BH PPF Minutes: 31st May 2024

Welcome and 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
• JE ( Operations Manager Belmont Hill and Modern Hill)

TLCP Constitution 

• JE 

TLCP wide PPF updates

• JE 

TLCP Updates

• JE

Other News 

Next Meeting

• 28.8.24 @ 4pm JE

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.    

Attendees

TLCP:  

• JE (Operations Manager for Belmont Hill and Modern Hill Surgery)

PPG Members:

• LB
• PC
• JC

Welcome and Introductions

JE welcomed everyone. The minutes of the previous meeting were reviewed and approved without any amendments.

TLCP Updates

GP Assistant – new role within the Practice.

A GP (General Practitioner) assistant plays a crucial role in supporting the operations of a general practice clinic. As previously discussed in the last PPF meeting we are ready for GP assistant to start end of Feb 2024. We wish the team good luck.

PPF Member: Will I know who I will be seeing if it’s a GP Assistant or not?

• JE: Explained the role of the GP Assistant and said that yes if an appointment is being booked with the GPA, the patient will be informed at the time of booking by the receptionist.

PPF Member: Todays PPG meeting was not advertised on the Website, also when called the team was not aware of when the PPG was happening or where. 

• JE : I will look into this and ensure in the future all information is visible on website and the staff are trained on this information

PPF Member: Surgery no longer feels it has personal touch, there is lack of continuity of care

• JE:  Assured that the information on health care is all available on Emis for all Drs to see and treat them accordingly. We strive to ensure that we provide good health care to all of all patients.

 PPF Member: Regarding Mr JC prescription

• Jo : Assured that i will talk about it outside of this meeting

PPG Member: The website has lots of information that it is hard to navigate to the right information.

• JE : We try to have relevant information on website as patients use the website to search for many different things and it helps patients as they don’t have to stay on the phone call for some information which can be easily available on the website.

PPF Member:  Noticed that when I called today I was quickly taken from 35 in waiting in queue to 5 in less than 10 mts

• JE: With the calls going to CN hub the call waiting times will gradually come down and we all are working best to achieve short waiting times.

JE Explained the Following to the PPF Members:

Reception 2/2
BH is ready to go into care navigation hub at St Johns Surgery which means more call handlers who are trained to a high level of training who can rightly navigate the call giving patients the right information. 

Duty Dr Hub for TLCP

Duty Dr hub is created to meet the increasing needs of our patients, this means that the Doctors can effectively see more patient and address any query and the GP at the site level can deal with more pressing clinical matters.

Other news:

It is with sadness that we announce the departure of Dr TS.

Dr TS has been with BH since 2023. She provided excellent patient care during her time with the practice, and we are very sad to lose her. She has been a fantastic team member and a very dedicated GP. 

We wish her all the best and thank her for all she has done for our patients. 

Drive way:

Jo explained that we are looking into quotes.

PPG Structure

JE: Explained that we are all working towards TLCP wide PPG meeting, which will be  held every six months. PPG Members will from across all sites. All TLCP PPG groups can review and provide feedback on the proposed structure

AOB

Improving BH Site Patient Forum Representation

Team Discussion – the following ideas have been proposed:

• Promotion of the PPG via website 
• PPG Open Day – to promote PPG and the Practice

Next Meeting

Proposed date of the next meeting:

• May 2024

Confirmation to follow

Attendees

• BOC
• AS (chair)
• AH
• RS
• SP
• JH– Practice Manager, HR, Comms, Complaints  
• OO - HR, Comms, Complaints
• GW – HR, Comms, Complaints,Operations
• Dr JA

Apologies

• BB
• MJ
• BW
• MB

Minutes from Last Meeting

These were distributed pre meeting

TLCP patient survey 

Following the original GP national survey in January 2024, a further survey had been carried out by TLCP in October 2024. Both results were compared with the Southeast London Integrated Care Board (ICB) survey and the national survey.

A summary of the findings was discussed during the meeting.

There was an improvement in all survey feedback Between January and October 2024 except for the question about overall experience which paradoxically showed a decline. 

RS observed that the survey was dependent on the proportion of consultees who were actually active in attending the practice regularly. These may have a different view to those patients who do not make much use of the service. JH commented that it wasn’t possible to identify this from the data they had.

It is still a challenge getting feedback as doctors have a lot of other duties and it can be difficult to remember for them to mention the survey after consultation. Often patients make less effort to give positive feedback as opposed to negative. Some other areas such as friends and family are more successful in obtaining feedback. The practice will print leaflets that clinicians can hand out to patients to remind them to complete the survey next time. 

One of the nationwide aims is for patients to have better awareness of enhanced hours. Feedback on this was particularly disappointing. The meeting discussed better ways of achieving this, such as a poster perhaps. However, it is a difficult objective to achieve. 

Up-to-date list of staff at Hillyfields

SP raised the concern that patients do not know who the medical staff are at the practice. JH explained that they need consent to put names on the website and notice board and that this had been problematic since some staff are reluctant to give consent. The lack of consent is not from clinicians but from non-clinical staff however the practice would like to update the information at the same time. 

The meeting made various suggestions such as nameplates and badges, as well as putting into employment T&Cs but JH emphasised that this issue was being looked at and work was underway to resolve. 

Access to routine appointments

SP expressed concern about the wait. Currently this is running at six weeks. The practice feedback was that this is improving and that calling or completing the form on the website is a more effective route for patients as the practice is able to control the allocation of these when compared to the NHS app. 

RS said that he had not found it immediately clear as to how to get a routine appointment for something such as a PSA check (test for prostate cancer) which is not part of nationwide screening. JH said that they would review this and see whether the information on the website was sufficiently explanatory and accessible. However, she added the digital front door initiative was intended to help with problems like this. This is when patients can come into the practice for support with navigating the NHS app or website. 

