HIGHPARKS MEDICAL PRACTICE
MINUTES OF A MEETING OF THE PATIENT PARTICIPATION GROUP

Date: 10th November 2022
Time: 1.30pm – 3.00pm
Place: Emmanuel Centre, Cliffe Woods

Present:
Dave Bowen
Jane Cartwright
Christine Cavender 
Mike Cavender
Jess Cross                    Practice Manager
Jerry Doyle                    Chair
Jenny Dunster               Secretary
Jill Fanner                     Joint-Treasurer
Kath Gilbert
Dr Asser Ghozlan          GP Partner
Kath Johnson
Sue McDermid
Jasvir Selvan                 Deputy Practice Manager
Pat Tomlinson.
David Townsend
Caron Waters                Practice Nurse supporting GP Registrars (from item 8)
Caroline Wells               Business Manager

The Chair welcomed Jess Cross to her first meeting and introductions were made.

	Item	Action	
1.	Apologies for Absence
Received and accepted from Sandra Fenney and Rita Horn.
		
2. 	Notification of Any Other Business 
None declared
		
3.	Declarations of Conflict of Interest
None declared
		
4. 	Election of Chair and Vice-Chair 2022/23
The Secretary took the chair –
•	As there were no other nominations it was agreed that Jerry Doyle takes the role of chair for 2022/23
•	As there were no other nominations it was agreed that Kathy Johnson takes the role of vice-chair for 2022/23
		
5.	Membership of the PPG
No change	

6. 	Minutes of Previous Meeting
Minutes of 25th July had previously been agreed by all participants via email and have now been posted on the Highparks’ website.	

	
7.	Matters Arising and Action Points
All actions had been completed or were on the agenda.	

8.	Chair’s Report
•	Communicating with patients still needs improvement and is perceived as the biggest issue that the PPG faces.
•	A recent national patient survey by IPSOS revealed that Highparks provides a high quality of patient care but is performing below national average for access to appointments.
•	Medway Healthwatch support remains ongoing and routinely receives a copy of the minutes.
•	Carers event – Jerry hopes to organise this event next summer.

(Caron joined the meeting)

Caron said that the greatest need for community support is for those caring for patients with dementia; carers can become very isolated and lonely.
Lisa Earle is the practice’s Dementia Champion.
There is a support group in Cliffe.
The practice could give support by identifying those in need.
Following discussion, it was agreed that more detailed plans would be discussed at the next meeting.
(ACTION: Jenny to put on agenda)
•	Medical student training – Caron explained that 1st-year students need to fulfil certain criteria. Caron is setting up a volunteer register of patients with cardio, respiratory, gastro or chronic conditions who would be prepared to work with the students. Members might like to volunteer.

Secretary 	
9. 	Practice Report
Members had received the report prior to the meeting. 

Appointments
Dr Ghozlan and other practice staff drew attention to the following:

•	15-minute afternoon appointments, for some routine patients, started in October and have been well-received by both patients and staff.
•	Following PCN guidelines, extended access has been put in place – 18:30 to 20:00 on Wednesdays and Thursdays, 08:00 to 13:00 on Saturdays. These appointments are available at Highparks surgeries and it is hoped to stabilise the extended hours system over the next few months. 
Going forward, the PCN plans to provide 08:00 to 20:00 availability across all their practices - Highparks, St Werburgh and The Elms.  Once the EMIS system concerns are resolved it will be possible for a patient to access an appointment at any of the 3 practices during these extended hours (1830-20.00 Monday-Friday and 0800-1300 Saturday).

Q: How can a patient receive continuity of care for routine appointments?
A: A practitioner of choice can be indicated via a phone call or on e-Consult.

Q: Why do so many patients fail to get appointments at 8am?
A: The phone system can only manage 25 patients in the queue. Once this is full the system reverts to No. 1 again. Therefore, a patient may hear that they are No. 4 in the queue but, if they are in the second group of 25 patients, they are in fact No. 29. So, by the time they get to the head of the queue, all appointments may have been taken. 
It must also be understood that receptionists might be dealing with long phone calls as well as patient drop-ins. 

Q: Could appointments be made available not only at 8am but also at 9am and 10am to ease the pressure?
A: GP templates were designed to make sure that the most urgent problems are dealt with early in the day where possible, especially if further onward treatment is needed.  There are other slots in the day for over-70s and under-5s to accommodate those patients. Other patients are then signposted when the practice reaches capacity.

