Patient Participation Forum

In attendance

• BB @ HF    
• SK    
• JH @ HF    
• AH HF
• AS@ HF        
• VR @ HO    
• MB @ HF
• BB@HF        
• JE @ BH    
• CK Operations Manager @STK
• LB @HF            
• Dr CG Partner @ STJ
• TS @ STJ            
• NDD @BH            
• PDD @BH            

Welcome introductions

JH welcomed everyone.

Terms of engagement:

• Confidentiality – must be maintained at all times
• Safe environment – we are here to support each other
• Respect – we are respectful of each other’s views/ opinions
• Learn – we are here to share knowledge and experiences, and we will not judge and point fingers
• Positive – please use positive language

Carers

SK outlined how Imago operates and supports unpaid carers. He highlighted the benefits and government support options available to unpaid carers.

LB raised some questions regarding support for unpaid carers and how they can access more information. SK agreed to send detailed information to her via email.

Carers Champions at Site-Level was explained.

SK has agreed for providing training to the Carers Champions to improve support and outreach.

There was confusion regarding the visibility of carer support resources/materials/poster at surgeries. VR clarified that informational posters are displayed at all sites, and relevant resources are also accessible on the website.

VR encouraged PPF members to visit sites to see first-hand how services could be improved, particularly in arranging carer support materials like posters. She also proposed that the agenda for the next meeting be posted on the website so that PPG members can stay informed and prepared.

Few PPF members recommended that surgeries take a more active role in identifying carers, educating them about available support, and directly sharing information on assistance options either via post or some information leaflet.

Update on achievements with support of PPF

JH shared recent accomplishments made possible with the support of PPF members and explained how PPF members are being promoted on the organization's website, where meeting minutes and schedules are also accessible.

All sites are holding regular meetings with their PPF members.

PPF Members have agreed to the constitution, and they are in the process of selecting a chair.

The job description and constitution for PPF are available on the website.

JH explained how PPF members provide invaluable suggestions to improve patient experience. One member contributed to a poster that is now displayed in surgeries.

TS inquired about the purpose of screens in the surgery, questioning if they were for virus protection or other reasons. JH explained that they serve both purposes—protection from viruses and safety for staff. JE added that the screens are also necessary due to instances of aggressive behaviour from some patients.

It was suggested that, by law, the surgery staff should provide a full name when answering calls from patients. JH agreed to review this requirement.

PDD recommended sending important information to patients via post and suggested checking with the post office on cost-effective mailing options. JH noted the financial constraints but agreed to explore this option.

It was suggested to distribute informational leaflets at local pharmacies for easier patient access.

The group discussed the idea of recruiting volunteers to assist, but JH noted difficulties in finding volunteers. However, this option will be further considered.

It was suggested that surgery staff contact elderly patients via phone calls rather than text messages sent to carers, as many elderly patients have only landlines and limited experience with mobile devices, information is missing when carers gets notification on their mobile phones via a text informing they are due for their asthma review. It was agreed that this will be reviewed. JH

Annual GP survey in house results

Time: 6:45 PM (Meeting extended beyond scheduled end time)

VR presented a summary of the in-house results from the Annual GP Survey. (Please see attached slides for details.)

Discussion highlighted TLCP's performance in comparison to national data marginal progress in several areas of General Practice management.

The survey indicated a general lack of patient awareness regarding the "extended access" service. TLCP is planning to enhance the promotion of this service to ensure patients are informed and can utilize the service fully.

Positive patient experiences with the GP practice were noted in the survey results.

PDD expressed concerns about the lack of continuity in patient care due to recent changes in the GP staff leading to patients seeing new doctors regularly.

VR addressed these concerns, explaining that several GPs had retired or relocated, but TLCP has proactively recruited over 10 new GPs to maintain continuity and increase appointment capacity.

Survey Findings and Next Steps

VR summarized the overall survey findings, including the areas for improvement.
TLCP shared planned changes based on the survey feedback to further enhance patient experience and practice performance.

