Date: 19th September 2024 @ 6:30pm
Location: Gosforth Valley Medical Practice
| In attendance: | Apologies | Invited in addition: |
| Glyn Jones – Chair : Margaret Askham Shelley Hinson Wendy Jones Evelyn Kirby Mike KirbyJohn Needham Carole Mason – Practice Business Manager [CMA] Dr Louise Moss – GP Partner [LM] | Pat Boyle Sarah Boyle Adrian Hubbard John Hutchinson Helen Lane Andrew Loughran Mary Milner | Rhonda Pickering – Deputy Director of Nursing and Quality (DHU) Judith Brown – Patient Involvement and Experience Manager (DHU) |
Practice Update
CMA shared the following practice update with members.
New Staff
Leavers
Practice Nurse at Gosforth and Moss Valley
Changes
Nurse Debbie Dujon – Working additional sessions on Wednesday and Thursday at Gosforth to cover maternity from 18 November
Administrator Kate Brooks – Cover Care Coordinator role at Moss Valley
Vacancies
New Initiatives
Relaunch of NHS Health Checks – from November 2024
Change to Ear Care – Monthly Ear Care clinic at both sites from November 2024
Events
Challenges
North east Derbyshire Primary Care Network (PCN) News
CMA added the following detail:
Welcome to new Registrars and Medical Students!
CMA shared the names and training status of the Registrars and trainees who had joined the Practice in August, and the sites that they were based:
- Rijuvani Sehgal – Foundation Year 2 Doctor based at Moss Valley
- Callum Edmonds – Specialist Registrar (ST) Year 1 Doctor based at Moss Valley
- Heba Elakabawy – Specialist Registrar (ST) Year 3 Doctor based returning to Moss Valley
- Amal Gabeyre – Specialist Registrar (ST) Year 1 Doctor based at Gosforth Valley
- Lilian Obloma – Specialist Registrar (ST) Year 1 Doctor based at Moss Valley
- Joseph Olupona – Specialist Registrar (ST) Year 3 Doctor returning to Gosforth Valley
- Atta Onate – Specialist Registrar (ST) Year 3 Doctor returning at Gosforth Valley
- Tsz Tsun Pang (Vito) – Trainee Pharmacist based at Moss Valley
- Osama Shaikh – Specialist Registrar (ST) Year 1 Doctor based at Gosforth Valley
- Amina Shokat – Kings College London Medical Student (4-week placement)
Connie Tracey
Connie Tracey (Maternity) would be starting maternity leave from 15 November, preceded by 2 weeks annual leave. Connie was expected to return in the Autumn of 2025. As per the update, nurses Emma Brealy at Moss Valley, and Debbie Dujon at Gosforth Valley, would be increasing their hours to cover Connie’s maternity leave. The Partnership were in the process of finalising the recruiting of a new nurse on a temporary contract to supplement the hours in addition.
There were no additional questions asked.
Presentation and Q&A Session: Rhonda Pickering – Deputy Director DHU
The Chair welcomed Rhonda Pickering (RP) and Judith Brown (JB) to the meeting and invited them to introduce themselves to members. RP advised that she was the Deputy Director of Nursing and Quality at DHU, and JB is Patient Involvement and Experience Manager. RP took members through a presentation that outlined DHU services and utilisation and invited questions (a full copy of the presentation is available to download with the minutes).
Q: What does DHU stand for?
A: It used to stand for Derbyshire Healthcare United but as the organisation has grown and expanded beyond the borders of Derbyshire, the “DHU” name has been retained, but it is no longer an acronym for anything.
JB shared the range of services offered by DHU, which were a combination of 111 and other services which included the following:
- Clinical Navigation Hub
- Derbyshire Urgent Care Home Visiting Service
- Derbyshire Integrated Urgent Care Services
- Phlebotomy Services
- Community Nursing Service
- Covid Medicines Delivery Unit
- Community Virtual Ward
- GP Practices
JB explained how DHU were also now taking on the running of GP practices in some areas, and currently managed three GP practices in Leicester and 2 practices in Derbyshire with another potentially coming on board.
