PPG Lead attended Citywide PPG Forum and reported back to practice:-
1. What can patients do to help GPs (Linda Collie)
Self-care and self-help education, be a partner in your healthcare and use other healthcare professionals.
Problem with cancelled appointments/no-shows
Home visits are resource intensive – get a taxi!
Use online services and be prepared for telephone consultations
Utilise self referral services (scope to expand?)
Give positive feedback to the surgery as well as negative, it is appreciated!
2. Integrated discharge services for complex cases Steve McInnes
The negative clinical impact of discharge delay
Most complex discharges are related to the over 65s
Discharge process to be removed from ward staff with the full needs assessment taking place in a community facility/home environment in order to release time for ward staff to care for patients
reduce the need to discharge through diverting the entry pipeline away from A&E/hospital admission.
3. Constitution in terms of reference for surgery PPGs – Roger Batterbury and Avril Adams
This was discussed in relation to the East Shore practice with the PPG fulfilling the role of ‘a critical friend’ to the practice, advising the practice on the patient perspective and providing insights and encouraging patients to take greater responsibility for their own and their families health.
To be achieved through communication with the patient population, to support the surgery by carrying out research into the patient perspective and contributing to the drive to improve health literacy.
I have the ‘constitution and terms of reference’ if anyone would like to see them.
CCG Patient Participation Group Workshop – Wednesday, 16 May 2018
PPG Lead attended Citywide PPG Forum and reported back to practice:-
1. Accessing same day care for people who are not normally ill
We worked in 4 sub-groups as part of the ‘Your big health conversation’ consultation. I am unable to feedback on three of the groups because the collective feedback was limited. However, the focus of my attention was on the group that was looking at ‘accessing same day care for people who are not normally ill’. The conversation was lead BY Nick Brooks, who is the Senior Communications and Engagement Manager for the CCG.
The fundamental premise was that General Practitioners are “an increasingly scarce resource” and therefore how can patients make informed choices about accessing same day care services. In other words how can the pressure on General Practitioners be relieved combined with reducing the footfall in A&E (which has been the subject of earlier discussions).
As a patient participation exercise the conversation was mainly about individual patient experiences and people telling their stories of how they made decisions about which service to access. What I got from it was that:
There is a need for further education, and the management of patient expectations, in relation to what is available.
No specific conclusions were reached as it is all part of this big conversation.
My contribution related to exploiting technology and social media to mediate the patient to health service professional relationship. Whilst the tendency is for the NHS to focus on patients with complex needs, and the older generation, who by definition will make more extensive use of health services, including social care, my concern is also with those who need access to same day care on an infrequent basis.
The digital natives, millennials and generation Z, whatever you want to call them, increasingly expect their needs to be met through social media and the use of smart phone technology. If the NHS is to future proof it services then it needs to engage, in my view, more extensively with these expectations. In reality this means greater opportunities for:
- Self-care through monitoring equipment in the home, with results sent to healthcare professionals for assessment
- FaceTime/Skype and instant messaging with healthcare professionals
- An interactive, on line 111
- The use of social media and blogs
- Extensive on line self-referral questionnaires
- The ability to access specialist medical expertise without going through the GP Gateway, although the GP/GP practice would be kept informed.
- More same day care services located in pharmacies
- Mega-surgeries for economies of scale, although I realise that as independent businesses this is not something that is always welcomed by GP practices
I appreciate that some of these ideas are already under consideration and that others may appear quite radical. I also appreciate the significant resource constraints that currently exist.
2. GP practice PPGs
There was again mention of Patient Participation Groups and we were told that since 1 April 2015 all practices are required to establish and maintain a PPG. We were issued with a document about a PPG purpose, requirements, development, reviewing patient feedback and action planning. We were also issued with a template for terms of reference. I can request these in soft copy if you would like to see them.
Summary report Citywide Patient Participation Group 21 November 2018 for the Practice Manager, North Harbour Group
PPG Lead attended Citywide PPG Forum and reported back to practice:-
The focus was principally on social prescribing, GP referral and self-referral depending upon the service provider.
Social prescribing would appear to have significant momentum and a broad definition to include support for: low-level mental health needs, psychological therapies, counselling in relation to isolation, domestic abuse, anxiety and financial issues, transport problems, befriending, gardening and housework, lunch clubs, structured problem-solving conversations inter-alia.
I interpreted the aims as being:
- To provide a referral opportunity for GPs
- To provide an alternative to ‘patients’ accessing clinical NHS services
- Ultimately to reduce pressure on the NHS.
It also relates to patient empowerment for self-care. And, a recognition that GPs are an increasingly scarce resource.
Talking Change – Dr Nick Moore
Portsmouth’s Talking Change (known as i-talk in Hampshire) is principally concerned with low-level mental health needs for adults and is a social model of support with open access through self- referral. I think it may be based on telephone conversations, but I’m not sure.
Well-being House – Dr Nick Moore and Suzannah Rosenberg
The aim of the Well-being House to support individuals to achieve good mental health and well-being. Single point of access through an assessment contact centre. The services include listening, extended conversations, risk assessment, signposting and other social prescribing. It is based on a social model of support and his peer led. Located in Southsea currently but seeking new premises.