TLCP to implement initiatives to increase patient awareness of extended access services.
Continued recruitment and retention efforts to ensure consistent patient care

BB raised concerns about the reception staff at HF, expressing dissatisfaction with the perceived lack of teamwork and specifically mentioning staff member OR, whose manner was felt to negatively influence the team.
VR assured that this feedback will be reviewed, and steps will be taken to address any issues identified.

New Telephone System Update

Update on New Telephone System and Patient Support Initiatives were explained

PDD emphasized the need for a text message reminder system for patient appointments, they feel this initiative aims to help patients particularly the elderly who may otherwise forget their appointments. However, it was noted that there is a limited number of text messages available to send each month, which restricts the frequency of reminders.

They also explained about a system in the telephony called “barge and whisper” which allows managers to listen in on active calls. If necessary, team members can join the call midway to provide additional support or guidance while the patient is still on the line. 

VR provided an overview of how the new telephone system operates, including data on the number of calls answered. Some issues with the call back facility were also discussed. In cases where patients call from withheld numbers or work phones (which are not registered in the system), the call back option may fail. This limitation is being addressed, but it currently impacts the reliability of returning missed calls.

VR also explained the challenges in recruitment for care navigators. Efforts are underway to recruit more care navigators to improve patient support and manage call volumes effectively. However, recruitment has been increasingly challenging as staff quitting rates are high due to various factors.

The document also includes data on the new phone system's performance.

Close

Attendees

TLCP:

• Jyothi Eregowda (Jo) (Operations Manager for Belmont Hill and Modern Hill Surgery)

PPG Members:

Welcome and Introductions

Jyothi Eregowda (Jo) (Operations Manager for Belmont Hill and Modern Hill Surgery)

Terms of engagement

• Confidentiality – must be maintained at all times 
• Safe environment – we are here to support each other 
• Respect – we are respectful of each other’s views/ opinions 
• Learn – we are here to share knowledge and experiences, and we will not judge and point fingers 
• Positive – please use positive language

Khaled welcomed everyone.

Introductions

Members introduced themselves.

TLCP Updates

Successful CQC visit. – TLCP had a CQC visit on 21st and 22nd of January 2025. It was a successful visit where the inspectors were pleased with the overall performance of TLCP. We are still expecting the full report. Once it is received it will be displayed on our website.

Retirement:

It is with great sadness that I announce the retirement of Dr. Cristina Melchor. Her final working period at TLCP will be in March 2025. Dr. Melchor has dedicated over 40 years to her career as a GP, with more than 20 of those years spent at BH. She will be greatly missed, but we sincerely wish her all the best in her well-earned retirement..

Resignation:

We had 3 nurses from BH and MH who have found new pastures in their career. 

Nurse Jane, Collette and Carlene have moved on to new careers. We wish the best of luck in their future endeavours.

Paula Gordon the ops supervisor has moved on to new careers and we wish her the very best of everything.

We are currently trying to recruit for these roles. The job adverts are on and we are interviewing for these positions.

Improvements at TLCP

Same-Day Appointment System: Since May 2024, the GP practice has implemented the same-day appointment system for patients, providing more immediate access to care. Where their clinical query is dealt with by the Duty Dr Triage hub. At TLCP we offer more than 500 appointments a day across all 5 sites.  We have received positive Patient Feedback where Patients have responded positively to this system, appreciating the quicker access to appointments. 

Positive Patient Feedback: Patients have found the callback system helpful in reducing wait times and improving communication.

Care Navigators' Challenges:

Abusive Calls: It was highlighted that Care Navigators are often receiving calls from rude or sometimes abusive patients. This issue is affecting staff morale and their ability to assist patients effectively.

Introduction of the proposed TLCP PPG Structure

• Young mothers
• Pregnant women
• Elderly patients (65+)
• Young adults (ages 24 to 40)

Aim: Ensure diverse patient representation in discussions and decision-making

TLCP Constitution

• Patient forum meetings will be held quarterly
• TLCP-wide meetings will take place twice a year

Last years success projects

TLCP is very proud to have been successful in many projects. They are

• Hypertension, Chronic Kidney Disease (Multi-Morbidity), and HIV projects were successful.

Other News

Lewisham wide TLCP awards – we were aware the best PCN for Hypertension Management.

We also won Best Practice Manager of the year for Lewisham borough.

