Patient Participation Group Wednesday 12th June, 2019

at 2 p.m.The Dining Room, Hertfordshire Community NHS

Trust, Gossoms End, Victory Road, Berkhamsted, HP4 1DL 

AGENDAMembers are respectfully reminded that the PPG meetings are to discuss

communal matters; individual problems should be referred to the Practice Management.

1. Introductions and Apologies. New members

2. Notes of the meeting held on 10th April, 2019 (attached)

3. Matters arising:(A) update on

1. telephone system2. online services3. staffing

(B) PPG Format. At the last meeting Members were asked to consider how they thought the PPG might evolve after July for discussion at this meeting. Please see attached note.

4. Gossoms End -update5. Merger with Rothschild Surgery Tring-update6. Medicine Wastage: Members will have read the item

on Medicine Wastage in the May Newsletter. Does

anyone have any suggestions on how such waste might be curtailed?

7. Date and Venue of Next Meeting

8. Any other relevant business

PATIENT PARTICIPATION GROUP

Wed, 10th April, 2019 at 2 p.m.

*Ros Ridout, Chairman(RR)Mary Anderson Wendy Banfield (WB) #Janet Bax Lydia Carmichael   #Graham Cartmell*June Crawley#Brigitta Case *Fay Cuthbert*Madeleine Donohue (MD)Sheila Francis *Sally Hodes *Sue Hood*Sarah Houseman *June Lightfoot (JL)*Allyson MacDonaldBarbara Markovic #David Martin #Jane Maskell

#Liz Maxwell *Linda Morgan *Pam Nicklin#Pat Oakley Penny Perry *Margaret Pike Kathy Ridges*Dr Chris Side            *Peter Such*Maggie Tomlin *Mike Wall, Group Sec. (MW)Howard Wells*Liz Wood *Judith Young *Dr Caitlin Bevan (CB)*Lynn Dalton (LD)*George Edwards (GE)*Sue Rivers-Brown (SR-B)*Shari Wharton (SW)

Present * Apologies#

1. Welcome by Chairman.

The Chairman, Ros Ridout welcomed the following:-

Dr Caitlin Bevan, Berkhamsted Group PracticeSheila Burgess, Consultant Practice Manager, Rothschild HouseLynn Dalton, Director of Primary Care, Herts Valleys Clinical Commissioning GroupGeorge Edwards, Chairman, Rothschild House PPGSue Hood new PPG memberSue Rivers-Brown, Practice Manager, Rothschild HouseShari Wharton, Deputy Practice Manager, Berkhamsted Group Practice

2. Notes of the meeting held on 13th February 2019. Approved.

3. Matters Arising:

update on telephone system/online services/staffing: SW reported answering times continued to improve with 4 or 5 receptionists on duty at most times The morning sessions, being dedicated to fixing appointments, delays were caused by calls on other matters such as repeat prescriptions, test results and queries regarding the online booking system, the last of which continue to be dealt with by a help service operating between 9 and 11 a.m. on the last Thursday of the month thus helping patients experiencing any difficulty. SW also drew attention to the fact that during March 100 patients did not attend for their appointments placing an unnecessary strain on the system. It was agreed that the above be added to the next Newsletter (MW/JL)

Dr Bevan reported that Dr Finn was to leave the Practice in June. There is a full complement of receptionists & nurses but not doctors.

Both Diabetic Nurses Have left BGP. 2 clinical pharmacists have been employed for 2 sessions a week; one of these has been appointed to look after Diabetic Patients; concern was expressed re the adequacy of the amount of time allowed, as

there are quite a number of Diabetic Patients at BGP.These two clinical pharmacists each worked one morning a week, mainly for the treatment of diabetes. As they are not directly employed by the Practice but through NHS England more time has been requested. Patients requiring treatment are referred by their GP.

The Bare Bones Guide-has been printed and placed in surgery receptions. This guide was also used as the basis for a hand-out at the Memory Event. The Guide along with other relevant PPG matters now appeared on the Practice website and is included in the new red folders to be placed in both Surgery Reception areas.

The name of the PPG. It was agreed that, until the proposed merger, it would be inappropriate to change the name at this time. Similarly the Terms of Reference and the Virtual Membership items are left till after July. (MW)

Newsletter- the first issue was published in mid March via the surgery internet and circulated to members. Reception areas and pharmacies. Copies were also available at the Memory Event.

4. Gossoms End Update:

(a) RR reported that the Gossoms End Project to provide a new base for the Berkhamsted Group Practice was now due to start in July and it was hoped would be finished in March 2020. Lynn Dalton clarified the next steps and explained that the timing was due mainly to changes at national level on the utilisation of Estates Technology Transformation Funding (ETTF). NHSE has recently confirmed that those ETTF projects that are proposing to use existing NHS premises assets may be able to receive 100% funding; however funding is dependent on a number of actions being completed including the submission of detailed architect plans, supported by a full business case. On the basis the partners were seeking a merger with another practice the plans could not be

finalised (design freeze) until the merger with Rothschild House was confirmed. This was to enable a joint review by the partners of both practices on the proposed plans re: future use.

