The Patient Participation Group Meeting

At the Earlsfield practice we have formed a patient participation group that meets up regularly throughout the year to discuss the delivery of health care services within our surgery and the NHS as a whole.

We welcome anyone who is interested in joining the group and sharing their views as we realise that patients have a key role to play in supporting the development of General Practice.

The patient participation group (PPG) reflects the views of patients and enables the practice to obtain feedback from a wide section of the practice population.

Our aim is to improve the services that the practice offers by setting clear priorities for improvement with the PPG.

If you would like to attend the next meeting on Tuesday 8th December at 6:30pm at the Earlsfield practice please email [email protected] or write to Karen Pace (Practice Manager) 2 – 4 Steerforth Street, SW18 4HH

Patient Participation Group Meeting From Year 2011 to Present

27^th March 2023

Attendees: TS, JB, SE, JR, JP, TW

Dr Bamford, K Pace (PM)

Introduction

Dr Bamford informed the group of the sad passing of Mr D recently and Mr W is now in a care home.

Matters arising from previous meeting. Patient Apps

KP explained that there are many apps available but the two that we would recommend to our patients are, Patient Access and My GP. It would not be necessary to print our guidance as it is a step-by-step process but if you are stuck please call the surgery and one of our receptionist will be on hand to help.

KP explained why Nurses appointments do not appear on Online Access because the length of nurses appointments vary and when we trialed it the results were unsuccessful. 

Refurbishment

The commencement date for the planned refurbishment has still not been confirmed, and therefore still experiencing issues with room availability. The installation of a lift was declined as the rent increase will be excessive.

On the ground floor the admin space and the waiting room will be reduced to allow construction of extra clinical rooms. 

The plans are for the first floor will be open plan offices insuring that there are sufficient desk space for clinical and admin staff to work. The only private rooms on the first floor will be the Counsellor’s consulting room and the Practice Manager’s office.

Report on telephone access

In January 2022 the volume of calls were 7,047 (235 per day) and waiting times 3m.5s. This increased to 9,274 incoming calls in January 2023. The average number of incoming calls was 309 and the average waiting time was 2m.42s. 

The patient group said that the telephone message informing them of how many people are in the queue is helpful.

How to respond to a large increase in our list size

Our patient list size has increased exponentially since 2019 from 11,200 to 14,600 and as discussed earlier we have a room allocation problem. Also, we need to ensure we have the required doctor-to-patient ratio but we are advertising for a GP and receptionist to keep up with the demand. 

If we are oversubscribed we have one or two doctors who can work from home to free up room space. 

The partners are restricting new registration patients to SW17 and SW18. Patients living outside of these areas are not automatically eligible for community services.

We could close our patient list but this is not something the partners want to do unless absolutely necessary.

Grounds and Estate Manager

Our previous gardener/handyman has retired and the practice is currently seeking a suitable replacement. Mrs B who kindly helped decorate the Court yard has expressed interest in the post. 

Staff changes

The Earlsfield Practice is now a teaching practice and our first trainee started back in February this year. Dr Sivagarajah is mentored by Dr Chittilappilly. Patients are made aware that she is a trainee prior to booking an appointment.

Dr Bamford has employed a Physician Associate (PA) to work at the practice for 2 days per week commencing in June. The (PA) will see patients for minor illnesses.

There will be a new trainee Talking Therapy Counsellor joining the team in May. 

We have a new Social Prescriber who joined the practice in February and she was appointed by the Primary Care Network (PCN) and comes in to our surgery once a week. The Social Prescriber can assist with non-clinical services and will offer support to our patients who require assistance with form completion. Jessica will refer patients to the correct charities who can assist them with various forms. 

Wandle Primary Care Network

The PCN employ a wide range of healthcare professionals known as ARRS (Additional Roles Reimbursement Scheme). These roles are made up of, Pharmacists, Paramedics, Physiotherapists, Psychotherapists and Physician Associates. 

Assisted by the PCN we provided the highest number of flu jabs this year. They also promoted Blood pressure monitoring this year. The PCN are creating a locum bank for clinical and non-clinical staff. 

CQC preparation

Our last visit from CQC was in July 2016 and our rating was good but unfortunately, the visit resulted in the closure of our branch surgery on Trinity Road. The results are available on our website. We are ensuring all policies are up to date. The practice has completed some redecoration and plumbing repairs to comply with current regulations.

AccuRx

We are encouraging our patients to use AccuRx to make contact with the surgery instead of using the phone or emails for non-urgent communication. It can be used to self-book, appointments and fully integrates with Emis Web. AccuRx can be accessed through our website under the heading ‘Patient triage’.

Next meeting June 2023

19^th October 2022

Held in the practice meeting room, with others joining by teams.

Present: NB, IS, JB, JR, SS, TH, EP, AS, JP, BP

NB presented the current state of the practice and the pressures we are currently facing. Following COVID, there had been a continuing demand for telephone consultations and allocating time for these was eating into available time for Management, Training and peripheral activities such as teaching and running Group activities.

There had been an increase in the practice this size. This is partly due to new housing developments in the area and also because we are seen as a good practice to be a part of. This is putting pressure on practice space and strategies to enlarge the building will be discussed later. We cannot recruit more GPs or nurses when we have no space for them

The nature of consultations had often changed, with people bringing more than one complaint to the consultation. Consultations run longer. Because telephone appointments are often booked at short notice there was extra pressure on these slots. This reduced the number of follow up and review appointments we have available on a particular day.

NB was asked whether the perceived pressure on the NHS and the surgery was still deterring people from booking appointments and getting treatment. He agreed this might be a problem but strategies such as the diabetes catch up program and the spirometry catch up program were helping here

There was an agenda item on getting through to book appointments by the telephone. It was, it was said that early in the day the wait can be very long. We were asked to see if we could have as many staff as possible on the telephones at this stage. However, the countdown that’s now available, where you are told where you are in the queue, was helpful. It was relatively easy to get through to the practice in the afternoon

There was an agenda item on booking through the patient apps that are available. It was pointed out there are many apps which offer slightly different facilities and it can be confusing which ones to use. Some people struggle to install them on their phone. The practice needed to help those people who were not aware of them or having problems installing the apps. It would be Helpful if the practice displayed guidance on which apps to use in which circumstances and how to install them.

It was noted that booking doctors’ appointments through the apps was variable. Some apps gave more appointments than others. There were no appointments available for nurses through the apps and the group felt this is appropriate as nursing appointments could be variable times and.one patient might need half an hour, one patient might need five minutes and self-booking for this would be difficult.

N B presented plans on enlarging the surgery. The plan is that the reception space to the left would become consulting rooms. The entrance space and initial reception area would join with parts of the waiting room to become a smaller admin area. The waiting area itself would become slightly smaller. There would be a lift for upstairs rooms. Over the clinical rooms five more consulting rooms and admin space would be constructed. Comments from the group were about how this would impact on the admin staff, while more consulting space and the lift would be very useful if the admin staff were packed into a smaller area there might be dissatisfaction. We need to be aware of that in the planning stage.

The new NHS initiative that from November most patients are able to see consultation notes written by the doctor was presented. Patients were concerned about how this might harm people with mental health problems. And asked about the strategies we have in place to protect people or make sure that the doctor’s notes remained confidential. The plans that they can only viewed when someone is competent to view them were discussed. This will be a massive new workload on us all .Records now need to be screened to consider someone’s mental state at the time and anything that might be damaging to someone who is going through a mental health crisis might need to be temporarily redacted. It was also noted that even when that work is done, when people change doctors or their health changes, it has to be done again. It was felt in general, with the crisis and pressures on general practice at the moment, this new initiative is unnecessary. NB said that we always strive for openness and it has always been true that if anyone made a direct request for their medical records, it was always available to them.

Other services that had developed since COVID. We run in conjunction with other practices by a link up called the Wandle primary care Network. With this link up, we are able to provide paramedics to visit people at home. Pharmacists to ensure prescribing safety. Extra nursing staff.  A specialist paediatric clinic. A care coordinator (someone to help people with chronic conditions to book their appointments) A Social prescriber (someone who helps with benefits and housing issues) .Extra counselling staff. And special clinics such as a BP Clinic for people who may have had high blood pressure in the past but have been lost to follow up and people with COPD, who’s Spirometry had lapsed during lockdown. PCN is giving us training in a number of areas. We work together to address any local issues. It was thanks to the PCN that we had a local coving clinic during the lockdown, for example.

The ending remarks from the patient group was that they were happy with the practice and very happy with the services they can access. They felt the practice was well managed, but we will need to be alert to keep on top of the increasing pressures, both from the expanding list and from the pressures on the NHS.

Our next meeting will be in three months’ time. And NB will circulate dates and minutes prior to this.

Dr Bamford

22 October 22

Email to PPI group 17^th July 2020

Dear all,

A quick update as lockdown is easing and shielded patients can now venture out (but with strict social distancing). We are now calling some patients in for reviews and, although most of our work is on the phone, we are arranging to see some face to face. One problem with this has been congestion outside the practice and communication though our intercom is difficult and can be seen as unfriendly. There was at last one social media post that commented on this. Today we have had installed a screen for the reception which will be a great help, although we are still learning new ways of working. A photo is attached.

We expect things to further ease in August and we should be offering a wider range of services then. If you have become overdue an annual review, for example a cardiac, chest or diabetes review, hold on until we contact you, although if you have problems phone us.

All the best

Neil

Dr Bamford

Well done Neil and all the staff in the centre. Apart from being safer for everyone it also looks good.

Best wishes

J

Sent from my iPad

24^th January 2019

Attendees: SS, PW, JB, WP, IS, JR, HA, MA, NI,

Dr N Bamford, Dr D Gordon, K Pace (Practice Manager)

Matters arising

At our last meeting in September it was announced that Dr Gordon would retire in April 2019.  Dr Gordon will not be retiring in April 2019.  His plan is to decrease his days and depending on how it goes he may retire in April 2020.

Representation for our patient group

It is good to see some new faces at our meeting tonight but how do we appeal to a wider audience?  Are there any patients that we are not representing or listening to? 

KP spoke to some of the mother’s that came into the baby clinic and asked them if they were interested in coming to the PPG meetings.  The general opinion was that 7pm in the evening is not a good time for them to attend our meetings.  If the meeting was held during the day they said they may be able to attend.  When they were asked what time would be convenient it ranged from 1pm – 2pm. 

PD said that St Andrews church is a popular venue for events and meetings and that maybe we would consider holding a meeting there but this raised the question that by holding a meeting in a church would put off people of certain faiths from attending?

Another idea was to advertise with a Lord Kitchener type of poster with the words ‘Your surgery needs you’

Reception area

NB said that someone who would like to come to our meeting who cannot attend today said that she finds the reception area does not run well.  Often there isn’t any one at the front desk and the staff are not very professional.  This patient would like to come in and observe and give some expert advice as she is a consultant in this area.

JB asked if the staff have had Customer Care training, KP said some but not all staff have had training and there is a rota for staff to sit at the front desk but there are times when the person at the desk is taking a sample to the collection point or looking for a prescription for a patient.

One patient said that because of the design of the reception area, staff cannot always see that there is a patient standing at the front desk and the patent cannot see the staff in the back office and there must be a solution to this problem and asked what happened to the bell that was once on the front desk?  Dr DG said that he had taken the bell away as it could become annoying when staff were busy on the phone and someone was constantly ringing the bell.

Dr NB asked if the group thought it would be a good idea to have a bell again but a couple of patients were strongly against the idea of having a bell again because it could be irritating for the staff.

NI suggested a light that is activated when a patient presents at the front desk. 

HA suggested that a glass arch should be made so as patients can see through into the back office on the phone and the staff can see the patients waiting at the front desk.

The group agreed that the Automated Arrival machine works very well.

Out of hours care

NB asked the group if they were aware of or if they have used one of the online doctor websites or apps, as there is a plethora of online GPs available the group were not very familiar with them.  

