Minutes of Meeting held on Thursday, February 23rd 2023

 

Present:

  • Arif Ladha (AL) - Practice Manager
  • Doctor Sam Randle (SR) – from point 5 onwards
  • Brenda Quelch-Brown (BQB)
  • Richard Hoffman (RH)
  • Derek Bird (DB)
  • Maureen Levy (ML)
  • Anne Millar (AM)
  • Denise Fonseca (DF)
  • Neil Singleton (NS)

 

Apologies:

  • Aga Hassan (AH)
  • Geoff Bell (GB)
  • Tom Harrison (TH)

 

Minutes of the meeting held 24th November 2022 were agreed

 

Updates

  • Tea Parties. BQB will be holding tea parties once a quarter at Toldene Court other monthly tea parties will be at the Cameron Hall. The next one will be held on 25th March. Transport members of community to Toldene./ Will relieve pressure on transport.
  • Spring & Summer presentations. Proposed dates 10th & 24th May, Croydon MIND to present and BQB has invited a representative from Croydon drop in centre. This will cover a fuller age range. The drop in centre is for children to the age of 24 and MIND covers adults.
  • Listening table to be re-introduced from April. AL discussed. Can resume but only once a month. These had been introduced as weekly shortly before lockdown. BQB, DF and DB had been running this before. Now it will be less onerous – only once monthly every quarter per person. Promoting digitalisation. Digitalisation is way forward.
  • This year’s Old Coulsdon Summer Fete is on 1st July. BQB requested assistance for the PPG to run a stall. Cost is £45 – AL agreed that the Practice would settle this charge in full. On behalf of the PPG BQB thanked AL. DF queried what we would promote at the fete and suggested similar to the last time we were there summer fete – BMI and healthy eating etc. But BQB wants to use the stall to encourage patients to use the newer digital services.

 

Digitalisation Debate

see also Q4 & Q5 below

AL explained that the practice are keen to encourage digital applications. 9,581 OCMP patients are now registered for the NHS App. 55% uptake.

A limitation of the app was explained by AL. At OCMP we see named GP as much as possible, so having a continuity of care. This means personalised lists within the App. So, if booking an appointment and the patient’s Doctor is away, the App cannot give the patient an appointment with an alternative Doctor. If your GP is not in or not rota in, you can’t see your own GP. App is subject to restriction that if your GP is not in cannot see other appts available. Need to overcome inability to book other GP than your own if your GP is away as GP is personalised to you.

AL asked AM about the practice she works at but she stated that people ring in and are given an appointment. AM now officially retired so unsure regarding use of the NHS app.

RH stated limitations of using the NHS app – the main one being not the app itself but the limitation of the 7-9 a.m window, restricting potential use. Also in respect of messaging, the app does not send replies back to app (but sends texts). Also, unlike other communications media, the app does not retain messages sent. Sometimes the response to messages is to call reception and make an appointment – perhaps counter intuitive for a digital app. That said, RH uses the app and BQB was happy to extol its virtues for prescriptions, blood tests etc..

Conversely, NS and ML stated their dissatisfaction in that visits to surgery after 8 a,m, were rebuffed by reception staff who told them to go home and use the app.

AL set out the privileged position of PPG to highlight what OCMP are trying to achieve.

Pre pandemic it was open surgery, then Covid impacted etc. As a result culture changed – phones, signposting to pharmacy, digital tools etc and now the NHS App.

Now we also have workforce issues, doctors and nurses recruitment issues, and also physios and paramedics . Things changing, way we operate is having to change. Cater for all the different groups. Change culture and mindset – don’t always need to see GP, X or Y. Move to other allied health professionals. OCMP are working through all of that.

If we start giving appointments at 8 am – we are driving the required culture backwards. Phone and online patients will lose the opportunity to book appointments . We need to encourage patients to use phone and app. It will make the practice resilient. Bulletins showing practices closing and merging. We are trying to strike the right balance. If you can use other avenues, try and use without reverting to traditional methods. Access to all with finite resources.

AL even set out an analogy to GP practices. We currently have issues with supplies of veg – people aren’t using greenhouses because of energy costs. Cannot sell their produce and will go bust. Similarly, we are not going to be able to magic GPs if the service does not make use of digitalisation advantages.

Attrition rate is low at OCMP. To maintain, AL looks at resources and multi-disciplinary team and manages the practice, so it remains resilient. As PPG members we have the luxury to hear this from AL. Communication direct from AL that we need a broader mindset.

ML responded that the practice should accommodate people who cannot use digital applications, but AL insisted that if he does and practice has to close down because of that, it’s a doomed strategy. ML maintained that we need to have accommodation for older users who cannot use digital medium. AL repeated that he cannot do it, rather than does not want to do it. Must do things the new way. Those without access online, the practice will try to accommodate – such as appointments at different time of day. Move from morning slots. Constantly reviewing, constantly amending. Cannot promise the earth. ML acknowledged that OCMP is best practice but there needs to be some sort of flexibility and accommodation for non-smartphone users, traditional users need to be accommodated. NS agreed.

BQB – told by AL predecessor. Earlier appts for commuters who could not do daytime appt. Slots at end of evening for same thing. AL – times are changing, and we need to adapt. Lifestyles changing. 8-5 is commuter time. Don’t start discriminating for early appts. In the 18,000 patient population cannot just have early appts for commuters. AM – noted WFH. DB – 18,000 patients 10 doctors. (BQB noted that not all the doctors are full time). Saturation ratio between doctors and patients? BQB has sent an article to AL about patient numbers. Interesting reading. AL – always looking at Doctor - Patient ratios. This was revisited again with SR under Q6 below.

