Minutes Fareham Locality Patient Group held on Thursday 18 th August 2016 at Fareham Community Hospital, Tom Smith Meeting Room

Transcription

1 Minutes Fareham Locality Patient Group held on Thursday 18 th August 2016 at Fareham Community Hospital, Tom Smith Meeting Room 1 Attendees Richard West Sue Martin Beverley Arthur Wendy Culverwell Susan Barton Bob Blackman Alan Walker Robert Holman Lisa Medway Lyn Darby Courtney Vychodil Introductions Chair/ Whiteley Surgery Deputy Chair/Westlands Medical Centre Lockswood Surgery Jubilee Surgery Brook Lane Surgery Fareham Centre Practice Stubbington Medical Practice Gudgeheath Lane Surgery Estates Project Manager, CCG Deputy Chief Commissioning Officer, CCG Communications and Engagement Officer, CCG 1.1 Welcome and Apologies Richard welcomed Lisa Medway and Lyn Darby. The meeting was well attended Minutes of the previous meeting held on 19 th May 2016 The minutes were approved as an accurate record. Summary of actions and matters arising The on-going concern about the under-use of Fareham Community Hospital to be discussed with the CCG. Requests for Any Other Business Bob Blackman raised concerns around the Buckland developments and consideration for a medical centre to cater for the increasing population. To be discussed by Lisa Medway. Focus items Fareham and Gosport CCG: Lyn Darby Lyn started by discussing the current local situation. Both Fareham and Gosport CCG and South Eastern Hampshire CCG work very closely together, alongside six councils including Portsmouth County Council and Hampshire County Council. It is the GPs that commission services, the CCGs responsibility is to work with GP s to deliver high quality levels of care. Dr Paul Howden of Whiteley Surgery is the lead for planned care, long term conditions and end of life services. Dr David Chilvers, a Gosport based GP, is the lead on urgent care for both Fareham and Gosport CCG and South Eastern Hampshire CCG. 1

2 The CCG is influenced by documents such as the Five Year Forward View as set out by NHS England which outlines the direction of travel for commissioning. A way in which the CCG has followed the guidelines within the Five Year Forward View is through the development of the MCP/ Vanguard project. This will tailor services to peoples individual needs thus producing more effective localised care. The CCG has also discovered that urgent and emergency care services are very confusing. The Five Year Forward View suggests the implementation of clearer pathways so as to reduce stress on acute trusts; services will be redesigned to meet this strategy. Lyn added that the CCG is putting more effort into checking what people really want, they recently met with local mental health groups, Age UK, Diabetes UK and the British Heart Foundation to ask them directly what they think their patients want and need to manage their conditions. The CCG faces a number of challenges, with regards to an engagement strategy, a commissioning cycle is followed; the CCG first addresses the potential problems and then investigates the commissioning of that service, this will include looking at how other services work nationally. All of these stages are carried out through a process of engagement, driven by those that do or may use the services. The CCG welcomes feedback from the LPG on how to improve outcomes for patients, how to work more effectively with the voluntary sector and opinions on what good engagement looks like. Concerns were raised around the cost implications of a new computer system as discussed at a Fareham and Gosport CCG meeting. Bob Blackman asked where the money is coming from for this new IT infrastructure and expressed concerns of falling into the same trap if this proves unreliable. This is believed to be the Hampshire Health Record, Lyn explained that through this system all practices will have access to the same record, meaning there will be enough information available for healthcare professionals, including out of hours to make decisions in patient care. This development will benefit patients through more efficient levels of care. Action: Lyn Darby will chase up the progress of the Hampshire Health Record with the CCG to find out how this will be funded and if it is still going ahead. Lyn will report back to Bob. A question was raised about the remit of Care UK. Lyn explained that they are a private provider, their contract covers St Marys Treatment Centre day surgery unit, minor ailments/injuries, outpatients and some diagnostics i.e. x-ray. Action: Lyn to inform the LPG group where Care UK operates. Richard West raised concerns around meetings with the CCGs stating that 15 minutes of public questions is not enough time, he proposed the idea of a public event purely focused on a question and answer session. A long standing issue is the subject of dialysis at the Community Hospital; due to the fact that this service is not currently offered at the hospital, patients are facing increased cost implications along with stress around travel arrangements. The decision relies on staffing and equipment. Lyn clarified that the CCG 2

