Meeting Minutes February 2024

Meeting Date: Thursday 8th February 2024
Time: 7:30pm via Microsoft Teams

Chair: Cath McLennan.

Minutes taken by: Yvonne Barrett.

Introduction of New Members 

Attendees introduced themselves. New members and guest speakers were welcomed.

Conflicts of Interest

None.

Minutes of the Previous Meeting

Read and agreed.

GP Training/Welcome one of our Trainee GPs

Dr V Wooldridge informed the group that BMG is a training practice and has many different levels of trainees, from medical students, FY2 doctors, GP trainees (ST1, ST2, ST3) trainee nurses, pharmacists, dietitians, paramedic practitioners, physios and many others. Many of the GPs at BMG are involved in supervision and have completed a trainer’s course to become trainers. All trainees have a supervisor attached to them.

Appointments at the surgery may be made with a trainee, these appointments have longer slots, thus giving the trainee time to ask questions and gain advice from their supervisor if required. Their supervisor is to hand to answer any questions/debrief and attend the consultation if needed.

Dr Al-Ani introduced himself to the group as a GP trainee (ST3) at Bay Medical Group under the supervision of Dr V Wooldridge. He started his final year of training at the surgery in August 2023, but previously has been under the supervision of Dr Wooldridge remotely for the previous two years elsewhere. Trainees are allocated to their trainer for the full 3 years/providing continuity.

VW asked the group if they had any questions for Dr Al-Ani, and the following discussion took place:

• PVG member noted that they had an experience with a trainee doctor recently who took advice from their supervisor, and this worked well.
• What is your experience of being a trainee at BMG? Very good. BMG is a large team with many different skill sets so my learning experience has been extremely good, with a variety of cases to learn from and many people to seek advice from. Before coming to BMG, I was in a small practice and what comes with this is limited resources and variety.
• Do you feel well integrated in the team? Yes, I have been given a lot of autonomy on what I do/lot of choices. Induction information, procedure policies, as well as all the tools I needed was supplied at the start of the training. Always have someone supervising, never in an unpredictable situation, lots of support.
• Do you feel you’ve been over worked? No, my workload has always been well balanced, evenly distributed, and I have never felt out of my depth.
• Dr Wooldridge informed the group that trainees are not employed by BMG so we have to apply certain rules regarding hours/teaching time etc.
• Has Dr Wooldridge been a good Supervisor? Yes, definitely. I have learned a lot from my supervisor as well as from many other members of the BMG team.
• Dr Wooldridge informed the group that many of the doctors that come to GP training, may have been qualified for quite some time and had taken a change in career path. Often trainees can be an already experienced doctor.
• Did you pick the placement? We are given a regional area choice. Allotment is based on the needs of each practice and the needs of the programme, trying to give a variety of different demographic groups, different populations so you get a more wholesome experience.

It was noted that there is often positive feedback given regarding GP Trainees.

Dr Al-Ani was thanked for attending the meeting.

QI project around diabetic foot checks and education

TK introduced herself to the group as Trainee ACP with many years experience as Lead Practice Nurse at Bay Medical Group. She has attended the meeting today to ask for feedback from the PVG members with regards to a project she is doing regarding diabetic foot checks/education.

Power point presentation will be emailed to the group for review.

TK explained that she has been looking at the facts and figures around diabetes, focusing on diabetic footcare and is looking for ideas/concerns/barriers as to why patients are not accessing a diabetic foot check each year.

Should be aiming for 50-90%, currently only meeting 60% of this target. National target met is around 78%.

TK has audited 80 patients that didn’t have an assessment or risk stratification in place, and the feedback has been that some of the patients didn’t understand the importance of checks, new nurses were not aware of what the assessment entailed, and sometimes data has not been recorded/documented in the correct place. TK wants to see a rise in the target achieved as many patients can carry on without even knowing they have a problem with circulation in their feet, and this can lead to further complications, even amputation. She expressed that it is paramount we reduce patients developing diabetic complications, so we need to educate patients and ensure they come in to attend their annual checks.

TK asked the group for ideas as to why they think patients aren’t coming for an annual diabetic check. The following discussion took place:

• PVG member noted that diabetic care has shown improvement in the CQC report, some markers are higher than the footcare, which suggests patients are being seen but the protocol is not being followed/checks are being done but not recorded. Educational element may be a barrier.
• Are the housebound patients included in the figures? No, just walk ins. The visiting team are currently working on foot checks for housebound patients. TK’s ideal vision is to have a small team that can pick up annual checks with regards to the housebound patients. Suggestion was made to possibly teach the nursing staff at the home to do the foot checks, give appropriate training to ensure competence

TK noted that we have around 1000 patients currently not coming in for their annual review. She is hoping that the new appointment system will help with this uptake.

