MINUTES OF CREWKERNE HEALTH CENTRE PATIENT FORUM (PF) HELD ON THURSDAY 19TH SEPTEMBER 2013 AT CREWKERNE HEALTH CENTRE
Present: Sylvia Allman, Geoff Clarke, David Hughes (Chairman), Annie Gleeson (Secretary), Bob Meades, Louise Walker. Guest speaker, Dr Sarah Pearce.
1. Apologies for absence were received from Joan Farris, Tesa Budd and Kerry Cousins.
2. The Chairman welcomed Dr Sarah Pearce who had been invited to speak to the PF group about how the recently formed Somerset Clinical Commissioning Group (CCG) is going to impact on medical practices in the County.
Dr Pearce began by explaining that the need for the Health Reform scheme had been underpinned by a “growth economic deficit”. Factors such as increased life expectancy, increased pressure on resources and the rising cost of more sophisticated health care meant that the old funding system could not continue as it was. The decision had been made to bring GPs into the discussion to reform the system in order to represent the patient group more effectively.
Somerset has been one of the first counties to deliver the Clinical Commissioning Group structure to replace the old Primary Care Trust and GPs have been involved in the development of the new system from the very beginning. The Group has been broken down into 9 areas, called Federations, to make the organisation more manageable, with each area having similar population numbers. Crewkerne was originally included in the Crewkerne, Langport, Ilminster, Chard (CLIC) Federation. Langport have subsequently moved into a different area – but the CLIC name has stuck!
Dr Pearce stressed that although economics play a major role in the function of the CCG, the policy of the CCG is for it to be patient driven, which is why every GP Practice is a member of the CCG. The governing body above the CCG is NHS England, and they are in turn directed by Parliament.
Apart from funding direct health care, the CCG also directs funds, through a Health and Wellbeing Board, into wider Community facilities such as Community Centres and Adult Social Care. The policy is to make a patient’s journey more individual, and a large part of this policy is designed to feed back patient issues into the system.
In terms of how the new CCG will impact on current GP health provision, Dr Pearce said that it was likely that GP practices will work more closely together, for example sharing practice nurses in specific areas. Practices will probably increase in size and by sharing resources there should be an increase in expertise. As a result, health outcomes will hopefully improve and the Government is currently engaged at looking at the best way of measuring these improvements with a focus on the outcomes of clinical appointments.
For the future, Dr Pearce said that she anticipated more private providers in the health care system, with long-term health conditions being managed by nursing staff with support from the GPs and more nurse-led clinics. Attention was being given to opening times at GP practices to accommodate patient’s work patterns and a plan was being considered to have more GPs in A & E departments, possibly with a GP surgery next to A & E departments. She referenced the new ‘space-age’ GP surgery in Frome that has an acute walk-in centre. She also referred to the use of new technology in managing long-term health conditions in the home, such as Telehealth.
Looking further to the future, Dr Pearce referred to an experimental American model that consists of one large Health Centre with 5 small surgeries attached with TV communication facilities. Patients can talk through the screens (like Skype) to someone in the main centre and a prescription can be issued if required. She felt that younger people in particular would be likely to respond to this type of approach. Although this might be some way in the future, she pointed out that some GP practices are already using a system of telephone and email consultations and, possibly, Skyping consultations could start to happen before much longer.
After some discussion it was agreed that the use of Technology would not suit every situation or every patient. BM suggested that there was a risk that with this kind of ‘remote’ consultation, it might be possible to miss subtle problems. Dr Pearce agreed that it was important to triage each patient. She also stressed that since its inception, both the nursing group and an independent consultant are now represented on the CCG board in order to ensure that it is more representative and that local information is fed back to the new service to make it more effective.
The legislation also allows for “any qualified provider” to be involved in care provision, for example in the field of community Podiatry for diabetes. There are strict rules governing the type of provision, which must be CQC (Care Quality Commission) compliant. It was considered that this could be better in the long run for the patient group, but there was a risk it could threaten the NHS. Responding to BM’s concerns as to whether GPs were sufficiently qualified to negotiate these contracts, Dr Pearce said that there is a team involved in these negotiations, including qualified accountants, and GPs have had extensive additional training to take on the task.
One of the other governing bodies in the CCG is the Clinical Operations Group of which Dr Pearce is a member. She felt that the GPs in this group have been quite sensitive in the decision making process and have turned around some decisions made by the management, on a clinical basis. She felt that it was too early at this stage to assess whether there have been any cost savings under the new commissioning system.
AG raised a question about the impact of Dr Pearce’s involvement with the CCG on her GP practice commitments. Dr Pearce said that although the initial workload for the CCG had been heavy, she did not feel that it had had a negative impact on patient care in her practice. She anticipated that as the CCG bedded in, the sharing of GP experience would form a vital part of its success.
