Meeting Minutes August 2024

Thursday 15th August 2024
Heysham Primary Care Centre - 7pm

Chair: Cath McLennan

Minutes taken by: Angie Davy

 

Introduction of New Members 

CM introduced Angie Davy who will now be attending to take minutes.

 

Conflicts of Interest

None noted.

 

Minutes of the Previous Meeting

Noted that some actions are still outstanding as some things take longer to progress than others, but all are being worked on. 

Previous minutes were agreed with the below points being raised:

  • Attendance list from previously meeting updated 
  • New Appointment System Stats – following the review of appointment stats at June PVG meeting there was a question about how the new booking system is impacting on appointments.  Are we saving appointments since introducing the new system?  AW confirmed that online data shows a reduction in number of appointments which could be due to reduced demand, but the number of appointments has fallen considerably during that time.  
  • The new system has meant our previous system of triage is no longer undertaken which will have reduced the duplication of bookings.   
 

CQC – Assessment/Action Sheet

There was a query raised with regards to the sharing of the CQC Action Sheet following the inspection which was carried out in October 2023.  

HF informed the group that we have very recently been made aware that we will be re-assessed by CQC on 27th/28th & 29th August.  We know that there will be 1 inspector only visiting for the re-assessment and as part of that process the action plan will be reviewed to ascertain what measures have been taken to address the points raised.  

HF confirmed that she would be happy for the action sheet to be shared once the assessment has been completed.  Some areas are still work in progress, but we have addressed everything we were ask to and those areas which haven’t been fully completed, have supporting evidence to demonstrate how we have progressed to date.  HF confirmed that no specific timeframes were given to the practice for actions to be completed however CQC would not have allowed timeframes of several years to applied – they need to be realistic. 

As previously the assessor may wish to speak to some of the PVG members and CG has liaised with individuals regarding this. 

CQC Assessment Team – the CQC is made up of NHS employees some of which have clinical backgrounds and others with managerial backgrounds.  Some will have experience of Primary Care whilst others won’t.

SE confirmed that we will not receive a visit from Healthwatch with us having our CQC visit scheduled as Healthwatch do not go where CQC are active.  Healthwatch have legal powers but no powers of enforcement.  They can make recommendations to CQC. Healthwatch focus on pt experience and listen to community feedback – they will talk to people rather than going through paperwork.  Healthwatch is Lancashire County Council funded.  

Action: HF to summarise CQC action plan including any new actions to be shared at next meeting 

 

Guest speaker – Bay ICC Development Lead

AS joined the meeting to run through some of the projects being undertaken via the ICC (Integrated Care Community) and Primary Care Network.

       Enhanced Health Checks 

The PCN were offered some funding from ICB (Integrated Care Board) to provide health checks with the purpose of offering enhancements to address issues such as mental health, standard of living etc to specific cohorts of patients.  The initial “ask” was for these to be offered to patients between the ages of 40 & 75 with no other long-term conditions – over 5000 patients were identified.   We felt that this number was too large, and we asked if we could focus on smaller numbers to work with for a longer period of time to hopefully have more impact, this was agreed.  

With the funding provided, an Outreach Nurse was employed, and we partnered with Citizens Advice to support patients.  

We chose to focus on the Poulton area which is one of top 10% of most deprived areas nationally.  Deprivation/life expectancy figures gathered from population health data/Aristotle system. 

The initial focus was on 3 streets in the Poulton area (94 households) which was expanded in year 2 to 131 households. Through the involvement with Citizens Advice between Oct 23 and June 24 there has been a total additional income generated for those residents of £227k (majority of this relates to individuals now claiming support which they were entitled to but weren’t aware of previously).  From a health point of view, some previously undiagnosed Long-Term Conditions were identified and in some cases, there has been reversal of type 2 diabetes whilst some patients have accessed screening programmes for the first time.  

Some patients in these areas were attending A&E with flare ups of conditions etc rather than taking a pro-active approached via General Practice. Some patients can be fearful and perhaps don’t always view health as a high priority.  The project team went door to door to link with these patients as well be arranging community events to engage. 

The hope would be to secure further funding for this project to continue beyond March 2025.  The idea behind the initially funding was to improve health now in the hope to save money in the future, return on investment.  

AS shared the annual report with the group and will circulate electronic version after the meeting.  