AOB

NA

Next Meeting

PPF members have agreed on the below dates:

• June 9th 4pm
• Sept 18th 4pm
• Dec 10th  4pm

TLCP AGM - will be held in May, but the exact date is yet to be confirmed.

Minute taker: OO HR (No PPF member volunteered) 

Attendance

Present: AS (Chair), BB, BO’C, SP, KG, R.S, J.H, A.G, GW, and O.O.

Appointment Booking & Communication

Availability & Access:

• PPF SP feel Patients struggle with routine appointment availability.
• RS The NHS App and Patient Access are only useful for specific services, leading to frustration. They found in their experience there are no routine for 4 weeks and that none are then released for a further month. However GW explained that further appointments are released daily at 8:00 AM & 6:30 PM on a first come basis. Appointments slots need to be allocated for NHS App, 111, duty doctor hub slots, site duty GP.
• PPF believe they still need to come in person at 08.00am is the best option. 
• Action: Add routine released slot times to the website.
• JH explained areas where improvements have been made:

Multimorbidity Clinic improving access:

• A new service for patients with three or more conditions (e.g.diabetes, hypertension, CKD) offers longer appointments to address multiple issues at once. Freeing up other appointments.

Call Waiting & Call Back Feature:

• PPF member RS shared an example: They were 24th in the queue at 3:15 PM.
• JH explained Patients can request a call back instead of waiting on hold.

Reception Staff & Call Centre

Care Navigator Training & Retention:

• Face-to-Face Reception Experience. Some patients reported good interactions; others noted staff were too focused on screens.
• Extensive training induction and probation plans are in place.
• There currently only two Care Navigators currently on site due to high staff turnover, 2 have been recruited. Generally we work two by two now. 
• Retention remains an ongoing challenge despite significant investment in training.

Call Centre Clarification:

• Calls are answered onsite during peak hours (8:00–10:00 AM), then routed to St. John’s call centre.
• Many patients mistakenly believe they are speaking with Hilly Fields staff.
• Action: Update website to clarify call centre operations.

Reception Challenges & Abuse:

• Some receptionists were noted for lack of engagement.
• PPF informed that Care Navigators face daily verbal abuse, affecting morale and retention.

Action: PPF request Staff retention to be a key topic at the AGM.

Reception Environment

Protective Screens:

• Screens cause communication difficulties but are necessary for infection control and health & safety.
• Design varies across sites (Hilly Fields has higher desks).
• Action: Raise issue again in the Manager’s Meeting.

BP Pod Placement

Privacy Concerns:

• Current placement is too close to reception.
• Alternative locations limited due to ceiling height and power supply constraints.
• Action: S.P. to assess the premises for better placement.

Budget Constraints:

No funding for a sit-down BP pod.

Website & Patient Communication

Search Function Issues:

• Website requires very specific search terms.
• A self-help section exists, but an additional search tool was suggested.

Staff Identification & Privacy:

• Name badges introduced, but full names/photos are not disclosed due to staff safety concerns and online abuse.

Health Education & Outreach:

• Regular educational updates (e.g., diabetes management) could reduce unnecessary visits.
• Period poverty project (free menstrual products) is awaiting funding from Lewisham Mayor. Currently, staff donations sustain the initiative, but this is unsustainable.
• Action: PPF asked to help promote the initiative in the practice and suggest ways to expand outreach.
• Food bank campaign also needs more visibility.
• Action: B.B. to distribute posters to churches, libraries, and relevant community spaces.

HIV Prevention (PrEP Pilot):

• From April 1, 2025, patients at risk can book a blood test and receive preventive HIV medication.

Hidden Work Survey (LCP Initiative):

• Tracks behind-the-scenes tasks like emergency appointments, lab results, safeguarding, admin work, etc.

Lewisham Innovation Award:

• TLCP won an Innovation in Health Award for blood pressure documentation improvements.

Patient Feedback & Surveys:

• Friends & Family Test: 83% satisfaction from 614 randomly surveyed patients.
• National GP Survey (Jan–March 2025): Uptake is low (~10% of the population).
• Action: PPF to encourage patient participation.

