Richard Garrard, Chair of the AshLea PPG, introduced himself to those present and thanked them all for attending.

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1 MINUTES OF THE EXTRAORDINARY GENERAL MEETING AND FIRST OPEN MEETING OF THE ASHLEA PATIENT PARTICIPATION GROUP (PPG) HELD AT ST. JOHN'S SCHOOL ON WEDNESDAY, 18TH MARCH Richard Garrard, Chair of the AshLea PPG, introduced himself to those present and thanked them all for attending. Apologies for Absence The following had registered their apologies for absence: Audrey Beeching: Christine Kerton: Stella Roscoe: Terry Savage and Robert Stafford. Matters arising from the Minutes of the Meeting held on the 16 th September Richard Garrard explained that a copy of these Minutes had been circulated by to all those who had expressed an interest in being updated with all relevant PPG information. As the PPG is not supported by any funding, it is important to keep costs to a minimum and as much information as possible will be delivered electronically. Of course, information has been and will continue to be posted to any interested party without internet accessibility. There being no comments raised, the Minutes were agreed as being correct and approved. Chairman's Report Richard Garrard presented his report covering the six months from September 2014 to March 2015 and a copy of that report, in full, is attached to these Minutes. Following on from this, the question of funding for the PPG was raised. In answer, Richard explained that the PPG receives no direct funding but reasonable expenses are covered by the Practice, for example the cost of the hire of the hall. For the benefit of all, it is therefore important that we work economically but without jeopardising our aims. The question was then raised regarding our assessment of future possible projects and what priorities were given. Richard Garrard explained that, at present, the possible projects listed in his report were a wish list and would be analysed and discussed by the new full Committee. A day in the life of a General Practitioner At this point Richard introduced to the meeting, three doctors from AshLea Medical Practice to give a brief insight as to the working of our surgeries. Firstly, Dr Alison Anderson explained that the Practice, consisting of 10 partners, cared for over 19,000 patients and no two days were ever exactly the same! Staff start arriving from 7 am and normally she arrives around 8.30 am to read reports and letters requiring more urgent attention. From around 9 am she will see around 15 patients at ten minute intervals following which she will make phone calls to those requesting to speak to her, ring for results or speak to pharmacists. Between 12 to 12.15, there will be a brief meeting between doctors to discuss and share information and, if necessary, seek another opinion. There will be further meetings with staff and nursing staff, including those from the Princess Alice Hospice to discuss patients under their care.

2 Home visits will follow, where necessary, and this often means visiting the elderly both at home and in nursing homes. Ashtead has a high population of elderly patients and this results in more complicated medical conditions and hence are more time consuming. Any time from around 3pm, she will see another 15 (on average) patients again at 10 minute intervals and deal with more letters and phone calls. She will leave the surgery any time between 6.30 and 7.30pm. Dr Anderson related her day to a student doing two 3 hour exams every day and all the concentration that involves! Dr Anderson reminded the meeting that the Practice was also a Training Practice and has been qualified to train and guide young doctors through the final stage of their own training. Being a GP is very different to being a hospital doctor where you are usually surrounded by others but as a GP, you work on your own and have to make decisions on a one to one basis with the patient. One afternoon per week is given over to the specific training and monitoring of these trainees. To follow, Dr Mark Jones explained that not only do the doctors carry out continuous patient care, the Practice is run as a business and as such, there is an enormous amount of paper work involved. Examples were given: budgeting of accounts; training of staff including nurses and hospice staff to ensure all involved are fully up-to-date; recruiting of staff; working with the CQC (Care Quality Commission) to collate funding; the support and re-organisation of Leatherhead Hospital, which is of prime importance to them, and the various networks being set up to pool resources to ease both workloads and duplication. All this, on top of the daily care of patients, takes a considerable amount of time. Dr Lynne Davies reiterated all the comments made by her colleagues but enlarged by saying that the Practice does, in fact, include many specialists in their own right all of whom work within Leatherhead Hospital and hence their 100% effort in supporting its continued growth. Dr John Wong is a specialist in cardiology and has clinics three times a week and at Leatherhead Hospital. Drs Lowes, Williams and Davies also do minor operations at Leatherhead. Drs Davies and Carver are very much involved in Women's Health and coils and implants are done by them in Practice clinics. Dr Watson specialises in E.N.T and although based in Gilbert House, runs two surgeries a week specifically for such consultations. In addition, there are specific clinics for Diabetes and Asthma. Dr Davies further advised that Linden House is desperately short of space and they are very conscious that they lack further facilities for consulting rooms and additional services. However, she emphasised that they have a hugely committed team of staff, they are up to date and diverse in all they try to achieve and they look forward to working closely with the PPG to take things further to the benefit of all patients. She thanked the Steering Committee for all the work and achievements over the past six months. Q & As: 1. Is it true that you are no longer able to take dangerous drugs, i.e. morphine, on your home visits? Dr Davies said that this is not true but was a decision made by the Practice. They felt that morphine was so rarely used that bearing in mind the strict NHS regulations it was impractical to hold stock themselves. They used the services of the local pharmacist and the district nursing staff when necessary and appropriate. 2. Do Not Attends: The Practice is able to give accurate figures on a monthly basis and the PPG are already using social media to draw attention to the fact that, on average, 75 hours per month are

