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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