PATIENT PARTICIPATION GROUP
Oaklands Health Centre are pleased to announce that we have managed to launch another Patient Participation Group. We had our first meeting in January and our second at the end of February. Please see below for the minutes of the last couple of meetings.
The next meeting is Tuesday 28th March 2017 at 7.00pm at the surgery.
We are looking forward to working closely with the PPG to share ideas and communication.
Last updated on 21 March 2017
OAKLANDS HEALTH CENTRE
PATIENT PARTICIPATION GROUP (PPG)
Meeting 17th January 2017
Present – Dr Aravinth Balachandran (AB), Sarah Roseaman (SR), Amber Wilson (AW), Patients (JC),(PC),(CH),(SG),(JW),(GO),(NT) & (PL).
Apologies – Patient (JD)
Everyone introduced themselves around the table. SR expressed the wish for a supportive PPG to work alongside the surgery to communicate pressures and changes within primary care to a wider audience. Expectations for the practice include sharing new ideas with our PPG and get their help to introduce changes and services. To work with us, provide a strong positive patient voice and for the PPG to play an active role within practice life.
AB thanked everyone for attending the meeting and for their time. AB started his presentation with background information about the practice. AB used some patient demographics to demonstrate the extra pressures we are under as a surgery. Although we are a busy practice our patient demographics show that we have higher numbers of elderly than our local colleagues. The additional pressure of more complicated patients is also experienced at the other practice in Hythe, the Lyminge surgeries, Romney Marsh and Deal. Folkestone, Ashford, Dover have a younger population so unfortunately our patient demographics is different to those of a wider catchment.
We currently have 7 GPs (three partners and four salaried Doctors). The Doctor patient ratio is around 1 GP to 2500 patients. The total GP sessions work is the equivalent to 4.5 WTE (whole time equivalent). This is because of a number of reasons, AB is a Governing Body Member within the South Kent Coast Clinicial Commissioning Group and he is also the lead for I.T Services. This commitment takes him away from the practice for one day a week but with all the changes happening within the NHS is important for us as larger surgery to be involved at the decision making stage. Dr Farida Latif is also the Hythe and Rural Locality Lead and is assigned to this work one afternoon – this is a group of practices, ourselves, Sun Lane, Two Lyminge surgeries, Oakhall, New Romney and Orchard House, Lydd are working together to identify services that can be shared between us as the pressures within primary care increase. The additional reason why GPs do not necessarily work full time is the burn out – the pressure on services, the patient paperwork and the bureaucracy attached to the role. AB advised the group that to advertise via the BMA the cost is around £3000 per entry – the last time we advertised for a Partner to join the surgery we had three applicants – only one attended the interview stage but was not successful. We also secured a salaried GP who only stayed with us 6 weeks – sadly he had a few health problems but he sighted the pressure of work as one of the deciding factors. The ideal ratio would be 1 full time GP
to 1800 patients. The last three GPs that we recruited have been from locums that we have engaged. Going forward – Dr William Moffat is retiring in February and Dr Emma Harvey starts her maternity leave at the end of January. We have secured long term locums to help ease this impact – but unfortunately the cost of them is quite excessive (as locum charges have not been limited by the Government) plus they are prescriptive of the work that they will do – so they tend not to work like an employed members of the team. AB advised that over the next 5 years the current GP workforce in the South Kent Coast area will be reduced by 30% due to Doctors retiring and lack of new GPs being recruited.
In our favour we do have the highest number of Nurse Practitioners employed who work alongside the GPs and see patients who have minor illnesses. These two work like a Doctor but within a smaller scope – they are able to prescribe, refer back to a GP or take immediate advice from the duty Doctor. One of our NP’s also assists the Doctors with home visits. We are currently one NP short as one of our team left to work at another less pressured practice. In addition we have a chronic disease nurse, a practice nurse and three Health Care Assistants – the PN is currently on maternity leave and one HCA is on long term sick. This gap is being covered by additional PN’s and an HCA on casual basis.
