Meeting Minutes November 2023

Meeting Date: 23rd November 2023
Time: 7:30pm via Microsoft Teams

Chair: Chris Greenwood.

Minutes taken by: Yvonne Barrett.

Introduction of New Members 

No new members, however CG noted there may possibly be three new members joining the next meeting.

• Action - CG contact the potential new members

Conflicts of Interest

None.

Minutes of the Previous Meeting

Read and agreed.

Review/Update of action sheet

Mapping of nurse appointments - Action completed

Many changes are happening in the rota team currently, CG feels now is not the right time to raise this with the Rota Manager. Item will be removed from the action sheet but CG will keep this on his agenda and approach JB at an appropriate time.

Agenda items - Action ongoing

Better links with hospital departments

Patient Groups - Breathe Easy, Low Carb Group, (Discuss some of the many ICB community groups)

• Action - CG arrange for the following agenda items/speakers to attend future meetings.

PVG info - Action completed

Info added to the screens. Further drive planned for the new year.

Redacted/anonymised version of the minutes have been added to the website. These can be printed to have on sites (one or two copies to be kept at the reception desk).

Views on introducing the Patient Voice Group to the BMG population - Action ongoing

CG has created a list of names. He is looking to arrange this at HPCC early next year, with possibly offering this at other sites in the future.

Hoping to catch patients as they come in.

• Action - CG arrange the above

Research Team (Visit to Stanleys) - Action ongoing

RT has not yet heard anything.

• Action - CM liaise with the Research Team to arrange a visit.

(Sharing FB posts) - Action ongoing

CM confirmed that FB posts can be shared, FB is a sharing platform.

PVG member noted that not everyone is aware they can share posts so it would be beneficial to add something to the post to highlight it is shareable.

• Action – CM add wording accordingly to inform people they can share posts

(Sharing information on Stanleys Screens) – Action ongoing

• Action - CM liaise with Stanleys about sharing information on their screens.

Incidents of no response from “contact us” - Action completed

PL highlighted an incident on the NHS app where their prescription request had been rejected on the app, however they received a text from the surgery saying it had been held back as it was with the GP for a decision. MW (Lead Pharmacist) informed the group that the Medicine Management Team need to cancel the request on the app to enable them to act on it, hence why a text is sent to the patient to informing them of the action currently being taken.

PL was happy with the information given.

Why extended access does not show on the NHS App/Patient Access - Action ongoing

Currently using two different systems. As this is an inconvenience to patients, we are looking at changing this, so hopefully we can do something about this in the future.

• Action - CM email JB (Rota Manager)

Website discussion and survey - Action ongoing

Feedback from the Young People’s Group on the website was that it needs to be more user-friendly and younger, considering colours/ background and amount of content. Currently hard to navigate. CG will invite them to a meeting to share their views. CM informed the group that the Website is managed by a company called Tree View Design and she is continuing to work on streamlining this.

• Action - CG/CM continue to work on streamlining the website/ CM speak with Tree View Designs
• Action - CG ask the Young People’s Group to attend a meeting to share their views

CM is adding the website/social media address onto BMG headed paper.

Check-in screen at HPCC - Action ongoing

Concern regarding where to place the check-in screen as the signal is weak. Possibly looking at removing this.

• Action - CM look into the placement of the check-in screen at HPCC

Introduction of extended access - Guest Speakers

Chris welcomed AM, AF, and JS from Fylde Coast Medical Services (FCMS) to the meeting and thanked them for coming.

AM introduced herself to the group and explained her role as Head of Services in the Lancashire area. Other members of the team AF/JS were also introduced. AM informed the group that the team is made up of Advanced Practitioners, GPs, Trainee GPs, Health Care Assistants, and reception staff.

An overview on what the service offers was given.

FCMS is the provider of services in the Lancashire area, made up of the following:

• UTC (Urgent Treatment Centre) – Access via walk-in.
• Minor injury – Access via walk-in.
• Minor illness – Access via 111. This is an appointment-based service.
• GP Out-of-Hours Service – This is open when the GP practice is closed and can be accessed via 111. This service is for acute illness. It is also open on bank holidays.

