Minutes of the Patient Participation Group Forum Monday 19 June 2017 12.30pm to 3.00pm Meeting Room 3, Beccles House Present NHS Great Yarmouth and Waveney CCG / Graham Dunhill (GD) Chair Central Healthcare Centre Lorraine Rollo (LR) NHS Great Yarmouth and Waveney CCG Roger Jackson (RJ) Jeff Dyson (JD) Laurette Burton (LB) Joy Scriven (JS) Stella Goodall (SG) Carol Schwille (CS) Paul Light (PL) Cynthia Phillips (CP) Sandra Etheridge (SE) Jean Goffin (JG) Dilly Turton (DT) Malcolm Ballantine (MB) Veronica Downing (VD) Michael Fleming (MF) Jean Macheath (JM) Jo Flounder (JF) Alexandra Road and Crestview Surgeries Alexandra Road and Crestview Surgeries Longshore Surgeries Longshore Surgeries Longshore Surgeries Rosedale Surgery Rosedale Surgery Beccles Medical Practice Beccles Medical Practice East Norfolk Medical Practice Coastal Village Partnership Cutlers Hill Surgery Cutlers Hill Surgery Cutlers Hill Surgery Great Yarmouth and Waveney PAG Sole Bay Health Centre In attendance Jonathan Williams (JW) East Coast Community Healthcare Rebecca Driver (RD) NHS Great Yarmouth and Waveney CCG Maggie Tween (MT) NHS Great Yarmouth and Waveney CCG Kelly Penton (KP) Minutes NHS Great Yarmouth and Waveney CCG Item 1. Welcome, introductions and apologies ACTION GD welcomed everyone to the meeting, introductions were made and apologies were received from Lyn Gibbs, Amanda Hood, Judy Clift, Gilly Shepherd, Pat Rayner, Melanie Craig, Mike Cheesman and Jackie Cheesman. 2. Improving the patient voice in primary care managed by East coast community healthcare (ECCH) Jonathan Williams, Chief Executive of East Coast Community Healthcare (ECCH) attended the meeting. ECCH are a social enterprise who run community services in Great Yarmouth and Waveney and provide public health
services. ECCH also work with two GP practices and partner with two others. JW informed the group of his background within the NHS and of today s aim which was to see how engagement works and what more could be done; especially with the changes that are due to take place in the future. JW has met with MPs Peter Aldous and Norman Lamb recently to see what their ideas of engagement are. JW is aware more can be done and the ethos of ECCH to be engaged with the population backs this up. RJ asked what ECCH are doing now in terms of engagement which JW listed: Many communications and publications Although ECCH don t have a PPG Forum the individual practices it supports do have PPGs and members of staff attend these. Assistant Directors and Non-Executive Directors are now part of an engagement group RJ asked JW to explain the way ECCH work which is as a central administration hub that has the ability to financially back practices; they also offer back office functions like HR. RJ asked if the practices ECCH support are still independent practices which they are so they queried how they receive funding which is still done via the CCG. RJ also asked how ECCH receives money which is done via contracts with CCGs, County Councils and private providers. VD asked what ECCH offers the practices under their control that is different to what individual practices are doing and what are the benefits. JW noted they run all community services, they have a partnership with social care and the mental health trust and they run community hospitals so this infrastructure is used to support the practices with management resources. PL raised a concern on computer systems being different and some not being fit for purpose in patient care (i.e. Lorenzo) and asked how ECCH are responsible for changing these. JW noted Lorenzo is only used within the mental health trust so ECCH do not have control over their systems and that most practices now use SystmOne. PL asked what training is offered to practices. A change management team attend all ECCH services to make sure there is regular training being offered. JG queried why there aren t PPGs in all the four practices. This is because some practices are very active and others not so much. JW explained where each of the practices are currently in terms of their PPGs. VD thought today s meeting would be more focused on the patient voice and how this could be improved. MB felt patients were beginning to appreciate the difference between health and social care but they don t understand the complexities within the NHS and its relationships with other organisations. JW stated a lot of work had been done across the counties so relationships had improved; there has been some co-location of services to help. VD asked if ECCH have a model of how to improve the patient voice as she is concerned that many patients use private services like physio as they cannot access NHS service due to eligibility criteria. JW noted there are limited resources within the health service and things like the STP are being put
