Patient Voice Group

Introduction & welcome to new members

VW informed the group that she has recently taken on a role as part of the practice Executive Team. There are 4 GP partners who are part of the Executive team who are more involved with decision making. VW will be the Operational Executive Partner which focuses on day-to-day operational procedures working closely with the Operational Management Team.

Update on New Area Hospital (from SE – Healthwatch Lancashire)

SE explained that Healthwatch Lancashire had been commissioned by the local ICB (Integrated Care Board) to undertake a series of community engagement conversations with service users about the new hospital proposals (both Preston and Lancaster) which were later cancelled. The planned sites for both hospitals have been purchased with Lancaster being sited North of the University and Preston being South of the main city. The new government have put a hold on all (14) proposed new hospitals whilst they undertake a review of the whole NHS systems to establish best plans going forward. At the current point in time, the Lancaster hospital is earmarked for building work to commence in 2035 with Preston being proposed to start in 2039. Healthwatch will watch/ensure there is still appropriate investment in the existing hospitals/facilities in the meantime. There may be plans that the existing RLI site (with originally building being listed) may be utilised in some form once the new hospital is opened as until the plans are drafted and announced no one really knows.

15 months on from the start of the new way of working/appointment booking system - what has your experience been?

Feedback/Experience of New Appointment Booking System discussed

Positive Feedback:

• New system feels much “safer” knowing that a clinician is reviewing and prioritising requests.
• New system better than expected with a very positive experience – appointment request form submitted which resulted in a phone call from a clinician later that same morning and an appointment arranged.
• Form submitted via App at 8.30am and by 10.40am a phone call was received and appointment arranged to see clinician where medication was given. Very good service. Two weeks later telephone contact made (8.40am) by patient due to query infection – the patient was back home with a prescription by 10am. Having that alternative contact option online has also significantly cut down the waiting times on the phone.
• Form submitted – just over an hour later patient received a call from a Patient Advisor offering an appointment 2 hours later.

Areas for Improvement:

• Non-urgent appointment requested which was responded to with message stating patient would be contacted to arrange appointment – no contact received resulting in patient having to chase up over the phone when appointment was then arranged.
• Follow up appointment requested with specific GP to review investigation results with pt. Appointment booking link shared with patient to book appointment but with other GPs – nothing offered with GP who had seen pt/requested the investigations. It may have been that the wait would have been too long with the original GP but if that was the case – that could have been communicated. In that instance the patient would have preferred to wait in order to see the original GP, but that opportunity wasn’t given.
• Another similar situation to that outlined above – patient had been seen by GP and investigations arranged with plan outlined to come back for review with GP however patient was advised would be appropriate to be seen by PN despite patient explaining previous advice to see GP – this led to issues with diagnosis.
• Some patients have, on occasions, struggled to find the online submission form. Level of IT skills vary across our patient population – we need to invest time for patients using the online systems. We have recently changed our practice website which may have contributed to this difficulty in finding the online form. Noted the form is also accessible through the NHS App.

In terms of feedback, a “friends and family” survey text is sent to pts following an appointment although the system doesn’t seem to pick everyone up. CG confirmed that we are due to run a survey about the new appointment booking process which CG will share with this group initially for honest feedback.

The above feedback demonstrates that when it comes to acute care, the practice is managing that well, but the issues encountered by patients seem to be related to the ongoing follow up care. The above also demonstrates the need for communication to be improved. Overall, the Patient Advisor team are fantastic and get things sorted in a timely manner.

A PVG Patient member mentioned having experienced the phone line going “dead” when call answered and then receiving a text advising of having missed a call. We aren’t sure why this “ghost call” would have happened – could be related to phone signal in certain areas or network issues but we have recently upgraded our telephone system so that should no longer happen. Top tip – if you add the practice phone number to your contact list it will display appropriately if you receive a call.

SE mentioned that “ability to making a GP appointment” is the biggest complaint received by Healthwatch across the whole area.

Will the abolition of NHS England affect the surgery?

The practice doesn’t yet know what is going to happen with NHS England and what the impact would be. We have had a lot of change at higher/national level over many years which often doesn’t affect us too much day to day in practice. SE confirmed that from a Healthwatch point of view, they too are unsure of what the impact/if any, would be. There was no prior notice shared of the planned announcement. We are used to dealing with uncertainly due to decisions made at higher levels and we have to adapt quickly.