QR Codes for Reviews:

• QR codes placed around the practice, linking to NHS feedback.
• Action: Check if the QR link can be added to the website.

CQC Inspection

• Took place January 20–21, 2025.
• Results not yet received.

General Practice Forum Topics

Future discussions will include:

• Care Navigation – Role and efficiency.
• Staff Retention – Addressing ongoing issues.(Not appropriate for PPF)
• Screen Removal – Impact on patient-staff interaction.
• Preventive Medicine – Expanding patient education.

Action: Invite Care First to discuss their operations.

Open Saturday Planning

• Proposal: Host on a weekend for better attendance.
• Decision: Tentatively scheduled for summer (next meeting in May).

Other Sites' Meeting Minutes

• No recent minutes available from other sites.(Only current will remain on website to keep current, later copies can be obtained from reception at site)
• BB to create poster requesting voluntary contributions to food and Menstrual cycle donation and then distribute poster at local church, library etc. (Currently Management are deciding if this information can go on website as only HF are doing this currently )
• O.O. recorded minutes in the absence of a PPF volunteer.

Next Meetings

• Hilly Fields Site Meeting: June 10, 2025 (12:00 – 1:00 PM)
• PPF-Wide & AGM: May 12, 2025 (1:00 – 2:30 PM) at St. John’s Medical Centre
• PPF-Wide Meeting: May 12, 2025 (2:00 – 3:30 PM) at St. John’

Action points:

Action items to be reviewed and agreed by Managers and Managing Partner prior to the next meeting.

• Minute taker from PPF volunteer prior to meeting
• Website suggestion updates:
  • Add daily routine appointment release times 08.00am and 18.30pm to the website. Under Book a routine appointment. 
  • Update website to clarify call centre operations, all sites taking calls 08.00am -10.00am, then all calls divert to Call centre.
• Proposal: Host on a weekend for better attendance, Saturday open mornings as previously done last year so patients can be informed of all access avenues. Start with one site then roll out to joint TLCP meeting or individual meetings.
• PPF request Staff retention to be a key topic at the AGM, clarification required on how this will be supported by PPF.(Managing Partner does not think appropriate topic for PPF)
• Request that Preventive Medicine to be added to main AGM agenda in May2025 (This is already in place, further information will be shared from GP from TLCP)

Welcome and Introductions

• Attendees: Jyothi Eregowda (Jo) (Operations Manager Belmont Hill and Modern Hill)

No members attended the meeting.

Agenda

1. Welcome, Introductions And Apology

2. Terms of engagement

• Confidentiality – must be maintained at all times 
• Safe environment – we are here to support each other 
• Respect – we are respectful of each other’s views/ opinions 
• Learn – we are here to share knowledge and experiences, and we will not judge and point fingers 
• Positive – please use positive language

3. Minutes and Action From Previous Meeting

4. TLCP Constitution 

• HO Chair
• Patient forum meetings quarterly – date confirmation
• TLCP wide meetings twice a year 
• Recruitment of PPG members- actively looking for more PPG members

5. Access

• Digital Inclusion Hub
• Carer’s Champion at each unit
• Multi morbidity Clinics
• GP National Survey 2024 and Action Plan

6. TLCP Update

• Last year’s success projects for TLCP (Hypertension, CKD) 
• Upcoming Project- PreP Clinic 
• CQC Visit – High Risk Drug Monitoring
• GP Behind The Doors

7. AOB

8. Next Meeting

Welcome, Introductions and apology

• Minutes – ST (Sallie Taylor Operations Supervisor)
• Chair – VR (Veeru Rajamuthiah Practice Manager)

Attendees

• SK (Sue Kirkum –Administrator) SJ (Sylvia John- PPF Member) EJ (Ezekiel John) KW (Kelvin Wheelan) 

Apologies

•  EW (Elaine Winter) GM (Graham Mulholland) KA (Kerry Abass) OC (Oliver Carr) BA (Beverley Ammon) AB (Ann Baker) KH (Katie Hale)

Minutes and Action From Previous Meeting

• N/A

TLCP Constitution

• ST to send email to PPF members with Job description and request EOI for Chair person’s position. 
• Annual PPF wide general Meeting 12th May 2025 at St Johns Medical Centre
• SJ to draft leaflet to advise Patients  and promote the PPF and ST suggested having a pop up where ST, SK and PPF members can encourage patients to join the PPF ( date agreed Wednesday 18th June at 10am)

Access

Digital Inclusion Hub

TLCP has introduced a hub across the 5 sites to help service user’s support with using apps associated with their health. Service users can attend any one of the units on the dedicated date and time to seek support or advice. The support is provided by a trained Care Navigator at each unit. Information is available on the website and in the practice. HO hosts the digital hub on Mondays 11.30am to 12.30pm. Hodan is the digital inclusion champion for HO.