together to make the best of those resources. In terms of transformation it needs the public to get involved. GYW has a fantastic history of managing change so generally there is a direction of travel to work together. JM noted there is a huge amount of voluntary work taking place in the community which is propping up the NHS and feels ECCH need start working with the voluntary sector to improve knowledge. JW noted practices now have activities like social prescribing which is a group of people working with practices to provide those links and increase communication. LR JW stated he would return to the PPG Forum at a later date to bring back a plan of what they are doing around engagement and what will be done going forward which the group agreed to. JW was also happy to attend any practice events. Action: LR to add to future work plan. The group thanked JW for attending the meeting. 3. Sustainability and Transformation Plan Norfolk and Waveney Rebecca Driver, Director of Commissioning and Engagement attended the meeting to update the group on the STP. It is now known as the Sustainability and Transformation Partnership and it is a plan to try and get health and social care to work better together and to save money. The Norfolk and Waveney (N&W) plan is looking to save 400m over five years with year one already finished. RJ asked what savings had been achieved now that the first year had passed? RJ asked what savings had been made by closing Lowestoft and other small hospitals. RD said projected savings for the Shape of the System project including Lowestoft Hospital were around 4m." LR The plan consists of 12 statutory organisations which RD listed. Action: LR to circulate the list of the 12 statutory organisations to the group. Some footprints are further ahead than others; some are looking at closing hospitals, A&E departments and mental health hospitals but within N&W there are no large scale plans like this being looked at. Patricia Hewitt has been appointed as Chair for the STP and has lots of ideas of what we should be doing. RJ asked about Patricia Hewitt s appointment and RD said it was a permanent appointment on a five day per month basis. The Lead for the STP is from Norfolk County Council which is likely to change to someone more NHS based. LR A lot of patient engagement took place at the beginning which seems to have diminished recently and this is the reason for RD getting involved. The plans were published in October and are available online. We have a database of stakeholder organisations that are being worked with and some working groups have patient representation. There is also a stakeholder forum which includes the voluntary sector and events have been held; the report of which is awaited Action: LR to circulate to the group once published. We need to work on getting patients and the public more involved and there will be opportunities coming up around mental health, maternity services, hospital services and estates. With an NHS leader we hope to get closer to the patients. RJ asked if the published plan highlights how the 400m will be saved which it
does; RD noted the CCG has to save 16m this year alone as part of its QIPP saving plan. RJ also asked if there are any milestones in place to manage this which there is but RD noted more work is needed. RJ asked how much the STP costs which isn t much because the small project management team running it are existing NHS staff. SE asked if anything is being done about care in the community as she feels services keeping patients in the community is more expensive than patients going into a care home. RD noted it is much cheaper as it is around supporting patients at home to save them going into hospital which is a high cost. JM felt part of patients going home from hospital wasn t to do with community services but delays in discharges like prescribing. RD noted the CCG commissions these services so can influence them and that it has heavily invested in the prescribing team to work with hospitals and practices to make sure patients are supported; if this isn t working then the CCG need to be informed. LR SG asked how much of the community does Beccles Hospital serve which is the whole area. CP asked how the finances now work between the health and social care. RD stated there are a number of vanguard sites where the local authority has merged with NHS providers and pulled together their budgets. This hasn t happened nationally and there isn t a plan to do so but locally we are doing it in parts so for instance in Waveney we have a pulled budget with mental health care which works very well. Healthwatch Norfolk are running a free event on Monday 17 July in Blackfriars Hall Norwich which will run a Q&A session with the leaders responsible for the STP RD noted there is a requirement to submit questions in advance but all are invited. Action: LR to add RD to a future work plan to provide a progress update. 4. Minutes of the previous meeting The minutes of 24 April were agreed as a true and accurate record of the meeting. 5. Action log The action log was reviewed and updated. Matters arising The issues of phlebotomy were raised at the last Governing Body (GB) meeting. CP noted the issues at Beccles Hospital have got better but queried what would happen going forward; the James Paget University Hospital (JPUH) will continue to run the service until March 2018. 6. Clinical reviews: Cancer and End of Life Maggie Tween, Head of Cancer, Palliative and End of Life Care for GYW CCG