Positioning of blood pressure monitor

This was not discussed in detail as SP, who had raised the issue, had had to leave the meeting. So it will be discussed in the next meeting. However, JH did say that they were limited through space and power sockets. 

AOB

AS asked a question about making an appointment for a specific GP. It isn’t possible to do this automatically, but the patient can ask when they request their appointment on the phone or on the web. However, there is no guarantee.

One point made by the practice for others to be aware about is that patients often don’t complete their appointment links in time and therefore lose their appointment. This can give the impression that getting an appointment is difficult when in reality the patient has not completed all the actions that they have been asked to do within the time scales.

There was a discussion about whether a website focused session in January would be useful. BOC raised the concern that maybe the PPF was trying too hard to address every single imaginable problem, rather than addressing particular issues as they arise.

Action

JH to look at a poster for publicising extended hours.

AS to carryover the positioning of the blood pressure monitor to the next meeting.

AS to discuss with other PPF members as to whether a meeting to review the website navigation and content would be useful

JH to consider ways of increasing survey feedback for next time possibly by giving patients a form as they leave their appointment.

Welcome introductions

JH welcomed all attendees and Practice staff introduced themselves.  

Apologies

RS 

Minutes from Last Meeting

JH reviewed the minutes from the previous meeting and discussed the actions taken:

• TLCP was to agree on the meeting length, which has been set for one hour.
• BC and IJ were tasked with working on the terms of reference, which has been completed.
• TLCP was to set a date for the TLCP-wide open day, and this has been done.
• RS was to send a statement from the PPF members, which has now been completed.  

Chair/ Minutes taker:

JH addressed the PPF members about the need for a chair, vice chair, and secretary for the meetings. The team discussed and voted for AS to continue as the chair and BC as the vice chair. AH agreed to be the secretary and to write the minutes for upcoming meetings. AS and BC accepted their roles.

Update on the New Duty Doctor Triage System

JH explained that TLCP is now using a new online system for patients to submit their queries to the practice, called Patient Triage. This system aims to reduce the number of phone calls the practice receives. Patients can access a link to the request form on our practice website.

The new online duty doctor system allows patients to submit medical or administrative requests online instead of queuing on the phone. JH also mentioned that patients needing support with technology can still visit the practice or call, where trained Care Navigators can assist them through the process.

OR noted that while the practice strives to respond to patients on the same day, it can sometimes take up to 48 hours. The form consists of about seven/eight questions to help determine the appropriate clinician to refer the patient to.

SP mentioned having used the system and found it generally satisfactory, but raised a concern that patients unable to get routine appointments might use the same-day triage system to secure an appointment. SP also inquired about provisions for patients needing a translator. The PPF members also raised concerns about the lack of pre-bookable appointments.

IJ responded that all existing systems remain in place, and the new system is an additional benefit, freeing up phone lines for those who need to call the practice. OR added that the system also helps free up appointments for patients who need them and noted an issue where patients were booking multiple same-day appointments for the same issue with different doctors, leading to numerous DNAs (Did Not Attends).

SP mentioned that she was booked for a face-to-face appointment but was informed it was a telephone appointment instead, causing her to rush home to ensure she had access to a phone. The PPF members at the meeting also inquired about the process for patients who want a face-to-face appointment.

IJ responded that during COVID, the decision was more clinician-led, but post-COVID, it is now patient-led, meaning it is up to the patient to request a face-to-face appointment.
BB mentioned that the new system was not properly communicated to patients. She gave an example of visiting the practice to request an appointment, where the staff simply handed her a paper explaining how to book an appointment without providing any further explanation.

Update on the New Telephone System (Surgery Connect)

JH mentioned that the new telephone system, Surgery Connect, is now live. Although the practice would have preferred to involve PPF members in crafting the messaging for patients, the process was rushed due to an incident at Hilly Field where patients were queuing outside, which made the news. Consequently, there was no time to consult with the PPF members.

JH asked for feedback on the new telephone system. BB mentioned that she found the system generally effective, but noted an issue with the call-back feature: when she requested a call back, the person who called her back asked who she was, which was unexpected as she assumed the staff would already have that information. Apart from this, BB found the system satisfactory and praised the staff at the CN hub.

AS also mentioned that the call-back system worked well for her, as she received a timely call back after requesting one.

Update on the new digital front door

JH mentioned that the practice is also running a "Digital Front Door" session every Tuesday to help patients who needs support with the online system, such as the NHS app and the new booking triage system. Additionally, the other TLCP practices will be running similar sessions on different days of the week, providing patients with a choice of when to come in. AH expressed her interest in helping out whenever she has the opportunity.

Any other business

JH mentioned that TLCP is also working on drafting a newsletter for patients and would like the involvement of the PPF members. BC mentioned that drafting newsletters used to be part of her job and offered to help the practice, provided she is sent all the content for the newsletter.

Carer Promotion Discussion:

JH discussed the practice's plan for carer promotion and how they intend to support caregivers. AH mentioned that, as a caregiver, the main challenge is often finding the time to manage other responsibilities. BC added that it is very difficult to get support, and caregivers should be made aware of the realities and challenges involved in gathering support for those they care for.

Action

• BC to send JH the information on carer
• BC to help the practice with drafting the news letter
• AH to support the practice re carer
• JH to send AS a carer pack to review 
• JH to send draft  newsletter to BC
• PPF members to check the message on the phone system and feedback
• JH to find out if the PPF member can have some flexibility in rotating chairs
• HJ to send the structure of the hierarchy   

Dates of future meetings

The proposed dates are: Agreed

• 27 August 2024
• 26 November 2024

Attendees

Patients

• BO’C
• AS (chair)
• AH (Note taker)
• BB
• CM

Practice Staff

• JH– Practice Manager, HR, Comms, Complaints  
• AG - HR, Comms, Complaints
• IJ – HR, Comms, Complaints

Welcome introductions

AS welcomed all attendees. Attendees introduced themselves.