• Could you tie this in with the medication review? Currently we try to tie everything into the patient’s birthday, so all chronic disease checks are done. Skillset sometimes causes issues, KT is looking into this.

TK expressed any ideas are welcomed, and asked the group to pass on any ideas they have via email.

Healthwatch

SE from Healthwatch thanked the group for inviting her to the meeting. She introduced herself as Senior Engagement Officer for Healthwatch/Lead for North Lancashire.

Healthwatch was formed by the government just over 10 years ago, formed as the people’s champions, and SE’s role is to speak to people in the community, highlight barriers of services, attend events and promote. SE noted that she attends support groups, GP surgeries etc to raise awareness and look at what is working and what isn’t. She also shares good practice with other practices.

Everything is anonymous, no personal details are taken. Reports are produced.

Healthwatch is part of the social health act and sits alongside the CQC. The CQC are inspectorates, however Healthwatch is all about the patient experience, talking to people, making observations based on feedback and to make recommendations for improvement. SE sits on the ICB, works with NHS Trusts, and feeds direct to service providers. She aims to speak to people that may not have a voice. Healthwatch is funded by the Lancashire County Council but are completely independent. All local authorities have to fund a Healthwatch, and there are around 154 local Healthwatch currently. They look at their local communities and feed into Healthwatch England, where things are looked at nationally.

It is an advisory body to the Social and Health Care Secretary. Healthwatch is community led.

SE is currently writing up a project for the deaf population. Carers for dementia, alzheimers, MS, parksinons etc are other projects that are possibly forthcoming.

SE noted that she is happy to meet with anyone for a coffee/chat, signpost, give advice.

SE has recently worked with CMcL to discuss the new appointment system that BMG have recently implemented, gaining feedback on how it has worked. Positive feedback has been given.

SE agreed to attend some of the PVG meetings when she can as it was felt it could be beneficial to have a relationship between the PVG and Healthwatch/liaise and feedback. PVG members can take anything they wish to discuss to SE at Healthwatch.

The following discussion took place following the Healthwatch introduction:

• PVG member previously tried to get in touch with Healthwatch, found it difficult, not seen any evidence of them being around/not very visible. How do you become more visible? SE noted that they were previously a small team, have since recruited and there are now four Senior Engagement Officers. It has taken a while to know the area and build contacts. Contacts and relationships are being built up gradually.
• PVG member suggested it would be good for Healthwatch to give a general hello somewhere to the area in Morecambe, and SE agreed this would be a good idea. Healthwatch have been working with PALs at the hospital, noting that although they work alongside PALS, they are also a critical voice with PALS. ·
• On looking at the website, I see you have an advocacy service. Do you have an advocacy service in other areas other than maternity? Lancashire doesn’t have an advocacy service, but they do refer to Advocacy Focus/signpost/advise. We also have good advocacy programmes on the website. SE welcomed the group to inform her of any areas they feel could be addressed.

PVG member highlighted a group that is not being heard, which is the long covid and vaccine damage group. He asked for this to be added to their list of communities to work with. SE noted that this subject was raised at the time of covid but long term covid hadn’t really been discussed, but this is now something that has come to light and needs to be looked into. SE noted that she has been getting in touch with the long term covid groups to gather some data/feedback to the ICB/do a project.

PVG member highlighted that there is no NHS service for vaccine damage. He feels there is an echoing silence regarding this, however he did note that he doesn’t feel unheard within the GP practice. He acknowledged that there may not be any answers, but it would be comfortable to know there is some interest in this subject. SE is happy to collect data on this and take this forward.

Many people on social media groups are highlighting these issues, so it was suggested that SE look at these.

SE passed on her email and contact details for the group to contact her regarding any issues they wish her to look into.

• Action- AW send data/details to SE (Healthwatch) regarding long term covid and vaccine damage
• How are you funded? Funder by the Lancashire County Council but unsure of the funding logistics, and are aware that it is public money, so we need to be as efficient as possible. Engagement/visits are the main part of Healthwatch’s work. We are also commissioned by other organisations, so we have a few funding streams we can tap into.
• How does Healthwatch raise awareness? We are currently trying for a national campaign, but unsure if this will happen. In the meantime we distribute leaflets/posters, attending pop ups/events, going into GP practices etc. We would like to get on the radio. SE was thanked for attending the meeting.

