Meeting Minutes September 2023

Meeting Date: 21st September 2023
Time: 7:00pm

Chair: Chris Greenwood.

Minutes taken by: Yvonne Barrett.

Introduction of New Members 

No new members.

Conflicts of Interest

None.

Minutes of the Previous Meeting

Read and agreed. Confirmation was given that AW’s data presentation had been emailed to the group.

Review/Update of action sheet

Update of actions noted below. The remainder of the action sheet will be discussed at the next meeting.

Website discussion and survey

Referral sent to Age Uk/Digital Navigator for MR- Action completed

PCN

Update from CM- 14.7.23 JB will email her contact at the extended access to see if they send appointment reminders, as our patients have become reliant on them and probably expect them now. Hopefully this will help and avoid any DNA`s.

Asked JB to also email to ask why appts don’t show and if possible could they make them show up in the NHS App.

Update from CM – 21.9.23- JB will chase today and ask about appointments not showing in the NHS app.

Presentation/discussion with ICB – sharing their 5 year plan for the NHE services

NHE services

The ICB Head of Communication and Engagement (DR) introduced himself to the group. He described his role within the Integrated Care Board (ICB) alongside the large communications team he works with. A group photo was taken with everyone’s consent.

ICB was formed in July last year to replace the 8 Clinical Commissioning Groups (CCG). These CCGs were amalgamated to make one ICB, focusing on commissioning services across Lancashire and South Cumbria. This change was set up by the government making the ICB the body alongside the views of the people, to make decisions regarding the provision of services. This change has

brought a financial saving and the body received the budget for Lancashire and South Cumbria. The ICB’s ambition is to involve the people as much as possible in development and to work in the community. Lancashire is broken into 3 parts, East Lancs, North and Central. ICB has legal duties:

• Health Inequalities, ensuring everyone has equal access to services, no barrier.
• Involve.

DR asked the group if they had any questions and the following questions were raised and discussion took place:

• Now that the ICB has amalgamated from smaller CCGs to one large ICB and will be looking after many more numbers of people, unless you multiply the number of places and give them resources, how does the structure relate to the ambition to stay in touch with the people?

DR agreed that there will be larger amounts of patients to consider however he feels that with the collaboration of health and social care (no longer separate as it has been for years, where social care has struggled in the past) it should show improvement as each local area is aligned with their local authority to enable integration with social care. He explained the importance of social care as well as health care.

• If the ICB is going to delegate a budget to specific areas, what will happen to the primary care budget?

Primary care budget is separate to the secondary care budget. The idea of delegation of funding is to enable integration where we can. Final approval for the delegation of budgets will possibly be next year if requirements are met. The national primary care budget is based on cost per patient for GP practices and this is ring fenced.

Integrated Neighbourhood Team is a model that is currently being developed.

Value and importance of primary health care was discussed, care closer to home, specialisation in areas where it is needed, more services closer to people’s homes. It was agreed that primary care is the foundation to this.

CG noted that each practice has their own patient list where the practice works around their group of patients to ensure they receive the care they need. Care services being specific to practice population.

• Value and importance of primary health care was discussed, care closer to home, specialisation in areas where it is needed, more services closer to people’s homes. It was agreed that primary care is the foundation to this. CG noted that each practice has their own patient list where the practice works around their group of patients to ensure they receive the care they need. Care services being specific to practice population.

Decisions are made with these struggles in mind.

It was noted that we have a lot of patients within Bay Medical Group who can’t even get to sites further afield, let alone travel for emergency services/secondary care. There is a lot of deprivation in the Morecambe area and many cannot afford the cost of travel. Public transport is not always easy to get to some hospitals, and for patients who work may even have to take a day off work to get there. People in specific areas are struggling to even get to foodbanks.

DR noted that some services do need to be specialised in a central place so clinicians can keep their skills up to date, as it has been found that many aren’t seeing specific types of illnesses within the area they were based.

ICB is looking into the Royal Lancaster Infirmary

• How do you get to casualty quickly if the local hospital is no longer available?

Sites are being considered, patients will be involved. The new hospital vision aim is by 2030 and there is a timetable of the plan available. The ICB want to hear the views from patients to aid their decisions.

PVG member noted that this is terrifying because we are used to having services available to us. DR expressed that the decision makers need patients and clinicians to help with the decision making/solutions. Networking is important, solutions often lay with the people. PVG member raised an incident in A & E at the RLI and discussed how the situation was managed, offering them the choice to drive elsewhere for a shorter wait.

