Minutes from Ongar Patient Forum 10.6.2015
Chair:
Arthur Moody
Present:
31 representatives of Ongar Health Centre
Apologies for absence
Sally Foskett, Doris Swann, Brian Surtees, Edwyn Gilmour, Sheila Jackman and David Jackman
Minutes of the last meeting
The minutes of the previous meeting were accepted as being correct.
1
Care Act – Peter Fairley
Unfortunately, Mr Fairley had been taken unwell this afternoon and so was unable to attend the
meeting.
2
111 Service – Helen Kimber
Helen Kimber attended on behalf of Marie Martinelli to discuss the 111 Service.
talk by saying that this was the best attended patient forum she had ever been to.
She opened her
Integrated Care 24 is the company locally who provides the 111 service
111 is the telephone number patients are encouraged to call instead of 999 for nonlife-threatening problems and advice.
It is a free call from both landlines and mobiles
It has been operating in South Essex for the past 22 months and in North Essex for
the past 14 months
In this time they have deal with 641,798 telephone calls
They have 266 employees based in call-centres in Ipswich and Ashford. Helen
offered people the opportunity to visit and see the centres in action
Staff are highly trained, having to complete a 10 week training course which is very
intense and not everyone passes.
Complex patient problems are passed to
clinicians.
Integrated Care 24 offers a higher ratio of clinicians to call-handlers than the
national requirement.
They are taught how to go through the NHS pathways algorhythm (which Helen also
demonstrated for the group). All non-clinical staff have to be signed off via their
Training Team and undergo regular updates in which they have to show on-going
competencies in order to continue to work. Clinicians are also trained in the use of
ToxBase (for use when dealing with poisons) plus how to deal with medication
queries. They are then accredited with a licence which enables them to work
nationwide.
Integrated Care 24 have piloted employing a mental health nurse, dental health
practitioner and pharmacist to increase their expertise and ensure patients are dealt
with by the most appropriate health professional. Under this pilot scheme, 1 mental
Ongar Patient Forum minutes – 11.3.2015
health nurse dealt with a patient which released a call supervisor to deal with an
additional 10 calls – showing the value of this pilot.
Over Christmas 2014 there was a 40% increase in calls. On 27.12.2015, 111 dealt
with 123,000 telephone calls.
111 have the ability to call ambulances if they feel the patient needs one
dispatched.
It is also a signpost for a directory of services in the local area
They are hoping to go into schools and Universities to help improve 111 awareness.
Patients needs to be re-educated to use 111 instead of 999 for non-life-threatening
problems, and to use their GP instead of A & E.
This was a very well-presented, knowledgeable presentation. There were some concerns from the
floor about when to use 111 and when to call 999. Helen was clear that this was for non-lifethreatening emergencies. She acknowledged that this service had not been particularly well
advertised but anticipated that there would be improved advertising and information locally.
3.
Travel information
Hazel Kilvington and Jane Howe, Practice Nurses from Ongar Health Centre, gave a talk on good
practice when travelling abroad. This is below.
WATER
Diseases can be caught from drinking contaminated water, or swimming in it. Unless you know the
water supply is safe where you are staying, only use (in order of preference)
1. Boiled water
2. Bottled water with the seal intact or canned drinks
3. Water treated by a sterilising agent.
This includes ice cubes in drinks and water for cleaning your teeth.
SWIMMING
It is safer to swim in water that is well chlorinated. If you are travelling to Africa, South America or
some parts of the Caribbean, avoid swimming in fresh water lakes and streams. You can catch a
parasitic disease called schistosomiasis from such places. This disease is also known as Bilharzia. It is
wise never to go barefoot, but to wear protective footwear when out, even on the beach. Other
diseases can be caught from sand and soil, particularly wet soil.
FOOD
Contaminated food is the commonest source of many diseases abroad. You can help prevent it by
following these guidelines :
 ONLY EAT WELL COOKED FRESH FOOD
 AVOID LEFTOVERS and REHEATED FOODS
 ENSURE MEAT IS THOROUGHLY COOKED
 EAT COOKED VEGETABLES, AVOID SALADS
 ONLY EAT FRUIT YOU CAN PEEL
 NEVER DRINK UNPASTEURISED MILK
 AVOID ICE-CREAM and SHELLFISH
 IN GENERAL, AVOID BUYING FOOD FROM STREET VENDOR’S STALLS
Another source of calories is alcohol ! If you drink to excess, alcohol could lead you to become
carefree and ignore these precautions.
