Meeting Minutes October 2024

• Date: Thursday 17th October 2024
• Venue: Microsoft Teams Call - 7:30pm
• Chair: Chath McLennan
• Minutes taken by: Angie Davy

Introduction of New Members 

• There were no new members at the October meeting, but CM informed the group that one of our Patient Advisors would be joining the group

Conflicts of Interest

None.

Minutes of the Previous Meeting

August Minutes were agreed.

Review/Update of actions

CM confirmed that quite a lot of actions have now been completed with some still ongoing but being progressed. 

Actions from August 2024 PVG Meeting

15.08.24 - CQC Action Sheet - HF to summarise CQC action plan including any new actions to be shared at next meeting - 17.10.24 – Update from HF – since the previous meeting we have had our CQC re-assessment and are awaiting the report from that which we were told could be up to 10 weeks.  

We felt that majority of actions from our previous 2023 inspection have now been addressed although we wanted to wait until CQC have confirmation that they agreed with us before we complete those. 

Option for group to either wait for the action sheet from our re-assessment and go through all together at next meeting or have sight of the 2023 action sheet earlier.

Request to see 2023 action sheet separately and review the re-assessment (August 2024) action sheet at next meeting as a main agenda item – Action Ongoing

Action – HF will organise for a summary of the 2023 action sheet to be shared

Action – Review of August 2024 CQC actions to be added as a main agenda item for next meeting 

15.08.24 - Prescription Item Rejections – CM to clarify with Medicine Management Team why reasons for items being rejected aren’t included - 27.08.24 – Update from CM – MMT confirmed that currently they text a patient if we reject an online request

We would love to be able to text every patient, but this would create a huge amount of work which we currently do not have the staffing for. 

This can hopefully be something the MMT team can look at in the future -Action Complete 

15.08.24 - Return Telephone Calls - CM to enquire regarding the wording on CAT form – should it say “when are you not available to receive a return phone call?” - 24.09.24 – confirmation that this cannot be amended as it is a standard form - Action Complete

15.08.24 - NHS App – Extracting of information required for forms - CM will liaise with Robyn to look at arranging some Workshops via Stanley’s and potentially training some champions  
24.09.24 – CM is liaising on this - Action Ongoing

Health & Wellbeing Coach Role (SW)

SW introduced herself and explained what her role is and the projects she has been involved with.  

SW was initially linking with our dietetic team to work with diabetic patients with great results having had some pts significantly reduce their HbA1c level (test used to evaluate a person’s level of glucose control).   

SW is now working with KR on a Cardiovascular project focusing on risk prevention which is showing great results in helping to support and building a rapport with patients.  Once the data from that project is complete it will be presented to the local ICB (Integrated Care Board)

As well as specific project work – SW’s role is working with pts on lifestyle/behaviour changes in response to Long-Term Condition diagnosis.  When a patient is diagnosed with a Long-Term Condition it can be quite daunting and overwhelming.  When a patient is referred to SW, she will make contact with them on a weekly basis over a 3 month period to discuss any concerns/general queries they may have and that allows for intervention and additional support to be put in place if required through an MDT (multi-disciplinary team) approach. The role bridges a gap recognising that an annual LTC review is often not enough for patients with a Long-Term Condition and provides care/support in a format which isn’t through medication.  

A patient (LL) mentioned a link that she has formed informally with someone who has a similar condition to her to share experience/support each other by just being there to listen and having that awareness of not being alone.  This sounds great - there could be something on the back of this that we could look to progress within BMG if LL were happy to be involved feeding into some of the LTC work. CM talked about a social media “Bay Medical Group Low Carb Group” which was running really successfully pre-covid.  It was initially set up by one of our BMG Pharmacists who brough idees/answered questions etc – she then stepped back and the group ran itself really successfully with individuals sharing self-help tips/recipes etc – unfortunately after COVID this seemed to fizzle out. 

RT mentioned having recently read an article regarding people who are matched with other people with similar conditions/on the same waiting list/undergoing treatment – so similar things are happening in other areas. 

See the Patients Like Me website

Action – CM/KR and SW to link with LL to take forward 

Cardiovascular Risk Reduction Project Work and Long-Term Condition Review Process in Practice

(KR Advanced Clinical Practitioner & Cardiovascular Lead Practitioner)

KR introduced herself to the group and explained that she is an Advanced Clinical Practitioner at Bay with a special interest in cardiovascular disease). KR has been working on a project which has been funded initially for 18 months.  We had previously been performing quite poorly in some cardiovascular areas – KR’s role involves looking at barriers/reasons for that and implementing change/new ways of working to improve outcomes.  

