th
Present and apologies: listed on Appendix 1
John Manley -Tucker, Chairman of the Westbank PPPG, in his welcoming speech told how the Westbank
PPPG was formed (in 2006) and how the group was successful then in helping the Practice persuade the
PCT not to make certain changes they had planned for services at the Westbank practice. This outcome proved that ‘Patient voice’ could be a powerful tool. Following this the Group set out a Constitution and, with the support of the staff, went on to grow and involve itself as ‘critical friends’ of the Westbank
Practice. He explained that the Group:
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Is affiliated to the National Asscociation of Patient Participation [NAPP]
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Meets on a monthly basis with Dr J Perkins attending and often the Practice Manager
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Has a core of eighteen members but has great difficulty in involving younger patients
 Does not raise funds- small expenses are met by the Practice, and Westbank Healthy Living Centre is supportive in providing meeting rooms
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Sometimes attends Practice meetings: interviewed the candidates when the last Doctor joined the
Practice : is present on discussions re. the Annual Practice Survey
 Organised and hosted in 2011 a successful Conference with delegates from all health Agencies and disciplines…see our website https://www.westbankpracticeppg.org.uk
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Values the Westbank Practice and has involved MPs, the heads of the PCT, County and District
Councillors and other relevant Agencies to mitigate proposed changes so that they do not too adversely affect the Practice and where possible can be advantageous
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Practice now has a virtual Group administered by Practice staff ..used for feedback on surveys etc.
Since the 2011 Conference the Group recognised the benefits of joining with other adjacent Practice groups to discuss common issues, exchange ideas and join forces to make sure that the Health Service does not deteriorate into a private sham. The objective in holding this meeting is to put this idea forward and to hold further meetings every three or four months. The WestbankPPG will be happy to help new
Groups by sharing our experiences, contacts and knowledge .
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PPG/ Practice Representatives’ introductions
There were 21 present around the table representing 11 Practices (including Westbank) of the 17 that we contacted in the Exeter area.
Barnfield Hill… not sure whether a PPG has yet been formed: was asked to attend by Practice.
Ide Lane… small committee, some fundraising: also have virtual group: failing to engage younger patients.
St Thomas… new Group (2 yrs): Chair is not a patient but Practice staff: also have virtual group: eager to learn how to influence practice and process.
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St Leonard’s…well established but finds it hard work to gain new members: has good support from
Practice: fund raising [specific projects are well supported]: acts as effective ‘critical friend’: participated in questionnaire design: also has virtual group: one GP is on a locality Clinical Cabinet of the CCG.
WonfordGreen…has virtual group but not sure if a PPG has yet been established: attending to gain information.
Isca Medical Practice… Chair of small PPG: attending to gain ideas, information and means to regenerate the group: difficult to attract young parents, ethnic minority groups, students: have produced questionnaires and Practice has acted where possible on findings.
Heavitree Practice… very new small PPG: intending to target specific health groups and young parents to recruit members and interest.
Mount Pleasant Health Centre… Chair of PPG , formed 2 yrs ago: formed by GPs nominating a patient, currently about 12 members: a GP, Practice Manager and member of staff always attends meetings
(every two months): not fund raising: aiming to keep status quo in the [training] Practice in view of new changes: actively participated in handing out annual surveys and gained insight to patients’ views.
Foxhayes Exwick… Virtual group only: Gillian Champion (the Nurse Partner) is the Co-Chair of the Exeter sub-locality CCG with a remit to liaise with the lay members and patient groups, so the Practice has an interest in patient engagement.
Hill Barton Surgery…. PPG formed but in infancy however as one of the Lay Representative on the Exeter sub- locality Clinical Cabinet ( Christine Buswell) is a patient of this Practice this may act as an incentive to proceed.
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Gillian Champion, Co-Chair of the Exeter sub-locality CCG, introduced herself and gave the floor to the main Speaker- subsequently adding that the CCG is going through a process of reviewing the provision of services such as Walk in Centres, Community Services (eg District Nurses, Physiotherapy services,
Community Hospitals) which will be commissioned next yearand there are currently public meetings being held to discuss this.
Dr Hamish Duncan Vice-Chair of the Exeter sub-locality, Eastern locality of the newdevonccg
Dr Duncan gave an animated speech explaining that as a salaried GP, currently working part-time at
Wonford , who also does locum work he has worked at every Practice in Exeter with the exception of
Mount Pleasant. He represents salaried GPs (as opposed to Partner GPs) on the CCG.
