Meeting Minutes June 2024

Monday 13th June 2024 at 7pm (F2F)
Heysham Primary Care Centre - Waiting area

Chair: Cath McLennan

Minutes taken by: Yvonne Barrett

Introduction of New Members 

• New members were welcomed to the group. 
• PL has resigned from the group. 
• CM talked of how members are recruited to the group and how feedback is valued.

Conflicts of Interest

None.

Minutes of the Previous Meeting

Minutes were read and a couple of amendments were made. 

Minutes should read as follows:

• Page 10 – Figures on appointments look like they only cover half the practice, data may not be representative of the practice?    The data is for any appointment request made via AccuRX and does not incorporate patient follow ups.  Data is on patient initiated requests only.
• Page 11 - Appointments offered previously was around 25% below the national average, the new system is showing 7% under provision.  Why is this?  This has reduced due to extra locums being used to reduce pressure.  Push Dr and Pharmacy First are also being used.

STAT figures

Questions were raised regarding call statistics and a discussion took place.

What do we consider the capacity to be? 

CM will look into the exact figures and feedback.  The reality is that we are trying to match the demand.   The new cloud telephony system should help with pulling data.

The plan is for the new telephone system to go live around August.  This will mean a new number for the practice, and this will be shared to patients nearer the going live date.  The previous number will be diverted.

The new telephone number was shared with the group.

PVG member raised concern that the stats are looking poor compared to before the new appointment system was implemented, calls being answered has dropped, calls abandoned has risen.  He is concerned the CQC will focus on this as national survey results will be viewed by the CQC.

Why are the amount of calls being answered dropped and calls abandoned risen?

Patient Advisors are busy contacting patients, there is a division of time between looking at Accurx online requests and answering calls.
We are looking at the process of how we manage AccurX and how we manage the calls.
At the moment, we are moving staff around to manage the work.  Despite recruiting Patient Advisors we are still short of staff.
Many patients have switched over the online requests.

Changes are being made to the appointment system as it is evolving, and we are continuously looking for better ways of working.   
Patients are now being informed of their patient journey following any request submitted, so this should help reduce calls coming into the practice. 
We are constantly learning from issues that arise and looking for better solutions, always striving to make the system as good as possible.  
PVG member noted that he focused his questions on GP appointments and not across the whole of BMG.

What is the situation regarding the amount of telephone appointments as to f2f appointments?

May 2024- Telephone appointments was 6918.  Unanswered 492, where the patient could not be contacted.  3 phone call attempts are usually made. 

May 2024 – 120882 appointments.  (DNA) Did not attend 912.

These figures were pulled from the BMG system.

PVG member raised that they may not match the NHS statistic figures, however CG assured the group that the figures were taken from the BMG system and are accurate.
PVG member raised that we have offered 11% less appts than we did in March.
NHS stats showed DNAs 4- 6% .  BMG is 7.5%,  so we are above the national average.
It was reiterated that we have implemented a change in our appointment system, to a digital system that has been pushed by NHS England.  This is an evolving process and will take time to get it to the best it can be.  This is a learning process.

PVG members were asked how they felt about their experience of the new system.  Some experiences have been positive and some negative.

• Telephone responses instead of face to face are not that friendly.
• Patient Advisors have been brilliant.  
• Submitted a request but had to ring a couple of times for a face to face appointment.
• Telephone appointment went well, but had to ring to change the telephone appointment slot time.
• Rang to make an appointment, was asked to complete the online request. Felt this should have been done by the Patient Advisor.  
• Patient has a long term problem and likes continuity of care but had a recent short term new problem, asked for a phone call from their regular GP, received two appts, one for the short term problem and one for the other.  What could have been one telephone appointment became two f2f appointments.
• No negotiation at the feedback point, so patient had to take an appointment that isn’t necessarily appropriate.

All the examples above are a good learning tool and will be taken on board.
CM explained the benefits of online requests.
PVG member thanked the practice for their excellent service.

Can patients be given a morning or afternoon telephone slot time?

There are many varying telephone slots, and we need to make this more clear to patients.
Red, amber and green telephone calls are around the time that is given to the patient.  Purple slots are anytime slots.  PVG member suggested that maybe it would be better to have the purple slots around a certain time i.e am or pm.
It was highlighted that patients don’t always know what a specific coloured slots mean.
Dr Akhtar noted that patients are rang, an answer message is sometimes left if they don’t answer, or a text is sent with a link for the patient to make contact.
We need to find a way that patients can get back to use without having to make a call into the surgery.

Can we alter the questions on AccuRX- online request?

It is believed this cannot be changed.