But also need to assess multi-disciplinary team – lots of other allied services, not just a GP – e.g. nurses, pharmacists, physios.

At this point of the meeting SR arrived and we discussed questions raised in advance of the meeting -

 

Questions raised.

Q1. Have you any information about the MRNA vaccine rollout?

There Is a very high incidence of severe reaction to it including death.

1 in 100. Even Dr Bob Gill, GP, is saying that if shouldn’t be rolled out to everyone, regardless of their immunity status.

  • Do you agree that these are worrying figures?
  •  Would you have any objection if Dr Bob Gill, is invited to a future PPG meeting to discuss the MRNA vaccine?

SR replied. MRNA vaccine not currently being administered by PCN or practice. Vaccine programme changing (boosters no longer available to many) as risks change. At present more likely to come to harm from flu than covid.

Bob Gill – self-described as an activist. Fairly extreme views – a long way from standard views. His views are far from govt health advice. SR biggest worry re vaccines is vaccine hesitancy in young people. Young people not being vaccinated from measles & rubella will lead to an outbreak and children will come to harm.

DF wanted him to talk about privatisation of NHS to PPG but in passing he answered about vaccine. Not purpose of DF question.

SR does not want to create an enhanced worry about vaccinations being supported by practice if Bob Gill gave a talk. SR doesn’t want a talk that might in any way impact on childhood immunisations. SR mentioned the example of a surgeon Aseem Malhotra cardiologist who was booked to discuss statin guidelines on the BBC but instead talked about vaccines and could not be controlled.

Q2. What is known of an issue of possible hack/ leak of patients’ data, that is believed to have occurred?

Both SR and AL unaware of any leaks.

Q3. The practice has been monitoring the Klinik triaging system that some practices have adopted, is this going to be considered by OCMP?

Klinik where system asking different questions – where to be signposted. Triaging system

SR outlined that basically there is no appointment system where patients can simply make an appointment at Portland MP. PCN is changing to include Keston and, Parkside – and they too will have to submit online form. If patients phone those practices an online form is created internally. Aim is to have the right patient in the right place. Our practice has changed but not to that extent. OCMP has online access but for the convenience of the practice. In these other practices where some appointments could be of lower value than they should be, the system avoids that. So, at OCMP a BP check may be booked with a Doctor – but a nurse could do this so not an optimal value.

However, patients might want a BP check with a Doctor and some patients like it, but others don’t.

SR concluded that there is an argument that GP systems are being created by 20-30 year olds for 20-30 year olds. But ironically, 20-30 year olds are minimal GP users.

BQB queried whether this system was in force now. SR responded that he thinks Keston, Moorings & Portlands are going to join from 1st April.

Q4. How many patients are now using the website and NHS APP?

SR advised NHS digital report nearly 70% of our patients have the NHS App and can book appointments, send their Doctor a message, book a blood test.

Proxy access and 3rd party access is also available – family members can book for elderly relatives.

But all imperfect because demand > supply. SR – Health is new religion – fills a “worry space”.

We can do more for patients now – amount of interaction is so much greater.

DB noted that patients can order prescriptions on website for other people, but not on App. SR advised that patients can do it on App once set up as a proxy user. E,g. parent for child. Proxy access.

The parent NHS App will include their children. And elderly parents, spouses, partner etc can be added. Set up not straightforward – need to ask practice to set up. Also needs to be a careful discussion between children and parents (e.g. for a teenager giving proxy access to parent details of an unplanned pregnancy will be on the parent’s app.). DB – this needs to be publicised. SR advised AL to highlight the possibility of the proxy access wherever feasible. Also, will be publicised in BQB newsletter.

SR advocated using NHS App wherever possible to request prescriptions or send messages - within half a second it can be on GP screen

Q5. What other measures are being considered by the practice to inform patients of digital tools and other relevant information, considering that it is doubtful many patients look at the website

AL noted that website is being used because we are doing more things through website. Other comms include the newsletter, posters.

 

Is the practice still taking on new patients?

Yes

RH queried Doctor patient ratios. Ours being 1:1800 and the average UK being 1:1700.

SR – figures don’t take into account training, so figures well below 1700. All trainees are on 15-minute appointments.

ML – queried impact of trainee doctors. SR advised that we lose 12 appointments, but deliver 100 extra so net contribution.

Closing lists because of increasing numbers is deemed a blunt instrument to cap workload. Always considered by commissioners as a real scrutiny issue. Only known of one practice which closed list. Normally only if significant issues such as GP dies or goes sick. Would be concern for newly located patients.

Numbers are relevant but in practise impact is that waiting time increases. Demand is not being met. Wait reflects unmet demand. That would be the reality.

 

Has the practice recruited any new members to the reception and admin teams

Admin & reception staff – full complement at present

AL noted his workforce plan – and utilising staff – constantly updating and review processes.

BQB raised this question because of not recognising staff when visiting the surgery.

AL responded that attrition rate among all OCMP staff was good despite the abuse received by reception staff – key aim to protect staff. For example, by rotating staff duties. We are fortunate that OCMP staff stay. Abuse is increasing even in OCMP. DB questioned how much abuse? AL replied that it happens every day. He has concerns for well-being of staff. All services within NHS access have front line gatekeepers who receive backlash from the public.

Abuse can happen on phone or at the surgery. Can be anybody of any age who is abusive. There is frustration with the NHS. The trend is everywhere and increasing.

 

Date of next meeting:

Date of next meeting 27th April 2023