The Chairman thanked Dr Pearce for taking the time to talk to the PF Group.
3. Minutes of the last meeting and Matters Arising
There were no changes to the minutes of the meeting held on Tuesday 23rd July. It was agreed to include the idea of a Patient Forum Development discussion on the next agenda. This would create an opportunity to establish the priorities for the PF for 2014.
4. Update on installation of new computer system
LW reported that the system is up and running, and that the process had gone relatively smoothly. She felt that the preparation work had paid off. It has inevitably taken the doctors extra time during consultations while they become familiar with the new system.
One advantage of the new system is that blood test results come in electronically and go straight into the patient’s records. In response to SA’s concern about the security of patient information, LW assured her that no other information was being transmitted electronically and that the new system was very secure. Other developments are possible, for example, the transmission of prescriptions directly to the Pharmacy.
In response to GC’s question about backing up the system, LW assured the PF group that it functions as a hosted system. The central system is “bunkered” down securely with 2 servers. If one system fails for any reason, information would be available elsewhere, which represents a substantial improvement on the old system!
5. Patient Survey
LW had circulated copies of the proposed survey form that had been drawn up following a productive sub-committee meeting. The following comments were submitted:
It was felt that establishing the demographic information about the patient group would be useful.
It was suggested that the word “Practice” should be included before “doctor” at question 3, in case patients should interpret the question as having seen any other doctor.
BM suggested that if the answer to question 6 is “No” (Have you seen a nurse in the last 12 months?) patients should be directed to go straight to question 9, questions 7 & 8 not being relevant.
There was some discussion about the word “Nurse” – for example, does this include the Phlebotomist? So, for example, question 6 should read “Practice Nurse”.
The survey will go on line on 1st October as well as being sent out to the Virtual Group. Hard copies will also be available to be handed out at the Flu Fun Day and can be made available at the Reception Desk, for example while patients are waiting for their prescriptions. LW also confirmed that some of the GPs might consider handing out the survey forms to their patients. BM, JN and AG offered to come into the Health Centre waiting room to encourage people to complete the survey forms. They will liaise with LW to establish the best times to access a good cross-section of the patient group.
6. PF Meeting Days
DH reported back on the responses of PF members as to their preferred days for meetings. It was decided that Wednesdays and Thursdays, on alternate months would be the best days. It was decided to keep the October meeting on Tuesday 22nd, at which time the dates for 2014 can be discussed. (The November meeting is already scheduled for Thursday 21st).
7. Flu Fun Day (FFD)
DH reported back on the sub-committee meetings that had been arranged to finalise the details of the FFD. A schedule for helpers had been put together, allowing for 6/7 helpers in teams dealing with washing-up, serving teas and clearing tables. Many offers of cakes had been received. It had been agreed to charge £1.50 for a drink and cake, and to sell raffle tickets at £1 per strip, and 3 strips for £2.00.
LW offered to be responsible for collecting the donated items from Waitrose, and coordinating the making up of the raffle prizes. She will also provide name badges.
It was agreed that the PF should have a table, from which they could also sell raffle tickets, as well as talking about the PF and encouraging new members. JF will be providing display material for the PF stand and was hoping to get the Western Gazette to take a photo of the PF group for a press release. (DH to email JF to confirm these arrangements).
AG will provide 3 floats (using £120 left over from the last FFD) – 1 for teas, 2 for raffle tickets.
LW, DH and BM will be going to the Henhayes Centre on Friday afternoon to do some of the setting up. LW confirmed that the Clinical team will be arriving at about 8.30am on the Saturday and that the first vaccination appointments start at 9.00 am, although things are normally quite busy at the beginning of the day.
8. Any Other Business
AG confirmed that, subject to a few minor alterations suggested by BM, the Newsletter was ready to go to the printers. BM suggested that we could ask patients for their email addresses so that copies of the Newsletter could be sent electronically. He also suggested that the Newsletter be put on the Web site. Copies will also be available on the PF stand at the FFD.
LW asked if the PF wanted to re-issue the fridge magnets with the new 111 number. DH thought it might be better to wait until confidence in the 111 number was restored.
With regard to the GP staff, LW confirmed that Dr Dean has left the Practice. Two new doctors, Dr Diane Stanley and Dr William Wilson will be joining soon, and Dr Hewson has now returned to work after her period of maternity leave. It is hoped that Dr Davies will return to work in November. LW plans to produce the new Health Centre brochure in January, to include details of the recent staff changes.
Date and Time of Next Meeting
The next meeting will be on Tuesday 22nd October at 7.00 p.m.