attended the meeting and presented a cancer and palliative care update which included clinical review findings. CP asked if a similar review would be taking place within the Norfolk and Norwich University Hospital (NNUH). A review was completed around 18 months ago and the biggest issue was around diagnostics. DT asked who has responsibility of giving results to patients as the two week wait (2WW) is often exceeded; a new initiative has been introduced for results to be given in 28 days; this includes improving ways of telling patients. Dr Helen McCall has undertaken an audit of all GYW practices to look at their 2WW processes which has prompted some changes. JM wanted it acknowledged the work the JPUH have done recently. VD asked if the hospice at home model is what we are working towards which it is. DT queried if the CCG cannot have a hospice why is it so difficult to help patients at home. MT stated we needed a hospice but they are very expensive so our system hasn t invested this type of money. JG asked who built Tapping House which was part of a community initiative. The group thanked MT for attending the meeting. 7. Surgery updates Rosedale Surgery Lisa Andrews The PPG continues to grow in numbers. The practice has recruited two Doctors salaried with view to partnership. The practice s GP Dr Lucie Barker is leading the Lowestoft Primary Care Alliance, an alliance of all the Lowestoft practices pledging to work collaboratively to improve patient care and cope with the increasing primary care workload. Central Healthcare Centre Lyn Gibbs CQC visited the practice on the 31 May. Tina (Chair), Chris and Tony (Vice Chairs) had a meeting with one of the inspectors representing the PPG and patients of the practice. The inspection seemed to go well but we are waiting to hear from Dawn, Practice Manager, what feedback she received. We are still looking at organising a patient event, hopefully with guest speakers, to make patients aware and to help them to understand what they should expect from GP services in the future. It is possible that this will be a joint event with at least one of the other Gorleston practices. At the moment there is no funding for such an event so one of our biggest concerns is how we let people know about such an event, without incurring the expense of a patient mail shot. PPG Awareness Week PPG members will be in the CHC waiting room on Monday 19 June to promote the PPG and generally chat to patients. As our PPG committee has, for various reasons, recently reduced in
size, it is hoped that this may attract one or two new members onto the committee. Following patient feedback, colouring stuff is now available in the waiting for children to use as well as the other play activities. Cutlers Hill Surgery Malcolm Ballantine As we have noted in recent reports, the work we have been doing in small groups continues: o The work reorganising the notice boards and leaflet dispensers in the surgery continues as does work on the practice website. We now realise that these will be continuing tasks. o Increasing the use of EMIS Patient Access has made progress and we look forward to significant developments in the coming months. o The work on providing information about making appointments to see a GP and, in particular, when to seek an alternative is making progress. o The project to identify resources which GPs can use to direct patients for additional help and support, the navigator project, is now under way. In the first instance we have been giving emphasis to information on patient transport to hospitals. Even this has proved to be a significant amount of work so we have further sub-divided it. o We now have a Walking for Health Group in Halesworth. So far four volunteers have carried out the training course required. Some of these are following up with the required shadow walk and lead walk which to make them fully trained. This training is taking longer than anticipated. At our AGM in April we agreed to look into the possibility of holding meetings for a wider set of patients than the PPG. We are planning our first meeting for September. It will look at the structure of the NHS, how it is changing and how this affects patients. We are basing this on the King s Fund animation An alternative guide to the new NHS in England. For the second meeting we are considering a topic within the area of mental health and we recently met Carolyn Gerber and Lynda Symonds from Great Yarmouth and Waveney Mind who have a similar but different initiative in mind. These two ideas could be linked. If we were able to take these matters further, Halesworth U3A and the Women s Institute might also be willing to collaborate. The uncertainty on the future of the Patrick Stead Hospital continues but we have been given assurances about the immediate future of the Rayner Green Resource Centre. We are particularly concerned about phlebotomy services at the Patrick Stead. The round trip from Halesworth to the James Paget Hospital is 50 miles and there is no direct public transport connection; Halesworth is the only town in Waveney without a direct connection to the hospital yet it is the third largest town - only Lowestoft and Beccles are larger. Including changes journeys frequently take up to two hours each way. As always, we are appreciative of the help and support which is being provided by our Practice Manager and her assistant, Hayley Witham who now attends our meetings on a regular basis. East Norfolk Medical Practice Elaine Bond