Another PVG member talked of an incident in A & E where the wait time was so long that after triage from the nurse, the patient was asked to come back the next day for treatment.

Concerns were raised regarding the following areas:

• A & E
• Ambulance services – GPs have felt the impact in the last 12 months. Inflation, recruitment crisis.
• Lack on NHS Services
• Saving of GPs

MA expressed that changes will no doubt happen again and the formation of the ICB will be changed. He feels questions should have been asked before the formation of the ICB, not after. He feels the presentation of the GPs within the ICB is less than ideal and also the budget, and it seems that no governing body talks of GP access or the shortage of GPs. It seems that GPs are left to pick up the pieces, however they can only do what is possible. DR informed the group of the Poverty Truth Commissions in Barrow which seems to be working well.

PVG member raised concern that they read data where the average child’s life expectancy is less than the state pension age. This is very concerning.

Core 20 plus

How will this programme debate with the local people before decisions are made?

ICB is working with the Population Health GP - Dr Andy Knox.

HF noted that Bay Medical Group have focused on enhanced health checks, especially focusing on the Poulton area where data has shown this to be the most deprived area of our patients. We are engaging differently with this group of patients and taking a different approach to look after them, however this has taken a lot of our resources and we would like to do more of this. Core 20 plus 5 - 40%

GP Access

PVG member raised concern that the ICB needs to look at the level of access within general practice, and provide a tool for bringing the information together. They need to tackle the issue of GP provision as general practice is heavily under provided. 

A discussion took place and it was noted that it is difficult to get GPs or trainees to come to work in this part of the country. DR expressed that the ICB is well positioned as they work with local authorities and have many connections to help promote the area as a place to work. ICB is currently planning for the retirement of GPs.

Bay Medical Group is a GP trainee practice who tries to hold onto trainees, and are often successful in this. MA expressed that the only way to make any job attractive is for it to be enjoyable and well paid.

PVG member noted that often GP Trainees from Bay Medical Group visit Stanleys and she feels this is a good way of breaking down barriers.

Deprivation Study Day

Planned for GPs in November and they will look at how they can work together.

Patient Participation Group

PPG works as a network/large group of practices to help recruit, they can help with the structure of surveys, give training on running focus groups/ local campaigns etc. There is lots of support out there, e.g. they can help with the advertising of a campaign. DR provided a list of support available.

PVG member asked if the ICB would come to speak with the Young Health Matters Group at Stanleys, DR agreed they would be happy to do this.

• Action - CG liaise with DR to arrange an ICB visit to Stanleys

PVG member asked about help with soft data, PPGs can help with this. This could be helped with targeted surveys and focus groups, the ICB can help with all of this.

PPG Offer of support letter

Quality committee

A written story is shared with the committee, the issue is looked at and a plan is devised to make improvements. The story is then made into a small video so the committee board gets the real life of people/trying to humanise committees. DR asked the group if they know anyone that would like to share their stories and if so to let CG know.

DR thanked the group for being invited to the meeting and expressed he would be happy to be contacted with any further concerns/questions. He would like for himself or a member of his team to attend future PVG meetings. He apologised for this being the first time anyone from the ICB has been in attendance. He expressed engagement is useful.

The group thanked DR for attending the meeting.

Phone calls to the surgery being cut off

PVG member raised concern about being on hold to the surgery for a lengthy time then being cut off, this happened many times so he drove down to the surgery to make an appointment. He contacted CG and CM to inform them of this and the frustration it caused.

• If there are over 10 people in the queue and the patient is being cut off, does that mean you go back to the end of the queue again?

It was agreed that this is not an ideal situation and unacceptable. Since we moved onto the new phone provider which is internet based, the phone lines/access has been affected for Bay Medical Group and four other practices. The provider is unsure where the issue lays but it is being looked into, trying to fault find.

HF informed the group that GP practice has access to funding for cloud based telephony which should improve the phone system, however we are awaiting this funding and much of it is being allocated to practices still on analog phone systems, so there may be a considerable wait.

• Is this affecting outgoing calls as well as incoming? Not as far as we are aware.

PVG member highlighted concern that an appointment he had was cancelled but he was never informed and he wondered if the outgoing calls had been affected also.