Two phrases to help you remember
1. COOK IT, PEEL IT, OR LEAVE IT!
2. WHEN IN DOUBT, LEAVE IT OUT!
Ongar Patient Forum minutes – 11.3.2015
PERSONAL HYGIENE
Many diseases are transmitted by what is known as the ‘faecal-oral’ route. To help prevent this,
always wash your hands with soap and clean water after going to the toilet, before eating and
before handling food. Using a hand gel is another sensible option.
TRAVELLERS’ DIARRHOEA
This the most common illness that you will be exposed to abroad and there is no vaccine against it
at present. Travellers’ diarrhoea is caused by eating and/or drinking food and water contaminated
by bacteria, viruses or parasites. The risk of illness is higher in some countries than others.
High risk areas include North Africa, sub-Saharan Africa, the Indian Subcontinent, S.E. Asia, South
America, Mexico and the Middle East.
Medium risk areas include the northern Mediterranean, Canary Islands and the Caribbean Islands.
Low risk areas include North America, Western Europe and Australia
You can certainly help prevent travellers’ diarrhoea in the way you behave - make sure you follow
the food, water and personal hygiene guidelines already given.
Travellers’ diarrhoea is said to occur when you pass 3 or more loose stools in a 24 hour period often
accompanied by stomach pain, cramps and vomiting. It usually lasts 2-4 days and whilst it is not a
life threatening illness, it can disrupt your trip for several days. The main danger is if dehydration
occurs during the illness, and this, if very severe, can be life threatening if it is not treated.
Treatment is therefore REHYDRATION. In severe cases and particularly in young children and the
elderly, commercially prepared rehydration solution is extremely useful. This can be bought in
tablet or sachet form from a chemist shop e.g. DIORALYTE or ELECTROLADE. (Dioralyte Relief
is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in
children). Prepare all products according to instructions, taking care regarding their use in very small
children and seeking medical advice where necessary).
Anti diarrhoeal tablets can be used for adults but should never be used in children under 4 years of
age, and only on prescription for children aged 4 to 12 years. Commonly used tablets are
Imodium, Lomotil or Normaloe.
None of these tablets should ever be used if the person has a temperature or blood in the stool.
DO
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


SEEK MEDICAL HELP IF THE AFFECTED PERSON HAS:A temperature
Blood in the diarrhoea
Diarrhoea for more than 48 hours (or 24 hours in children)
Becomes confused
(Please note, a woman taking the oral contraceptive pill may not have full contraceptive protection
if she has had diarrhoea and vomiting. Extra precautions must be used - refer to your ‘pill’
information leaflet. If using condoms, use products which are CE approved.)
HEPATITIS B and HIV INFECTION
These diseases can be transmitted by
1. Blood transfusion
2. Medical procedures with non sterile equipment
3. Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
4. Unprotected sexual contact
WAYS TO PROTECT YOURSELF
 Only accept a blood transfusion when essential
 If travelling to a developing country, take a sterile medical kit
 Avoid procedures e.g. ear or body piercing, tattooing and acupuncture
 Avoid casual sex, especially without using condoms
Remember - excessive alcohol can make you carefree and lead you to take risks you otherwise
would not consider.
Ongar Patient Forum minutes – 11.3.2015
INSECT BITES
Mosquitoes, certain types of flies, ticks and bugs can cause different diseases. e.g. malaria, dengue
fever, yellow fever. Some bite at night, but some during daytime, so protection is needed at all
times.
AVOID BEING BITTEN BY:
 Covering up skin as much as possible if going out at night, (mosquitoes that transmit malaria bite
from dusk until dawn). Wear loose fitting clothes, long sleeves, trousers or long skirts and socks.
 Use insect repellents on exposed skin. (DEET containing products are the most effective. A
content of up to 50% DEET is recommended for tropical destinations.) Clothes can be sprayed
with repellents too or clothing specific sprays. Check suitability for children on the individual
products. If using sunscreen always apply first followed by an insect repellent spray on top
 If room is not air conditioned, but screened, close shutters early evening and spray room with
knockdown insecticide spray. In malarious regions, if camping, or sleeping in unprotected
accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid
camping near areas of stagnant water, these are common breeding areas for mosquitoes etc.
 Electric insecticide vaporisers are very effective as long as there are no power failures!
 There is no scientific evidence that electric buzzers, savoury yeast extract, tea tree oil, bath oils,
garlic and vitamin B are effective.
