In attendance

• HF - AS
• MH-MC, EH, B
• BH-LB, PC, LC
• STJ - 
• HO - No Representation.

Welcome introductions

Jacqueline and Michael welcomed the members of the PPF Staff and PPF members introduced themselves

Structure of the PPF

As this was our first PPF wide meeting – we currently did not have a chairperson or secretary. Jacqueline asked the forum if anyone would like to chair, no volunteers at this stage PPF Members were happy with Jacqueline chairing. PPF Member asked if anyone would like to take minutes, no volunteers came forward, Members were happy for the Paula to minute the meeting. No objections were made

Site based PPF’s should have a chairperson and secretary

The chairperson is essentially the leader or presiding officer of a meeting. They are responsible for ensuring that discussions are orderly and keep conversations focused and balanced.

A chairperson will also need to be elected for the PPF wide meetings that are held twice a year.

It was suggested by a PPF member that the chairperson be rotated – This was agreed by all.

It is also essential each PPF group has a secretary – They will be responsible for supporting the chair, taking notes at the meeting and circulating them. They should include all action points agreed in the meeting.

It was suggested by a PPF member that we also have a co-chairperson. This was agreed by all.

It was suggested that it would be nice if the chairperson could write a little bio to introduce themselves to the forum.

Action

• Job description of the PPF will be emailed to members, this will include expectations of the roles within the PPF.
• PPF constitution to be emailed to members

Terms of reference and constitution

Recently at some of the site based PPF meeting, members questioned TLCP term of reference and constitution.

Term of reference

TLCP is an organisation that comprises of 5 GP practices. However to avoid confusion we will continue to use the word ‘site’.

PPG (patient participation group) has now been replaced with PPF (Patient participation forum)

Action

• Revised terms of reference to be emailed to members

Constitution

We discussed each concern that was raised, however some of the queries required PPF input for us to establish a mutual agreement.

What would excellence be - we have to collectively agree what excellence may be. The question was put forward to the PPF members.

Excellence starts from the point of contact to leaving. This should be a frictionless, timely and appropriate service. This includes the entire sequence of events that a patient experiences from the initial contact to making an appointment, arriving for the appointment, interactions with receptionist, the consultation, follow up/referral of required.

Action

• Patient journey to be emailed to members

How do we prevent vulnerable and housebound patients falling through the cracks

At TLCP we have care co-ordinators who run regular internal searches on the system that identify specific patients' groups, this may include patients with long term conditions, learning disabilities, smear checks, NHS health checks and many more that require appointments/follow up. These patients are contacted via phone or customised letters.

Many of these patients are discussed in our annual review, (MDT) multi-disciplinary meeting and clinical meeting. Patient that do not engage are also discussed as patients' wellbeing is paramount.

How do we manage patients that are not on the vulnerable or housebound list but on the edge?

We run a frequent attender search and a non-engager search which identify patients that we have not had contact with. These lists are distributed to each site and attempts are made to contact those patients.

We also spoke about if our Mission statement should be called a mission or vision statement. It was agreed it is a Mission statement.

A mission statement defines the organisations business, its objectives and how it will reach these objectives. A vision statement details where the organisation aspires to go.

Therefore, we agreed it would still be called a Mission statement.

We continued to go through the queries raised in the constitution and provided TLCP response and reasoning.

Collectively we agreed the constitution has now been approved and no further changes will be made.

New Duty Hub & Telephone System

TLCP are aware the current phone system is not fit for purpose. We’ve had to take time to research other providers and give the 3 months required notice to end our contract. The new phone system will go live on the 24th May. The new system will give patients the opportunity to join a virtual line and they will receive a call back.

Concerns raised regarding the new phone system – what happens if you miss the call, the system will put back in the que and another attempt will be made.

The New Duty Hub will start on the 7th May 2024. All patients will need to complete a digital form they can access via the website or the link can be sent via text. Patients that are unable to complete the link can call and a call handler can assist and complete the questions on their behalf. The information provided will be uploaded for the duty doctors to action accordingly.

