Minutes of Meeting held on Thursday 22nd June 2023

Present:

• Arif Ladha (AL) Practice Manager
• Brenda Quelch-Brown (BQB)
• Derek Bird (DB)
• Denise Fonseca (DF)
• Geoff Bell (GB)
• Neil Singleton (NS)
• Maureen Levy (ML)
• Richard Hoffman (RH)
• Tom Harrison (TH)
• Agah Hassan (AH)

Apologies:

• Anne Millar (AM)

Last Meeting Minutes

• Minutes of the meeting held on 27th April. Agreed

Matters Arising

None

BQB Update

Presentation organised. Mr Gordon to give a talk on prostate cancer at Cameron Hall on 20th September at 19.00. He will have use of OCMP screen.

GB to provide BQB with contact details of bowls players who have expressed an interest to attend. 

BQB to organise advertising posters in August, to be reasonably close to the event.  

Listening Table

Report sent out. Well received by practice. DB commented that one of the practice doctors had complimented the listening table – underlined that the listening table was viewed as useful and DB was pleased that the PPG felt appreciated by the practice.

DF stated that when she ran the Listening Table there were not many patients for her to speak to outside treatment room 1. 

BQB to carry out next Listening Table, wants it to be late morning – more patients and a mixture across age ranges. She will be using Consulting Room 6 and intends to hover outside and maximise patient throughput,

Abusive Behaviour Notice

Now distributed to PPG and virtual group. Very important that all patients are aware of the requirement to treat OCMP staff with courtesy and respect.

Tea Party

The next Tea Party was to be held on on 24 June. Held at Toldene Court. Suggestion made to introduce ballroom dancing for beginners but this had been tried and failed before, after initial interest. Lorraine Drolet has tried before to generate interest for dancing classes. 

Tea parties started 2019 and still going strong. BQB invites people from Toldene Court and they enjoy themselves. DB stated that he has entertained as Father Christmas and enjoyed giving back

DB asked how Tea Parties were financed? BQB explained that invoices are submitted for payment to the hall and the Local Voluntary Partnership (affiliated to NHS and Croydon Council) submit the funds which are routed through the Social Prescribing team – they have the budget

Carers Group

NS asked about Carers Support Group, which was mentioned back in the 2021 AGM minutes. BQB advised that it had recommenced May 2023. 3 people attended. They all discussed their positions and BQB advised them of their entitlements, blue badge etc. Next meeting is scheduled for July [date TBA] at the Heath Room, Cameron Hall.

Practice Update - from AL

Recent staff movements: 

• Dr Murphy left – patients redistributed.
• Dr White – gone on Maternity Leave

Acquiring replacements is difficult, so the practice has been using locums. The locums need to have OCMP ethos. PCN care co-ordinator Jo is leaving, so she will also need replacing.

Baby changing facilities: listening to patient needs, both patient toilets now have a baby changing facility.

Telephony Patient access had been reassessed: the Listening Table has assisted in identifying issues – and telephony has clearly been an issue in the latest feedback report, but the situation has improved. TH asked when it had changed for the better. AL responded that improvements had taken place over the last four weeks. He outlined that it is a synergetic win-win. Once patients receive a phone appointment or their issue is discussed/resolved then this leads to patients being satisfied, then non-abusive to receptionists, and stress-free receptionists in turn makes them better able to perform their duties.

TH asked about the double queue system. AL answered that it is a partial cloud telephony system and is working through to be fully cloud based. DF – asked for more understanding as to what this is. AL responded that this relates to digital aspects of telephony. BT will stop ISDN lines in 2025, residential & business. Cloud telephony will be fully utilised instead. Analogue lines still deployed at some GP practices will end, whilst we are already partially cloud based. Cloud telephony can be used to offer patients to avoid queuing in the system and provide a callback; other elements of cloud telephony allows integration with clinical systems. The NHS are supporting practices working with cloud systems. Cloud telephony includes voice operated internet protocol (VOIP). 

However, ML noted that there is no service if there is a power cut and if the ISP goes down – Virgin, Talk Talk etc. – the system fails. AL advised that there are pros and cons of any new system, but the pros outweigh the cons and the system improves.  ML stated that it is all about profit, but AL again stated that it is in fact a continuation of technological improvements. GB likened it to 5G roll out with the aim being advancement and improvement as communications become quicker and more efficient.
DF suggested that the queuing system would be improved if the caller could be advised how long person at front of queue has been waiting. AL noted that cloud telephony can provide that information. TH observed that the timings of the 1st person at the front of the queue may not be relevant to 10th person. 
NS suggested a practical response to queueing – wait until 8.55 before ringing. AL agreed that avoiding the 8 a.m. rush by spreading call commencement could assist patients.

Staff welfare, support with GPs and practise staff in general: AL explained that staff welfare and patient access remain key objectives. Having gone through significant issues regarding capacity & demand, things are now settling down. 