3 pays for transport however this would be a conversation to have directly with Portsmouth Hospitals Trust who are the Wessex renal provider. Lisa Medway added that after attending a League of Friends meeting, it was apparent they are keen to move forward with this having pushed to make contact with PHT. They discussed raising money to purchase the relevant equipment as a certain amount of machines are needed per nurse. The CCG has not been the best at joining with planners but it is slowly improving. The strategic group now includes local planners at the meeting and the team is much closer now. Action: Lyn to speak to Sara Tiller about an open forum. Richard West asked if patient choice is available in Fareham with regards to mental health commissioning. Lyn explained that choice as described in the NHS constitution only applies to consultant led acute services. However, if a patient has a particularly difficult issue with a provider, they are advised to talk to their GP. Under the discussion of community providers, Bob Blackman, also a governor for Solent NHS Trust, spoke of an increasing work load; there is a vicious cycle through people leaving which detracts from patient care, but hospitals continue to push people into community care. Lyn assured that the CCG is trying to improve services in the community. Southern Health last year received additional funding to help with those coming out of hospital. 2.2 Services at Fareham Community Hospital: Lisa Medway Fareham Community Hospital is approximately five years old; it is a Hampshire lift building under a local finance initiative similar to PFI (Private finance initiative). It is leased to provider organisations on a lease plus basis and maintained at a category B standard, giving it a 25 year life expectancy, the building is also viewed as an expensive facility. The landlords are Solent Community Solutions, Community Health Partnerships (CHP) are the head tenants and are responsible for arranging the leases etc. Southern Health, PHT and Solent have tenancy agreements, whereas UHS (University Hospital Southampton) tend to use bookable space. Reception services are currently run by Southern Health, on behalf of CHP. The situation overall is very complex; the financial structure is an issue for service providers, however there is no real void, within the hospital. Costs are recovered by rents in tenanted space; however there are areas for sessional (bookable) space. If this space is not rented, the CCG must cover the costs. The Red cross are still planning to take space in the Hospital although there is no firm date for this to happen. In the meantime the CCG continues to pay the rent for the unused facility. A recent utilisation survey on the hospital uncovered that only 40% of the facility is currently being used thus leaving a 60% void in tenanted areas relating to unused facilities. The survey was based on a Monday to Friday 8am to 8pm working week, 3

4 however, due to being closed for two of those hours every day, it is possible to challenge that the hospital is slightly better utilised than the figures suggest. The CCG is trying to make money flow but where services aren t well utilised this can open them up to greater financial risk if space is given back as the CCG has to cover the costs. Fareham and Gosport CCG has a very high rate for leg amputations, a huge amount of work is being carried out by lead, Dr Paul Howden to look at why this is the case and how to improve the services available to those at risk. This started around eight to nine months ago and improvements have already been made including a vascular clinic set up at PHT, of which a separate specialist service is available for diabetic patients. The Community Hospital is not designed for beds, there is no infrastructure to support that, however five beds are commissioned directly in Hawthorn Court to discharge to assess. Action: Lisa to send around a list of services currently available at the hospital. Lisa discussed how the Better Local Care concept will work in Fareham, with a central Fareham facility and the community Hospital serving the population. In December last year, a strategic estates plan was submitted outlining estate plans, however further detailed work needs to be done in conjunction with The Better Local Care Group, to ascertain where services need to be provided from. Fareham Community Hospital is a strategic hub for western wards and for Southampton and Fareham services, however a central Fareham hub is needed alongside this as the hospital is difficult to access from areas such as Portchester. A bid for this central hub was put into this years ETTF (Estates and Technology Transformation Fund), as the CCG views a central Fareham hub as a key scheme. The CCG is unable to hold a head lease for the building so is looking at how to use the facility in a different way i.e. utilising space, the CCG is also working with the Department of Health to formulate a financial lease agreement. More usable areas are needed. The intention is to look at all space in the building and see how it could be used more flexibly. Lisa informed the group that NHS Property Services are moving to market rent which could cause issues for individual practices. A private finance agreement with the landlord would be more cost effective than a lift scheme so may be a preferred option for future new builds, but until a need has been identified, this will not be tested. Whiteley Surgery has already adopted this approach. Lisa went on to explain that with regards to development, making this move too soon would be a waste of tax payers money and phase two cannot be built until the building is fully utilised. However, the CCG is not forgetting the unused land and has no plan to release it. The topic changed to the allocation of beds and an increase of dementia patients. Lyn Darby explained that beds in Hawthorn Court are not dementia specific but for general use. Action: Lyn Darby to confirm the number of beds allocated at Hawthorn Court. 4