In addition to the clinical team there are a further 14 admin staff who provide background support. Out of this 8 of the team are admin/reception (who are either downstairs or upstairs answering the phones and dealing with other patient tasks), 2 are medical secretaries, 2 are medical audit (who ensure patient recalls are up to date – for example co-ordinating the 5000 flu invites sent every autumn) and 2 managers.
The group enquired about practice income and AB told the group that the money we receive is directly related to the number of patients registered to the practice. This basic fee is around £85 per patient per year with supplementary enhancements to take account of our patient demographic and the services we provide. This is the money that we receive as a whole for providing general medical services (GMS) and enhanced services to all of our patients – but this one pot has to service all the staff costs, running costs, maintenance of the building and all the other associated costs so there is not much leeway.
In addition to this with all the residential development within our catchment area our patient numbers are bound to increase – this includes Martello Lakes, some of the race course at Westenhanger, Twiss Road (Hythe Imperial, Fisherman’s Beach, The Paddocks and the possible development of Marine Parade to name but a few. AB reported problems in trying to identify/release Section 106 monies that are held with the Council for infrastructure and development of these sites (health and education) but it is a constant battle.
AB advised the group that we have introduced eConsult – any patient can access their GP online for treatment and feedback remotely 24/7. The surgery will then respond back to the patient within 24 hours. Just access our website www.oaklandshealthcentre.com and visit consult online. Find your health condition and fill in a simple online questionnaire and then press send, this is then received at the practice and the GP will get back to you. This was launched in November 2016 and the take up has been steady but increasing. Concern was raised that older patients may not be able to access this service – but we have found that many of our elderly patients do have access to the internet and whereas the national take up of online activity is on 5-6% within our surgery 20% of our patients have registered with online services. Online services include booking appointments online, repeat medication and now eConsult. We are the first practice in Kent to offer our patients this service. The filtering out of this service has been controlled (flyers and information in reception and cards sent out to patients with correspondence). This was deliberate as we needed to ensure that all the GPs were comfortable with the system before it became main stream. We will shortly be sending an SMS text message to all of our patients who have registered mobile phone numbers to advise them of the service. It is always difficult to secure up to date contact
information from our patients and despite us having forms in reception and for any new information to record as it is presented – there are a lot of patients who do not advise us if they change their mobile number or have shared their email address with the practice.
As a practice we do try to uphold continuity of care – so all our patients are registered to a GP and in the main we try to encourage patients to see that Doctor when they come in or for follow up as the GP will know of their history. In reality for a routine appointment this may mean a wait for an appointment of 2 to 3 weeks. AB explained that we moved away from the triage system 18 months ago. The GPs and NP were contacting the patients to signpost them to the most appropriate person. But on a Monday this involved contacting up to 100 patients, which caused chaos with continuity, additional pressure to the GPs and less appointment availability. Now we have a mixture of pre-booked appointments, face to face and telephone, some urgent slots on the day, online appointments and some appointments which are released during the week for a couple of days ahead. All patients are asked the reason for their request so that the admin/reception team can direct them to the right service – as agreed by the Partners.
Discussion arising from above
The group appreciated the pressure a more elderly population places on a surgery they were surprised at the low level of funding given for GMS work. It was suggested that our recruitment problem should be viewed as a community problem, not sorely a problem for the practice and perhaps a joint lobby from the PPG together with the GPs would generate more interest if we were to approach the local council or MP.
Some of the group did not think that we achieved continuity of care – as the delay in seeing your own GP resulted in seeing another Doctor for the results or follow up. Does a patient’s own GP have to give the results out? AB advised that we are in the process of looking at our internal systems to streamline activity where we can.
A couple of the attendees talked about their own personal experiences and sadly some of these encounters were not positive. They understood the need for the Doctors to be protected as they have their own pressures but it was felt that Reception and Admin can be obstructive, an additional barrier that is not necessary. As the public face of Oaklands and first point of contact this negativity does not reflect well on patient experiences. Lack of empathy, rudeness and rigidity have been encountered and also the number of contacts that patients have to make to secure re-assurance or paperwork was also commented on – they feel that staff were blocking rather than assisting and the time taken to secure the information that is required – return visits and phone calls. Constructive ideas were voiced – perhaps an admin co-ordinator who could oversee where the bottle necks lie who can act as a liaison between the patient and the clinician, analysis of phone lines in and out, when there is more pressure do we put on staff on the phones to deal with it? Customer service could be improved.
