Patient Voice Group

Our Patient Voice Group (PVG) meets to provide a forum for discussion about the practice.

Latest PPG Minutes

• Date: Thursday 16th January 2025
• Venue: Microsoft Teams Call - 7:30pm
• Chair: Chath McLennan
• Minutes taken by: Angie Davy

Introduction of New Members 

• Welcome and introductions to new group members.

Conflicts of Interest

None noted.

Community Diagnostic Centre Overview

Presentation shared giving background and overview of CDC (Community Diagnostic Centre) which open in April 2024 located on the first floor of Heysham Primary Care Centre utilising 3 consulting rooms. The centre is open 6 days a week (looking at options for Sunday opening) 12 hours per day. Community Diagnostic Centres were highlighted recently in the NHS Elective Recovery Programme as method of providing extra diagnostic capacity across England and Wales.

The centre offers services across whole of Morecambe Bay population of over 300,000 people and is run by the GP Federation whose shareholders are GP Practices across the area and are involved in the decision-making processes.

Following COVID there was recognition of the backlog in diagnostics and funding was provided by NHS England for trusts to look at increasing diagnostic facilities. Secondary care trust in most areas took on contracts and utilised the funding in various ways focusing on diagnostics. UHMB (University Hospital Morecambe Bay) wanted to use this to help support primary care and therefore subcontracted to the GP Federation to help delivery of these services. The vision was to try to package testing into one appointment where possible to avoid patients having to go to one place for blood test, somewhere else for heart tracing etc and able to offer testing within 2 weeks in most cases.

Admin staff in GP practices can book the CDC appointment (as appropriate) and the medical IT system (EMIS) pair nicely together with diagnostic results going directly in the practice medical records and being accessible to patients via the NHS App.

Services offered include such things as phlebotomy (taking blood), heart and lung testing/traces, sleep studies, 24-hour blood pressure monitoring – in total the service delivers around 500 diagnostic test per week.

Some patients on the group have had experience of using the service. Whilst some diagnostics procedures can be carried out quickly, they may take time to be reported/interpretation such as 24-hour ECG as they have to go via the Clinical Investigation Unit cardiology team at RLI for reporting (run through triage system and screened for significant arrythmia/risks ASAP).

Another query raised during the meeting was in terms of having to travel up to Heysham for quick procedures such as blood testing when there is the Queen Victoria Centre in middle of Morecambe. It was felt the CDC was probably located in Heysham due to the available space and although traveling when there is QVC in centre of Morecambe may feel unnecessary – the centre is commissioned to provide service to South Lakes as well as Morecambe Bay so other patients are travelling much further than Bay Medical Group patients. A “hub & spoke” model is something being look at to reduce some unnecessary travel in the future. Services such as phlebotomy are still available at Morecambe Health Centre and other BMG sites for BMG patients but is dependent on appointment availability. We have been lucky having the CDC located in the Morecambe area.

On the discussion of estates – the group touched on the ongoing consultation regarding the re-location of RLI from its’ current site in centre of Lancaster to potential identified sites near the University on the south side of the city. There is an online survey which anyone can complete (details previously shared on BMG Social Media page) with a meeting having been arranged in February at Morecambe Football club for local people at attend (tickets required).

First Contact Physio Service Overview

• Presentation by FCP Physio

The FCP (First Contact Physio) role is a diagnostic role (rather than hands-on physio) to establish the cause of a presenting musculoskeletal symptoms and establish treatment/management plans which could include onward referral to physiotherapy teams, secondary care Orthopaedic team for surgical management or secondary care Rheumatology team amongst others. The system means that patients are seeing the right person at the right time and outcomes demonstrate reduced prescribing and reduced secondary care referrals for surgery and/or potentially inappropriate investigations.