Carer Champion

VR mentioned that each unit within TLCP has a carer’s champion 

Who is a trained care navigator to support carers and the patients with any queries they have. Members raised queries if the champions have all the relevant information/access to support the careers VR stated that the Carer’ champion might not have the relevant or updated information however are trained to escalate or signpost to the required service eg social prescriber, Lewisham Carers Hub(imago), unit manager, leads so the service user has appropriate support. HO has a dedicated care navigator who will is currently going through the training.

Multimorbidity Clinic

The above project had triggered a process for management of 2 or more conditions effectively and efficiently in one enhanced appt. TLCP plans to implement the multimorbidity clinic from April 2025 focusing initial on certain long term condition and expands its other conditions. Urooj (GPA/HCA) is working alongside GPs with this project   

PPF member SJ highly appreciated a recent medication review that was extremely thorough. VR thanked and agreed to pass this feedback to the team member.

GP National Survey and Patient Survey

VR informed the members of the GP national survey for 2024 and its outcome. VR mentioned that TLCP as a practice hasn’t done well compared to local practices in Lewisham and nationally. The national survey is done yearly and service users from the registered practice are randomly selected to feedback on the practice service-using questionnaire. For TLCP 900 surveys were circulated and only 200 responses for received. Though this not a true representation of the service user, nevertheless, VR stated that it was important for TLCP to look at this feedback. VR explained the action put in plan following these reviews. Following these changes, VR stated that TLCP undertook a local survey in Oct 2024 on the underperforming areas and confirmed that there has been improvement as evidenced by the service user feedback.

VR stated Saturday Routine appointments are available at SJMC as part of our extended access requirement by NHSE. HO offer early morning appointments on a Monday from 7am. It was discussed that this is not widely advertised and should be displayed on our website and also on the phone message. ST will look into this.

Website -A new website is being developed for make it user-friendly. Kelvin suggested using the flags of the countries to allow non- English speaking users to be able to access the website. Suggestion noted. ST to raise this in the managers meeting.

Accessible Information Standard

VR stated the central hub has developed screening letters (cervical. Breast, bowel) in different languages and will be using these resources to engage with patients. VR stated it is start of the journey and TLCP will continue working on the different formats.

TLCP Update

• VR awarded best practice manager in Lewisham at the end of last year.
• Hypertension-TLCP was awarded quality improvement award for improving blood pressure patient management
• New phone system- now gives patients the option to have a call back instead of waiting on the line to be answered
• TLCP have recruited a new GP to start in May based at HO Tuesday to Friday. Also more pharmacists are being recruited we have advanced clinical pharmacist based at HO 2 days a week.
• Care Navigators have been receiving extra training and attend workshops during PLT days.
• HIV PreP Clinic TLCP has signed to offer HIV pre-exposure prophylaxis for reducing the risk of HIV infection. This service will operate from St Johns Medical Centre and will commence in April 2025 and is open to registered patient in Lewisham.
• CQC- VR stated that TLCP was inspected in Jan 2025 and most areas were found to be good except the high-risk drug monitoring. The high drug monitoring is drugs that are required for management of the health condition however needs regular oversight of the vitals for safe prescribing eg lithium for mental health or warfarin.
• VR stated that though there was a process in place, the CQC expectation was to reduce the quantity of the scripts for non-engaging patients. VR stated TLCP is awaiting the final outcome of the inspection.
• VR stated that introduced group consultations as part of the Health inequity process and seen the benefit of group consultation. The aim of group consultation in primary care is to bring together individuals for support with long-term conditions, helping them to better manage their own health and share their experiences and learning. Typically, it consists of 12 individuals supported by facilitator and a GP. Currently the group consultation is on hold and once the health inequity fellow is recruited, TLCP will look into reinstating group consultation.
• Chronic Kidney Disease. VR explained that TLCP is now part of the Southeast London (SEL) initiative in management of Chronic Kidney Disease. This is a pilot project that focuses on identifying patients that are not diagnosed for chronic kidney disease and doing a targeted/focus with diagnosed CKD patients. It is preventive measure to stop patients with stage 3 CKD disease to stage 5(dialysis).Interested practices in each SEL borough had to bid for the service and TLCP in Lewisham was selected to offer the service. The service is led by Dr Uti (clinical lead) and UA(Care coordinator). The process involves first initial 30 mins appt with UA to complete physical checks, blood, social, mental followed by another 30 mins with Dr Uti.
• GP behind closed doors, we have been approached to accommodate filming for the TV series, dates to be confirmed.