MALARIA
If you are travelling to a malarious country, the travel health adviser will have given you a separate
leaflet with more details, please read it. REMEMBER, malaria is a serious and sometimes fatal
disease. If you develop flu like symptoms, including fever, sweats and chills, feeling unwell,
headaches, muscle pains, cough, diarrhoea, then seek medical advice immediately for advice and
also mention where you’ve been abroad, this is vital, don’t delay.
ANIMAL BITES
Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain.
There are 3 RULES REGARDING RABIES
1. Do not touch any animal, even dogs and cats
2. If you are licked on broken skin, scratched or bitten in a country which has rabies, wash the
wound or area thoroughly with soap and running water for a minimum of 5 minutes then apply
an antiseptic solution if possible e.g. iodine or alcohol. Such precautions also apply if you are
licked by an animal with their saliva coming into contact with your eyes or inside of your mouth
(essentially any mucous membranes)
3. Seek medical advice IMMEDIATELY, even if you have been previously immunised, this is essential
ACCIDENTS
Major leading causes of death in travellers are due to swimming and traffic accidents. You can help
prevent them by taking notice of the following
PRECAUTIONARY GUIDELINES
 Avoid alcohol and food before swimming
 Never dive into water where the depth is uncertain
 Only swim in safe water, check currents, sharks, jellyfish etc.
 Avoid alcohol when driving, especially at night
 Avoid hiring motorcycles and mopeds
 If hiring a car, rent a large one if possible, ensure the tyres, brakes and seat belts are in good
condition
 Use reliable taxi firms, know where emergency facilities are.
Ongar Patient Forum minutes – 11.3.2015
INSURANCE COVER
 Take out adequate insurance cover for your trip. This should possibly include medical
repatriation as without it, this service if needed is extremely expensive.
 If you have any pre existing medical conditions, make sure you inform the insurance company of
these details and check the small print of the policy thoroughly.
 If you travel to a European Union country, make sure you have obtained an EHIC card before you
travel which takes some time to obtain. Further information about the EHIC is found at
http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/Introduction.aspx and to make
an application go to https://www.ehic.org.uk/Internet/home.do Please note additional travel
insurance is still advised.
AIR TRAVEL
It is sensible on any long haul flight to
 Be comfortable in your seat
 Exercise your legs, feet and toes while sitting every half an hour or so and take short walks
whenever feasible. Upper body and breathing exercises can further improve circulation
 Drink plenty of water and be sensible about alcohol intake which in excess leads to dehydration
Further information can be obtained from the websites detailed at the end of this leaflet with more
specific advice and information on travel-related deep vein thrombosis.
SUN AND HEAT
Sunburn and heat-stroke cause serious problems in travellers, but in the long term can be a serious
cause of skin cancer. Long term damage to the skin due to sun exposure can lead to skin cancer.
There is no such thing as a safe suntan but the following advice should be taken
PRECAUTIONARY GUIDELINES.
 Increase sun exposure gradually, 20 minutes limit initially.
 Use sun blocks which contains both UVA and UVB protection and sufficient sun protection factor
(SPF) and a minimum of SPF 15. Children under 3 years should have a minimum SPF 25 and
babies under 6 months should be kept out of the sun at all times. Reapply often and always
after swimming and washing. Read manufacturer instructions
 Always apply sunscreen first followed by an insect repellent spray on top
 Wear protective clothing – sunhats, T shirts and sunglasses etc.
 Avoid going out between 11am - 3pm, when the sun’s rays are strongest.
 Take special care of children and those with pale skin/red hair.
 Drink extra fluids in a hot climate.
 Be aware that alcohol can make you dehydrated
Interesting web site addresses and further information:
Scottish NHS public travel health site - www.fitfortravel.nhs.uk
National Travel Health Network and Centre – www.nathnac.org
NHS Choices www.nhs.uk – go the ‘Live Well’ menu and select ‘travel health’
Foreign and Commonwealth Office – www.fco.gov.uk/travel
Malaria for the general public – www.malariahotspots.co.uk
International websites for travel health
World Health Organisation www.who.int/ith
Centers for Disease Control and Prevention www.cdc.gov
International Society of Travel Medicine ‘global travel clinic locator’ www.istm.org
This was the end of the educational/information section of the meeting.
Ongar Patient Forum minutes – 11.3.2015
4.
What’s in a name?