3 lost to people who do not attend booked appointments. Not only is this creating work for the administrative staff, it is denying other unwell patients the opportunity to see a doctor. The PPG has already raised this profile on Facebook and Streetlife and they are confident that social media will have a growing impact on highlighting this problem. Another point being stated is the fact that appointments are not necessary for repeat prescriptions and by advising on the means to do so, hopefully this will release appointments for those who are in need of seeing a GP. 3. We know what we expect from a GP, but what does our GP expect from us? This question raised interesting replies: firstly to be aware that there are appointments booked at ten minute intervals and patients often go in and mention a minor point first, leaving the main problem to the last part of the consultation. They ask that patients discuss the main problem at the beginning and other minor points, if time, later. Secondly, to remember that it is a two-way partnership and they stressed that GP and patient must work together and to appreciate that the doctor is really working with them in all they do. 4. The question of the Appointment system was raised and it was appreciated that, whilst there is no perfect solution, the Practice felt that they were dealing with the problem as well as they can. There are certain pre-bookable slots and others are on the day only. There is also a sit and wait period at the end of each morning. A major problem appears to involve the elderly who feel they just cannot cope with the system of ringing constantly at 8am until the phone is answered. Experience has already shown that they often give up and don't see a doctor as soon as they should. Sarah Fisher, Assistant Practice Manager and HR, advised the meeting that this would be taken on board and discussed at future GP meetings. 5. Patient Funding. The question was asked as to who pays for say, a patient to be sent to St Peter's in Chertsey for tests to be carried out. The meeting was advised that the Practice receives a certain amount of funding per person and any additional funds are provided, with agreement, by Primary Care. It was agreed that this is not necessarily the most efficient and accountable way of running a Practice. 6. Leatherhead Hospital. The Practice and PPG confirmed that they are working for and supporting the continued services provided by Leatherhead Hospital, including the opening of Leach Ward and Richard Garrard, as a result of his various contacts, felt that most people on the SDCCG (Surrey Downs Clinical Commissioning Group) want to see an increase in Community Hospital services. The PPG will continue to push for this and make our views well known. 7. The PPG was asked if they could put pressure on the local pharmacists, and particularly Boots, regarding the problem of them now being unable to supply blister packs to relevant patients. It has been said that the only place to obtain these is Boots in Redhill and this, of course, is completely out of the question for the majority of patients. 8. The recent report regarding the opening of a pharmacy within the GP Practice. The meeting was advised that this would not be acceptable in our area as we have too many pharmacists already providing a service in the vicinity. The article in the press applied to Practices with no local pharmacy within a certain radius of the clinic. Election of Officers Richard Garrard proposed that from the original Steering Committee, five had agreed to stand for another year: Maurice Baker, Stella Roscoe, Susan Eddleston, Lynda Feeney and Richard himself. He asked, and received, agreement to his proposal that this be accepted. Susan will now be Vice Chair and Lynda will continue as Secretary.

4 He, as Chair, had received five new Nominations to fill the vacancies (3 from Linden House and 2 from Gilbert House) and each gave a brief outline of themselves: Jane Owens: She trained as a nurse, working both in the acute Hospital and Community environment and also specialised in Cancer services. For the past 22 years has been an independent volunteer reviewing and monitoring health and is a member of the Mid Surrey Community Health Council, Patient Public Involvement Forum and Surrey Link & Healthwatch Surrey. Also experience in cancer and acute care services and mental health and learning disabilities. Julia Jarrett: Is a retired teacher in various aspects of special needs and is committed to maintaining the good service provided by our Practice. She is keen to use aspects of her experience in special needs with the young and elderly and to contribute to relevant areas of our voluntary work. Ray Harris: Retired Management Consultant and Project Manager with extensive experience in helping public sector organisations to define and implement service improvements and management changes. Mike Munson: Is a Mental Health Consultant and has experience of team work on Committees, Strategy Groups and Stakeholder Groups. He has a good knowledge of the NHS and Social Care structures and of Surrey's Mental Health delivery in particular. Has further experience in engaging with Service Users/Patients and of representing their interests at a higher level. Rowan Munson: Despite being only 15 years of age, Rowan felt he had gained a wealth of experience at many levels and has held a number of youth voice and health related positions from which a number of skills have been achieved. Among many other things, he was elected leader of the Mole Valley Youth Council, partnering with the local CCG and ensuring health was a consistent topic on the agenda and has built a Youth Voice Network partnership of local organisations interested in broadening participation of young people. Following the Chair's recommendation, the five were elected to the Committee for the following year. Any Other Business: The Chair advised that the next Open Meeting was planned for Wednesday, 15 th July Details will be sent when appropriate. The next Committee Meeting will be held on Monday, 30 th March and the Secretary should be informed as to any points you may wish to be raised at the Committee Meetings in the coming months. Richard Garrard thanked all those in attendance and looked forward to an increase in participants at future Open Meetings. Lynda Feeney PPG Secretary

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