Seascale and Bootle Patient Participation GroupMeeting 6th Feb 2013

Held in Seascale Health Centre1.15pm to 3.15pm

Attendees:Mike HarringtonAlan JacobKen MawsonMary JamesBetty Jacob

Viv StuckeLiz CleggGillian HartleyLynette EdwardsMarion Thornton

Practice Staff:Dr Gemma TaylorDr Kathryn IllsleyLisa Drake, Practice ManagerNiki Barnes, ReceptionDawn Johnson, ReceptionPippa Tyson, Reception

Apologies:Judith DakersMarion GlassbrookWayne IngamellsJane FisherJoan Marlow

Minutes, Questions and responsesItem Ref ActionSignificant events:At a previous meeting the group enquired about how the practice record and manage ‘events’ (and near misses). The group were provided with a copy of the practice’s Significant Event Review policy. LD demonstrated how we review the events in a quarterly learning forum, to avoid similar events recurring. Some examples were provided and patient details were anonymised to protect confidentiality.Q: Is everything that is noted in the policy as a significant event treated as one?A: We respond differently depending on the impact or likely consequence of an event and also the department affected. Some events are investigated and then discussed with all of the other clinical team, especially if changes to systems are required. The Dispensary have their own protocol for recording events as they issue many medications during the working day. They record examples such as: incorrect drug, incorrect strength, incorrect formulation Prescriptions not sent to correct pharmacy for collection etc

Q: Do we inform other surgeries about major events and how do we take advantage of learning from each others events? A: There is currently no central point for risk analysis and management as GPs in Primary care are independent businesses.

Action: LD to contact PCT staff in risk management and clinical governance and discuss with other practices at practice manager forum.

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Seascale and Bootle Patient Participation Group

Appointments: Dr Illsley and Dr Taylor and three members of the Reception team joined the group to discuss the Telephone Triage system implemented mid Dec 2012.

The main aim of the system is to make clinical need the priority for offering an appointment and to make the unpredictable, predictable. We also hope to improve access to a greater number of patients and to respond to ‘unmet need’ from the previous system. The practice have been gathering data since May 2012 and surveyed patients in Jul/Aug/Sep 2012. Examples of the data collected were presented. The group were asked to reassure patients that the intention is to improve access to a GP. This is to address concerns raised in the community (which are unfounded) that patients will no longer be able to see the GP face to face. The group agreed to act as advocates but asked to be involved at an earlier stage with future design changes so that they could be better prepared in the community. The practice agreed to do this and apologised for the swiftness of introduction but provided explanation why.

Dr Illsley, Dr Taylor and LD provided examples of reasons why speaking to the GP first may be beneficial i.e.

The blood van collects at 12:45 so if blood samples are required Dr is best to do this on a morning.  

UTIs often require urine sample, GPs remind patients to bring one in.  If the Dr knows why the appointment is requested, then they are better prepared and

can check for hospital letters, test results etc before phoning the patient. Finally, many things like prescriptions and some tests can be arranged without patients

needing to see the GP first. In the five weeks since implementation, GPs are currently bringing in approx 50% of patients they speak to each day but this is because its coughs and colds season. We expect this to drop to approx 30% based on other surgery’s experience. Some patients have yet to understand and feel confident with the change and so are ‘demanding’ a face to face appointment. There have been some very rude patients and the practice feel this is unreasonable for the Reception staff to deal with who are trying to help. This is also unnecessary as GPs will discuss with patients if appointment is required and offer

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Seascale and Bootle Patient Participation Groupa suitable time based on other service availability.Early indications are that access to a GP has improved, as the new system is enabling us to contact 5 more patients a day than for the same period in 2012. We have experienced some difficulties with capacity, especially after New Year and also at Bootle where the GP is only present in the morning. These difficulties are mainly to do with the time taken to call back timings but we will continue to review and adjust as necessary. Comments have been collated from patients who have concerns (generally representing older patients and highlighting telephone or transport problems). These are reviewed weekly by the practice team. Individual patients who have made specific complaints in writing have received a written response. The group all agreed that whilst they do not like wasting their own time, nor do they want to waste Dr’s time. It was acknowledged that with the previous system people still had to wait for a Dr, or couldn’t get an appointment at all and so it was generally felt better to wait in your own home for telephone call than not get seen. We would ask though, that patients don’t come to the surgery to request an appointment (this applies to both Seascale and Bootle) as this will not provide them with priority over patients who have telephoned. The GPs have a full list each day and can only fit in emergencies. We do not have the capacity to provide a ‘walk in service’ like some town or city based larger practices. We want the system to provide equal access for all whilst acknowledging that telephone consultations are not feasible for some patients and they will still have their needs met. Other comments received from the group and via email:‘People are pleased with the new system but would like a better idea on when the Dr’s will ring’. ‘Most people are happy for Dr’s to leave a message’ so they know that the Dr has called.’ ‘From my own point of view and I absolutely hate visiting the doctor, last week I had to test the new system myself.   From making my phone call at about 1030 am, by 1230 I had been called back by the doctor,  been to the Surgery,  diagnosed, prescribed and collected medication,  and was back home.   Absolutely brilliant, no complaints at all.’ ‘The school are more than happy with the service from the surgery and any incidents they have had, have been dealt with well.’ ‘It is reassuring to know that I will be able to get an appointment if I am unable to have a telephone appointment, I was not aware of this. I understand that the surgery is trying to accommodate all different types of people and circumstances and it is not easy.’Reception will ask when people are going to be unavailable so that the GP avoids that time