5 Lyn went on to explain that dementia patients are not normally moved to discharge as this proves much too stressful for patients, they must follow a strict policy to move patients from the acute trust to a dementia bed or directly home in one single move. Over time, fewer patients will be required to leave PHT and go into a bed rather than straight home, a strategy is in place to get more patients home and investments are being made into community services to assist this development. Collectively, the LPG explained they felt as though Southern have not been performing as well as Solent, Lyn explained that Solent have the benefit of a rapid response team, Southern do not have access to such a service, as a result, they have received an extra 900,000 to match the service levels of Solent and so far have don t very well in their improvements. On average, it costs 1.5 million per year to run a single ward of 20 beds, many local areas do not have any community beds as they felt the money could be better spent on community services to provide at home care to patients. A recent survey found that most people would prefer to be cared for in their own homes rather than community beds, investing into this patient need means a better package of care will be provided Standing items/ regular updates Richard explained how there are concerns around children s mental health care. West Sussex CCG commission all children s mental health services in the local and surrounding areas including Hampshire, there is however confusion around the CCG commissioning a service without any beds available. Richard went on to say that Pat Shirley, Chair of the CEC meeting, provided an explanation adding that it is a national problem. If levels of demand cannot be met in West Sussex, patients will be moved elsewhere. Action: Lyn Darby to arrange a speaker on this subject. A presentation was held at the CEC by Alex Berry, Chief Officer at Fareham and Gosport CCG around the STP (Sustainability Transformation Plan). The STP aims to upgrade intervention and GP integration through the de-layering of services. Money will be provided for the first year. Richard added that there is still confusion around the subject and the levels of patient involvement in decisions. Richard also queried the use of the Community Hospital facilities for meetings and the cost implications to do so. Local MP Suella Fernandez and the League of Friends will be attending a task force meeting in September to address this. Shared concerns about the Community Hospital will also be taken forward and discussed at the MP meeting with Andy Wood (potentially replacing Richard Samuel) and David Chilvers. 5

6 3.2 Feedback from PPG members Fareham Centre Practice: Bob Blackman The new EMIS system was introduced in mid-july and has proven quite a challenge; the main concern lies around reception staff familiarising themselves with the new layout and operation. Due to this, there have been delays for patients on reception, difficulties with on line ordering of repeat prescriptions and appointment bookings. The practice has been awarded dementia friendly status, members of the PPG assisted with a dementia audit and made a number of practical suggestions for improvement that were later actioned in areas where the practice had authority to do so. Other areas such as inadequate outside signage await action from other organisations including Fareham Borough Council and NHS Property services. A recent CQC inspection was carried out at the practice to which PPG members provided some input. Unofficial feedback from the CQC suggested that the practice has an overall rating of Good with a rating of Outstanding for looking after vulnerable patients, many of whom are in residential care homes. PPG members have communicated their concerns to Fareham Council and Developers Buckland about a lack of planning for a Medical Centre in the proposed garden community (Welborne). It is hoped that the impact of this development (6000 houses) on GP practices and current patients in Fareham will be considered. A number of PPG members attended a recent public meeting of the Fareham and Gosport CCG, they will report back at the next meeting. Dr Keith Barnard and Secretary Phil Weston are both stepping down from their responsibilities; they have been thanked for their hard work and valuable input shared during their time with the PPG. Jubilee Surgery: Wendy Culverwell An update was given on DNAs (Did Not Attend), text reminders are in place and are having some effect thus reducing the number of DNAs. However, cases of nonattendance are flagged on the patients record and where possible, doctors will call nonattendees on the day of their appointments and often find they are able to deal with problems over the telephone. A recent friends and family survey has shown that things are starting to improve. However, results are less satisfactory during pressure times e.g. Doctors holiday period and winter appointment availability. Doctors will be staggering their summer holidays to address and potentially avoid continuance of this issue. The subject of accessible information was discussed; the practice is required to make all information available to everyone regardless of ability or language constraints. They are looking for ways to ensure notices are readable by those suffering with cognitive or eyesight difficulties. 6