Acute on the day illnesses are dealt with, sick notes cannot be given. The team has access to x-ray, wound dressing following a minor injury, can plaster following an injury, and refer onto the fracture clinic.

The group were asked if they had any questions and the following discussion took place:

PVG member noted they have heard good reports about the service.

How busy is the service?

The service is well used, 50/50% split between minor illness and injury. FCMS will see patients from A & E. Ambulance service can refer into FCMS. Seen an increase in injuries, so hopefully this means it has taken some pressure off A&E. CM informed the group that she attends Morecambe Health Centre on a Friday and has seen how busy the service is. FCMS try to give waiting times/appointment times to patients to help manage patient expectation.

The team expressed that although they provide core services, they are also involved in various other work/projects. They have direct access into care and nursing homes. The homes can call in directly. They have been doing Health Checks for asylum seekers, and have been working together with the GP practice.

They are working together with Health and Social Care on a project called Trail Blazer, to help with the step down into a care home bed from an acute hospital setting bed, and enable patients to get back into their own homes.

Mental Health Team and Social Care have recently won an award.

FCMS are often asked to get involved in trialling projects. They enjoy this variety this brings, as it makes the work more interesting for the clinicians, helps with engagement in the community, and develops new skills.

Do you cover service in care homes out of hours?

FCMS works closely with the GP practice, and if the practice is closed and the care home rings up, then the FCMs would get involved. There is no duplication of work, the patient is safety netted and this involvement can often prevent the patient going into an inappropriate bed at the hospital. This involvement helps the care home staff, as it removes any concern on decision making.

FCMS are currently working on an End of Life project and are looking into how to support each other better/how to make it a better experience.

HF informed the group that the practice is aware of their projects, and there are links/information sharing between FCMS and the practice. She expressed that it is good to work closely with other services.

Who are you governed by?

FCMS is commissioned the same as all NHS Services, a bid for a contract/service is made. They are commissioned by the ICB. Regular audits are carried out to ensure any service contract is met.

FCMS have been invited onto the INT Board - Group effort to share the load and work together.

Why are you being commissioned at ICB level when there is a PCN?

ICB holds the funds, however this may change in the future. FCMS would fall under 3 PCNs, Morecambe, Lancaster and Carnforth, so this would make it difficult to commission.

How do FCMS inform patients about what is going on?

FCMS has a FB page/service leaflets. AM is happy to share the service leaflets with CG so he can share with the group. Joining meetings like today helps get the information out there.

• Action - CM/CG discuss with FCMS about sharing information on BMG website/FB

Do you have access to patient records?

Yes, we have access to patient records, despite us being on a different clinical system. FCMS can see a patient’s records and can share consultations and attendances with the GP practice. This sharing is done by 8am the next morning following a patient attendance. AM expressed that unfortunately there are a few gaps with regards to sharing, for example, the sharing on DNACPR, however the doctors at BMG are very keen on advance care plans, so this is being addressed. FCMS is keen to remove any barriers for a seamless service for patients.

Would FCMS be happy to attend a BMG PLT training day to help educate the Patient Advisors?

Yes, this would be possible.

• Action - HF look into inviting FCMS to a PLT training day

FCMS often get requests for medication. This can be for various reasons, so this is why it is beneficial to have access to patient’s records to prevent the misuse of drugs. If a clear pathway cannot be seen on the records, then the patient will only be given the lowest duration of drugs to help get them through until they can discuss this further with the practice. FCMS keeps a log on how often patients have requested lost medication, especially in relation to specific drug types.

CG thanked the members of the FCMS for attending the meeting and expressed how beneficial this information has been. He reiterated the importance of using this service to help relieve pressures in A&E.

Launch of GPIP

HF updated the group that the practice was still waiting for the finalised CQC report. The CQC have highlighted what we knew about patient access issues and that the practice has already been looking at significant changes in this area.

BMG has been taking part in GPIP since June, where this programme helps support practices to look at their appointment system/call stats/appointment activity and helps find ways to improve the patient’s experience/workload.

