Monkspath Patient Participation Group
Minutes of meeting 14 October 2014
Owing to the high numbers attending the meeting (45) it started five minutes late as more and more
seats had to be brought into the room.
Vic Lloyd introduced himself as Chair and welcomed everyone. As background for new members, he
said that all patients of Monkspath surgery are entitled to become a member of the Patient
Participation Group (PPG) just by attending a meeting or by giving their contact details – preferably
their email address, if they have one - so they can be kept informed.
The PPG has a steering group consisting of Ginny Lassam-Jones, Tony Green, Amanullah Khan, Martin
Tolman, Eddy Ankrett and himself. Martin and Eddie had submitted apologies for this meeting. The
PPG has an open meeting every two months, and the steering group meets in the intervening
months in order to plan the next and subsequent open meetings.
The steering group currently lacks a secretary, so these minutes are compiled by SG members' notes
and memories. If a minute-taking secretary can be found, she or he could, if they wish, cover a
wider range of planning and communications work as well. If anyone else would like to join the
steering group they would be welcome.
Vic introduced Dr Simon Green GP, the surgery’s senior partner, and our guest speaker, Ms Chris
Doolan, the Pharmacist at Taylor Dudley Pharmacy in the Shelley Farm shopping centre close to the
surgery.
ITEM 1: Order of business was changed to give priority to Chris' talk and Q&As.
The key points Chris made were that:
1. Pharmacists have specialist knowledge and experience in dispensing medicines (also known
as drugs). In order to become a pharmacist it’s necessary to study for four years to gain a
masters degree in pharmacy, then spend a year practising as a pharmacist under the
supervision of a fully-qualified pharmacist, then pass another exam. Once qualified the
pharmacist must keep their skills and knowledge up to date through doing Continuing
Professional Development (CPD). No drugs or medicines can be sold or dispensed from a
pharmacy unless a pharmacist is present. Pharmacies are regulated by an OFSTED – type
body.
2. New staff joining the pharmacy must enrol straight away on an NVQ level 2 course, and then
can fulfil more responsible roles when they have had two years training and also gained an
NVQ level 3.
3. In England 1.3 billion items are prescribed per year, costing £8.3 billion. The average cost of
an item is £8.96, but is dropping because of the increasing use of generic rather than
branded drugs. Generic drugs can be bought from many different drug companies so whilst
the drug itself has the same strength and effect the disadvantage is that it can come in a
wide range of possible containers, and the pills or capsules could differ in shapes and sizes
each time. But the great advantage is that generic drugs are much less costly than branded
drugs.
4. On average each patient gets 19 items prescribed per year. This has grown because of a shift
towards preventing illness rather than waiting until it occurs and then treating it.
5. About 90% of patients are exempt from paying for prescriptions, and 60% of those who don’t
pay are exempt because they are aged over 60.
6. Staff are the highest cost to the NHS and drugs are the second highest cost.
7. Pharmacies are the most accessible part of the NHS: 96% of patients can reach a pharmacy
within half an hour. I.6 million patients visit a pharmacy per weekday [ we need to verify this
figure.]
8. In terms of drugs, diabetes is the most costly condition to treat. The treatment of depression
is the fastest-growing cost.
9. Pharmacy services can be classified under three headings, namely Essential; Advanced; and
Enhanced. Essential services are those that every pharmacy must provide such as dispensing
prescribed drugs and signposting (directing) patients to other or additional sources of
support. They must operate within the NHS Governance Framework and the Information
Governance Framework that requires confidentiality. They also have to report safeguarding
issues to the appropriate body in accordance with multi-agency agreements. Advanced
services can include medicines use reviews and advice for patients who are on high risk drugs
or have recently been discharged from hospital on drugs they have not been prescribed
before. Enhanced services are commissioned (and funded) by the pharmacy’s local Clinical
Commissioning Group (CCG). Chris’s pharmacy is currently commissioned to do flu’
vaccinations; advice to methadone users ‘emergency hormonal protection’, that is the
‘morning after’ pill which can now be effective if taken a longer period after, but it is strongly
advisable to check in advance rather than rely on this. Other possible enhanced services
might be to advise patients on methadone; treatments of minor ailments; and cancer
screening.
