Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 7pm 8.30pm Wednesday 30 th July 2014
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1 Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 7pm 8.30pm Wednesday 30 th July 2014 Attendance from the Practice: Dr Elizabeth McGinn (GP Partner), Sandra Connolly (Practice Manager), Jonathan Wilmshurst (Shared Services Manager) and Viviana Farias (Reception Supervisor) 18 patients attended the meeting. Sandra welcomed everyone to the meeting and introduced Dr McGinn. Sandra thanked everyone for attending and introduced the purpose of the Patient Group and the meeting agenda for the evening. The Patient Group is an opportunity for a group of committed patients to work with the practice team to support the practice and improve services. It is a chance for the practice team to listen and respond to the views of patients. Agenda: 1. Review of our Repeat Prescribing policy 2. Discussion about the Practice Quality Improvement Plan 3. Any other business 1. Repeat Prescribing Sandra explained that the practice wishes to review our repeat prescribing policy and gain feedback from patients on how well the process works for them. Dr McGinn asked the patients present whether they were on repeat prescriptions, which about half of them were. Dr McGinn explained the process from the practice perspective: Medicines are only available on repeat prescription (to be issued without seeing the doctor each time) if the patient has first seen a doctor at the practice and discussed their medications. The doctor has a lot to consider before allowing a repeat prescription to be started and will first check that the medicines are safe for the patient, that they will help them and that the patient s condition is stable so they do not need to be seen as often. When requesting a medication for the first time, even if the hospital have suggested it, patients always need to discuss this with the doctor, either during a telephone consultation or a face-to-face appointment. Patients can only request repeat prescriptions for medications listed on the white page that is attached to the green prescription. Patients should keep this slip in order to request more medications, but be careful discard old out-of-date copies that may have previous medicines and doses listed. Repeat prescriptions can be ordered in the practice by ticking the items on the white slip that are needed and then handing it to a receptionist or leaving it in the
2 box in the foyer. The prescription will be ready to collect after 2 working days, provided there is no query. Patients can also arrange for their pharmacist to request the medication on their behalf. This is an arrangement between the patient and the chemist of their choice. We also offer an online service so that patients can request their repeat medications over the internet. To register to request prescriptions patients need to get a form with an activation code from reception. When they log-in, the system will list the items that are approved for repeat prescription (this is the same as the list on the white slip attached to their prescription). Electronic prescriptions are also available. Pharmacists may ask patients to sign up for this service; many of them now offer it. It means that instead of printing a prescription, the prescription is sent electronically directly from our computer to the chemist s computer. We do sometimes refuse a request for a repeat medication because the patient is due for a review with the doctor. We ask that patients remember to book appointments for their check-ups as instructed by the doctors, so that we do not have to refuse medications. We do not want patients to run out of their medicines! We can only issue up to 3 months of a medication on each prescription because of NHS rules. The practice spends an enormous amount of time processing prescriptions and each prescription has to be individually reviewed before it can be issued Dr McGinn invited comments, questions and feedback from patients. One patient said that he can t get into the system to order his medicines online though he has been issued with a password twice. The system says that the data held on file does not match the information he is entering. The patient felt that problems like this would prevent patients from using the system as they would try it once, it would not work and they would give up. Sandra apologised and said she was aware of some patients who have been unable to register because of problems with the software. Reception staff will help as best they can. Unfortunately the practice has no control over the software which is the same in all Lambeth practices, but it is starting to work well for some patients (6% are now registered). Sandra offered to help the patient get registered with the system. Another patient said that they ordered the script online, waited the usual 2 days and when they came to collect it and it was not ready and there was no record of the request. The patient has been ing her requests, which works well.