The new appointment system

HF gave a brief overview/update of the new appointment system. We are now into week 3, seems to be going well. Monday is the most challenging day as this is when the bulk of the work comes in (around 1000 requests) so provided this is completed that day, the remainder of the week and Fridays are not as bad as they have been. Half term week will however be challenging. Feedback from patients is good, phone stats are better, 756 fewer calls came in last week, 1500 people used the online form themselves, 150 more calls were answered by the Patient Advisors from the previous week. Every appointment is being assessed, we are planning ahead as to what we need. GP availability hasn’t made a big difference as yet. Workforce is not making a difference to availability at the moment, however we are giving out a lot of advice. When things settle down, stats can be given.

Patient Advisors have had positive feedback and they themselves are enjoying using the digital platform. They are helping patients with the app/completing the online form, and have time set aside on the desk to help patients. The general feeling amongst the Patient Advisor team is that the new system is fantastic and going well. The footfall around Westgate is an elder generation, so patients are getting help and support around any technical issues, patients are not being forced to use the technology if they aren’t comfortable and help is given. Patients can still phone or come into the surgery, where the Patient Advisor will complete the online form for them. It was noted that Patient Advisors are not clinically trained so this takes the pressure off them and is a much safer way of working. Clinicians decide the appointment priority, therefore ownness is taken away from the patient/Patient Advisor regarding timeframe. PVG member highlighted an incident where a text message was received to book a blood test, however when the person went onto the system to arrange this, it was unclear whether this should be

under admin or a medical request. They completed an admin request and received a text back with a link to book the appointment. Shouldn’t a link be given out initially to avoid a two step process? Patient Advisors can send a link to book the appointment and aim to do this when possible. Bloods can also be booked at the desk. Apologies were given for any teething troubles/ongoing process. It was expressed that anything clinical would come under medical, i.e blood test etc and anything like a sicknote etc would come under admin. If a request is entered into the wrong box, this will be moved into the correct box, so the patient doesn’t need to worry about this. PVG member expressed that he had used the system once and didn’t get a response. His request was acknowledged, but he had to ring the surgery to find out the outcome. The GP had actioned the request, however he hadn’t been informed or given any feedback at all. He did get an appointment for bloods and continuity of care, so was pleased with this.

• Action - CMcL raise the lack of feedback to the patient with the CAT team

Is there any facility to see the request you’ve made and when? Requests made are recorded on the medical record so you can see this on the app in the consultation.

PVG member raised concern that his appointment time was changed without any notification. Thankfully this was a telephone appointment, but if it had been a face to face appointment then he would have been unable to attend due to the change. Scheduling appointments around work/life and health issues is paramount to some patients.

• Action - CMcL look into why PL’s appointment was changed. PL will send the image of the initial text to CMcL

Submission through the website or the NHS App is the way to contact the practice to make a request.

Positive feedback was raised by a PVG member regarding an appointment with the ACP, a health problem was raised, and they were booked in on the new system to see a doctor, were sent for an xray, results came back and they have now been booked in for an MRI scan. A blood appointment was also booked on the NHS App and this worked well. They feel this is a brilliant system, much improved, and happy with the new system and want it to remain.

On the whole, feedback has been extremely positive and welcomed by patients and staff. Some glitches are yet to be ironed out, however overall it is improving access to the practice.

HF will share general practice improvement stats to show the changes that have happened, and a discussion will take place around this at the next meeting.

• Action - HF share general practice improvement stats with the PVG Group for discussion at the next meeting.
• Action - YB add as an agenda item

Continuity of care is massively important. We are hopeful that the new system will bring improvement with this. The Clinical Assessment Team (CAT) are working extremely hard trying to fit patients in with their GP/clinician to provide continuity of care. Purple telephone slots are added into the GP’s clinic where they can book these themselves to follow patients up. If a purple slot is booked then the patient doesn’t receive a text message, as these slots are fitted in at a time that is best within the clinic and can often be moved around. When Patient Advisors pick up requests, the GPs are asking for patients to be booked in with their own GP and they are trying to accommodate this.

Has everyone in this group got the NHS App? Most members have the app, however any member who doesn’t have to let CMcL know if they need any help with this.

PVG member trialled the new system before it went live, one request worked perfectly, the other unfortunately did not, however any issues have now been resolved. He has since been to the surgery to make an appointment about another issue and had further treatment done without having to use the app. The Patient Advisors took care of arranging it all.

