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Billericay_ Brentwood _ Billericay PPI Forum Meeting

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					                 Billericay, Brentwood & Billericay PPI Forum Meeting
                                    Monday 19.3.07
                                        2.00 pm
                               The Old House, Brentwood

Present; Maureen Dann, Charles Novis (Chair), Edwin Fisher, Derek Paffett, Tom
Legg, Richard Cleary, Zelda Jeffers (Note taker) June Pereira (SWE PCT) Marc
Davis (SWE PCT Locality Director for BBW), William Guy (BBW commissioning
manager), Dr Patel (Public Health Doctor for BBW area).

Charlie welcomed everyone, and explained that Peter Jefferson had resigned due to lack of
time as he is devoting more time to his charity work, but also due to the PCT reconfiguration
making the forum’s work less local.

Apologies; were accepted from Anne George, Richard Cleary might be late, and Duncan Wood
who is to be informed of other Forum meetings.

Notes of Last Meeting
There were several adjustments to make to the notes before they could be accepted.

Matters arising
Re Practice Patient Groups June reported that she has now visited 21 out of 22 GPs and all
but 5 have agreed to have patient groups. Some will start meetings in April, the rest in May or
June, she has been pleased with the response, those who are reluctant are mostly one person
practices.
Re difficulties phoning Queen’s Hospital June reported that it is getting better, Zelda would
send June a copy of the letter she received from the hospital.
Derek raised concerns about GP registers of patients with long term conditions (LTCs) he was
not convinced they were kept fully, there seemed to be confusion about whether these existed
as documents, how the information was kept and how it was used. It was explained that these
are checked up on and there are financial benefits to GPs for keeping them, although all GPs
do not always do it. Charlie suggested that Derek ask his GP to show him his own patient
notes on the computer and explain how the system works.
There was a discussion about the prevalence of LTCs and public health measures to try to
reduce it, and best ways to treat them.
Charlie offered to circulate the QOF (Quality Outcomes Framework) headings to show what is
looked at.
June reported that statins were being changed, a letter is being sent to patients it will save a lot
of money.
Derek said that a lot of money was wasted when repeat prescriptions were given for all a
patients medications although they did not need some of them.
June reported that she would be having her job interview in the week beginning 9 th April, the
forum wished her all the best.
Charlie brought up the Patients log books for cardiac patients.
Ted said that at the last P3 group meeting they had looked at the British Heart Foundation
(BHF) version. The network is unable to fund the log books but the BHF may be able to help,
some pages for regular checks should be added.
Charlie showed the forum an example of what information GPs can print off from their
computers. Zelda will circulate it.
Ted said that he had had verruca treatment and only recently been given printed information
and he learned a lot he did not know before.

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Charlie said that the Out of Hours (OOH) service was going to the HOSC (Health Overview
and Scrutiny Committee) although it is not actually changing.
There are concerns about the high level of treatment registered because nurses with
computers rate the urgency of calls and if in doubt call problems more urgent rather than
risking missing something important. It is hoped that GPs with experience of making quick
diagnoses will ask for less call outs.
The problem for the public is the change in GP services, many people want to see a GP out of
hours because they do not want to miss work.
Phone calls to GPs out of hours should go direct to the OOH service. NHS direct does triage,
Essex Ambulance service in emergency, SEEDS staff in Primary Care Centres (PCC) where
patients may have appointments made for them to visit or they may make home visits to
patients.
They are aiming to add dental care there is a dentist on call in South Essex and patients can
be booked into a dentist the next morning.

Ted asked about the Patient Prospectus.
June said that Sue Morris-Newnham will involve forums in patient information and other
documents including the PPI strategy.
Charlie said the Sue would be at the next meeting on 10th April and Malcolm McCann is also
coming. They were expecting a response to the visit notes to Highwood and Mayflower
Hospitals.
Ted raised the issue of GP referrals to Occupational Therapists, if it is not clear how this
should be done the PCT should arrange training.

Practice Based Commissioning, Marc Davis.