Since Ongar Health Centre and Ongar Surgery will now have their own patient groups there is a need
to decide upon a name that identifies each group. Arthur Moody has been in contact with Tracy
Beckley, Practice Manager at Ongar Surgery, and confirmed that they would eventually have their
own, virtual (electronic) patient group at some point in the next 12 months. He also confirmed that
they are keen to retain ‘Ongar High Street’ in their name in order to differentiate between the two
practices. It was agreed, therefore, that Ongar Health Centre patient group would retain the name
Ongar Patient Forum.
5.
Comments from the Practice
Yvonne Pope, Practice Manager, shared the following information:
Early indications show that the new ‘Sit & Wait’ surgery, which is operating each Monday,
has been both successful and popular with the patients who have used the service. This is a
pilot which will run for 3 months. If a patient needs to see a GP on a Monday with a
problem that cannot wait, they are asked to phone the practice and will be given a time to
come along so that they can sit and wait to be seen. It is not a fixed appointment. The
practice can guarantee they will be seen, but they cannot guarantee which GP will see them.
All GPs will be working from one single list of patients and the next available GP will see the
next patient on the list. The practice invites patients to come along at staggered times
throughout the day in order to spread the workload and to try and avoid excessive waits. If
a patient wishes to see a specific GP then they can do this any day except Monday. Yvonne
is collecting data on waiting times, GP workload and patient satisfaction. Already, some
patients have indicated that they would like the service extended to other days of the week.
No decisions will be made until the pilot has been completed and Yvonne should be able to
present findings at the next patient forum meeting.
Dr Varun Potluri will be joining the practice in July 2015. He is a Salaried Partner who has
been recruited as part of the succession planning in relation to Dr Hugh Taylor’s planned
retirement in May 2017.
A new partner is also expected to join the practice around October/November.
Dr Shah Arghandawi, one of our registrars, will be staying on for a further year in a shared
post between the practice and West Essex CCG. He will be here for 2 days a week.
Both Lloyds and Co-op chemists have put in a request to NHS England to open a pharmacy in
the building. It is now up to NHSE to decide.
Patient comments and questions
A patient requested that the practice advertise the number of sessions each GP works and
any other commitments they may have. YP will get this added to the website and to the
practice leaflets for those who do not use the internet.
YP will arrange for a supply of practice leaflets for established patients to collect when they
attend the practice. Normally, these are given to patients when they join the practice but
additional copies can be made available. YP will add the information above regarding
number of sessions each GP works before printing these.
A request was made for a handrail to be fitted in the lobby (between the sliding glass doors).
YP will contact NHS Property Services who own the building with this request.
There was a comment that the information screen font is still too small and too fast. YP will
arrange for this to be made larger and go more slowly. Arthur Moody felt that there was too
much information on the screen. YP said that other patients remarked on how helpful and
informative it is. (YP has subsequently emailed AM and suggested that a small working
group take responsibility for review this information from a patient perspective).
Stellar Healthcare – the local GP Federation – have won a bid for £2.7 million to provide Outof-Hours services in the area. Dr Hugh Taylor, Chair of Stellar Healthcare, explained that 3 or
4 hub practices would open between 8.00am – 8.00pm every day, including weekends. They
would be able to access patient records from all member practices (only with patient
permission). Below is a copy of the press release:
Ongar Patient Forum minutes – 11.3.2015
PRESS RELEASE
The West Essex Seven Day Primary Care Innovation and Integration project aims to improve primary
care access for the population of west Essex CCG with a special focus on those patients at risk of A&E
attendances and unplanned admissions by maximizing collegiate working across primary cares “in
and out of hours” services.
The pilot encompasses 38 GP practices and a total patient population of 297,043. Whilst it has a
multi-agency approach but will be led by grass roots general practice. The aim of the project is to
achieve enhanced access to primary care services, initially 8am to 8pm Saturdays and Sundays,
followed by 6.30pm to 8pm on weekdays.
By using innovative Information Technology General Practice will be working in a collaborative,
“joined up” way to support the implementation of the latest in modern approaches to patient
access, such as Skype consultations and self-care smart phone applications.
The new service will be operated from a number of key “hubs” across west Essex and will see local
general practice teams working together to manage patients with acute exacerbations of chronic
disease and those otherwise at risk of unplanned admissions.
The key aims are to:
• Provide additional services in weekday evenings 6.30-8pm and weekends 8am-8pm
• Integrate the working of 111, out of hours, community and primary care
• Enhanced primary care experience in hours through use of new technologies
• Maximise self-care
• Improve the navigation through the patient care pathway
Date and time of next meeting
9th September 2015 at 7.00pm
Ongar Patient Forum minutes – 11.3.2015