PPG: Meeting Minutes 9th November 2023

BACK TO MAIN INDEX

Name	Organisation/Representative	Initials
Sheila Pitt	PPG Chair	SP
Breda Pooke	PPG Chair	BP
Colin Brown	PPG Member	CB
Theresa Houghton	PPG Member	TH
Neville Hudson	PPG Member	NH
Brian White	PPG Member	BW
Oena Windibank	CEO, Invicta Health	OW
Lisa Barclay	Director of Operations, Invicta Health	LB
Lucy Spencer	BMC Assistant Practice Manager	LS

Agenda Items

Welcome

• SP welcomed attendees and outlined the agenda items and topics for discussion. 

Apologies

• Elizabeth Carlton (EC), Katy Thomas (KT), Fay Godby (FG), Ann Bay (AB), Don Bay (DB), Christine March (CM), Stephen March (SM), Tracey Moon (TM), Stephen Crump (SC), Karen Wilshaw (KW), Daniel O’Connell (DOC), Andy Walsh (AW), Frances Westerman (FW).
• Nil apologies received from: Margaret Coombes (MC), Brenda Garroway (BG), William Wraith (WW).

Notes and matters arising from 14th September 2023

• Minutes were a true reflection of meeting. 
• Action updates
  • Local Veterans Association: PPG members advised to research services provided by the local new service.  Association has been canvassing local residents for contributing to the charity
  • Patient Information Leaflet: Action: Leaflet to be added to the BMC webpage which is accessible for all. Physical leaflets have been sent to the local printers.
  • SP responded to ICB following request for feedback.  ICB currently undergoing a consultation and will unlikely be unable to provide a response. 
  • Automated telephone message for cancelling messages: completed. 

BMC Updates

Dashboard

• Nil DNA data available.  Nil progress on being able to cancel weekend appointments. Appointments can be cancelled via Patient Access. 
• Data to be compared to previous months at next practice Quality Meeting. Comparisons to be detailed in future reports in order to review ‘hot spot’ areas.
  • Waiting average times (excluding weekends)
    • GP Routine: 13 days
    • GP eConsult: 13 days
    • ACP eConsult: 5 days
    • Nurse Consultation: 6 days
    • Nurse treatment (HCA): 7 days
    • HCA consultant: 7 days
    • Blood Tests: 10 days 
  • Telephone Data:
    • 261 calls per day.
    • Average call wait time: 6m 11s
    • Longest call wait time: 31m 45s
• Reports of patients being unable to obtain an appointment when calling at 0800hrs.  Consideration for a walk-in/drop-in clinic to be re-established (as per pre-Covid).   Action: LS to research the remits of this service and raise at the next clinical team meeting. 

Staff Changes

• Ian King, Frailty Team due to leave at end of November 2023. Experienced staff in place to manage the vacancy.
• New Secretary/Administrator due to start in December 2023.
• Senior Nurse to commence ACP training in Winter. 

Flu and Covid Clinics

• Clinics now completed and being offered ad-hoc within the practice. Good feedback from PPG members and patients regarding the management of the clinics. Unsure if there is going to be a Spring booster.

Future Changes to nursing appointments

• Due to increased capacity and demand and limited ability to attend to time critical services, blood test appointments will be scaled back at the practice from January 2024. Appointments will only be offered up until 1030hrs. Patients will be asked to book an appointment at QEQMH using the dedicated telephone line. Other local GP practices have already stopped this service. This will be added in the next Parish Magazine. Action: PPG to work with practice to ensure that patient who have mobility issues are offered a blood test at the practice in the first instance. 

PPG Updates

Website/Education Sessions – Dementia

• Future meetings to be discussed at next quality meeting and consider involved other local charity agencies in education sessions. 

Parish Magazine items

• ‘Top Tips’ have been added to the last 2 publications.  Good feedback with a request for further top tips to be added. New student nurse and trainee doctors and process for blood tests to be added to the next magazine.

Disability Working Group

• CB chairs this meeting on behalf of the Parish Council.  BP to be the PPG representative at this meeting. Relevant information will be shared with the PPG.  Will be looking at accessibility, and carers support. LS looking at improvements for accessibility for disabled patients. Action: Consideration for prescription transcription for patients with disabilities. LB to discuss with AW. 