Some negative comments have been made on social media which contain incorrect information, however concern was raised that people will read this and believe it. How do we tackle this? We need to keep trying to educate patients. It was suggested that we address these comments or remove them/respond to them/update patients

• Action - CMcL respond to negative comments/signpost/give updates

A post was added on social media/website giving an explanation as to why we were moving onto the new system, however some felt it wasn’t made clear that this is an additional pathway for access and that nobody will be discriminated against who don’t want to use the digital pathway.

A discussion took place and it was highlighted that CMcL is doing a great job informing patients of all the changes, however it may be HF YB CMcL CMcL beneficial for CMcL to look at it again and possibly make some tweaks.

• Action – CMcL look into making the information regarding the changes clearer/give updates

PVG member noted that he feels Facebook seems to have become a dated form of social media, and it is difficult to find the right platform to use to promote services/systems.

CMcL noted there has been an upbeat feeling and sense of worth happening within BMG since the new system was implemented. It is working well and patients and staff are enjoying using it.

Appointments running late

PVG member raised the question that when appointments are running late, why aren’t patients advised of this when they check in and asked if they are okay with such a delay. Recently a 40 minute delay occurred at HPCC and patients were complaining but no explanation was given.

The Site Manager has reiterated to the Patient Advisors to inform patients when appointments are running late, however it is not always possible for the Patient Advisor to keep track of this, especially with all the clinics.

Positive note - PVG member had an appointment recently and was taken in early.

Clock in consulting room 10

PVG member highlighted that the clock in consulting room 10 at HPCC was showing the wrong time/hour fast, and expressed that this could be worrying for a patient who may not have a watch or phone with them when checking the time in there.

The Site Manager at HPCC has been informed of this and has adjusted the clock to the correct time.

Review/Update of actions - (not otherwise on agenda)

Views on introducing the PVG to the BMG population

Following a discussion with Healthwatch, CG would like those who have agreed to come along with Healthwatch and get some really valuable patient feedback regarding the new appointment process.

GO asked about when the PVG members will introduce the group to the population, YB noted that she has collated a list of members who are happy to introduce the group to the population, CG to arrange a date for this to take place – Action ongoing

Research Team

Reply received from the Research nurses, they will look at some potential dates in the New Year to visit Stanleys and get back to CMcL- Action ongoing

Redmoor Health have reiterated that permission is not required for sharing posts - Action completed

CMcL will speak with RT about health visuals for their screens when she next goes to Stanleys - Action completed

PCN

MW has spoken with the MMOs, it seems the handling of requests and subsequent replies to patients can be quite variable. Ideally when any medication is rejected a patient should be notified, but with the complexity of the processes, interruptions with phone calls and sheer volume of workload, this step may have been missed/forgotten. I have sent out a message to staff about this recently and we have a meeting where I will reinforce the importance of this - Action completed

SB confirmed that the federation doesn’t use our emis for their clinics, which is why the appointments don’t appear - Action completed

CMcL emailed about extended access not showing up on the nhs app/patient access, with a view to either cancel or serve as a reminder. Reply received from extended access service: Since December we now send out text reminders which have the option to cancel. Reminders and option to cancel can only be sent for any appointments provided by MBPCC (Telephone calls Friday's 18:30-20:00 & Saturdays 12:00-17:00). – Action completed

Website discussion and survey

Streamlining the website is ongoing/constantly evolving - Action completed

GP Trainee attending a PVG meeting

Dr Musttafa Al-Ani attended today’s meeting. See below for details - Action completed

QR code check in at HPCC

Wifi signal is poor at HPCC, posters have been taken down - Action completed

FCMS

All local NHS organisations info has been added to the facebook page/followed/linked. CM regularly posts about all these organisations on our pages which are Facebook, Twitter, Instagram. ACP is meeting with FCMS Managers to look at how we can work closer - Action completed

Launch of GPIP

We hope the new system will eradicate any issues with patients not getting a response to messages.

 

AOB

PVG member made a request for an agenda item to be added to the next meeting - Discussion on the CQC report.

HF expressed that a CQC action plan has been devised from the report and she could give an update of the actions that have occurred.

It was agreed that it would be beneficial to have an update on all areas on what is going on within in the practice.

• Action - HF arrange CQC action plan update
• Action - YB add Discussion of CQC Action Plan to the agenda

Date of the next meeting

Thursday 18th April 2024 at 7pm – Heysham Primary Care Centre Reception.

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.