We originally trailed the duty hub which highlighted that not all patients that call for appointment need an appointment.

Providing a triage system allows the doctors to direct patients to the right practitioner or service.

This will hopefully also free up the phone lines for those that cannot access or complete the digital form

Patient empowerment is also important to TLCP. Often appointments are made as a patient wants to query a pre-existing referral. Patients can contact the hospitals directly to obtain this information as GP surgeries use the same contact information as the public.

Questions raised

Who will review/triage in the duty hub – two doctors will be in the hub and they will make the decisions

How long do you have to wait for a routine appointment – Currently routine appointments wait time is 2-4 weeks. This may reduce with the new system.

What are the percentages of appointments on the appointment book?

Collectively we have 150/160 book on the day appointments. Each site also has an emergency doctor. 70% of the appointment book is pre-bookable but these appointments go fast. To reiterate a lot of these appointments booked do not require a GP

Do we risk assess the demand – The demand has increased and will continues to increase due pressures on the NHS. We will continue to strive to cater to our patient list size.

Would it be easier to go to the surgery to get an appointment – We do not encourage patients to go to the surgery as the triage form will still need to be completed and the patient will go through the same process patients go through that call or use the website to complete the form.

This information needs to be communicated to all patients. How do you propose to support patients that are not tech savvy?

We have a new digital hub that will be introduced at each site. TLCP will run a digital hub on different days at each site.

Each site will have a specific digital hub trainee that will support patients and teach them how to use the app.

When will this start?

Training for site representatives of the hub will start mid-May and the hubs will commence shortly after that.

Action

• Information regarding the digital hub will be added to the website

Review GP annual survey

The PPF members and staff were provided a recent annual GP Survey. This is a national survey and patients are picked at random.

The department of health sent out the survey to 868 patients and 208 responded.

The results highlighted that we have dropped nationally.

Patients that tend to not be happy are the ones that complete the forms and with only 24% of our patient population completing the form the results do not show a true representation.

The question was asked if our surveys are anonymised with equality and diversity monitoring. This would provide help to promote equality and diversity by collecting data on characteristics as ethnicity, gender, disability and age, employers can identify areas for improvement and implement targeted initiatives.

Engage the PPF in health promotion campaigns

The PPF members were asked to be involved to help promote campaigns. We discussed ways this could be achieved

• Word of Mouth
• Setting up an area in the surgery to speak to patients
• Posters
• HR hub can add information to the website

Frequency and length of meeting

We discussed and agreed PPF wide meeting would be 2 hours twice a year. Site based PPF meeting would be 1 hour every quarter (4 times a year

We will endeavour to provide these dates for the whole year so enough notice is provided.

Someone to be at reception to greet and bring the PPF members to the meeting room

Any other business

Agenda

It was discussed and agreed the agenda would be set by the PPF members and staff. We will work together to ensure the agenda is standardised across all sits.

PPF members were asked if they would be happy to share their email addresses. However a concern was raised when individuals reply to emails and select ‘reply all’ you can end up with multiple emails.

If emails were shared, regular GDPR forms would need to be signed.

• Agreed emailed will be sent individually

Communication

We discussed ways we could get information to everyone

• Website
• News letter
• Posters

PPF members advised that we keep communication simple.

Confidentiality

PPF members discussed an issue relating to confidentiality when trying to book appointments at the desk. Often patients are within earshot and this can be uncomfortable for patients when trying to discuss their personal information.

Some of the sites do have posters to inform staff they can request a piece of paper if they don’t want to say their reason for the appointment or personal information out loud. However we need a standardised poster for all sites

• PPF member has agreed to create a poster to inform patients they can ask for pen and paper if they want privacy.

Website

Can the website be more patient friendly and have easier access for those that are not tech savvy.

One of the PPF members suggested having an individual like herself that is not tech savvy involved in the website changes. If the website can be access by those that struggle with IT, it would mean it is accessible to all.

The website is currently being updated. Once this is complete will discuss this with our PPF members for their opinions.