The whole scheme will be dependent on final approval by NHS England upon submission of detailed plans being submitted to NHSE for final approval. The partners of Rothschild House and Berkhamsted Group will engage with patients on their proposed merger prior to submitting their merger request to the CCG seeking formal approval.

The introduction of Primary Care Networks (PCNs) throughout NHS England would, coincidentally, occur in July, but has no direct bearing on Gossoms End.

(The subject of PCNs is covered later in these notes)

(b) Meeting Room: RR raised the matter of a room being available in the new surgery for PPG and other meetings. LD advised that it was intended that adequate provision would be made, CB added that clinical requirements would have to be given priority but that it was hoped such a facility, possibly multi-functional, would be included.

(c) JL asked when the plans would be available for comment by the PPG and LD indicated that they were aiming for the end of May. The partners may liaise with the Assistant Director of GP premises and share the plans when ready, but that design freeze has already been achieved and the architect is currently drawing up the detailed plans. Sally Hodes asked whether the building would be user-friendly for Alzheimer sufferers and LD advised that the architects producing the plans are experienced at producing plans for GP premises including taking into account statutory premises requirements and she anticipated such needs would be taken into account.

5. Memory Event:

MW reported on the successful Memory Event held on 3rd April at Berkhamsted Civic Centre, attended by about 150 people of which about 120 were members of the Public + about 30, speakers, stall holders & Helpers.  The evening was generally perceived to be worthwhile with good feedback some of which awaited analysis. The return of feedback forms was 42 but MW thought this most likely because the evening had been attended by couples only one of whom would have thought it necessary to submit their views. Attendees were asked to indicate how they had heard about the Event. As expected a number of people ticked several boxes but as previous Evaluations showed “Word of Mouth” remains the most popular.

JL who had organised the PPG stand at the event reported that they had issued information about the role of the PPGs and their membership. Manor Street Practice was also represented on the stand. Four people had expressed an interest in joining our PPG.

George Edwards from RHS PPG had also kindly attended. JL advised that they had received no questions about the merger mainly because most seemed unaware of the proposal.

RR reported on the results of how guests had learned of the event with the majority being by word of mouth followed by posters, Surgeries, social media and through their organisations.

RR thanked Wendy Banfield and all concerned with organising the event.Wendy had also indicated that she wished her thanks as Chairman of the BPG be recorded to all the volunteers who had helped make this a success.

6. Merger with Rothschild House Surgery, Tring:

Dr Bevan explained the background to the proposed merger in that the Berkhamsted Group Practice partners had in

November, 2018 given consideration as to how to improve the services available and make the Practice more sustainable from a clinical and financial view. Whilst the Boxwell Road and Milton House surgeries were considered good practices the nationwide difficulty of recruitment of medical staff meant that practices such as BGP struggled to maintain an adequate level of service, a situation made more difficult by the loss of Dr Finn. The Partners decided to approach the Herts Valleys Clinical Commissioning Group as to what options existed. Accordingly the BGP Doctors appealed to the CCG for help, in Dec. 2018.

Lynn Dalton, Director of Primary Care at the CCG outlined the options. These were:-Merger with another local practice. If the partners choose to resign their contract the CCG would have to consider the options of putting the contract out to a full commercial and competitive tender that would enable a range of organisations to bid for the contract including private companies. Or close the Practice and reallocate the patients to other practices.

This would have been impractical as there aren’t enough alternative surgeries in Berkhamsted to absorb that many patients.

The suggestion that a merger with Rothschild House might be possible was considered the best option. It is a successful practice with experience of mergers, it is a training practice which greatly increased its recruitment potential and the economies of scale meant both practices could be financially viable.

Practices elsewhere in the CCG area were approached to see if any might be interested in a merger and Rothschild House was the frontrunner, the patient approach of the two surgeries being similar.

It was emphasised that this was not part of the NHS long-term plan for Primary Care Networks (PCN’s) that will bring

general practices together to work at scale. However the fact that all Berkhamsted Practices were to be in the same PCN Group as all Tring Practices was another advantage. Practices have to submit their sign up form to the CCG by 15th May confirming their proposed PCN and the names of the practices in the PCN. The CCG will be required to review, agree the PCNs and ensure there is 100% coverage across the CCG and report to the position to NHSE at the end of May. Being in a PCN will bring additional funding and staffing but with the expectation of expanded service delivery and working in an integrated way with other provider organisations

For more info on PCNs please visit

https://www.england.nhs.uk/gp/gpfv/redesign/primary-care-networks/

or

https://www.kingsfund.org.uk/publications/primary-care-networks-explained

Sue Rivers-Brown, Practice Manager at Rothschild House and George Edwards, Chairman of the Rothschild House PPG outlined how the previous mergers had benefitted their practice and how they felt the same would be true of Berkhamsted Group Practice.