Questions were put to Chris:
Q: Which body regulates pharmacies: is it the Care Quality Commission?
A: No, it’s the General Pharmaceutical Council.
Q: If prescribed drugs are prepared by the pharmacy but not collected by patients, what action does
the pharmacy take?
A: If none are collected the drugs are returned to the GP for investigation as the patient may have
died, moved to another surgery or to a hospital, or be unable to get to the pharmacy any more. If
some of the prescribed items are collected but one is not, it may mean that the patient’s need for
that uncollected drug have reduced, so the GP is told so that a medicine use review can be carried
out.
Q: Why aren’t there standard quantities in all drug cartons: some of mine have seven tablets and
others have ten. Surely this leads to waste?
A: Because generic drugs are bought from many suppliers there is unfortunately no standardisation
of numbers: some monthly packs contain 28 tablets or capsules while others contain 30.
Q: What if packaging of different drugs look very similar: if a patient has poor eyesight or takes drugs
in a hurry, it would be easy to take the wrong drug.
A: Again, this is because several suppliers are used. So if a single supplier standardises the
appearance of all its packaging it may issue two or more different drugs with very similar packaging.
Or a company may deliberately release each of its drugs in different packing but by chance one of its
drugs may still match by coincidence the packaging of a different drug from another company.
Sometimes the solution is to transfer pills to a separate dispenser box where each tablet or capsule
can be placed into a mini-tray marked for the day and time it is meant to be taken.
Q: What’s the line between going to a pharmacy or going to the surgery?
A: That’s something that needs explaining better, but until clear guidance agreed by the surgery and
pharmacy can be issued, in the short term, just ask pharmacy staff or surgery staff.
Q: Do you just take it for granted that the GP has prescribed the right drugs in the right strength?
A: No, my staff check the prescriptions against a software system that shows the normal strengths
and, quantities normally provided and tell me if anything doesn’t look right. I also check each one: I
am legally the Responsible Person for making sure that there are no mistakes. If something seems to
be wrong I raise it with the GP before issuing the prescription.
Q: How do you interact with NICE?
A: None, beyond using its guidance where it seems appropriate to do so.
Q: What is ‘NICE’?
A: The National Institute for Health and Clinical Excellence. Dr Green explained that NICE guidance is
produced by NHS medical staff but also some drug company staff, so the guidance, though often
useful, does not have to be followed.
Q: We can buy Paracetamol from Poundland, which doesn’t have a pharmacist. Why isn’t that better
controlled?
A: Drugs are classified into three categories, namely General Sales List, which can be sold over the
counter by any store; Pharma (P) medicines, which can be sold without prescription by a pharmacy
under the supervision of a pharmacist; and prescription only medicines (POM). Some drugs are only
ever in one category, while others, like Paracetamol, can be in each category depending on quantity:
you can only buy 16 Paracetamol in a retail store. You can buy up to 32 from a pharmacy, but can
only get 64 on a prescription. This is because you could do limited harm to yourself if you took 18
tablets too quickly, more harm if you took 32, and serious harm if you took 64.
Q: Are most drug containers recyclable?
A: Yes, providing they are empty. The drugs themselves are not re-usable: if drugs are returned to
the pharmacy they are put in a locked store cupboard until they are collected by a van and taken to
be incinerated. This is a fixed NHS rule: drugs prescribed and issued to one patient cannot be
reissued to another patient under any circumstances.
Vic thanked Chris for her detailed, informative and interesting presentation and she was given warm
and enthusiastic applause in appreciation. Chris then left the meeting.
ITEM 2: The minutes of the previous open meeting were proposed, seconded and approved.
There were no matters arising from the minutes.
ITEM 3:
Report-back from the Network meeting of Patient Participation Groups in Solihull.