You Trust (and Mytime?) – Julie Hawkins, Ellie Gray and Louise Wilders
You Trust aims to reduce patient presentations to the medical profession through counselling and advice and offers an opportunity for face-to-face conversations with community health and well-being partners. The support is for emotional, social and practical needs. I understand that these are by way of a guided conversation that results in a plan of action, which can include support or referral to other agencies. I think it is by GP referral.
Good neighbours Rev. Nick Ralph (Anglican)
Good neighbours is extending to Portsmouth. Currently 123 groups in Hampshire. Volunteer run to provide practical support such as transport to and from medical appointments. A group is being planned for Paulsgrove.
Carer respite and provision of volunteer domiciliary carers?
Hampshire Fire and rescue STEER – Andy Piper
STEER stands for ‘Safety Through Education and Exercise for Resilience’. A free exercise course for over 65’s focus is on falls prevention. It is based on the ‘12 main causes’ of falls and is available through self-referral. It results in a frailty scale assessment and a reduction in the risk of falls. Self-care philosophy that will also advise referrals to GPs or other support services. Currently in Southsea but coming to Cosham. Because the Fire and Rescue Service visit so many homes, principally fitting smoke alarms, they seem to be engaging in some sort of assessment of need process with referrals be made to the medical profession and also social prescribing services
A PCC initiative bring together service providers in a collective, known as ‘the Hive’, engage in ‘bridging projects’. There is a plan to have premises in Portsmouth central library. PCC is developing a Portsmouth database of social model support services.
Most of these are highly reliant on volunteers and some funding from Solent NHS, but this wasn’t explained in detail. I suspect the Practice will know about these things anyway, but if you think I can be of help please do not hesitate to let me know. Happy to come in to the Practice. I have some information leaflets which I will drop in.
A big issue for me is that I was entirely ignorant of all these opportunities and therefore it was very educational, but I wonder how effective these organisations are at marketing and promoting their services so that the people who need services are aware of the opportunities available.
NHMG PPG Representative attend Drayton PPG Meeting as we are now collaberative working with Drayton Surgery under Primary Care Network initiative. Please see our reps summary below from that meeting:-
Citywide PPG 22 May 2019 and Drayton PPG 23 May: Summary report
Carer friendly practices
The session was concerned with the well-being of carers and providing support to carers through ‘carer friendly GP practices’. Figures quoted included: 72% carers suffer mental ill-health and 61% carers suffer physical ill-health as a result of caring, with carers attributing the health risk principally due to lack of support. GPs are often the first point of contact and there are challenges with identifying carers, with 90% of carers being unidentified. One problem is a reluctance to be labelled as ‘a carer’ and therefore not self-identifying as a carer, “I just look after someone I love”, and consequently not proactively seeking support opportunities (to become a social prescribing role?)
A framework of quality markers in relation to GP practices has been introduced with a toolkit to guide implementation. There is to be an annual declaration with evidence of how the practice is supporting carers, and the evidence can be used in CQC inspections.
NHS long-term plan
This was a very brief and quick overview. The highlights that had resonance for me included:
- the new service model of primary care networks – shared responsibility for resource use, service design and local population health through cooperation and coordination.
- the promotion of social prescribing
- access to digital first primary care by 2022
- online consultations for secondary care within five years
- all Trusts to did digitise by 2024
Primary care networks (PCNs)
PCNs will be GP practices, typically covering 30,000 to 50,000 patients, which work collaboratively and where there is potential for shared services and the diagnosis of, and meeting, local patient needs, with funds designated to flow through the new network contracts. There is to be funding for additional staff – paramedics, physiotherapists, social prescribers and physician associates inter-alia. The aim is a multidisciplinary team supporting patient health and well-being not only in the surgery, but also in care homes.
The espoused potential benefits include the economies of scale through having a critical mass of healthcare professionals with a good skill mix to meet local needs. In some ways redefining the role of the GP as the first point of contact and more like the hospital consultant role where the GP is the overlord of the clinical practice with patients flowing through other health professionals as required and other health professionals consulting with the ‘GP consultant’.
There are a host of practical issues and challenges which will be encountered and some time was spent in facilitated groups identifying ‘the concerns and the opportunities’. 90% of the time was spent with concerns about individual patient access. This is of course to be expected as the group are PPG representatives who see things through the lens of the specific practice and particular patient experiences. Whilst these are of course valid concerns I found, as I normally do, there is a preoccupation with the older generation (which to be frank is the profile of the PPG group), which I understand may have multiple/complex health problems, and their putative reluctance to move away from the ‘I always need to see a GP’ paradigm, coupled with an inability/non-acceptance of technology facilitated consultation and health care being the future. Of course, all citizens should have equal access to healthcare and the needs of the older group must be taken into account. However, in order to future proof GP practice, and the NHS in general, we will also need to look at how the rest of the population want their health care delivered and this will be through smart phones and home technology.
The Portsmouth PCNs are:
- North Portsmouth – 28,000
- Island City – 47,000
- Portsmouth South Coast – 34,000
- Brunel Health Network – 80,000 (including 20000 – 25,000 students, against which there were significant unreliable, anecdotal prejudice in terms of the perceived excessive demand on health services generated)
- Portsdown Group Practice – 44000
I understand that whilst funding will eventually relate to the size of the PCN in terms of patients there appears to be a first year allocation of money for a pharmacist and a social prescriber person in year one to each PCN, regardless of size.