Meeting Minutes April 2024

Thursday 18th April 2024
Heysham Primary Care Centre - 7pm

Chair: Chris Greenwood

Minutes taken by: Yvonne Barrett

Introduction of New Members 

New members introduced themselves to the group, and all were welcomed.

Conflicts of Interest

None.

Minutes of the Previous Meeting

Read and agreed.

General practice improvement stats

(as req at previous meeting)

STAT figures were emailed to the group. CG shared November’s appointment figures at the meeting.

The following discussion took place:

PVG member questioned the data collected and how this is reported on the report. It was felt it would be better to have a rolling total, and in summary a yearly total. CG agreed this would be beneficial and will add an extra column to the next report.

PVG member asked for data on abandoned calls and wait times to be added to the report for discussion at the next meeting. CM to arrange this.

CQC action plan update

(as req at previous meeting)

HF shared the action plan that has been created since the CQC visit. This demonstrates what we have been doing since the CQC report.

The CQC rating was downgraded from good to requires improvement, with much of the downgrade being related to access. We are working on the actions and reporting back to the CQC to inform them of our timeframe for improvement, demonstrating change, giving feedback, and providing evidence of any improvements.

Quality and safety was flagged at the visit, and this related to the CQC feeling the monitoring process was disjointed. This has been investigated and a new incident process has been implemented, and a Quality Safety and Governance group (QSG) been created to oversee things.

The documenting of verbal complaints was raised by the CQC, and although we were keeping a log of any written ones, the CQC felt that we should have a history of verbal ones too. CG has now implemented a log for verbal complaints.

Reporting complaints to the CQC is now different to how it has been done previously. We are no longer use the significant event process and have replaced this with a reporting system that logs anything that has happened. This is investigated by the QSG Manager, with the more serious issues being taken to the Quality Safety and Governance meeting for further discussion. This has enabled a more robust/learning  system.

CG explained the current process of when a complaint comes into the practice, whereby an acknowledgement letter is sent to the patient with details on where they can contact regarding complaints, however CG noted that the parliamentary ombudsman on the information was amiss, and at the suggestion of the CQC this has now been added.

CG agreed to give a summary review of complaints at a PVG meeting on an annual basis.

Infection control was raised by the CQC, processes had changed. The Clinical Services Manager is working on training and new guidelines.

Staffing and reviews were also raised, and we are ensuring to demonstrate supervision and that appraisals are being done.

In summary we are working through the action plan to address anything raised. Once the actions have been completed, we will contact the CQC for a review. We can’t guarantee whether this will change the rating as improvement to patient access is a long process and will take time.

The following discussion took place:

Has the CQC toughened up and this is why BMG have received a lesser grade?

• The CQC focused on great detail, bringing along 8 inspectors with them, whereas smaller practices have usually had 1 inspector. The level of scrutiny was rigorous,  and this was the first CQC full inspection since BMG merged.
• HF expressed this is not an excuse for the rating, and assured the group that we are  working extremely hard to improve/implement change on any issues raised on the  CQC report.
• Succession planning is now being done with GPs and across the whole of the  practice team.

How can learning happen if you don’t escalate verbal issues to a complaint?

• All complaints are investigated, verbal and written. CG speaks to the person(s) involved and investigates what has occurred. If the complaint is related to a process issue, then the patient will be written to with an explanation, however if learning is needed then we follow this up with an SEA/share learning with the QSG group and learning is shared via the group. Learning points come from SEAs, and these are shared with clinicians and microteams.
• The way we report SEAs has now been changed.
• It was noted that many complaints are regarding processes rather than clinical care.
• Complaints are forwarded/shared at various meetings.

PVG member raised that he has submitted a complaint but has had no feedback with what has happened yet. CG will ring PL to discuss.

PVG member raised concern that 5/6 areas on the CQC report require improvement.

HF explained that access was a main issue on the CQC report. The CQC comment relating to high risk drug monitoring related to the use of secondary care system results, where these were accessed but not  always recorded in the patient notes to say they have been reviewed.

The process for doing this has now been reviewed/tightened up across the practice.

One of the group members raised that there has been an issue on patient access with results being marked as been seen, letters not marked as being read, however there has been a national issue with online visibility within Emis/Docman (software) with regards to letters not showing as having been read/marked. This national problem has now been resolved on the 1st April 2024 however there may still be some online visibility issues with historic letters.

BMG are working on a 6 week routine turnaround, scanning has improved.

Why is there a gap with communication?

• CG explained that when a letter comes in online, the doctor views this but emis is not allowing this to be marked as read despite the clinician viewing the letter.

PVG member highlighted that he has found many sites that give information about the national issue with online visibility, and suggested the practice adds this information to the website.

CM has added it to the Facebook page but will add it to the website also. CM will also confirm the issue has been resolved.

PVG member expressed they were unhappy that Facebook is being used so much, and feels the website is a better source of knowledge. A discussion took place, and it was noted that many patients use Facebook along with other social media platforms, so it makes sense to share info on these as well as the website to target more of the population. We need to ensure we use the right tools to promote information as widely as possible, and Facebook seems to work well for short information and further sharing.