7 A talk was held by Dr Bertram on BetterCare Fareham and the introduction of Web GP, part of the BetterCare initiative, which is a new online system to help ease the pressure on GPs and appointment bookings by directing patients to the appropriate level of care to manage their problem. This will improve patient education on caring for themselves, access to patient care and make it easier for patients to see a specialist if necessary. Contracts were also discussed as these are expected to change next year, there are, however, no structures currently in place for this as an Accountable Care Organisation is needed. The next meeting will be held 24 September 2016 Westlands Surgery: Sue Martin A few staff changes have taken place; one doctor has returned from maternity leave and the trainee GP is leaving to be replaced by another. All session members remain the same. Westlands is the first Fareham practice to take on the Surgery Signposters initiative. Six signposters have been receiving training and started work in July. There has been a significant increase in the number of registered carers, this remains a priority with work to continue. One of the PPG members attended the QA meeting about improving support for carers in the hospital. It was reported back that the initiative is doing very well under Sarah Balchins leadership. Flu clinics have been planned and will be supported by the PPG members. GPs and nurses have been encouraged to increase awareness of the PPG in the hope of recruiting new members. The next meeting will be held 21 September 2016 Lockswood Surgery: Beverley Arthur A survey was recently carried out to gather information on the Electronic Prescribing Service (EPS); participants included a virtual group and two separate clinics to which hand outs were given in the waiting room. Results showed that less than half of those surveyed used the EPS system. The practice has decided that the sample used was not a full representation of the practice as a whole therefore the survey will be repeated in another six months. The practice still has a very high DNA (did not attend) problem. A DNA policy has been produced explaining how missed appointments impact on the practice along with consequences for those who continue to waste unwanted appointments. The notice has been posted on the website and attached to the surgery newsletter. The surgery had a CQC visit on 21 July; results were expected at the end of August. The practice has not been given any indications of any issues found and hopes for positive 7

8 feedback. The new online system econsult is live on the website; more information will be given at the next meeting. Gudgeheath Lane Surgery: Robert Holman The practice is still receiving good feedback from patients, most of which are likely to recommend the services provided to a family member or friend. Since the last meeting, a complaint has been made regarding a prescription; it was discovered that the electronic prescription line was not working; paper prescriptions are now being issued where appropriate whilst the issue is resolved. The new telephone system is working well and the call queuing feature is acceptable. However, getting through on the telephone to the surgery when it first opens in the morning is still proving an issue, there are three receptionists in place and two telephones are answered at the same time throughout the day to process all calls. The surgery will be changing clinical system in September; due to this there will be a reduced service from Tuesday 13 September until Tuesday 20 September. Urgent cases will still be seen in this time but routine appointments will be postponed until the new system is running. Information for patients will be provided in the surgery, on the website, via and on prescriptions. The community board will take on the theme of alcohol awareness; this will be carried through to 2017 to cover the Christmas and New Year period. The practice has been informed of Flu Clinic dates, healthy children will be vaccinated in more than one clinic and some flu clinics will run during surgery opening times during the week to help those who cannot attend weekend dates. A patient survey was run during August; PPG members were responsible for encouraging patients in the waiting room to participate. The surgery is keen to take part in the Surgery Signposters initiative, as this is still under pilot in Fareham, the surgery can currently refer to Signposters at Westlands surgery who are part of the pilot scheme. DNA (Did Not Attend) statistics show that there has been great improvement over the last year for the surgery; there is an average 1% decrease in reported DNAs. Stubbington Medical Practice: Alan Walker 40% of the PPG members, including the PPG secretary, have left the group over the past 12 months due to family or health commitments. The three new joiners attended the informal meeting (August 22), but the loss of the secretary is delaying NAPP (National Association for Patient Participation) membership. The TORs (Terms of Reference) review has been conducted and these are still relevant. Approval has also been received from the practice to proceed with a number of 8