The meeting due to a close because of the time but there are many issues that we need to talk about. It was felt that a monthly meeting for the next three months would be beneficial (majority of patients were happy with an evening meeting) and then the meetings could be tapered off to perhaps bi-monthly or quarterly. Initially the patients will have to identify someone to chair the meeting and appoint other officers to run the committee.
Next meeting Tuesday 28th February 2017 at 7.00pm
Oaklands Health Centre
Patient Participation Group (PPG)
Minutes of Meeting – Tuesday 28 February 2017
MB, MG,PG, SG,CH, JH, VH, PL, JN, GO, CP,TS & NT
Health Centre Representatives:
Dr Farida Latif, partner and Sarah Roseaman, practice manager
- Matters arising from minutes of 17 January – Sarah Roseaman
* Recruitment of GPs.
Sarah said someone had suggested Martin Whybrow, local Kent County Councillor might attend this meeting as he may be able to communicate our problems to a larger audience. As we need to agree a formal structure as a PPG, this should be a decision for the future.
* Personal Experiences
Following a personal problem raised by one of the group when she lost her father, the surgery has taken steps to ease processes in house to reduce pressure at this very difficult time.
Concerns about customer service were noted and from next week, there will be a fully-staffed administration team. Some will be under training which takes a minimum of six months. The surgery is awaiting funding arrangements for Kent and Medway GP staff training but the plan is to enrol all admin/reception staff into a formal customer service module as our standard.
It was reported that there had been improvements at the front desk.
- Healthwatch UK Presentation
Sarah introduced Jo Parnell, programme manager of Healthwatch UK, who explained that the responsibilities of a PPG are:
* to work in partnership with your practice
* commitment to confidentiality and data protection
* to establish a clear way of working/ground rules
* to agree on what you hope to achieve
* to plan for the coming year
* to have a recruitment plan
She stressed it is not a forum for personal complaints. It was explained that Oaklands surgery has a complaints procedure and any concerns should be addressed to Sarah directly.
- Election of Officers:
JH was elected Chairman:
NT Vice- Chairman; and SG, secretary.
- Sharing of PPG information
The group said they were willing for all emails/contact information to be shared between members of the group. It was also suggested that no actual names of those raising matters should be mentioned in the minutes.
Jo Parnell said that it would be good to have our minutes on the Healthwatch UK website.
- Surgery update - Sarah Roseaman and Dr Farida Latif
Sarah reported that Dr Moffatt has now retired. They had hoped that one of the locums would have continued long-term, but unfortunately, this is not the case. There are still 3 locums: Dr Maggie, Dr Pinto and Dr Dardenns.
Dr Latif explained that to help with the shortage of GPS and to ease pressure on individual surgeries in the East Kent area, a new system of ‘hub working’ is being developed and she is the lead for the Hythe and rural localities hub which comprises surgeries in Hythe, Lyminge, New Romney and Lydd. The logistics of the hub working are still to be discussed and the services they will provide. There will be similar hubs in Folkestone and Dover and Deal.
There was much discussion about this and Dr Latif answered many questions.
Discussions are taking place for this hub to be sited at our surgery which will mean having to find finance to build it. It was suggested that this group could lobby Kent County Council to help with this. Dr Latif said this would be helpful but she would report back as no decision has yet been made.
This matter is at present confidential for the practice partners to decide.
- Suggested attendees for future meetings
There was some discussion about who should be invited to speak at future meetings but as we are in our infancy as a group, this will have to be decided at a later date.
- Shepway Patient Participation Group
VH will attend the next meeting of this group as representative of our PPG.
- Home visits and surgery call system for appointments –
A concern was raised about staff asking patients a reason for making an appointment. Dr Latif said that this had been agreed by the partners so that the admin/reception team can direct them to the right service.
A few members said that they had no idea what section 106 regarding new building developments is. One member said that she would produce some information about this.
Date of next meeting
Tuesday 28 March at 7pm in the Randal David Room.