Marc Davis arrived accompanied by William Guy BBW commissioning manager and Dr Patel
Public Health Doctor for BBW area they were introduced and June left.
The Forum members introduced themselves. Charlie explained that this was the BBW Forum,
part of the PPI Forum for South West Essex and they were interested in Practice Based
Commissioning (PbC)

Marc explained that the reorganised PCT had an emphasis on commissioning and would
divest themselves of provider services, they would recognise the needs of the population,
recognise gaps in the services and insure delivery involving the public.
They had 3 primary responsibilities;
      Improve the health and well being of the public,
      Commission primary health services,
      Commission secondary health services.
Services were to be provided as locally as possible to be more efficient.
Payment by results PbR was part of these changes begun by the government. Previously the
PCT had a contract with a hospital for a level of activity, PbR simplified this, when a patient
goes into hospital for a treatment the PCT pays for that treatment according to a National tariff.
If they do things in a Primary Care setting then they save the money they would have paid the
hospital.
Nationally there have been aspirations to invest more in Primary Care but there were historical
barriers. PbR is a tool to make change a reality.
(Richard Cleary arrived)
PBC will get front line clinicians to take responsibility for the use of resources.
Prescribing and secondary referrals use most of the funds spent by PCTs. GPs spend most of
this money. Now they can see how their activity drives costs and can redesign services to
improve outcomes for patients.
They can question the value of interventions and if there is no value they can look at how to
manage it differently.
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The expectation is to map PCT resources back to practices, management costs, prescribing,
referrals, community nursing etc.
Clinicians could decide to manage diabetes better, for instance evidence shows that 80% of
diabetics can be managed appropriately in Primary care. PbC can put in place a system for
that to happen.

Regarding the Organisational structure they need to work with front line clinicians to get them
on board, to convince GPs to take on extra responsibilities as well as manage a workload.
Pam Court the Chief Executive of the SWE PCT is keen on the locality structure, to keep the
PCT close to the population it is serving, to be aware of local needs and priorities. Each of the
3 localities in S.W.Essex has a director working to bring clinical activity closer to people’s
homes, public health skills such as Dr Arun Patel’s were needed. To support the process they
were working with and performance managing GPs and other services.

Richard asked if systems were in place for this.
Marc replied that the NHS was not light in data but that historically it had not been well used to
make decisions. They needed to get smarter.
GP practises had a lot of information but how should it be used to make judgements? They
needs checks and balances, and to look at the bigger picture, to gather information and
interpret it.

Dr Patel spoke about the prevalence data; most of it is historic it tells us what happened last
year. Real time data is needed, computers can now tell us what happened last week. Most
NHS spending is on chronic diseases, we know more about how these conditions proceed and
can develop plans for the future. Models can predict future needs.

Tom commented that GPs are running businesses but have a captive audience. They are
Jacks of all trades and do everything, but are they up to it?

Derek asked whether information was available to those who ask for it. In the past, he said,
the NHS took action and then justified it. Openness is in the Code of Conduct but will it
happen?
Marc said that if they were not open they would get into difficulties, information should be
shared, at the same time confidentiality must be protected. There is a need for
contextualisation to avoid misunderstanding. They hope for a mature dialogue.
How to move forward?

Derek asked whether the forums will be involved in gathering and using information. The future
of the forums is unsure, forum members are in limbo it would be a shame to lose the expertise
that has been built up, we need to create relationships so that forums can help the PCT.

Charlie said that forum members did not just want to be critics. There was some forum
member involvement in Practice Based Commissioning and it was hoped that this would
increase as it took off.
Ted mentioned the ongoing problem of getting information about complaints.
Marc said that the PCT directors had been looking at complaints handling and response, there
was a feeling that it should be improved.
The Health Ombudsman gave the main cause for complaints to be poor communication.

Charles gave examples of the PPI Forum phlebotomy study and eventual appointments
system. Many PALS problems related to hospitals and these were often the most serious.

