PPG Minutes 20th June 2022

  • Date: 20th June 2022
  • Time: 1.00 pm
  • Location: Online (via Teams)
Attendees Position/Role
Bill Proudlock PPG Interim Chair (BP)
Morag Roberts PPG Committee Member (MR)
Julie Clarke PPG Committee Member (JC)
Marion Pitt PPG Committee Member (MP)
George Woolf PPG Committee Member (GW)
Elaine Hooper PPG Committee Member (EH)
Dr Sian Dronfield GP Partner (SD)
Teri White Lakeside Hub Manager (TW)
Emma Wilson Lakeside Patient Services Manager (EW)
Apologies Position/Role
Alison Warrick PPG Committee Member
Paddy Jellen PPG Committee Member
Peter Roome PPG Committee Member

 

Glossary

  • LHC = Lakeside Healthcare
  • CQC = Care Quality Commission
  • PCN = Primary Care Network

 

Committee Meeting Minutes

Introductions

Made by EW

 

Comments on minutes of last meeting

None offered

 

Matters arising from last meeting

  • Terms of Reference
  • Date of reconvened AGM

 

Briefing from the Practice, given by TW following the recent CQC Report

Rating has improved. Were rated “inadequate” in June to September 2021 and on reinspection in March, there have been improvements in the practice. One area where LHC were still rated as “inadequate” and now working with CCG (now Lincs ICB) on those areas, including medication reviews. Referred to report from last year and has, since then, completed 15,000 medication reviews. CQC are still not content with that level of details completed within the medication review. Pointed out that within contract with NHS and PCN, there is no guidance around the level of reviews which must be carried out. They vary between “structured medication review”, involving full contact with patients and “intermediate” review to ensure safety and compliance and confirm that GP is happy for medication to continue. Going forward, a patient who is overdue for a review will not receive repeat medication until a review has been carried out. LHC believes they are now much safer than they were 18 months ago. They are happy that they are providing a good, safe level of review now. This was the main concern from the review and, although there are other things arising, it is now about embedding improvements within the practice. There have been definite improvements since a year ago, but the CQC cannot raise ratings up by more than one level, so a reviewed service that was rated “inadequate” cannot be re-rated as “good”, following an updated inspection, but can only be rated as “requires improvement”.

Still struggling with recruitment, down to patient population, demand and expectations of what General Practice should deliver at the moment. TW mentioned that the Oakham practice has recently closed their reception, due to abusive behaviour of patients and says that Stamford reception has also suffered in the same way. GP practices are seeing this on a national level and this is making the work of reception staff hard. LHC is working to review working practices and access, as discussed at the AGM of 26th April, this is due to a shortage of clinicians. Early retirements are contributing towards this. Dr Sarah Hall retires at the end of June, representing the last of the cohort of GP within retirement age and this should mean a more stable situation going forward. There is a lower level of GPs than five years ago and this represents a national picture of GPs leaving the profession earlier. LHC needs to make a safe space for patients to visits and for GPs to work in. This may result in less face-to-face contacts, although this will coincide with digital appointments, via ‘Doctrin’.

 

TW invited questions from the committee on her response to the CQC report

BP asked LHC how they would communicate changes to the patients.

TW said that they need to determine their new practices and they inform patients, with the help of the PPG about how to get the best use out of the practice. Often the best person to see (or speak to) is not the GP (cited, for example, diabetes nurses etc). Mentioned re-educating patients in the way that LHC works in Stamford. SD said she got the impression, during the April 26th meeting, that patients weren’t fully aware of the excellent clinical supporting staff the practice has, such as the pharmacy team, who deal with a lot of the queries on Doctrin, for example.

JC asked about the CQC report, which said that 51 staff answered the CQC questionnaire.

How many staff do they have? TW/EW said about 100. JC pointed out this equates to around 50%. Was this at the request of the CQC. TW said it was left up to the staff about whether they responded, so it was their choice.

JC queried the number who said they had a DBS safeguarding check in place.

LHC confirmed that 100% of their staff are DBS checked, but that they didn’t all realise this. JC said she thought this was problematic and TW agreed and said it would need to be dealt with at practice level.

BP reported feedback from patients he’d spoken to.

They felt that the CQC report identified communications problems and they believed it was that the practice was overwhelmed. He asked how committee members, if they felt there had been improvements, felt these should be communicated to the patients.

JC said feedback she had canvassed, specifically about the CQC report

Showed patients were concerned about mention of infection control and members of staff not being fully up to date with training (or saying they were not), and not even knowing who the infection control manager was.

MP said all repeat prescription drugs contain a date when a review should happen and asked whether patients would be contacted by the practice at that point?

EW said that they did fall behind with reviews but were now arranging for reviews to fall with a patient’s birthday month, so ensure a level of consistency. New procedures may include an online questionnaire, but many people do need to be spoken to directly. MP reported that the pharmacy always appears to be “too busy” to speak to patients. TW said that pharmacy staff are not only dealing with calls, but many other duties and this is a staffing issue. She asked that queries be put through Doctrin, where possible.

