Grosvenor Medical Centre

GROSVENOR MEDICAL CENTRE

PATIENT GROUP MEETING

17 SEPT 2014

10.30 – 12.30 pm

Purpose of the meeting: To review the progress of the 2013/14 Patient Participation Questionnaire Action Plan. To provide the panel with an update of current developments within the practice and to agree key priorities for the 2014/15 survey areas.

Present:

Dr A Spooner – Partner, Grosvenor Medical Centre

Rachel Patrick – Service and Patient Participation Group Administrator

Caroline Harley – Practice Manager, Grosvenor Medical Centre

Trish Vickers – Senior Practice Nurse

Colin Yoxall – Patient Panel Representative

Catherine Edwards – Patient Panel Representative

Apologies

Trevor Gomersall – Patient Panel Representative

Kevin Larkin – Patient Panel Representative

Sylvia Davey – Patient Panel Representative

Nino Mastroianni – Patient Panel Representative

Michelle Bromhead – Patient Panel Representative

Lynne Jones – New Patient Panel Representative

The meeting opened with welcoming another new patient panel member Lynne Jones. Unfortunately Lynne could not be at today’s meeting but hopes to come to the next one.

1. Review Action Plan

The Action Plan was reviewed see document below.

A lot of progress has been made on the action plan particularly with identifying vulnerable patients specifically those who may be housebound or in a residential or nursing home. These people are of concern during the winter months.

Also the practice has taken on board the comments made by patients with respect to getting through on the telephone. In May 2014 the practice made changes to the location of the receptionists. Behind the enquiry point just off the foyer area two members of staff are sitting there. One member of staff is dealing with prescriptions and taking calls in the first hour when the phones go over. The other member of staff is dealing with queries on the phone and at the window. The remaining 3 members of staff are located at the reception desks and in the first half hour when the telephones go over two remain behind the blinds to concentrate on telephone calls and the third desk deals with the patients booking appointments or checking in. If a patient has a query they are advised to go to the enquiry window thus freeing up the receptionist to deal with other patients. Over the summer this has meant that more staff have been available to answer the telephone which has been appreciated by patients. There are less people waiting at the front door in the morning which is an indication that people are getting through on the phone. Staff dealing with queries have benefited with being located next to the prescription member of staff as they have been able to extend their prescription knowledge. Feedback from staff is that the new system is working well. The practice has also agreed to accept prescription requests two weeks in advance for patients on straightforward repeat medication to assist patients with planning ahead.

Also in the Spring of 2014 the surgery in conjunction with Cheshire East Council Public Health is now providing a Smoking Cessation Clinic to practice patients. The number of patients attending this clinic is increasing which is very encouraging.

In June the practice when onto Electronic Prescriptions which has meant that repeat prescriptions can be electronically sent to a chemist of the patients’ choice. This new system has had a few hiccups but things are running more smoothly with the electronic links.

Recently the South Cheshire CCG (SCCCG) has re-launched the minor ailments scheme with local pharmacies enabling patients to seek advice and guidance, including a prescription where appropriate, on a number of agreed minor ailments e.g. Acne, Athletes Foot, Conjunctivitis, Constipation, Cystitis, Diarrhoea, Gout, Hayfever, Head Lice, Indigestion/Heartburn, Impetigo, Migraine, Oral Thrush (in infants), Piles, Rash (mild dermatitis, eczema), Scabies, Threadworm & Vaginal Thrush. This will give patients a suitable alternative to seek support via a prescription from the chemist.

In October the practice will have a Young Persons Drop in clinic available at the Gresty Brook Surgery on a Monday afternoon. It is important to the practice to encourage young people to attend and a clinic aimed at their sexual needs encourages more to attend. The clinic will be open to young people from other surgeries.

TV advised that recently Cheshire East Council had launched a survey of Sexual Health Services in Cheshire East aimed at young people that has had a poor uptake despite it being advertised. The Sexual Health Team has approached the surgery with respect to seeing if the surgery would help with the survey. The survey has been developed to seek views about the Cheshire East Sexual Health Services that Public Health are responsible for commissioning. Young people are not always easy to engage with and in view of the new Young Persons Clinic this would be an ideal opportunity to engage with young people so would like to take this initiative forward.

