Present: Karen Sadler (KS) Managing Partner at East Lynne Medical Centre Centre

Patient Participation Group (PPG) Meeting – Thursday 27^th April 2017

18:30 – 19:45

Present: Karen Sadler (KS) – Managing Partner at East Lynne Medical Centre Centre

Dawn Lambert (DL) – Finance Officer at East Lynne Medical Centre (Minutes)

Wendy Nicholls (WN) – Nurse Practitioner/Nurse Manager – East Lynne

Lynsey Bessent (LB) – PPG Member Elizabeth Boyle (EB) – PPG Member Helen Burfoot (HB) – PPG Member Patricia Chamberlain (PC) – PPG Member Jackie Fairweather (JF) - PPG Member Sara Foster (SF) – PPG Member

Rose Goodwin (RG) - PPG Member Eunice Hayes (EH) – PPG Member Jacqueline Lyons (JL) – PPG Member Brian McKeown (BM) – PPG Chair

Kaushik Patel (KP) – PPG Member Alan Penney (AP) – PPG Member

Michael Pheasant (MP) – Patient Diana Splarn (DS) – PPG Member

Elaine Symonds (ES) – PPG Member

Apologies: Pauline Mackenzie (PM) – Practice Manager at East Lynne Medical Centre

Heather Simpson (HS) – Practice Nurse at East Lynne Medical Centre

Janice Brierley (JB) – PPG Member
Abbreviations: East Lynne Medical Centre (ELMC). Clinical Commissioning Group (CCG).

NHS England (NHSE). Anglian Community Enterprise (ACE). Community Interest Company (CIC).

• 
  Welcome and apologies.
  

Chair BM opened the meeting by thanking all parties for attending.

• 
  Minutes and corrections from last minutes.
  

Minutes were passed by the group.

• 
  Surgery update from KS, Managing Partner.
  

KS advised the group that the surgery staff had put in an awful lot of work to implement changes to improve systems and this had been recognised by the latest CQC inspection on 31^st January 2017, whereby they awarded the surgery “Good” in 4 out of the 5 areas. She stated the one area still to work on was some further training in reception to prevent confused messages or inconsistent information given to patients. CQC rating was a very pleasant surprise as the improvements have raised the rating by two levels.

BM added that when the inspector spoke with him on the day, they were pleased with the amount of interaction and influence the PPG had with the surgery. This had also been noted as good within the report. Next CQC inspection will be in the usual schedule of five years.

AP asked if the appointment system was going to stay as it is, where you telephone in the morning for an appointment for the whole day, as he felt it was good.

KS stated it had been working better and there were no plans to alter the system.

PPG member asked if there were going to be any online appointments again as there had been none lately.

KS advised there are some put on for frequently but they are booked quickly. DL to check.

BM stated on 3^rd April there was only 1 doctor and the surgery had been unable to obtain a locum as it was the school holidays.

KS explained this was not for the lack of trying. Obtaining locums during holiday periods is always difficult but the surgery uses many agencies, although often the same doctors join multiple agencies. The locums have control of the market at present and agency Doctors can pick and choose where they work. KS stated the surgery may be unlikely to recruit new doctors for years; however the focus will be on using Doctors for things only a Doctor can deal with. There will be patient education regarding emergency appointments, which are held back for patients who are very ill. Some patients have used emergency appointments inappropriately, such as for a verruca. Discussions are being held with other surgeries regarding potential triage systems. There would be dramatic changes for the area.

SF wanted to thank the surgery, she brings a lot of people through the service and has noticed a much better service, particularly getting a call back to give results but also reception being much better and very polite.

AP reported there had been very few comments on Facebook, although other surgeries had received detrimental comments. Only slight complaint was regarding appointments.

KS stated there would always be patients unhappy with appointments but the surgery is seeing more patients than before.

KS explained that the Clacton GP Alliance was now set up and that we had a memorandum of understanding with Ranworth, Crusader, Old Road and ACE to engage in a Nurse Practitioner led Care Home Project, Care Navigation and Minor Ailments as a group. The Care Home project was the first contract and is up and running, an Easter service was provided and there will be further discussions to offer a weekend service between us.

PPG member voiced concern that locums do not always take the time needed to listen to problems.

KS explained they were not necessarily looking to staff with locums but use GP’s within the area for weekend or 8-8 service.

• 
  Introduction to Wendy Nicholls and the role of Advanced Nurse Practitioners (ANP).
  