CQC had flagged up the national survey results highlighting telephone access as being an issue and we have been moving ahead with changes to improve this area.

The AccuRX online appointment requesting system (total triage) is being launched fully in early 2024, training has been ongoing. The plan to move to this was started before the CQC inspection with the aim to improve patient experience and streamline contacts, therefore reducing pressure at the desk and on the phones.

The new system will work as follows:

• a patient would complete the online form via the website or the NHS App, where their request will be directed to the most clinically appropriate person and appointment type. If they are not able to complete the online form, the patient can telephone or come into the practice where a member of the team will either help them complete the form or do this on their behalf. Uniformed questions will be asked, so this will help take away the decision making and pressure from the Patient Advisors.
• Each request will be triaged by the clinical team, and the Patient Advisor will then follow up by offering the patient an appointment following clinical instruction, so this should simplify their role and accountability. HF expressed that requests may not immediately be answered with an appointment as they are now, but patients will be seen according to clinical need e.g. if it is urgent they will still be seen that day. The team of clinicians will look at all the requests as they come in and action accordingly. The clinical team dealing with triage will be made up of GPs/Advanced Practitioners, Mental Health Practitioners and First Contact Physiotherapists.

BMG are hoping that this will improve patient/staff experience and how we use our appointments.

Patient Advisors will be encouraging patients to message in online and start using the system, then around Christmas time a campaign will start.

An audit will be carried out on a Monday to monitor this.

Is it like triage?

The new system will be sorting and directing. The previous system didn’t triage, it consulted in the form of F2F or as a telephone consultation (although we called it a triage, list this is rarely what it is used for currently)

Are there other practices that use AccuRX like this?

Yes, lots of practices are using this very successfully.  PVG member expressed that sometimes they don’t get responses to messages.

• Action - CG/HM look into this

Is it like using Ask My GP?

No, we would internally always use AccuRX so everyone gets the same treatment. If you phoned the practice or came to the desk, then the same AccuRX questions would be asked. Patients will not be required to contact us online we will still have all options available.

PVG member expressed that he finds the Patient Advisors excellent and feels it is beneficial to communicate with a person. HF highlighted that patients who want to can still communicate with the Patient Advisors, but the practice is aware that many patients prefer to communicate online so providing this choice is beneficial.

PVG member discussed their friends/family experience with using the online system, one had used it and heard nothing back but has now got an appointment, and the other used Push Dr (video consultation) where they signed on and had an online consultation which worked really well. HF confirmed that the option of video consultation service via Push Dr will continue for the foreseeable.

Are there any restrictions/ID requirements for the use of Push Dr?

The ID requirement has been removed as this was creating a barrier to patients. A verification question will be asked instead.

• Action - RT inform CG on who had issues with their online request so he can look into this

Feedback from the soft launch has been positive, benefitting the Patient Advisors and patients.

CB (Patient Advisor) informed the group that she recently took 86 calls for routine enquiries and sending patient links, were previously in the same timeframe she would only have been able to deal with around 50. She expressed that this has brought a good atmosphere to the phone room. Patient Advisors are calling patients and talking to them, therefore human interaction will not been lost.

Is this integrated into the patient’s records. Does interactions that take place, go onto the records immediately?

The whole interaction from request will be visible on the patient’s records. When a request is made, a link is sent to the patient’s phone, the link is opened and the patient answers the questions, and as soon as this is received it is logged onto the patient’s records instantly.

The patient will see this on their NHS App.

• Action - PL advised to test the system out on the NHS App and send in a request

• Will AccuRX be used for medication requests?

The medication query box would continue to be used as it is now via the website or you can request your repeat prescription via the NHS App.

Will there be a set response time to AccuRX requests?

These requests will be coded as red/amber/green. Waiting times would be dependent on the priority of appointment. BMG are currently working through the protocol at the moment and this will be explained.

How will you measure the result?

The result will be measured on telephone stats/online stats and patient feedback to demonstrate improvement.