Do we need to be alarmed with regards to our list size diminishing due to signing up to online GP service?  It is used by the younger patient population and it is not so good if you have multiple health problems, so at this stage we don’t think we have anything to worry about.

A patient told us that he read that in Wandsworth 3000 people have signed up with the various online GPs and he asked if we had many patients leaving our surgery to sign up them.  We have had patients sign up with the online GPs but not many.  The patient does not always realise that when they sign up to the online apps they are often de-registered from their usual GP practice. 

Another patient said that he chooses to see the same GP at the surgery

NB said that there have been cases of patients being mis-diagnosed and inappropriate prescriptions for antibiotics being given out by the online GPs

111 are very good at giving advice and sign posting patients to the appropriate level of care and are available 24 hours a day, 7 days a week.

EMIS Access

There has been a campaign for the last few years for patients to access their local GP services online. It has become popular with patients as it is convenient to use on the move however, as we touched on when discussing Out of Hours care, there are many GP apps available to the public and leaves patients confused as to which one to sign up to. Our surgery promotes EMIS access as it offers more than just booking appointments.  You can access parts of your medical records such as test results, current medications and you can order repeat medications. 

Telephone consultations

The doctors handle many phone telephone calls from patients each day.  They are often requested when there are no available appointments on the day but now they are used as an alternative  to an appointment as they can be more convenient for the patient.  We have had to cap the number of calls that the salaried doctors receive each day as there can be as on occasions there can be as many as 20 calls for one doctor. 

A suggestion was to filter the calls but this would be very difficult to assess and overall the Telephone consultation service works well.

Walk-in clinic for sick babies and children up to 5 years old

Dr Salim has been running the Sick baby clinic for a number of years now and it is very popular with the parents.  We are not aware of any other surgery in Wandsworth or indeed anywhere else that offers a Walk-in clinic for sick babies and children.

We have had complaints in the past from patients regarding the noise and sometimes unruliness in the waiting room.  The clinic is a ‘walk-in’ clinic based on first come, first served and it runs between 10 -11am. 

Dr NB asked the group their thoughts on the clinic work,  would you like to see an appointment only system?

One member of the group who has used the Baby clinic said that it works very well for her as there is a window of one hour to attend the clinic and if it were to become by appointment only you can often be running late when your child is unwell which could mean you turn up late for your appointment and she said that Dr Salim sees many babies and children each day and is very quick.  The overall view was that the clinic is running well and attempting to change it may backfire as it is running sufficiently.

Arranging special health events for some of the Patient group meetings and inviting clinicians to host them.

We discussed arranging health events for patients with conditions such as diabetes, asthma, arthritis and Lifestyle and Healthy living and to have a clinician to host them. The questions were, how will we advertise it, where will we advertise it, and how we will guage how many people to expect?  It was suggested that events could be held in ST Andrews Church and one of the patient group is the Diabetes champion for Wandsworth and could assist with the preparation of a diabetes event.  We could advertise via our local pharmacies.

Should these events be aimed at newly diagnosed patients who would probably be more receptive? 

We decided to go ahead and organise an event and see how it takes off. 

AOB

Disabled Access

Dr NB applied for some funding for better access for the disabled but had applied too late in 2018.  He was advised to apply again in 2019 for help with the financing of this project.

Wi-Fi

 All Wandsworth Practices will be having a faster broadband service installed in their practice before the end of March 2019.  It will cover all areas of the surgery including the waiting room.  The group were in intrigued to know why this would include the waiting room as there are posters requesting patients not to use their phones in there.

KP said that although we request patients not to talk on their mobiles in the waiting room, they can use their phones to access the internet.

Next meeting TBC

24^th October 2019

Attendees: JB, ST, IS, HA, MA, BP, TS, PD, PW, JR

Apologies: JR

Primary Care Network

The Primary Care Network (PCN) is in its infancy and is generating lots of shared work.

Social Prescriber

In September this year the practices that are part of our PCN have recruited a Social prescriber who comes in once a week to see patients who have been referred by the GP.  Although he has fully booked there are a lot of missed appointments which is frustrating.

The role of a Social Prescriber is to connect people to the community, for example, signposting people who have been diagnosed with Dementia to local Dementia support groups.  The Social Prescriber will do an assessment to find out what care and support the individual will need. 

Once he has settled in he will need to work out where the demand is.

We need to promote his services within the practice such as on the notice boards or on the website.

A high level IT advisor for the PCN has been appointed and a pharmacist is in the pipeline.

Cancer death rates in the UK are higher than other EU countries. The PCN is planning to do some work around this and will be looking at poor or cancer screening.  It will involve a lot of work.

Care Quality Commissioners, CQC

We had our Annual Regulatory review on Thursday 17^th October and they touched on two clinical areas where we are not performing as well as we should. We are not reaching our targets in Diabetes management, prevalence is 2.9% but it should be 3%.  We need to have a plan to improve and discussed this at our practice meeting earlier.

The other clinical area where we are not doing well is prescribing of anti-biotics we are above our CCG average and again we need to improve to fall in line with our CCG average.

We realise that we are falling behind as it is easier to get an appointment with a GP than it is a practice nurse.

The PPG members were not asked for any input as they were in 2016 when the CQC visited the practice.

One of our members told the group that on the first Saturday in December the council will be opening a pop up shop and he will disseminate some leaflets to promote it.

High Risk Drug Monitoring HRDM

Patients who suffer with Rheumatoid Arthritis and are taking medications such as Methotrexate, Sulfasalazine, leflunomide and Minocycline need regular blood monitoring as although Disease-Modifying Anti-Rheumatic Drugs, (DMARDs) will decrease the pain and inflammation they also bring side effects that can be serious.

This is why regular blood monitoring is essential but not all patients comply with having regular blood tests and those patients who are under the care of the hospital, blood tests results are not always available for the GP when requesting prescriptions.  Prescribing medications without recent blood markers is risky.

Dr Bamford asked the group and they suggested that the GPs stick to their guns when it comes to this and a solution may be a booklet to record the results of the test and when requesting medication they take the record book along to the GP.  This would be on same principal as when prescribing Warfarin and Lithium to ensure safe prescribing.

KP to order DMARD record booklets.

SMS messaging

The group asked if there are too many messages being sent such as appointment booking, results and surveys.  Not all phones are equipped to take long messages as not everyone has an android phone. This is why it is important for patients to have a choice on how they communicate.

Test results

The group said that test results are not uniformed within the practice. Some GPs wait until they receive all of the results before they message the patient and other GPs send out individual results as and when they receive them which can be confusing for the patient. Dr Bamford said that he puts as much information in the text message as possible.  If a result comes back and it is within a normal range or nothing serious a text message would be sent to the patient with something along the lines of ‘Your results are normal there is no need for treatment’. The group said that they did not like it when there is no response at all.

If it is positive result the GP would phone the patient.  Dr Bamford will raise this at a clinical meeting with his peers.

Availability of drugs

There are certain drugs that are currently unavailable and have been taken off the market this has meant ‘drug switches’ some businesses could be speculating on Brexit and stockpiling causing shortages.

A member of the group said that he has experienced drug switches and has had no communication as to why this has happened. Dr Bamford said that although these decisions are made at a higher level by the CCG, he agreed that patients should be informed when enforced switches are made.

A member of the group asked why he can only order 1 month’s supply of Gabapentin.  Dr Bamford said that Gabapentin has been reclassified as class C controlled drug because there have been a rising number of fatalities as it is being used illegally.

LED message board

One of our patients suggested having a message on the LED screen prompting patients to look at the message boards.

New members of staff

We have recruited two new receptionists/admin staff who have been here since October.  We have had some very positive feedback from patients already, including a member of the patient group regarding customer service and commending him on the revamp of the poster displays in the waiting room.

Next meeting January 2020

23^rd April 2018

Attendees: JR, PD, VL, PD, AM, HF, BP  

Dr Bamford K Pace (PM)

New Salaried GP

Dr. NB announced to the group the arrival of a new salaried GP Dr. Langdon who started with us in March.  Dr. Langdon is one of three salaried GPs at the surgery. 

Pharmacist

There was a national pilot that started around 5 years ago to introduce pharmacists into primary care settings   James Payne a clinical pharmacist who started with us in November 2017.  James works with us on Monday and Friday.  He came to us with a wealth of experience and his day to day duties include minor ailment treatment, medication reviews, sign off prescriptions and seeing patients face-to-face in clinics for hypertension helping to lower their blood pressure and diabetic clinics and referring patients for blood tests.

 The pharmacist consultations will be for longer than the average appointment with a GP whereby more can be covered in the appointment and this will be beneficial to the patient.  

JP shared with the group the many different aspects of his role including, prescription management which involves medication reviews with the patient,  reconciliation of medicines in outpatient and discharges letters, conducting clinical audits,  Medicine management, working alongside GPS to manage practice formularies to improve the choice and the clinical effectiveness of medicines.

Physician Associates

The Physician Associates (PA’s) have been at the practice for 1 year out of their two-year placement under the supervision of Dr. Bamford.  The students attend class 4 days a week and the surgery one day a week.  One student was previously a paramedic and both are well qualified before becoming PAs.   They see patients face-to-face for longer than the average appointment time,  such as poorly controlled diabetics and they too have longer than the average time for appointments and can gather a lot of useful information that is difficult to do in a 10-minute appointment.

Patients were concerned that if they book an appointment with a PA it may be a waste of an appointment, if the PA then says that this is something for your GP, please re-book and they are also concerned that rather than being able to book an appointment to see your GP that you will be booked to see a PA which is seen to be downgrading.    Dr. Bamford thinks there is a niche for them in the surgery and would like to keep a PA on after the two-year placement is up.

Flu Season 2017/18

KP said that the overall flu vaccination uptake for 2017/18 was 60.8%.  The pharmacies are also offering flu vaccines and in 2017/18 they received their vaccines a couple of weeks before we did and many of our patients had their vaccines administered at the pharmacy making it difficult to meet our target of 75%. 

JP explained that what patients are not always aware of is that the vaccine given at the pharmacy is trivalent which has a valency of 3 and the flu vaccination which the Earlsfield practice was giving was a quadrivalent which is more effective.

Courtyard

It was agreed at the last patient’s meeting to use Easy grass to lay the astroturf in the courtyard.  We had to wait for the winter to pass as the ground was too hard for it to be dug over.  So, I am making arrangements for it to be started in May and it will have to be done at the weekend and not during the week when there are lots of patients in the waiting room. 

Landlords

At the last patient meeting, we had discussed the prospect of becoming a dispensing pharmacy at the request of the Landlords and despite the overall consensus not to have a pharmacy attached to the practice, landlords have raised the question again. 

• The group cannot understand the need for a pharmacy attached to the practice as there is not one but two local pharmacies literally around the corner and across the road.  
• We could end up losing both of the local pharmacies as it is not guaranteed that the local pharmacies would win the bid.
• Restricted stock – there would not be as much stock as there is currently at the two pharmacies.
• Where is the space to accommodate the pharmacy – would it mean losing some of the waiting room space which is much needed?
• We must take into account of all the upheaval it would cause to our patients and staff alike.

General Data Protection Regulation GDPR

The EU General Data Protection Regulation (GDPR) replaces the Data Protection Directive and was designed to harmonize data privacy laws across Europe, to protect and empower all EU citizens data privacy and to reshape the way organizations across the region approach data privacy.  We do not know exactly how it will affect the NHS but we will know more soon as there is an awareness workshop that the WCCG are hosting and KP will attend at the end of the week and it should all be clear then as there is lots of speculation at the moment.  The BMA is looking over the new regulation and there may be amendments in the policy if it is not practical within the NHS. 

AOB

It was suggested that the surgery needs easily accessible door openers for wheelchair users, especially the door leading to the waiting room. 