Apologies

• RS
• SP 

Minutes from Last Meeting:

JH reviewed the minutes from the previous meeting and discussed the actions taken:

• Further work has been carried out on providing carer guidance which is now published on the website. However, this work is ongoing with Imago. 
• BO’C provided input to the newsletter, and this is now on the website and available in hard copy ion the waiting area.

Booking Appointments 

CM fed back some observations on the appointment booking system and same day appointments. She had found the distributed guidance impenetrable. She had more success in booking an appointment when attending reception in person. JH explained where the website guidance could be found. She also said that practice staff had been allocating time on Tuesdays to talk through the booking system with patients and the new digital front door to assist patients with online access. The best way to book urgent appointments is through the website, this saves the patient coming to the practice and queuing, it can be done from the comfort of their own home. Appointments booked this way quickly go through triage. Alternatively, reception can send a link to patients attending practice so that they can book through the website or assist the patient in manually submitting their request. JH discussed the new telephone system and the call back facility available.AS agreed that time would be required for the new processes to become embedded.

BB commented that when things go wrong (eg. an appointment is accidentally cancelled or the patient does not receive a call back), practice staff need to admit their mistakes and not blame the patient. JH requested this example be shared separately as the practice would like to think this is what would happen, however will investigate.

BO’C asked whether urgent appointment capacity ever gets used up. JH said that she only knew of one instance where this had happened. BO’C pointed out that there seem to be a current problem where urgent appointments were not available. JH said that she would get someone to investigate.

There is a problem that non-urgent appointments are booked up far in advance so that it is quite difficult to get one for the NHS app, forcing patients to use the urgent on the day process. The meeting all agreed that putting all appointment types (both urgent and non-urgent) into the same triage process, so that they are processed in a similar way would be the preferable way to go. JH to follow up on this.

 Communication between hospital and GP practice

AS raised concern about delays experienced by a patient in a case where a diagnosis required urgent action (medication). JH explained how the communications worked. Comms from the hospital go to a generic email address (for the practice as a whole) where they get directed as appropriate by the Docman team. JH confirms that urgent medications are brought to the attention of a clinician within 24 hours. There are some situations where the paper communication is received first. This gets scanned into the patients note and sent to the relevant GP as high priority. However, although the practice tries its best in processing communications in a timely manner, it has no control over hospitals and how quickly they send letters/emails. Therefore, where there appears to be a delay, patients may need to follow up (eg. on prescription changes).JH confirms that all letters are filed into the patients notes within a week for non-urgent once receiving. It was acknowledged that this might be more difficult for some patients. E.g. those who are housebound.

How is Hillyfields working with Imago for the benefit of carers? 

BO’C is working with Imago, but there are some questions about how they are communicating with GPs. JH explained they had recently had a national carers day where they encouraged carers to self identify. There is now a 64-page document on the website with all information carers may need. Imago had been invited to attend the meeting and the practice are awaiting a date for the staff meeting and also invited to  the next PPF wide forum in October 2024

GP survey

JH explained that the feedback was not as extensive as they would have liked. Also many changes have been made since the original survey in January, particularly with the introduction of changes to appointment booking in May 24. 829 Surveys went out and 201 surveys were sent back 24% completion rate.

The Practice is going to run the survey again and push to get at least 500 replies so that they have a better representation. The survey is on the website, and it can be completed either by scanning a QR code or it can be filled in manually and handed back to reception. AS suggested that perhaps the survey could ask which site the patient attends. However, since the survey has been published, it is too late to change it to include this. AS suggested that perhaps introduction of the survey could be changed to explain that the focus is on recent experience, rather than long past. JH to look at whether this is possible.

AOB

JH explained that the practice was now working extended hours. The attendees fed back that this was a positive change and happy with the enhance hours offered of early 07.00am start, 18.30pm -20.00pm late and all Saturdays 9.00am to 5.00pm.

JH explained the situation with Sanofi and blood tests. They have contacted all urgent cases. They are currently putting a process in place to contact all patients with routine tests and trying to remove the backlog. They are now closer to getting back to normal. GPs can now request routine at consultation again.

JH explained how the seasonal flu campaign would work. This year the practice is rolling out an additional RSV vaccine to certain demographics (incl over 75s and pregnant women). This means that the vaccination program for flu will not start until beginning of October. It is expected that there will be Saturdays for four weeks where patients can either opt for walk in or pre-booked appointments, this service will be available at the St Johns site and The Hillyfields site. Volunteers from the PPF would be appreciate to welcome patients and ask them to get ready by taking coats off and rolling up sleeves.

There needs to be some action to ensure that housebound patients get visited and vaccinated but the logistics are difficult as they do not have the extra staff to do this. BO’C fed back that this did not happen last year and so is a major concern. Plans are being worked on currently to ensure this happens.

AS had raised a suggestion that the practice sets up a Patient information evening where patients can come in and ask questions regarding the current service. It would be good if the Patient participation forum members attend to answer these questions so patients can see their involvement. A provisional date was agreed for Tuesday 24th September. 630pm to 730pm.

Action

• JH to feedback about a single triage system for all appointment types, urgent and non-urgent.
• JH to investigate whether there are current problems with providing urgent appointment capacity today.
• JH and HR/comms to liaise regarding the introduction to the patient survey and whether it can be changed to clarify that the focus is on recent experience
• AS and PPF members to firm up on plans for a patient information day and for advance advertising.

