Open House event – 17th June 2014

Facilitator Georgie Herskovits The task: Participants listened to a 15 minute presentation about Primary care in London. This consisted of a brief overview of the GP standards and the work carried out to date. Following the presentation, they were asked to have a discussion around what they valued about their local primary care services and what could be improved. At the end of the discussion each table provided feedback on three key issues discussed.

SUMMARY OF TABLE DISCUSSION:

Discussion topics

PPGs

Is there a way to compel practices to have PPGs? One practice changed the date of their PPG with little advance notice and then when no-one went, they said a PPG was not needed for their practice.

Do practice managers receive training in setting up and running PPGs? Also do the patients who attend these PPGs have training?

PPGs are independent and should network but not merge or be used for the aim of the CCG

PPGs – some patients love their GPs and don’t criticise them and GP spend time charming them as they are on their PPG and this influences the patient. PPGs should be independent and representatives should only be on a PPG for a certain length of time.

Access

Staff in one practice were re-rostered so that all reception staff took turns to answer the phones. It worked very well. Other practices should consider re-rostering staff to accommodate the needs of patients

One practice started using a “doctor first” hybrid approach which worked very well and DNAs dropped.

Patients want to be able to call the practice any time of the day.

Patients are happy to have a phone call sometimes rather than face to face

One practice has a Saturday AM service for workers only which patients are happy with

Patients said that if they called their practice at 4pm they would be happy to wait until the next day for an appointment

In one practice as long as the carer calls by 3/4pm, the practice can co-ordinate an appointment for the elderly patient. It would be a priority appointment.

Cultural issues around accessing primary care-some people automatically go to A&E

One patient didn’t have a telephone or internet but lives close by his practice. He prefers to see his own GP but will need to wait 1 or 2 weeks for this. If it is urgent he will see any GP. The receptionist will ask him to wait at the practice or come back later.

One patient said her practice update their computer system regularly and now the receptionist has a better appointment system

Good emergency system

Some ethnic groups aren’t used to primary care and prefer A&E so better communication about the options could resolve this.

There is a need to raise awareness of primary care.

It would be useful to have non face to face consultations as well

Practices in an area should close at 8/9pm a couple of nights a week so prevent people from going to A&E

Patients commented that while they were talking at reception, the phone is ringing and patients were put on hold meaning they run up big phone bills.

One patient whose son had mental health issues gave an example where access is an issue. His practice always requires the patient to call by 8am. For this patient, early mornings are not good because of the medication so he never gets chance to ring by 8. He also finds the staff are quite abrupt and they need a better approach to someone with mental health problems. There needs to be 2 way listening to what the patient needs. Receptionists should have training so they can deal better with patients with mental health problems. Her son is now nervous of the staff at his practice so his Mum always needs to go along. He often throws letters away but is never rude to the practice staff. There needs to be a link to mental health services to see how they manage with these patients as there may be good ways to help. One idea was to put a symbol on the patient’s record so the receptionists know the patient has mental health issues and can speak carefully to the patient.

One patient said her practice tell her to call 999 if it is urgent rather than allowing her to speak to a GP.

One patient’s practice is open 7 days from 8 to 8. It’s a hub for all of Harrow area to avoid patients needing to attend A&E. She doesn’t get to see her own GP though but that wasn’t an issue for this patient.

Extending services

It’s a good idea to have a pharmacy attached to the practice

A paediatric clinic (run by GPs) is required to take the pressure off A&E and WICs

A paediatric WIC run by GPs at a weekend is invaluable.

There should be drop in clinics at supermarkets

There should be phlebotomists in a pharmacy (Spain do this)

It would be useful to have an older person’s clinic.

Phlebotomy service every day would be useful.

The physiotherapy service should be taken out of hospital and out of GPs and put into places like town centres e.g. leisure centres where people could access them better. They would still need to be referred by GPs. One example given was an area where they put STD clinics and physio in a leisure centre. In the day it was for physio and in the evening for STDs. It took the pressure of practices. GPs could refer in for up to 6 sessions

Collaboration across GP practices would be good to have specialist services like GPSI, neurology.

Co-ordinated care

Need to find ways of keeping carers informed

Co-ordination of care needs to be improved

For on-going and complex needs, some GPs need to be more aware of children with palliative care. Parents need to know who they can access GP support at this time. For example, a community nurse can help with blockage of a tracheostomy. We need to work more to link up and refer in GPs giving more authority to nurses. GPs need to let go of control.

Integrated services would be useful

Proactive care

Community groups could be utilised more

Social prescribing is useful for things like dance classes, language classes, exercise class.

More screening would be useful.

Self help groups and wellbeing groups are good. For example, arthritis care set up groups so maybe with groups of practices they could have services like physio within a practice or diabetes care within a practice.

Navigators are good as they support patients.

Other issues

Nurses should be skilled up to take on more work

Initiatives should be made to standardise care/equity of service

Receptionist are better in London than they used to be (in terms of rudeness)

Open House event – 17th June 2014

Facilitator Keziah Bowers The task: Participants listened to a 15 minutes presentation about Primary care in London, this consisted of a brief overview on the GP standards and the work carried out to date. Following the presentation, they were asked to have a discussion around what they valued about their local primary care services, and could be improved. At the end of the discussion each table feedback three key issues discussed.