Q: In terms of the Urgent Treatment Centres, can patients just walk into these?
A: For Ashbourne, New Mills and Swadlincote did offer a walk-in service, however DHU wouldn’t advocate this for the other centres. Patients wouldn’t necessarily be turned away if they did walk in, but they worked on a triage basis, which informed the right decision in each case.
Q: How do patients access Urgent Treatment Centres?
A: Patients can get booked in through the 111 service, and there is some access via GP services.
DHU successes were shared with members:
- DHU had achieved an ‘Outstanding’ CQC rating for its Urgent Care Derbyshire (North) services.
- DHU had delivered over 21,000 evening and overnight community nursing visits to housebound adults; the organisation had adapted the ‘swift queue’ booking system for phlebotomy.
- DHU worked with East Midlands Ambulance Service to reduce ambulance requests and increase non-ambulance resolutions.
- They had completed 41,000 face-to-face consultations and 19,000 home visits out of hours.
- DHU had achieved timely service delivery with 93% of urgent home visits completed within 2 hours, and non-urgent visits within 6 hours.
The usage of DHU 111 services by patients at The Valleys Medical Partnership was shared for the period January 2023, to September 2024. This indicated that there had been a total of 4,451 interactions for the period, with between 170 and 270 patients accessing the service each month.
Q: Does the data represent patients who have been referred to 111 by a GP, or all patients who have accessed the service?
A: The data is all patients who have accessed the service who match the demographic of being a patient at The Valleys.
Q: How many call centres does 111 operate?
A: There are 4 call centres.
Q: Have you done any comparisons of the data with other areas/other practices etc?
A: We are just starting to, and comparative data is currently being tested.
Q: Do you expect there to be more demand for 111 services if pharmacies close?
A: Yes; there are Pharmacists working as part of our team.
Q: [From DHU to patients] Have you head of pharmacies closing?
A: Only on the news.
Q: Have you picked up any patterns from the data?
A: The data is quite consistent/steady – September 2024 looks lower but this is because it is a part-month.
Q: What is the difference between clinic and non-clinical telephony?
A: All patients who contact the 111 service speak to someone; some will go on to speak to a clinician, some will receive other advice for example, an appointment will be booked, or other guidance/support may be signposted or offered.
Data for the use of DHU Urgent and Emergency Care (UEC) Services for patients of The Valleys Medical Partnership was shared for the period January 2023 to September 2024. The total number of interactions were 4,034 for the period, with a range of between 150 and 260 interactions per month.
Q: This feels a high proportion – is there any correlation between the data and proportion of time wasters?
A: Frequent callers and high impact users do contribute to the figures and may have multiple interactions with the services. These are flagged back to practices.
Q: Are there any challenges with how service users treat the service?
A: DHU have a zero-tolerance approach in respect of abusive and/or threatening behaviour, so where this is evident, it is addressed in the strongest terms.
Q: What proportion of the support provided is for mental health?
A: We see a high proportion come through 111 as there are no mental health services operating out of hours. These patients will always be managed by a GP and if it isn’t appropriate for them to come to the practice, they’ll be visited at home and if they are known to the service, they may be admitted. There are specific mental health nurses working as part of the service and DHU are currently piloting a child/young person service.
Further data was shared, which provided an insight into other aspects of DHU work. It was recognised that the organisation, and the services they provided, were multi-faceted, and equally, there were many layers to the data that had been provided. This made it difficult to draw any conclusions but did provide valuable insight into utilisation.
RP invited members of the PPG to share their experience of DHU services:
- One member advised that they had had reason to use 111 over recent years and the main problem they had found was communication and they had found call handlers sometimes difficult to understand, particularly in instances where the call handler had a particularly strong accent. Other than that, PPG member felt that the service had been excellent. DHU response: Ability to communicate effectively is a priority for all staff and tested as part of the recruitment process. DHU empower staff to complete qualifications to support effective use of English. Where this remains a challenge, support plans are put in place which can include a range of measures including elocution training.
- Members shared their admiration for the call handlers, particularly recognising some of the heart-wrenching calls they had to deal with.
- A member shared that they had had to use the 111 service on three occasions over the past 15 years and had always found this to be positive.