Members of the Group asked about the “Rothschild House model of care” quoted in the initial announcement of the merger. S R-B explained this was based on patients being able to see their named doctor (on routine appointments) and Dr Bevan confirmed it would be her wish to re-adopt that practice which circumstances at present did not allow. Additionally the R H appointments system was operated on a triage basis with priority obviously given to urgent cases. At present Rothschild House is able to offer appointments within 48 hours. This was all welcomed by the PPG.

1 or 2 GPs from Tring would be allocated to Berkhamsted and the vacancy filled at Tring. As previously stated it was anticipated that the recruitment of staff for both Practices would improve because of the scale and “training” status.

Pam Nicklin told the meeting that she had been invited to Rothschild House to speak on “Health Walks” to a meeting attended by over sixty patients on Pre-Cardiac Rehab and had been impressed with the pro active educational approach of the Practice.

George Edwards told the group that his PPG had received excellent support from the Practice with the same GP attending their meetings. Markyate PPG remained separate from Tring though they do co-operate

He also mentioned the Purple Star Award presented to Markyate surgery and The New Surgery, Tring in recognition of providing excellent health equality for people with learning disabilities.

This accreditation was originally awarded to Rothschild House Surgery and Little Rothschild Surgery in June 2017.

(more details can be found here)

https://www.rothschildhousesurgery.co.uk/rothschild-house-group-receives-purple-star-award-for-providing-outstanding-services-to-patients-with-learning-disabilities/

The merger is still subject to a formal consultation process including public meetings organised by the CCG which are being scheduled for May. The Group expressed concern that many patients were still unaware of the proposal; any notice having been available only on the internet. LD indicated that letters could be sent to each household affected and SW agreed to examine the possibility of using text messages to advise patients of the meeting(s) (SW)

7. Format of the PPG.

Following on from the discussion of the proposed merger the Chair asked the group to give some consideration as to how they thought the existing Berkhamsted Group Practice PPG might continue post merger. Given that we have a current membership of over 30, (Rothschild House Group is much smaller) and presumably wish to continue to reflect the views of the Berkhamsted Group Practice patients whilst having a role in the merged practice, how might the structure of the Group best achieve these aims? There would appear to be a need for a small co-ordinating group for rapid response & organisation for the Berkhamsted Group PPG and a small group comprising members from both Practices to consult, and collaborate on matters affecting all.

MD stressed the importance of maintaining the current access patients have to Stoke Mandeville & other Bucks based services.

Members were asked to consider how they thought the PPG might evolve after July and this would be discussed at the next meeting on 12th June 12th 2-4pm at Gossoms End. Each PPG will retain their own Group but RH, Berkhamsted PPG & Markyate will form a small Exec.  Group, probably of Chairs & Secs, to consider common strategy and Policy such as Terms of Reference, names of each Group etc. (See 3c).  RR urged members to consider what they wanted from our Group and to convey ideas regarding this to MW or JL so that they can be published in the next Newsletter and considered at our next meeting.

8. Any other business.

The following invitations have been received from NHS Herts Valleys CCG

GP Practice Patient Group Network – 'let's get connected and support people to live well'

We would like to invite you to a patient group session where we will discuss some initiatives that GP patient and community groups can get involved in to support people to live healthily. 

The agenda will include examples of involvement in parkruns, healthwalks, social prescribing, preventing loneliness, well being, healthy eating and smoking cessation.  We will start the meeting with a chair based exercise 'taster' and end the meeting with a dementia friends session (supporting patients living with dementia to live well).

Date:               Monday 29 April 2019

Time:               9.45 – 2pm

Venue:            Stanborough Centre, St Albans Road, Watford,

Parking:          On site

Catering:         Sandwich lunch and refreshments provided (please advise on any dietary requirements)

To book or for more information contact heather.aylward@nhs.net

(b)      Equality Delivery System 2 review and grading event  (have your say on equality in health care

NHS organisations are required to collate evidence and gather feedback from stakeholders on performance which includes a score rating of underdeveloped, developing, achieving or excelling.  The Equality Delivery System 2 (EDS2) is a national equality performance toolkit developed by NHS England and is

in the NHS standard contract and the CCG Assurance Framework.   The process allows the Trust to focus its efforts on improving access, experience and outcomes for groups.   

