Minutes People s Council 26 February 2014, Reception Room, Gedling Civic Centre GB 14/049 Present: Geoff Barker (GB) Hazel Buchanan (HB) Jeff Burgoyne (JB) Bruce Cameron (BC) Michael Ellis (ME) Chris Foster (CF) Francis Henman (FH) Mariea Kennedy (MK) Tony Morris (TMo) Dr Paul Oliver (PO) Stephen Storr (SES) Dale Wells (DW) Mike Wilkins (MW) Sam Walters (SW) Newthorpe PPG Assistant Director of Strategy, Planning & Assurance Calverton PPG Patient Stakeholder Engagement Manager Highcroft PPG Westdale Lane PPG PALS South CCGs Park House PPG NNE Chair/Clinical Lead Patient & Public Representative NNE Governing Body Appletree PPG Lay Member, Governing Body (Chair) Chief Officer In Attendance: Fiona Cambridge (FC) Ceri Charles (CCh) Antonia Smith (AS) Assurance Manager (Minute Taker) Deputy Programme Director, Nottingham University Hospitals NHS Trust Communication Manager Apologies: Phil Barlow (PB) Brenda Chambers (BCh) Clive Duckworth (CD) Jean Lewis (JLe) Dennis Purbrick (DP) Doreen Williams (DW) Les Williams (LW) Westdale Lane PPG Highcroft Stenhouse PPG Torkard Hill PPG & Healthwatch Representative Oakenhall PPG Whyburn PPG Whyburn PPG Item Action 14/010 Welcome and Apologies Mike Wilkins (MW) welcomed Ceri Charles, Deputy Programme Director Nottingham University Hospitals NHS Trust and Antonia Smith, the NNE Communications Manager. Apologies were noted as above. MW marked Richard Cornish s sad passing. Michael Ellis (ME) attended Richard s funeral to represent the People s Council and a letter had been sent to Richard s wife from Sam Walters and Mike Wilkins. Richard s input, kindness and enthusiasm will be missed and we will remember him through
14/011 14/012 our People s Council. Declarations of Interest No declarations were received. Minutes from last meeting Minutes from the previous meeting were accepted as an accurate record with the following amendment: 14/008 DES & Patient Participation Groups the statement JB stated it is not worth using the Friends and Family test should be replaced. Jeff Burgoyne (JB) was objecting to the new DES, not the Friends and Family test. 14/013 Matters Arising and Actions from the Previous Meeting 13/030 Discharge Project Ceri Charles (CCh) attended the meeting to update regarding the discharge project at Nottingham University Hospitals NHS Trust. The pilot has indicated that 80% of patients can be streamed upon admission to simple or supported discharge. Simple discharge implies there is no added support or services needed, support discharge implies there is a likely need for extra services from NHS, Local Authority community support or admission to a care/nursing home. This information is captured on a daily basis, recorded on the bed management system and appropriate plans are put in place so that when someone is fit for discharge they are ready to go within two hours. There are currently 200-300 captured timings per week which also demonstrate where the backlogs occur. Barriers around medication prescribing, pharmacy and transport are currently being addressed. Pharmacists are now identifying and logging, a day prior to discharge, medication required for the junior doctors to authorise. This will speed up the medication process. Sam Walters (SW) asked what the Clinical Commissioning Group can do to support the roll out of the new pharmacy system across all wards. CCh confirmed that the trial is in the early stages and discussions are to be held with the pharmacy team on the implications on capacity if the service was rolled out across the hospital. CCh noted the support from the CCG and will take into consideration during further internal discussions. SW raised the query whether for planned admissions, patients could have their medication ready prior to their admission. CCh confirmed they are working with pre-op and asking people to bring their own medication. Hazel Buchanan (HB) suggested it may be beneficial for the discharge checklist to be given at pre-op. Dr Paul Oliver (PO) suggested patients are advised at pre-op to notify their GP who may give patients anticipatory medication. Concern was also raised regarding discharge medication as only one week supply is given upon discharge. If GPs do not receive discharge information quickly, people s discharge medication may run out. Page 2 of 7