Patients were angry, abusive and expectations were not being met. It was a time where 50% of calls were patients screaming and shouting down the phone. Obviously this had a negative impact on staff. 

Now though, generally, patients are happier and a recent training session focused on staff welfare. Staff need to feel valued and OCMP staff are so much more fortunate as the practice prioritises their well-being, including administrative staff such as receptionists – we have 10/12 part-time receptionists.

Complementary roles at OCMP: The practice has introduced other roles to assist the practice, such as pharmacists. DB queried how these roles have helped. AL gave examples -
Pharmacists carrying out a medication review that they are qualified to do, which now releases a GP appointment, as they would previously have had to carry out this review.

• A social prescribing link worker can discuss diet and weight with a patient and signpost to local services, the GP time is freed up to deal with complex medical problems. 
• A paramedic assigned to the practice can deal with acute issues, as they are trained to do so.
• A physiotherapist can take over responsibility for muscular skeletal issues. 

All of these practitioners support the GP to manage patients, all are qualified to do so and all relieve the burden on GPs.

GPs will always be made aware of any decisions made by these specialists e.g. by pharmacists, and GPs cannot be overruled without their express agreement. Patients are given access to services that they require and where the care giver is more appropriate given the specific condition. It is a mindset of changes within the NHS where traditional GP work is now sourced by a relevant specialist. All part of a need to determine how we correctly deploy the scarce but vital resource of GP time and primary care.

DF raised what she considered might be a drawback with this system – consider a repeat prescription for several years. If the pharmacist only has to send a questionnaire for patient completion, the patient could lie. But of course patients could lie anyway, however the form is completed. AL set out that GP services evolve, change and adapt. Previously, the pharmacist asked questions on the phone and ticked boxes, now the questionnaire can improve the system by making it quicker – patients answer questions online and generate a prescription. 
BQB noted that pharmacies can prescribe some things without requiring doctors but AL assured her that this only related to certain medications for minor ailments. 

Technological advancement: Traditionally face to face appointments were the norm. Now telephone and  video consultations have evolved to using technology via questionnaire. All of this adds value to the practice and patient. Systems and processes evolve. 
BQB observed that some patients will always prefer to want to see their Doctor. AL countered that it becomes a matter of patient choice as many patients will prefer the quicker non-contact process. AL summarised that there is a balance between moving forward and utilising technology, whilst still being accessible and being seen by the Doctor.

Patient Registration: BQB mentioned that homeless patients were refused at some practices. AL stated categorically that this would not happen at OCMP. Any patient walking through door can be registered and accepted as part of practice, whether homeless or a refugee etc. AL also advised that Rainbow charity have stated that they cannot cope with growing numbers and NHS England are being advised about structure and concerns in Croydon possibly exacerbated by having Lunar House in the Borough.
TH queried whether an abusive patient – removed from one or many lists would be accepted? AL noted that until the patient was abusive, the practice would not be aware. Such a patient would go through a process, firstly a warning letter and then a final warning and then an application to have them removed. There is one practice in Croydon that registers people who are often removed.

Pharmacy2U: TH queried on line pharmacy advertising and whether Pharmacy2U threatens local pharmacies. BQB remembered Dr Randle being against this online pharmacy because the patients are not being monitored. They will simply keep sending the prescription. BQB also noted that our local pharmacy is very busy.

Any Other Business

PPG Meetings: GB asked about PPG F2F meetings. BQB advised that 1 meeting per quarter would be F2F.

Discussion was held about time of PPG meetings – the afternoon is less convenient than evening, but they are now held in the afternoons. BQB asked AL about whether PPG meetings could be held at 18.00 because attendance is easier. AL’s reservation is because the meetings could go on until 20.00, which is too late. AL agreed that quarterly F2F meetings could commence at 18.00 and Zoom meetings at 17.00. BQB suggested that meetings starting at 18.00, should end by 19.30. 

NHS Administration errors: ML described an issue with ENT appointment – 19th May letter, posted 19th June. Endoscopy 4 weeks’ time initially set out as 12th June, a week before the letter was posted. An example of how trusts appear to be in a mess, particularly in respect of their administration. Volunteer roles are to place appointment letters in envelopes, but the procedure appears to be poorly administered and the question regarding volunteer access to private patient information was also raised.
BQB – asked AL if as a PPG it was appropriate to point out errors to the NHS. Must be in name of PPG, and not from OCMP itself. AL agreed – Trusts in difficult situation, backlog, strikes etc. AL queried the prioritisation of such feedback and suggested using a broad-brush approach. If it’s a “moan fest” it might be a “switch off” for the Trust. Needs to try and be constructive. BQB to send to Mr Matthew Kershaw, Chief Executive Croydon Health Services NHS Trust.

Meeting Closed 16:55

Date of next meeting

• September