Next meeting tbc

11^th September 2018

Attendees: VL, PD, PW, TS, VB, ST, JR

Dr Neil Bamford, Karen Pace (PM)

Matters arising

At the last meeting, we announced the arrival of a new GP, Dr Langdon who joined the surgery in March.  We now have another new GP, Dr Jayanthan who is working as a long-term locum with a view to becoming a salaried GP.  Currently, we are fully staffed with clinicians.  This is good news as in April at the last patient meeting the prospect of employing a new doctor was looking bleak.

Courtyard

The courtyard was refurbished in August this year and this is the first opportunity for the patient group to take a look at it.  They were very impressed with the fresh new look and the colour scheme. 

In the spring VL said that we will buy some big terracotta plant pots and plant some spring flowers to decorate the courtyard.

Landlords

Dr NB said that it has gone quiet as far as the on-site pharmacy proposal made by the landlords earlier this year.  An extract of the minutes from our previous meeting was presented to the landlords showing patients were not in favour. 

Easy Access

 At one of our previous patient meetings, the subject of wider doors for easy access for wheelchair and prams was discussed.   KP did not get round to making inquiries but Dr NB said that he will find out if we apply for an improvement grant from NHS England.

Dr Gordon’s retirement

Dr Gordon, the senior partner is planning on retiring next April.  Dr Chittilappilly has accepted a partnership for when Dr Gordon retires.

Receptionist retirement

One of our long-standing receptionists (Brenda) retired in August, she had worked at the Earlsfield Practice for 26 years.  We are now advertising for a new receptionist to replace her.

New Administrator

We have employed a new administrator named Mary who was once a Practice Manager, she has a wealth of knowledge and experience of general practice and she is working with us two days a week.

Flu season 2018/19

Our flu clinic is taking place later than usual this year, it will be held at the beginning of October.

Smear clinic

We are offering Saturday morning smear test appointments for patients who cannot find it difficult to attend during the week.  Our patient uptake for smear tests is already very good at 80 % but we want to maintain a high percentage and we would like to see if Saturday clinics increase the uptake and benefit our patients.

Next meeting

December 2018

12^th October 2017

Attendees: JR, PI, PD, AM, PW, VB, VL, TS,

Dr D Gordon, Dr N Bamford, K Pace (PM)

Previous minutes and matters arising

Minutes were correct as of previous meeting on 6^th July.

In-house Pharmacy at the Earlsfield Practice

Dr. Gordon told the group that the surgeries Landlords were proposing to put a pharmacy on the premises which would mean that there would be some disruption to the surgery during the building process but without going into the complexities what did the group think?

The patients asked why we need a pharmacy on the premises when there are two local pharmacies on Garratt Lane, they could understand if we were located in the suburbs and pharmacies were far and few between.  Dr. Gordon said that the landlords would consult with the two local pharmacies and offer the opportunity of relocating to one of them. 

The group could not see what benefits there would be to either the practice or the patient.

Dr. Gordon will keep the group posted.

Recruitment

Dr. Bamford started by saying how difficult the recruiting of GPs has become. If we were a teaching practice we would be at an advantage as we would have an attachment to registrar’s when they have passed out of medical school. 

After dear Dr. Lowe resigned in August we have been trying to replace her sessions.  Nationally, this is an ongoing problem for surgeries looking to recruit more doctors. We have advertised locally and with a couple of high profile recruitment agencies, BMJ and the Pulse the response has been slow but we have been contacted by a couple of doctors who are interested in a salaried post.   The partners will be interviewing in the next two weeks.

Clinical Pharmacist

Our practice, along with the Brocklebank Group practice, have jointly recruited a clinical pharmacist.  The pharmacist will work at our practice for two days a week and will work closely with the GP team looking at medications of patients with Long Term Conditions (LTC).  Helping patients who have had medication changes at the hospital understand the changes and making sure they are working well for them.  He will also be doing analytical work such and clinical audits. 

Physician Associates

Dr. Bamford told the group about the two Physician Associates (PAs) who have started 2-year student placements at the surgery.  Originally it was going to be one PA but we have taken on two students.  One of the PAs was a paramedic and the other was a Healthcare Assistant.  They have a biomedical science degree and are undertaking a second degree to become a PA.  Eventually, they will be qualified to perform triage, home visits and run surgeries but for now, they are sitting in Dr. Bamford’s consultations. 

The patient group overall were not convinced about the role the PAs will have.  Some members of the group were skeptical.  Although Dr Bamford assured the group that they would be closely supervised and he will have overall responsibility throughout their time with the surgery.

The reservations of the group are as follows:

• underqualified  – different levels of competency
• prescribing without a GP
• more work for the GPs as the PAs would be referring to the GP’s for advice.
• concerns that as time goes on, appointments will be with the PAs rather than your GP

Dr. Bamford said that he will find out more regarding the role of the Physician Associate within the Primary Care setting. 

Courtyard

Quote 1

We have received 3 quotations to makeover the courtyard. All 3 were quotes to lay synthetic grass.

The first quote to quote included, Astroturf, raised beds and tubs to be installed, trellis planted with climbers and mural artwork on the wall.

The overall cost for this project is £6,892.00

Quote 2

This quote is for ground works to prepare for the artificial grass. 

The overall cost is £3,9040.00.

Quote 3

This quotation includes cutting back the ivy and preparing and laying the artificial grass.

Depending on which grade of grass we choose it will cost between £2950 – £3250 + VAT.

The idea of the mural was not very popular amongst the group and to bear in mind there would be a maintenance fee on top for quote 1 for the upkeep of the plants.

The group agreed that taking into consideration that the property does not belong to the partners and that the makeover is to make it look more pleasing to the eye, the surgery should go with the cheapest quote as Mrs. Bell and Mrs. Lambert have offered to paint the wall to help keep the cost down.  Mrs. Lambert suggested doing one thing at a time as to not overspend and to invest in resilient labour saving plants as painting the wall and laying the grass will be a vast improvement.  It was also suggested that we negotiate a better price for quote 3 as it seems too much.

Karen will call up the company to see what they can come up with.

AOB

At the last meeting, it was suggested that a poster asking for the public to give priority to those who are in need of the high seated chairs was displayed on the wall in the waiting room but it does not seem to be there.

Karen will check as there was a poster put up after the last patient meeting.

Next meeting

January 2018

06^th July 2017

Attendees: HF, SS, TS, JR, PW, PD

CQC final outcome

The initial outcome from our CQC report in July 2016 was that we were deemed ‘Unsafe’ in five main categories and this was more to do with the Trinity Road branch surgery rather than the Earlsfield Practice but the report lumped together the two surgeries and the report did not differentiate between the two. The partners were in no doubt that the Trinity Road Practice was the reason for the ‘unsafe’ decision.

It led to the decision of whether to refurbish or to close the branch surgery.   There was a Public consultation with the patients who used the branch surgery and when everything was considered the decision was made to close down the Trinity Road surgery.  The CQC decided to amend the report upon the closure of the surgery and to our delight, we have now been validated as ‘Safe’ across the five areas.

Trinity Road Surgery closure

When it was decided to close the branch surgery permanently it was agreed that those with mobility problems would be offered a minicab to and from the surgery to the patient’s house.  It has been working successfully.

Summary Care Record’s (SCR’s)

Dr Bamford asked the group what they thought about hospitals holding details of patient’s medical records.  He went on to explain that a SCR is an electronic patient record, a summary of a National Health Service patient data base covering England.  The details include current medications, allergies and details of bad reactions to medications.  Overall the group said that it seemed to be a good idea but IT safety maybe an issue, such as the cyber-attack a couple of months ago that affected the NHS.

Physician Associate Student Placements

Physician Associates (PA’s) at St George’s Hospital are seeking to identify placements for their 2017 uptake.

Physician Associate students are trained to perform a number of roles including medical histories, performing examinations, diagnoses, analysing test results and developing management plans.  They will also be qualified to do Home Visits, run clinics and do Research and Audits in the practice.  The placement would take place over 2 years when the PA would be fully trained.

Dr Bamford asked the group what they thought about the prospect of the Earlsfield Practice taking on 2 (PA’s).

The group on the whole were skeptical and were concerned that this scheme was to fill the gap of the GP’s who are leaving the NHS and that this would basically result in downgrading the role of the GP and that when given the choice they would always prefer to see a doctor.  Other concerns were that it would be extra work for the GPs would be mentoring the PA and overall responsible for them.

Dr Bamford said that he would seek to find out much more about the Physician Associate Student Placements with caution before the next PPG meeting.   The group was told that Dr Gordon and Dr Salim were not convinced that this would work.

Recruiting a Practice Pharmacist

Our practice along with two other practices is considering recruiting a pharmacist to work as part of the general practice team.   One pharmacist would work between the 3 surgeries approximately 35,000 patients.

The idea is for the clinical pharmacist to resolve day-to-day medicine issues by means of consulting and treating patient’s directly.   As well as extra help to manage long term conditions, synchronizing patient’s medicines and auditing for reviews.  This will help manage demands on GP’s time.

Frequent Do Not Attenders DNA’s

Over the past 6 months we have been looking at the number of appointments that are wasted when patients do not cancel appointments that they no longer require.  KP produced a graph that showed the number of DNA’s and they were broken down into 3 categories, GP, Nurse, and Healthcare Assistant (HCA) and at the end of each month the number of DNA’s were counted.   The patient group was given a copy to look at and were astonished by the number DNA’s that the surgery had each month.

KP said that each day she has been calling patients who do not attend appointments as an awareness campaign informing them of the number of appointments that are wasted each month when patients do not cancel their appointments.

The group agreed that maybe some formal research into DNA’s could be done and that it may be worth contacting the Kingsfund Charity who undertake research and analysis.

Dr Roach

Dr Bamford gave the sad news of the passing of Dr Roach who had served the community for over 30 years.    Dr Roach suffered from Alzheimer’s disease towards the end of her life.

Dr Bamford and the patient group thought that a plaque would be befitting for all her years at the surgery.

Patient Online Access Fund 2016/17

The Earlsfield Practice reached the targets set in Wandle and Wandsworth localities and won awards for Appointments bookable online, live users and Electronic Prescription Service (EPS).  Lyn Crawford is the Earlsfield Practice ‘champion’ who has been dedicated to promoting these services to Patient’s she was also chosen to promote online patient access in a video available  to see on YouTube.

IPlato is a new messaging service for appointment reminders and health promotion that Wandsworth clinical Care Group has procured which includes a Patient Facing service called MyGP

AoB

Since the tragic events of the Grenfell disaster it has provoked the thoughts of everyone into the safety of their surroundings whether it is their home or a public building that they use and the group mentioned fire safety in the surgery.

I received a letter from our Landlords explaining that they have appointed Health & Safety Consultants to investigate regarding Cladding safety checks to minimise risk to properties in the Primary Health Properties portfolio.  Our building does not have cladding but we will undertake an immediate review of our existing fire risk assessments

High seated chairs in the waiting room

A member of the patient group pointed out that the chairs that are specifically for senior citizens use are being used by all patients and often patients who need the high seated chairs cannot use them.  He suggested that we put a notice by the chairs, similar to the ones on London transport asking people to keep them free for people who need them.

The courtyard

Dr Bamford bumped in to the founder of the New Leaf Educational Gardens (NLEG) who are a non-profit community group for the long-term unemployed who will come to have a look to see what can be done to make the most of our little garden off of the waiting room when Dr Bamford returns from his holiday.

Between Mrs Bell and the (NLEG) we should see a vast improvement by 2018.

Next meeting October 2017

12^th January 2017

Attendees: BP, SS, TS, JR, JB, VL, PD, VB

Dr Bamford, Lyn Crawford (Receptionist/Administrator) Karen Pace (Practice Manager)

Matters arising from last meeting

The invitation to Balham Park surgery’s patient meeting has been postponed due to the deputy Practice Manager leaving.  Once the new manager has had time to settle in I will contact her to arrange a joint meeting.