EH said she understood that the practice was planning to stop the process of requesting repeat prescriptions by telephone and that they would need to be requested online, asking LHC to confirm this.

EW confirmed that this would be the case from August 2022 and that this is now a common practice nationally. She suggested repeats be requested directly by visiting the surgery, or through the pharmacy. She said this was much safer, as it was a more accurate way of LHC knowing what was being requested, as telephone communications can be unclear. She also suggested repeats could be requested online. EH pointed out that this might not be suitable for the elderly and EW said that pharmacy staff are able to request repeat prescriptions if requested by patients, so that they do not need to contact the surgery directly. EH mentioned that this might be a problem for those who are housebound, as it will put additional stresses on carers EW said that they would work with patients to provide a solution.

BP said that the CQC report said that there was a possibility of the practice being closed and asked LC to explain.

TW said that this had to be included in the report, as it would become an issue if the areas identified for improvement, to bring the practice out of special measures, were not improved. She emphasised that this was not the outcome anybody wanted, but said that LHC were working hard with the CCG, the CQC and other bodies to make sure the required level of improvements are made and that this doesn’t happen, but, as a measure open to the CQC, it had to be included in the report. Dr Dronfield said that she had every confidence that, with the improvements thus far and recognising how hard the staff had all worked, the remaining improvements would be made and that they would regain their previous status. She also said she believed that LHC were now doing far better than surrounding practices on medication reviews.

 

Communications

JC asked why the minutes of PPG meetings were not available on the website. BP said that the committee had made the decision last year not to do so, as they felt that the newsletter was sufficient to communicate with patients. JC said that she would like to see the minutes posted on the website, for reasons of transparency and so that patients were confident that their PPG was working on their behalf. She also said she would like to see copies of the minutes of meetings from the past year. BP asked the committee whether they were happy for the recommencement of minutes on the website and they agreed. BP asked JC to liaise directly with the practice for historical minutes.

JC asked whether the PPG newsletter had been stopped. LHC said there were gaps, due to annual leave, but they are now available on the website.

JC addressed the issue of staff being abused and threatened. She made clear that this is never acceptable and that there are no excuses for it. She asked whether LHC had put in place any discussions or training on identifying why patients are becoming so unacceptably frustrated. Had they considered issues of communications with the surgery not being passed on, notes, calls and e-mails not receiving responses? LHC said that they had changed their telephone answering service to now begin, rather than with the zero-tolerance message, to thanking patients for their support and understanding. They said they are doing their best to support reception staff and patients and hope that the ongoing efforts in communication will help. JC will liaise directly with TW to address some of those issues. EH said that she had found St Mary’s surgery to be far less busy and easier to navigate than Sheepmarket, which regularly has very long queues at the desk.

GW suggested that the PPG drop-in sessions should continue and offered to take charge of arranging those. LHC said they had received very positive feedback about them. EH will also attend.

 

The PPG Terms of Reference

JC asked why the Terms of Reference, which are still in place until a replacement is voted on at the reconvened AGM, needed to be re-written. She pointed out that the existing terms, following the nationally agreed template, issued by the Patients Association is all-encompassing and only needs to be amended when minor issues change. She produced the national template, which is a comprehensive 10-page document and compared it to the re-drafted version, which had been put forward to be voted on at the AGM on the 26th April. This one consisted of only two pages and missed out a great deal of important information, which embodied the principals of the PPG, in accordance with the obligation on GP practices to form patient groups, in accordance with s5.2 of the General Medical Services Contract. She said that the redrafted version was unclear and incomplete. BP asked JC to liaise with Peter Roome, the committee member who had re-drafted it, and to bring the matter back to the committee, if necessary. She wished to put on record that she wanted the Patients Association template to be used and would be bringing this up at the AGM.

 

Meetings

AGM (to be reconvened)

A new AGM is to be convened, due to there not having been enough notice given for the re-drafted Terms of Reference to be ratified in April. The date of 28th June was published in the local press and on social media, but had to be cancelled, due to the resignation of the Chair, the non-availability of the Vice-Chair and the number of committee members who would have been unable to attend. BP said that, prior to agreeing a date (which the committee had now indicated should be in September, to allow for holidays), we needed to sure up our committee numbers, which he believes are too low. He said that around half of members are offering apologies for upcoming meetings and said that committee members should compare diary dates, so that we could ensure the biggest possible attendance. BP said it would be useful if the new Chief Executive of LHC could attend, but she was only starting on the 1st September. JC said the AGM must still go ahead, having already been postponed, even if the new CEO could not attend. BP agreed.

MP suggested the PPG might consider contacting Stamford Hospital about using the meeting room for the next AGM. BP to consider and make contact.

Next PPG Committee meeting

Lakeside offered 25th July, but some PPG members are unavailable, so they were asked to provide any other days that week. They could not, but said that they would check which partners were available and get back to BP.