Dates for the diary of our upcoming meetings

• 24 September 2024 Open Evening  Hillyfields Site 6.30pm to 7.30pm
• 31 October 2024 Annual General meeting (Outlining achievements)  @ St Johns Medical Centre 5.30pm to 6.30pm
• 26 November 2024 Next meeting date @ Hillyfields site 12pm to 1pm

Attendees

Patients

• BC
• RS
• AH

Practice Staff

• MU – GP, Managing Partner
• JH (Chair today) – Practice Manager, HR, Comms, Complaints
• Dr C F – GP Partner 
• GW – HR, Comms, Complaints  
• CJ – HR, Comms, Complaints  
• IJ – (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 .

JH 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 MU 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 MU 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 MU response, there was no further communication from the PPG member.

Annual National GP Survey and Access 

The meeting commenced with a unanimous acknowledgment 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.

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 MU addressed the PPG Members and offered apologies for past communication issues with the PPG members. Dr MU 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 MU emphasised the importance of leaving those issues behind and focusing on building a positive and constructive relationship moving forward. Dr MU 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 MU 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 CF discussed some of the new changes coming to TLCP.
Among the changes discussed was the implementation of a new telephone system.
Dr CF 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 CF 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 CF and Dr MU provided an overview of the current TLCP structure within the practice. They also addressed CS resignation and informed the attendees that, following discussions among the partners, Dr MU 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 CF 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.
JH 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

Attendees

Patients:

• BO’C
• AS
• AH
• SP
• BB    

Practice Staff:

• Jacqueline– Practice Manager, HR, Comms, Complaints
• Oriana – Care Navigator Lead
• Gemma – HR, Comms, Complaints  
• Isatu – HR, Comms, Complaints (Minutes taker) 

Welcome introductions

JH welcomed all attendees and Practice staff introduced themselves.  

Apologies

• RS 

Minutes from Last Meeting

JH reviewed the minutes from the previous meeting and discussed the actions taken:

• TLCP was to agree on the meeting length, which has been set for one hour.
• BC and IJ were tasked with working on the terms of reference, which has been completed.
• TLCP was to set a date for the TLCP-wide open day, and this has been done.
• RS was to send a statement from the PPF members, which has now been completed.

Chair/ Minutes taker

JH addressed the PPF members about the need for a chair, vice chair, and secretary for the meetings. The team discussed and voted for AS to continue as the chair and BC as the vice chair. AH agreed to be the secretary and to write the minutes for upcoming meetings. AS and BC accepted their roles.

Update on the New Duty Doctor Triage System:

JH explained that TLCP is now using a new online system for patients to submit their queries to the practice, called Patient Triage. This system aims to reduce the number of phone calls the practice receives. Patients can access a link to the request form on our practice website.

The new online duty doctor system allows patients to submit medical or administrative requests online instead of queuing on the phone. JH also mentioned that patients needing support with technology can still visit the practice or call, where trained Care Navigators can assist them through the process.

Oriana noted that while the practice strives to respond to patients on the same day, it can sometimes take up to 48 hours. The form consists of about seven/eight questions to help determine the appropriate clinician to refer the patient to.

SP mentioned having used the system and found it generally satisfactory, but raised a concern that patients unable to get routine appointments might use the same-day triage system to secure an appointment. SP also inquired about provisions for patients needing a translator. The PPF members also raised concerns about the lack of pre-bookable appointments.

IJ responded that all existing systems remain in place, and the new system is an additional benefit, freeing up phone lines for those who need to call the practice. Oriana added that the system also helps free up appointments for patients who need them and noted an issue where patients were booking multiple same-day appointments for the same issue with different doctors, leading to numerous DNAs (Did Not Attends).

SP mentioned that she was booked for a face-to-face appointment but was informed it was a telephone appointment instead, causing her to rush home to ensure she had access to a phone. The PPF members at the meeting also inquired about the process for patients who want a face-to-face appointment.

IJ responded that during COVID, the decision was more clinician-led, but post-COVID, it is now patient-led, meaning it is up to the patient to request a face-to-face appointment.
BB mentioned that the new system was not properly communicated to patients. She gave an example of visiting the practice to request an appointment, where the staff simply handed her a paper explaining how to book an appointment without providing any further explanation. 

Update on the New Telephone System (Surgery Connect):

JH mentioned that the new telephone system, Surgery Connect, is now live. Although the practice would have preferred to involve PPF members in crafting the messaging for patients, the process was rushed due to an incident at Hilly Field where patients were queuing outside, which made the news. Consequently, there was no time to consult with the PPF members.

JH asked for feedback on the new telephone system. BB mentioned that she found the system generally effective, but noted an issue with the call-back feature: when she requested a call back, the person who called her back asked who she was, which was unexpected as she assumed the staff would already have that information. Apart from this, BB found the system satisfactory and praised the staff at the CN hub.

AS also mentioned that the call-back system worked well for her, as she received a timely call back after requesting one.

Update on the new digital front door:

JH mentioned that the practice is also running a "Digital Front Door" session every Tuesday to help patients who needs support with the online system, such as the NHS app and the new booking triage system. Additionally, the other TLCP practices will be running similar sessions on different days of the week, providing patients with a choice of when to come in. AH expressed her interest in helping out whenever she has the opportunity.

Any other business:

JH mentioned that TLCP is also working on drafting a newsletter for patients and would like the involvement of the PPF members. BC mentioned that drafting newsletters used to be part of her job and offered to help the practice, provided she is sent all the content for the newsletter.

Carer Promotion Discussion:

JH discussed the practice's plan for carer promotion and how they intend to support caregivers. AH mentioned that, as a caregiver, the main challenge is often finding the time to manage other responsibilities. BC added that it is very difficult to get support, and caregivers should be made aware of the realities and challenges involved in gathering support for those they care for.

