PRESENT: Patient Reference Group 04 April 2017 Room BG.01, Woolwich Centre, Ground floor. Name Job Title Organisation Dr Sylvia Nyame (SN) (Chair) CCG GB GP Executive Greenwich CCG Angela Basoah (ABa) Head of Communications and Engagement Greenwich CCG Yvonne Lesse (YL) Director of Quality and Integrated Governance Greenwich CCG Carol Berry (CB) Compliance Manager Greenwich CCG Paul Richardson (PR) Lay member PPG Plumstead HC Rikki Garcia (RG) Chief Executive Healthwatch Greenwich Clive Mardner (CM) Volunteer Development and Outreach Officer Healthwatch Greenwich Shirley Gibbs (SG) Lay member QEH Patient User Group Frances Hook (FH) Lay member PPG Manor Brooke MC Eileen Smith (ES) Lay member Vanbrugh Practice Buz Dodd (BD) in attendance Interim Asst. Director Greenwich CCG Commissioning: Contracting & Procurement Busayo Beyioku (BB) in attendance Business Support Officer - Minute taker Greenwich CCG 1. Welcome and Introduction SN opened the meeting and welcomed everyone. Advised that everyone should be clear about the organisation/group they are representing. 2. Apologies Dr Greg Ussher (GU) Patricia Kanneh-Fitzgerald (PK-F) Angela Burr (AB) Gilles Cabon (GC) 3. Conflict of Interest None declared 4. Minutes of previous meeting Minutes were accepted 5. Action Log & Matters Arising Action 3 Estate Strategy Executive summary: section 1.6 it says short term work actions and to link further with our local patient and public groups as well as the third sector going forward - PR does not recall anything being discussed about third sector group. Long term section bullet point 8 engage with the public and patient. PR has been All Re-inform GP s that the PRG minutes are on the internet. Send link as well. Chair: Dr Ellen Wright Chief Officer: Jo Murfitt
asking for the Primary Model to be shown SN Form a group which works on making the estate strategy accessible to the public and that PPG s and others are aware of it. Request Primary Care team to come back and talk but be aware that resources are limited. Action 5 - ABa has contacted Steve Whiteman and he has nominated Alexia Fergus who is Public health senior lead on public and stake holder engagement. He has asked for the terms of reference for the PRG. Action 8: SN The CCG currently commission two interpreting services RBG (deliver the face to face interpreting services at the practices) and Language Line (to deliver telephone interpreting services within practices). Current service provider has come back to CCG with a potentially competitive offer so CCG is reviewing it to ensure that patients with clinical need will continue to face to face interpreting service as well as telephone based service. It is anticipated that patients won t experience difference in service (if it continues to be offered by two service providers as it is now) both telephone and face to face will continued to be delivered. Action 13 List of engagement done on MSK ABa the CCG have said that some limited discussion took place with patients about the model of MSK services and problems with the current service model. These discussions were used to shape the MSK service specification that was eventually used as the basis of the procurement process. The service model based on triage and then clinical direction to appropriate clinicians is standard and based on national best practice. In terms of consultation it would not be expected that discussion took place during the actual process of procurement. However the CCG accepts that its consultation prior to the decision to go to tender was scanty and could not be defined as best practice. I hope it can be acknowledged that a number of lessons have been learnt and that the CCG is trying hard to engage with its patients and the public which we hope can be demonstrated by actions such as the recent engagement event at Charlton Football Club (8th March) and our current consultation where we have attempted to attend a wide range of different venues as well as using other means to communicate. FH there was a document from the alliance team which cause this to go lead to procurement which has never been seen. Action 14 CM wants to see the process of recruitment the new lay member went through - We advertised post on NHS jobs. Then recruitment process was done via NHS jobs i.e. short listing and interviews. RG suggested that for future recruitment to roles like this, it should be circulated through different avenues. Matters Arising PR would like the borough level numbers of whole time equivalent GP, number of patient s and what the trend is in those ratios. 2