CM is working hard on the website to make it easier to navigate due to its large content.

Stanleys are finding Facebook useful.

CQC has approved the action plan, and we are now addressing what they have raised.

Timescale- Review will be around the end of the summer.

Has there been many comments from patients on the change in rating?

• We have not had much feedback regarding this.

Is the action plan published on the website?

• No, as this is an internal plan.

Can this be shared with the group?

• HF will look into sharing the plan with the group.

Review/Update of actions

Introducing the Patient Voice Group to the BMG population

We hope to involve the group with the feedback survey in surgery, so they will have a positive role when introducing themselves- Action ongoing

Research Team visit to Stanleys

No date set as yet, however the team will give an update at the ICC monthly meeting in March- Action ongoing

FCMS - Invite to PLT training day

Awaiting discussion with FCMS and a suitable PLT – Action ongoing

Launch of GPIP

Issues with online requests – On the agenda for discussion, reported on by Dr Benville – Action completed

New appointment system

CM emailed the clinician regarding lack of feedback when a request had been submitted and actioned, awaiting response.

CM has spoken with the clinician regarding PL’s appointment and asked they be mindful about changing times and the impact it can have on patients- Action completed

New appointment system feedback

Dr M Benville introduced herself to the group as Lead GP on the new appointment system.

She explained that her attendance was to explain how the new system worked, and answer any questions raised.

The system has been up and running since the end of January and the idea for this implementation was to improve patient access. Phone lines were an issue, and the driving point was to make a fairer system so appointments could be allocated more clinically appropriate. The accessibility of an online system to contact the surgery via AccuRX was introduced, in addition to the traditional methods.

A medical request form is completed online, with help from the Patient Advisor if required. All requests are triaged, and any admin requests are filtered out and sent to the relevant internal departments. Medical requests are triaged by the CAT (Clinical Assessment Team) which is made up of various clinicians, and appointments are allocated accordingly. Red, amber, green rag ratings are used.

Dr Benville expressed that we have been experiencing difficulties with getting through all of the requests with regards to allocating appointments, but noted they are triaged on the day and may sit in the inbox for when an appointment becomes available. Red rated requests are actioned on the day with a phone call.

PVG member has used the system successfully through the NHS App and feels it is superb. She recommended putting as much information into the form as possible to help with triage. PVG member expressed that they had experienced a problem with receiving a response following a submission of a request, but does acknowledge they have had success with the system since. It was felt this may have been due to it being the beginning of the soft launch, and although the issue was looked into, it was difficult to be certain why the AccuRx request was not received.

CM is happy to do an AccuRX test submission for anyone who requires it.

MB/CG expressed that we are trying to feedback to patients regarding routine requests, and are looking at ways to improve this communication to let them know their request has been reviewed and is being dealt with.

MB informed the group that we also triage out to physio and the Mental Health team who follow the same system.

Are patients happy with the software?

• As this is the primary method of access, a survey based on a small number of patients trialling the soft launch was done, and we intend to repeat this when the system has further imbedded.
• CG confirmed we have not received any complaints regarding AccuRX specifically but some patients will comment on how the system hasn’t worked for them.

Why is the number of appointments booked 7% more than appointments offered?

• Extra slots are used if they are triaged as red. Clinicians will add extras on until the triage box is empty.
• Benefits of the new system is that we are able to manage the workload easier, add extras, more flexible, know our demand earlier in the day, move doctors around etc, offer more clinically appropriate appointments.
• PVG member had submitted a form and didn’t get a reply back, however he expressed that he had entered the data incorrectly. The second time he made a submission it worked well, was triaged as red, and they received a phone call. The system worked perfectly.
• It was agreed that as the system evolves, it should work more efficiently as staff and patients become more familiar with it.

Can the request form be added to the Patient Access platform?

• No, this is not possible. The form is accessed via the website or the NHS App as we are no longer promoting the Patient Access platform and encouraging patients to use the NHS App. The NHS App can be downloaded easily.

Can we create a leaflet advising patients not to use Patient Access and to move onto the NHS App?

• Yes, this can be arranged. CM informed the group that Patient Access had been used as a fail safe alternative way to contact the practice if the NHS App went down.

Stanleys are seeing an increase in people asking for help to get them onto the system as not everyone has wifi/digital access.

Concern was raised with regards to the forthcoming plans for landline telephone lines being replaced with digital ones, and how will these people contact the surgery when this happens. Traditional methods can still be used to contact the surgery.

Wait times have not yet improved, why is this?

• This is partly due to staff sickness/recruitment, and that the Patient Advisors are actioning the online request inboxes which has taken some away from the phones.
• A significant amount of patients are ringing up and asking the Patient Advisors to complete the form for them, which is slowing down the system.

Could it help if we signposted to Stanleys? Worth a thought.

• Attracting and retaining staff has been difficult, especially with the minimum wage recently increasing, this brings lots of financial pressures to the practice.

CM informed the group that the first day the new system went live, we received around 861 online submissions. This freed up the phone lines for those who aren’t as digitally able.

Age UK will help patients aged 18 and above with any digital issues. This is a great resource that can be used.