Action

• BC to send JH the information on carer
• BC to help the practice with drafting the news letter
• AH to support the practice re carer
• JH to send AS a carer pack to review 
• JH to send draft  newsletter to BC
• PPF members to check the message on the phone system and feedback
• JH to find out if the PPF member can have some flexibility in rotating chairs
• HJ to send the structure of the hierarchy   

Dates of future meetings

The proposed dates are: Agreed

• 27 August 2024
• 26 November 2024

Attendees

• Kelvin Wheelan
• Beverly Ammon
• Penelope Beaumont
• Sylvia John
• Graham Mulholland

PPG members: 

• VR
• AO
• JE
• WT
• SK
• AO - Site Operation Supervisor
• SK - Reception/Care Navigator
• VR - Practice Manager
• JE - BH Operation Manager
• FC – GP Partner

Minutes drafted by AO.

Apologies:

• Ezekiel John
• Elaine Winter
• Helen Robinson
• Juliette Ratton
• Annie Baker
• Ollie Carr
• Katie Hale

Introduction

Introductions were made for the benefit of new members from FC explaining TLCP structure.

Honor Group Practice PPG

Previous PPG minutes approved, request for chair and vice chair to produce agenda items for the following PPGs. JDs were circulated, request for this to be sent again.

Suggestion for PPG open day to encourage patients to join and flyers/leaflets to be disseminated. Suggestion for PPG members to engage with mission statements, particularly stressing the importance of dignity and respect for all parties involved. 

Confidentiality agreement – GDPR explanation of practice/TLCP procedure for PPG meetings not to be discussed outside of the events and not to discuss specific patients details to safeguard privacy. 

Receptionists now retitled as Care Navigators (CN), trained and able to signpost patients to the right services/consultants (pharmacists, PAs, HCAs, nurses etc.). 

Constitution

Suggestion to change term patient as they aren’t the only ones involved but also the carers. Requirement for definition of carer. Request to differentiate in various languages for equality re patients’ access, explanation that website itself asks for language to be changed should the need arise. Info to be sent re accessibility language website. 

Request to get interpreters, explanation on the interpreting service provided via telephone system, written material produced by other services rely on their procedures. If done on site we rely on site and further assisting services. Clinical staff trained on how to use interpreting services, noted that family members should not be used as interpreters. 

Digital Frontdoor

Request for more appointments on patient access app as there are hardly any slots available. Explanation that demand is higher than capacity. Current plans to move into a different cloud system – 50 pts on hold then call back.
Digital triage for urgent queries pilot: CN pick up phone calls send pts’ online AccuRx triage/create for them if patients not IT literate. Online triage will improve queue and streamline processes. New phone system will be implemented and will request to press specific digits according to needs to be allocated to the right service. Requests will be limited to specific hours. 

Disappointment expressed for not being able to see the same GP. Sympathy offered with explanation for it not to be feasible due to the demand and demographics. To be considered a possibility to add the triage also to routine appointments to potentially be able to see a regular GP. All TLCP sites are training sites – PAs, registrars etc. 

Request to have more private consultations – difficult to discern issues on front desks. Explanation of online triage to be more private, additionally staff is trained to ask many info to get the appropriate consultant and maintain confidentiality, patients not giving exact reasons for appointments may lead not to get an urgent appointments due to uncertainty of the request. 

Query re appointment times not respected. Explanation on the way the appointments will be booked via the online triage: link will be sent to patients with the availability so patients can choose their preferred time. If drs are running behind they usually prioritise the f2f. Telephone calls are usually given 2 attempts when pts’ don’t respond – to be standardised across. 

Request for feedback from elderly patients and statistics on accessibility. Confirmation of demographics to be analysed for audit purposes. Pilot went ahead with good feedback from staff, awaiting for confirmation to get launched – ideally in 4/8 weeks. Data can be discussed at next PPG meeting. 

Survey

National survey from NHS discussed, sent by NHS England. Members suggest to get a site based survey also. Confirmation that our own systems allow us to analyse data. 

TLCP Structure

Patients confirm they are aware who they speak to when having a consultation. Suggestion to have a skillset matrix for various roles so that even patients are aware and better able to signpost themselves with the right consultants. 

AOB

Request of what’s in place for clinicians safeguarding/abuse. Confirmation of zero tolerance, remove pts when needed, discussion to clinical and practice meetings, support given.

Next Meeting

The meeting closed with members agreeing to Thursday afternoon in May/June – date tbc.

MDT Meeting Action Points

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:

• Je (Operations Manager for Belmont Hill and Modern Hill Surgery)
• PG (Supervisor MH)

PPG Members:

• FT

Terms of engagement – provided to all 

JE reviewed the minutes from the previous meeting 

TLCP Updates

PG asked if the new triage system had been used and if so, how the new triage system was going – 

FT stated - it is brilliant, it has been very useful. FT has used the new system twice, received a text to book in a routine appointment and received a same day appointment another time. 

A patient friend to our PPF member has experienced issues with the call back service on the phones. 
Advised to please inform TLCP when experiencing any problems with the system as we can investigate the issue and report if necessary to ensure the smooth running of the service.

Carers champion 

TLCP recognises the importance of Carers.
A member of staff at each site will become a Carers Champion who will help to promote and support carers in the practice. 

We discussed some of the challenges carers face:

• Some carers neglect their own health needs 
• Older carers can face difficulties with the current technology 
• Emotional strain
• Lack of recognition and support 
• Not being aware of entitlement or how to seek support 

Each site has a designated notice board for their Carers in the patient waiting area and welcome suggestions regarding ways we can help our carers and the information we provide. 