Shadowing TLCP

It was mentioned that it would be a good experience for our PPF members to see how the GP surgeries run. This would give them the opportunity to see the demand/pressure and workload that is currently expected.

However, in hindsight we will have to retract that offer due to GDPR regulations.

Next meeting

• October 2024 – Venue to be confirmed.

Attendees

• TLCP: Jyothi Eregowda (Jo) (Operations Manager for Belmont Hill and Modern Hill Surgery), Paula Gordon (Supervisor MH)
• PPG Members: EH, FT, JC, CG
• Apologies: MC

Welcome and Introductions

Jo welcomed everyone. 

• Terms of engagement – provided to members 
• Introductions – members introduced themselves.

TLCP constitution

The constitution was discussed at the TLCP wide meeting. At that meeting we discussed the queries regarding the constitution and Collectively agreed the constitution has now been approved and no further changes will be made.  

The constitution will be reviewed annually. 

TLCP Wide PPF Updates

We discussed some of the topics that were mentioned in the PPF wide meeting

PPG /PPF

PPG (patient participation group) has now been replaced with PPF (Patient participation forum)

The new phone system

Jo provided an explanation on how the new phone system works. The new system provides patients the options for a call back, calls are recorded and gives TLCP more data on how calls are managed. With this data we can make the necessary changes if needed to continuously improve the service. 

The New Duty Hub 

The Duty Hub started on the 7th may and so far is going very well. A brief description was provided. Patients that require a same day appointment are able to complete a digital form. Patients that are unable to complete the link can call and a call handler can assist and complete the questions on their behalf. The information provided will be uploaded for the duty doctors to action accordingly.  The duty hub doctors have the capacity to each triage 100 patients’, that’s 200 per day.

Not all requested appointments are necessary nor require a same day appointment and patients are will be informed. All decisions are made by the duty doctors.

The question was raised regarding – what is considered ‘on the day appointments’.

Same day appointments are for patients that consider their health issue as something that requires attention that day and cannot wait. We respect and understand that each individual’s interpretation of an emergency may differ and the new triage system was designed so the doctors can identify those that need same day, routine or even to be signposted to another service.

A question was raised regarding routine appointments and the difficulties in boking appointments 

Paula explained, that there have always been routine appointments but they go so quickly. Previously we have released routine appointments throughout the month, however this has recently changed. Currently 80% of the appointment book is routine. 

These appointments get booked up fast, sometimes appointments are book that are not necessary.
We also have a high rate of DNA (did not attend) appointments, this is always a concern when having the book open for the month as patients may forget or no longer need the appointment. 

Can DNA appointments be used 

Unfortunately we are not aware when patients are not going to turn up for an appointment. By the time the slot changes into ‘D’ it is too late to offer to someone else. 

Can we send appointment reminders?

No unfortunately we cannot send reminders. Text messages are not free for the surgery and if we were to send reminders to patients this would be very expensive. 

A question was raised regarding continuity of care with the changes of staff

Many years ago GP surgeries were family run and therefore your GP knew the majority of your household. However things have changed as the pressure and demand on the services continues to increase.  
It was explained that unfortunately GPs are leaving for all different reasons. This is not just in GP surgeries – any sector you work in peoples circumstances change.  Whist GP’s may leave, doctors will see patient’s health history to ensure they are providing the best care/ follow up care.   

The demand on GP’s is under estimated. The pressure on the NHS and the workload GPs face is increasing constantly, especially when we experience outbreaks of certain conditions. The paperwork, follow up/actions from secondary care whilst still trying to provide a service to the public is very challenging. 

A question was raised about the continuity of care for our vulnerable patients and those that may not be identified as vulnerable but potentially are and need appointments  (This question was raised at the PPF meeting)

With the new triage system the doctors will be able to make the decisions regarding if a patients needs a same day or if they require a routine appointment. If the patient does need a routine appointment the doctor will send a text with a booking link so the patient can book the appointment themselves. The link does expire within 7 days.