Is there a way you can add info to a patient’s records stating the best time to contact a patient?

We can add an alert but that would be a slow process and alerts change, so this would be difficult to manage. Phone calls or face to face preferences may also vary depending on specific issues.
Dr Akhtar will as the clinicians to follow up any unsuccessful telephone appointments with a text.

Can you submit an online request at any time?

Admin requests – Yes.
Clinical requests – No.
Clinical requests are triaged by the CAT team and they aren’t available all the time, they triage between 7.30am - 2.30pm.
We need to be careful that patients don’t avoid calling the surgery when they are unwell just because their preferred GP doesn’t work that day.  Many GPs work part time.

Are f2f appointments back to back?

Yes.  Admin also needs to be done in the appointment time.

It was agreed that patient expectation is often high, and many patients would prefer a face to face appointment, however telephone consultations are extremely good due to convenience for the patient.
PVG member noted that often waiting on the phone brings frustration, so tends to ring in the afternoon and finds access easier.
Dr Akhtar reiterated that when a good balance of consultations is found, i.e telephone consultations, face to face, and video consultations, this will bring better statistics.  

CM expressed how imperative it is to let the surgery know if you cannot attend an appointment.  With every appointment that is sent via text, there is a section to enable you to cancel this appointment if needed.
Patients are sent text reminders before their appointment.
A discussion took place as to why patients are not cancelling appointments therefore resulting in DNAs, and it was felt that this may possibly be due to the patient not realising they can cancel via the text, or that they are just not making the effort to cancel.
It is difficult to identify patterns for repeated DNAs.  We try to contact the patient and find a way forward.
Missed appointments are costing the NHS a lot of money, and educating patients would be beneficial.

Suggestion was made to display posters highlighting the costs of DNAs, however there was concern this could bring a fortress mentality.  
Suggestion was made to ask the patient to confirm on text that they will attend, but it was felt that patients may not do this either.
CM will add some information notices around the practice that are less negative/accusing, aiming to keep a positive slant on this, however this positive slant doesn’t take away from the seriousness of DNAs. 
Phlebotomy home visit DNAs were discussed, and how frustrating and waste of resource it is when a patient has requested a home visit for a blood test due to being housebound, but when the phlebotomist attends, they have gone out shopping.  

Suggestion was made for a member of the CAT (Clinical Assessment Team) to attend the next meeting so we can caption the data correctly.  CM will ask the Rota Team Manager and a member of the CAT (Clinical Assessment Team)  to attend the next meeting.

Many patient contacts are not being captured in the data.  AccuRX requests are patient contact, and these are not always shown as an appointment.   Hospital letters that require patient contact also need to be captured in the data.
Such data is not captured due to a problem with emis, as unless you have a face to face slot or telephone slot, it doesn’t capture other patient contacts in the data.   We need to find a way to capture this.

If a patient puts in a request and has to wait a few days to get an appointment, but then decides to go to the hospital instead, is this recorded as a DNA?

Unless the appointment is cancelled by the patient then it would be recorded as a DNA.

Could you have a look at DNA stats and look for a pattern?

This could be done but would take extra financial funding.  We have a limited budget.  
We are pulling together a small working group to look at DNA figures to help make a change.

We have many complex chaotic patients who miss appointments, and this is not always their fault and is down to lifestyle.  We need to be careful about victimising patients when a DNA is not necessarily their fault.

Can these complex patients be recorded as a different type of DNA?

We would not necessarily know who these patients are, their lifestyles are not part of their clinical make up.

Can you remove a patient from the practice register?

The NHS is a free service for all, and it is our duty of care to provide health care to these patients.  It is difficult to deregister a patient as we have a protocol to follow.
Some patients present for all sorts of reasons, and tolerance is low when patients are ill, so we need to bear this in mind.
There are two systems for removal of patients, one being if they become violent/aggressive to the point where the practice team are scared for their safety, which means they can be removed on the day with police involvement, however we need to evidence that we tried to engage with the patient to alleviate any situation.  The other is an 8 day removal where the relationship between the patient and the practice has broken down. In this instance we would write to the patient asking them to re-register with another practice, however as we cover the whole of Morecambe, this makes it difficult for them to register elsewhere.
PVG member noted that patients also don’t have a choice where they register due to BMG covering the whole of Morecambe, just as the practice doesn’t have a choice who registers with them.

With regards to dental services, what would happen if you didn’t pay?

Patients can be seen by the emergency dental service but only in an urgent slot for urgent pain.  This is accessed via ringing 111.

CQC action plan was to be shared with the group, will this happen?

