Stennack Surgery PPG
Meeting Minutes
Monday 28 th May 2012
– 6.30pm
Present
Linda Petzing – Interim Chair
Fiona Vinnicombe – PPG Lead for surgery
Dr Rupert Manley
Mrs Alford
Mrs Breakspeare
Miss Buckley
Mrs Stevens
Dr Wooton
Suzy Goodeve
Liz Mogridge
Pat Sanger
Roger Weatherly
Alison Martin
Becky Cross – nurse
Margaret Mudge
Apologies
Chris Gendall – Strategic Business Manager
Dr Sam Freegard
Paula Berriman
Mrs Hoskins
Chris Parker
Jane Parker
David Strickland
Terry Murray
Introductions/Welcome
LP thanked everyone for attending and welcomed existing and new PPG members.
Pre-circulated minutes of the meeting on 26 th March 2012 were agreed, approved and signed.
Chronic Disease Management Presentation by Karen Jenkin Practice Nurse Manager
KJ explained her role at the practice as nurse manager. Part of the team’s role is chronic disease management. The NHS has strict guidelines for monitoring patients with specific long term conditions. These include Hypertension, Chronic Obstructive Pulmonary Disease and asthma, Diabetes, Chronic Heart Disease, Chronic Kidney Disease. The surgery maintains registers and needs to ensure all patients are checked at intervals appropriate to their condition. Letters are sent out by an administration team to all the relevant patients on these registers. At present patients with multiple Chronic Diseases (CD) have each condition managed separately, necessitating frequent visits. KJ asked what the Group thought of introducing annual one-stop checks for stable patients based on month of birth. This would

minimise inconvenience to patients and improve capacity. The group was reassured that if a patient felt they needed to be seen that this would not be a problem. The Group were supportive of the proposal.
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RW asked for the % of patients at the surgery who are managed by the CD nursing team
–
Action FV

What about neurodegenerative conditions? MS & Parkinson’s. Why isn’t there provision for these patients?
RM explained with the exception of migraine and epilepsy, the relatively low numbers of these patients in an individual practice population would not support the highly trained specialist nurse required. It is normally a hospital based service for that reason. However the
Group concluded it could be an option for Kernow Clinical Commissioning Group (KCCG) to consider across a group of local GP practices, and may be worth raising at one of the forthcoming KCCG “ It’s Your NHS; Be Part of It” meetings. St Ives Guildhall on Tuesday
26 th June 2012 from 2 to 3.30. (Incorrect date given – meeting is 25 June)
Virtual Group
FV informed the group that we now have over 30 members of the actual PPG and 22 in the virtual group.
FV updated the group on the feedback received from the virtual group and other comments via PPG information point.

Several patients support and would benefit from of a microphone/ hearing loop.
Patients will continue to be called into an appointment by the GP/Nurse from the waiting room and not through an impersonal tannoy system. LP apologised if the newsletter did not make this point clear. Quotes for suitable systems are in hand and will be brought to the next meeting.
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Some constructive comments on the phone system were received with some suggestions as to how it could be improved.
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One member had asked for further clarification of the “Buddy system”. This has been mentioned in the newsletter and will be followed up with further details.
Appointments
FV took the Group through a presentation on Surgery Appointments-what do we offer?
This generated much discussion. It significantly helped patients understand the framework, demands, limitations and the way the surgery tries hard to meet the expectations of all patients within the resources it has available.
Presentation Feedback -

Who are the GP Partners, salaried GPs & regular Locums? Action FV/LP – Next newsletter
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Photo of each clinician with a brief bio, time at Stennack, including any areas of special interest in waiting room and/or GP/Nurse of the month. – Action FV/CG


Could GPs attend PPG meetings on a rota basis?
Action FV – to ask for future meetings
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Clarify NHS directive that patients are registered with the practice not a specific GP.
RM reassured the Group, GPs equally value long term trusted relationships with patients. Patients have a right to see a clinician of their choice so may “choose” to see their usual GP, but have the option of consulting any other. The Buddy system was also discussed. Action – posters in waiting room FV