The decision to have one Clinical Commissioning Group [CCG] for most of Devon (excludes South Devon and Torbay) was made primarily to benefit from economies of scale. This large CCG covers North, East and
West Devon, i.e. newdevonccg, with the Eastern locality further divided into four sub-localitiesfor ease of management. See Appendix 2 or go to the website http://www.newdevonccg.nhs.uk/ whichcomprehensively describes these localities and their respective
Boards.
The localities cannot work in isolation,all decisions made in any locality have a knock-on effect and will be considered with regard to the whole.
Every Practice is a member of the CCG which operates with 3 Lead Clinicians and a team of Managers , in a parallel way, with decisions no longer driven by Managers alone but by the Clinicians with Patients’ interests in mind. Cost implications are important but that will be balanced with the need for a safe, good quality, excellent health service - which the area already has - and making it better. The CCG is currently reviewing structures and services, looking at what could be adjusted: what is necessary: what is under-
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used: what is liked and needs to be preserved: what is missing: and asking questions at a number of public engagement events all over the area.
The CCG commissions services but not Primary Care , so is not involved in GP Practices and cannot deal with Practice issues such as appointment availability.
The lay representatives who will be liaising with Exeter patients are Christine Buswell and Alistair
MacIntosh, these will be your main point of contact and pathway to the CCG , although you can contact the
CCG direct through the website, with comments, ideas etc regarding services . It would be useful if
Practices raised patients’ awareness of PPGs as an ideal single point of contact to the CCG. There are currently many ongoing public engagement events but these will, naturally, become less once the CCG has gathered public opinion. It is hoped that there will continue to be regular but less frequent events where the public can have their say.
Dr Duncan feels that the focus should be on prevention : management of people with chronic diseases – keeping them at home where possible , where they want to be: community services and hospital services.
He closed with the acknowledgement that it is impossible to please everybody but the CCG are committed to providing cost effective high quality, safe, necessary healthcare balanced across the whole population .
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Christine Buswell Lay Representative on the Exeter sub- locality Clinical Cabinet
Christine spoke with conviction about this new, developing role which has statutory obligations and is bounded by some parameters. One of the two key aspects is championing patient and public involvement and ensuring that the voice of the population is heard. This is a crucial part of the role and requires input from groups like PPGs.
It is necessary that socioeconomic and political factors are recognised in decision making and that all groups are represented, reaching the younger age groups may be difficult. Christine sees patient involvement (not merely consultation) as important and hopes, with help, to develop this.
This is a voluntary unpaid post allowing autonomy in speaking up if necessary to ensure that patients’ views are heard and considered.
Later , when asked if she would be prepared to attend occasional regional PPG meetings, Christine indicated that she would be more than happy to do so and hoped to work closely with the PPGs.
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There followed an open discussion with Questions put to the Speakers and host PPG:
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Dr Perkins opened by speaking about how he felt the intervention of the patients, when the PCT had been proposing to move Westbank’s community and Hospital services from Exeter to Torbay, had played a significant part in quashing the plan and made him appreciate the power of patient groups. He recalled the early meetings of the Group when patients were made aware of how the
NHS works - that GPs are mostly self-employed [partners], owning and maintaining their premises
, employing staff, paying taxes, with all the problems of any business and contracted to the
Government to provide primary healthcare . This fundamental fact is sometimes not understood by the public.
In response comments were made regarding the pressure to expand surgeries following large new developments with little money forthcoming from 106 agreements (now replaced by CIL –Community
Infrastructure Levy) with developers, and sometimes an influx of new patients from an adjacent area meant there was no means of reducing the cost of capital outlay.
 Comment was made regarding the fragility of some Practices and the need to support them in order to maintain the individuality of Surgeries and avoid big businesses replacing GP Partnerships
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A question was asked regarding the decision making process of the CCG with regard to the different board levels , and how the budget will operate from sub-locality level through to executive level.
Each locality and sub-locality has different needs and priorities ; at the moment all decisions are discussed fully between the various localities’ clinicians (who recognise and understand these variations more readily than Managers alone did) and come to a consensus decision. There is no way of ring-fencing money for particular areas.