2. Practice Nurse Update

Trish Vickers (TV) advised that as part of her Practice Nurse role for the SCCCG she was asked to do some work around vulnerable patients i.e. housebound patients, patients with chronic diseases who do not attend disease management clinics. A VIP (vulnerable & isolated patients) register is therefore in the process of being set up. TV has worked with Seonaid Sichel, Grosvenor’s Deputy Practice Manager, in designing computer searches to capture these patients and in designing a template for patients to be asked specific questions around their physical and mental wellbeing. TV felt the most appropriate clinical person to contact the patient is the practice nurse ideally by telephone. TV has already contacted a small number of patients and feedback to date has been good as she has identified potential support for the patient including 3rd Sector Voluntary organisations e.g. Wishing Well for support for meals. The process has highlighted a clinical need to contact this cohort of patients and to work differently with these patients. There is also a need for the co-ordination of the 3rd Sector services available to support these patients. This is the biggest hurdle – gathering the information i.e. what services they can offer and the organisation’s capacity; compiling a Directory of Services and more importantly keeping it up to date. It is hoped that the ambulance service or Cheshire East Council will have a directory that the practice could adopt.

The computer search and template has been rolled out to other practices in the area for them to commence the work. TV hopes that ultimately Practice Nurses will have ownership of this process with mini caseloads of patients. Colin Yoxall advised that in Crewe there is the Cheshire Academy that can offer breakfasts and lunches at reasonable prices and activities for people. He would get some more details of the services they offer so that this can be added to the list.

TV updated the panel that the annual Flu clinics were being run on two consecutive Saturdays – 4th and 11th October with patients invited from 9 am to 3.30pm. A number of voluntary groups – Action for the Blind, Wishing Well, Be Steady Be Safe and maybe the Fire Service – are hoping to attend with useful information and guidance for vulnerable people. On the 11 October the practice is hoping to have a ‘kiosk’ which is going to be uploaded with some survey questions for patients attending to answer making use of the opportunity of the large numbers who attend the Flu clinics. If possible it would be brilliant if patient panel members could attend one of both of the Flu clinic sessions for either the day or part of the day to assist patients with the Kiosk and also to promote the patient panel.

TV also advised that she is going to be a Carer’s Champion for SCCCG. As a result of the work TV has been doing with the SCCCG in promoting new initiatives for the benefit of patients and the health community she has been invited to Afternoon Tea at 10 Downing Street next month. The practice is delighted that her hard work has been rewarded in this way.

3. CCG update

Dr Spooner (ALS) update the Patient Panel that at present the current Government is putting an element of ‘control’ into health services with no local choice in what could, or should, happen. He felt very strongly that there was a need for patient awareness as to what was happening and for patients to be provided with information of what is needed or is priority. This could influence how things can be organised locally and nationally. The national direction at present is for patient-centred care with the patient being empowered to make decisions with goal based care. However the finance for healthcare is being squeezed and resources are not sufficient enough to fund everything that is available. At present local support is wanted to increase social care and District Nursing Care to ensure these two services are part of an ‘extended team’ to local practices to support patients. However pressure is more for a single point of access of clinicians thus losing the local focus and relationships.

ALS advised that recently East Cheshire Trust has been financially challenged and due to his has made cost improvements and changes to local District Nursing services. A local crisis occurred whereby first in Nantwich and then Crewe where up to 50% of the District Nursing Team were off sick or away, some stress related. As a result the team based at Grosvenor Medical Centre, led by their Team Leader,temporarily moved to Eagle Bridge Health and Wellbeing Centre to support them over the crisis. The Team Lead, Sister Reynolds, was pivotal in supported the remaining staff and also new staff which included temporary agency staff. However concern was raised as this situation should never have occurred in the first place. District Nurses now provide a wide spread of services to patients including Palliative Care, supporting the frail and elderly (social care and mobility support), post-surgical support to patients and day to day support to patients.