A lot of work has been done on the CQC action plan.  Helen is looking into the possibility of sharing this.
Dr Akhtar noted that when GP appraisal was implemented it was strict, but it then became obstructive to clinical work and has become more supportive over the last few years.
He feels there needs to be an overhaul within the CQC as it doesn’t seem to be working.  They are picking up on one or two small things, and not focusing on all the hard work that is being done in the practice.

Call statistics/patient access is an area that is being focused on by the CQC, this seems unfair.

Practice overview

Dr Wooldridge gave an overview of the practice.  

Clinical Recruitment

2 GPs have been recruited, 2 have retired (Dr Craven and Dr Dodd).
Trainees change over in August so a new batch will be joining. 
Dr Al-Ani is finishing his training in August but will continue working with BMG. 
In autumn we have another GP recruitment in the pipeline.
Dr Wimborne is due to retire soon, however the GP retainer scheme means Dr Craven and Dr Wimborne can return. 
GP recruitment is an ongoing process. 
Nurse due to retire soon.
ACP (Advance Clinical Practitioner) team have recruited a couple of new members.  
It was reiterated that we try to keep the staff that we train.

PVG member noted that many GPs are unemployed, this may be due to salaried GPs not being hired because of funding, so there are lots of available GPs out there.  
HF informed the group that we are not far from our goals for recruitment.

PVG member advised that he raised the question of GP workforce when asked by the political parties who he would be voting for, however the topic was evaded.   
PVG member expressed that balancing the budget must be extremely difficult.  

Admin recruitment

Recruitment of the Patient Advisor Team is an ongoing process, 8 new starters will join the team in July.
Recent retirement of a long term Site Manager. 

In summary, there is much more positivity around recruitment.

Overview of our successful smear screening

TW (Lead Practice Nurse) attended the meeting to discuss the success of cervical smear screening within the practice.  TW introduced herself to the group, she has been with BMG for six years and is Lead in Women’s Health and Contraception.  She has looked into how to make smears more available to our patients, as there were many DNAs.
A piloted walk-in smear clinic was introduced in July last year.  This was advertised via posters, social media etc..  4 patients attended the first clinic, however this is 4 more than before, so it was felt it would be beneficial to run a walk-in clinic every month since then.  
November/December clinics had 16 walk-in patients, so the numbers are rising and we are on our way to improving the cervical screening of our patients. 
The clinics are held on a first come-first served basis, and they are not only for doing smears but also for patients to discuss concerns around having a smear.   
There will be an outreach nurse starting a smear walk-in clinic in the Poulton area. 
TW has had chats with outside sectors promoting cervical screening.  

We have had excellent feedback from patients saying the clinics being walk-in and times of the clinic has helped regarding fitting around childcare/work etc…  The clinics run from 4pm -8pm.

TW talked of a recent experience a patient had following TW’s encouragement to have a  smear, and how it can actually save lives.  

BMG was invited to an event with the Lancashire Cervical Screening Team, CM attended. 
The presentation showed good statistics for BMG, and they plan to use the practice as an example of success. They continue to ask us to share our success.  

TW expressed that DNAs are a problem, however if this occurred she sends a text to the patient and asks them to make contact to rebook.  Some patients reply and some don’t, but we try to capture them all. 

CM expressed that BMG are grateful to have TW as a member of the team, she goes above and beyond to find ways to improve screening in our population.  
A video has been made explaining the process of a smear.  This has been useful to target those who don’t attend due to fear, and this video has been helpful to alleviate this.

TW was thanked by the group for attending the meeting and sharing the cervical screening success.

CM informed the group that we have done many videos in relation to many procedures, and she will try to send some to the group.

Health & Wellbeing, overview of the service

Did not discuss.  This will be discussed at the next meeting.  
CM will ask SW if she can attend.  

SW has been nominated for a newcomer award at the nursing awards.  This is positive news for SW and also the practice.  

CM expressed that there are many positive things happening at BMG.  

Practice Nurses, overview of our immunisation programme

HS and KC (Practice Nurses) attended the meeting to talk about the immunisation programme.  
Immunisation clinics are held on all sites, variety of nurses do baby vaccinations. 
Baby immunisations often carry a high DNA rate, follow up appointments tend to be booked at the time of first immunisation.  If a baby DNAs, then the parent is contacted by phone/text asking them to rebook.  

BMG has a Vaccinations/Recall & Imms Team who recall patients for a variety of vaccines, i.e.  shingles, flu etc…   We have hit our targets, ensure we are boosting appropriately at the right times, and the DNA rate has reduced.  We have more availability across the practice.
Other clinic slots are converted to an immunisation slot if they have not been filled.  This prevents wasted appointments. 