SN advised that this will have to be taken to the Primary Care team to come back with a response. 6. Introduction Yvonne Leese, Director of Integrated Governance YL described her background into the lead up of become Director of Integrated Governance and Quality. The last 5 years she was Director of Operations of community services working in North West London working under North West health care trust managing community services for 3 boroughs Brent, Ealing n Harrow. Coming from a provider background she has managed lots of staff and services. She is new to SEL London and looks forward to working with everyone. Her role involves being the lead for: Quality, Clinical Governance, Corporate Governance, HR, Medicines Management, Safeguarding Adults, Safeguarding Children, Information Governance, and Patient and Public Engagement. Looking forward to working with the PRG group PR it is good to have more permanent staff to roles in the CCG rather than interims. YL her style is partnership and collaborative working this is what she aims to do. She will be focusing on developing a robust engagement strategy for the CCG where thoughts and feedback are welcomed. 7. Equalities Annual Report CB the Governing Body have seen this and advice for it to been shown at PRG meeting. The equality strategy, the EDS2, the WRES and the action plans are included in this report of what the CCG have done throughout the year. CB updated on some of the work: WRES action plant there is an amber action - Unconscious Bias Training for CCG employees for staff specifically involved in the recruitment of new staff and those responsible for line management. - New training package has been developed and been agreed but hasn t been rolled out this is because there has been a lot of changeovers in staff. We will identify those staff who responsibilities for recruiting and management of staff and then the training will be rolled out- on-going process. CCGs in SEL may wish to consider a joint action plan based upon an amalgamated report in the future works still needs to be with contacting other CCGs and getting them on board but we are currently working with LGT around they workforce equality standards. EDS2 action plan - Maps and review use of data across CCG, in terms of demographic data relating to access, outcomes and experience at the moment we are trying to set up an equalities steering group. The terms of reference have been drafted and they are currently waiting to go to the quality committee. We are identifying members of staff who will sit in this group including someone from health watch or Grip to sit on that committee. FH Is there any news to bring all the SEL CCG s into one organisation? CB currently this is not happening. SG do you see any of the consultation documents before they go out with regards to 3
equality because CB I didn t have any input into this consultation document but I did see the business case on TAP policy which had my comments and recommendation. PR When does the Equality impact assessment on the consultation document (TAP) come into play? CB it should be before, we currently looking to roll out training around EIA. YL we will be looking into the process of this. FH the CCG should be looking at what is coming up going down the line. SN the equalities steering group, how will this link with the PRG? CB the work that would be happening will feed into this group. 8. Home First Update BD This is a project which is being worked upon across what is known as the systems (Oxleas, RBG, The CCG and the acute providers) to look at how The CCG could do better in terms of navigating the front door of A&E and also discharging the back door. The healthcare teams have provided and increased presence within ED and the community and acute healthcare teams have a closer working relationship as a result. In addition, the non-healthcare teams have commenced delivery as part of a new Discharge to Assess service. This has started on two wards at QEH and will continue to roll out across further wards. Discharge to Assess allows people who are no longer requiring acute hospital care to be discharged to their own home or another community setting. They can then be assessed for longer-term care and support in the most appropriate setting and at the right time. Research from these models elsewhere in the country shows the following clear benefits to the patients: Reduced length of stay even when there are increased pressures on acute hospital beds. Resulted in better outcomes for patients. Reduced assessment timeframes. Identified pathways where patients can go home earlier and have assessments at home In addition, Discharge to Assess is recommended by NHS England, NHS Improvement, ECIP and ADASS. Friends and family tests will be used to monitor the patients views of their hospital stay and admission and discharge processes. There are new elements to be added: Consultant connect NHS 111 FH this should look at how many people go from urgent care into A&E 4
