PPG Minutes - 16 February 2023

  • Date: 16 February 2023
  • Time: 5.00 pm
  • Location: Sheepmarket Surgery and Online (via Teams)
Attendees Position/Role
 Julie Clarke (JC) PPG Committee Chair
Elaine Hooper (EH) PPG Committee Member
Paddy Jelen (PJ)  PPG Committee Member
John Morphy Godber (JM) PPG Committee Member
Petar Opacic (PO)  PPG Committee Member
Ken Otter (KO) PPG Committee Member
Marion Pitt (MP)  PPG Committee Member
Bill Proudlock (BP) PPG Committee Member
Alison Warrick (AW)  PPG Committee Member
Dr Gavin Cattigan (GC) GP Partner/Non-Executive Director - Lakeside Healthcare Stamford
Emma Wilson (EW) Patient Services Manager – Lakeside Healthcare Stamford
Apologies Position/Role
Peter Roome PPG Committee Member
Teri White Hub Manager - Lakeside Healthcare Stamford
 

1. Chair’s welcome (including introductions in the event of new attendees)

JC welcomed the group to the meeting and introduced new members, John Morphy Godber, Peter Opacic and Ken Otter.

 

2. Minutes of last meeting

The minutes of the last meeting, which was the AGM, were to be proposed as accurate. MP said that she would like it to be noted that she and EH left the AGM at 6.30pm, in order to attend the Stamford Town Council Meeting. This noted, the minutes were then proposed by BP and seconded by PJ.

 

3. Chair’s update (including matters arising from minutes of last meeting)

  • JC said that her request for patients to make contact with the PPG had resulted in some e-mail correspondence. She said all patients who had written to the PPG had received a response, thanking them for their correspondence and giving answers where it was possible to do so, but confirming that some matters would be brought to the meeting.  Correspondence is discussed in "Correspondence received from patients" section below.
  • JC reported that she had been in communication with Lincs Integrated Care Board (ICB) and will attend the Engagement meeting for Lincolnshire PPG Chairs on 21st April.  She will also attend the Lakeside Group PPG Chairs’ meeting on 15th May 2023.  She has spoken to a member of Stamford Health, Education and Awareness Charity (SHEAC) and suggested a meeting, with a view to discussing further events this year, including our quarterly meetings. She encouraged members of the committee to attend SHEAC’s event “Healthy Living with Long Term Conditions” at Stamford Arts Centre on 20th February at 1pm, emphasising the importance of working with all organisations concerned with the health and wellbeing of Stamford patients, towards a joined-up approach to health betterment.
  • A meetings calendar has now been distributed for the rest of the year, so that there is certainty over meeting times.  JC worked with dates and availability of committee members, as well as meeting with Lakeside, to ensure the largest availability of members, as well as GP and Practice Management attendance at all meetings.  Where the quarterly patient engagement meetings take place,  a working group to help organise those was suggested and JC asked PPG committee members, to let her know if they are happy to be involved.
 

4. Declarations of any other business (AOB)

No declarations.

 

5. Lakeside Update

The Practice was asked to provide data as follows:

  • Latest appointments data:
    • Appointments data is produced weekly, but current data was not available at the time of the meeting, due to a software issue. EW has confirmed that it will be provided to JC when available. [NB JC: If data is made available, it will be included as a post-meeting note].
  • Processes directly impacting patients’ access to services, improvements and initiatives:
    • The Practice is looking at a range of options and opportunities to remedy some of the manifest issues associated with a same-day booking system. GC explained that the existing system had been focused, post Covid, on a “Workflow at a glance” model, with appointments being given at 14 days, 21 days and 28 days, enabling appointments to be triaged to ‘today’, ‘next week’, ‘two weeks’ etc., with urgent cases receiving a face-to-face consultation at first appointment. AW asked whether calls made at 8am could be triaged to determine whether a face-to-face consultation was necessary.  KO asked whether staff taking calls could keep a manual record of how calls had been directed, so that the Practice could consider further improvements. The Practice are open to suggestions for better modelling if it is in evidence at other surgeries.  Further discussion will take place at the next PPG meeting. Ongoing
 

6. Update following the Care Quality Commission (CQC) report – Lakeside Response

GC reported that the Practice has been taken out of special measures, however it is still graded overall as ‘Requires Improvement’. Three of the areas inspected have shown improvement and two are now rated as ‘Good’. PO asked GC ‘good’ looked like from the perspective of a list of items to resolve in order to reach ‘Good’ overall. He said that there was no fixed checklist from the CQC and each inspection was bespoke, based on previous inspections and issues raised.  JC asked, while it is unlikely there would be a further inspection within the next year, whether there was merit in asking the CQC to come back to perform a spot check on a particular area of concern, which had been the pharmacy, particularly the periodical medication reviews.  GC said that a large part of the Practice’s focus had been on this area and that their review system meets all of the requirements asked of them. The report says that they have made significant improvements and there is little that they can do to improve on the medication reviews processes they now have in place. He said that their safeguarding team’s work was exemplary. JC asked whether, in summary, it was the Practice’s assertion that their medication and review processes are now at least on a par with nearby surgeries and that, if they were inspected in the future by the same parameters, they will receive a good rating. GC said he believed so. KO said that the report ended by saying the CQC recognises the significant improvements that have been made to the quality of care provided by the Practice and that this should be noted.

On the question of access to appointments and telephone queue problems, BP asked whether the Practice had considered bringing in external expertise. GC said they currently use the services of a telecoms technical company used by other GPs in the area.  Their telecom technicians had tested the system and could find no fault in it. BP asked whether the Practice thought the current waiting times were satisfactory and GC told him that delay in accessing appointments was less to do with the telephone system and more to do with resourcing and capacity.