Update from PPG Chairs Meeting

• This has been reschedule for the end of November 2023.

Financial Flows in Primacy Care – OW and LB

Primary incomes financial flows:

• Global sum equates approximately £100 per patient per year. This is reviewed every three months whereby the number of registered patients is reviewed. 
• BMC is part of the CARE Primary Care Network (PCN).  Funding is provided for participation.  It is expected that direct enhanced service contract is fulfilled (offering services outside of ‘normal working hours’, care homes, National Targets, and Medicine Optimisation Scheme) for the whole CARE PCN. 
• Quality and Outcomes Framework (QOF) which provides additional support for patients with long term conditions (such as diabetes or respiratory diseases). This is paid once a year.
• Enhanced Services  are defined as primary medical services other than essential services (i.e. baby immunisation, women’s health, 24 hour blood pressure).
• Private Fees (life insurance, DVLA) although this is a small financial flow compared to the above. 
• Staffing costs (including overheads) take over 95% of the budget. Locum costs pushes this up and is uncommon in the local area. Trend seen across England where GP’s prefer to work as a Locum rather than in a ‘substantive’ position. 
• Estate is ageing and is not large enough based on the demand and need of the local area. BMC holds and internal repairing lease which means that Invicta is responsible for the upkeep. Rental Value is paid back but maintenance costs are not reimbursed. Nil return from the pharmacy attached to BMC.  Long term plan in place.  Invicta has been in discussions with Assura (landlords) to extend the premises.  Planning permissions is dependent on local population growth and currently sits with Thanet District Council. Invicta could make pragmatic decision to fund an extension but this dependent on residents objections.  
• As Invicta manages a number of practices, it is in their gift to move funding temporarily to where it is needed most.  
• The team at BMC will be looking at opening on Saturday mornings on a rotational basis for specific long term conditions. This will assist with the lack of space at the surgery during the week. This will be funded via the CARE PCN.

Q&A’s

• Does the PPG have an input in the use of the finances for the surgery and what are the communication pathways if a PPG member/patient has an idea to improve the service?
• PPG should be used as a forum to raise ideas. Ideas and topics of discussion is raised at quality meetings which is attended by the management team.   PPG is able to influence patient quality and change processes (i.e. telephone system). 
• BMC has a large number of patients aged 65+ and over.  Is this taken into consideration with steams of funding and is more staff employment based on this need?
• Funding is based on socio-economic factors (weighted). At BMC there is an older population but there is a better quality of life. 
• Healthcare delivery has changed.  Is there a change is the delivery since conditions which previously would have been managed in outpatients is now managed in practice?
• There is a Shared Care agreement whereby patients are followed up in primary care following treatment in a secondary care facility.  Additional lists added to secondary care does have an impact on primary care.  No additional funded is provided for this. 
• Is the team prepared for extending the medical centre and when is this likely to start?
• An element of funding needs to put aside for building management. Invicta can negotiate release of these money from the landlord. They are responsible for employing the contractors.  As its public money, a value for money test is to be undertaken. If planning is permitted and the ICB supports the request to extend, the building construction could occur within the next 18-24 months. 
• When locum doctors work at BMC, are they paid more than the ‘substantive’ doctors?
• Take home pay for a locum or agency pay is always more than a salaried member of staff but they do not benefit pensions and they are responsible for NI and tax payments. 
• Could St Thomas Church (which is due to be closed) and the attached medical centre.  Could this be converted and used by BMC as an annex? Invicta does not have the capital to support the changes that would be required to make this a viability. This would need to be discussed with a developer.  

Issues raised by members

Area outside front entrance

• New pavements with planters in the front of the building.  Parish Council will pay for planters.  Actions: LB to obtain costings to be obtained for the re-paving of the front entrance. 

AOB and Meetings Management

• New directory of health and social activities and clubs in local areas recently distributed. Actions:  BP to share information with KE to add to the website. NH to obtain a printable copy for the surgery.

Date of Next Meeting

• 11th January 2024
• 14th March 2024
• 9th May 2024
• 11th July 2024
• 12th September 2024