One of our members recently received a booking link to book a medication review and thought it worked very well and was impressed. 

We also run searched to identify patients that have not used the service within a certain timeframe. We will then attempt to contact these patients and if necessary refer accordingly. 

These searches are also used to identify specific groups that require annual or regular appointments in accordance to their health condition. 

How do we provide support to housebound patients or patients unable to leave to leave the house?

We use a service provided by One Health Lewisham, a doctor from their team will visit patients at home after one of our GP’s have spoken to the patient/carer. A referral is sent to the OHL team. If however OHL have no availability one of TLCP doctors will visit the patient. 

Housebound patients can also be visited by the District Nurses who can take bloods, urine, change dressings, blood pressure, administer b12, insulin and other injections.  

Website Accessibility

This was raised in the PPF wide meeting and currently the website is still being worked on. We agree that the information needs to be/have  ‘user focused language’ , big format and easy to navigate.

TLCP Updates

New Digital Hub

We have a new digital hub running at each site once a week where patients can come in and be assisted with how to download the NHS App. At Morden Hill we will be running our session on Fridays between 11:30am to 12pm.

We are encouraging all patients to download and use the NHS App. On the NHS App you can receive message from the surgery, consultation notes, request medication, test results and book appointments. 

We are hoping patients that require a same day appointment will use the app or the website to access the triage link. This will enable those that are unable to access the digital link to call the surgery and get through in a timely manner. 

We no longer use ‘Ask NHS’.

AOB

Gillick competent and proxy children’s online access

One of our members mentioned she was recently informed that due to her child’s age she would no longer be able to see her child’s record. 

Patients are receiving text messages as their child approaches 11 making them aware that they will no longer have access to online services for the child. If a parent requires access they will need to contact the surgery to book the child a telephone consultation with one of the GP’s so that they can be coded as ‘Gillick competent for consent’ where the child can give consent for parent/carer to have online access.

• Why can’t 2 parents have proxy access

Action point

Paula to look into this further and feedback.

We also discussed other service patients can be signposted to like the pharmacy as they are able to manage and prescribe medications for the following:

The new Pharmacy First Service will enable community pharmacists to complete episodes of care for patients without the need for the patient to visit their general practice. 

The seven conditions are:

• Acute Otitis Media* (Ear issues)- 1 to 17 years
• Impetigo - 1 year and over
• Infected insect bites - 1 year and over
• Shingles - 18 years and over
• Sinusitis - 12 years and over
• Sore throat - 5 years and over
• Uncomplicated urinary tract infections - Women 16-64 years

PPF

The PPF provides an opportunity for us to meet and discuss practice issues and patients experiences help to improve the service. Each PPF member should represents all patients on a whole and work with the surgery to find ways to improve the service. 

All meeting minutes are available on our website.

Next Meeting:

20th August 2024 at 12pm - Morden Hill Surgery

In attendance

• PPG Members: BC, RS, AH
• TLCP Representative:
  • Michael Uti - GP, Managing Partner
  • Jacqueline Henty (Chair today) - Practice Manager, HR, Comms, Complaints
  • Dr C Ferdinand - GP Partner
  • Gemma - HR, Comms, Complaints
  • Chanice - HR, Comms, Complaints
  • Isatu (Minute taker for today) - HR, Comms, Complaints  

Welcome introductions

JH welcomed all attendees and Practice staff introduced themselves. 

Apologies

No apologies received.

Background on why this meeting has been requested

• Patient Participation
• Patient experience

Summary of statement of PPG Members

RS read out a statement on behalf of the PPG members regarding the breakdown in the relationship between the practice and the PPG members and mentioned some key areas for example not been asked date before scheduling PPG meeting, not forwarding the email of the current Managing Partner after a request via email, request to update the term of reference .

Jacqueline highlighted that an email was sent with proposed meeting dates, but the practice did not receive any feedback regarding alternative dates and the dates sent via email clearly stated proposed.

