Minutes of PRG Meeting 2nd November 2015
Present:Staff:
Dr Simon Robinson (SR)
Deborah Hollings, Practice Manager (DH)
Christine Rutherford, Receptionist
Apologies: xxxx
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Patient Representatives:
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Agenda: Welcome and review of meeting held on 2nd March 2015
1.
2.
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4.
5.
News round-up and update (practice, locality, CCG, national)
Leeds North CCG Commissioning Intentions 2016-17
Improving Access to General Practice CCG Survey
Any questions, suggestions and ideas
AOB
DH - Introductions and welcome - extended to new members of the PRG
Review & update on Meeting held 2nd March 2015
Friends and Family Test:
DH - Quick update reporting on the total as of end of September.
January to September inc. 180 Extremely Likely, 11 Likely, 1 Neither Likely or Unlikely and 4 Unlikely
Doing very well, good results but not good uptake.
Only 4 "unlikely" - these were 'gripes' on the day and all were sorted.
Access to Medical Records:
DH - No update to report - still only access to Summary Record.
Leeds Care Record:
SR - re sharing information within Leeds.
"virtual" wards - see which of our patients in Leeds hospitals. Can view correspondence and future
appointments. In the future sharing information like this should contribute to discharge and
'reclaiming' patients.
PRG - would need to have somewhere to 'reclaim' the patient to.
SR - Intermediate Care - would be a vehicle for getting them out of hospital
Explained re scheme - discharge to assess - on discharge assessed at home. Alternative would be
assessed in hospital, which is an artificial environment. Much better at home.
SR - Time sensitive - hospital do assessment - patient to leave by 1pm - someone at home to assess
by 4pm - if not system breaks down.
PRG - who does assessment - is it GP?
SR - No, could be occupational therapist, nurse, physiotherapist.....
Appointment Texting:
This has now been re-introduced, but there was a problem with Secretary's computer which 'died' on
Friday (texts are sent from this PC). This proved the benefit of texting as the DNA (patients who 'do
not attend' their appointment) increased - even in that short period.
Proving a worthwhile service and hopefully will be up and running again tomorrow.
1. New round-up and update (practice, locality, CCG, national)
SR - CQC - nothing to report as yet - as soon as there is anything will share the information.
SR - Workforce crisis in General Practice. GPs, nurses, healthcare assistants. Must increase
training all clinicians.
We currently have a Physician Associate (PA) linked to the surgery. "Paramedic" for GPs. These have
been around for a while. They have no nursing background - have science based degree.
Westgate Surgery was approached to have a PA and Rehma joined us on 25th September.
Rehma is delightful and has been sitting in with Practice Nurses and Healthcare Assistants and will
begin sitting in with GPs from this week.
She will learn clinical skills here - taking BPs, bloods, listening to patient's chests...
Assessment at the end of each term.
PRG - How long will the PA be at the surgery?
SR - 12 months initially. Advantage for us – they may choose to work here once qualified.
PRG - What qualification>
SR - Training lasts two years - graduate with a postgraduate diploma. Could be another couple of
years before 'see them on the ground'.
PRG - How do they differ from Nurse Practitioner.
SR - Will be very similar, although won't have had nursing background, will be able to prescribe.
SR - Informed Dr. Louise Lodh went on maternity leave last Friday and will be away for one year. We
have two locum doctors covering her sessions - Dr Helen Aveyard and Dr Jennifer Baretto.
SR – New Community Matron Team commenced in March 2015
2 new staff working with Community Nurse, Sharon Youhill - shared with Chevin Medical Practice and
Aireborough. (New members work one day a week for Westgate)
Same system in Wetherby - few issued – been hopefully resolved. Team working well here.
Care Home Scheme:
SR - not many care homes on our patch - Tealbeck and Spring Gardens.
Chevin also have residential home in Bramhope and Aireborough Practice have Ghyll Royd
Idea is, instead of GPs visiting from all practices going in on an ad hoc basis – GPs will go in once a
week and have a 'ward round'. We will look after Spring Gardens.
Staff will be aware going in (and be able to save non-urgent reviews for session and relatives will
know. Should provide better care. Will be audited.
Setting up Skype - Face-time link - see patients - talk to staff.
A need for infrastructure - WiFi - iPad.
Difficulty is people who are registered at different GP - if ok with patient can register with different
practice (no obligation to move)
CCG boundary - we are Leeds North – we are beginning to join up with Leeds West practices in the
North of their patch to do some bits of work. Neighbourhood teams (District Nurses, Health Visitors,
Social Services) are already a unit - makes geographical sense.
Developing new ways of working that are right for this area and population.
New ways of working is part of NHS Five Year Forward plan.
NHS needs to survive enormous financial deficit.
Lots of people contributing to the care of the community - should be talking to each other.
In particular, looking at early discharge - diabetes, people who are housebound.
Oliver Sykes is our lead on this.
PRG - what is happening with Wharfedale General Hospital (WGH)?
Lots of discussion re this:
Was a district hospital with all services provided
Services wound down gradually
"glorious" hospital built approx ten years ago.
Now wards all closed
No inpatient service - largely outpatient
Thoughts of opening a unit (40? beds) - for Care in the Community beds.