AOB

ST stated she wished to apologies for the inconsistency of prior meetings and has recently returned to TLCP in January and is passionate regarding improving the PPF uptake with patients. She will be organising a pop up to promote this prior to the next meeting and will email details to members to support this if possible.  Also all future dates of PPF meetings for the year will be on the website and posters to help promote and provide plenty of notice for those wishing to attend. She will also be meeting and encouraging the reception team to try to encourage new members where possible. Once we have an elected chairperson ST would like to work closely with them to build the HO PPF group.

Meeting dates for 2025

• 18th June: 10am to 12pm pop up in HO Reception to promote PPF
• 19th June: 6.30pm - Honor Oak Group Practice 
• 18th September: 6.30pm - Honor Oak Group Practice
• 11th December: 6.30pm - Honor Oak Group Practice

In attendance

TLCP:

• Khaled Chowdhury (Operations Manager for St Johns Surgery)
• Jyothi Eregowda (Jo) (Operations Manager for Belmont Hill and Modern Hill Surgery)
• Arial Tazrial Alam (CN)

PPF Members:    

Welcome introductions

Terms of engagement

• Confidentiality – must be maintained at all times
• Safe environment – we are here to support each other
• Respect – we are respectful of each other’s views/ opinions
• Learn – we are here to share knowledge and experiences, and we will not judge and point fingers
• Positive – please use positive language

Khaled welcomed everyone.

Introductions – members introduced themselves.

TLCP Updates

Successful CQC visit.

Improvements at TLCP

Same-Day Appointment System: Starting in May 2024, the GP practice will implement a same-day appointment system for patients, providing more immediate access to care.

Positive Patient Feedback: Patients have responded positively to this system, appreciating the quicker access to appointments.

Callback System: The call center hub has established a callback system, enhancing the patient experience by reducing wait times for inquiries and appointments.

Positive Patient Feedback: Patients have found the callback system helpful in reducing wait times and improving communication.

Care Navigators' Challenges

Abusive Calls: It was highlighted that Care Navigators are often receiving calls from rude or sometimes abusive patients. This issue is affecting staff morale and their ability to assist patients effectively.

Introduction of the proposed TLCP PPG Structure

• Young mothers
• Pregnant women
• Elderly patients (65+)
• Young adults (ages 24-40)

Aim: Ensure diverse patient representation in discussions and decision-making

TLCP Constitution

• Patient forum meetings will be held quarterly
• TLCP-wide meetings will take place twice a year

Last years success projects

• Hypertension, Chronic Kidney Disease (Multi-Morbidity), and HIV projects were successful.

Other News

Lewisham wide TLCP awards – we were aware the best PCN for Hypertension Management

We also won Best Practice Manager of the year for Lewisham borough

AOB

PPF members will get back with their thoughts about how can our staff handle abusive calls from patients. 

Next Meeting

PPF members have agreed on the below dates:

• 21st May 2024 at 16:30 PM – St Johns Medical Centre
• 20th August 2024 at 16:30 PM – St Johns Medical Centre
• 19th November 2024 at 16:30 PM – St Johns Medical Centre.
• TLCP AGM -  will be held in March, but the exact date is yet to be confirmed.