PO suggested that the patient s local pharmacy could be informed of the discharge medications and print off the new medication required. The GP practice could then alter their system accordingly. Transport links are currently being established to improve the system along with electronic discharge systems for district nurse letters. CCh confirmed discharge letters should be available for patients when they leave the hospital. GPs using SystmOne should be able to view the discharge letter as it is generated. Examples were given from the People s Council regarding elderly people who were discharged home as late as 8pm with no food in the house. Also someone was discharged with short notice who required 24 hours notice to enable carers to be present when they returned home. The family contacted the GP who said they had not received the discharge letter for 48 hours. Dr Paul Oliver (PO) thanked CCh for her work on the discharge process as this has been an on-going issue. Opportunities to work with local pharmacies to improve the pathway with electronic prescribing can make a substantial improvement in the process.. Bruce Cameron (BC) expressed concern as to why the QMC and City Hospitals were not being assessed together. CCh reported Arriva transport expressed there would be difficulty if all patients were discharged around the same time. BC suggested this should have been assessed prior to the contract. SW confirmed that the contractual agreement means that there should not be capacity issues if patients are discharged before noon. PO stated that this had been discussed at the Urgent Care Board where it was noted that Sprays transport are also being used. Chris Foster (CF) raised the issue around quality and patient safety and gave an example of discharge where someone was discharged on a Saturday with an illegible discharge note. Ten days later the GP had no knowledge of the admission/discharge. The query was raised as to whether information was given to patients as to what to expect when they leave hospital eg medication, infection, problems, family/support at home? CCh confirmed there is a patient information leaflet with contact numbers. Currently there is a discharge checklist for staff which could be put in place for patients. Action: CCh to produce checklist for patients CCh & HB CF queried whether NUH had protected time for administration staff to type up patient records on discharge. CCh could not confirm this. Hazel Buchanan suggested that checklist for patients could be used by the CCG to promote patients self management. Action: CCh to produce patient checklist & send to CCG for HB to use in patient self management Tony Morris (TMo) raised the issue that some patients did not have family at home and rely on services. Patients are often discharged home without the appropriate services in place and then are re-admitted within 24 hours. Page 3 of 7
The group expressed their thanks and recognised the improvements made by the project. MW expressed the group would like to remain in contact with the project and would be willing to ask for volunteer to assist in the processes. 14/014 *PPE Project Updates Nottingham MSK Assessment and Treatment Service: Michael Ellis (ME) reported that all practices refer into the service. Phlebotomy: Stephen Storr (SES) reported that the phlebotomists are currently having to handwrite the bottles, there are no printed labels. Patients are given a printed form from the GP. PO clarified that once on the system by the GP, the phlebotomist will be able to print out. Mariea Kennedy (MK) updated that this will be rolled out and should be implemented in mid March. BC reported that he phoned to make an appointment and was re-directed three times. However, the appointment process at the clinic was an improvement. MK confirmed that blood testing is divided into north and south Nottinghamshire ie if a blood test is requested from Kings Mill, this will have to be performed in the north. CF raised the query whether she could still walk into QMC to have her blood test as it needs to be analysed within ½ hour of the blood being taken. MK confirmed there had been no further changes as far as she was aware. An evaluation of the phlebotomy service will be undertaken in April and feedback will be available in May. Action: ME to feed back in May ME 14/015 Clinical Cabinet Membership Changes HB reported that to support engagement with member GP practices, GP representatives from each practice now sit on the Clinical Cabinet. The Practice Forum will meet ad hoc relevant to any business needs and if convened by the member practices. Each practice has a named GP lead to attend with the first meeting being on the 18 February. 18 of the 21 practices attended whereas previously at the Practice Forum, attendance had been around 8 or 9 reps. It was felt there was good engagement and input and the GPs reported it was a better forum. PO reported a GP Clinical Advisor is to be appointed to work for the CCG. The interviews will be held next week. 14/016 LES Review Anti-Coagulation Services PO reported that most practices are now at Level 1 with Calverton undertaking the Level 4 pilot. The majority favour near patient testing. An initial report will be presented to the Clinical Cabinet. JB confirmed that Level 4 is beneficial to the patients, it is straightforward and immediate with doses being adjusted before the patient leave surgery. PO Page 4 of 7
