Patient Participation Group

We are a newly formed Patient Participation Group serving the three surgeries of Lakeside St Neots - Cedar House, Eaton Socon and Dumbelton.

We meet regularly with Lakeside staff and provide feedback to the practice with the aim of improving the patient experience.

We  encourage patients from all ages and background to join us so that our diverse population is fully represented. 

To join our PPG please complete our online form or pick up a paper application from the surgery

Latest Minutes

Monday 18 November 2024, 6pm

Attendees

• Jonathan Banting – Chair
• Dr Thaven Chetty
• Sarah Parren - Hub Manager
• Jeanette Teague - Secretary
• Peter Lane
• Clare Hall
• Helen Banting
• David Denton

Apologies

• Sue Johnson - Deputy Secretary

Matters Arising

Sarah confirmed that the new bank account is now open and she has a paying in book and cheque book. She is waiting for a statement to confirm the current balance and she will then pay in some money from book sales.

PPG Facebook Group - Survey and Questions

Jonathan explained that the PPG Facebook group went live in October and has 47 members currently. A survey was posted during October to ask patients about their experience of using Anima.  

The following are questions and comments from the Facebook group:

Anima

a. People found that the suggestions after entering initial description didn’t fit , some gave up, others then just choose something close and then answer irrelevant questions and only in the final free text box are they able to say what the real problem is. Can there be a “Other” box at the end of the suggestions?

• The Practice is investigating with the Anima developer the possibility of a generic enquiry template for Anima. However the risk is that a patient will use this for a matter which should be treated urgently but the system will not be able to flag it.

b. A common complaint was the number of questions that get asked 

• This is necessary for the system to be able to flag how urgent the case is. It also gives detailed information to the practitioner, thereby reducing the consultation time.

c. Could there be an easier way to follow up a previous issue without repeating the whole set of questions?

• This isn’t possible on Anima where the process is to close cases and track open issues (the old Doctrin system allowed multiple cases to remain open for long periods making the current status unknown). However patients can phone for a pre-bookable appointment and can request the same GP they saw previously.  It may be possible to use the generic enquiry template in Anima (if it gets implemented) to refer to a past case.

d. Anima is billed as for non urgent cases so why is it only available early in the day at Lakeside St Neots? Can opening hours be extended or perhaps add an afternoon or  shorter evening session (e.g. limited to the first 10 cases) that would then be processed with the next days cases?

• There is a general issue with the practice being “responsible” once you have informed them of an issue e.g. If you were to enter in Anima that you had tingling in your arm at 7pm on a Friday evening then this would not be looked at until Monday morning. The practice is constantly reviewing the number of cases and has recently increased the number of Anima appointments to 70 on Monday and 60 on other days and Anima remains open until these limits are reached  (However the number of phone calls have not decreased.) 

e. Even though Anima is for non urgent cases, patients are sometimes offered same day appointments unnecessarily which then means that patients who do have urgent cases that day have to call 111 and sometimes travel elsewhere.

• Anima determines how urgent an appointment is. but there is also a need to not waste available appointments reserved for Anima on the same day.   More generally once the daily appointment allocation has been filled , then patients will have to travel to another location to be seen that day (e.g. Pharmacist, 111, A&E etc)

f. Does a clinically trained member of staff have an overview of all Anima cases on a daily basis to ensure they are being dealt with appropriately?

• No.  Reception allocate appointments according to the inbuilt flag system as part of Anima. Helen asked how Reception decide which patients should see a GP as opposed to another practitioner.  Sarah explained that they will allocate to a practitioner with the right skill set.  GP’s will usually see babies & children, and those with long-term complex health issues. Helen asked if it is possible for Reception and/or confirming text to state which member of staff an appointment is with.  Sarah suggested that we discuss with Sally (Patient Services Manager) who will attend the PPG meeting on 21 November.

g. What is the practice’s mid term target for Anima. PPG understands that an online service must be offered but currently perhaps only ⅙ of patients are registered (Please confirm current numbers registered). Would  the practice like most cases to be raised using Anima allowing better triage and allocation of appointments and so a new campaign to get people signed up would be welcomed?

• The practice does not want to disadvantage those who cannot or do not wish to use online systems so Anima  should just be seen as another way to contact the surgery like phone or visiting in person

Test Results

SMS / Email Messages to patients

a. We have flagged before that face to face appointments were being sent with the confusing “Do Not Attend” text but we have also had patients receive messages for telephone appointments that look like they should be face to face:

• Sarah explained that this is a systems issue.  Dr Chetty would like to be able to change this in future.  In the meantime, Reception should explain to patients who are given a phone appointment that this will be sometime in the morning or afternoon, and not at an exact time.

b. For the above telephone appointment the patient (who was expecting this to be a telephone call)  waited 1 hour and then contacted surgery to be told that afternoon slot calls could be any time between 2 and 6 - better information in the message would just make the whole process more efficient for both patients and staff

• See answer in (a)

c. We have also experienced appointments being booked for patients but the patient not being notified at all - they only become aware if they either see the appointment by chance in System Online / NHS App or get an unexpected call. May possibly be an issue with the in-practice Pharmacist booking reviews and not able to send messages. Is sending SMS/Email a manual task or can it be automatic when an appointment is made/changed/cancelled ?

• See answer below about pharmacist appointment notifications

d. A patient has an appointment booked to speak to the pharmacist on the phone but this was not recorded anywhere online (Systmonline or NHS).  Reception confirmed the appointment but stated that they didn’t know why it wasn’t showing online as they don’t use the systems! 

