NORTH DURHAM PATIENT REFERENCE GROUP

Tuesday 1st November2016

5.30pm - 7.30pm

North Road Methodist Hall, Durham

Action Notes

Present:

(CL) Carole Lattin, Claypath (Acting Chair)

(BJ) Brian Jackson, The Medical Group

(ID) Ian Doyle, Cestria

(NC) Nancye Carr, Lanchester Surgery

(JG) John Goodwill, Cheveley Park

(JK) John Kelley, The Medical Group

(PR) Pat Rafferty, The Medical Group

(DHa) Denise Harris, Coxhoe

(AM) Ann Maughan, Great Lumley

(SH) Stephen Hann, Pelton and Fellrose

(GR) Gill Rees, Coxhoe

Support and Notes:

CCG-Mike Brierley (MB)

DCA Support- Louise Harlanderson (LH), Anne-Marie Parkin (AMP)

Guest Speaker- Nicky Harmer, CAMHS

No. / Note / Action
1. / Welcome
2. / Apologies for absence
Jean McCormick, Keith Holyman, Daniel Blagdon, Helen Doyle, Jennifer Mole
3. / Declarations of Interest
Carole Lattin- Daughter in Law is Head of Service for CAMHS
4. / CCG Update- Mike Brierley
There has been a lot of work done around the Community Hubs and this was discussed at the Patient Congress in October. The feedback to this will be on the CCG’s website.
The PPCE public rep interviews have taken place today.
The 2 year operational plans are to be written and delivered by the end of November.
The STP has been submitted to NHS England. The financial profile has been removed from the South STP and now sits in the North STP. Mental health and community services are still within the South STP.
Rapid Specialist Opinion:
MB said that About Health are not paid for the Choose and Book appointments. This is still managed by NECS. The patient’s choice is not affected and the patient will still have a choice of where they are treated. In discussion, it was revealed that a Variation Order to the value of £70,000 had been issued to the current contractor who does choose and book, in order to support R.S.O.
Action- MB to get back to the group with information on the change in contract and that patients would not be affected by lack of choice where they receive their treatment
PR asked about the Diabetes 2 service model. The tier 2 service is being decommissioned and the CCG want to contract with Federations to provide this service at three levels - care basic, care+ and care++. Care++ will include dealing with complex insulins. Durham Federation are not keen to contract as they do not feel they have the expertise as there are not enough specialised people across the patch to provide care++. There is a concern that if the prescribing budget for this is overspent the Federation would not be paid for the service - it appears that payment is dependent upon making savings on the prescribing budget. However, practices would need to employ more specialist people to provide the service and they need to ensure that they have the funds to pay them.
Action- MB to come back to the group with more information on this issue
Frail/Elderly
The weekend service for the frail and elderly run by Durham Federation has stopped due to funding issues. Derwentside Federation have agreed to provide the service to the whole area at a substantially reduced cost. There are issues around lone working as GPs drive themselves to call outs and they do not know the patients in this area and issues regarding access to patient records.
This is a very expensive service as few patients have been visited - there are concerns that this may have an effect on funding availability to provide the winter Saturday morning opening this year.
MB said that these are all different services and that being “Winter Ready” will be looked at by the STP plan.
Action- MB to provide more information to the group regarding the frail/elderly services
Proposed Hubs- A private company called G E Finnamore has been asked to look at the Hub options and give their opinion. There appears to be a question over payment as figures of £20,000 and £50,000 have been given. Clarity needed over costs and where the funding has come from given the current constraints. In addition, clarification is needed as to how developed this proposal is. MB said that this is a fast track piece of work to develop an outcome based piece of work for community hubs. This information has gone to the new integration director who will take this forward. There will be an outcome based spec and will include how those outcomes will be delivered. No comment was made on the payment to GE Finnamore.
Physio Hub- DH asked if it was correct that GP’s will no longer be able to refer directly to Orthopaedics and that the Physiotherapist will decide whether to refer to the Consultant. MB explained that there will be a triage service. The GP can still take the decision as to whether the patient needs to be referred to an orthopaedic surgeon. The physio hubs went live in September. / MB