The practice is piloting the use of a paramedic as part of its same day team. Time for Care Programme workshop was held on Wednesday 10 May. The practice in conjunction with ECCH is part of the pilot being run by NHS England. The areas the practice is looking at are social prescribing and active signposting. The workshop was one of a series of events aimed at supporting the practice to release GP time. In conjunction with our PPG a further Great Yarmouth Working Together event was held on 31 March 2017 at the Acorn Centre, Regent Street, Great Yarmouth. Over 60 organisations took part. The event was open to the public and was an opportunity for people to drop in and learn about the different organisations working within the area and the support they can offer. Dr Wang left the practice at the end of May. The practice has successfully recruited Dr Mueller who will join the practice as a Partner from the 1 July. Practice staff are supporting the Food Bank which operates from Herbies at the Salvation Army with donations of food. Beccles Medical Centre Cynthia Phillips Beccles surgery have had to abandon Doctor First owing to unsustainable pressure on GPs. It was working extremely well and "no shows" we're practically eradicated, however we have lost GPs and will continue to do so over the coming two months resulting in our total GP hours reducing by one third. The revised way of working initially met with hostility from some quarters as the patients had become used to the excellent service that Dr First gave them but, nearly two months on, the modified system is bedding in and apart from the odd tweak here and there it is working. It has also given the opportunity for implementation of sign posting patients to appropriate care pathways which everybody will be required to do at some point so some positives have come out of it. It does highlight the worrying loss of GPs to on overstretched system. Alexandra Road and Crestview Surgeries Christina Easter We are currently recruiting a new Practice/Business Manager. Barbara Craddock has been back at the Practice for just over a year, and as expected would now like to enjoy her retirement! Interviews are being conducted on 7 June. Dr Karen Gallie gave a presentation of her audit findings to both the clinical team and the receptionists in separate meetings. She identified areas where she felt we need to change the way we work; letters, triaging at first point of contact; diversifying the clinical team. Karen felt very strongly that we very much had an open door policy when it comes to patients and this is something that could be addressed immediately. Dr Amer Shaikh has replaced Dr Abeyratna due to maternity leave. We were affected by the cyber-attack and like many other practices had to shut everything down immediately. It was felt the situation was handled well by those communicating with us and those within the surgery who gave up time in the evenings and weekend to make sure the service was back up and running as soon as possible. The surgery has identified another potential source of funding to buy
additional/up to date equipment for the practice and so are canvassing the whole team to see what items would be most beneficial to the patients. The Doctor First service was to be on the October agenda but CP noted this service no longer exists. GD would still like Dr Julia McClean (the GP who original introduced the system) to attend to explain the results of why the service is no longer working. MB raised a point around the phlebotomy service in his update because appointments were being cancelled but patients were still attending; some of which were making a 50 mile round trip. It has now been identified as an infrastructure issue which has now been fixed. VD suggested the use of a mobile screening unit like the breast screening one may help to make services more accessible for patients. SG stated Kessingland have a phlebotomy service run by the JPUH but due to funding it isn t clear whether this will exist going forward. Action: LR to ask what has been done. SE feels today s conversations seem to be around cost cutting and savings and that the money doesn t seem to be filtering back to the patients, for example car parking fees for the JPUH and wanted to know where this money goes. All money like this is reinvested back into the hospital. 8. Feedback from the Governing Body and issues for the Governing Body The PPG annual report was presented at the last GB meeting. 9. Primary Care Commissioning Committee issues/feedback The CCG were the first organisations to get back up and running from the cyber-attack. The CCG is now working in four localities. The Waveney locality has put forward a business plan to have a lead GP to cover the area. The Care Navigator scheme is something new and JG felt we should have a presentation on it to see what s involved. Funding is available for Care Navigators and training will be provided. 12 practices overspent on their prescribing budgets. JG was approached by an auto immune group about saving money for repeat prescriptions and noted patients are being put onto lower cost drugs due to cost savings which may not suit them. She asked if any other practices are experiencing problems to pass them on to the CCG. GYW are leading a bid to recruit EU GPs. PCCC meetings will now be every month. 10. Any other business There was no other business raised.
11. Date of time of next meeting Monday 21 August 2017 12.30pm to 3.00pm Norfolk Room, Kings Centre