Apologies were given regarding the unfortunate events and the PVG members were thanked for raising the issues.

QR code check in giving an error message

PVG member recently used the check in machine with the QR code but received an error message, so he went to reception where he was told that he had checked in successfully.

CM confirmed there has been a blip on the checking in system and this has been a national issue that we weren’t told about. CM has informed the providers that faults need to be reported to the practice.

Another PVG member noted that you don’t get a good mobile phone signal at HPCC and often the QR code doesn’t work there, however this was not the site that had been used.

• Action - CM look into QR code check in at HPCC- message the provider

Apologies were given regarding the unfortunate events and the PVG member was thanked for raising the issue. MA talked of his own experience of calling his GP practice, and hopes that once Bay Medical Group’s phone/IT system is sorted, access should improve. It was noted that GPs lose lots of time daily with IT issues

AOB

NHS app

53% of our patient population use this. Film crew came to Bay Medical Group and filmed the promotion of the NHS App and explained how this is beneficial to patients. NHS App will be going live for appointments soon.

Receiving a call from the practice but no message left

PVG member raised the suggestion to leave a voice call message or send a text to the patient when the surgery has tried to make contact, as it is difficult to know why a call has been made or exactly who made the call.

It was agreed that leaving a voice call is a good idea with the consideration of confidentiality in mind. CG had called the said PVG member and will be in touch.

• Action – CG ring PL to follow up

Missed calls

PVG member received a message to say the doctor tried to ring but he says the phone didn’t ring and feels this is not acceptable, especially as you can’t phone the number back. A discussion took place and it was felt this may have been due to a number of various things, possibly related to Cisco jabber/internet based phone line system meaning some calls won’t go through, or possibly the patient’s mobile phone signal/provider. It was agreed we need a robust system in place and hopefully when we get cloud based telephony this should show improvement. CM noted that while we are having problems with the internet based phone system there is not a lot we can do.

Patient Advisor (CB) confirmed that the clinicians at Bay Medical Group add “failed encounter” to the patient’s notes when a call has been unsuccessful to make it easier for the team to see who has called and why.

Many calls are made from the hospital with the same cisco number so it is difficult to tell who it has come from.

HM informed the group of the triage list and expressed that when a call for a possible urgent appointment is required, the patient is tried at least 3 times and this is logged in the notes. The patient is not crossed off the list until the call has been successfully received.

Update on digital access

AccuRX has gone live for routine requests and this links into the NHS App. A message has been added to the phone line and Patient Advisors have been put in place to deal with requests daily. So far we have dealt with 6962 requests and 1008 in the last month. The Patient Advisors are enjoying using this and having the variety in their role.

This has now been rolled out to the admin teams where relevant requests will be directed to them, so this should speed up and streamline the process. MMT is working directly with this for prescription requests. We are pushing towards advertising this. CM suggested to the group to download the NHS App and try it out. She is available to give help to anyone that needs it. HF reiterated this is for routine requests only. HM noted that Team Leaders have looked at the data for a week and around 10% had completed the online form within the app incorrectly. The form is built into the system and can’t be edited by Bay Medical Group so we are looking at making our own templates

• Can spelling mistakes be rectified on the App? Can it work out what is requested?

If in doubt the practice would ring the patient.

CM expressed that when AccuRX was chosen, we opted for software that had limited questions as it was found that patients would often abandon the app if questioning was lengthy. AccuRX has the functionality to send photos which is extremely helpful and the app is being used to educate patients also. There is currently a 48 hour turn around at the moment, but this is longer over a weekend period.

CM informed the group that you can also make a request via the “contact us” section on the website.

PVG member informed the group they have recently successfully booked their flu and covid vaccine through the app, however it doesn’t have any information/link about cancelling the appointment on the text message he received but it does on the App.

Chris thanked HM for her update.

CQC visit

HF informed the group that the Clinical Commissioning Group will be coming to the practice for an inspection on the 10th October 2023. Lots of work has been done in preparation for this. Virtual and physical inspections will take place on most sites and they will speak to the teams, but they also want to speak to some PVG members. CG will be in touch with some of the PVG members.

Pharmacy referral journey

PVG member was involved in filming a video to promote the pharmacy referral journey for the ICB. He really enjoyed this experience and CM thanked him for his help.

Date of the next meeting

Thursday 23rd November 2023 at 7.30pm via MS Teams

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.