3 Sandra asked the patient to provide her with the details of the missing request so she could speak to the software company and see where it went wrong. Sandra explained that the practice prefers not to use the system as patients often request medications that have not been authorised for repeat prescribing or get the names and doses of medications wrong, which delays the process for the practice. Sandra asked that the patient allow her to get the online system working for her, but she could use s in the meantime. A further patient asked how they should contact the practice if they were experiencing difficulties. Sandra said that she was always happy to speak to patients and hear their comments so she can get a feel for any recurrent problems, but also that the receptionist will always try and resolve any issues. Dr McGinn mentioned that Sandra does often have to go to meetings outside the practice, so may not be around. She asked the patients how they would like to give feedback? She can then get a feel of the issues that come up and start to sort them out. Question asked to patients, How would they like to feedback? Responses: , letter, appointment with practice manager, patient groups and request for a comments and suggestions box in the practice. Dr McGinn and Sandra agreed that patients can give feedback in whichever is the easiest way for them, further suggestions are welcome. Sandra said that is she was not around she will always contact a patient as soon as possible, if a message is left for her. There is a comments and suggestions page on the practice website where patients can send feedback ( and also another option via the online booking and repeat prescribing service. Summary of discussions about repeat prescribing: Patients did not suggest any changes to the current prescription process, but wanted more help in registering for online services. All patients in attendance were given the practice leaflet with information about repeat prescribing. Explaining the repeat prescriptions process at the meeting was generally thought to be helpful. Patient with interest in IT identified. Actions: Sandra to arrange comments and suggestions box for reception. Practice to provide assistance to patients to register for online booking. Sandra will help the two patients who raised queries. 2. Practice Quality Improvement Plan Sandra explained that all Lambeth practices need to submit a Quality Improvement Plan. It is designed to ensure that Lambeth practices offer the same standard of services and to help us work within our budgets. There are various elements that make up the plan and these have been determined by the Lambeth Clinical
4 Commissioning Group (Lambeth CCG). All practices in Lambeth are members of the group and are each responsible for a share of the government money given to the CCG to pay for things like hospital appointments and A&E. Sandra talked through each of the areas of the plan and asked for patient feedback. Practice engagement This part of the plan includes speaking about the plan with the patient group and hearing patient thoughts on what priorities we should set for the plan. It also required the practice to attend various meetings, training sessions and events designed to ensure the practice is an active member of the CCG and works within the borough to improve care for patients. The CCG also directs the practices to follow certain agreed pathways of care for patients with particular conditions. Health outcomes This is about how we can look after patients better. They look at whether we manage patients with certain long-term conditions such as diabetes, hypertension and COPD (chronic lung disease) by looking at how many of our patients with these conditions have blood pressure and particular blood results in a set range. We are set targets and these are judged by a traffic-light system. Our practice generally performs well and meets these targets, but we focus on doing this by regularly reviewing patients and providing the good care, rather than just aiming for a target. Prevalence By looking at data from around the country the NHS knows how many people in the population have particular long-term conditions this is called Prevalence. The practice has fewer patients diagnosed with these long-term conditions compared to the national average and we are expected to work to identify more people who may be undiagnosed. However, the targets set for us are challenging as we are a London practice with a young population, so naturally fewer of our patients have these conditions that usually effect people later in life. For example the national figures suggest we should have 180 patients diagnosed with COPD, but we only have 61. Whilst we are never realistically going to record the same number of patients as the national figures, because of our younger population, we are working to identify patients. This means that we routinely test patients who may be at risk of developing some of these conditions, such as asking patients who are heavy smokers to do breath tests to check their lungs or testing the blood sugar of patients with a family history of diabetes. In doing so we help get patients treatment earlier and manage their condition better and this can improve their outcomes. Referrals The practice is allocated a share of the pot of money Lambeth CCG has to spend on patients going to hospitals and other care outside of the practice. The amount of money is limited and the practice is being asked to reduce the number of patients
5 that we send to hospital consultants. For example last year our budget said we could refer 586 patients to hospital, but we actually referred 774, 188 more than we have the money for. This meant we overspent by 42,000. We now have a number of checklists and approved pathways to follow to help us look after more patients without them needing to visit the hospital. This means doctors may not refer straightaway, but may go through a number of other steps before sending a patient to the hospital. A patient asked who checks the number of referrals and what happens if you re over referring? The CCG keeps data and comes to the practice and may review referrals we have made. Sometimes, this is a good thing as they might take a closer look at certain referrals and explain to us that it may have not been necessary to refer patient to hospital. However, we do now have to work hard to justify why we refer patients to hospital. The CCG has to remain in budget and this is becoming more difficult. Dr McGinn stressed that, whilst we need to ensure we only refer patients who need to go to hospital, our budget will not be part of the decision if the doctor believes a patient requires a referral. A Patient asked what happens if patients do not attend their hospital appointments? Sandra explained that we don t get charged if a patient does not attend. However, if patients don t go to their hospital appointment the GP has done a lot of work for nothing. It takes some time to arrange for a patient to go to hospital; the GP has to examine the records and make a case for any referral, get the results that the hospital may want to see, gather information on the patient s medications (which could be a lot) and put together a case history with any other information the consultant may need. The secretary then has to take time to reserve a place in the queue for the patient so they can get an appointment. If a patient does not attend their appointment but later wants to be seen, we can t just resend the letter, but have to go through most of this process again, which is onerous. A&E attendances Last year, our budget was enough for 1865 patient attendances at A&E. Actually there were 2040 attendances by our patients, 175 more than we can afford, and leaving us 20,000 over budget. For each patient registered with our practice we are paid around 86 per year to look after them. That s 86 to look after the patient for the whole year regardless of how many times the patient comes to the doctor and how much time we spend looking after them. This is less than the price of one single attendance at an A&E department. The Government wants us to try and stop patients going to A&E unnecessarily. A&E attendances are high because of many reasons, such as language issues, patients who are not aware of how the NHS system works, it may be convenient for some patients who live or works nearby, or the patient is worried about something and
