Meeting of the Leeds Road Practice Patient Participation Group

MEETING OF THE LEEDS ROAD PRACTICE PATIENT PARTICIPATION GROUP

Thursday 15 September 2016

1830 hrs in Meeting Room

Leeds Road Practice

Attendees: Malcolm Wailes (Chairman) - MW

Anne Olesqui-Meadus – AOM

Brenda Sutcliffe - BS

Claire Golightly (Practice Pharmacist) - CG

Patricia Bickerton (minutes)| – PB

Andrew King – (Managing Partner LRP) – AK

Tracey Donkin - TD

1 APOLOGIES AND WELCOME

Apologies from Jennifer Stacey (JS), Amanda Lee (AL) and Helen McDonald (HM)

Welcome to Tracey Donkin

2 MATTERS ARISING FROM MINUTES OF LAST MEETING

A new list of members was circulated as one of the names on the PPG was not up-to-date.

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3 PRACTICE UP-DATE INCLUDING NURSE PRACTITIONER

New staff included:

Anna Marsden (Reception)

Claire Golightly (Practice Pharmacist)

Janet Mosey (Dispensary)

Leanne Jowett (Health Care Assistant)

Rebekah Benson (Apprentice Dispensary Technician)

Charlotte Willmore (Apprentice Medical Administrator)

Joanna Ashton (GP Registrar [until February 2017])

Leanne Jowett (Health Care Assistant) had worked in the community with children in Leeds. Studied two years to be a nurse. She gives healthy lifestyle advice, takes ‘bloods’ (for which the surgery is paid), carries out ECGs, flu and pneumonia vaccinations, cyst removal, minor wounds and can do home visits. May do ear syringing in the future when extra training has been given, though there is no funding for this at the moment and it may be discontinued. Children have to be referred to a specialist for ear syringing.

Due to lack of GPs, Carol Claire (Advanced Nurse Practitioner) now has a permanent role in the Practice.

Fiona Mettham (Dispensary) has returned from Maternity Leave.

4 PRACTICE PHARMACIST

Claire Golightly introduced herself. She started work at the Practice on 4 July 2016. 28 hours a week, Wednesdays excluded. She briefly listed her extensive experience. (Please see annex at the end of these minutes).

In answer to a question about ‘post-code lotteries’ Claire said this happened less so than before. NICE advise the CCG, for example on gluten-free prescription; a patient information letter would be sent out late October/early November about these. The question of Statins was also raised and Claire said they are normally considered a life-long medication once started.

The question of expiry dates on drug boxes was raised – these dates are printed on the blister packs and of difficulties opening ‘child-proof’ caps; Claire said there were aids available (though not on prescription) and priced in the region of £2-£3.

It was noted that there was a new pharmacist at Leeds Road Pharmacy and that Sainsbury’s were now within the Lloyds conglomerate.

AK pointed out that, as a result of shortage of GPs and the changing face of the NHS, customary practices would have to be changed. In future, a team of experts would be available, eventually leading towards Primary Health Centres.

Thanks were given to Claire for attending the meeting.

5 AREA REPRESENTATIVE REPORT – Spofforth

MW spoke for AL in her absence. She said that the appointment system was difficult for those who didn’t use the website and could she make appointments on behalf of patients. AK said that this was not a problem as long as she had authority from the patient.

AL asked if Claire would be able to attend a meeting at Spofforth Village Council; AK said he would see if it could be arranged.

Re minimum age for making appointments AK said it was at the GPs discretion when he saw the patient about whether parents needed to be contacted; it could, for instance, be a young carer asking for help.

6 AREA REPRESENTATIVE REPORT – Huby

Nothing to report

7 PATIENT FEEDBACK SESSIONS INCLUDING NHS CHOICES

AOM reported that all the patients she saw had no complaints. Observation about continuity of care was made. Receptionists were said to be very helpful.

MW had been sent AJK’s report (in his absence). AJK had seen 12 patients, 3 of whom did not want to participate. Generally patients felt that things were better than they used to be, with only one patient (of 50 years standing!) recalling how she was able to see the same doctor in the past.

There were encouraging comments about:-

·  The improved appointments system

·  Reception and support staff.

·  The good manners of doctors and nurses.

·  Information on the walls, especially about GPs, nurses and secretarial staff.