In January we are hoping to add extra appointments to the system in time for the start of the full launch, so we have capacity with the availability to book. The new system will be constantly monitored and reviewed.

• Action - HF share information with CG/YB to send to the PVG Group

CG asked the PVG members to share their experience of using the system with YB. Discuss again at the next meeting.

Medicine Management Team update

MW introduced himself to the group as Lead PCN Pharmacist at BMG. A presentation was shared explaining the role of the Medicine Management Team which gave facts and figures (copy attached). MW expressed what an incredible job the team does and how this is a challenging role.

The following questions and discussion took place after the presentation:

PVG member raised that a batch of repeat medication was issued by the chemist however he hadn’t remembered ordering all of this.

How would this happen?

MW asked if it was maybe historic items that had been sat at the pharmacy. The PVG member expressed this was a recent request that had been made.

• Action - AW advised to try out the online medication request system and see how it works and feedback

It was agreed that the presentation has shown there is a huge quantity of work that goes on behind the scenes. MW expressed that his team are working extremely hard, often dealing with negative comments/problem-solving. 

There is a large amount of requests that come in from hospitals, which has increased over the last five years. Staff are working extra to catch up on the backlog, some giving up their weekend, they are doing their best for the patients.

How many scripts are done on a monthly basis?

About 30,000 a month. The team also answers calls and works with the rest of the practice team.

Future plans within MMT are to move some processes to the Pharmacy Technicians, where the technician will look at correspondence that comes from the hospital. This has previously been done by the Pharmacist, however the Technicians are trained to a standard that they are able to deal with these requests. This will utilise staff to the upper levels of their qualifications, and will release the Pharmacists to see patients. Many of the Pharmacists want to have clinics and are keen to see patients/look at management of long term conditions. This will be beneficial to the practice as this should free up the GP to see more urgent matters.

CG thanked MW for coming to the meeting. 

AOB

Online Patient Journey - Video

CM informed the group that she may require further help regarding the online patient journey. This invite is open to all.

Phone Stat figures

BMG acknowledges that access is not ideal at present, but this is being addressed with the launch of the new system.

CG shared the phone statistics with the group.

Answered calls were significantly better. Average wait time- 8 mins. Max wait time was 58 mins, but this figure is possibly obscured with the recent phone line problems. Calls were changed to internet based calls, some weren’t coming through, some on hold longer than others. This has now been changed and resolved. The issue was with the provider, so this was beyond our control.

Abandoned calls are currently at 33%, hoping this will improve with the new system. Changes being made, expression of interests have been sent for funding for cloud based phone lines. This should help with call handling.

PVG member raised concern that a few months ago there was improvement, but now it seems it is not going so well. Is this due to a staffing issue? - We have lost time to sickness and other areas, it has been a difficult couple of months. We are recruiting this week, as we have had movement within the Patient Advisor Team. The plan is that if we have a more simplified system for Patient Advisors to work to, then this should make us more efficient and have more staff answering calls.

PVG member also raised concern that GP appointments are down on appointment availability compared to the national figures. They have gone up by 10% but this is still about 20% below the national statistics. HF asked if these figures factored in the other clinical appointments that BMG offers, for example MH, FCP, ACP, and if not then these figures are not representative to the practice as we have many other practitioners working within BMG.

PVG member confirmed these figures only included GP appointments. 

They asked about the GP figures and continuity of care, why have the figures improved? Has anything changed? – HF noted that there have been more Locums working in the practice, a new member of the Mental Health Team has started, and we have taken on two new First Contact Physiotherapists.

HF expressed that with further recruitment and the launch of the new system in January 2024, this should help with access, availability and continuity of care. She expressed that BMG is a multidisciplinary team, so it is difficult to compare like for like with national statistics. Some practices are GP led, however many of the bigger practices are multidisciplinary and have moved away from solely looking at GP figures.

PVG member asked for this to be discussed again at the next meeting.

• Action - YB add to agenda for next meeting/Review GP availability 

Date of the next meeting

Thursday 15th February 2024 at 7:30pm via MS Teams

Rules of the meeting/purpose of the Chair

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