 Could Dr Duncan identify an area which can be improved?
One area being trialled by Dr Bob Turner is the RAH team (Rapid Access at Home) whereby for a patient in
extremis , who could be needing hospitalisation, the GP can access an immediate care team to assess the patient (often within an hour) and liaise with the GP and other agencies to keep that patient at home when possible with the necessary support team in place. There is evidence that people respond quicker to treatment and recover sooner at home so the outcome is better for the patient and with a cost saving.
 What happens if a decision made locally, say for childhood measles , is not in accordance with the wider CCG needs?
This would come under the Health and Wellbeing Board (public health issues) which is the responsibility of
Devon CC and Exeter CC. Gillian Champion explained that there has been a ‘catch-up programme’ where
NHS England have been inviting young people who missed the MMR pre 5 years old to attend their surgeries now, where appropriate.
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When commissioning do you think you are going to be compelled to buy in from big business?
Also bearing in mind that there have been problems with Private companies looking after children in care… and will we as groups get feedback from the CCG on this?
No doubt the CCG will be under political pressure from all sorts of things, but there is a robust, rigorous procurement process which will have to be followed when something goes out to tender . All bids will be carefully considered but beside cost , quality and patient safety will be overriding in how the decision is made.
Realistically we will have to accept that if Private companies can produce the quality care, patient safety and service that we need at competitive costs then we will sometimes have to use them to achieve the ultimate aim of keeping the NHS free at the point of use.
If you want more information on how a decision was made email Christine or the CCG direct. We are aiming for openness and transparency.
 It is a comfort to know that Clinicians are making these decisions, but what will happen to surplus managers who in past reformations have popped up, mostly at higher levels with increased salaries ?
The Clinicians need managers but there is always a danger of management getting out of control and we will have to question it if this should occur.
 Concern was raised about the quality of carers entering elderly peoples’ homes to give personal care – sometimes the elderly are at risk from unsuitable, unsupervised and sparsely trained carers.
Care agencies need to be regulated, better training of carers is needed and more supervision should be given.
This is a recognised problem and one which the CQC (Care Quality Commission) is looking into. It is a national problem and there should be better regulation. On a local level if you see poor care delivery then report it to the Care Agency employing that person.
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Has any thought been given to producing a reciprocal rights document for patients, such as parents have when registering children at school? Many people do not know their rights e.g. you do not
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have to stay in hospital if you do not want to. Also should you not be communicating in a more modern way, using social media to reach younger people.
The CCG is linked to the City Council twitter account and the website also incorporates twitter, facebook, linkedin and another social media app. Most Practices now have websites through which you should be able to contact GPs. The NHS Constitution sets out patients rights, perhaps there should be more links to that. The RDE Hospital hands you a booklet on your rights and what you can expect, and a similar one as you leave with contact numbers.
 Where does Healthwatch and the Health and Wellbeing Board fit in with the CCG?
Dr Duncan will be meeting with the Health and Wellbeing Board (public health) to discuss ideas around schools and similar issues.
There is communication with Healthwatch who signpost patients to appropriate organisations / agencies to resolve problems.
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Will the CCG produce a Report ?
The Devon CC produce a public health report which goes to the CCG Board , this has just been published.
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How do you get a PPG started in a Practice that does not have one?
Most importantly you need to persuade the Practice GPs, Manager and staff that they need a PPG because if you do not have the support of the Practice you really have an uphill task.
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Is there one place or publication giving advice on setting up and running a PPG?
Yes, NAPP the National Association of Patient Participation. We will forward you details of their website which has many resources and helpful leaflets etc.
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John Manley -Tucker voiced his hope that there will be more meetings like this in the future and asked for feedback from the floor. It was strongly felt that this should be the beginning of a collaborative group of
PPGs and the Westbank PPG offered to facilitate the next meeting in about October/November.
Thanks were given to the Speakers , Westbank HLC for the venue, and all present for contributing so fully in what was seen as a very informative and useful meeting. We are all looking forward to working with
Christine Buswell and Alistair MacIntosh as our main conduits to the CCG.
A report of this meeting will be distributed in due course and Westbank PPPG will follow up with a date for next meeting. Meantime if anyone requires information or has any questions please contact
Westbank PPPG Chairman –John Manley-Tucker, Maggie Hayes or any of our Group.
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