Feb. 27, 2024

Minutes

Minutes of hybrid meeting of the Patient Participation Group held at the Church of the Good Shepherd, Pyford at 5:00 PM, February 27th, 2024.

1. Welcome and Introduction

Andrew Grimshaw, Chair of the meeting, introduced himself and the speakers. He explained the timings, process and health & safety arrangements for the meeting. He asked members to complete the feedback form for the PPG Steering Committee so that they could decide future meeting topics and improve meeting effectiveness. He then introduced the first speaker Carol Leong-Son.

2. Updates to the NHS App and the Access to Timely Healthcare forms

Carol said the NHS App had been updated in December 2023 & explained how to now use the App to request a GP appointment.

WBHC Appointment Request system

She drew attention to the WBHC Appointment System information sheet showing the four ways to request an appointment. She explained the changes to the NHS App process. Patients now need to click on the ‘services’ button (shown as a cross) on the blue banner at the bottom of the screen, then click on ‘Contact your GP about a health problem’. All other steps and ways to request an appointment remain the same.

Access to Timely Healthcare sheet

Carol then drew attention to the Access to Timely Healthcare information. It had now been simplified and updated with the latest information since it was first circulated at the inaugural PPG meeting 18 months ago.

If a patient can’t access their GP Practice or it’s out of hours, local NHS services available are listed with examples of when and how to access. There are now two options (telephone and online) to use the 111 service.

Other changes include ‘Pharmacy First’. Under this scheme Pharmacists can prescribe treatments for a number of conditions as follows:

earache (aged 1 to 17 years), impetigo (aged 1 year and over), infected insect bites (aged 1 year and over), shingles (aged 18 years and over), sinusitis (aged 12 years and over), sore throat (aged 5 years and over and urinary tract infections or UTIs (women aged 16 to 64 years)

NB there are restrictions on these services. The most important one is that UTI’s issues are for women only.

. Carol then described the two ‘walk in and wait’ services: Woking Walk-In Centre run by Advanced Nurse Practitioners for minor injuries and urgent illnesses and the Urgent Treatment Centre at St Peter's hospital, a GP led service which diagnosed, treated and referred patients on as appropriate.

3. Introduction to the Friends of West Byfleet Health Centre/ Wit Knits

Pamela Witze, a trustee of the Friends of the West Byfleet Health Centre spoke on behalf of the Chairman, Nick Quinn, who was unable to attend. The Friends were set up in 2001 and were a registered charity supporting the 30,000 patients of all three practices. The purpose of The Friends was to provide ancillary services, including medical equipment, services and facilities for WBHC patients. The Friends helped fund extras that the NHS doesn't pay for such as specialist equipment for GP’s to diagnose and treat at the Health Centre which avoided a hospital waiting list at local hospitals.

In 2017 the Friends bought an echocardiogram and ECG machine for £50,000 to allow patients’ heart health to be assessed on site. The Friends also pays £ 000s of pounds annual maintenance contracts but at some point they will need replacing. In 2019, The Friends paid for a £35,000 pelvic ultrasound scanner and a 3D probe to support the gynaecological service and also paid the salary of a sonographer to operate it. Also in 2019, The Friends purchased Doppler machines that make it possible to diagnose damage to patients’ blood supply.

For many years The Friends have paid for on-site physiotherapists, provided wheelchairs (for health centre use) and recently purchased several phlebotomy chairs which makes taking blood easier and more comfortable.

Pamela then paid tribute to the ‘Wit Knits’ led by Janet Hodges who had raised many thousands of pounds for The Friends over the years and who would shortly be holding their Easter sale and urged members to buy their products. Finally, she drew attention to the pro forma’s available to join The Friends and support this very worthy cause.

4. GP presentations

4.1 Dr Natalie Jesshop - Wey Family Practice, Partner

Dr. Jesshop spoke at a PPG meeting one year ago where she introduced her role and work as the Clinical Director of the West Byfleet Primary Care Network (PCN). The WBHC PCN pool resources between the 3 GP Practices to offer additional services for all 30,000 patients.

She referred to the many changes in General Practice over the past decade and explained how funds were allocated to general practices on a per capita basis i.e. a fixed amount and not affected by the number of patient visits to the Practice. There had been a decline in GP numbers and those joining now often wanted to work part time.

The patient population is living longer becoming frailer with more complex medical problems requiring more medical intervention and care and more appointments in primary care which have to be managed within reduced NHS payments.