- Another member agreed; they couldn’t fault the 111 service and had appointments made with Ashgate a couple of times on the back of the calls they had made.
- A member shared feedback from a friend in Derby who had used the 111 service; they hadn’t liked the service because they had wanted to direct what support they believed they needed without going through the questions.
DHU response: The pathway system patients experience when they call is a nationally directed system. There can be duplication, with patients asked the same questions, but it is an important structure to help direct the most appropriate support for patients. A member asked if the pathway was reviewed, and DHU confirmed it was; there were regional and national meetings taking place regularly, and where a change had been agreed nationally, this would be built into the protocol. RP asked members what they believed DHU’s top 5 priorities should be. The group felt that the sharing of data and the outreach to the PPG had been particularly useful and said that they thought that this would be useful moving forwards.
Members also referenced advertising of the service, which appeared to have been something that used to happen but had now stopped. Representatives from DHU said that they were no longer permitted to advertise, as directed by NHSE, as this was believed to have a negative impact on service use.
RP closed the meeting by outlining opportunities for members of the PPG and the wider patient body, to become involved with DHU which included:
- Becoming Patient Safety Partners by Participating in Quality Walkaround Visits at Our Sites and Services
- PPG Visits – Using Observe & Act Model
- Patient Advocate roles
- Patient Story’s from Patients who use of services
- Patient Focus Groups to support innovative solutions that lead to better outcomes and experience for patients & their families
Members of the PPG were invited to come and visit an emergency call centre and complete a quality walk-round using the observe and act model.
Action: Members who are interested to contact the Chair, who will liaise with RP to arrange a visit. The Chair thanked RP and JB for attending, and for their presentation.
GP Collective Action – Overview and Practice Response
The Chair invited CMA to address PPG members.
We Work Collaboratively – Social Media Statement
You may be seeing news reports talking about “industrial action” by GPs and we with to update our patients.
The British Medical Association (BMA – the registered trade union for doctors) recently undertook a ballot of all GPs who hold a contract to provide GP services to patients – the vast majority of GP Practices are independent partnerships holding an NHS contract. the ballot asked if GP partners were prepared to participate in join (“collective”) action with the BMA. An overwhelming majority across Derbyshire and the UK said yes.
This is NOT about pay but about General Practice receiving the amount of funding needed to employ enough doctors, nurses and other staff to provide sufficient appointments and for our staff to work safely.
As GPs, we have for years been doing work that is to funded and not contracted due to gaps in commissioned services and pressures in secondary care services; we have been doing so out of concern for our patients and to ensure that you continue to receive the care you deserve. However, with chronic underfunding and increased demand it is no longer sustainable for us to continue working in this way.
Across the country, since 2015, we have seen 1600 Practices close or merge, there are 6 million more registered patients and 2000 fewer full time equivalent GPs. Our funding levels are significantly lower than 2018 levels.
The joint action across the country is hoping to force the government to look at General Practice and urgently reconsider the amount of funding it receives.
Though you may hav heard this referred to in the press as industrial action; this is factually incorrect. This is not industrial action. We are not on strike. This is “collective action” which is about working legitimately within our contracts. We will not be doing anything that compromises your safety, and we will not currently be going on strike. But we are fighting to be able to provide better services to you.
Please continue to use our services as normal and rest assured that patient care is still our priority.
We hope you understand that we are taking this action to ensure that general practice locally, in Derbyshire and across England is there for our patients in years to come.
There were no questions or comments from members following the presentation.
The Chair thanked CMA for the update.
Any other business
AccuRx/Sysm1 Text Messages and Notifications: The Chair had asked CMA prior to the meeting if there had been a change to the way text notifications were handled. CMA advised that the messages were now being sent as notifications through the NHS App, and would only come through as a text message if a patient didn’t have the NHS App, or if the notification hadn’t been accessed/read on the NHS App after a specified period.
CMA advised that this was a national change and not something that had been implemented at practice level.
Date of next meetings
The next meeting of the PPG was confirmed as Thursday 20 November 2024 from 18:30 at Moss Valley Medical Practice.