspection given to the practice, and give proper and up to date information on the services that are available. Mr Gorcia said that he will address this matter as a priority and will engage the help of the IT expert to make this happen BEFORE the next meeting. Sarah said that she would make available folders containing the last 2 year’s minutes and a set of newletters so that these can be properly incorporated in the web site. 9 Any further business Dr Patel wanted to ensure that patients know that the extended appointments on a Tuesday between 18:00hrs and 20:00hrs are ‘by appointment’ only. They are not offered on a `drop in’ basis nor is the office open to take enquiries. This will be advertized in the next Newsletter. Dr Patel reported that patients who are sent a GP questionnaire and do not respond, will be automatically removed from the GP patient lists. She has no control over this. This is particularly important if patient have changed address and so does not receive letters. So it is URGENT that patient’s let reception at the surgery know if they have a new address and that they respond to communications sent to them by the NHS. 12 Date and time of next meeting The next meeting will be held at 7pm on 7th December 2016, when, as usual, pizzas and fruit will be available for all who attend. Note 1 from Brent Patient Voice (www.bpv.org.uk) Will “optimization” make things better: Brent’s new referrals service . 21 August 2016 In the real world “optimisation” means making things better. In “NHS speak” you can’t be too sure. Brent CCG has contracted Bexley Health Ltd (BHL) to provide a Brent ‘Referral Optimisation Service’ (BROS). This will start on 1 September 2016. Brent Patient Voice has followed this development for several months. We think it could have some advantages for patients and GPs but these now appear to be heavily outweighed by its serious disadvantages. 4 From 1st September all Brent doctors’ referrals of patients for specialist investigation or treatment must be sent through BROS including hospital Consultant to Consultant referrals. The BHL website claims that this referral management service will produce an improvement in the overall quality and completeness of referrals and a reduction in unnecessary and inappropriate referrals which will improve both the efficient use of NHS resources and patient’s time. It is clear to us that this new Service will play a keystone role in the Brent Sustainability and Transformation Plan for transferring much hospital speciality out-patient referrals to new cheaper community services run by the single proposed new GP Brent Care Ltd ‘Alliance’ of all 66 GP practices. The new referrals service is to be financed entirely by Brent CCG taking about £3 million per year out of its healthcare leaving an extra healthcare “savings” of about £2 million a year after using £1 million per year to pay for the new referrals service. We have serious concerns about Brent CCG attempting to impose new restrictions on patient choice with this service. NHS Improvement (the re-named NHS Monitor) issued new guidance for CCGs on 16 August 2016. We also have serious concerns about Brent CCG attempting to reduce GP’s clinical independence to refer their patients to the hospital services that they believe best for the patient. The referrals optimisation service will never have met the patient and not have access to the patient’s full medical history. Our concerns about this service have been greatly increased by Brent CCG at the last moment pulling out of a meeting arranged by the independent statutory Local Medical Committee (LMC) on 16 August 2016 to which we had been invited. Brent Patient Voice had given Brent CCG notice of our questions. The CCG have not offered any new date for this meeting, and we are just told indirectly through the LMC that ‘they will instead address your queries and concerns through their patient engagement structures’ without any date suggested. On 16 August we wrote a strong letter to Brent CCG protesting at their failure to answer our questions, and pointing to their statutory duty to involve Brent Patients and public in their proposals for their healthcare commissioning and changes to it that affect patients. Our letter has been acknowledged saying they hope to reply by 1 September. Our worries about the BROS have been increased by the report by Caroline Price on 17 August in Pulse that a 6 week urology pilot ROS by NE &W Devon CCG has resulted in 142 (30%) of GP referrals being sent back to the GP mostly to carry out more investigations themselves such as ultra-sound scans – for which the GP’s complain they will receive no extra pay. Peter Latham