Highlands Surgery PPG
Highlands Surgery, 1643 London Road, Leigh on Sea, SS9 2SQ
Minutes of meeting held on Wednesday 27th November 2013
Present: SF, Dr Grant, AJ, LL, TL, CM, SM, MP, MS, LS, ST (Chair), Debbie
Warrington, Debbie Worrall
Welcome and Apologies:
MS joined the meeting for the first time and was welcomed to the group.
Minutes of the Last Meeting and Matters Arising:
The minutes of the last meeting were agreed as a true record.
Automated System:
The automated system is still crashing from time to time and can be slow. Debbie
Worrall has been informed that the software is new and this is a national problem.
She has continued to chase the company to ensure they are trying to resolve the issue.
The system has been purchased by the surgery and it is used by a number of other
larger surgeries, although they have not experienced the same problems.
Flu Clinics:
The flu vaccinations for the year are almost complete and approximately 2,400 have
been given. The Surgery has high targets to reach. There are 4 criteria; COPD,
Diabetes, Stroke/TIA and Heart Failure. Between approximately 90-97% of people
need to reached and there may be 400 to 500 people within each criterion. The
doctors have to show there has been some contact with the patients by them either
having the vaccination or declining it.
It was asked what the procedure is if someone has not been able to attend one of the
allocated clinics for their vaccinations. If the patient is in an ‘at risk’ group they will
be called twice and if there is no response it will be recorded that they have declined.
A message is not left on the answer phone to maintain patient confidentiality. If the
patient contacts the Surgery, a time will be allocated for them to see a nurse to receive
their vaccination.
Many years ago letters were sent out, however it meant that approximately 5,000
letters had to be produced. The flu clinics are now advertised in the Surgery and on
the website. They run for approximately 6 weeks and although they are run in bands
of surnames to reduce the chance of long queues, there is flexibility of when patients
can attend.
Healthwatch:
The group agreed that it was very helpful to both patients and Surgery staff to have JK
at the last meeting. JK had raised the point that if the Surgery was unhappy they had
not received funding for running the PPG they could report this to Healthwatch. It
was asked if the Surgery managed to receive the funding they had worked towards
Page 1 of 3
last year. The Surgery only received the basic funding. Debbie Worrall was very
disappointed knowing how useful the PPG is and has been. She has made the funders
aware of her disappointment and suggested they should offer support for the enhanced
service rather than just declining the funding.
This year the survey, which is one of the requirements, has been completed, with both
online and paper surveys available. This has proved to be quite helpful. A large
report detailing how the surgery has met the requirements needs to be submitted by
the end of March.
It was asked if the exercise is cost effective and Debbie hopes it will be. She
explained that doctors have core services such as looking after patients, blood
pressure tests, vaccinations and nurse provisions. The Direct Enhanced Services
(DES) provide the doctors with greater scope for what they can offer patients, and
they receive money back for completing these. The patient group is one of the DES.
Practice Updates
There is a new locum doctor, Dr Gobolyos, who is covering for Dr Guyler until
August next year. She is known as Dr Juditt in the Surgery. The feedback from
patients who have met her has been very positive.
There is an issue with the time patients have to wait to obtain a routine appointment
with the doctor of their choice. Debbie Worrall appreciates this is not acceptable and
a team of people have come in to look at the system and see if there are ways it can be
improved. The way the doctors deal with urgent appointments works well and
nobody is turned away.
The way the emergency booking in system works at present is that each doctor has a
normal surgery plus 3 urgents. When these urgent spaces have all been filled, the four
doctors on will then each get an extra emergency appointment, therefore some doctors
may have to see 9 extra patients plus their own surgery in a morning. Once all these
appointments are filled, afternoon appointments are then offered.
The possibility of dealing with some routines appointments over the telephone is
being considered. For example, often the doctors will ask the patients to attend a
follow-up appointment after their initial appointment to ensure the problem is
resolved. If the patient is fine they could let the doctor know this via telephone. It is
still being worked out exactly how this would work as the Surgery do not want to set
up the system unless they know it will work properly and be effective.
It is not possible for the surgery to close the list of new patients as they would then be
unable to offer any of the Direct Enhanced Services. There are over 11,000 patients
at present.
In the last month 198 appointments were missed; if these were cancelled in time it
could bring routine appointments forward a week earlier. Out of the 198, 15 were
urgent access appointments. These patients were sent letters and letters will continue
to be sent.
Page 2 of 3
There is the text message direct line for people to use if they need to cancel their
appointment, so they do not have to wait to get through on the main telephone line.
The text message reminder service is still working well despite a small blip in the
system a while ago. It was asked if there had been a change in missed appointments
since the reminder service began, but Debbie has not noticed a change. Occasionally
there may be a valid reason for patients to miss appointments if they have certain
medical conditions. The Surgery are aware that the elderly may not have internet or
mobile access. It was asked if the reminder message that goes out 48 hours before an
appointment could be changed to 24 hours before but it cannot, as it goes through
NHS email which is very secure.
Some surgeries operate a 3 strikes and you are out of the surgery policy but Highlands
do not want to operate this policy.
Debbie is open to ideas of how the problem of missed appointments can be addressed.
Diabetes Event
Dr Grant is struggling to get specific dates from the consultants for the Diabetes
Health Event, which could be partly due to staff changes in the department. The
possibility of inviting registrars instead of consultants was discussed, as they are still
well qualified and knowledgeable. The only difficulty will be knowing which
registrar will be there as they work on rotation. Dr Grant knows a dietician through
the CCG who would be able to advise on a sensible diet. Community diabetic nurses
would also be useful for answering specific questions from patients.
Generally the diabetic community can be hard to engage. The event will be targeted
at both diabetic and pre-diabetic patients. Patients with a fasting blood sugar over 7
are classed as diabetic and a fasting blood sugar under 6 is considered normal. There
is a grey area between 6 and 7 when patients are considered pre-diabetic as if their
blood sugar rises they will then be in the diabetic category.
There are risk factors which include weight gain, advancing age and genetic links.
Some of these are out of the patients’ control; however leading a healthy lifestyle can
help control the diabetes.
The main symptoms that patients come into the surgery with before diagnosis are
fatigue, recurrent skin infections and they generally don’t feel well.
Decisions on the event will be made in the January meeting.
Informal PPG
The informal PPG meeting will be held at the Estuary Club on Wednesday 18th
December at 12.30pm and nibbles will be provided.
Time and Date of Next Meeting
The next meeting will be held on Wednesday 29th January 2014 at 12.30pm.
Page 3 of 3