Wharfedale Hospital Forum 'died'.
SR - to enquire at CCG meeting what is afoot - all gone quiet at the moment.
Out Patient Clinics not represented on Choose and Book at WGH - relies on how hospital feeds in
their availability on the system. It appear they are not doing it right.
Harrogate District Hospital (HDH) is expanding - use WGH for some clinics
Physio referrals discussed - fracture clinic in Leeds - follow up physio is in Leeds because Leeds
Teaching Hospitals Trust (LTHT) has been paid for appointments and follow-up physio. Why not
local? Post fracture can't go to Otley because this is run by Leeds Community Health not LTHT
Two levels of physio referral – Tier 1 (simple) & Tier 2 (more complex and may lead to surgery).
All referrals we make to physio - are WGH or other local.
SR - spoke on Co-Commisioning.
CCG taking over the contracts for General Practice.
Idea that GPs run own contracts - potential conflict of interests.
Relating problems - no money available for management - a time of great challenge.
Nevertheless – the CCG has been asked if wants to take over General Practic - deadline for
expressions of interest is this Friday!
If application put in this does not commit us.
If goes ahead would start next April.
If other Leeds CCGs choose to do this it would make sense that we all do it as better to be a larger
body. Would reduce some conflicts of interest. Other two CCGs are applying. Difficult for us not to
do it.
SR - has reservations.
Some GPs are enthusiastic – They say the Government will want/make this happen.
Disciplinary issues - not dealt with by CCG
UPDATE - Council of the CCG did vote to apply and an expression of interest was
submitted.
PRG - What is best route for patients?
SR – CCG with new powers may take money from one pot to another - more flexibility.
NHS England barely coping – the CCG are already doing a bit of it
40% reduction in money for CCG compared to Primary Care Trusts. Have managed it and done a
good job.
PRG – If ‘one body' - more efficient?
SR – Each Leeds CCG has responsibility for different areas of health - we trust them - they trust us
(CCGs).
SR - discussed joining together with other practices to form a Federation or similar larger group of
practices.
Better to share - instead of all doing everything. Small practices will struggle – need to be able to
share negotiating, human resources, finances (e.g. same accountant).
SR - we want to preserve Westgate Surgery’s identity and values whatever we do. Want same staff in
same building and ability to protect our reputation and maintain as much autonomy as possible.
PRG - if inspected by CQC - how can they inspect a Federation?
SR - Will have group policies - data centrally held and managed. Would make inspection easier.
SR – GP Workforce - SR went to a public meeting at Otley Court House six weeks ago to a talk by
the CCG
How to increase number of GPs - retain GPs approaching retirement.
In May GP registrars - on-call pay cuts.
What will they do to keep GPs of SRs age working?
Not heard anything.
2. Leeds North CCG Commissioning Intentions 2016 - 17
Asked PRG group what they thought.
PRG - surprised not more detail - a bit more information would have helped.
SR - commented this is third year of this - no-one recalled seeing this before.
SR - Much more information than last year!
High cost to price up accurately - if they get a lot of support they may price up the options.
SR - along with group we decided best way to share views would be to score each proposal between
1 and 5. One being the highest score and 5 the least.
List is examined by all CCGs member at the CCG council meeting - clinicians' views and it will be good
to have rough idea of what PRG think to feed into the equation.
SR - explained each proposal in more detail and group agreed much better understanding of them
helped make a decision on their score.
(As discussed and scored)
3. Improving Access to General Practice CCG Survey.
(1) What does PRG think?
Feedback: General
Really good - can get an appointment when needed - can book in advance.
PRG - asked if early hours are popular?
Yes
PRG - commented on continuity of care - has changed over years. Used to see one or two Drs. - now
can be many different Drs.
DH - explained - lot of GPs part time
SR - shift from high percentage of male to more female GPs.
Continuity is managed through computer records - GPs will put a plan of action on records.
(2) Out of Hours (OOH)
Surprised by only 52% trust and confidence in OOH.
PRG - concerns: Time waiting for call back
Sometimes feel have to play the system to get past the operator.
Thought Westgate patients expectation of OOH were possibly too high - used to high standard here
and is reflected in result.
Different experiences - good and bad - discussed.
What are priorities?
Continuity of care, being seen quickly.
OOH having access to up to date records
(3) Extended Access
Thoughts on 8am - 8pm 7 days a week. Convenience? Continuity of care? Seen promptly – Group
were concerned about current workforce would be spread too thin and normal weekday care would
suffer.
DH - what do group feel about Saturday and Sunday opening?
PRG - early morning weekday opening more important - Saturday mornings good idea.
Felt if OOH service was better - wouldn't matter as much.
DH - extended hours are meant for routine care.
Need to get OOH service right.
SR - explained - no more hours are available - just distributed over more days.
4. Any questions, suggestions and ideas
Regarding new members - asked what group feels:
Optimum number for group?
Try to attract a cross-section
At the moment there are 15 members.
Shouldn't discourage interest - but wouldn't want dozens of members.
What is a reasonable number?
Decided number of members at present is enough plus recent applications (who would be invited to
next general meeting of the PRG - but do need younger members.
Have a waiting list (application form is "expression of interest")
5. AOB
There was no other business
The team thanked everyone for attending.