To compound the situation Cheshire East Council also has a plan to end respite care for elderly and dementia patients for the locality due to difficulties in funding. This will have an enormous impact of patients and relatives. The Council’s intention is to close Lincoln House currently the main location where respite care can be accessed by South Cheshire patients. The SCCCG difficulty in funding local services was compounded by significant amounts of funding that is administered by NHS England now being ‘top sliced’ to go to teaching hospitals (specialist commissioning) rather than local services that are important for stability. This has been decided nationally with no local choice. ALS advised that local people should have a choice is what patients would like and what services should be available. At the meeting he provided two papers capturing his thoughts around what might be important to patients when specialist services are required and also what is important for District Nursing service provision – the two recent key impacts.

The papers circulated are attached:

ALS hoped that the Patient Panel will take these impacts into consideration when agreeing three key priorities for the panel to take forward in 2014/15 as part of the PPG Enhanced Service.

4. Revised PPG Enhanced Service Specification

As of the beginning of April and number of changes were made to existing practice contracts and enhanced services. The Patient Participation Enhanced Service was one of those specifications that had major changes. There was no longer a payment weighting for the development of a patient panel as this is now a prerequisite and there is no longer a requirement to carry out an annual patient survey, though collecting feedback is still required to inform the development of the action plan. The purpose of the enhanced service is to ensure that patients and carers are involved in decisions about the range, shape and quality of services provided by their practice. Sources of feedback can come from various sources:

• National surveys
• Reviewing complaints or suggestions
• Other local surveys organised by voluntary & community groups, or South Cheshire CCG
• The Friends and Family Test (FFT) - when available (@December 2014)

It is anticipated that the enhanced service will promote innovative forms of patient participation to provide feedback from all groups and allow a better understanding of patient and carer needs. For example

• Insight between the practice and patients to co-design services that meet the needs of the population
• Supporting patients so that they are able to manage and make decisions about their own care
• Providing opportunities for patients to find out more about the practice and how the wider health economy works

The Practice and the PPG will review the feedback received from the practice population from the sources chosen at an agreed frequency. The Practice and the PPG will then develop and agree an action plan based upon three key priority areas and agree how the practice will implement improvements. The actions taken will be publicised to the practice population including providing the PPG with updates on progress. The practice and PPG will have to complete a reporting template to report actions taken during the year, involvement of the PPG and benefits of the improvements. The new reporting template was circulated at the meeting so that the PPG members are aware of what has to be completed with the practice at the end of the year. Template is attached:

It will be important for the process to be inclusive of all of the practice population so some of the harder to reach groups e.g. youngsters will need to be considered.

Friends and Family Test (FFT). From December 2014 all practices will have to undertake the FFT and report the results of this. There will be a standard question for all practices and one follow up question. The current default questions is:

‘How likely are you to recommend our practice to friends or family if they need similar care or treatment?’

The follow up question will be up to the practice and can be an open ended question. Often patients get fed up with answering questions so an open ended questions such as ‘What do you like about our Practice?’ would be more meaningful and something that the practice could learn from and improve further.

The exact wording for the first question for general practice is being considered by NHS England with the running of a series of pilots with practices. Guidance will then be agreed around who should and should not be asked, on data collection methodology, arrangements for reporting etc.

The patient panel proceeded to agree the 3 key priorities for 2014/14. These were:

1. Sexual Health services for young people – the panel agreed to support the practice’s decision to support Cheshire East Council’s local survey for young people by the practice promoting the survey at the Young Person’s Clinic starting in October to capture views from attendees who will be Grosvenor Medical Centre patients and patients from other practices. It was important to engage this age range in their views as current users of services and influencers of future services. Hopefully the practice can use the kiosk at this clinic
2. Appropriate Local District Nursing Service Provision – To ensure the stability of the current provision particularly continuity of care and access to staff with the right skill mix to provide services to patients who cannot get to the practice premises. The panel felt continuity of care was valued along with the appropriate number of senior staff who can make decisions and associated staff who can provide holistic care
3. Convenient Hospital Services – Can more hospital services be provided locally for ease of access for patients and can specialist services be in a hospital or local surgery that is the most convenient to South Cheshire patients?

Areas 2 and 3 will be surveyed at the 11 Oct Flu Clinic when the kiosk is available. The priorities are quite significant areas of services so it was agreed that questions for patients will be specific to ascertain current awareness and initial thoughts. These would be reviewed by the panel and practice and where appropriate fed up to relevant organisations that can assist in ‘making things change or happen’ i.e. SCCCG.

The panel proceed to work up two questions for areas 2 and 3.