Litchdon Patient Participation Group, Barnstaple Devon

Previous Meeting Minutes

These are the minutes of previous meetings.

PPG Minutes 24.10.17
Dermatology Clinic Building Litchdon Medical Centre 6.30 pm

Present Public: Rosie Haworth Booth (Minutes), Micky Squire (Deputy Chair) Cathy Chick, David Trueman, Ralph Brown, David Adams
Surgery: Sharon Bates (Chair), Hannah Doidge, Dr. Sally Hunt
Guest speaker: Julie Hatch from Fremington
Apologies: Mair Manuel, Sue Matthews, Michael Latcham

Minutes of last meeting agreed.
Matters arising: Dementia friendly work ongoing with signage, switches etc and visiting support worker.
DA suggested that it would help doctors if the patient online-appointment-booking-in screen could allow for additional comments to be added by patients after making their initial appointment, as their symptoms/problems could evolve between booking and seeing their GP.
Waiting room screen – now as slow as possible. It may be helpful to put links on the practice website to items mentioned on the screen, so patients can follow up, or a sticker next to the screen to say that the helpdesk can provide more information on any specific item.
Mobility Aids waste - Rosie reported back (item 7 on agenda). A letter was sent to the CCG who provided a response stating their position linked with DCC on this - e-mailed with these minutes as a pdf. Meanwhile Cathy Chick has provided press cuttings from a Scottish Borders paper reporting on how local authorities there deal with waste which appears to be more environmentally aware and financially more efficient than Devon’s. External Website Link External Website Link

The last PSN meeting at South Molton 5 October did not provide any further feedback. Sue Matthews also provided information regarding Milbrook who have the contract for collection/ recycling of aids from DCC and the CCG SEE Link ACTION Rosie to continue to press for updates on strategy regarding re-cycling with the PSN.

Julie Hatch Fremington Wellbeing Club (FWC)
Julie had asked to attend Litchdon PPG to spread the word about Wellbeing Clubs. She said there is a need to reach isolated people who would normally not be attracted to the idea of going out to ‘clubs’ . FWC encourage patients to take care of themselves.
- JH says there is a need to interact with the isolated/lonely. They don’t attend events for fear of criticism, exclusion or because of disabilities. If people don’t come along to the Medical Practice you don’t see what they need. But if the practice calls someone in for legitimate reasons, e.g. Diabetes, this can be a lead- in. The focus of the ‘club’ can be changed for each event and if a person comes to one the chances are they will come to the next. One such focus has been home safety checks with the lead Safety Officer for Devon and Somerset Fire and Rescue Service in attendance. At one event many commented on being lonely.
- Need to provide refreshments (NOT Cake!). People will chat to each other while waiting to see a podiatrist etc., Many are frightened ( of e.g. death, living, home maintenance, being ill, taken into care, recognizing need for a different home but not knowing how to go about it.).
- It’s possible to do a big combined well-being event – it would be familiar to those who have already taken part elsewhere. Venue would be a public space like a church hall.
- Event should be run by the PPG with Practice manager there to collate contact details of attendees. A GP should also be in attendance.
Melanie Cullen is Fremington’s Practice Manager- her observations might be sought on procedure.
Events included guest speakers like:
Tom Lewis – microbiology consultant – on urinary issues, Bladder and Bowel service.
361 Energy volunteer rep Tara Bowers - will visit patients’ homes and check for best fuel tariff and help patients away from pre-paid-card meters.
DrinkWise/AgeWell rep Tracy Watts - does a LiveWise/AgeWell presentation (focus shifted away from potentially confrontational issue of drinking)
Nurse Specialists with special gift for interaction [*but when they have ‘interacted’ what happens next?]. People need to be told they can stay in their own homes. Local pharmacies are now beginning to engage.
Adaptacar motability [The Motability Scheme enables disabled people in the United Kingdom to become mobile by leasing a new car, scooter or powered wheelchair through their Government funded mobility allowance; It is also possible for their families and their carers to lease a vehicle as well.
Motability also raises funds and provides financial help to Scheme customers who would be unable to afford the mobility solution they need.]
RNIB [Julie has a hotline to them]
Rod Teasdale, co-ordinator, Red Cross
Citizen’s Advice Bureau.