The abolition of NHS England may mean we have more input as to what happens with finances in our own area with decision being made more locally.

What are BMG doing to implement the announcements that the government are making about gaining appointments etc with the same doctor?

This links every much with continuity – already raised during above discussion. It is something we know we don’t do very well as a practice which we have struggled with as we have grown in size. Some GPs are very passionate about continuity and will try to maintain that as much as possible with patients by pro-actively following up, but it is harder in a large organisation with the number of patients we have registered per GP.

We had hoped our new appointment booking system would help also address continuity, but it hasn’t so the next step is for us to look at that as a priority focus – having been the main topic of discussion at the recent Practice Business Planning Meeting with the plan to set up a Working Group to look in detail at this. We know this is also a focus area which the government want practices to address asking practices to RAG (Red/Amber/Green) rate patients depending on their need to continuity. We know that a significant number of our registered patients who present with self-limiting issues don’t need or want continuity. A smaller proportion of our practice population do need that continuity such as those with Long Term Conditions/Mental Health conditions/Social Issues etc. As a practice we need to work out how we undertake the RAG rating process.

We currently work in Micro Teams which are quite site based with GPs and other clinicians working within each team – one idea would be to try to ensure patients are offered appointments with clinicians within that Micro Team if their usual clinician is not available rather than any clinician in the wider practice.

Another point which was raised in relation to continuity is when letters are sent by the hospital back to the practice (following a referral), they can often just be addressed to a generic GP rather than the referring GP which can cause confusion. SE mentioned that someone from the Patient Experience team at the hospital would probably best place to explain why that can be the case – perhaps inviting a member of that team to a future PVG meeting would be beneficial.

There was a general discussion about appointment availability with the allocation of appointments being based on the number of clinicians/GPs we have factoring in such things as supervision of trainee GPs etc. As a practice we need to ensure we are using our workforce resource (our ability to recruit is limited by our funding from government) as efficiently as possible. SE confirmed that appointment capacity is a national issue. We (BMG) work in a deprived area which impacts on demand which will therefore always outweigh what we can provide.

What is the BMG position on Shingles vaccinations for over 65’s?

The information from the NHS online is totally conflicting – CG and CM have looked online as well as speaking to our Screening and Immunisation manager to clarify this – it is a complicated system to understand/relay but in essence there is a “catch-up” campaign running alongside the standard vaccination programme. It appears that some patients will be invited at 65 whilst others aren’t being invited until they are 70. This is an example of a national NHS message communication failure which is very confusing leaving practices having to interrupt and relay a complicated message to patients.

Power of Attorney for Health and Well Being

One of our PVG patient members explained background surrounding an issue encountered around the care of an elderly friend for whom she has power of attorney which highlighted a breakdown in communication between various services, sharing of information and confusion/lack of understanding from health care teams related to Power of Attorney for Health and Wellbeing, a combination of which lead to long delays in things being put in place in relation to the treatment/care for patient.

SE (Healthwatch) would be happy to link initially on this case as involved multiple health care services.

Acknowledgement that “third party access” to notes is something we need to discuss in more detail and understanding for our practice teams as to how Power of Attorney for Health and Wellbeing links with that. The practice would need to have a copy of the Power of Attorney paperwork in line with data protection.

Close & AOB

Prescription Orders prior to Easter Bank Holiday – the highest number of emergency calls received by NWAS (Northwest Ambulance Service) over Bank Holiday weekends are due to pts not having their medication.

NHS App Document Storage – Concern raised by PVG Patient Member regarding documents on NHS App records with date not relating to date of reporting/procedure but actually a prior date making it difficult to follow up on information related to particular issue. The NHS App was initially launched for use by primary care (GP) and secondary care (hospitals etc) have come onboard since so may not be as “user friendly” from their side. Again, this is something that a member of the hospital Patient Experience Team may be able to explain.

Date of next meeting

Thursday 24th July – Face to Face 7pm Start

2025 Dates
Thursday 16th October – Teams 7.30pm Start
Thursday 15th January 26 – Teams 7.30pm Start

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.