Dr M Uti commented on a point raised in the statement regarding a request for him to share his email address with one of the PPG members. Dr M Uti explained that he received an email requesting a meeting from JH, to which he replied with his available dates. It was noted that following Dr Uti response, there was no further communication from the PPG member.

Annual National GP Survey and Access 

The meeting commenced with a unanimous acknowledgement of the significant challenge patients are facing regarding access to healthcare services. The practice reaffirmed its commitment to addressing these issues, particularly amidst rising demand. In response to feedback and data collected, the practice is on the process of implementing various changes, including the introduction of new systems such as the AccuRx patient triaging system and new virtual telephone queuing system.

See the latest results from our GP Patient Survey

Key Points Discussed:

• Result from annual Survey discussed. Patient access remains a significant concern.
• Practice efforts to mitigate access issues.
• Introduction of changes, including the AccuRx patient triaging system.
• Despite access issues, overall patient experience remains above national average.

Breakdown in Relationship/ Communication Breakdown

The PPG members express dissatisfaction with the current state of their relationship with the practice. Dr M Uti addressed the PPG Members and offered apologies for past communication issues with the PPG members. Dr Uti acknowledged the importance of building a better relationship with the PPG members and committed to improving communication moving forward. It was agreed that communication with the PPG members would primarily be conducted via email. Recognising that it may not always be possible to reach them via phone, email communication provides a more reliable means of interaction.

Dr Uti emphasised the importance of leaving those issues behind and focusing on building a positive and constructive relationship moving forward. Dr Uti highlighted the significance of fostering a better relationship with the PPG members for the benefit of all patients.

He stressed that improved communication and collaboration with the PPG members would ultimately help in better healthcare outcomes and satisfaction for all patients.

Dr Uti mentioned that the TLCP is not perfect, however the organisation is trying it hardest to provide a better care for all our patients. 

Discussion on New Changes to TLCP 

Dr Ferdinand discussed some of the new changes coming to TLCP.

Among the changes discussed was the implementation of a new telephone system.

Dr Ferdinand elaborated on the new telephone system, which includes the implementation of a virtual queuing system. The virtual queuing system aims to streamline patient waiting times by allowing them to hold their place in the queue without physically waiting on the line.

Patients will receive a call back when it is their turn, reducing wait times and improving overall patient experience. 

Dr Ferdinand introduced a forthcoming change regarding the implementation of the AccuRx patient triaging system for same-day appointment requests. This system will require patients to complete an online form detailing their symptoms. Subsequently, a clinician will review the form and direct them to the appropriate department/clinician. Patients will receive notification regarding how their request will be handled, ensuring clarity and understanding that the assessment will prioritise clinical need while respecting their communication preferences.

Key Points Discussed:

• Utilisation of an online form for patients to explain their symptoms.
• Clinician review of forms to direct patients to the appropriate department.
• Emphasis on prioritising patients based on clinical need.
• Improvement in matching practice capacity with patient demand.
• Clarification that patients can still walk in to request an appointment, with assistance provided by the reception team to complete the form.

Organisation structure 

Dr Ferdinand and Dr Uti provided an overview of the current TLCP structure within the practice. They also addressed Colin's resignation and informed the attendees that, following discussions among the partners, Dr Uti has been appointed as the managing partner, reflecting a strategic business decision.

RS enquired about the role of the Patient Participation Group (PPG) in assisting the practice in achieving its targets. In response, Dr Ferdinand emphasised that, given the current priorities of improving patient access and fostering stronger relationships with patients, the primary focus remains on these areas.

PPG Meeting Structure for TLCP

Each site will hold quarterly Patient Forum Meetings; the times and dates of the meetings will be displayed at the sites and on the TLCP website. The Site Patient Forum aims to represent all patients regardless of age, gender and ethnicity to provide an accountable method of input and feedback to and from each TLCP site. By doing this, the group endeavours to facilitate the smooth operation of TLCP sites and assist in the transition and implementation of future improvements and changes. 

Site Patient Forum roles:

• Site PPG Forum Members (TLCP PPG Members)
• Site Patient Lead
• Site TLCP Lead 

Site Patient Forum Members will be asked to select two representatives to attend TLCP PPG-wide meetings, which will be held at a designated site twice a year. 