Many patients praised the Duty Doctor role, part of which ensures that even if all appointments are fully booked, anyone who clinically needs to be seen will be.
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Surprise at the scale of operations, volume of appointments, logistics and other duties undertaken by clinicians. Day in the life of GP article would be welcome.
Action LP / FV

The last slide introduced the problem of DNAs (Did Not Arrive). FV advised the group that on average 40 appointments are lost with nurses and about the same with GPs each week. This equates to six hours of nursing time and almost three whole GP clinics every week.
The Group agreed to carry some of the remaining agenda items over to focus on this item and DNAs.
DNAs Group discussion
Possible reasons

Dementia /memory problems
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Forgetting
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Depression/mental health/chaotic lifestyle
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Unable to get through on phone to cancel. Especially if working, attend college.
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Transport problems. Car parking- difficult at times. RM acknowledged ongoing problem, and with the increasing clinics this was likely to continue.
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Patients not understanding the need/importance of attending clinics
Potential solutions ( outcome where known )
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Blanket mobile texting remindersrecent trial unsuccessful . Texts sent to patients without appts/non-patients.
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Pre-appt call to patients previous day- impractical due to the volume of appointments.
However FV confirmed that the surgery does remind patients due to attend specific clinics e.g. Minor Operations and Women’s Health Clinic.

Generic email address patients can use only to cancel appointments – would need monitoring by a staff member continuously.


Satellite surgery branch in Carbis Bay. Increasing operational capacity of
Stennack/reduce reliance on transport for residents.
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Phone persis tent offenders with reminders and DNAer’s to explain missed appt. This would require administrative time and therefore cost.
LP has been looking into the problem of DNAs. It is a common problem across all of the
NHS.
She said that nurse appointments are perceived as less important than GPs, resulting in higher DNAs.
LP shared research on DNAs. Generally the “stick” approach is not effective, takes time, resources and potential need for conflict resolution skills to manage.
The Royal College of Medicine ran a pilot in Bedfordshire GP practices resulting in significant DNA reduction through a behavioural science approach.
Key premise -
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Praising the behaviour you want to see encourages it.
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Demonstrating negative behaviour normalises it.
Group consensus to request practice trial for a limited period -

Asking patients to write down/ repeat back details of the appointment. – Action - discuss with General Ops Manager/Reception

Gain commitment to cancel at time appointment made.

Change focus of posters re DNAs to positive message – Action FV
LP thanked FV for an interesting and informative presentation and Group for their contribution.
St Ives School Y11 engagement
LP informed the group that we will be attending St Ives School for a Health & Social Care class on 5 th July. One group member who has taught GCSE H&SC to Y11s volunteered to assist. – Action LP/FV – invite to planning meeting
Other matters arising from previous meeting

PPG Information Point (PPGIP) now in waiting room. Newsletters and feedback slips for patient comments. Newsletters here and on reception counter.

First newsletter published – Positive feedback from patients and practice
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Visit to St Ives School 5 th July planned to engage with Y11 students (16/17 year olds)
Items carried forward

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Adoption of Terms of Reference (any comments or feedback ahead of next meeting appreciated)

Logo/branding
Future Newsletter articles
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Life of a prescription

Day in the life of a GP

Features on different types of clinics
AOB
It’s Your NHS; Be Part of It”
LP informed the group about a KCCG meeting. St Ives, Guildhall on Tuesday 26 th June
2012 from 2 - 3.30pm. (Correction to date – 25 th June)
LP invited members to join her at the Royal Cornwall Show PCT stand representing our
PPG. 7, 8, 9 th June - SSPPG representation has been arranged for every day of the show.
Next Meeting
Monday 23 rd July 2012 6.30pm Stennack Surgery Conference Room