9 outstanding proposals. The practice has a policy of not increasing the use of social media, current content is not official. Formal meetings are held every two months, often with two GPs present. Informal meetings are also held six times yearly. Out of the ten Fareham practices, Stubbington Medical Practice is the only one not under Suella Fernandes s constituency but instead comes under MP Caroline Dinenage. Whiteley Surgery: Richard West Progress has been made around car parking at the surgery, Nexus, who own the surgery building and land, have agreed to extend the car park. Discussions are continuing with two land owners to buy more land to make into a car park; however planning permission will be required. The matter is ongoing. A new family and friends survey has been handed out, so far 200 survey results have been returned. There will be a dedicated telephone line for patients to call if they need to cancel an appointment. Currently, appointments can be cancelled online. The new computer system EMIS went live from the 28 June, the cut off of data to be placed on the computer came 22 June. In the first week of operation, the number of appointments was reduced due to the changeover in systems and familiarisation with the system. Comments on social media about the surgery and individual staff members still remain an issue. The partners have decided that staff must not respond to any comments that are posted. The PPG learnt that Web GP will soon be available to the surgery. A pilot for the scheme has already been completed using online software to triage patients. The scheme equates to costing 64 pence per patient so is very cost effective, this will be funded by the Vanguard Project. This is an ongoing process that has been safety checked by the RCGPs (Royal College of GP s), all practices can log on. Dr Ridgway will start maternity leave in July, a female locum doctor will stand in during this period. A new receptionist joined the team in June along with a new nurse, Sarah Smith, in July. The surgery is also looking to appoint a healthcare assistant soon. As from July, with the aim to offer more flexibility for patient appointments, two GP s will be available Monday evenings and one on a Thursday evening. Whiteley surgery opens from 8:00am to 6:30pm Mondays to Fridays, it currently provides late evening appointments, pre-booked only, on a Monday and Thursday and alternate Saturday mornings. During extended hours (Monday/Thursday 6:30pm 7:45pm) there will be no access to a receptionist via telephone. 9

10 The PPG is in the process of updating its terms of reference as it is now outdated. Brook Lane Surgery: Susan Barton The PPG is happy to announce the recruitment of three new members thanks to a concerted effort by the GPs to encourage volunteers. Brook Lane PPG now has a total of ten members but remain conscious that the demographic could be enhanced through the addition of younger members to bring diversity to discussions. The PPG explored the DNA (Did Not Attend) policy and concerns around lost appointments by those who fail to attend but do not cancel. Practical solutions were discussed including the use of a text service and the possibility of retaining patients who repeatedly do not turn up. It was agreed that the surgery would write to DNA patients to explain the impact on the surgery and to encourage future attendance. The PPG is still very concerned about the use of the Community Hospital, particularly those patients who are required to travel to Havant regularly to undergo dialysis. There has been an ongoing struggle to arrange a mutually convenient meeting between the local councillor, Brian Bayford, a GP and the PPG group, this remains unsuccessful. The group now intends to contact local MP Suella Fernandez to invite her to visit and talk with the PPG. The PPG would like to know how many patients from other surgeries in the locality are experiencing the same service and would prefer to be treated in the Community Hospital. Until recently Brook Lane Surgery had onsite NHS physiotherapy but patients now face a nine to ten week wait for physiotherapy at the Community Hospital which is an unwelcome change and disappointing for patients. The planned CQC visit was cancelled, a revised date has not yet been provided. 3.3 Feedback from Hampshire Healthwatch Apologies received from Jon Piper. 4.0 Any other Business Future Focus items Lisa Medway discussed a one team event as part of the Better Local Care initiative to which local reps and clinicians etc. have a meeting to discuss concerns and clear up understandings and confusions.outcomes involve the production of a logic model which looks at an issue, how to solve it and what should be in place to reach that target. If there is enough interest, Lisa will extend the invite to LPG members. Action: Lisa to pass on details to Courtney to then circulate around members. 5.0 Date of Future Meetings (all to be held at Fareham Community Hospital (all Thursdays) from pm 17 th November th February

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