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Seascale and Bootle Patient Participation Groupwhere possible. However, as we are a minor injury centre and GPs look after terminal patients, it’s difficult to give a precise time for call backs.

Patients do have the option to pre-book a telephone consultation at an approx time of their choice via the practice website www.seascalehc.co.uk ‘Online options’ are on the home pageQ: We need a process in place for young vulnerable people to make an appointment to see the GP of their choice, as this can become very difficult at times and they may not want to leave a telephone numberA: Action LD to meet with LE afterwards to develop this

Q: Concerns over confidentiality in the Reception area were described, e.g. a case where a patient had overheard information about another patient, including names, addresses and when the patients were not going to be contactable. This doesn’t happen every time and the patient acknowledged that on another occasion she was aware that the receptionist did not repeat any patient details. A: We are aware that people have concerns since we built the new reception in Seascale and would advise patients to speak to the Receptionist at the hatch if they wish for privacy. Bootle surgery requires some improvements but we are limited by the confined space. Would a self serve check in benefit in this area so that queuing at the desk is minimised? Action: LD/DJ to review Bootle reception area. All Reception staff understand the need for confidentiality on the telephone and this comment will be shared again. The practice will consider purchase of mobile ear piece devices so that Reception can take calls in the back office.Productive General Practice The practice is taking part in Productive General practice, a programme of work to release time and avoid overlap and duplication or unnecessary waste.

Action: LD to send Involving Patients Module handbook to group for consideration

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Seascale and Bootle Patient Participation Group

Palliative and End of Life care update:VS introduced a new website that has been set up initially for clinicians but is going to be extended to include information that would be of value to patients and carers of those who are terminally ill. ‘Deciding right’ is the process to express patients End of Life plans and there are a number of forms for patients to use including Advanced Directives, when to resuscitate etc.

http://gp-palliativecare.co.uk/

http://www.theclinicalnetwork.org/end-of-life-care---the-clinical-network/decidingright

Action: LD to send link of website to all membersAction: All members to consider what type of information would be of value and forward to Viv’s email address. Action: LD to ensure that a message goes in Well Well Well about the aims of ‘Deciding right’ timed to coincide with ‘Dying Matters’ week in May

Other items discussed:Q Are diabetes results posted out to patients. A: Yes, these should be sent after your sample was taken and before your next appointment with the Clinic nurse.Update on Actions since last meetingQ: Patients asked for help and support with healthy lifestyles.A: We are now referring a number of patients to the new Gym at Seascale. We have always provided advice for healthy lifestyles as part of new patient checks, well person appointments as well as in chronic disease clinics.

Q: We have heard that the Exercise on Referral scheme has a high drop out rate. What can we do to help, especially to promote health in young people?A: Action LD to establish numbers and advise group so we can see where to target effort

Q: Suggestions for ordering repeat medicines, can we add an option on the online repeat medication system to help prioritise the most urgent medication, along the lines of ‘if you do not need this urgently, when do you need this by?A: Action LD to discuss with Dispensary manager and Website provider

Q: Can we have the Dr’s Rota posted on the website.

Action: LD to update website and also place all of papers from today’s session on Patient Group page

Action: LD to ensure that we forward this information to LC.

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Seascale and Bootle Patient Participation Group

Q: There is still an issue of transport for rural areas, especially regarding Blood collection van. Could the practice provide case study type information so that this could be used to lobby local transport providers?The group agreed that is was OK to share email addresses for its members to all

LD thanked everyone for their contribution and the meeting closed at 3.15pm

Date and Time of next Meeting17th May 2013, at 1.15pmThe following meeting would be held at a later time so that working members can attend

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