MB
MB
5. / Guest Speaker- Nicky Harmer CAMHS
Nicky explained the new services offered by CAMHS. The crisis team take self-referrals and is available 8am-10pm 365 days a year and there are plans for it to go 24hours a day. There is a bid in for an Intensive Home treatment service to start in the New Year. This will be a 24-hour service and will try to reduce the need for patients to be admitted as the nearest in-patient unit is in Middlesbrough.
There is a single point of access telephone number which is being promoted by CAMHS, through training, with GP’s, practice nurses, schools and colleges and the police.
There are 5 workers who will be employed to work in schools around emotional wellbeing. They will cover schools in County Durham, firstly secondary schools and then onto feeder primary schools.
The CAMHS service offers support to children and young people up to the age of 18. If they are one day over 18 then they would be seen by adult services but they have a different set of criteria. At 17 ½ years the transition starts into adult services. There is work done with Waddington Street in Durham for over 18’s. the service covers 0-18 years but anything under preschool should be seen by the Health Visitor or Paediatrician. The service deal with lots of different issues such as ADHD, anxiety, self-harm. There are long waiting times for autism diagnosis.
The crisis service are in contact with A&E. if there is an overdose or self-harm case then the sister will ring CAMHS for an assessment to be done. The only hospital liaison service is an adult only service.
6. / Minutes and Matters Arising
The minutes were signed and agreed by the group.
7. / Patient Issues and Items of Good Practice
a)Rapid Specialist Opinion
AM spoke to Great Lumley’s practice manager who had received some information but not on costs. There was positive feedback from the doctors.
PR said that the doctors from the Medical Group are going along with it because it is up and running but there has been very limited communication with practices.
Concerns raised:
- very limited communication with practices
- no engagement with PRGs or public
- impact on GPs professional judgement/autonomy
- cost of staff time
- paying a fee to a private company
- reduction in patient choice over referrals (previously patients had an opportunity to look at appointment availability across hospitals before making an informed decision but this is no longer the case as patients will have to choose a hospital prior to the referral going to About Health. This could result in longer waiting times for patients.
Potential benefits:
- one patient thought the speed of referrals could be a plus for patients, although the practice staff did not think it would be any quicker
- might help to deal with issues surrounding the very small number of patients who want to be referred for everything.
The group felt that there had been lack of consultation regarding this and the CCG had said it was a change to an existing service and not a new one therefore did not require consultation.
The group felt that they were unhappy at not being informed and the lack of involvement and a letter would be written to Nicola Bailey regarding this from the group.
Action- CL to draft two letters to Nicola Bailey. One for the Rapid Specialist Opinion and one regarding lack of involvement. Letters to be sent to Louise to forward to Nicola Bailey.
b)Physio Hub.
This was covered during the CCG update
c)Cath Lab Update
No update from NC. Letter was given to Keith to send.
d)UHND Smoking Policy
Letter has been drafted.
Action- LH to send to Lee Mack.
e)Diabetes 2 Service Model
MB to come back with an answer to the groups queries in previous CCG update.
f)Frail/Elderly Weekend Cover
MB to come back with an answer to the groups queries in previous CCG update.
g)Proposed Hubs
Previously discussed in CCG update
h)Examples of Good Practice
AM told the group about her practices CQC inspection in August. They were given 2 weeks notice of the inspection and have received an ‘Outstanding’. The full repost is available on the inspection website.
SH asked if neighbouring CCG’s have the same issues as North Durham regarding consultation?
It was suggested that it may be beneficial to the group to meet with the DDES PRG early in the New Year. The group requested LH to support the chair to contact the three DDES PRG chairs.
Action- LH to pass on contact details to Keith re: DDES PRG chairs. / CL
LH
LH
Date & Time of Next Meeting
Tuesday 6th December 20165.30pm
North Road Methodist Church Hall, Durham

Agreed as correct:

Date:

Signed:Name:

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