Q: How far ahead are appointments available on the system?
A: 6 weeks

Q: Is demand higher that the practice can cope with?
A: Medway has the lowest ratio of GPs to patients in the country. 
Allocation of GPs is dictated by the NHS depending on the number of patients. 
Highparks has approximately 15 thousand patients.

Did Not Attends (DNAs) - 344 in October:
95 (covid/flu vaccinations)
64 nurse consults
63 blood tests 
67 routine GP consults (ie patients with long-term or chronic conditions)
25 on the day GP consults 
14 Health Care Assistant consults
10 Child Immunisation
6   Other 

Any DNAs are concerning but members agreed that it is especially worrying to see that 25 GP on-the-day consultations were not attended. 

Q: What action does the practice take when patients fail to attend?
A: If a patient misses 3 appointments a phone call/message/letter is sent from the practice.
Q: What reasons are given for DNAs when a patient is contacted?
A: Most common are, ‘I forgot’ or ‘I don’t need it anymore’.

NB there is a cancellation option on the phone system which does not require the patient to speak to a receptionist.

Highparks has more DNAs than the national average of 3.5%. In an effort to reduce DNAs, the practice is working on a more positive strategy than simply posting the numbers in the waiting rooms.  

Staff Health and Welfare
Jess reported that receptionists are dealing with very challenging situations and facing abuse not only on the phone and in the reception areas but also on social media. This undermines and demoralises staff and it was agreed that this is totally unacceptable. Jess asked the PPG for support. 
Following discussion, the following points were agreed:
•	Dave will approach the administrators of the 4 village Facebook groups to invite them to a meeting with himself, Jess and Jas, to ask for their support in moderating posts that are potentially damaging to practice staff.
•	PPG members will monitor the FB groups and inform those who post negatively to contact the Patient Group. It’s hoped that this might help to de-escalate abusive posts.
Cliffe Woods – Jerry
Higham – Dave
Wainscott – Dave
Cliffe – Jenny

Q: Can a practice exclude an abusive patient?
A: On the grounds of violence, eg when police are involved, in which case the patient will be removed immediately. In cases other than violence and abuse, the decision for a practice to remove a patient should only be made after careful consideration. The practice has a zero tolerance policy and if anyone at the practice receives verbal or threatening behaviour, the patients are written to explaining they will be considered for removal from the practice if this continues.

Jas mentioned that receptionists get local and national training and support. 

Covid-19 and flu vaccinations update 
These were made available every Saturday starting in late September. Approximately 200 housebound vaccinations were done. 
There are still appointments available for the over-65 age group.
The PPG thanked staff and volunteers for the smooth running of the vaccination clinics.

Communicating with patients and website update
Jerry said that the PPG needs to have a greater public profile.
Following discussion, it was agreed that:
•	Dave will work with Jess and Jas on the PPG element of the website and produce a PPG poster for the waiting rooms; he will give feedback on the practice web page. 
•	A generic email address will be set which members of the public can use. Emails will go to the PPG secretary who will direct enquiries appropriately;
•	NB - the PPG will be referred to as the ‘Patient Group’ in all public-facing communications.

Complaints
A report had been circulated.

Impact of the government’s proposed ‘Plan for Patients’. 
Jess reported that currently nothing definite has been sent to practices so she might know more at the next meeting.
(ACTION: Jenny to add to next agenda)

Secretary
	
9.	Any Other Business
Although not declared in item 2 there were two points: 

1)	Q: Is eConsult for routine or acute appointments?
A: Make a phone appointment for urgent/acute conditions or call 111.
2)	Q: Hospital transport - G4S no longer take patients to London hospitals so what should patients do?
A: Currently there’s no information about a replacement service so consultants are trying to refer patients more locally until the situation is resolved.

	
10.	Confidentiality
None identified
		
11.	Dates of Meetings, all at 1.30pm at the Emmanuel Centre  
Thursday 19th January
Thursday 20th April
Thursday 20th July
Thursday 19th October

Jerry thanked everyone for their attendance, apologised for the over-run and closed the meeting at 3.20pm.

Signed ……………………………………………………………………………….

Date……………………………………………………………………………………