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. 

NHS APP

FT is experiencing an issue with the NHS APP, previously FT has attended our digital hub sessions and received support from MH Champion but unfortunately, the issue was not resolved.
FT is currently liaising with the NHS APP support team but expressed that we all need to work together to essentially make identified issues be resolved faster.
We have asked FT to keep us updated with the feedback and explained that it is important for all patients to aware that GP surgeries/ TLCP did not create the app and therefore when staff members are trying to resolve issues they are trying their best with the knowledge they have. 
We understand the app tells patients to contact their GP surgery but when we try to raise an issue on the behalf of patients, we are informed the patient needs to contact them directly. 

FT has agreed to let us know the outcome of this ongoing issue.

GP Survey

The GP survey was emailed to all PPF members and no feedback was provided.  868 surveys went out and 208 surveys were returned. Therefore we had a 24% completion rate.

TLCP will run another survey and we potentially are aiming to have a higher amount of surveys completed, as this would provide better representation. This information will be at each site and on the website once finalised. 

AOB

Flu 

We will be offering patients the Flu jabs as we have previously, we will also be running a Saturday clinic but details regarding timings and location are yet to be agreed, when more information becomes available, patients will be notified accordingly. 

RSV: From 1 September 2024, those who turn 75 and those aged 75 to 79 (including pregnant woman) will be eligible for a free vaccine to protect them from respiratory syncytial virus (RSV).

Physio service 

Our PPF member praised the prompt service. 

Question – can patient s have more appointments with physio while they await their MSK appointments?

It was explained the physio service is limited but the feedback would be passed on.

Blood test

Following the recent cyber-attack, we were informed we could go ahead and start processing blood test as of the 15.8.2024.  Patients whose blood test were compromised and urgent will be the priority. Currently there is a backlog but patients will be contacted if they are require to repeat their test. 

Next meeting

• TLCP wide meeting at St Johns Medical Centre. Thursday 31ST October  5.30pm to 6.30pm
• Morden Hill PPF meeting – Friday 22nd November 2024 @ 4pm

Attendees

TLCP:

• JE (Operations Manager for Belmont Hill and Modern Hill Surgery)
• PG(Supervisor MH)

PPG Members:

• EH
• FT
• JC
• CG

Apologies:

• MC

Welcome and Introductions

JE welcomed everyone. 

Terms of engagement – provided to members 

Introductions – Everyone 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 

JE 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 11.30-12.00.

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:

Clinical pathway & Age range

• 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:  

20.08.2024 at 12pm – Morden Hill Surgery 

Attendees

TLCP:

• JE (Operations Manager for Belmont Hill and Modern Hill Surgery)
• PG (Supervisor MH)

PPG Members:

• CG
• JC
• MC

Welcome and Introductions

JE welcomed everyone. 

Terms of engagement – provided to members 

Introductions – members introduced themselves. Paula and Jo gave a brief description of their role within TLCP. 

TLCP Updates

GP Assistant – new role. 

A GP (General Practitioner) assistant plays a crucial role in supporting the operations of a general practice clinic. 

Common roles and responsibilities of a GP assistant were provided and given to the members. 

PPF members questions what exactly a GPA can do.

• It was explained that GPA’s can carry Simple medical procedures: Performing basic clinical tasks, such as taking blood pressure, measuring vital signs, and preparing patients for examinations.
• Phlebotomy: Collecting blood samples for laboratory testing.
• Dressing changes: Assisting with dressing changes for wounds or minor injuries

We also discussed the administrative support they will provide. 

New phone line system

We discussed some of the issues regarding the phone lines. TLCP are aware that some patients have reported the phone lines disconnect after waiting long periods to get through. We are changing our phone line provider and hoping the new system will be more efficient. Phone calls will be recorded and give patients more options when calling.

Other news:

It is with sadness that we announce the departure of Dr TS, she provided excellent patient care during her time with the practice. Dr TS has been a fantastic team member and a very dedicated GP. 

Introduction of the proposed TLCP PPG Structure:

TLCP PPF will consist of Site Patient Forum Members and TLCP-wide PPG representatives, members drawn from the patient population at TLCP. 

TLCP Site Patient Forums - each site within TLCP will host a quarterly Patient Forum -  all groups will aim to establish and embed an effective relationship between TLCP sites and the patient population, objectively communicating patient experience, concerns, suggestions and comments. TLCP Site Patient Forums aim to represent all patients regardless of age, gender and ethnicity to provide accountable methods of input and feedback from each TLCP site. 
TLCP Site Patient Forum Members will be asked to select two representatives to attend TLCP PPF-wide meetings, which will be held every six months. TLCP PPG-wide meetings and members will contribute to TLCP-wide decisions and facilitate the smooth operation of TLCP as ONE practice.

TLCP PPF Open Day (Annual General Meeting) - TLCP aims to hold an annual Open Day for TLCP Site Patient Forums and TLCP PPG-wide members; the annual general meeting will also be open to all patients of TLCP. The purpose of the annual general meeting is to present the activities and achievements of the Group and promote TLCP Site Patient Forums.

There were no questions regarding the proposed structure, and the members were happy. All TLCP PPG groups can review and provide feedback on the proposed structure.

We are hoping that the feedback will be available in the next meeting.

TLCP Constitution

• TLCP constitution was provided to all members and we agreed we would keep this on the agenda for the next meeting.

AOB

1.    Data – Members felt it was essential that they have data to enable them to be able to identify the areas of concerns.

• Friend and family feedback data
• Average wait to see a GP 
• DNA data
• How many appointments we offer daily, how many calls for appointments, how many satisfactory calls and unsatisfactory calls.  