Criticisms were:-

·  Décor and ambience of the waiting rooms (dull, shabby and boring) with not enough to distract and occupy young children

·  Lack of privacy when talking to reception

·  Need for weekend opening

·  More individualised and tailored approach to patient’s needs – “One size fits all” not acceptable.

·  Appointment booking system, tempered by the comment that it would be difficult to suit everyone.

HM had sent in a written report in her absence. She had spoken to two elderly ladies, one who had been very pleased with the way her recent appointments and on-going care had been handled and another who had been going through a very stressful period and who had nothing but praise for Carol Claire (Advanced Nurse Practitioner) and Dr Shacklock for the care she had been given. She remarked on the vast improvement in the attitude of reception staff. Another patient had tried to make an appointment after being advised to do so following a 111 call and had found the receptionist to be brusque, but had been treated quite differently and sympathetically by another receptionist when a further call was made. An elderly gentleman had praised the physiotherapy he had had at the surgery.

AK commented that improvements in the ambience of the practice were noticed and welcomed. There was praise for almost all the practice staff.

AOM said that she knew of no practices where there were good facilities for children or for privacy at Reception. AK pointed out that there was a notice in the waiting room telling patients that they could ask for privacy if it were needed.

NHS CHOICES: Despite a high regard being expressed for GPs and nurses in the survey result, one in four said they would not recommend the Practice and the rating was 73.4% (middle range) compared to other Practices scoring 81% (middle range), 89.4% (one of the best) and 70% (middle range). On-line booking scored higher than the rest. TD asked if the questions referred to a time frame as one bad experience could have occurred before any improvements had been put in place. AK said he would put some questions together focussing on a time frame and distribute them for comments.

MW put forward a suggestion made by a patient for there to be one afternoon a week at Pannal. AK said special clinics had been used in the past, but that it had been found better to leave it ‘open’.

Timetable for next Feedback sessions:-

·  September – MW

·  October – BS

·  November – AOM

·  December – JS

8 APPOINTMENT SYSTEM AND DATA UPDATE

The system is working very well, and now opens at 8 a.m. Patients can now book four weeks ahead. DNAs have crept up. Appointments at Pannal had to be cancelled on Friday due to the flood and may be closed for a few weeks. It was of note that many people said they no longer wanted the appointment.

9 FAMILY AND FRIENDS UP-DATE

Covered in (7)

10 REVIEW OF PRESCRIPTION DISPENSING

The review is on-going.

11 CQC INSPECTION REPORT

Thanks had been given in the newsletter for those who provided feedback to the inspection team. The overall grading was good, with particular mention being given to how vulnerable patients were dealt with. The next inspection will be in five years’ time.

12 CCG UP-DATE ON PREMISES AND THE WAY FORWARD

The architect had said it was not possible to bring the premises up-to-date without knocking everything down and starting from scratch. A bid has been submitted to NHS England. Locations are difficult to find. There will have to be a patient consultation whatever premises are mooted.

There is a new 120 bed dementia nursing home at Pannal opening in December, whether or not the surgery will be allocated any of these is CCG decision. The practice already has 20 appointments a week from Crystal Court Pannal (60 residents).

13 PRACTICE PATIENTS SHORT SURVEY

This was being considered and put together.

14 ANY OTHER BUSINESS

·  AOM is going to AGM of the CCG next week and will report back.

·  MW had been to the Hospital Trust meeting. Issue of standard appointments raised. This is being reviewed. If patients waiting more than 4-6 weeks a letter will be written reassuring them that they are still on the ‘system’. Liz Dean (Governor) had said she would come to speak to the PPG.

·  There will be short clinics on Tuesday and Wednesday due to the flooding at Pannal.

·  MW brought up the subject of an ‘A’ board outside Pannal surgery to inform patients when a clinic is in progress. This had been discussed in the past, but there is already and ‘A’ board on the pavement for other therapies taking place.

·  Flu vaccinations were taking place on 24 September, 1 October and 15 October with health screening (including arterial fibulation) at the same time where possible

15 DATE OF NEXT MEETING

THURSDAY 15 DECEMBER 2016 @ 6.30 pm. Leeds Road Practice

Abbreviations

HARD/CCG (Harrogate and Rural District/Clinical Commissioning Group). CCG is the NHS organisation that commissions (or buys) local health services for the residents of the area.

