The minutes of the meeting held on 21st December were approved with minor typing errors noted, there were no matters arising.
Practice Update
- The practice shared an update on some of the changes that had been introduced: offering appointments within 14 days of first contact, introducing cloud based telephony, improved on-line access, reducing call waiting times and working to eradicate the 8am rush. A member asked for clarification about the appointments that should be offered within two weeks. The practice advised that GP appointments should be within two weeks however if a patient sees a doctor who then doesn’t need to see them again for two or three months or when an annual review is due then patients are advised to make contact two weeks prior when appointments open and book one or use the call back facility. A further query was raised around an annual diabetic checks when a wait could be up to six weeks. The practice said that under the contract, the two-week wait focussed on GP appointments. The member felt this should be made known to patients who may expect all appointments to be within two weeks.
- GP recruitment has been one area where RPC has always struggled but the practice has successfully recruited in a different way through a GP Fellowship scheme with GP FTE (full time equivalent) rising from 12.6 in February 2023 to 21.3 now. A further GP Fellow was due to start and another GP is being sought for Brooklyn surgery, recruitment has gone very well in the past six months. A Clinical Safety Fellowship role is now in place with two dermatology specialists, a research specialist, respiratory specialist, musculoskeletal specialist and population health specialist.
- A phone room has been established at Ashgate, with all call handlers at one site there is a lot more oversight. The call-back function is now operational; patients press the hash tag (#) to book a call back without having to hold on. The focus on same day appointment calls between 8:00 and 10:30 has been in place since November and is working well. Additional phone room staff have been appointed with more two more due to start shortly.
- ICB funding for primary care to switch phone suppliers is enabling current contracts to be terminated and new, cheaper systems using NHS buying power to be used which will be significantly better with improved phone/clinical system integration. This should save 30 seconds a call which may not make much difference to individual patients but with 10,000 calls every month that will save the practice considerable time. This is due in April and is cloud based technology so should be more stable with less drop outs. More calls are being answered than ever before, in November this was an additional 100 extra calls a day. One member mentioned that a few days previously they had waited 26 minutes to get through when phoning for an urgent doctor’s appointment. The practice apologised, saying that although the average wait time had not been above 10 minutes since January there were days which were short staffed though it was hoped that further recruitment would reduce this; seven to eight minutes was the current average wait time.
- Being part of the GP Improvement Programme has brought in extra funding. The data indicates that in November, December and January there have been nearly half the number of complaints about access compared with the same period 12 months ago; in January there were nine complaints compared with 25 in 2023.
- The additional GPs have increased the number of appointments offered, we’re not running out of appointments as early and the split in releasing certain appointments at three o’clock in the afternoon is providing more flexibility with a drop in the number of calls at eight o’clock. Having more GPs rather than depending on locums and agency GPs meant that continuity had improved. Locums were only being used when someone phoned in sick which reduced spending on GPs whilst providing a better service. A member asked whether, when doctors joined as a salaried GP, there was a contract length. The practice advised that there was not, though notice periods ranged from three months to six months for GP Fellows.
- A member asked about availability of appointments at Brooklyn surgery for on-line booking as currently this wasn’t possible. The practice said that on-line capacity would be looked at now that other changes had been implemented
- The practice shared that there had been a decrease in DNAs following the autumn spike that had been due patients having Covid vaccinations elsewhere and not notifying the practice. The practice shared that though the decrease in DNAs to 5.7% was encouraging, it was still 1309 GP and ANP appointments and could be better. With clinical team appointments now being 15 minutes, two missed means half an hour wasted. The practice shared an example of a patient who had made an appointment for themself and two family members, a total of 45 minutes, yet none had attended. As a result, a working group is reviewing the DNA policy with a view of making it stricter. A conversation was had with the PPG to ask views regarding how many missed appointments should trigger a letter to the patient to inform them of the cancellation policy. The discussion concluded with the group agreeing that three letters should be sent, the first and second giving advice and warning, the third advising of off listing. In all cases, particularly in the case of children and vulnerable patients, discretion would be applied.
- The practice continued with their update, explaining how there had been a surge in on-line booking last autumn due to Covid vaccinations being booked though the NHS app with a fall-back in December to average levels. The practice are considering rolling out drop-in clinics to help patients register for and use the NHS app and understand its functionality. This had been done with some success at Brooklyn. Demand needed to be assessed and time per patient worked out, there might be an opportunity for PPG involvement once patient interest had been determined. One member wondered whether a video accessible via YouTube might be worthwhile then patients could watch it at home. The practice agreed to consider this.