2.    We need standing items on the agenda – It was explained going forward we would have standing items on the agenda. However as this is the first meeting since covid we wanted to take the opportunity to provide an update on what is currently happening in TLCP and discuss with the members what they would like to be on the agenda. 

3.    Members requested to  be sent a reminder before meeting

4.    We discussed ways to recruit new PPG members – 

• Promotion of the PPF via website – TLCP Communications Hub –  Already in place 
• PPF Posters/leaflets – Already in place but we did agree to be mindful of poster placement. 
• It was also suggested that a poster could possibly if agreed be placed in our local pharmacy. 
• We discussed the possibility of a hybrid meeting for members that are unable to attend the surgery.
• Care navigator training – It was explained that the care navigators have one of the hardest jobs within TLCP. They undergo training but it is a role that you are constantly reflecting and learning from. The potential new Duty Hub may provide additional support to the call centre as previously when tested it gave care navigators the opportunity to ask questions to the GP’s in the rooms when they had queries. This was a good learning opportunity. 
• Pros and cons of the surgeries merging – The members expressed that prior to the merge they were informed of all the benefits the merge would provide but they feel that TLCP are yet to live up to that expectation. It was highlighted that due to the merge patients can benefit from the specialised clinics we provide – Joint injections, substance abuse and physio. Due to the merge we are able to offer a wide range of extended hours throughout the week including Saturdays. Due to the merge, you can also get appointments at other sites that can reduce the waiting time. We are aware there are areas that need improvement and we are trying to resolves these issues as we only want to provide the best service to our patients.

The members questioned – how do we measure if the merge is working?  

• Lack of appointments – We spoke about the frustration patients face when they wait for long periods to be informed there are no appointments nor pre bookable appointments. It was explained that unfortunately there is a certain amount of routine appointment for the day. The example was given - within the 40 minutes a patient is waiting, a lot of calls are being answered and appointments given. Pre-bookable and online appointments are available but get booked up very quickly.  We are aware of this and trying to improve the system.  Each day we do provide emergency appointments. 
• Patient’s wellbeing - Our patients and staff wellbeing is paramount to TLCP. We have many posters within the site promoting healthy eating, stop smoking support and we signpost patients to various different support groups. 
• General – We discussed the reality of the pressures that primary care are currently under.  The workload the GPs/ workers face on a daily basis, admin - docman, labs, prescriptions, referrals, complaints, follow ups and etcetera.

One of member at the end of meeting said he has a wider appreciation of the surgery and happy to be on the panel. 

We feel the PPG input can contribute to the smooth running of the service we provide. 

Next Meeting:

TBC 

Members did state it would be more helpful to have all the dates’ sets for the year and potentially different times to enable them the notice required to be able to attend. This is a reasonable / practical request but unfortunately there may never be a day/time that is convenient for everyone.  

Attendees

TLCP:

• Jyothi Eregowda (Jo) (Operations Manager for Belmont Hill and Modern Hill Surgery)
• Paula Gordon (Supervisor MH)

PPG Members:

• FT

Terms of engagement – provided to all 

JE reviewed the minutes from the previous meeting 

TLCP Updates

Paula asked if the new triage system had been used and if so, how the new triage system was going – 

FT stated - it is brilliant, it has been very useful. FT has used the new system twice, received a text to book in a routine appointment and received a same day appointment another time. 

A patient friend to our PPF member has experienced issues with the call back service on the phones. 
Advised to please inform TLCP when experiencing any problems with the system as we can investigate the issue and report if necessary to ensure the smooth running of the service.

Carers champion 

TLCP recognises the importance of Carers.

A member of staff at each site will become a Carers Champion who will help to promote and support carers in the practice. 

We discussed some of the challenges carers face 

• Some carers neglect their own health needs 
• Older carers can face difficulties with the current technology 
• Emotional strain
• Lack of recognition and support 
• Not being aware of entitlement or how to seek support 

Each site has a designated notice board for their Carers in the patient waiting area and welcome suggestions regarding ways we can help our carers and the information we provide. 

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. 

NHS APP

FT is experiencing an issue with the NHS APP, previously FT has attended our digital hub sessions and received support from MH Champion but unfortunately, the issue was not resolved.
FT is currently liaising with the NHS APP support team but expressed that we all need to work together to essentially make identified issues be resolved faster.
We have asked FT to keep us updated with the feedback and explained that it is important for all patients to aware that GP surgeries/ TLCP did not create the app and therefore when staff members are trying to resolve issues they are trying their best with the knowledge they have. 
We understand the app tells patients to contact their GP surgery but when we try to raise an issue on the behalf of patients, we are informed the patient needs to contact them directly. 

FT has agreed to let us know the outcome of this ongoing issue.

GP Survey

The GP survey was emailed to all PPF members and no feedback was provided.  868 surveys went out and 208 surveys were returned. Therefore we had a 24% completion rate.

TLCP will run another survey and we potentially are aiming to have a higher amount of surveys completed, as this would provide better representation. This information will be at each site and on the website once finalised. 

AOB

Flu 

We will be offering patients the Flu jabs as we have previously, we will also be running a Saturday clinic but details regarding timings and location are yet to be agreed, when more information becomes available, patients will be notified accordingly. 

RSV: From 1 September 2024, those who turn 75 and those aged 75 to 79 (including pregnant woman) will be eligible for a free vaccine to protect them from respiratory syncytial virus (RSV).

Physio service 

Our PPF member praised the prompt service. 

Question – can patients have more appointments with physio while they await their MSK appointments?

• It was explained the physio service is limited but the feedback would be passed on.

Blood test

Following the recent cyber-attack, we were informed we could go ahead and start processing blood test as of the 15.8.2024.  Patients whose blood test were compromised and urgent will be the priority. Currently there is a backlog but patients will be contacted if they are require to repeat their test. 