You are invited to a workshop, details below, to score Hertfordshire Community NHS Trust's efforts on improving access, experience and outcomes for everyone.

Date:               Monday 29th April 2019

Time:               1.30pm to 3pm

Location:       Friends Meeting Room, Harpenden Memorial Hospital, Carlton Road, Harpenden, AL5 4TA.https://goo.gl/maps/UXKaUg7RAyn 

For more information and to book a place please contact:  marta.searle-barnes@nhs.net

The Chair (Ros Ridout) thanked Dr Bevan, Lynn Dalton, Sue Rivers-Brown and George Edwards for attending and contributing to the discussion.

The meeting closed at 3.57 p m.

Agenda Item 3(B)

Future Format of Our PPG.

1. Introduction

At our last meeting the PPG was asked by the Chair, Ros Ridout, to consider what they wanted from our Group post-merger and to convey any ideas to either Mike Wall or June Lightfoot so that they could be discussed at our next meeting (12th June).

Such comments will, of necessity, also be viewed in relation to the merger with Rothschild, Tring & in the longer term, the Primary Care Network.

It was suggested that each PPG would retain their own Group but Berkhamsted, Rothschild House, & Markyate PPGs would form a small Co-ordinating Group, probably of Chairs & Secs, to consider common strategy and Policy such as Terms of Reference, names of each Group etc. Each Practice will continue to have its own PPG.

2.Comments received so far are, generally, in agreement that:-

a. each PPG should continue to represent the views of their Practices’ patients. They should be representative of their

patient base as far as possible & most importantly of their patients’ concerns & requirements;

b. ideally, the BGPPPG should comprise up to about 30 active members, willing to take on active roles and responsibilities around specific issues or activities when needed/appropriate.(e.g. Membership Secretary or acting as PPG rep in regard to the Surgery move, or undertaking patient surveys) .

c. the option of Virtual Membership should be developed d. a smaller BGPPPG Steering Group could be formed

comprising the Chair, Group Secretary and two other members.

The BGPPPG Steering Group would

provide stability & consistency, take overall responsibility for organising the

meetings, offer leadership & a contact point for communication The Chair and Group secretary could meet with the

same number of Rothschild /Markyate PPG members on a regular basis via the co-ordinating group once the merger is established to  ensure that each PPG is satisfied with the merged practices & in general agreement about the way forward

e. in regard to the PCN there should be a strong patient voice within the PCN and it should come from the PPG's in order to maintain proper contact with the grass roots- the patients

3.Reservations expressed by members at the above included:-

More work and time commitment for the Steering Group

a. If we have three separate groups and meetings of core personnel, that will involve more meetings and travelling

b. There needs to be some mechanism for ordinary members of the PPG to make meaningful contributions or proposals during PPG meetings.  This could be done by prior notification to the Group Secretary by members who wish to contribute.  At present the meetings seem to be modelled on an ‘information giving of chair and manager activities’.

c. Can all attendees hear the Chair and debate clearly at PPG meetings?

d. If there is a Steering Group, which makes sense from the functionality point of view, it would be important that minutes of their meetings be circulated to the wider group and there be some feedback mechanism via the Steering Group minutes secretary.

4. Addressing the reservations above the group are asked to consider the following:-

(a)and (b) In order to reduce the number of meetings attended & provide cover for sickness & holidays should the four Steering group members have 2 appointed deputies?

(c) Should an item “Members’ Matters” be added to future agendas? (prior notice having been given to the Group Secretary)

(d) the Practice Manager be asked to ensure when the Gossoms End works are finalised that a meeting room be provided , with adequate layout for at least 30 members with a loop system?

(e) the clerking arrangements for the Steering Group and any Co-ordinating Group for PPG’s have yet to be agreed but as always volunteers would be welcome. It would, as far as possible, be intended that Notes of meetings of either be circulated to all Members and any “newsy” items included in the Newsletter. Urgent and significant matters would be circulated via email as at present.

5. Decisions.The PPG is asked whether they agree that, post-merger:-

1. as a matter of principle, each Practice retains its own PPG;

2. ideally, this PPG should comprise up to about 30 active members,;

3. While the Merger takes effect the BGPPPG still needs to develop itself and we need to find individual members with some experience if possible, to volunteer to take stewardship of the following roles and activities which are in suggested priority:

PPG rep in regard to the Surgery move ; Developing Virtual Membership and undertaking

patient surveys Membership Secretary;

4. a steering group be formed comprising the Chair, Group Secretary and two other members and 2 deputies. If agreed two members and 2 deputies are sought for this role in advance of the merger.

5. The Chair & Secretary of this Group to attend Co-ordinating meetings held jointly with Rothschild and Markyate Representatives to discuss matters common to all three PPGs including the Primary Care Network.

6. any other decisions arising from this discussion