Sharon Bates noted that Shopmobility and Go North Devon could be useful contributors with advice on easy parking and accessibility.
David Truman noted that Tavistock GP Practice have CAB advisors in the Surgery. It was also noted that a marriage guidance councillor as a fully paid up member of the practice team has been cost-effective.
Sally Hunt noted that some of these issues need to be taken out of the surgery – ‘de-medicalised’. There is a need to help those who are isolated and need guidance on access to services but maybe the PPGs across Barnstaple should liaise over this.

Julie noted that the Barnstaple Patients Alliance annual event if linked to a medical practice may help patients to feel more comfortable coming along. The next Fremington group will be on 10 January 2018 and we are welcome to attend. She suggests the ‘medical’ string attached will encourage people to go along but if it is just a ‘club’ event they won’t bother.

David Trueman thinks there is EU money to target the isolated. Petroc college and students could be involved and college could supply transport. They also have professional bid-writers.
Isolated patients’ problems could slide into mental health issues. Information about events could be spread word of mouth from GP to patient. Important to get young involved. E.g. young mothers. Messages could also go out via surgery clinics e.g. diabetes clinic.
David Adams asked about attendance. Julie said there were 20 at first meeting
Following Julie’s presentation the group felt that there was no appetite to take this forward by the Litchdon PPG at this time. However, we may look at a joint venture with other Bple PPGs in the future.

Practice Update: Sharon
1. Net increase in patient numbers by 500 since March 2017.
2. Boutport practice closure and changes at Queens Medical Centre have impacted on no. of patients transferring to Litchdon.
3.New GP, Will Carlino, starts as permanent part time member (3 days per week) of staff from 4 October. WC has previously been attached to the practice as a trainee.
4. There are additional receptionist hours in place from October.
5. There are extra nurse and HCA hours for the treatment room from November
6. There is a nurse associate trainee place in the surgery now, with the second student on a two week placement in early October.
7. Green Impact Award: Litchdon will be going for the Gold award in May 2018 having already achieved Bronze and Silver.
8. Flu Clinic: 1,300 patients seen on 1st Saturday and 750 on the 2nd . More patients are treated in normal surgery hours now. Thanks to Micky Squire for his help on Day 1; Rosie who came in to talk to patients about Care Closer to Home and SOHS; 361 Energy, and Fire Safety officers, who came in to talk to patients about advice on bills and energy saving, and on home fire safety checks respectively.

Social Prescribing Update: Hannah
1. Dietician Clinic: run monthly at Litchdon by Lindsey Cook, dietitian from NDDH. Lindsey can accept patient referrals from GPs, nurses and district nurses, for patients who require or are already on nutritional supplements. Lindsey can see patients by appointment: face-to-face in her clinic at the surgery, or at home if patient is house bound.
2. Dementia Support Services Clinic: a monthly clinic run by Pat Diango, Support worker, Alzheimer’s Society. She can see anyone who is either diagnosed with Dementia, or is a friend/carer/family member of a person with Dementia who needs support, help and guidance after the initial diagnosis of the disease.
3. North Devon Dementia Carer’s Group: Litchdon now holds this monthly group which is solely for people who care for a person with Dementia. This allows the group to share their own experiences, ideas and problems they have found whilst caring for their loved ones.
4. Student counsellor: this is a new weekly clinic which starts on 10 Nov., every Friday. Sophie, who is a level 4 student from Petroc, needs to complete 100 hours of face-to-face counselling to complete her course. Sophie will be able to see patients referred to her by the practice who need support for depression/low mood/ anxiety linked to a life change/problem such as bereavement, divorce, grief, general feelings of being stuck and general unhappiness.
5. Working with Drink Wise/Age Well: Hannah is working with a resilience worker from DW/AW to look at setting up some free classes/sessions for patients, to help with their wellbeing, such as yoga/art classes. HD has put the idea to GPs and Nurses to see if they can identify a need for their patients.