Flu vaccinations

This year we have had a good uptake with the flu vaccinations including the children’s fluenz vaccines.  We are on course to meet our targets.

Job Share

We have two doctors who will be joining the practice on a permanent basis, Dr Bruce Websdale and Dr Michelle Durham who will be covering 6 sessions per week.

SELDOC

The Out of Hours care in SW London (Care UK) have been taken over by SELDOC, Dr Bamford asked if any of the patients have used this service since the change but no one in the group has used this service recently.

Patient Participation Group

The Earlsfield Practice is looking to recruit some new patients to become involved with our patient group.   We will canvas the mums who bring their children in to the sick baby clinic to come along in order to add some diversity to the meetings.

CQC report

Dr Bamford asked the group if they had and comments regarding the CQC report.

The patients agreed that the comments in the report were ambiguous as to where we not safe.  Dr Bamford went on to say that we think that those comments apply to the Trinity Road surgery but the report does not make this distinction as it could apply to the Earlsfield Practice. 

To refurbish the Trinity Road surgery it would cost in excess of £200.000 and this would not be cost effective.  We could apply for individual pots of funding to cover some of the costs of the refurbishment but this would be time consuming and there is no guarantee it would prevent the surgery from being deemed unsafe.

It would not be easy for some of the patients who use the Trinity Road surgery to travel to the Earlsfield Practice as there is not a bus that runs directly to Earlsfield.  Two bus rides would be needed to get from Trinity Road to Earlsfield.  It was suggested that for those patients who genuinely find it difficult to travel to the Earlsfield practice for an appointment to have transport arranged for them.  Patients who use this service would be on a register which would be routinely reviewed. 

One of the advantages of the closure of the surgery would be that the GPs would not have to travel to and from Trinity Road and this would mean that they could see more patients at the Earlsfield Practice.

There are surgeries at either end of Trinity Road for those patients who would prefer to be registered with a practice closer to Trinity Road. 

The future of the Trinity Road Branch surgery

Dr Bamford asked the group what their thoughts were on the closure of the Trinity Road branch surgery and the group said that having heard how much it would cost to make improvements to the building and how prolonged it could be they realize why a permanent closure may be inevitable.  They also understood that the patients who use the branch surgery would be opposed to the closure and that a meeting should take place for them to discuss their concerns.  Dr Bamford said that he has arranged a consultation on the future of the Trinity Road surgery to be held on 25th January where an open discussion can take place.

Jo, the Trinity Road receptionist will ring the patients to invite them to the meeting that will be held on 25th January.  Transport will be offered to those who would like to attend but who find it difficult to get to the Earlsfield Practice.

Infection Prevention control visit

The Earlsfield Practice had an Infection Prevention control audit in November 2016 and we scored 99%.  We will have to conform to the recommendations made at the time of the inspection.  

The horizontal blinds will have to be replaced with vertical blinds within the next two years.

The tiles at the back of the sinks in the clinical rooms will need replaced with a smooth and easy to clean splash-back panel

There are some chairs in the clinical rooms which will need to be either replaced or covered with impervious material.

One of the sinks has a swan neck tap, this will need replacing to comply with Health building requirements.

Waiting room

The playhouse tomato that was in the children’s corner for a number of years has now been dismantled and taken away and will not be replaced and although it was popular with the children, patients had complained about the noise in the waiting room when the children were clambering on it. 

Our group said that the waiting room looks sparse, although it is looking much better now that we have fewer posters over the walls on the advice of our patient group.

Any suggestions will be welcomed as to how to we can give the waiting a makeover.

It was suggested that instead of the Life Channel TV that is currently in the waiting room, we could have a TV with a news channel instead.

The garden next to the waiting room

The little garden area off of the waiting room in the main surgery is in need of some care and attention.

Janet Bell and Viola Lambert kindly volunteered to do some gardening in the springtime. 

Patient Online Services

Lyn explained to the group that our practice is above the national and regional average for signing up patients to the On-line services (POL). Having on-line access gives the patient more choice in accessing patient services, these include, Booking and cancelling appointments with the GP, renewing prescriptions and accessing parts of your medical records.  

Patients who have signed up to access their medical records online are at 51% we need to increase this by 1% (115) patients to meet our targets, by 31^st March 2017.

Electronic Prescription Service (EPS)

If you collect your repeat prescriptions from your GP you will not have to visit your GP practice to pick up your paper prescription. Instead, your GP will send it electronically to the place you choose, saving you time. You will have more choice about where to get your medicines from because they can be collected from a pharmacy near to where you live, work or shop. You may not have to wait as long at the pharmacy as there will be time for your repeat prescriptions to be ready before you arrive.

We are currently at 81% and our target is 80%.

Receiving new patient’s records in electronically the national average is 65% and we are at 95%.

Overall we are doing very well but we would like to get more patients on board as online access is a very convenient as there is an App that can be used on your mobile phone.

The next meeting will be on 25^th January at 1pm for patients who use the Trinity Road branch surgery.

The next Patient Group meeting tbc

22^nd September 2016

Attendees: VL, PW, DC, PD, JR, T S,

Dr Neil Bamford, Karen Pace, Practice Manager

Matters arising from previous meeting – none.

CQC Inspection

We have not received the CQC report since having the inspection in early July and therefore cannot discuss the outcome of the report at this meeting.  It was suggested that if there were recommendations in the report the group would reconvene to discuss matters.

Patient Group meeting at Balham Park surgery

KP asked Practice Manager’s how surgeries structured their patient meetings and how often they met.   It varied between practices as to how often meetings are held.   Often there will be speakers at the meetings, including doctors talking about a chosen subject.

Siobhan Moriaty, deputy practice manager at Balham Park Surgery invited members of local PPI groups to join their own patient group at one of their monthly meetings whereby the groups could share experiences and ideas.

KP to email Siobhan Moriaty re:  PPG meeting

Health & Social Care Coordinator

Surgeries across Wandsworth are appointing Health & Social Care Coordinators.  The aim of this is to build on the positive relationships between Community Adult Services (CAHS) ensuring patients better access to care in the community.

Our practice has nominated a member of staff to become a Health & Social Care Coordinator (HSCC) for our practice.   Coral is currently attending a training course to gain an understanding of what the role entails and how to manage the administration and organisation for this cohort of patients, who have complex health and/or social needs and are vulnerable to sudden deterioration but with careful planning including good coordination of care can be managed safely in the community.   The HSCC will be the first point of contact for patients, carers and health professionals

At present a lot of time is spent by the GPs chasing up referrals and organising appointments with CAHS.   Once Coral has finished the training to become a health & social care coordinator she will work alongside CAHS ensuring appointments and access to care has been organised and help provide a joined up approach, freeing up GPs from admin and phone calls.    The role involves

Building a rapport with the patients and their carer’s as the HSCC will be their first point of contact.

Influenza Vaccination 2016/17

It’s that time of year again!

We are now giving the flu vaccination to adults who are eligible.  We are expecting a delivery of the children’s intranasal spray at the end of September.  We will be vaccinating children between the ages of 2 and 4 years old.

Salaried Job share/GP post

We have a new salaried GP, Dr Durham who is here for two sessions on Fridays.  We may have another GP who is interested in becoming a salaried GP doing up to 4 sessions per week.

Dr Bamford explained to the group that general practice can be extremely busy and highly pressured environment and finding the right person who is up to the challenge is not easy which is why he thinks it is sensible to continue to seek a suitable candidate as this may take some time to achieve.

Emis Access Online services

Some patients say that they find EMIS access is not very user friendly and quite ‘clunky’ to navigate around and on the other hand others find it really easy to use.   The feedback has been that overall our patients find the portal very easy to access.   It has to be a very secure portal for obvious reasons and maybe that is why it can be cumbersome to use.  If our patients are having difficulties trying to access the system or for any reason please, let us know and we will be happy to see what the problem is and get you up and running.  Often the problem with logging on to the system is because patients need to activate their account within 48 hours of signing up.

Out of Hours provider Care UK

NHS 111 and Out of Hours providers will be transferring to South London Doctors Urgent Care (SLDOC) on 28^th September 2016.

Guest Speaker

Mr DC, Recovery Consultant

Next meeting TBC

20^th April 2016

Attendees: ST, JB, JR, TS, PD, PW

Dr N Bamford, K Pace Practice Manager

Matters from the last meeting arising.

None

Dr NB presented a letter from a patient who commented on how laborious it is to navigate around the website, especially to fill in forms on it. 

Unfortunately the practice has no control over the software or network (N3 network security). It is a very large network with over 1,000.000 end users and is built on its robust security measures to protect patient data but the downside can be that it is arduous to use.

New phone system

At last the upgrade to our telephone system has been completed. 

There are new features that allow call queuing and the caller will be informed of where they are in the queue.

Call recording will enable us to record and assess interactions between staff and callers. This process is used for staff training and development, 

The nurse line for test results is active between 12.00-1pm daily.

Waiting room

Mrs Bell has kindly offered to refresh our posters and leaflets in the waiting room in the autumn and her help will be very much appreciated. 

Flu invitations 2015

The feedback is that the flu invites were not very successful in 2015 as patients either did not receive an invite or the invite was very late in reaching them. 

The plan for flu invitations in 2015/16 was to send SMS messages to patients via their mobile phone and for those who did not respond a phone call would ensue.  If the patient only had a landline number we would phone them and only as a last resort a letter would be sent out. 

We will review the flu recall system for 2016/17 to ensure patients receive their invites in good time.

PPG’s

Patient Participation group members are on the increase on the whole and as with all patient groups the Earlsfield practice is always looking to recruit new members to ensure a representative group.  We discussed how we can appeal for new members for the group.  

Recruitment of Salaried GPs

As the patient group is well aware there is a national shortage of GPs.  The Earlsfield Practice has been adverting for a salaried GP for some time now and continues to do so.   There has not been a great response to the adverts so far.

Patient Online services

Patients registered at the Earlsfield practice have been able to access various services online since 2012 such as booking appointments, ordering prescriptions and viewing parts of their medical records including medication and allergies.   

Now patients will be able to access more of their medical records, including illnesses, immunisations and test results.  These can be accessed any time, day or night without the need to print them off,

The security is very similar to online banking. In most cases, you need to register in person and with a photo ID at your GP surgery to get started, you’ll then set a personal password and PIN. It is your responsibility to look after and protect your own login details.

Practices are being urged by NHS England to offer 70% of appointments online. The practice already offers 40% of appointments online and will try again  to offer healthcare assistants (HCA) and nurse slots online as some appointments will take 10 minutes and other require longer appointment times.

The patient group agreed to the practice offering more online availability of appointments to reach the 70% target set by NHSE whilst remembering that some patients preferred method is contact by the telephone. 

Diabetic Retinal screening

The diabetic retinal screening is no longer hosted at St Georges Hospital but it is working well over at venues over 4 boroughs.

Guest speaker

It was suggested that would be a good idea to invite a guest speaker along to the next PPG meeting and invite other patient groups to ensure a good turnout. 

Maybe one of the ‘Seldom heard’ groups could be invited for instance, homeless people or substance misusers.

AOB

Wandsworth Hub

The patient group were interested in finding out what the Wandsworth Hub is about.

The Wandsworth Wellbeing Hub can put people in touch with support services, self-help groups and activities available in the local community. 