What are people’s views on first immunisations?

This can be difficult at times as some of our population may have a lack of understanding of vaccines.  With regards to babies vaccinations, the parent tends to focus on the baby being okay during this so information given is not always heard.
Information leaflets are given, and we try to send as much information as possible.  
MMR video has been created to help raise immunity.  MMR is not only for babies, and  adults born between 1970 and 1990 are eligible for this.  
BMG are currently in the process of encouraging all staff to have the MMR vaccine if they haven’t already, or do not have evidence of having had measles.  

Immunisations are extremely important, the younger patients are targeted the better.  

Seasonal vaccinations are done at the practice - covid/flu.  This is a successful programme and is going well.  Plans are being discussed for a vaccinating team for the housebound patients, so we can capture these sooner.    

Shingles vaccination is offered to patients who fit the relevant criteria.  This information can be found on the boards/screens in the surgery.

Pneumonia, tetanus, MMR, whooping cough etc are many of the vaccines that we offer at BMG, however we also offer travel vaccines.  Weekly clinics are held offering appointments to patients.  Often patients do not know they need travel vaccines, so this brings risk.  
The vaccination team are extremely busy and they will become even busier when the seasonal vaccines begin.  
In summary, vaccination uptake is going well within BMG, however this is dependent on patients attending.  

What age range are the DNAs?

Mixture of ages.  Previously we had many babies, but this has improved.  
MMR is often declined.  
If a vaccine is declined, we cannot remove the patient from the target list.  

What are the rubella statistics?

We are getting towards 90%. 

To note, vaccines have a fridge life so to avoid many being destroyed a large amount of work is carried out behind the scenes.  
Fridge can however malfunction and vaccines have to be destroyed.

Flu season starts in October, and we are starting to prepare for this now.  
We are heading towards the end of the covid vaccinations.

Both nurses were thanked for attending the meeting and praised on the success of the immunisation programme.

Review/Update of actions

(not otherwise on agenda)

Online visibility issue – Action completed

Update 10.5.24 - Info added to the website as a news article and will also be displayed as BREAKING NEWS on the homepage for one month. 
Fb post uploaded on the 19th March.

New appointment system feedback – Action completed

Update 10.4.24 - Leaflet created explaining Patient Access isn’t as intuitive and informative as the NHS App, and that it is a bit easier to use.
CM will continually explain on social media about the new appointment system and “how to”.  
Each site has an internal display screen which has “how to” guides and explanations about the new system on a rolling set of images.
CG and CM are working closely with the CAT team to keep our patients more informed of what happens with their submission and the time scales for appointments, this will be via a text to the patient.

AOB

Healthwatch representation

PVG member is concerned regarding the lack of Healthwatch representation at the meetings.  CM assured the group that they have been invited to the meetings but as the representative lives out of the area, it is difficult for them to attend.  
PVG member suggested she will try to do something about this and make contact.  

PVG member noted that he made contact with Healthwatch regarding long covid and had met with the representative.  They felt it was helpful and she was easily approachable.   He suggested to anyone in the group that has anything they wish to discuss to make contact with Healthwatch. 

Plans for the next meeting

Dr Akhtar will give an overview of the visit team. 
Admin Operational Manager will give an overview of the admin teams/recall/imms team etc. 
Rota Team Manager will attend.   
PVG member requested that someone from the CAT team attends, CM will arrange this.
CM hopes to have a Site Manager attend in the future.

National screening programme for men

It was highlighted that unfortunately despite the national screening programme we have for smears, we don’t have anything like this for men’s health.  We have anxious patients who ring requiring prostate blood tests, and we have seen a spike in these requests.  This brings additional work to the practice.  
Trainee GP has developed a text that explains limitations of the test.  This has saved a lot of admin/clinical time.  

Do you speak to other practices to share ideas?

Informal mechanisms occur.  Dr Akhtar works weekly with LMP, teaches trainees/shares ideas.  
Recent example of learning - How they managed their rota and training timetable.   We have many trainees but not many trainers, so we have looked at multiple supervision/induction.  
CG often shares/compares ideas with the Complaints Manager at LMP to help with learning. 

NHS App

Uptake of the NHS App has been successful.  
CM is an Ambassador for the NHS App and is regularly asked to speak to other practices to help with their uptake. 

CM has met with one of the new PVG members TS and discussed/shared positive ideas.

Date of next meeting:

Thurs 15th August 2024 at 7pm – HPCC (F2F)

Rules of the meeting/purpose of the Chair.

Rules of the Meeting:

• 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.