Vine House Patient Participation Group

Vine House Patient Participation Group

Minutes of meeting held on Thursday 5th May 2016

PRESENT: Madeleine Watkins, Gloria Stuart, Kate Simmons, Gity Buxton, David Stower, Linda North, Sue North, Sally Davies, Bob Cockerell, Jennifer Cockerell, Jo Stanley (Assistant Practice Manager, Vine House)

APOLOGIES: Sara Bedford, Paula Smith, Lesley Meredith, Jane Lay, Wanda Foulkes, Joan Gentry, Alison French, Laila Namdarkhan

ITEM 1 – Welcome

Jo Staley welcomed four new members to the meeting

ITEM 2 – Minutes of last meeting held on 4th February 2016

• Prescription wastage update will be discussed in Item 4
• Electronic Prescription Service – now up and running. Approximately 3000 patients signed up so far with a target of 5000. Information in waiting room and on website, doctors and pharmacies to discuss with patients opportunistically. If you are already signed up for your prescription to be sent to a nominated pharmacy, please speak to your pharmacist to re-sign up for the new service.
• Home visits – the pilot where doctors triage patients before agreeing to home visit has proved to be helpful in reducing the number of daily home visits and this will continue.
• Text message reminder for appointments – awaiting decision from HVCCG as to whether this may be funded again.
• Electronic payments at front desk – awaiting meeting with our business banker to discuss costs.

ITEM 3 – Election of a patient Chair and Secretary

As discussed at previous meetings, these two positions need to be filled. Gity has kindly volunteered to act as Secretary and this was agreed. Jo will liaise with Gity in readiness for the next meeting. The position of Chair is still unfilled so if any patient is willing to take this on please let Jo know ().

ITEM 4 – Prescription Wastage Update

Bob circulated some thoughts following the working party’s questionnaire of local and out- of-area pharmacies (attached).

• Dressings –once these have been prescribed and issued to a patient any spare, unused dressings cannot be used by GP practices, nor re-issued by pharmacists. It was agreed that there must be huge and unnecessary wastage with regards to dressings across the board.
• Changes to prescribed items due to cost – GPs are required to make cost savings by prescribing a cheaper generic option.
• Electronic Prescription Service – For routine repeat prescriptions the process is now streamline. However, there are occasions when a request for a repeat prescription cannot be dealt with immediately, for example if a patient needs a medication review. Also it needs to be borne in mind that some GPs are part-time so are not in every day in order to process their prescriptions. However, double issue of prescriptions should not arise as there is a ‘tracker’ system where you can see exactly where the prescription is in the system so it should not be issued again.
• Patient awareness – this is extremely important. Leaflets are now widely available with regards to repeat prescriptions and safe and effective use of medication. Medicines that are ordered and not used cost the NHS in this part of Hertfordshire around £3m a year!

With regards to the percentage use of a medication, this is recorded automatically in a patient record. With the new electronic system if this is out of range, ie under or over used, the prescription will be forwarded to the GP to “approve” rather than “sign”. The GP will then know to do a medication review. Currently there is no system in place on a daily basis for this to happen with paper prescriptions and the review will be made when it is due, either 6 monthly or annually.

Synchronizing tablets is a problem that is often raised. Please speak to your GP on an individual basis regarding this. It was agreed that part of the problem is that pharmaceutical companies are not regulated in the packs they produce, for example some may contain 28 tablets and some 30 tablets.

With all of the above issues, it was agreed that a letter to your MP would be helpful to try to bring these matters to their attention to help facilitate change!

ITEM 5 – Carnival

It was agreed to take a break and not participate in the carnival this year. It was felt that carnival day is a fun day and handing out leaflets was not particularly exciting! In addition, many visitors come to the village who would not be our registered patients. To be discussed again in good time before next June with ideas!

ITEM 6 – Patient Participation Group Awareness Week 6-12 June

It was hoped to promote this at the carnival but as this is not going ahead information will be available in the waiting room. Jo will also try to get an article in My Abbots (although the June edition may come out too late!), along with information about Carers Week which is the same week.