EW said that she and TW were working very hard with Justin Wilkinson, the Group’s Senior Project Manager, on processes around capacity v demand and would keep the committee informed.

GC said that although improvements are ongoing, four out of five areas have improved and there has been a good overall rating. 

GC reported that a new paramedic started this week and that an improved rating with the CQC should help in the drive to recruit more GPs and other clinicians.

 

7. Correspondence Received from Patients

  • There were some concerns about the venue of the AGM, but JC said she had answered those concerns and had confirmed that the AGM was called at relatively short notice, due to the Practice and the PPG waiting for the updated CQC report. This left very little time to find a bigger venue, or to arrange better audio-visual facilities and that this would not be repeated. 
  • There were some positive messages, thanking the PPG for the work they were doing.
  • There were both positive and negative remarks about the Doctorin software, mainly about the time it took to receive a response.
  • There was a further request for patients to be furnished with details about Lakeside’s finances, but it was noted that the question had been answered at the AGM, when patients were told that the Group was a partnership, not a limited company. As such, there is no requirement for accounts to be made public. Any concerns around spending should be addressed to the ICB.
  • There had been an inquiry about a patient being referred to the 111 service and JC asked for clarification about the how a decision was made to make a 111 referral. GC explained that 111 is part of the overflow capability if no appointments are available at the practice.  A system is in place, where patients referred to 111 may be referred back to the GP, after they have contacted and consulted with 111 and not deemed to be an emergency.  GC made clear that 20 of these return appointments are reserved daily, which is more than twice the amount the Practice is contractually obliged to provide, and that the 20 slots are typically consumed each day. GC also advised that for some patients who need special care an appointment is always available on the day as their medical record is marked to expedite this.
  • There was a discussion about access to appointments being hampered by the necessity to call at 8am for an appointment, which caused a tremendous bottleneck and kept patients online for a very long time, only to then be told that there were no appointments remaining.  Several members of the committee asked whether the appointments line access could be staggered, allowing more people to call at different times.  The Practice will look at the suggestion to see whether this can be done with their current resources.
  • Doctorin system works for some but precludes patients who are not digitally engaged.  The PPG committee also expressed concern that it is not available at weekends.  JC asked about the possibility of re-introducing SystmOnline, which she said was an enormous help for those who can access the Practice online and saved time for both the patient and surgery staff who take the calls for appointments and would also free up phone lines for those who were only able to make appointments by telephone. The Practice said SystmOnline was suspended at the onset of Covid, but that they would consider the possibility of re-introducing it.
  • AW asked about a case she had heard of, anecdotally, about the wait for a response to a Doctorin request and EW confirmed that the system was currently under repair and should be back up and running on Monday 20 February, by which time, patients who are waiting will receive a response. 

MP asked GC about plans for an Urgent Treatment Centre (UTC) at Stamford Hospital, replacing the Minor Injuries Unit (MIU) and GC said that the plans were not finalised and he would be able to say more when he had further information.  JC said she had some information on the matter and would address the Committee on it.

GC and EW left the meeting at 6pm, to return to surgery matters, but the Committee continued with the meeting to discuss executive matters.

 

8. PPG Executive Matters

The PPG Terms of Reference, which had been voted on at the AGM were signed by the PPG Chair (JC) and the Practice (GC).

JC asked whether any of the committee members had considered volunteering for the roles of Vice-Chair, Secretary, or Communications Administrator.  KO volunteered to take on the role of Vice-Chair and said he would be happy to also fulfil the communications role.

This was agreed by the Committee and KO will assume this joint role with immediate effect.  JC asked KO to review the renewal of the banner for the reinstated drop-in sessions at the surgery and will liaise with him on updating.

JC said the committee still needed a Secretary, or a minute taker. BP volunteered to take minutes at future meetings. 

Addressing the earlier question about the Stamford MIU, JC told the Committee that all MIUs will close by October 2024 and should be replaced by access to UTCs. In the case of Stamford hospital MIU, Lincs ICB are still reviewing the feasibility and costs and believe that the current MIU is under-utilised.  If it is replaced by a UTC, it would normally be GP-led.  The ICB could, however, put the management out to tender and another body, such as the hospital’s Trust (NWAFT) could bid to run it (as they do in Peterborough). JC said she hoped that the need for the MIU (or, subsequent UTC) would be supported, as the assertion that it is under-utilised comes about as a direct result of it only be open during ‘office hours’ and closed at weekends.  She said that it was unreasonable to fail to see the need for an MIU or UTC which was open at weekends, when people are most likely to incur minor injuries.  Converting the current MIU into a UTC (open at weekends) would prevent patients in an around Stamford from having to travel to Peterborough (if they are able), putting further pressure on the hospital’s A&E. The extraordinarily long waits at Peterborough UTC are exacerbated by patients visiting, who could be utilising a facility more local and accessible. JC said she is in touch with various organisations, including the NWAFT Foundation and that she attends some of the Lincs CC Health Scrutiny Committee, so would report back to the Committee with any updates.

 

9. AOB

JM asked why patients could not contact the PPG by phone. JC said that there was no facility or phone number for this purpose and that the Practice did not have the resources to take calls on its behalf.  She said that there had been no member of the PPG available to take calls, but should that change, the committee could discuss it.  Currently, patients are able to make contact by e-mail, or in writing.  She said that JM might want to consider asking for it to be added to the agenda for a future meeting, when more time could be given to the matter.

 

Date of next Meeting

Date: Monday 13th March 2023

Time: 5pm

Location: Sheepmarket Surgery

The meeting ended: 6.30pm