• Sarah explained that the Practice has deliberately removed reminders for appointments with the Pharmacist because patients were attending at the surgery when it was either an admin task for the pharmacist or might be dealt with as a phone call

e. Some patients report that they receive unexpected messages asking them to submit blood pressure or book an appointment and when they contact the surgery the reason has not been clear. Others have seen very clear messages for annual reviews so please can messages be made as standard and clear as possible.

• GPDR rules limits how much personal information can be sent in messages. From time to time the surgery will run bulk searches to identify a set of patients and invite them for a test and this will result in an automatic  generic message being sent 

Preferred Communication

a. Patients report frustration when specific communication  issues seem to be either not correctly recorded in the system or are repeatedly ignored:

• Registered blind patients asked to print out and fill in forms
• Patients with hearing issues called on phone 
• Patients with dexterity issues called on mobile phone rather than house phone

Please can practice explain how communication issues are recorded in a patient’s record  and how clearly they are flagged if a member of staff needs to contact a patient?

• Sarah explained that some messages are sent in bulk therefore it isn’t possible to personalise them.  If patients don’t want their mobile phone as a contact they can ask Reception to remove it from the system and/or they can remove consent for text messages.

Patient Referrals

It is often difficult for a patient to know what the early status of a referral is (even with the NHS App) and whether or not they need to do anything (and how)  and what timescale they should expect. PPG has highlighted there is not any content on current or new websites about referrals but clearly once you have been told you need to see someone in a hospital there is a greater sense of urgency on the patients part - and if something has gone wrong in the process then it will most likely mean additional delay.

Some recent examples:

a. Referral sent from Lakeside to Hinchingbrooke but due to misunderstanding the referral was refused and Hinchinbrooke told Lakeside this. Patient was not informed and it was only when patient chased did they find out and some additional information provided. Patient was told that they don’t inform patients in case of refusal

b. Patient phoned 111, attended Urgent Treatment Centre who advised need for Urgent referral. Referral was then sitting inside Lakeside for 1 week, patient raised Anima cases to chase.

Please can Practice provide some guidance on referral  timescales, what notification the patient should expect and  how/when to request right to choose?

• Dr Chetty explained that hospitals rejecting referrals from GP’s is relatively new but is increasing.  He will discuss this issue with the other GP’s and will suggest that they explain to patients that if they haven’t heard anything within 4 weeks, they should contact the practice.  Dr Chetty will also discuss with his colleagues how the issue of rejected referrals should be dealt with. The timescale for the practice to send in referrals is 48 hours for urgent and 7-10 days for others.  When patients are placed on waiting lists, the practice doesn’t receive an update until they have been seen. Patients can contact the PALS service at hospital who can liaise with departments about waiting lists etc. During the discussions there were a number of answers where the functions available in the practice computer systems, the wish to give patients flexibility and the requirement to provide very detailed data to NHS monitoring would sometimes combine to give some of the issues we have raised. For example:

1. The need to generate the statistics leads to all activities having to be booked and these can show up in Systmonline as if they were appointments even if it is just the pharmacist doing a review. 
2. When a telephone  appointment is made it is still open to the patient to ask for it to be face to face - this leads to the text message being the same as a face to face appt -  just stating a time and place - PPG agreed that it was better to have the appointment message and reminders even if it meant that occasionally you could be unsure if it was a face to face or telephone (especially if the appointment had been made for more than a few days in the future
3. Online access to test results can be very helpful if the patient has a long term condition but can also be worrying if you see a low/high result in a new test (The Abnormal/Normal ratings are initially just generated by the computer system)

New Lakeside Website

The PPG had submitted detailed comments and suggestions regarding the proposed new Lakeside website.  The site has now gone live.  Sarah is due to meet Caroline at Corby office to go through our suggestions and will give feedback asap.

Practice Capacity and Access

Dr Chetty said that the NHS data regarding appointment availability which the PPG had presented at the meeting in September was very useful, in particular the comparisons with other local practices. As a result, Lakeside has increased availability of appointments by 30% since 19 September. This will hopefully be increased again in future. There were 1100 more appointments in September than in August. October data is awaited. The practice has achieved this by increasing online consultations including 10 more Anima cases per day and by creating other efficiencies including ward rounds at care homes.  The practice currently has 7 registrars who are supervised by practice staff.

Practice Funding

Jeanette brought to the meeting a leaflet which has been distributed to residents recently by Ian Sollom, Lib Dem MP for St Neots.  Below is a quote from his campaign website (www.sclibdems.org.uk/campaigns/fairer-funding):

• Figures reveal that since 2017, funding for GP services in Cambridgeshire has been frozen. Due to an unfair funding formula imposed by central government, our county receives the lowest funding per person in the entire country.

Ian Sollom MP and the Liberal Democrats are campaigning to change this unfair formula and to secure more investment in primary care, bringing more GPs to Cambridgeshire.

Sarah explained that the Carr-Hill formula which is used by Govt to fund GP surgeries means that the practice is only funded for 19000 patients, but has 21000 registered.

Another funding issue for next year is the increase in employer National Insurance costs and the increase in the National Living wage which will mean additional cost for practice staff (except for partners).  This may lead to a reduction in staffing.

Next Meeting

• Next meeting date: Monday 20th January 2025. This will also be the PPG AGM