- Family and Friends responses in January had resulted in some positive feedback including about improved access to services and good experiences with the clinical team. The introduction of 15 minute appointments has enabled clinicians to connect better with patients when discussing symptoms and treatment. Of the 725 responses, 89% would rate the service as ‘good’ or ‘very good’ and 86% would recommend RPC to their friends and family
- There were now three first contact physiotherapists, two working in-house, the other doing remote work and there has been wonderful patient feedback since they started in the East and West practices. Some people have been wary of seeing a physiotherapist but after their appointments they have been very happy with the outcomes. This has also taken some of the workload from GPs; a positive result all round.
- A question for PPG members. The practice had received a number of blood pressure machines that could be loaned to patients for them to check their blood pressure at home. However, after giving one to a patient, nurses have found they’re not being returned and it was suggested that a returnable deposit of perhaps £10 be charged; what did the group feel about this? Subject to low-income or otherwise disadvantaged families and patients being given discretion the group agreed that a £10 deposit was acceptable given that free-to-use machines were in reception areas and it was for patients own convenience that they were being loaned one. The practice suggested it might be a voluntary deposit which the group opposed. Loan of the machines was for patients who would otherwise have to travel to a surgery or pharmacy for a blood pressure check, the group felt that a deposit was entirely appropriate and reasonable.
Navigating the AccuRx portal
- A member had read of patients having difficulty using the new portal and asked for members’ opinions. One said that they had found it easy once they had known what to do and where to look. Another member also found it easy to use though irrelevant in places. One member said that what had been confusing patients was the heading ‘Outside of core hours’ followed by ‘What would you like help with?’ Admin query, Online advice. There is no obvious link to ordering prescriptions or making an appointment which are probably the most usual things patients want to do. It was agreed that the portal could be more ‘patient friendly’ and that the language used might not be easily understood by those who had a low reading age. The practice agreed to speak to AccuRx as the practice was limited in what it could change.
PPG Matters
- Constitution: It was agreed that the name of our group be ‘Royal Primary Care Patient Participation Group’, abbreviated to RPC PPG.
- AGM: The AGM will precede the regular March meeting and include re-election of officers or the election of any members who wish to stand for office. At previous meetings the Chair had mentioned that they felt it necessary to form a small committee to spread the group’s work load. This will be acted on at the AGM.
- The future of PPG – a fresh approach: the Chair had become aware that the PPGs of other large practices in the area had expanded their way of working and of recruiting members. They had set up an email distribution list of patients to which newsletters and items of interest from their practice and external agencies were regularly circulated. These distribution lists or ‘Patient Liaison Groups’ number hundreds of patients with contact details being provided from patient records. They seem to be very successful in generating interest in the practice and service delivery with increased interest in PPGs as a result. Further investigation needed.
Questions for the Practice
- Opening times for Holme Hall surgery were difficult to read on the notice attached to the railings, could this be improved? The practice agreed saying that when it had been fixed to the gate it had been ripped off so had been put in a more secure place though at a longer viewing distance. It would be replaced with one with large lettering.
- PCNs – their future: A member had asked about the future of PCNs. The practice advised that the future of PCNs was assured until 2025, the present arrangement having been extended by 12 months.
A.O.B
- A member had wondered about the possibility of setting up walking groups for patients to encourage them to get more exercise as an ‘add on’ to Dr Fenton’s project however this was discounted on insurance grounds. Information provided since the meeting has found a number of established groups and these will be investigated further.
- Derbyshire Health United, provider of the 111 out of hours service in Derbyshire had been rated ‘Excellent’ following a CQC inspection at its Ashgate Manor call centre.
- One member mentioned the lack of clearly visible signs to the Urgent Care Centre at Ashgate Manor and it was explained that this is outside RPC’s control and may be due to restrictions placed by the building’s landlord.
- One member drew attention to the lack of PPG information at Clay Cross. To be dealt with at all surgeries.
- A member praised Dr Elattar at Clay Cross who they had seen for the first time recently and who they felt was a great asset to the practice. He asked for his comments to be passed on.
- A member concluded by mentioning their fundraising efforts for Alzheimer’s Research UK. Their efforts had been recognised by the charity which had placed him in its Hall of Fame. £1,100 had been donated the previous Sunday with a further £1,100 from his RALB lodge plus £900 from his Chief Officer making a total of £3,100. Over the last two years they had raised £7,300,a remarkable achievement for which the group congratulated him.
There being no further business, the Chair thanked everyone for attending and closed the meeting.