Vic spoke about the PPG Network meetings. He said there are 34 GP practices in Solihull and almost
all have a PPG. We send three delegates (the maximum allowed): Tony Green, Martin Tolman and
Vic are the delegates from our PPG, and Vic chairs the meetings. At the last network meeting there
was a presentation on abdominal aortic aneurisms (AAAs) and the need for all men over 65 to be
screened for them; an up-date presentation from West Midlands Ambulance Service where an
ambulance is now based in Solihull again; and another from a Practice Manager at Hobs Moat
surgery who explained the very wide range of duties she and her counterparts have.
[Some notes from the minutes of the PPG Network meeting are appended below.]
A patient said the surgery’s website is very good: it is easy to use and gives a lot of useful
information. Vic said the website has a section on the PPG.
ITEM 4: Dr Green was asked about whether GPs would provide weekend cover.
He said it’s not in
GPs' contracts to do this. If it eventually becomes a contractual duty it won’t mean that any doctor
works seven days per week: there would have to be a rota system for GPs and other surgery staff.
Another question was about the proposed ‘harvesting’ of patient data from surgeries under the
care.data system proposal, which had been put on hold but now seems to be coming back. Will opt-
outs that are already in place still remain in force if care.data does start? Dr Green said the opt-outs
would remain in force. Some comments suggested that there are still concerns about the potential
danger of our medical records being accessed by unauthorised bodies. Vic said that an opt-out form
was on the surgery's website. Any member of the surgery's staff could be informed of a patient's
request to be opted-out of the harvesting of their medical records. Dr Green confirmed this remains
the case.
Dr Green said the government thinks that Tramadol, a pain-reducing drug, is being over-prescribed
so is being changed to a controlled drug.
'Flu clinics were discussed. Dr Green said the last two Saturday 'flu clinics at the surgery covered
1,600 patients very quickly and efficiently: the clinics saved 1,600 individual patient appointments.
There will be more 'flu clinics in future because the government has decided the best way to prevent
children from catching flu will be to squirt live virus into their nostrils.
There are staff shortages at the surgery. It has been short of a practice manager for many weeks but
at the end of a rigorous recruitment process an offer of the practice manager role was made today to
one of the interviewees. Because the practice manager has very wide duties it has been decided that
the new practice manager will be strategic, and will be able to recruit administrative support.
There are also three out of six nurses off work, including the nurse practitioner. One GP is on
maternity leave and is covered by agency staff.
Dr Green mentioned that the practice’s income has dropped for each of the past few years and
seems likely to continue to drop over the next seven years.
Patient visits to the surgery have doubled over the past few years, from 36,000 per year to 72,000
per year. It is sometimes difficult to get to see a preferred doctor: most GPs work part time and their
appointments lists are almost full. It is however easier to see a doctor, whether preferred or not.
Nationally there is a shortage of GPs. Political parties are competing in their offers to create
thousands more GPs in short timescales, but will not be able to deliver their promises because it
takes ten years to qualify as a GP and the numbers of people training to be a GP has reduced
considerably.
A question was asked about practice boundaries. Dr Green said the general rule is that if a patient
moves to live outside the practice boundary he or she must register with another practice. Practice
boundaries can overlap. Under the new GP contract Boundaries are being reviewed and patients may
stay with a practice outside the current boundary but responsibility for home visits under these
circumstances still has to be organised. This change was due for October 2014, and is now scheduled
for January 2015.
Another question was asked about patients who do not attend (DNA) their appointment. Are they
de-registered? Dr Green said that only one patient has ever been de-registered, and that was
because the patient never attended any surgery or hospital appointments despite all attempts over a
long time to assist him to do so. Sometimes there can be valid reasons for DNA’s, for example if the
patient suffers dementia and forgets.
A team from NHS England is coming on Thursday to do a practice review. The Care Quality
Commission have said they will come and do an inspection but haven’t disclosed when: Dr Green
guessed it would be early next year.