David Trueman – best way of getting info out to patients - send out e-mails
Cathy Chick- community psychiatric nurses – what has happened to them?
Sharon says there are community psychiatric nurses as part of the Devon Partnership Trust (DPT) but they have not been directly linked to GP practices now for many years.
There is the website PINPOINT a directory of all voluntary services. External Website Link

361Energy Fuel Poverty feedback:
20-30 visits have been booked as a result of 361’s presence at the flu clinic. And phone nos. given for follow up calls. Suggested that Pat Diango is linked up with 361Energy – HD will pass on details.

PPG Litchdon 4 July 2017
Dermatology Clinic  6.30pm

Present:  Surgery: Sharon Bates (Chair), Hannah Doidge;  Public: Rosie Haworth-Booth (Minutes),  Mair Manuel, Sue Matthews, David Adams, Cathy Chick.
Apologies: Micky Squire, Dr Sally Hunt, Dr Angus Jefferies.

Minutes of last meeting passed: Matters arising:
Dementia Friendly surgery: SM : see Dementia awareness below.
Liaison with Petroc on Mural: HD no response from Petroc despite repeated attempts to contact over 6 month period. DA advised that should project go ahead some parameters should be set regarding content.
Waste equipment: RHB sent draft letter to other surgeries. had response from Melanie Cullen, practice manager Fremington but not from others.
MC reported that Fremington PPG thought issue important and should be put before Public Stakeholder Meetings at N Devon CCG. ACTION RHB to ask for it to be tabled at next PSN meeting 25 July. ACTION RHB to check with ME about Exeter contact for re-cycling.
Walking for Health. ACTION RHB to pass details to HD for social prescribing file and PPG noticeboard.
ME  suggests details of ‘Outdoor Gyms’ in Rock Park and other local places like Ashford could be added to file and advertised alongside details on PPG noticeboard– ACTION ME to check where local ones exist.  Info received from ME 12 July: Rock Park, Tews Lane, and Fremington
Chair: SM nominated and accepted.