FCP’s can discuss issues directly with GP colleagues if not felt to be a musculoskeletal cause, provide onwards referrals, issue Fit notes, social prescribing as well as requesting and reviewing investigations. Unfortunately prescribing isn’t available at present but our FCP physios can discuss appropriate analgesia with a patient’s usual GP and arrange for prescriptions if deemed appropriate.

From feedback gathered – patients have generally found the FCP physio service helpful, it is not about replacing GPs but to support. Traditionally a high proportion of GP appointments were for musculoskeletal health issues so by providing an alternative it is supporting our health system in managing that demand and creates GP capacity for other conditions. There are specific inclusion/exclusion criteria as to what is appropriate for consultation with FCP Physio, and no patients would be forced to see the FCP team rather than GP. There is also the potential for some of the team to administer joint or soft tissue injections (with additional training) as well as joint aspirations.

Limitations for the service is that FCP physios can only deal with musculoskeletal conditions as well as being unable to prescribe currently (although as mentioned above – prescriptions can be issue via usually GP following discussion) When reviewing dated over a 3-month period only 12% of patients who saw an FCP Physio then went on to see a GP for a musculoskeletal condition and 84% of patients having used the service would recommend to friends and family and majority rated the service highly at level 5.

Discussion around Pain Management Secondary care referrals with current wait at 30+ weeks. Unfortunately as the FCP Physio’s don’t currently prescribe it would be difficult to use the FCP service as an alternative to pain management currently however if a second opinion was required on the cause of a problem or a patient felt they had been prematurely referred to Pain Management services, there would be no reason why that patient couldn’t see the FCP physio at the practice to consider if there is anything that could be offered as an alternative although usually by the point a Pain Management referral is made, other options have already been considered.

A patient on the group reported having had experience using the service which was “amazing” although felt that the service could have been “sold” better by the Patient Advisors when at point of initial booking. We did have a video outlining the role which was produced 2 or 3 years ago – we could look at updating that and adding to our website to advertise the role.

Given the high number of musculoskeletal conditions still presenting to GPs – would there be room for expanding the FCP Physio service further? HF explained that the FCP Physio role is funding from an Additional Roles budget so practices are limited to the roles they can fund from that budget which is also used to fund other roles such as dietitians, social prescribers and many others. Our FCP Physios (current team of 4) are actually employed by the hospital trust.

The FCP physio service is a very cost-effective service with good evidence for its value and we are lucky to have our team with their specialist knowledge on musculoskeletal issues. It is a great service for our patients which works well and the team link well with other clinicians in practice.

Action – CM (Chair) to review/update the patient information video and add it to the website.

Agree Minutes of the previous meeting and Review of Outstanding Actions

Previous minutes were agreed. Note that some tables included within Microsoft Word documents don’t always print so request for minutes to be shared as PDF instead. Use of initials rather than names in minutes was raised and will be reviewed.

Outstanding Action from 17.10.24 – LTC Peer Support Groups - 22.10.24 – update from Cath - contacted LL and suggested a teams meet with KR to finalise and see if the FB group would work – Action Complete

CQC Actions/Report

The practice had a Care Quality Commission Inspection in September 2023 with a re-inspection/assessment in August 24. Our overall rating is still “requires improvement”. In theory inspections are supposed to be every 5 years but if you have actions outstanding there will be a re-assessment earlier.

High level summary of report was shared with the group. As a practice we were moderately pleased with the feedback
following the August 24 assessment with 3 out of 5 areas being rated as “good” compared to 1 of 5 in September 2023.
We are currently rated as requires improvement in “safe” and “well-led” areas and we are working hard to try to
improve those areas – noted that in both areas we were only a couple of points below receiving a “good” rating which
is frustrating.

The inspection process for CQC changed between our 2 visits – with September 23 being classed as an “inspection” and August 24 classed as “assessment” with other “goal post” changes which also meant a duplication of work which had to be submitted.

Overview of main feedback points detailed in presentation including being pleased with our new triage system (implemented following our first inspection) and set up of our emergency trolley’s (standardised across all sites). 