Health Coaches

This is run as a subcontract with The Well which is a lived experience recovery organisation.  The benefit of support from people with lived experience of recovery is recognised.  The Well Health Coaches also run sessions from Heysham Primary Care Centre.  There were 128 pts support by our Health Coaches 2023-24. Patients can be referred by their GP to the team but our Health Coaches can also link with patients directly from A&E attendances – it is recognised that having that contact at point of crisis is the best time to engage - Health Coaches (baymedicalgroup.co.uk)

One of the initial targets set was for 17% of those patients who were receiving support from our Health Coaches to feel more committed to the recovery process but from feedback gathered, 84% of patients felt more committed.  Of 104 patients who became active with the team – 17 of those now no longer require support and have turned their lives around. 

We are one of the few PCNs (Primary Care Networks) that subcontract with voluntary community organisations and this has proved to be a successful approach. 

Social Prescribers 

Team will help with a range of things and can link with patients who may be feeling isolated or lonely with little/no support networks.  Patients can self-refer or be referred by practice/school.  GPs might pick up on potential underlying issues with patients or a sense that things just “aren’t quite right”. Social prescribers can link patients to groups such as Walk with a Doc, Seagull Café, activities at Stanley’s, Rainbow Centre, More Music etc.  

Stanley’s

Currently over 800 adults and young people on system. They offer a range of activities to improve health and wellbeing running at different times of the day or people can just pop in for a brew/breakfast which is free of charge. They can provide food packages for a cost of £7.50 and people can actually choose the items in the package (i.e. eggs/bread/meat/fruit etc).  

Morecambe Bay Poverty Truth Commission

Focus is to facilitate meaningful, hopefully transformative, listening and learning between two groups of people: those who understand poverty by living it, and those who know it from a governmental, civic or statutory point of view. 

Breathe Easy

Specifically for those patients with lung conditions – this is held at Heysham Mossgate Centre every third Tuesday of the month 1pm to 3pm. It started back in 2022 to provide some peer support. Running cost for full year is around £550. It was funded by Morecambe Bay Respiratory Network in 23/24 and Morecambe Bay Hospital Charity group in 24/25 – the group are currently looking to become formally registered as a charity.  Guest speakers (relevant to those with lung conditions) are invited and the maximum attendance to date was for presentation by the Lead Respiratory GP from BMG, when the attendance was 54.  

The group run quizzes at Christmas and have had children from local primary schools attending to sing Christmas songs. There are also gentle exercises undertaken for those who want to participate at the end of the session from a trained instructor. Texts are sent by BMG to patients aged 55+ with a lung condition, but they are not sent to all patients each month due to number involved so only around 100-200 texts are sent each month to different patients each time to help up control number at the group.

Morecambe Bay Foodbank

Event scheduled for Thursday 22nd August at Food Bank to demonstrate some of the work undertaken, have a tour of the premises and provide information about what they offer the community including the School Uniform Project.  Two members of the PVG voiced their interest in going along to the visit. AS will link with them to co-ordinate this. 

Christians Against Poverty

AS mentioned a workshop which was run in a local primary school to help build relationships/trust with statutory organisations such as Police Service to help to break down barriers. The event was a great success and plans to replicate in other primary schools. 

The ICC meets monthly, and AS would be more than happy to extend an invite to the September meeting on Friday 13th to any of our PVG members who would like to attend. 

There are so many different groups running which patients can access – it is difficult for clinicians to keep to up to date with what is happening/when.  Information is shared on our waiting room screens and it is this type of thing that our Social Prescribers would direct patients to. 

AS circulated paper copies of reports from some of the above projects with the group at the meeting and will forward electronic copies to be shared with Patient Voice Group members.  AS confirmed that it is fine for these to be shared – all case studies have been anonymised and the pts have consented to them being shared.  Stanley’s current timetable of activities will also be shared with the group.

The group thanked AS for her fantastic presentation.

 

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

New Appointment System – Response to Comments 

15.08.24 – Update from CM - I continually monitor the FB page and respond to comments both positive & negative.

Action: Complete

New Appointment System – Making information regarding changes clearer 

15.08.24 – Update from CM - I am also regularly posting information about our new ways of working on our social media pages.

Action: Complete

STAT Figures

Posters regarding DNAs - 15.08.24 – Update from CM – I’ve added the DNA posts as a regular feature to our FB pages in an attempt to reduce and we have also set up a task group to look into how we can reduce these.

Action: Complete

STAT Figures

Rota Team Manager Presentation - 15.08.24 – Rota manager invited to attend October PVG meeting.

Action: Ongoing

Smear Screening - Update 17.6.24 - MMR/Cervical Screening video clips emailed to the group.

Action: Complete

Awaiting discussion with FCMS and a suitable PLT.