SUMMARY OF TABLE DISCUSSION:

Discussion topics no

What patient representatives said they value about their primary care services - Personal relationship with doctor - Very knowledgeable nurse – she calls the doctor in when required - Can ask GP to call me back - Nurse triage system works well – nurse can refer on to GP - The Doctors listen well - GP was aware of local third sector / charity services which could offer support

with long term condition

What patient representatives said could be improved about their primary care services

- Need greater consistency and standards - Not everyone uses 111 service - What you get depends on the size of the practice - Create more nurse let clinics - Often no appointments or asked to call back - If urgent / same day, willing to see any doctor. Usually 2-3 weeks to get the

doctor of your choice. - Would like to see more GPs with special interest – the GP is good and listens

but is not always up to date with specialist / complex conditions. Patients said they would be willing to travel to a specialist GP service e.g. neurology, rather than be referred to a hospital.

- Services are not delivered the same way – maybe a franchise system would be better?

- 111 Service – all doing things in a different way, no information sharing e.g. for safeguarding

- Some practices use receptionists to triage – patients don’t like this, lack of privacy, lack of clinical expertise.

- Patient is part of a PPG – and feels that they now receive better care because of this – concerned that this is not the same care that patients who are not part of PPG receive.

- Public perception is very different from profession / clinical opinion - Concern about waste in the NHS - Too much bureaucracy – prevents innovation – abuse can happen even where

staff have been vetted and checked more unannounced inspections e.g. of care homes etc – some patients are prepped to answer inspectors questions.

- Concerned about district nursing – there are shortages, they are very stressed which would lead to mistakes and accidents due to high levels of stress.

What patient representatives thought they would like to see in their primary care services

- Case Study – Guildford & Waverly – patients with referrals are looked at to consider what is the best referral option e.g.. seeing a specialist GP may be more appropriate than going straight to hospital.

- Patients with long term conditions want continuity - Community Hospitals where you can get tests and have results quickly - Protected learning time for GPs to learn about local services that can support

patients e.g. third sector groups that offer services - Community matron – someone to connect people and guide them through

the system – especially for elderly people and those with long term conditions (hospital departments only focus on their own specialty, GP is supposed to be the person who guides patient through the whole system)

- Polyclinics - Patient’s GP had been recently refreshed – staff seem more friendly now. - Develop communities to look after each other – across all ages - Case Study – Talking News Islington – an organisation that supports blind and

visually impaired people by recording news items. Social Care sensory list – when people are certified as sensory impaired, they should have visits from social services, but two people recently identified who hadn’t had a visit in 5 years. Age UK has started visiting some of these people.

- Prevention – o It would be good if GPs had information of prevention activities going

on in the local area so that they can encourage / support patients to undertake those activities.

o Acute & Primary clinicians could support patients to get involved in activities e.g. walks, gardening, TaiChi, cookery classes etc – patients could provide these but need support to set these up and for clients to participate.

Open House event – 17th June 2014

Facilitator Heleno Ferraz The task: Participants listened to a 15 minutes presentation about Primary care in London, this consisted of a brief overview on the GP standards and the work carried out to date. Following the presentation, they were asked to have a discussion around what they valued about their local primary care services, and could be improved. At the end of the discussion each table feedback three key issues discussed.

SUMMARY OF TABLE DISCUSSION:

Discussion topics no

It is not possible to get an appointment on the same day, usually 2 weeks wait.

Call back service works for some people but it is not ideal, sometime you want to see a professional and explain the issue face to face

Pharmacist could be up skilled and take on some of the volume of work from GPs. They are more accessible and often understand more about meds than GPS

We need more GPS and practice nurses to cope with the increase in population

How does a member of the public know where to go for help?

How much more consultation is required before action is taken, we know the critical issues in primary care already.

We need to survey GPs appoint and deal with DN’s

GP referral is an issue – GPs are not referral or when they do, they refer to a cheaper provider

Positive experience with the GP practice, always see GP when needed , surgery staff always helpful

Single owner with salaried staff is a big problem, what happen to continuity when salaried GPs leave

PPGs group not compulsory how can patient give their views, my surgery keeps putting it off meeting with us.

GP should be able to Skype a consultant if he/she , with the patient in the room to get advice on whether a referral is needed.

Home visits were very useful and should be reintroduced

Some questions

1. Can the working population register with 2 GPs – so they can make appointment near work

during working hours and home during weekends

2. How do we tackle low referral rates by GPs due to lack of awareness about conditions e.g.

hearing loss, patient need much more power to refer

3. Diagnostic tool usage increase. Primary care to increase early diagnostic hearing screeners to

tackle undiagnosed hearing loss by GPS or Pulse oximetry test on babies to detect respiratory

CHS and other conditions

4. GP appointment London wide review is needed

5. Review of commercial incentives of prescription

6. Patient dying from over prescriptions because of commercialisation

End of summary (Heleno Ferraz)