TLCP-wide PPG 

TLCP will hold two meetings yearly at a designated site for TLCP-wide PPG

TLCP-wide PPG Forum aims to represent all patients regardless of age, gender and ethnicity to provide an accountable method of input and feedback to and from each TLCP site to the TLCP-wide PPG Forum. By doing this, the group endeavours to facilitate the smooth operation of TLCP as one and assist in the transition and implementation of future improvements and changes throughout the organisation, all TLCP patients, and the local population. 

TLCP-wide PPG roles:

• TLCP Chairperson
• TLCP Site Representatives 
• TLCP Representatives (TLCP Staff/ Site Leads)
• TLCP PPG Organisational Lead

Any other business

BC raised a concern regarding the adequacy of the current meeting time to cover the agenda thoroughly. She suggested that the practice should consider either reducing the frequency of meetings or extending the duration to ensure all agenda items are adequately addressed.

Jacqueline presented a sample template poster designed for patients interested in joining the Patient Participation Group (PPG).

Action: 

• TLCP to gather feedback from all site PPG attendees on their preferences regarding meeting length and frequency.
• BC to work on another version of Terms of reference, date TBC, with HR team at HF site. Partners to review once submitted and decision made, along with other PPG groups.
• TLCP to set a date for the TLCP Wide PPG meeting.
• RS to send statement from PPG Members. 
• PPG Members to confirm proposed dates.

Dates of future meetings

The proposed dates are:

• 27 February 2024
• 28 May 2024
• 27 August 2024
• 26 November 2024

Welcome and Introductions

Jo ( Operations Manager Belmont Hill and Modern Hill)

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

AOB

No members attended the meeting. All members who had initially confirmed their attendance had to cancel last minute due to unforeseen family emergencies and were unable to notify us in time.

TLCP Constitution

TLCP wide PPF updates.

TLCP Updates

Other News 

Next Meeting

Proposed date of the next meeting: 28 August 2024 at 4pm

In attendance

• PPG Members - OC, KW, EW, HR
• TLCP HO Representative- VR(Manager),AO(Site Ops Supervisor), IJ(Ops Admin), WT(Receptionist),SK(Recepetionist).

Introductions were made for the benefit of new members.

VR opened the meeting and discussed the need to restart the PPG and the terms of reference should be circulated to members again. This was to fully understand the structure of what the Patient Participation Group is about.

Discussed the need for PPG members to create a structure and assign a chair.

Digital Front Door

Explained the role of digital front door – triage online via AI enforced by NHS. This allows allocating resources for patients and signpost them to the right consultants within 24 hours. We will have a digital inclusion hub, trained receptionists who will be able to triage effectively and teach/support patients who are not IT literate.

KM suggests to have tablets with several languages available for non-native English speakers. Hellen suggests to have cafes to train elderly in digitalisation.

KM informs us he works with dementia patients and end of life care, he explains how his organisation is promoting diversity and looking at how black people are treated within dementia/mental illness environments.

VR proceeds in sharing the footfall audit for TLCP and shares the documents across.

VR explains how the care navigation hub works and when it will go live, further explanation of TLCP structure and its hubs.

TLCP Vision and Terms of Reference

VR shares TLCP vision and terms of reference – what would excellence be? How to involve the community more?

Hellen suggests to remove mission statement and use the term vision instead.

OC asks re research/feedback – Is it independent or PPG working with the Practice?

Suggestion on the fundraising – help support the practice and get more involved in the processes, PPG members to volunteer to cooperate with the practice.

How to prove the PPG are actually representing their members?

VR(Manager) advise to have a specific PPG structure – chair/vice chair, email and request availability. Deadline on 13th September, next meeting can be arranged for 23rd.

O asks if it’s possible to get JDs for these roles and requests to shadow the most senior PPGs meetings in other practices once the chair has been established.

The meeting closed with members agreeing the 23rd September 2023