GPC. General Practitioners Committee (BMA)

PMS. Primary Medical Services

GMS. General Medical Services

CQC. Care Quality Commission who inspect and audit all aspects of health and social care services in England.

ANP. Advanced |Nurse Practitioner

DNA. Did not attend

ANNEX to minutes of 15 September 2016

PRACTICE PHJARMACIST INTRODUCTION

My background…

Pharmacists in primary care – Individual cases of pharmacists working in general practice for 25 years. Predominantly undertaking medicine management roles. Eg switching high cost medication to low cost. Much of this is now undertaken by CCG or computer based systems such as Optimize px (pop ups).

·  Practice pharmacist role now evolved to undertake medicines optimisation roles with a focus on patient safety.

·  5 year Forward View identified pharmacists as one cohort of allied clinical professionals which could further support primary care, as GP recruitment had dropped.

·  NHS England 3 year pilot scheme £31 million over 698 practices.

·  Many practices also have taken on their own!

Since 2004 (12 years, since I qualified!) the number of prescriptions issued in primary care has increased by 55.2%. Over 1 billion items were prescribed in 2013.

Medicines expert, medicine specialist practitioner.

·  Medicines Optimisation: The safe and effective use of medicines to enable the best possible outcomes (NICE 2015).

What is medicines optimisation?

Getting the most from medicines for both patients and the NHS is becoming increasingly important as more people are taking more medicines. Medicines prevent, treat or manage many illnesses or conditions and are the most common intervention in healthcare. However, it has been estimated that between 30% and 50% of medicines prescribed for long-term conditions are not taken as intended (World Health Organization 2003). This issue is worsened by the growing number of people with long-term conditions.

Drug related hospital admissions

Report commissioned by DoH found that 5-8% of unplanned hospital admissions are due to medication issues.

Me in 1 paragraph-

Pharmacist based solely at the practice working as part of the team to support the prescribing and review of prescribedmedication.

Providing safe and prompt responses to acute medication requests, review of discharge and clinic letters requiring medication changes and answering prescriber and patient queries concerning medicines.

Tackle the ‘administration’ of prescribing requests, queries & letters to free up GP’s to focus on the acutely unwell and complex/most unwell patients.

1st surgery in hgt was Spa. Now pharmacist here and also Moss and Partners. Hopefully will be able to demonstrate savings of GP time and increased safety to warrant a pharmacist in other surgeries.

So far -

·  Responding to acute medication requests eg salbutamol inhalers, creams for psoriasis

·  Prescription reauthorisations and QoF medication reviews

·  Scans – clinic letters, treatment advice notes (TAN) & discharge letters – logged as medication requests or medicine reconciliation

Approx. 70 per week in first month of the above

·  Prescribing queries – from Gps, nurses eg cautions and contraindications for Fluenz

·  Ad hoc level 2 medication review (review with medical notes +/- telephone contact with pt) to support medication adherence

·  Appropriate ad hoc saving switches – because I am more familiar with BNF and product availability. Reviewed specials prescribed in May

·  Production of cardiovascular pt information sheet with LJ & TR

·  Contacting pt’s reviewed at NHS Health check & QRisk re audit to discuss CV risk

·  Developed contacts with hospital, community pharmacists & CCG colleagues. Attended local pharmacy practice forum (CCG, Hosp, Community). Aim to minimise error when patients transferred between settings. Support them with medication. Provide information.

·  Point of contact for patient medication queries via reception

·  Identification of possible audits on safety of prescribing, or where advice on prescribing has changed.

o  Clopidogrel and omeprazole

o  Dosulepin (On DROP list)

·  Passed on medication safety information distributed by CCG to colleagues

To do –

·  Develop a role of clinical medication review with emphasis on medication safety and patient satisfaction.

o  Establish level 2 (with medical notes) and level 3 (face to face) reviews

o  Identify and review highest risk patients, those on polypharmacy, or identified as not managing their medication.

Ø  High risk care home patients – highlighted by home or GP, new patients to home, recent hospital discharges

Ø  Frail elderly

Ø  Renal impairment

Ø  Hepatic impairment

Ø  Use of STOPP/START review process

Long term – Further training and prescribing qualification to enable-

·  Face to face medication reviews in clinic

·  Management of chronic conditions such as uncontrolled hypertension.