There were 3 main areas focussed on:

Hypertension (raised blood pressure)

This is one of highest contributory factors to cardiovascular disease.  Before KR’s involvement in this area are figures in terms of patients reaching their target blood pressure level were:

60% in those aged under 80 and 77% in those aged over 80 – with a diagnosis of hypertension. 

From the work that KR and some other clinicians within the practice have undertaken mainly in terms of improving education within nursing and wider MDT (multi-disciplinary team) team as well as having received funding for 100 home BP monitors to be loaned out to patients meeting a set criterion therefore enabling blood pressure readings to be taken regularly at home by pts.  Having the new Community Diagnostic Centre (CDC) now based at Heysham Primary Care Centre has also helped as we have been able to work collaboratively with them to provide investigations such as 24 Blood Pressure Monitoring.  

The Community Diagnostic Centre provides some NHS services/investigations for Lancaster/Morecambe and Carnforth pts.  

We have set up dedicated hypertension clinics in practice which are being run by KR, members of our Pharmacy team and members of our Practice Nursing team. 

As a result of the interventions figures have now improved to:

76% of those under 80 years and 84% of those over 80 years reaching target blood pressure.

We have also manged to identify an additional 241 pts as having hypertension who we can now treat. 

Lipids

There are 2 pathways to consider in terms of lipid results.  

Those patients with established (secondary prevention) cardiovascular disease and those without established disease (primary prevention) for whom we need to focus on reducing their risk. We use a QRISK calculator with calculates risk over next 10 years.  Those identified as having a QRISK greater than 10% should be offered as statin (lipid lower mediation) with lower the LDL (bad cholesterol).  Again, there has been a real focus on education within teams not just at annual reviews but the early identification. There were some issues flagged with how we had been receiving some of these blood results which we have been working with the lab to resolve so that some impact on this. 

Atrial Fibrillation

We weren’t too bad in this area, but our prevalence was lower than the national average.  We are now at that national average level with 95% of our AF pts now being on anticoagulant therapy. Again, we have achieved this through additional education as well as purchasing some AF diagnostics which are in waiting rooms on sites – these can be used by patients to check for irregular heart rates.

In terms of our processes for Long Term Condition reviews – we recognise that there have been some issues without pathways which perhaps haven’t been as efficient for both the practice and patients as they could be.  We are now undertaking a large project to review these processes, and we are keen for any patient feedback/input as to how they feel we might be able to improve our LTC review process.  If anyone has a long-term condition attending for annual reviews and would like to offer any feedback/suggestions – please let us know. 

We know that continuity of care does improve outcomes for Long Term Conditions, but we also recognise that our GPs probably aren’t the best clinicians to be doing that LTC management – we have a huge team of clinicians including nurses, Advanced Clinical Practitioners, Dietitians, Pharmacists, Pharmacy Technicians etc who are all ideally placed to undertaken this work with a holistic approach.  Those clinicians know that they can escalate things to a GP if felt to be indicated.  In today’s climate GPs can’t work in isolation due to demands and we have a fantastic clinical team at BMG to work alongside the GPs.  

RT mentioned that Stanley’s would be happy to consider some “drop-in” sessions for LTC if that would be of benefit – we know some patients can be fearful of coming into a GP surgery setting.  KR felt that would be a great option to consider and could link with some of the work which one of our GPs (DC) is doing in relation to Outreach LTC pathways.

Noted that West End Impact have an Outreach Nurse so that could be another link for progress with Stanley’s  

CM thanked both SW and KR for attending and presenting at the meeting as well as congratulating both on having recently received awards at the Annual Nurse Awards which were held in July – SW for Most Impactful Newcomer and KR for Contribution to Primary Care with Cardiovascular Disease.

Action – KR will link with RT to discuss further

Feedback on Foodbank Visit

CM along with a couple of members of our Patient Voice Group attending a visit to our local foodbank in August.  

Feedback from AW as to how inspiring the visit was.  

Food poverty is a significant issue for lots of families including those who are in employment and can be a marker for other issues.  Often people’s lives are in crisis and things like forgetting a GP appointment when there is so much else going on in someone’s life is understandable with so many other pressing needs.  It is therefore important that we take a holistic view and consider what else is happening in patients lives when looking at how we can reduce our DNA rates for example. 

Our ICC teams will use every method possible to establish if patients are in food poverty when they undertake a home visit.  

In terms of referrals to the food bank (maximum of 3 referrals in 6 months) – they generally come from services like Stanley’s or CAB rather than the GP – as much information as possible needs to be included on these referrals such as allergies etc as often the food bank staff don’t have direct contact with service users.  RT mentioned that Stanleys are setting up a monitoring system which should help to identify is households are using more than one food venue at a time to try to establish the levels of deprivation/need.  Stanley’s have a good relationship with the food bank.  
 