Chair thanked Dr Green for his input.
Chair thanked everyone for their attendance and hoped to see them at future meetings.
The meeting closed at 8.25pm.
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APPENDIX: Notes from speakers at the PPG Network meeting held 25
September 2014:
1)
Presentation given by Kimberley Kavanagh – Abdominal Aortic
Aneurysm Screening.
Kimberley explained what an abdominal aortic aneurysm was and that they occur
predominantly in males over 65. The screening has been running in Solihull for the
last 5 years.
The Central England scheme was implemented in 2010, services covered
Birmingham East and North (BEN), Solihull, Tamworth and Lichfield, 2013 saw the
service expand into Burton and Uttoxeter, South and West Birmingham and
Sandwell.
You can contact Kim on 0121 4243612 or 0121 4241200, she is based in
Birmingham Heartlands Hospital.
Questions and answers:
Q.
Can we contact you directly?
A.
Yes contact numbers [as in minutes above]
Q.
I had a AAA approx. 5 years ago, I had to follow up with my GP is this correct?
A.
The AAA screening is done for the initial screening only
Q.
If I have had a AAA, can my children get screened?
A.
.
Q.
Is it an automatic referral from GP for gentleman over 65?
A.
Any gentleman over the age of 65 will be contacted.
Q.
A.
Does it do with any age over 65?
Yes any male over 65.
Q
How do you follow up with a re-call for patients who have not attended an
appointment?
A.
The initial letter is sent out, if a DNA is recorded, this will be followed up 3 months
later with another letter (this has just been introduced)
Q.
If they don’t make an appointment as per above question, do you contact them?
There is a follow-up procedure
A.
2)
Presentation given by Dean Jenkins – West Midlands Ambulance
Service Update.
About 4 meetings ago, WMAS gave a talk to the group, it was agreed that they
would be invited back to give an update.
Dean explained that he has been at the Holymoor Hub since July 2013.
“Make ready model” has been live for a year.
Traditional ambulance bases have been closed and the move to a hub system
implemented.
Erdington hub has 250 staff with 25/29 ambulances supported with 10 community
ambulance schemes.
They are covered 24 hours a day split over 3 shifts.
Feedback is constant, both positive and negative. This feedback is being acted on,
as such they have put ambulances back in Solihull hospital.
The hospital conveyance numbers are down from last year from 100 to 40
Handover times have been reduced 11 over the hour last year, 4 the same period
this year.
These are not all being transferred into Solihull hospital, eg Stroke patients are being
taken to Heartlands.
There were 73 WIC patients transported.
NHS 111 – continues to see praise for the service, for the period of August 2522 calls
received into 111, 309 ambulances were called out to, 168 patients were conveyed to
the hospital.
Factors
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3)
Paramedics come from all over the country.
Sickness in the West Midlands is 4.8% compared to the national of 4%. In
Birmingham this is 3.5/3.6%
Handover talks with QE and Heart of England
Jobs taking longer, less productivity as paramedics
8 student paramedics started
Presentation by Sandra Reynolds Practice Manager Hobs Moat Surgery
Sandra explained the role of the practice manager to the group. Sandra has been a
practice manager for 11 years and her role has changed significantly in those 11
years. When she started 11 years ago her role was looking after staff and the
buildings. Now she deals with CQC inspections. HR / Training, Building and
facilities, infections prevention / control, risk assessments, finance, enhanced
services, governance, monitoring returns, complaints, patient liaison, service
improvement, CCG committees, ordering supplies, patient safety, PAT testing, Flu
Vaccines.
Patient reference groups have been going for 11 years, they used to meet yearly.
There were not much uptake from advertisements. Part of the policy was that if a
patient made a complaint they would be invited to join the PPG.
Now they have 6 x yearly, chaired by a patient, they have their own agenda. The
practice use the PPG’s as a sounding board. They input into the various campaigns,
ie Flu.
Every year the practice gives the PPG £1000 to spend accordingly in the practice.
END