6 feels that A&E is the obvious choice to sort out their concern. Some patients tell us they go to A&E because they can t wait for an appointment at the GP surgery. Dr McGinn stressed that we provide a same day emergency service all day every day and that patients who feel they need to be seen on the same day can always be seen. A patient commented that it may be more difficult for non-english speakers to know where to go. A patient asked if it was cheaper to go to the minor injuries unit at Guy s. They had to use this service previously when they needed a dressing changed and our nurse was on leave. It is cheaper than A&E, but ideally patients should come to the practice. Unfortunately there is a high vacancy rate in Lambeth for practice nurses and it can be difficult to find good locum cover when the nurse is away. The practice only has 1 nurse, who doesn t work on Fridays, which can be difficult. We are currently joining forces with other local practices in Lambeth in the hope this will provide more support to us all. Sandra invited any comments about the Quality Improvement Plan. A patient agreed that the prevalence work was important and that helping detect their own condition sooner could have made a difference to her. A patient said that our nurse Sharon is fabulous! and they would like us to employ another nurse like her. This was seconded by another patient. Summary of discussions about the plan: Patients did not have many comments to make about the plan, but were interested in the ongoing work and how it might affect them. Early detection of conditions was a priority. Patients found the discussions about the budget enlightening. The group really like our practice nurse and would like to see more nursing staff in the practice. Actions: Prevalence to be a key priority for the QIP To promote alternatives to A&E, particularly to non-english speaking patients 3. Any other business Sandra invited everyone to raise issues they would particularly like to discuss with the practice team One patient said that appointment times are too short and that they would want to spend more time with the GP in consultations. Dr McGinn echoed this and said that our doctors would also like longer appointments, but we do not have the capacity to offer this at present. Patients said that it was difficult sometimes to get through to the practice by phone.
7 Dr McGinn explained we are looking at options for addressing the phone service and are trying to get a new system. We need more lines available; in particular, it is difficult to carry out telephone consultations as the doctor can t always get a free line. Another patient said that if a GP is running late, why can t they be told about it? Patients generally said they understand why GPs run late but it isn t fair if they are the first appointment and they still get seen late. Dr McGinn reassured the group that we don t keep patients waiting needlessly. Sandra explained that in addition to the face-to-face appointments the doctors are juggling amongst other things; home visits, telephone consultations and all the referral and prescriptions paperwork we have talked about. Sandra explained that we really understand this and ideally our receptionist try to keep patients updated. However, our receptionists are extremely busy, given the nature of the job that they have to do. It is difficult for them to juggle their work with checking on several doctors as how on time the doctor is, which can vary throughout the day. The self-check-in system tells patients if a doctor is running late at the time the patients arrive and the receptionists do try to tell patients when they come in if a GP is already running late, but this doesn t account for the doctor falling behind when the patient is already waiting. Sometimes the receptionists can get quite a lot of verbal abuse from patients who are frustrated about waiting and this means they are sometimes reluctant to approach this topic. A patient asked if we could have an electronic system to say what the waiting time is and suggested that a ticker system would be really good. Sandra explained that there isn t a system available, but the practice would love to have one. Dr McGinn raised the rule about patients who arrive late for appointments by 10 minutes or more. The late patient can rebook for another day or be seen in the emergency clinic if their problem cannot wait. It is frustrating for a doctor when a patient arrives 9 minutes late, allowing only 1 minute of their consultation time and causing the doctor to fall behind. Dr McGinn explained that the doctors find running behind extremely stressful. Another patient said that it is really important for receptionists to enunciate what time an appointment is. This patient s heard over the phone that their appointment was for 3:15pm and when they arrived, they found out that their appointment was for 3:50pm. Sandra agreed to feed this back to the receptionists. Dr McGinn reminded the patients we have a text messaging service, so we are always working to keep mobile numbers up to date on our records so that patients can receive text messages about appointments, campaigns, etc. Patients will get a text message reminding them of appointments the day before, unless they have booked their appointments less than 24 hours before their appointment time.
8 Sandra invited patients to raise any other points, but there were no further matters arising. Actions: Sandra to feedback patient comments to reception about waiting time information and being clear about appointment times. Practice to review telephone systems Sandra gave patients details on how to comment about their experience of the practice on NHS Choices. Positive comments on here can really help the practice, but sadly patients are more likely to complain anonymously than give the good feedback we often hear from patients in the practice. If patients do make comments on the NHS choices, please also remember to complete the star-rating option. Sandra also invited patients to the MacMillan coffee morning taking place in September; details will be available in the practice and on the website shortly. Dr McGinn and Sandra thanked everyone for coming to the meeting and offering such helpful feedback. Next meeting to be scheduled for the autumn
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