WN explained she is one of three ANPs and also the nurse manager. A fourth ANP (another Zoe) will be starting on 19^th June. They all have different levels of experience, Sister Zoe has a Master’s Degree, although they all provide the same service and can complete Medication Reviews, prescriptions, blood tests, x rays, complex problems and whilst unable to sign a sick certificate, ANPs can assess a patient and prepare a sick certificate for the doctor to sign and patient to collect.

On occasions where there is only one GP, there will be 3 ANPs and if ANP considers the patient needs a GP, she can arrange this speedily. ANP have consultation and diagnostics skills and can arrange an ambulance if needed. They triage all home visits to see who the best healthcare professional would be to attend and split the visits between GPs or ANPs. If there are few home visits requested, further in house appointments can be opened up. Every home visit equals 3 appointments, therefore all home visits need to be clinically triaged and patients are asked if they are housebound as some patients have abused the system and have not been housebound or have just been unable to get an appointment.

WN stated the new nursing home scheme has been helping with many visits, which enables us to open up appointments. WN has been doing this for 3 years but now shares it with Sam. Sister Zoe sees children so is utilised at the surgery more. WN, Sam and the new Zoe are all previously community matrons. Practice Nurse Heather will become a fifth ANP when she completes her course. She has already finished diagnosis and consultation, and is currently working towards prescribing. The surgery would possibly be looking to recruit a new practice nurse then, however clinical space within the surgery is a concern.

ANPs have 15 minute appointments and use a holistic approach. They are trained to be caring and aware of surrounding issues. Long term conditions can be managed, often better, by an ANP than a GP, however if after they have done a full assessment, they wish to seek further guidance, they can go straight to a GP. The surgery is supporting the new Zoe through a prescribing course, therefore until completed (hopefully end of the year) she can do clinical diagnostic and take the prescription to another ANP or a GP to sign.

PPG member suggested listing the illnesses an ANP can do and displaying it in reception.

KS agreed this is a good idea. DL to follow up and ensure it is on website too. Similar for nurses, for example one nurse can do ear syringe but the other cannot, therefore the receptionist may ask what is wrong to ensure correct clinical appointment is booked.

PPG member stated they had never been asked what is wrong. They suggested displaying a poster showing the comparison costs of NHS Services, GP appointments, Ambulance, self-medication etc.

PPG member stated this surgery was good at tackling more than 1 problem at a time.

KS asked the group to advise us if there are further posters of interest which we can source for display. She also stated they were looking at putting more information on blood results so that ANP can help more patients.

PPG member stated the review date on their prescription is still vastly out of date, despite having a review.

DL to remind Prescribing clerks to ensure correct box ticked following the review.

KS advised the group, a GP does not always need to see the patient to do a medication review; they can sometimes do a review whilst checking bloods.

PPG member suggested getting another BP machine in reception wall, where you can obtain a print out.

BM suggested the previous machine was often tampered with by children and was not cost effective. He thanked WN and invited her to return for an update in 6-9 months.

• 
  Chairman’s report
  

Forum meeting on 12^th April was cancelled without notification. Re-scheduled for following week but BM unable to attend. Verbal notification regarding CQC reports from other surgeries had not been good.

BM reported that they are cutting funding to Pharmacies as they feel there are too many in the area. 11% deduction to some, average 8% deduction meaning some of the smaller Pharmacies will be forced to close. One pharmacy continued to issue repeat prescriptions for a patient who has died 3 months previously. Also a pharmacy had issued prescriptions for 3 years without a review. BM reminded the group that the prescription goes the Chemist but they do not pull them down and open them promptly.

BM requested a PPG Member take the chair for a future meeting.

JF offered to take the chair for a meeting, however is unfortunately unable the next meeting.

• 
  Any other Business
  

PPG member suggested promoting patients to get a first aid kit for minor ailments, possibly displaying a poster with suggested contents of a basic first aid kit.

PPG member advised the group that patients can still obtain hearing aid batteries at the library, CBS and Church in Pier Avenue.

BM stated Specsavers have the contract in Tendring and patients can have hearing aids fitted and maintained at Specsavers, Leisure Centre or Old Road.

PPG praised new pop up screen notes, which prompted the clinician straight away of possible issues and potentially saved contraindications.

BM thanked the surgery for all the hard work and progress made.

KS thanked the group for supportive and beneficial feedback, to implement at the earliest opportunity.

BM thanked the group for the good attendance and the meeting closed at 7:45pm.

Next meeting Wednesday 5^th July 2017 at 6:30pm at the surgery.

Members are reminded that they can contact Brian by his telephone number: 01255 436977 or email address: [e-mail]