Patient Voice Group members reported feeling listened to with good feedback and the team noted improvement in monitoring of childhood vaccination and screening as well as commenting on our “drop in” cervical screening clinics and videos on procedures which are shared with patients to provide reassurance.

We now have a plan to address the remaining areas rated as “required improvement” which we had to submit as a detailed action plan to the CQC assessor with attached timeframes (latest being July 25). The assessors want to see evidence that the processes have been changed. 

BMA Collective Action Update

The reason behind the BMA Collective Action was for the government to recognise the volume of “additional unfunded” work which is being undertaken by general practice. 70% of practices have made the decision to take part in the BMA Collective Action in conjunction and we have done this with together with our local practice colleagues. The partners didn’t take this decision lightly.

As part of the BMA Collective action, we altered our appointments from December 24 to provide 25 appointments per day per clinician. The majority of these are now 15 minutes in length (which was also a BMA recommendation) which clinicians and patients both seem to like. There was some concern this would create issues with not having enough appointments but at the moment it seems to have had positive impact with patients being less rushed and clinicians being able to deal with more issues in an appointment. We don’t seem to be running out of appointments and we have made tweaks to the number of “urgent”/”routine” appointments provided based on the demand.

In addition to the above, we wrote to UHMB (University Hospital Morecambe Bay) NHS Trust regarding 3 x unfunded services we were no longer able to provide:

• Ring pessary monitoring/change - gynaecology department
• PSA (Prostate Specific Antigen – blood test) monitoring - urology department
• CML (Chronic Myeloid Leukaemia)/Mgus (Monoclonal gammopathy of unknown significance) monitoring - haematology department

We wrote to the departments with a list of patients which we had been previously asked to monitor as above requesting for that department to take over the continued monitoring. We also informed the affected patients by letter. In response to our initial letter, the hospital wrote back to us to state they were unable to accept the list and requesting that we re-refer individual patients. We are in process of sending a further update letter to patients outline the change in process and advising that they will be individual referred when monitoring due.

Concern was raised from a patient at the group regarding the wording of the above-mentioned letters in that it wasn’t made clear which aspect of the monitoring was changing. Apologies were expressed for the inconvenience this has caused to patients and the way the letter was written.

The practice will cease undertaking dressings from 9th February but will continue to provide dressings to patients who have already started courses of dressings with us. Other patients will be referred to the relevant hospital department, District Nurses or Urgent Treatment Centre.

In terms of GP funding – the GP Partners share of “take home” income has not increased despite percentage increases in funding to general practice. The running of the practice has to come from that funding including maintaining buildings, paying staff etc. If the government states we have to increase the minimum wage of staff in line with National Living Wage for example – we have to do that without any extra funding. There will be a massive impact with the change in Employer NI contributions from 1st April 25. Hospital Trusts work very differently in terms of funding.

Feedback on Practice Website

Thanks were expressed from CM (Chair) for the feedback provided on the new website. We are yet to go live with the new website which should happen shortly.

Close and AOB

Online Vaccination Booking Query

A patient raised a requiring as to whether there was a problem with the system as a friend had reported being unable to book for a pneumonia vaccination via the online system. The practice team were unaware of a problem, but CM (Chair) will look into this and feedback directly. 

Date of next meeting

Thursday 3rd April 2025 - Face to Face HPCC 7pm

See our events page for details of our scheduled meetings 

Rules of the meeting/purpose of the Chair

• Read agenda and papers in advance of the meeting and arrive prepared.
• All questions to be through the chair and only one person to speak at a time.
• Stick to the items on the agenda 
• Respect the role of the Chair and allow the Chair to undertake the role to the fullest extent.
• For all decisions Chair to invite everyone present to give opinion without interruptions.
• Vote on all decisions and those members not present must inform the Chair of their voting decisions in advance of the meeting.
• Declare conflicts of interests.