Surgery Update: SB:
Green Impact Award. Litchdon has now achieved Bronze and Silver Status. Winning elements included Social Prescribing with HD. Innovation Award also achieved with combination of Social Prescribing and ‘health navigation’ via reception (e.g. redirecting patients to pharmacies) SB stressed that no pressure on patients who still wished to see a doctor for whatever reason (e.g. avoiding prescription payment)
Press Releases on Litchdon success here and on its NHS environmental awareness day in March combined with the retirement of Anette White a nurse after 50 years service, sent to both local papers but no response. ME suggested approaching The Voice.
Nurse Associate Training: the recently created training post to get Health Care Assistants trained to a higher level receives bulk of training in hospital but includes placements in primary care for periods 2 weeks. Litchdon had one placement in May and will be taking another in September.
Student nurses: Litchdon will have another student nurse for 10 weeks in Sept as well.
New phlebotomist- Martine- has previously worked at Litchdon returning to surgery after 4 years.
Dementia Awareness. Two training sessions for staff deemed enlightening. 30 staff attended and all depts were represented. Focused on variety of issues eg. loss of colour awareness. Red is last colour to be lost in spectrum so useful to improve  surgery signage with red indicators – eg. Surrounds to light switches. ACTION HD to investigate.
Self completed booklet “This is me” approved by worker with Devon Carers, Mary Austen, can be issued to diagnosed patients although advice is to issue at an appropriate time after diagnosis rather than at same time. Can be reviewed annually and used for reference on development of condition in individual patients. 
General discussion on the issues:
ME asked if there was any policy on reviewing patients for symptoms by age. SB: there is a routine memory test that can be given in response to subtle indicators.
DA suggested pharmacies might  be asked to be aware and record indicators and asked if patient’s online record would alert new doctors to a patient’s potential or existing issue. SB also confirmed that diagnosed patients will be reviewed annually. The discussion also noted that patients often aware that something is wrong but will attempt to ‘cover up’ so ‘sneaking in’ a test might be helpful. CC noted ‘memory cafes’ were helpful, like those in Castle Street and Pilton.
Changing Receptionist Role to Health Navigator:
Members of the PPG had reported back to SB on trial new reception message now including a message from Dr Hunt explaining the new navigation system. There was a general view that the message was too slow in enunciation but the wording was fine. ME noted that hard-of-hearing patients would struggle with any message and simply need to be able to leave a message at moment of pick-up.
Waiting room screen ME still having problems with speed.  This is a chronic problem but ACTION SB and HD to have another look at it.
Green Impact issues:  The surgery would like to ascertain if behavioural changes regarding environmental issues, such as keeping closer watch on ambient temperatures or  requesting patients not to run car engines while parked, in the surgery have been noticed by/had any impact on patients (they have been advertising what ‘greening’ has been happening for at least six months).  There will be a patients’ newsletter on website and in waiting room and SM kindly volunteered to speak to patients in the waiting room. ACTION SM to liaise with SB on collecting info.  ME suggested that an A5 sheet  questionnaire could be handed to patients attending reception or pharmacy.
Boutport Medical Centre will close 26 August. Due to considerable financial pressures and lack of GP’s.  The process is that patients can transfer to Queens and don’t need to take any action or they can change surgery should they wish. The practice was the smallest of the Barnstaple Alliance with 3 doctors (one of whom leaving) and 5,000 patients in a rented rather than owned building. Boutport had tried for the proposed new surgery on the ASDA site but this surgery proposal dropped. The impact of closure is being felt by Litchdon and other local practices as patients are transferring – so far 205 patients have moved from Boutport to Litchdon so having an impact on staffing and appointment availability.  Part of the reason for having the additional GP starting in October is to cope with the increased demand.

Acute Services Review briefing.
The Acute Services Review was undertaken because doctors said key acute hospital services were likely to become unsustainable in future due to difficulty recruiting key clinical staff, large increases in demand for services – and difficulty meeting national service standards. It was carried out by leading clinicians, nurses, managers and patient representatives, through the CCG and Healthcare Trusts, under the aegis of the STP.
SM and RHB reported back saying there was generally great relief at the decision to  retain acute services at all four Devon Hospitals including NDDH. However  it is vital that the public remain vigilant and continue to put pressure on the CCG, NDHT, NHS England, our MPs and central government to ensure improved staffing levels, adequate pay and other factors on which maintaining the services depends. SM said the introduction of rotational services for consultants was a great improvement but concerns remain about Stroke Service at NDDH. Whilst the proposals state "no change in current service", the current Consultant is scheduled to retire this year and the proposal to upgrade Exeter and Plymouth services to Hyperacute means greater investment away from North Devon. We need to monitor changes and next steps carefully.

CC spoke about the problematic link between nursing/clinical and social care for patients who have a discharge ‘care’ package for a limited time. E.g.12 weeks after which care will become means-tested. ME spoke about dire response of physiotherapists to care requests but helpful response by the Pathfinder Service.

Care at Home questionnaire by SOHS
RHB reported that the campaign group, Save Our Hospital Services been unable to elicit from the CCG clear documentation on patient satisfaction and health outcomes to evidence the reliability/validity of the Care Closer to Home service with which the STP proposes to replace care in the Community hospitals. SOHS have now drawn up a questionnaire which can be issued to patients who have experienced the Care at Home package without the potentially biasing presence of the carer. We are hoping such evidence will support the case for care in the home, but should it prove otherwise then it will be invaluable for putting a case for the retention of hospital services.  RHB asked if Litchdon would be happy to act as a distribution point for the questionnaire, which could be issued with an SAE if necessary, so patients could complete in the privacy of their own homes. SB said she thought the Surgery would be happy to do this.

Date of next meeting
Tuesday 24 October 2017. 6.30pm Dermatology Clinic Building.