confirmed that the whole process is under evaluation. 14/017 Review of People s Council ToR & Constitution A presentation was given by MW (copy attached). The proposal was made to allow for discussions on Primary Care by having 6 Area Team meetings and 6 CCG People s Council meetings per year. The meeting set up will remain the same with the Area Team attending and leading on agenda items for their meetings. BC suggested having a link with Collaboration for Health Leadership in Applied Research and Care CLAHRC on the People s Council, which was agreed. HB confirmed that members would still be attending from all 21 practices and the other members would be in addition. SES and TMo agreed that it was important to get closer to the Area Team as there was a danger things get diluted as they go through various layers. It was agreed by members in principle. Terms of Reference will be updated for the next meeting. Action HB/FC to update the Terms of Reference for the March meeting HB/FC 14/018 Feedback from Primary Care Access Group SES reported the Primary Care Access Group is one of four sub groups under the Urgent Care Board. The remit is to manage urgent care access and A&E activity Currently there is 50m of government funding for improving primary care access, eg the Park House initiative. There is a winter campaign which will start in August/September. Using NHS resources, NHS Nottingham City CCG are visiting 22 schools to present on using health services effectively to 13/14 year old including videos to help spread the message with family members etc. 14/019 South Nottinghamshire Transformation Board SW reported that there are 11 organizations involved. In five years there will be a financial gap of 100m. The CCGs five year plan final submission date is 20 June 2014. There are two events planned in March for clinical engagement on delivering transformational change. The People s Council has three representatives interested in being involved in the transformation work and they are Dennis Purbrick, Jeff Burgoyne and Stephen Storr. SW confirmed that the NHS will look very different at the end of the process. JB thanked SW for her contribution and presentation at the Forest Ground event which was attended by around 130 people. It was encouraging to see the public engaging in the financial aspects of the NHS. PO reported there is a project Connecting Communities which the CCG have contributed to with NNE focusing on people in the community to improve their independence, health and wellbeing at home. TM confirmed that having interaction with and supporting people in the community is important. Page 5 of 7
14/020 Primary Care GP Access Aspirations PO presented Primary Care Aspirations at the Clinical Cabinet in February. NHS Rushcliffe CCG and NHS Nottingham City CCG are developing similar aspirations. This is for practices to take back and choose what they wish to implement. The patient voice is very important. It was noted that with the pressure currently on acute demand, no 8 I expect to be offered a non-urgent appointment within 3 days may not be feasible. CF raised concerns that although the focus may be on urgent care, the nonurgent appointments will not go away. TM suggested that whilst everyone wishes to see a doctor, they may be seen by a different clinician for example physio, pharmacist, and triage nurse. PO confirmed that he had tried many different appointment systems but with the level of demand, delivery for all is not possible. Acute demand is the current driver from the government and the CCG are currently undertaking a pilot of an Urgent Care Model. The group agreed to provisional sign-up. Action: Chairs of PPGs to take to PPG meeting for feedback at the March meeting. PPG Members 14/021 14/022 14/023 Impact of DES Payments for Patient Participation Groups MW confirmed the DES is going ahead and thanked members for their comments. Any Other Business Gluten Free: BC raised the query re the outcome of the gluten free discussion. ME confirmed that a survey had been undertaken of 337 participants with only 20 being complete. Further feedback is being sought and will be shared with the meeting. Action: ME feedback to the group in April Finance: Questions for Jonathan Bemrose to be sent to Fiona Cambridge prior to the next meeting Declaration of Interest Forms: These were circulated to the group. Action: All members to complete and return the forms to Fiona Cambridge Details of the next meeting Monday 24 March 2014 1.30-3.30pm, Reception Room, Gedling Civic Centre, Arnold ME All All Page 6 of 7
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