Please click on the link below for more information about the Hub.

http://www.wandsworthccg.nhs.uk/localservices/Wandsworth%20Hub/_vti_bin/spsdisco.aspx

Next meeting:

September 2016

8^th December 2015

Attendees: PD, JB, TS, NW, SS, NB, PW, ST, JB, KP, NB, JR, DC, LG, VL

1. Matters arising from minutes. There was uncertainty about email communication. It was noted there was no email address on the web site. Not every email address seemed to be being checked regularly. Discussion about appropriate use of emails and risk of being overloaded. There was concern that urgent queries might be placed and so there should be a warning that this was not the appropriate route for these. Difficulty navigating between emis patient access and our website. Could there be a link between them
2. Minutes accepted but apologies were incomplete and updated.
3. Flood at St Georges discussed with reference to real life documentaries from GP practices and A&E. If we were to do this the patient group would want to be consulted first.
4. Experience learnt from holding ultrasound and physiotherapy clinics.  This was welcomed but could we approach the companies to see if a wider range of ultrasound examinations could be offered. Likewise for physiotherapy, could this be expanded to shoulder, hip, knee etc.
5. The Counselling Service. This was discussed and contact details for IAPs, BWW and drug and alcohol services handed round. The in house practice counselling was discussed and it was confirmed funding was secured for this year and next year.
6. Changes to the Diabetes Retinal Screening Service. Concerns about this were discussed. There was uncertainly at present but the potential was for more responsive and local service in community hubs. The Diabetes champions programme, prevention of diabetes and the diabetes epidemic were discussed.
7. Patients groups. What other practices are doing. PD gave an overview on this and confirmed he was able to represented the Earlsfield Practice at Wandsworth wide and Wandle locality joint meetings   
8. Information leaflets. Comments were given on the suitability of leaflets we are handing out about reducing antibiotic prescribing. General consensus was that they were over complicate d or we were “preaching to the converted”. Much better for the doctor or nurse to explain the reasons for non or delayed prescribing clearly to the patient
9. Any other business.

• Presentation of posters and information in the waiting room was much improved. Ther were still room for further improvement and JB offered to help organise the information into themes. KP to speak with her about convenient time.
• Phones were still taking a long time to be answered at busy times. The new telephone software which is being installed in January should help with this – where you are in the queue etc.
• Text messaging. Over 65’s got reminders for their flu jabs but not diabetes or other risk groups seemingly. This could be improved next year.
• Increasing numbers. PW and JB offered to speak to patient in February to canvas membership of the group and increase awareness. Could they be contacted nearer the time

NJB 9 12 15

25^th August 2015

25^th August 2015

Attendees: PD, NB, BB, AF, SS, JR, LG, MB

Apologies: TS

New Website

NB asked the group if they had been on our newish website.  Not all of the group had been on the website but those who did gave their approval. 

JR asked if there would be updates such as when the flu vaccines would be available. NB said that the site needs updating regularly and that there are various updates to be done soon such as the flu clinic dates and the new vaccines that will be available in September.

PD said that he would like to receive updates and it would be useful to send out emails informing you of updates.

Closure of the Travel clinic

KP said that it had been almost two years since the Earlsfield practice had closed their travel clinic and our patients have not been inconvenienced by the closure as there are other Travel clinics in the area that provide travel vaccine and advice.

Online Access

Patients have been able to book appointments and order repeat prescriptions online for some time now.

It has recently been made possible for patients to access parts of their medical records online.  Patients need to make a formal application in order to access them by producing photo identification on request. 

A secure log-in and password will be generated for the applicant and should kept safe as any other password would be.

New Ultrasound service (Physiological Measurements Ltd)

PML is an ultrasound service that has been accredited by Wandsworth CCG to provide a community diagnostics service across the UK.  They support the local health network by allowing hospitals to use their scarce resources to look after more unwell patients while

PML provide a community service in local GP practices working in partnership with GP’s.

The partners at the decided to provide a clinical room for the ultrasound service at the Earlsfield Practice once a fortnight as it would cut down on waiting times and many types of scans could be done locally here at the surgery.

It did not start off without some teething problems, such as the particular Sonographer that carries out the ultrasound cannot do muscular skeletal scans and we were not informed of this until they had started running the first clinic at our practice.

To prevent our patients from being inconvenienced providing they agree, clinicians will refer our patients to PML but at another surgery within the Wandsworth locality. 

The feedback from patients has been positive as they find that once they have been referred they receive an appointment usually within two weeks and they would much prefer to come to the familiar surroundings of the surgery whenever possible. 

In House NHS Physiotherapy Service

We have recently been approached by an NHS physiotherapy service who would like to use a room at the surgery to deliver this service to our patients within 7-10 days of being referred by the doctor. 

The partners believe that having an In-house physiotherapist would also be beneficial to our patients. 

The quicker turnaround time from seeing the GP to being seen by the physiotherapist would hopefully reduce the number of patients failing to turn up for their appointments. The hospital physiotherapists report high rates of DNA’s (did not attends) and they believe that this is due to patients having to wait weeks, if not months before they can be seen by a physiotherapist.

The patient group agreed that the In house physiotherapy service seems like a good idea.

New phone system at St George’s Hospital

NB asked the group if they had used St George’s new phone system and if so, how did they find it?

A couple of patients from the group said that they had used it and one patient said when they left a message their call was returned within 24 hours. 

Earlsfield Practice email address

There are various email addresses attached to the Earlsfield Practice and they are used for different purposes. 

The email address for patients to use for non-urgent queries is as follows: 

[email protected]

Specialist services hosted at local surgeries

NB explained that surgeries in localities are offering specialist services such as Counselling, Substance misuse clinics and Children’s clinics run by experts.  

NB asked the group what their views were on holding a specialist service such as a diabetic clinic or a pain management clinic or any other disease area hosted by a specialist as there is a great need for information for like- minded people with the same problems.  The group thought that this was an excellent idea and agreed to give it a go and sign up with their contact details. 

It was suggested that leaflets were made available for patients travelling to different locations informing them of how to get there.

Antibiotics

NB explained to the group that there is a nationwide awareness campaign limit the amount of antibiotics being given to patients unless they are really needed.  Now that the winter is approaching and coughs and colds will be more widespread now is a good time to involve and support patients with information and guidance on this subject.

Bad experiences in the waiting room

NB asked the group to give some feedback on their waiting room experiences and some of the group said that when the baby clinic was running it could be quite noisy and some children were allowed to run up and down the waiting room and this could be quite disturbing.

KP handed out the leaflet that is given to parents and guardians using the Baby clinic that asks them to consider other patients who are in the waiting room at the same time the Baby clinic is running

The group approved of the wording on the leaflet.

Next meeting will be on 24^th November 2015

19^th February 2015

Attendees:  PD, JB, TS, JR, VB

Dr N Bamford, Karen Pace Practice Manager

Medical record storage:  Dr Bamford showed the group members the vault storage system that is now in place in the back office.

Update from the last meeting:  our new website is now up and running.  There are some items that are still a work in progress.  We have two members of staff who have been designing and inputting data on to the website. 

Travel clinic:   It has been almost one year ago that we stopped running the travel clinic at the surgery and we have found that we have far more nurse appointments to offer. 

Update on the District nurses:  At the time of this patient meeting I did not have any information with regards to the District nurses being re-located but I have since spoken to the District nurse’s locality manager and she has given me an up-date as to what is in the pipeline. 

The theory is that all district nurses will be based at one hub and this will be at Tudar Lodge in Southfields.  The move is expected to be around September 2015.  The team that we currently have at the Earlsfield practice will occasionally come to our surgery to use a computer to input and extract information of our patients. The nurses will not need a clinical room in which to do this. 

Sofas in the waiting room:  The two sofas that were in the waiting room for many years had developed holes in them and so had to be disposed of.  Dr Bamford asked the patient group if they thought it a good idea to buy two new sofas.   It was a unanimous no from the patient group as they thought that the seating that is in place of the old sofas is more than adequate and that it would be an extravagance to buy new sofas. 

On-line access to your medical records:  From 1^st April 2015, patients will have online access to the coded information in the GP records eg list of medications, allergies and adverse reactions.

Some practices have piloted patient online access to records, and found benefits in patients self-managing their health by having access to medical information. One example would be patients with chronic diseases having access to test results, eg in diabetes, with a self-management plan of when to see the GP. This can reduce workload by reducing the demand on GP time, while offering convenience and empowerment to patients.

Expanding surgery facilities: Our surgery has been approached byPhysiological measurements LTD who are accredited providers of Community Diagnostics and accredited by the CCG.   They would like to use one of the clinician’s rooms to provide Ultrasound services for our patients within the community. 

We have also been approached by a Physiotherapist asking if we have room availability.  When we put this to the patient group they thought that having these services at the practice would benefit our patients.

On-line Access:  KP was asked by the patient group, how many patients have signed up for the on-line booking service.  We have 11,196 patients in total and we have 4,818 patients who have signed up for the on-line booking service which is 40% of patients and still rising.

Friends and Family test:  The Friends and Family test (FFT) aims to provide a simple headline metric which, when combined with follow-up questions, can drive a culture of change of continuous recognition of good practice and potential improvements in the quality of care received by NHS patients and service users.

The Friends and Family test provides an opportunity for patients and users of the practice to give anonymous feedback with at least one follow-up comment within a free text box.

  Next meeting:  End of May 2015

15^th May 2014

Attendees:   JB SS ST AS NB LG Dr NB KP (PM)

Care data

Using information about the care you have received, enables those involved in providing care and health services to improve the quality of care and health services for all. The role of the Health and Social Care Information Centre (HSCIC) is to ensure that high quality information is used appropriately to improve patient care.

NHS England has therefore commissioned a program of work on behalf of the NHS, public health and social care services to address gaps in information. Our aim is to ensure that the best possible evidence is available to improve the quality of care for all.

It is important that the NHS can use this information to get a complete picture of what is happening across health and social care and to plan services according to what works best. The new system will provide joined-up information about the care received from all of the different parts of the health service, including hospitals and GP practices.

Your date of birth, full postcode, NHS Number and gender rather than your name will be used to link your records in a secure system, managed by the HSCIC. Once this information has been linked, a new record will be created. This new record will not contain information that identifies you. The type of information shared, and how it is shared, is controlled by law and strict confidentiality rules.

Sharing information about the care you have received helps us to understand the health needs of everyone and the quality of the treatment and care provided and reduce inequalities in the care provided. The new system will also provide information that will enable the public to hold the NHS to account and ensure that any unacceptable standards of care are identified as quickly as possible. Information will help to:

• find more effective ways of preventing, treating and managing illnesses
• make sure that any changes or improvements to services reflect the needs of the local patients
• understand who is most at risk of particular diseases and conditions, so those who can plan care can provide preventative services
• improve your understanding of the outcomes of care, giving you greater confidence in health and social care services
• identify who could be at risk of a condition or would benefit from a particular treatment
• make sure that the NHS organizations receive the correct payments for the services they provide
• improve the public’s understanding of the outcomes of care, giving them confidence in health and care services
• guide decisions about how to manage NHS resources so that they can best support the treatment and management of illness for all patients 

TIP

It is important that you read the leaflet Better information means better care (PDF, 2Mb) so that you understand how information in medical records can be used to improve the way that healthcare is delivered.

If you are happy for your information to be used then you do not need to do anything. But if you have concerns or if you do not want information that identifies you from being shared outside your GP practice, as described here, inform a member of staff at your practice. They will make a note of this in your medical record. This will prevent your information being used other than where necessary by law, such as in case of a public health emergency.

You will also be able to restrict the use of information held by other places you receive care from. However, this will not affect the care you receive.

You can change your mind at any time and as many times as you wish. Just inform your GP practice and ask them to record your wishes. 

Medical record storage

CQC compliant ie Fire proof lockable storage system.  Owners of the building want us to have a structural survey to ensure the concrete floor can take the weight of the rolling shelves.

Two new recruits

We now have 2 full time reception/admin staff.

CCG, CQRS,  

CCG there are a high turnover of staff moving from one role to another, this means that you constantly having to make enquiries as to who to contact.

Our locality Manager Claire Frampton is usually accessible.

CQRS There are still problems with the GPES system that extracts the data from practices.  Practice managers were asked to be patient with it for another year but as someone told them we had to be patient this year.  Cannot extract data on left or deceased patients.

7 day opening

NJ encouraged members to think collaboratively (Federation).  Issues around it are IT support, Pharmacy opening hours.  Only to be used as Urgent Care not normal working day – no phones?