RT from Stanleys informed the group that Stanleys are taking over another property on West Street, a bid has gone in for funding which will help provide free wifi within the West End and should springboard throughout the whole of Morecambe.

Stanleys are supporting the population as much as possible.

MB highlighted that a long time has been taken when implementing the new appointment system, taking into consideration vulnerable patients etc.

Patients can continue to go into the surgery for help with access when required, and all traditional methods remain in addition to the online access.

Do we invite a Healthwatch representative to each meeting?

• Healthwatch representative attended the last meeting, but not all as she is covering the local area alone so may find it difficult to attend all meetings. She is in the process of looking for another representative to work alongside her covering the local area.
• Suggestion was made to invite the Healthwatch representative to all meetings.

Figures are showing that PA staff sickness has increased since the new system has been implemented, why is this?

• Feedback received from staff is that they are enjoying using the new system, however as it is much easier to access the practice, this has been met with a lot of unmet need so pressure is currently heavier than it was.
• We are in the process of recruiting, so hopefully staffing will be better and the change in Patient Advisor role will help with retainment.

RT from Stanley’s raised concern that some patients could be isolated in their homes for lengthy times waiting for calls from the practice on their landline.

It was noted that the Patient Advisors try numerous times to contact patients.

Figures on electronic requests looks like they only cover half the practice, data may not be representative of the practice?

• The data is for any request made via AccuRX and does not incorporate patient follow ups. Data is on patient initiated requests only.
• GPs often make f/u appointments and f/u phone calls themselves.
• F/u appointments are booked as far as 3 weeks ahead.
• GPs often wait for blood result to come back before they book the patient in for a f/u telephone call.
• There are many GP to book slots available for GPs to use.
• CG to add f/u data to the data report.

PVG member discussed their successful f/u call from the GP, they were referred on, and now has an appointment pending. They have no complaints with the new system.

PVG member is extremely happy with the care they receive from Dr Wooldridge and feels continuity of care helps.

VW noted that we all try to provide continuity, however this is difficult at times.

We have a sector of patients who value continuity but others who are happy to be seen by any clinician. It is often hard to find that balance within the practice.

The online request form asks the patient if they wish to see a specific clinician, therefore continuity is recognised as being extremely important.

The CAT team try to provide continuity where possible.

PVG member who was unable to attend the meeting gave the following feedback:

• Whilst the online booking system seems to work well enough, the follow up is lacking. A text message response may well be sufficient for many cases, however if it raises another question there is no simple opportunity for a conversation to resolve a query. I would like to see all clinical requests answered by a phone call, so that the patient has the chance to engage fully.
• I used the online system to request a blood test. I was sent a link to make the booking, but was only offered very limited appointments, none of which were at the sites local to me. It would be better if a wider range of appointments could be offered.

The feedback above was discussed and CG expressed that we unfortunately don’t have the time to ring all patients. We need to keep calls to within a safe limit.

Why do we give patients the option whether they want a phone call or text?

• The online request form was created by AccuRX. Many patients choose to be contacted by text, especially if they are at work for example or unavailable to take a call.
• Red rated requests are always communicated via phone calls. Amber/green via text or call.
• We are working on better communication/feedback regarding routine requests, as we can’t always currently get back to the patient quickly to let them know we are dealing with their request.

Phone calls offered previously was around 25% below the national average, the new system is showing 7% under provision. Why is this?

This has reduced due to extra locums being used to reduce pressure. Push Dr and Pharmacy First are also being used.

Is too much time being spent on supervision?

• CAT team are more flexible, so blocked out time is not needed.
• We are now doing group supervision.
• Suggestion was made to add Pharmacy First to the data report, CG will arrange this.

Who gets offered a Push Dr appointment? Concern was raised regarding being offered a Push Dr appointment and not having the ID requirement to hand, how do you prevent this barrier?

• Push Dr has now removed this requirement.

Dr Benville was thanked for attending the meeting.

AOB

Medical checks for the over 80s

Are there provisions made for the over 80s for a medical check at the practice?

• Checks are no longer routine but can be requested. CG will confirm this and feedback.
• Stanleys have recently had FCMS doing health checks for 40-75 year olds. These were bookable checks, and they are planning to do more. This is advertised widely.
• RT will check on the age range and feedback.

Over 65s vaccination for shingles

Over 65s vaccination or shingles doesn’t seem to be advertised at the practice but is advertised on TV, why is this?

• BMG are routinely inviting all patients who are eligible.
• Invitation is done on date of birth order.

CG thanked everyone for attending the meeting and the feedback given. The meeting came to an end.

Date of next meeting

Thursday 13th June 2024 at 7pm - Heysham Primary Care Centre (waiting area)

Rules of the meeting/purpose of the Chair

• Read agenda and papers in advance of the meeting and arrive prepared.
• All questions to be through the chair and only one person to speak at a time.
• Stick to the items on the agenda 
• Respect the role of the Chair and allow the Chair to undertake the role to the fullest extent.
• For all decisions Chair to invite everyone present to give opinion without interruptions.
• Vote on all decisions and those members not present must inform the Chair of their voting decisions in advance of the meeting.
• Declare conflicts of interests.