BD this is happening and we are working closely with Greenbrook FH Hospital around don t know what is available in Greenwich, more education is needed to clinical personnel. SN what is timescales? BD the mobilisation and navigation and front telephone system should be in place in the next 2months. However we know we are not where we need to be. Single point access should be available by everyone. CM was there something prior to where you pick this up? BD there was a model that was worked on last year and since then we have learnt from events in winter. We have also been gathering knowledge from our colleagues in Bexley etc. to develop this model. CM - What role in this model does the patient have? BD initially it is about the resources we had how could we do thinks better; as opposed to major pathway changes. We haven t engaged with patients but the intention now is that moving forward this is about using resources better which has been appreciated through the commissioning intention etc. There will be a plan soon. RG how closely will you be working with RBG adult s transformation team because they are doing a full revamp of their adult social care services and looking at the pathway which has a significant impact on the home first model. BD original document was sign last year August 2016 which missed this element but improvements are being made to the model now which should include this. RG relating to the patient engagement what they are doing for their adult transformation stuff they have just appointed a co-production lead to someone who is dedicated to making sure that there is a voice for people. There needs to be that process. SG The hot clinics are for rapid assessments and on-going monitoring but there is also the ambulatory service which is very similar. BD they are very similar but there needs to be a link between the two as there are services that are specific to the hot clinics. SN Lewisham does have a fully functional ambulatory care and the model in QEH is not the same and the CCG are working towards something similar. FH How much have the CCG look at the demographic of the borough because we did a discharge process and discovered that 38% of people then were single going home to single. And If you don t have the proper care you might end up with more problems, there needs to be a better discharge system. BD looking at the discharge case and planned discharges these demographics questions are asked, which forms part of the pre assessment 48 hours before. 9. Post Engagement Report: Urgent Care 5
ABa The next steps from the 31 st January patient forum which 33 people attended What was said? Understand difference between emergency care and urgent care but less aware of local urgent care options Poor advice / After care e.g. in Care Homes leading to repeat visits/ readmissions PRG: Urgent care contract coming up for review: What changes will be included in specification and what patient input in the new specification What we the CCG Could do: Publicity material / on-going promotion of local urgent care options and when to use them (e.g. GP Access hubs, GP out of hours, Health Help Now) Feedback to project team / colleagues monitoring contracts / on-going relationships with re: care homes Engagement team written to project lead and awaiting response SG the 33 people that attended the event are very aware of the NHS system and how it functions and because of that they did know the difference between emergency and urgent care. Urgent care is the wrong name and we need to think what else we can call it. CM the group wasn t utilised to its full potential because they were well diverse in information and knowledge with regards to the NHS system. Also more knowledgeable facilitators as picker seemed not to be able to answer questions or hold the session constructively. The procurement timetable would be helpful for everyone to see. ABa The communication and engagement team have written to the project teams and still awaiting response. 10. Engagement Update TAP ABa At the next meeting we will be looking at the QIPP projects and what will be required in terms of engagement. 2 sessions will be happening on the 6 th April regarding more consultation on the TAP: GAVs Health and Wellbeing Group Woolwich Centre 10 th April The Greenwich Centre 11 th April Abbey Wood community Centre 19 th April Eltham Community Centre SG my local library and local GP have stated that they have no clue what this is or what is going on 6
SN Leaflets and booklets were sent to every GP Practice CB out of the engagement sessions taking place how many are part of the protected characteristics? ABa I cannot provide the list at this moment RG within the consultation document there is lack of potential criteria for the other treatments; how they might be applied under the treatment access policy. ABa The whole idea of the consultation is actually to let your feedback inform what decision you arrive at which will include the criteria which will be partly clinical but also inform by the responses received. The current situation is that there isn t any criteria at all which one of the discussions being had; is should there be a criteria and the criteria will always be clinical however the ultimate question is should there be one or not? PR the consultation is at my health centre but there are massive problems with questions that are being asked. 11. AOB Medicines Management to come to PRG to discuss survey of patients affected by the OTC Dates of future meetings: 06/06/2017 04/07/2017 01/08/2017 05/09/2017 03/10/2017 07/11/2017 05/12/2017 7