In April 2023, the government imposed a contract stating patients were to be offered an appointment within two weeks of a request. That objective was introduced without any extra funding and, if GP Practices did not meet this target, they would receive even less funding.

All three practices had therefore set up clinical triage of appointments to ensure the patients who needed to be seen urgently could be accommodated whereas those whose needs were less urgent could wait for a routine appointment.

She drew attention to the pressure on hospitals which led to GP referred patients taking much longer to get an appointment there and hospitals were asking GPs to manage patients at home who would formerly have gone into hospital. All with no additional funding.

The practices still do not have any indication of the details of the GP contract that's due to start in April 2024 or for the future of the PCN model, which is due to end in April 2024.

The West Byfleet PCN was set up in 2019. Since then, 21 different roles had been established including clinical pharmacists, care coordinators, a social prescriber, dieticians, a mental health practitioner and an Advanced Nurse Practitioner. Dr Jesshop gave examples of their work and how they had contributed to providing better and more rapid services to the patients of all three practices.

Dr Jesshop praised The Friends of WBHC for their magnificent fund raising resulting in improved diagnostic equipment reducing hospital waits for cardiac and gynaecology patients.

She outlined the staff changes at Wey Family Practice and shared statistics on the triage system, which is working well coping with appointment requests of about 100 per day, although Mondays are the busiest with 150 -180. The number of phone calls each month had dropped from 8,000 to 5,000 allowing more time for receptionists to help patients unable to book online. Over the previous 3 months this was 1,400 out of 9,100 patients had needed this assistance.

4.2 Dr Sundeep Soin – Madeira Medical Practice, Partner

Dr Soin started by expressing the view that the biggest problem faced by primary care was its workforce, which has been dwindling downwards

across the last 15 years. Many people thought the problem with availability of appointments was something new resulting from the COVID period but the problem has existed for over a decade. A ministerial decision had been made that the 8:30 am ‘mad rush’ where practices were overwhelmed with calls from patients had to stop. This had forced the introduction of a triage system, which had worked well because the phones are less busy and attention can be focused on those patients who most needed it. Those unable to use the online request system were assisted by the reception staff who completed the forms for them.

Dr Soin drew attention to the size of some local nursing/care homes and pointed out that patients over 75 years of age used GP services on average 22 times per year rising to 36 times for the over 90s.

He then spoke about the substantial increase in new houses and flats being built in the area and the 500+ new units planned for the area near West Hall nursing home. No additional provision of health care facilities was planned

even though this would add at least 1,000 new patients to the load already carried by the three practices.

Dr Soin said he was often asked about continuity of care for patients and that it was both doctors and patients who wanted this because when he sees a patient he was not familiar with an appointment might take 25 minutes vs a patient he knows may only take 10 minutes thus making him more efficient.

He expressed thanks to Pamela and The Friends of WBHC for raising funds for the echocardiogram and the amazing ultrasound machine for pelvic scans.

He then shared some workload figures for the practice. Madeira Medical has 9,000 patients. Over the past year the number of appointments increased by 22% to 63,000. Dr Soin then referred to DNA’s (‘did not attend’) patients. Last year there were 1,100 DNAs. That is 1,100 wasted appointments which could have been used for other patients. He urged all members not to waste their appointments and cancel if they couldn’t attend.

4.3 Dr Claire Burden – Parishes Bridge Practice, Senior Partner

Dr Burden echoed the points expressed by her 2 colleagues that primary care faces challenging times but all three practices were working closely together to determine how to use existing resources better. She stated that at Parishes Bridge there are 3% of patients who take up 15% of all available appointments. There is work starting to support these patients so the number of appointments available to other patients can be increased. She also said that the 3 Practices are working with Surrey Heartlands to look at capacity and access particularly with the expanding patient base caused by new and future residential developments.

5 Q&A session with the GP’s coordinated by Carol Leong-Son

See Appendix A for all Q&As

6 Closing remarks – Andrew Grimshaw

Andrew thanked the audience for attending both in-person and via Zoom. He said that there would be two further PPG meetings in 2024: An online only meeting for parents and carers of children spanning pregnancy up to secondary school age. Likely date will be September ‘24. Then an in person only meeting in the Autumn which, depending on feedback might be purely a Q&A session. He asked that everybody complete the feedback form as it would help enormously in planning future PPG meetings.

DW/JL

12/03/2024