Ahmet Ziya

Wands Carers centre Fri pm

GPs leaving

One GP is leaving the other is having a baby in August.  We have a new GP starting in June.

15^th May 2014

Attendees: NB, AS, JR, NW, SS, LG, VB, PD, JB, AB, ST

Matters arising from meeting in December 2013

Front desk

The re-design of the front desk is on hold as we will be re-locating the medical records from the boardroom into the reception area to a fire proof rolling system.   This will be a major manoeuvre.

Expiry dates on medication packs

In the Patient meeting held in September 2013 VB asked why the expiry dates on medication box were not clear and hard to read, we did not have the answer to his question at the meeting held on May 15^th but Dr NB made enquiries subsequently to our Community Pharmacist and her answer follows:

There are three main strands to managing this problem some are within our control but number 3 probably best answers the query:

1. At the point of dispensing- Pharmacies will have a standard operating procedure (SOP) for date checking of stock. This should ensure that all stock within the pharmacy has a reasonable shelf life and is regularly checked. Stock should be rotated to ensure that the product is given out with as much time left to expiry as possible. This is obviously longer with some products than others.

Any products that are due to expiry within the next 3 months (generally but this could vary by pharmacy), is marked as such by the use of coloured labels or elastic bands etc. If these are dispensed the patient should be counselled about the short date and has the right to ask for longer dated stock if required. So for example a product that is used when required may not be used by the expiry date whereas medication taken every day would be used within 1 month.

Therefore if there has been no mention of a short shelf life then it can be assumed there is at least 3 months left, in many cases it will be longer than a year.

2. Quantities prescribed- generally it is recommended that only 28 days or a maximum of 56 days of medication are prescribed. This reduces stock piling at home and should therefore reduce the risk of stock going out of date or not being rotated. In some cases where there is a very short shelf life quantities given would be less e.g. liquid specials.

3. The MHRA are responsible for legislation regulating product packaging and information in the UK.

The Patient Information Quality Unit is part of the Vigilance and Risk Management of Medicines (VRMM) Division. The Unit is responsible for policy and regulation of all types of product information.

Information to patients or consumers is provided on the label and, more recently, by patient information leaflets (PILs) – unless all the necessary information can be included on the label. All medicines in the UK have labels and/or PILs approved in line with Title V of Council Directive 2001/83/EC.

• The Unit assesses labels and PILs provided by the pharmaceutical industry for compliance with the Regulations (Directive 2001/83/EC). After assessment, and approval by the Unit, the pharmaceutical companies must use the registered labels and PILs in the packaging of their medicines. For further information please see Legislation and guidelines.
• The Unit responds to correspondence from members of the public received by Members of Parliament, the Health Minister and Secretary of State for Health regarding patient information and advises as appropriate.

There has been work ongoing to address the issue of similar packaging following a large number of dispensing errors where packaging has been a contributing factor. Therefore if errors and near misses where expired medications are being dispensed or taken then this would also led to a review. Patients are welcome to contact the MHRA direct to raise their concerns.

Medical Records filing system

As mentioned in our meeting in December, we will be relocating patient’s medical records from the boardroom downstairs into the back office to comply with the Care Quality Commissioning (CQC) regulations as where they are situated presently, although the room remains locked and secure it does not comply with fire proof regulations.  We have been told by the owners of the building that we need to get a structural surveyors report to say that the floor is strong enough to support the unit, even though there were medical records stored in the back office some years ago.  This is causing delay in the project going ahead.  When we do get the go ahead this will be a major project in the way that it will cause a lot of upheaval to the reception area as this will involve a complete re-arrangement of the back office. 

AS asked, although the storage complies with the fire proof regulations, is the system water proof?   We did not know the answer to the question at the time but I spoke to the design co-ordinator who told me that one side of the storage is not enclosed and it is not waterproof but does comply with CQC regulations and these storage systems are installed in many government buildings and hospitals.

Data Sharing

In the Patient meeting in December we talked about Data Sharing of patients medical records for research purposes whereby patients would need to opt out if they did not want their medical records data shared rather than to opt in.  We were aware that information explaining Data Sharing to the general public was not freely available and so decided that we would print out information leaflets and display them on the chairs in the waiting room so as patients can make an informed decision to opt out or opt in.  The staff are completely impartial when asked for advice as to whether to opt in or opt out but they do explain that it is not to be confused with Summary Care Records (SCR) it is agreed that more information is needed as Data Sharing may hinder information being shared across the NHS.

NB pointed out that the Data sharing leaflets were not displayed in the same way as at the Trinity Road Practice (displayed on seats).  I will ask the receptionist to put them out on the seats of the chairs to ensure maximum exposure.

Items on today’s agenda

PACT (Planning All Care Together)

Dr NB explained that the Wandsworth Commissioning Group (WCCG) is taking the commissioning helm at a very challenging time for the NHS, the population is ageing and there is an increasing demand for healthcare.  Improved diagnosis and treatment means more people are living with Long Term conditions (LTC). 

In order for patients to receive the best treatment and advice as to how they manage their conditions clinicians use a risk Assessment Tool that forecasts patients who will be at high risk of admissions into hospital. 

These patients are then divided up into cohorts such as Housebound, patients with one or more chronic diseases and Carers.   They are then booked in to see a Healthcare Assistant to have a blood test to see biochemically what is wrong.  Then they will see a GP or nurse who will talk through a care plan with the patient.  This will take place annually and is intended to keep the patient a fit and healthy as possible and to avoid hospital A&E attendances and admissions.

New free Advice and Information service

We have recently started a new service at the Earlsfield Practice for our patients come in on a Friday afternoon and speak to an advisor from the Carers centre.

 This service is free and provides advice on a range of matters including, health & disability issues, carer’s services, housing issues, benefits advice and assist with filling in forms for benefit claims and can refer you to other advice agencies. They also offer a very good Dementia service.

Developing the Earlsfield Practice website

Dr NB said that the website for the Earlsfield Practice was looking tired and was in need of an up-lift and was thinking of choosing EMIS our system supplier for developing and maintaining a new website as they are a known quantity to the practice and are very reliable and cost efficient.  The patient group thought that this was a good idea.

 For those patients who do not have a computer the practice would provide a quarterly newsletter.

GP surgeries to open 7 days a week

Very soon practices nationally will be required to open 7 days a week to take the strain from A&E departments. Although there are Urgent Care centres already in operation the government want surgeries to provide out of hours care for their patients.  At this point we do not know the details of how it will work and whether it will be that all surgeries open 7 days a week or if it will be on a rota between the local surgeries.

Appointments within 48 hours

It has been in the news that if Labour win the next General Election they will make appointments to see a GP within 48 hours.  Our surgery offers a range of appointments.

Patients can book up to two weeks in advance to see a GP.  You can book over the phone or sign up at the practice to book online using the Patient Access system. 

We offer pre-bookable appointments on Saturdays and early morning and late evening with clinicians. 

There are a number of appointments saved for each day for patients with urgent medical conditions.

Patients can also speak to a doctor over the phone for advice these are known as Telephone consultations.

Patients with multiple DNA’s (Do not attend)

We spoke previously in the meeting in December about wasted appointments whereby patients do not cancel appointments that they no longer need in order for it to be given to someone else.  It was suggested that they should be removed if they accumulate 3 or more DNAs.  It is not something the GPs at our practice would remove a patient from our list for as they are often vulnerable people with multiple health care needs.

Next meeting 11^th September 2014 at 6:30PM

30^th October 2014

Present: JB, SS, LG, NB, PD, ST, AS, JA,

Dr Neil Bamford, Karen Pace Practice Manager

Update from last meeting – the medical record storage system has now been installed in the back office.  There is still some work involved in transferring the medical records from the boardroom into the new storage system.  We have our receptionists dedicating some of her time to this huge task and although there still quite a lot to do she has made a huge amount of progress.

New website – Our new practice website will be up and running within the next couple of weeks. The website address remains the same www.earlsfieldpractice.co.uk.   Patients will be able to register as a new patient via our new website and book appointments with their GP and order repeat medication.

Travel clinic – In January this year the partners decided to stop running the travel clinic as it was running at a loss and as the surgery has 1.5 nurse time, many appointments were taken up for the travel clinic thus leaving very little or no appointments for anything else.  We have found that since stopping the travel clinic we have do have more available nurse appointments for the type of things we are measured on for example, child vaccines, smear tests and diabetic and heart disease clinics.  The practice will still offer vaccines such as Tetanus, Typhoid, polio, Diptheria and first Hepatitis A.  The patient group decided that it would be a good idea to display posters at the Earlsfield Practice and Trinity Road Practice, informing our patients of local travel clinics. 

PD mentioned that in the future all vaccines will be administered by pharmacists.

Talking Therapy Counsellors – Jane Anghelatos who is one of a very good team of Talking Therapy Counsellors at the Earlsfield Practice and has been with us for 15 years spoke about the different counselling services that are available and how they work.  Patients are referred by their GP to the Talking Therapy Counsellors who offer psychological and psychotherapeutic counselling services. The patient will then be asked to complete an assessment form that then is given to one of the counsellors who then contacts the patient for normally 6 weekly sessions.  Some patients will need more than the average 6 sessions, the counsellor and GP will decide.  There is often a several months waiting list as priority will be given to patients with Post natal depression.  There is the option of going private which costs between £50 -£60

Cognitive Behavioural Therapy (CBT) – this therapy is also available through the NHS and is also a talking therapy that can help you manage your problems by changing the way you think and behave.  We have a CBT counsellor at the Earlsfield Practice

Big White Wall – This is a web based and developed its Live Therapy services as NHS commissioners were looking for innovative ways to reduce waiting times, extend access and offer more choice of psychological therapies.  The Big white wall is a very popular choice with younger people.

District Nurses – Dr NB informed the group that the District nurses will be based together in community hubs.  That will mean that they will be moving from the Earlsfield Practice where they have a room.

EMIS Access – the patient group wondered how many people had signed up to EMIS Access whereby patients can make an appointment with a GP and order repeat medication on-line.  KP said around 5% but the actual figure is 4648 patients are signed up on-line and that equates to 42% of our patients.

AOB– New sofas.  Unfortunately our sofa’s in the waiting room have seen better days and need replacing.  KP to talk to Dr DG on his return from annual leave

Next meeting Thursday 26^th February 2015

12^th September 2013

Present: Dr N Bamford, Nurse Vinolia Nyaho, Karen Pace, Practice Manager plus 12 patients (names on file)

1. CQC visit. 

The practice had a visit carried out by inspectors on 22^nd August, there was no notice of the visit (post the meeting the report was issued which requires us to make a minor change to a vaccines fridge, we will make the change and we successfully met all other standards)

• Front desk

Due to a lack of confidentiality at front desk, we are investigating options for making the desk area more enclosed so that patients cannot accidentally see the screen containing other patient’s records.  Some patients thought this was a good idea, others did not, agreed to ask a bigger number of patients via the survey.

• Extra clinics

During the busy winter months we will be working in a different way.  One GP each day will have some unbook slots to deal with urgent cases which arise.  Our past experience has taught us that the unpredictability of winter can cause havoc with surgery timings and so we are trying to manage this by this new initiative.  During the winter months we well also be having a second GP working on a Saturday morning for pre-booked appointments only.

• Out of hours GP

During out of hours the 111 service is in operation, patient feedback was that in general it seemed to be working well and but there were occasional problems reported. We will continue to monitor and would value any first-hand accounts of using the service

• Triage service

We are considering getting one of the GPs to triage all requests for same-day appointments.  Patients can currently book advance appointments for non-urgent issues but many patients ring to book same-day appointments for these problems.  This means that sometimes a patient who does need to be seen urgently can not get a slot.  If the same-day requests were triaged by a GP they could make the best judgement about how soon the patient needs to be seen.  Agreed we should test out this idea on a wider number of patients via the survey

• Nurses

Vinolia explained the roles of nurses and healthcare assistants.  In the coming months there are a number of nurse-led immunisation campaigns (Shingles for over 70’s –starting with those who are 70 and those who are 79, Flu and Pneumococcus for over 65’s and those on a register of being at risk, MMR catch up, Rotavirus for babies and nasal flu for 2-3 year olds and those under 17 years on a risk register) Agreed that these all needed to be well publicised including on the website.  Feedback from patients was that there did not seem to be enough nurse appointments.  Practice will review although there is a national shortage of Practice Nurses and it is particularly acute in London.