Action: ongoing

 

AOB

New Booking System

Confirmation that patients can use the online submission form if they are able or alternatively, they can still contact via reception who will complete on their behalf.  The submissions are filtered accordingly (i.e. to mental health team, to physio team, to admin team, to clinical team etc).  All clinical forms are then triaged by our CAT (Clinical Assessment Team) which is made up of GPs, Advanced Practitioners etc and actioned according to clinical need.  This has removed that “first come first serve” 8am scramble for appointments.  

Whilst we know thar some patients aren’t comfortable with the online systems – as outlined above, our Patient Advisors are happy to complete forms on behalf of patients either at reception desk or over the phone.  CM mentioned a recent session she had run at Galloways Society for the Blind on how to use the new system and most patients there felt comfortable in using our online system after CM had gone through it. In terms of internet access – there is a new facility on West Street which is starting to provide free internet access for those who do not have access at home. 

We know there are still issues which need tweaking and response timeframes could be improve which we are working on. 

There can be significant variation in the quantity of information which patients include on their online forms and at times we have to go back to the patient to ask for more information.  We would therefore advice pts to put as much information as possible on initial form. 

A patient flagged an issue encountered when ordering a repeat prescription with one item being rejected without any explanation as to why.  This is frustrating for patients – if something is being rejected a reason really should be given 

We recently sent a text out to patients who have used our online submission form asking for feedback on the system which has been completed by over 2000 patients so far.  We are aware that not all phones will allow the link to be opened which is something we need to consider when gathering feedback. Feedback received is reviewed by CG & CM on a weekly basis and reviewed as a management team in the monthly Operational meeting.  Majority of feedback has been positive, but we know there are still areas which need tweaking.  

Action: CM to clarify this with Medicine Management Team 

Return Telephone Calls

Missed telephone contacts – do we consider that patients may be in areas where mobile signals are poor?  There is a question on the submission form regarding preferred method of contact but perhaps that should be re-worded “when are you not available to receive a return phone call?”.  We know the convenience of a telephone consultation can work well for some patients. 

One elderly patient had received a return phone call from a clinician at 11pm at night – not sure if this would have been from practice or from Out of Hours GP.  VW confirmed that our practice GPs would generally only ring a patient at that time with something particularly urgent such as abnormal blood results etc where attendance at A&E (for example) may be required. 

Action: CM to enquire regarding the wording on CAT form 

DNAs

Recent meeting held in practice to review DNA rates – from reviewing cases at meeting we have become aware of things we have been doing, for example sending text appointment reminders to a visually impaired patient.  We have alerts on our system which would flag issues when a patient presented allowing us to make adjustments to our communication method but unfortunately our electronic systems aren’t clever enough to apply that an automatic text message (such as an appointment reminder which is generated automatically).  We really need to run searches to exclude certain cohorts of patients from some automatic texting processes and that is one of the things the DNA group will be looking into. 

We don’t always know about our patients homelife which may be chaotic leading to missed appointments – if lots of things are going on in people’s lives – a GP appointment may not be a priority.  

Our GP Assistants are working on a project linking with patients who attend/contact the practice on a frequent basis regarding things which may be going on in their lives which may not be directly linked to their health.  Our GP Assistants will talk to those patients and help to provide support linking with other services.

Whilst we are able to carry out home visits on patients which may go some way to addressing the barriers faced by those with more chaotic lives who frequently miss appointments – unfortunately due to capacity we are only able to carry out home visits on our clinically housebound patients.  We already offer the ability for patients to cancel appointments easily online when they receive their appointment reminder text, but we acknowledge that there may be some patients who don’t necessarily have the ability to text back. 

The number of DNAs sounds high however as a percentage compared to national figures we are doing quite well.

How we deal with our DNAs will be an ongoing piece of work in terms of understanding of the barriers some of our patients face and doing what we can to try to overcome some of those. 

NHS App

It would be good to use the app to help to promote the PVG – unfortunately the app is national so we can’t make our own tweaks to the app, but we can put forward suggestions for consideration.  

Online forms/extracting of required information from NHS App – this as an issue encountered by some of our patients.  AS mentioned some feedback which she had been given from Citizens Advice as to how helpful our Patient Advisor teams were when patients came to desk asking for print outs from their records for purposes of completing forms. 

Action: CM will look at arranging some Workshops via Stanley’s and potentially training some champions  

New GPs

We have had 2 new GPs starting with us recently with a further 3 due to start imminently.  The overall situation with recruitment does seem to be getting better.  Our website is regularly updated with information regarding new GPs.  We are still a training practice and had 9 new trainees starting with us this month. 

Feedback

Please remember you (PVG members) are the voice of our patients – we want you to let us know about feedback you hear from friends/family – both positive and negative. 

 

Date of next meeting

Thursday 17th October 2024 at 7.30pm - 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.