We know that poverty affects health heavily.  VW explained that Community Orientation and awareness of local organisations is part of the required elements for our GP Trainees.  Suggestion that visiting the food bank could be useful experience for the trainees and that is something that we could explore. 

It was a very worthwhile visit.

BMA Collective Action (VW)

VW shared and went through the attached presentation.  

98.3% of GPs nationally voted in favour of BMA Collective Action as outlined in the presentation. Action is being undertaken on large national scale and locally other practices are taking the same actions and  

Two main elements:

• Unfunded/under-resourced work directed to General Practice from Secondary Care – this is a small cohort of services, and most patients will experience no change.
• Safe Consultation Numbers – limit of 25 per clinician per day 

We will be making changes to some of the services we offer and how they work.  We have (along with other local practice) sent letters to the ICB commissioners to inform them of our intentions and we will hopefully be able to discuss recommissioning of the underfunded services.  GPs have had more and more work put upon them from secondary care without adequate funding for years.  

There is no intention to reduce workforce, and we will be working with patients/practice teams to ensure the changes run as smoothly as possible.  

The above was presented to BMG staff at meeting last week. 

The decision regarding the capping of consultation numbers was a difficult decision for the partnership to make but we feel we must work together with all GPs across the country to take a stand.  It is about creating a day that is manageable and safe.  If we get funded properly, we should be able to employ more GPs and other clinical staff so hopefully it will be short term pain for long term gain.

It would be great if our PVG group members could get behind us in understanding the reasoning behind the action. 

Appointments Stats

Concern raised from AW that the practice already provides less than the national average number of appointments per year.  Our demand is high due to our high level of deprivation on our practice population.  Statistics from the practice would be useful to have from the patient/user point of view.  Statistics are more difficult to provide as BMG is not a GP only lead service and therefore not comparable to other practices without the same extended teams. We do have some stats that could be shared but not sure what that would achieve. Noted that CQC have never said we do not provide enough appointments but have recognised our access issues. We have been very successful in our GP recruitment this year in line with the funding we have.

In some areas we are running fairly close to the 25 per day now for example in the Visiting Team so the impact may not be as significant to patients as envisaged.  

How is General Practice Funded?

Practices have a GMS contract, and we receive an allocation of funding which does include element for deprivation.  There is also funding for undertaking Local Enhanced Services which are for specific things such as dressing for example.  Some of these LES were introduced years ago and the funding has never increased, and some services aren’t funded at all.   Unfortunately, there isn’t an equal split of the funding between primary and secondary care.

It is a political issue at a national level.  HF confirmed that our local MP has been copied into the letters we submitted to the ICB (as with other practices) and she is planning to visit BMG in November.  

Patient Awareness

The next step following discussion tonight is to work with other local practices to ensure we are giving the same message out to our patients – we know that raising awareness is vital.  Patients need to know and understand what the GPs working day is like to understand why the action is being taken particularly in relation to the safe number of consultations.  No patient would want to be the 50th patient seen by a clinician at the end of a very long day.  

We will do our best to continue to provide a good service as much as possible and put messaging out.

AOB

Choice of appointment time

Point raised by pt on behalf of a neighbour.  Background that request submitted for son and appointment offered in the middle of the day meaning parent taking time out of work and child being taken out of school.  When this was questioned in terms of having a later appointment time – they were informed that was the only option.

HM explained that all appointment requests are triaged by a clinical team to establish clinical level of urgency.  Based in above, this must have been assessed as requiring an urgent appointment which need to be booked in time order on the day.  If we didn’t book those in time order and allowed “urgent” appointments to be booked after school/work hours if requested, it would be impossible to manage the day/workload.  Noted we worked in the same way in terms of booking of urgent appointments in time order prior to the appointment booking system change earlier this year.   

We always ensure someone who clinically needs seeing urgently is seen within a clinically appropriate timeframe. Unfortunately, we don’t have capacity to offer everyone an appointment when they want to come. 

Feedback from group

SW mentioned how well a member of the PA team had dealt with a situation for her recently and LL wanted to pass on how amazingly well our ACPs and other clinical teams undertake/support pts with LTCs

• Agenda Plans for January Meeting:
  • AI Presentation from WH
  • Admin Team Procedures Presentation from Admin Manager
  • Clinical Rota System Presentation from Rota Manager
  • CQC Actions/Report from HF

If any members of the group have any suggestions on other topics, they would like to know more about to be included in future agendas please us know.  

Date of next meeting

Thursday 16th January 2025 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.