• Out of hours nurse

Patients fed back that the out of hours GP service run at Brocklebank Health Centre might be better if there were also a nurse working at the same time.  Dr Bamford to feed back to CCG.

• Electronic Prescription Service (EPS)

The practice has been trained in EPS which should allow those patients who want to use this service to nominate a particular pharmacy so that their prescriptions can be sent electronically to the pharmacy without the need for a paper copy.  Some patients have signed up for this and while we can see that there will be benefits, there have been a few teething problems at the outset (caused largely by the central IT). We will be monitoring this closely and will write out giving further updates.

• Medication issues

One patient raised the issue of expiry dates on medication not being clear.  (Post meeting patient needs to write to the Manufacturer about the specific pack concerned)

Patient questioned whether change to from Warfarin to new medication was a patient choice.  Patient was advised to speak to Warfarin Clinic at St Georges to discuss his concerns.

1. PACT (Planning All Care Together)

All practices in Wandsworth have the opportunity to take part in this initiative.  Patients have been identified who might benefit from a more holistic way of being treated.  Different sets of people (many with several long term conditions) will be invited in for special tests with the healthcare assistants followed at a later date with a longer-than-usual appointment with a GP where they will be able to talk about all of their conditions and look at how they can be managed going forward.  We hope patients will like this way of dealing with them rather that waiting for them to become ill.

1. Patient survey

We are about to run a survey across large numbers of our patients and want to get input from the group regarding questions they would like to see answered.

To include:

How patients feel about telephone access

Ease of booking appointments with GP/nurse

What do patients think about the proposed triage system for same-day appointments

Are patients aware of the number of DNA’s

Are patients aware of the complaints procedure

Do you feel cared for by your GP

Next meeting to be arranged for early December on a Thursday to consider the results of the survey.

Next meeting TBC

12^th December 2013

Attendees: ST, AS, PD, NW, JB, PW

Present from surgery Dr N Bamford, Ms K Pace

Care Data

Before discussion of the survey K Pace advised patients of the forthcoming data extraction proposed by NHS England (called care. Data)  NHSE have decided to allow extraction of patient level data which will have patient name removed.  The data will be held by a private organisation on behalf of NHSE and the intention is to join the primary care information with any other secondary care and mental health records so that the data can be used to model services on behalf of patients.  While the name will be removed, concern was expressed that the postcode together with NHS number would make the data identifiable.  Further concern was expressed that this was something which was going to go ahead unless patients opt-out.  An information campaign will be run by NHSE in early January where 22 million homes will have a leaflet explaining the data extraction.  Patients can opt out and if they choose to do this, their medical record will be marked with a code which will prevent any data extraction of their personal data.  Details of how to opt out included with these minutes)

The meeting was convened to discuss the results of the recent patient survey and to determine what actions the group want to take as a result of the survey.

The survey was run in November 2013 and was a mixture of on-line responses and returns from patients who were visiting the surgery for an appointment.  The on-line  patients were selected randomly from lists of all patient e-mail addresses which had been put into age and sex order so that we could ensure a fair spread of age and sex were represented.  Paper responses were completed by randomly selected patients attending morning and afternoon surgeries and on different days of the week. 

Key findings

174 patients completed the survey completely (other responses were received but some were spoiled)

60% of patients book their appointments via the phone but now 30% of patients use on-line booking

55% of patients are finding that getting through on the phone is not too easy or even difficult

50% of patients have difficulties in making same day appointments but 65% of patients find it very easy or easy to make an advance appointment

49% of patients were unaware that it is possible to speak to a GP on the phone without an appointment

81% of patients are happy with the opening hours we have currently

91% of patients were happy with the care they receive from the doctors and 84% from the nurses but only 52% with the care they get from reception

There were a number of verbatim comments left by patients and what we have heard is that they would like to see an improvement in training and helpfulness of reception staff

There was a high awareness of most of the services we provide but the awareness of electronic transfer of repeat prescriptions and patient blood pressure checking was relatively low

Patients increasingly use the website to find out information about the practice (58%)  but many patients still rely on the phone as a source of information (53%) of course some patients use both services.

A proposal to improve the confidentiality of patients at front desk was to erect a glass partition to try and ensure that we could provide a more confidential space.

51% of respondents support this action

22% would prefer not to but can see it is probably necessary

16% of respondents did not agree with this solution and

11% had an alternative suggestion

A proposal to consider all requests for same-day appointments to be passed to a doctor or nurse so that they could determine whether  the patients needed to be seen that day was made and the responses were that

37% of respondents felt that they would rather not have this but could see the sense in it to ensure same-day appointments go to those who actually need them

46% of respondents support this proposal

15% of respondents did not support the proposal

Actions as a result of the survey

The area of reception had come under some scrutiny and so new staff were to be recruited and existing staff would be re-trained

The confidentiality of patients at front desk was being compromised and so we will ask a designer to produce some options to help resolve this issue and we will aim to have a short list of options on display so we can poll more patients

The website is in need of a major overhaul so that patients can navigate their way round more easily and find out key information quickly.  We will look at having access to the website in the waiting room.

Next meeting TBC

28^th February 2012

Attendees:

Patients: ST, LG, MR, JE, DC, PD, SD, AP, JR

Practice: Dr N Bamford, Ms K Pace (Practice Manager), Mrs S O’Donnell (Business Manager)

Dr Bamford welcomed all to the 9^th patient Group Meeting.

NHS Bill

Dr Bamford discussed with the group the issues of the Health Bill in light of the concern being expressed in public by various groups.  There is some doubt about whether the bill will be passed in its entirety, in part or not at all at this point.  The uncertainty is unsettling for everyone concerned and Dr Bamford emphasised that our care of patients carries on whatever the background and hoped that patients would feed back to us if they had any issues caused by their dealings with the wider healthcare system.

Dr Bamford explained that the GP’s in wands worth have agreed to progress as a single commissioning group which is currently in existence in shadow form so that it can be ready to take on the services previously provided by wands worth PCT with effect from April 2013.  Dr Bamford made the point that in wands worth the GPs were supportive of the changes and so much had been done that they would now just prefer to get on with it.  Patients were told about the sort of things which have been changed to date as an illustration of how things might happen in the future.  The example of scanning was used to illustrate the in the past an Ultra Sound Scan (USS) required a hospital referral even though the GP knew that it was a scan that was required.  Now GP’s are able to send patients directly to scanning without having to send them via a hospital consultant.  This will save time for the patient, gets the scan done quicker and avoids the cost of an unnecessary hospital referral.

Questions from patients

Question: Is scanning the only service that this applies to?

Answer: No other services are/will be possible to go directly from the GP, hearing aid fittings, spirometry, ultrasound, MRI scanning, ECGs and Echocardiograms

Question: Are there any plans for rationing of services eg tummy tucks

Answer: There have always been procedures for which special funding has to be sought because they are not considered to be generally available but Exceptional Circumstances funding can be sought if the clinician feels there is a good case to be made on behalf of the patient.  Tummy tucks would fall into this category where a GP might make the case on behalf of a patient if he believed they might be psychologically damaged by not having the procedure.  This sort of funding will carry on being available.

Question: How much more time does it take to do all of this extra work?

Answer: The work can be time consuming and Dr Bamford now does not do clinical work on a Monday as a result.  The practice has got new GPs to ensure that no patient appointment time is lost but it is inevitable that with less appointments with Dr Bamford available, some patients who particularly want to see him may be disappointed.

Question: How much extra admin is this generating for non-clinical staff and have you got enough?

Answer: New requirements are always more time consuming at the start until we get used to different requirements and we are actively lobbying with the Wandsworth Practice managers to push back on the amount of reporting that is required.  We feel it is extreme at the moment and hope the incoming Commissioning group will have learned during this period that being overly bureaucratic is not helpful to anyone.  We do feel that there will have to be a review of all the additional work we are given so that we can agree what of the old requirements can now be dropped.  We do have additional staff and are coping well at the moment.  In addition to the staff patients see in reception we have others upstairs who play vital roles in keeping the practice running smoothly eg. Making sure all letters and reports are scanned onto each patient’s medical record.

Question: What about Out of Hours (OOH)? Some concerns expressed regarding the standards and quality of care provided.

Answer: The current OOH contract is held by HARMONI and is up for review in April.  There is a group currently looking at the whole area.  We have been able to ensure that the group who will make decisions on this includes some GPs and some patients. It is important that patient views on this are known and the information fed into the decision making process.  A patient example of an OOH doctor who made a house visit without properly examining the patient and not leaving any record of visit was cited.  This case was taken up by the ambulance service who later visited the patient but it is vital that this sort of information informs the group looking at appointing the new contract.

There was a general discussion regarding patient Involvement showing that all clinical pathways which are now being reviewed are requesting to have patients included in their group meetings.  There is a group of patients from all of the surgeries of wands worth (2 from each practice) and this group are contacted whenever a pathway comes up for review.  Patients with a particular interest in the pathway can apply to join the review group eg, there is a group looking at falls and we have patient representation on that group.

Patients were asked if they had examples of using services which were direct from GP

Example 1: GP referred a patient for USS and this was to be done at Queen Mary’s Roehampton, the speed of the service was good but there were a few administrative problems on the day of the scan as there was no direct telephone number to ring to cancel.  This has now been resolved by In-Health the group who provide the scans.

Example 2: GP referred a patient for a hearing test and the patient was offered a test the next week.  It was so quick that she was unable to take the appointment but was given another without any problem a few days later.  Very good.

Example 3: Patients being able to book their own appointments for GP using the on-line system.  Patient is aware that there are more appointments available going via reception than there are by using the on-line option.  (There are only a small number offered on-line for a variety of reasons

Eg, appointments need to be retained for those without internet access and the system needs to be able to cope with multiple users possibly on line at the same time) We will have a look to see if anything can be done to increase the number offered without disadvantaging others.  One patient pointed out that the surgery should be commended for allowing patients the chance to book with a named GP, many surgeries do not do this.

Patient approval

Dr Bamford requested that patients who are moving outside of our current catchment area but staying within wands worth should be allowed to stay on the list if they want to.  This is with the proviso that it is unlikely that they could have a home visit and should these become necessary, the patient would be asked to register elsewhere.  Patients agreed that if the practice thinks it can cope that they were happy with this.

Mrs O’Donnell requested that money from practice savings (Freed Up resources) could be used to get Customer Service training for Reception staff.  Patients were very quick to commend the excellent staff in reception and asked us to pass on their thanks.  Particular mention of Mrs J Pace at Trinity Road who applies a very practical and sympathetic touch to her work.  Patients were very happy that resources should be used to invest in staff training.

Money for larger clinical bins for each consulting room approved in light of new requirements to use only disposable instruments.  Money for new chairs in consulting rooms for clinicians.

The patients could see evidence of equipment previously bought using savings (Patient BP monitor in waiting room, 24 hour BP monitor and 6 regular BP monitors for establishing if patients have Hypertension (high blood pressure), each room has a consulting couch which can be raised an lowered to allow easy access for elderly or injured patients, waiting room chairs, baby changing facilities in patient toilets, new vaccine fridges in nurse rooms.

Open discussion

Patient raised the issue of how to feedback on poor services which are not provided by the Practice eg Out of Hours. 