ITEM 7– AOB

• Upstairs seating–time would be saved if patients who were seeing a GP upstairs could wait upstairs. This was agreed a good idea but there is a lack of seating upstairs which, due to space constraints, cannot be extended. Also from the bench it is not possible to see the call-in screen so patients may not feel this is a good place to wait. A request for a further small call-in screen to be sited upstairs will be costed and discussed with the Partners.
• Call system – it would be helpful to know how many patients are waiting ahead of you. This system is not able to give this information so if you wish to know please ask at reception.
• New flooring in waiting room – this will be carried out over the last weekend in May. Apologies for any disruption caused.
• Telephone access/Reception–discussion around the problems getting through on the telephone and the front desk being manned. Demand has increased significantly in recent years with no great increase in patient list size. The practice is well aware that there are frustrations with telephone access and have asked the telephone providers to make changes to the system. Unfortunately the system has been unable to cope with the upgrades and we have reluctantly had to revert back to a simplified version. However, patients will now hear an engaged tone when all lines are busy instead of it constantly ringing. We may be able to add extra options when dialling in so that if a patient simply needs to cancel their appointment then can be diverted straight to our dedicated answerphone, as this appears to be currently underused. The front desk should be manned, especially in the busy morning period, but telephone calls cannot be taken here due to confidentiality.

ITEM 8 – DATE OF NEXT MEETING

Wednesday 3rd August, 7.30 pm at Vine House.

Some thoughts on Prescription Wastage in Abbots Langley

Following the sub-committee’s questionnaire of local and out-of-area pharmacies, it would appear that wastage based on returns to pharmacies is low compared to other areas.

Exceptions appear to be:

• Dressings

One pharmacy in particular reported that there were frequent high level returns of sealed dressings. It would appear that prescriptions are issued for complete packs of dressings, where perhaps 1 or 2 would be needed by the patient.

Furthermore, we were given to understand that a pack of dressings issued to a patient became the patient’s property and could not be used by others in, for instance, a Care Home situation.

ALL items returned to a pharmacy have to be destroyed, however returning unwanted dressings to the GP practice or giving them to The Red Cross, Scouts & Guides or other community-based organisations could see them re-issued to the benefit of others.

• Changes to Prescribed items due to cost recommendations

Where there are alternatives, it appears that GPs are often instructed to prescribe the cheapest option.

An example is diabetes test strips. Most patients with diabetes manage their own care to a major extent, thus taking pressure off GP surgeries and Diabetes Clinics where available. Diabetes monitoring by the patient includes not only taking blood samples, but also linking monitors in to software programs to look at trends, peaks etc. These infrastructures vary tremendously, some being very good whilst others are flakey in the extreme.

Test strips are not cross-compatible, therefore changing strips means changing the complete system for the patient, including learning how to handle another program suite. Inevitably this means more visits to the GP or Diabetes Clinic to re-establish control.

Additionally, the market price fluctuates month by month, often making the cheapest option the most expensive. Meanwhile, pharmacies are seeing an increase in returns of blood test strips for meters that patients have been told to stop using.

• Effective introduction of the Electronic Prescription Service (EPOS 2)

Prescriptions should now be available for collection at your nominated pharmacy within 4 days of the request (2 days maximum for GP practice to prescribe and a further 2 days maximum for the pharmacy to order and dispense). Delays to this process can see double issues of prescriptions, with the patient taking the second prescription to another pharmacy.

• Patient awareness of the true cost of an item

Approximately 85% of patients are exempt from paying prescription charges. It is therefore tempting to ask for a prescription for low-cost medicines, which may be bought across the counter. As an example, Paracetamol – cost approximately 0.65p for 16 caplets. Cost to the NHS if prescribed is several pounds. No doubt Jo can give us the true figures.

Making patients aware of these true costs (which we all pay via taxation or cuts in other services) would help.

Rasila Shah has asked for our ideas to cut down on pharmacy waste and all ideas are welcome, whether improvements to the NHS infrastructure or to patient education.

Bob Cockerell 5th May 2016