Minutes of Meeting held on Thursday 27th April 2023

Present:

• Arif Ladha (AL) Practice Manager;
• Brenda Quelch-Brown,
• Derek Bird,
• Denise Fonseca,
• Geoff Bell,
• Neil Singleton,
• Maureen Levy,
• Anne Millar

Apologies:

• Richard Hoffman,
• Tom Harrison,
• (none Agah Hassan)

Last Meeting Minutes

• Minutes of the meeting held 23rd February 2023 were agreed.

Matters Arising

GB had submitted his apologies for the last meeting. BQB confirmed this.

DF asked for clarification of Item 4. Digitalisation

AL: This has been taken out of context a bit too much.  Like everything we have to become resilient and have to use all of the different tools at our disposal and use to try and increase access. Some practices are giving their contracts back to the NHS and ICBs and some are merging with other practices because they are not resilient themselves.  Practices are no different to households, we are a business and have to operate within financial restraints, if we don’t, we could be faced with other alternatives as some practices have already had to do.

Several comments were made about older people not having mobile phones and impact on making appointments as discussed at previous meetings.  It isn’t total digitalisation it is part of looking at services and using all the tools that we have available.  We are not going totally digital it is introducing other projects.  We are offering more appointments than we used to and yet we still cannot meet the demand.  Demands are outstripping capacity.  We have to sustain the practice; our energy costs and staffing levels are going up.  There are a lot of changes in the NHS that the practice must absorb and different ways that patients can access the practice.

BQB Update.

Presentations

At present unsuccessful in getting consultants to agree to give presentations.  BQB suggested she approach consultants who had given excellent presentations in the past, topics, Cardiology, Prostate Cancer, Osteoporosis.

Summer Fete

We had hoped to have a stall at the Summer Fete however circumstances had arisen that has prevented us from doing so.

Listening Table

DB had undertaken the first of the Listening Table sessions yesterday.  Results had been circulated prior to the meeting and Arif had circulated to doctors, who found the results interesting and useful.  It was agreed that this proved to be a positive way of gathering patient feedback.  The Listening Table will continue to be undertaken for 2 hours once monthly. 

DB: This is the most useful contribution we can make as a PPG and considers the practice will have found the comments useful.  Patients seen were staggered that we have 17000 plus patients.  A lot said they were unhappy with the appointments system and the NHS App.  One point raised is when a doctor is running late patients should be informed.  This has been addressed by the practice as confirmed by NS. AL said the list is nearer 18000.  The feedback is helpful and allowing the practice to understand how patients are feeling; the format is fine.  Mornings can be more difficult as clinical space is limited therefore afternoons are preferably.

NS: On Monday was unable to make an appoint at 7am, rang at 8.45am and was able to get through easily and given a morning appointment.

Carers Group

BQB will be resuming The Carers Group on the 25th May at The Heath Room, 2.30 - 4.30pm that had been on hold owing to Covid.

PPG Terms of Reference

BQB had been concerned that it had been reported at the last meeting very clearly that Abuse by patients to Reception Staff is on the increase.

This is also an issue with a lot of practices and Chairs of other PPGs are also expressing concern.  In view of this, BQB recommends that a clause - Abusive Behaviour: to be an addition in our Terms of Reference.  A draft copy of the wording to be circulated prior to the next meeting.

Whilst it would be most unlikely that any member of the PPG would be abusive to any member of staff, it is always better to be prepared and would be considered essential by the CQC’.

Response to Questions submitted and Practice Update.

Question 1

Why is it so difficult in this day for different NHS Hospital Trusts to communicate re a patients’ history?  Currently if you go into a different trust hospital other than within your trust, the only way they can search your records is your personal records via your personal phone NHS App, that’s if you have one.  Computer capacity?

AL: A lot of work has been done by the NHS as a whole, but there is still a great deal that needs to be done to enable systems to be able to speak to each other.  It is not something that practices are involved in.  A patient voice to the NHS could be more powerful. 

DB: is there no feedback from practices to the NHS. 

AL: practices are primary care providers and trusts are secondary care.

BQB: recalls this question being raised in the past that SR answered and will look through past minutes and add to the minutes when circulated.

Extract of minutes dated 28th October 2021

‘Dr Randle explained that there is a problem where the first trust is in London and the second outside London.  Communication between London and East Surrey works well for many data transfer items but not always for MRI scans – where the data involved is more detailed and requires manual processing.  Within London excellent data sharing but unfortunately there are issues between East Surrey & London, that DB has correctly identified.’

Question 2

Letters have been sent to patients who have or have had mental health issues in the past requesting them to make an appointment.  By contacting a patient who has recovered well from any mental health issues by letter, could result in the patient becoming stressed thinking that their past is being brought up and possibly causing a relapse.  Do you not think that a telephone call would be more favourable or leave alone?

AL confirmed that letters had been sent out to patients that are coded as having / had mental health issues.  As a practice we have a duty of care to check that patients are OK and that we are here to support if they need help.  

Mental Health is a big issue and in terms of trying to show that GP practices are caring for their patients we have a duty of care to support those patients. AL does not know why this may cause a relapse in a patient and if anything patients are more appreciative.  Leaving patients alone is a failure in our duty of care.

BQB: Perhaps if the letter could be reworded to say something on the lines of ‘if you need help we are here to support you’.  AL agreed to raise this at the next meeting with the doctors.  

AM: is it part of QOF (Quality and Outcomes Framework).  AL: Yes, COF is about supporting patients with certain health issues.     

Question 3

Some patients who have been on medications for a considerable time, are having their medication changed to a similar product.  Is this being discussed with all relevant patients prior to change either by a phone call or face to face appointment?

AL: It is usual practice for this to take place either face to face or over the telephone.  Any change of medication, the patient would be contacted and given the reasons why.

BQB is aware of one patient who was not consulted and had advised that they should write to their GP with a copy to AL.  To date no written response has been received.

Practice Update

We are recruiting and retention more admin staff and clinicians to meet the Demand.  There are changes in this financial year coming into place, e.g. Patient Access – Access to appointments or assessment of need and sign- posted on where appropriate or use other services.  Reviewing practices and  systems.  This is going on throughout England.  There are challenging times ahead.

DB: Has the practice team been affected by the Junior Doctors and Nurses Strikes and are they likely to be a union member?  Does the union have control over practice employees?

AL: The Junior Doctors strikes has affected practices, demand is greater.  Some patients prefer telephone consultations whilst others want face to face.  The Nurses’ strike has not affected us so much.  Our nurses are not involved in the strike.  Hospital staff are paid on Agenda for Change whilst our staff have different pay scales.  We are a training practice and trainees are paid by another organisation, if they want to go on strike the practice can do nothing about it.

Any Other Business

Boosters are being given at Tesco Purley for over 75 years.  Boosters are also being given by appointment at Caterham Dene and St Aidans, Chipstead Valley Road. Texts and emails are being sent out by the NHS to patients who fall into the vulnerable category.  The vaccination is meant to improve the immune system against Covid bacteria.

GB; There has been a lot of bad publicity about the booster, does the practice recommend patients to have?

AL: The practice recommend that patients have the booster, particularly those that are vulnerable but it is an individual’s choice.  Vaccines are not given by the practice as we don’t have the resources.

Date of next meeting

• 22nd June 2023