Answer, pass on the comments to us and we will look to pass it on to the correct channel

E mail addresses

Karen Pace, Practice Manager [email protected]

Sue O’Donnell, Business Manager   [email protected]

Patient suggested that every one in ten patients who contact HARMONI (or the new out of hours provider) if HARMONI do not win the contract) should be given a questionnaire to feed back on their experience.  Dr Bamford agreed this was an excellent suggestion and would pass it on to the out of hours working group.

Next meeting TBC

17^th October 2012

Attendees: RL, MR, JE, AS, BS, VB, PD, JG, LG, JB, ST, ME, SO, AP

Dr N Bamford, Ms Karen Pace (PM)

1. Matters arising from last minutes

1.1) We remain time constrained by the additional work arising out of a change from the current system to the new organisational structure which will take effect from 1.4.13.  However, in addition to that this week we have had an additional factor of changing our medical system from one type to another.  The changes are time consuming for all our staff but we are sure that one the teething problems are ironed out, the improved capability of the new system will offer many benefits to patients.  Dr Bamford indicated that one of the possible benefits was a function in the system which allows us to send a text message to the mobile number of a patient once their test results come into the system.  The text would only say that the results were normal no action or that the patient should make an appointment to see a clinician. Dr Bamford explained that some tests on blood are done testing for several different things and each thing tested might generate its own text message, there could be for example four text messages resulting from one blood test.  Patients had a number of questions

1. Could we prevent text messages being sent to land lines?
2. Would the system ask the patient to reply to it to confirm they have received it?

Dr Bamford stated that texts would only be sent to mobile numbers and the system was not one where a patient could reply to confirm receipt.  Dr Bamford stated he would do further research to see if this would be a useful tool and report back to the next meeting.

1.2) HARMONI

            Since the last meeting HARMONI have been reappointed as the out of hour’s provider.  Dr Bamford asked for feedback from any patients who had used the service

Negative: Patient had attended at Brocklebank walk-in and was told there were no more slots available and was advised to return very early the following day (Saturday) before the centre opened to make sure she was first in the queue.  Mrs O’Donnell stated that this should not happen, patients who cannot be accommodated by the service need to be told where they can go where they will be seen, and she will feed this back to HARMONI

Positive: Patient had attended Brocklebank walk-in on two separate occasions and the first was seen within 20 minutes of arrival and saw a good and helpful GP.  The second visit the patient had to wait over an hour due to other patients ringing in and being given priority over him.  When he was seen the GP was excellent and treated him very well.

The minutes can be approved and posted providing an edit was made of including a list of services which might be suitable for delivering in primary care rather than via a hospital.

• Childrens Services

Dr Bamford reported that while a large amount of workload is done for children/pregnant women, there was little evidence of them being involved in the patient group which was disappointing.  Dr Bamford announced that a new service is being piloted.  This will be a walk-in service for sick children who will be seen by Dr Salim (or Dr Martin/Bamford when Dr S is not there) and ideally this will ensure that worried Mums will know that they can be seen and this may well free up phones/other clinicians for other patients.

For a number of months the Health Visitors have been running a walk-in baby clinic at the surgery on a Tuesday afternoon.  While this has been popular, it has caused quite a bit of congestion both for the Mums but also for other patients attending the monthly wart Clinic.  The Health Visitors have decided to move to the purpose-built Smallwood Clinic which means they can run clinics more often for local Mums.  Publicity for the new clinic is round the surgery and on the web site.

• Care Quality Commission (CQC)

Mrs O’Donnell briefed patients on the forthcoming registration of the practice with CQC.  As of 1.4.13 all GP surgeries will need to be registered with CQC and at some stage in the future we can expect a visit from the commission to review our practice.  Agreed it would be a good idea to have a list of practice policies in a leaflet available to patients, the patient group should be briefed once the practice is informed of the commission’s intention to visit.  Many of the policies do already exist but we will have to improve our record in making them more visible eg Complaints policy, Chaperones, Guide Dogs

• Pharmacy issues

Dr Bamford is keen to have other organisations closely linked to us at our meetings.  This meeting Anita one of the pharmacists from Dumlers attends and next meeting a Pharmacist from lloys will be invited.  Dr Bamford requested questions from the floor:

What is the optimum number of tablets in a repeat 1month v 3 months?

This depends on the item and also the patient and what stage of disease the patient has.  Dumlers will arrange to order repeat prescriptions from the surgery if the patient wishes them to do so (this is a service patients have to sign up to at Dumlers) Once the prescription is on repeat the patient can ask for further prescriptions until it is time for the annual medication review.  If the patient asks the practice we will want this to be in writing either by using the counterfoil from the last prescription and ticking the items required or by writing the items needed in a letter giving name and date of birth of patient.  If the patient want the pharmacy to arrange the prescription with the practice, the patient can ring the pharmacy and ask them to order their prescription and then it can be picked up directly from the pharmacy.

Is it possible to label the actual blister packs?

It is actually difficult to label the actual blister as the patient might not be able to get the tablets out of the blister.  The box in which the blister pack is dispensed will have full instructions on how to take the tablets.

Is there a “best” time to take medication?

This depends on the medication.  Some should be taken in the morning, others at night, and others several times during the day.  Instructions will be on the pack.

Why does the look of tablets change from one prescription to the next?

This is caused by pharmacists having to buy the medications from Wholesaler and it depends which tablets are available.  The medications concerned are called Generics and they all contain equal amounts of the active ingredient of the drug but they may look different (different colour/shape etc.) There is nothing the practice or the pharmacy can to about which drugs the wholesaler provides but if the GP is very concerned they can write the prescription for a particular brand of tablet to ensure the same one is dispensed.

Anita advised patients of two new initiatives to help with medication usage

1. Medication User Review, patients will have a review with the pharmacist to discuss any concerns they have
2. New Medication Services.  If the GP prescribes a new medication and patient is unsure of anything, please attend the pharmacy and ask for a new medication review.

• Physiotherapy Service

Dr Bamford advised that as a result of long waiting times for Physiotherapy services for neck and back problems at St Georges a number of alternative providers have gone through a selection process and this means that GPs can now refer patients for these services which means that the waiting time will reduce a lot.  The providers have to provide the service for the same price as St Georges but the service will be available in a number of private facilities.  The patient will be able to choose where they want to go so it is most convenient for the.

• New NHS Organisation

Questions were asked at how well the plans were going for moving to the new structure where practices will hold the budget for patient services.  Dr Bamford announced that the Wandsworth Clinical Commissioning Group (CCG) has its visit from the NHS Commissioning Board and plans are on target for them to assume responsibility.  Practices are noticing an increase in their workload but due to budget constraints we are unable to just employ more people (indeed we have increased the number of GP sessions per week since the last meeting but cannot commit to more admin staff)

• Next meeting

More patients from younger age groups will be encouraged to attend.  Agenda sent out in advance. 

• Patient Survey

The patient survey was discussed.  Agreed we could use the CFEP survey since this has been used previously and was capable of covering most patient needs -phone access, appointment availability, ability to be able to make any comment necessary.  The survey results will be known in time for the next meeting and we will also look at the annual complaints review.

Next meeting TBC

15^th March 2011

Attendees: PW, ST, PD, VB, LG, JB, JG, NW, DC, JE, PC, MR

Dr N Bamford GP Partner, Karen Pace Practice Manager                          

Sue O’Donnell Business Manager, Vinolia Nyaho Practice Nurse                             

Lyn Crawford Administrator/receptionist            

Notes from Patient Meeting held 15^th March 2011

1. Dr Bamford advised of two new GP’s who have joined the practice, Dr Stephanie martin and Dr Delfy Chitillappilly.
2. Dr Bamford advised that he had been approached to see if the practice was interested in having space in the new surgery facilities at the proposed Bolingbroke development.  This would be in place of the Trinity Road branch surgery.  Dr Bamford has agreed to follow up and find out more information before trying to assess whether this would be viable.
3. A question was raised about the new health bill which proposes to remove practice boundaries allowing patients to register anywhere they want.  Dr Bamford advised that until arrangements were in place to deal with issues such as home visits, the current system of practice boundaries still exists.  If a patient is moving out of the catchment area but lives relatively close, we will consider allowing them to stay on but new patients registering must be within the published boundaries.
4. Dr Bamford talked about recent developments at the practice.  Having a full complement of GPs is making it easier for patients to get appointments.  Mr PW agreed that it is much easier to see GP’s than previously but commented that the nursing appointments were in short supply.
5. Dr Bamford pointed out that there are 2.5 nurses which is actually more than previously but there are times of the year where appointments are fewer due to training and annual leave commitments.  We try to avoid the use of agency staff since the feedback on their performance is never as good as our own staff.  There was a question to know whether District Nurses could step in to help on occasions of nursing shortage but it was pointed out that their remits are very different and their own workload was pretty much full.

Other new developments are the launch of booking appointments on-line.  This helps out the pressure on the phone system, we have also made improvements to the repeat prescription system which now allows for a 24 hour turnaround (previously 48 hours) this also helps the appointment system.  The surgery runs extended hours so that it opens at 7.30am 4 days per week for pre booked appointments, is open until 7.30pm on Wednesdays and is open on Saturday mornings for pre booked appointments.  We have recently trained up our healthcare assistant to be able to take bloods at the practice so that patients are not forced to go to other places (they still can go elsewhere but we hope the home surgery service is of value)

Patients group welcomed the new developments.  They asked that there should be more publicity regarding the blood tests.

Dr Bamford also described the improved Counselling services available to patients.  Greater numbers of counsellors and more sessions per week has reduced wait times to 3 weeks (previously over 6 weeks).  Lots of the work is done in surgery but we also have telephone based counselling.  We have a Drugs and Alcohol team which run clinics twice per week (Tuesday and Thursday).

In conjunction with 7 other local practices we are able to access out of hours services of a GP based at Brocklebank Health Centre at weekends and Bank Holidays.  If patients call the out of hour’s service and mention they are from this practice, they should be directed to Brocklebank.  This service is not for general medicine but for unexpected illness which can be dealt with by a GP (no repeat prescriptions but emergency supplies can be prescribed if a patient has run out).

6) New practice developments in the pipeline.  We would like to use our Freed Up resources to buy a blood pressure monitoring machine for patients use, some variable height consultation couches. Patients approved these suggestions and also the purchase of 24 hour blood pressure monitor to allow patients to take them home.

7) The practice will be getting a new phone system which will allow patients to understand what position they are in the queue.  We are conducting a patient survey to try and find out how patients are able to get through on the phone.  This will be in place of the large survey we used to do every year.  Unfortunately it is normally the patients who are unhappy with the service that respond to the surveys. 

      8) List cleansing is still in progress, up to now there has now been a 

          Significant drop in the list size. 

9) New GP commissioning: The PCT have many roles, they commission     services such as Community and Dietician services to name but a few.  The PCT manages us and gives us help with the premises and how we deliver services.  The local Council will take over Public Health.

10) Wandsworth GP’s have joined together to form a pathfinder group and their aim is to try to commission services away from Hospital.  GP referrals will go through a triage centre.  Trying to keep services out of hospital will be much cheaper.  It is now possible to send a patient for a Dermatology appointment at Southfields practice.  The patient will see a consultant.  The tariff is cheaper than seeing a specialist at hospital. 

GP Federations and GP’s will link together to have the best Consultants who would see our patients to provide local tailor-made services. Patients could be tested and receive a hearing aid within 2 weeks, but we must remember that not all services can be taken out of hospitals such as ENT.  Private companies are welcome too providing that the tariffs or price remains the same. Private Healthcare companies will not be able to cherry pick the services that they want to provide. Private clinics will be no competition when it comes to tariffs set by the NHS.  This is a Social Enterprise breaking down the bureaucracy which will mean more time with the patient. It will also give the patient more choice and a much improved service.

11) The Virtual ward is up and running again, this service is also for treating the patient at home and to keep them out of hospital.  The patient’s medical records can be accessed by the clinicians at the Virtual ward (with the patient’s consent) and can write a report straight into the patient’s records. 

The next patient meeting will be held in September 2011

KP Aug 2011