Next meeting 

• TLCP wide meeting at St Johns Medical Centre. Thursday 31ST October  5.30pm to 6.30pm
• Morden Hill PPF meeting – Friday 22nd November 2024 @ 4pm

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

Attendees

• TLCP: Dr Chrisanthan Ferdinand (GP Partner)
• Khaled Chowdhury (Operations Manager St Johns)
• Jo ( Operations Manager Belmont Hill and Modern Hill)
• Jennifer Gayle (Reception Supervisor St Johns)
• Terms of engagement

Welcome and Introductions

Jo/Khaled welcomed everyone.

TLCP Updates

GP Assistant

New role within the Practice.

A GP (General Practitioner) assistant plays a crucial role in supporting the operations of a general practice clinic. Common roles and responsibilities of a GP assistant:

Administrative Support:

1. Scheduling appointments: GP assistants often manage the appointment book, ensuring that patients are seen in a timely and efficient manner.
2. Patient registration: They may help with patient registration and data entry into electronic health records.
3. Handling patient inquiries: Assisting patients with general inquiries, providing information, and directing them to the appropriate resources.

Patient Communication:

1. Communicating test results: Following up with patients regarding test results, explaining them as needed, and addressing concerns.
2. Medication management: Ensuring patients understand their medication instructions and assisting with prescription refills.

Basic Clinical Tasks:

1. Simple medical procedures: Performing basic clinical tasks, such as taking blood pressure, measuring vital signs, and preparing patients for examinations.
2. Phlebotomy: Collecting blood samples for laboratory testing.
3. Dressing changes: Assisting with dressing changes for wounds or minor injuries.

Health Promotion and Education:

1. Providing patients with information about preventive care and healthy lifestyle choices.
2. Offering guidance on managing chronic conditions through diet, exercise, and medication compliance.

Clinical Documentation:

1. Accurate record-keeping: Maintaining up-to-date and accurate patient records, including documenting patient interactions and clinical information.

Patient Follow-Up:

1. Monitoring patients' progress: Following up with patients to track their health status and compliance with treatment plans.
2. Referral coordination: Assisting patients in arranging specialist referrals and tracking referrals to ensure timely care.

Assisting with Minor Procedures:

1. Preparing patients for minor surgical procedures and assisting the GP during these procedures.

Medication Management:

1. Ensuring medication adherence: Educating patients about prescribed medications and addressing any concerns or side effects they may experience.
2. Prescription management: Helping GPs with prescription renewals, referrals, and other medication-related tasks.

Quality Improvement:

1. Contributing to quality improvement initiatives by identifying areas for improvement and participating in process changes to enhance patient care.

Emergency Response:

1. Providing assistance during medical emergencies and helping to stabilize patients until more advanced medical personnel arrive.

Team Collaboration:

1. Collaborating with GPs, nurses, and other healthcare professionals to ensure a cohesive and effective patient care experience.

TLCP is currently in the process of recruiting GP Assistants, who will be part of our multidisciplinary Team and they will start end of Feb.
When patients are booked to their slot, patients will be made aware that they will be seeing the GP Assistant.

Reception 2/2

St Johns reception is ready to go into care navigation hub which is based on site in St Johns Surgery which means more call handlers who are trained to a high level of training who can rightly navigate the call giving patients the right information. This has proved to be an ease with patients trying to que up at 8am in front of the surgery or hold the call for several minutes. We now have more reception staff to attend to patients when they are waiting in the surgery at reception desk.

Other news:

TLCP wide meeting is scheduled to run on 29/4/2024 at St Johns. It is a AGM ( Annual General Meeting). This platform brings all PPF members together to understand the PPF better and how to improve TLCP’s services which will benefit patients and east pressure on TLCP staff. 

Introduction of the proposed TLCP PPG Structure:

TLCP PPG will consist of Site Patient Forum Members and TLCP-wide PPG representatives, members drawn from the patient population at TLCP. 

TLCP Site Patient Forums - each site within TLCP will host a quarterly Patient Forum -  all groups will aim to establish and embed an effective relationship between TLCP sites and the patient population, objectively communicating patient experience, concerns, suggestions and comments. TLCP Site Patient Forums aim to represent all patients regardless of age, gender and ethnicity to provide accountable methods of input and feedback from each TLCP site. 
TLCP Site Patient Forum Members will be asked to select two representatives to attend TLCP PPG-wide meetings, which will be held every six months. TLCP PPG-wide meetings and members will contribute to TLCP-wide decisions and facilitate the smooth operation of TLCP as ONE practice.

TLCP PPG Open Day (Annual General Meeting) - TLCP aims to hold an annual Open Day for TLCP Site Patient Forums and TLCP PPG-wide members; the annual general meeting will also be open to all patients of TLCP. The purpose of the annual general meeting is to present the activities and achievements of the Group and promote TLCP Site Patient Forums.

There were no questions regarding the proposed structure, and the members were happy. All TLCP PPG groups can review and provide feedback on the proposed structure.

We are hoping that the feedback will be available in the next meeting.

TLCP Constitution

TLCP’s PPF constitution is given to every member who could go revise the constitution and add any changes that helps patients. This will be discussed in the AGM (Annual General Meeting)

AOB

Improving St Johns Site Patient Forum Representation

Team Discussion – the following ideas have been proposed:

• Promotion of the PPG via website – TLCP Communications Hub – in progress
• PPG Posters/leaflets – TLCP Communications Hub/PPG Leads – in progress
• PPG Open Day – to promote PPG and the Practice, potentially within the flu season, the group is happy to support the Practice on the Open Day

Next Meeting

Proposed date of the next meeting:

TBC

Confirmation to follow