Zelda mentioned that if patients were given copies of the letters about themselves between
clinicians this would improve communication.
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Marc said that the ability of the PCT to make GPs do this was limited.
Ted said that all complaints were important to the person who made them.
Marc said that many issues of concern were made to members of staff and never came to the
attention of the PCT.
Charlie said that complaints via carers were often about communication.
Regarding PBC the figures were interesting but the public were mostly interested in better local
treatment in High Wood or in the future Brentwood Community Hospital.
The Out of Hours service functioned from local primary care centres but transport connections
may make a more distant location easier to get to.

Marc said that the locality directors did not want to be stuck in ivory towers, they want to get
out and talk to people, small things can have a big impact. We have a huge task; in the forum’s
view what are the priorities?

Ted said that from a personal point of view he thought that there was a need for a dedicated
Multiple Sclerosis nurse, like the excellent Parkinson’s disease and epilepsy specialist nurses.

Charlie spoke about the initiatives to move services more locally, some GP specialists are in
place but not being seen. Hopefully more publicity to GPs would ensure that where relevant
more patients were referred to them.
Marc commented that there was a need to review specialist GP services and assess their
value for money.
William said that there was a drive for more GP led services, GP specialists should be
reviewed there was data on treatments but not on patient satisfaction. GPs pass on some
patient’s views need to hear from patients and public what patient’s experience and needs and
expectations are.

Tom said that the journey to King George’s Hospital was very long. He had to go to Ilford for a
urine collection test. Local diagnostic services seem to be good in the U. S. but poor in GP
practices.

Ted asked about the strategic services development plan. BBW had one for improved GP
services.
William replied that BBW had an agreement for ultrasound in the community. Now hope to
have them for CT scans, MRIs and more, locally. BUPA, the Nuffield etc can deliver services
for GPs.
BBW data shows that GPs in the area are high referrers to secondary services, one of the
reasons is to get diagnostics, this should be available to GPs and then they may be able to
manage conditions themselves. BBW has opportunities for this with private providers and the
new hospital.
Charlie said that resources were the key, if specialist GPs are used locums are needed to
replace their normal work. You can have an x-ray at an hours notice and then wait 3 weeks for
the result.
Marc said we are building the new Community Hospital, patient’s images are taken locally but
it is not necessary for the report to be done locally, they can be sent away for a quick
response. If GPs are kept waiting they can become anxious and refer on unnecessarily.
Endoscopies get quick reports, patient anxiety is lowered and GPs can manage the case well.
The new hospital in Brentwood is a good opportunity.

Charlie said that the Forum had had many speakers over the years, we would like to know who
is who in the new organisation, communication could be improved, prevalence data would be
useful.
Marc said he hoped to talk things through. They don’t just want to move services from High
Wood to BCH, services need to be reviewed and adapted for the future.
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Ted said that BBW PCT’s reason for building a new hospital was to offer additional local
services for Brentwood residents.
Charlie said that they had had some input into the process when BCH was designed, he was
concerned that the PCT was only going to be commissioning, sub-contracting was not always
a good thing, it is better to do it yourself, at least at first.
Marc said that the PCT manages some GP practices, they have discussed privatising them,
the view is to hold on for 12-20 months before divesting themselves of them. There is an option
for the PCT to keep on some services. The Important thing is to get it right it is secondary who
provides them.
Charles said that for example one concern was that Wickford Health Centre treats Travellers
private GPs might not be so willing.

Marc said that the state of facilities was often poor, some good GPs were in a difficult situation,
their buildings were not up to standard. The PCT has not been effective in helping find new
premises. County Council involvement was needed, different places need individual solutions.
Charlie added that car parking was also a big issue, patient groups can put pressure on the
council to get things improved.
Marc agreed that there was a need to put the public’s point forward to councillors and the Local
Authorities. We need the planning people on our side.
The SW Essex PCT is aiming to be recognised as a “teaching” PCT, but how many practices
are teaching practices? They need support and encouragement in this. Some do it but facilities
may hold them back.
There was a discussion abut the Physio survey which showed that patients were not waiting
long but GPs still thought they did, now a weekly report is needed to inform GPs of waiting
times according to the urgency of the problem, we need joined up health care.
Marc agreed that communication was the key. He asked what the Forum thought of the
inpatient environment when they visited wards.
Charlie said that he had been to Firs and Poplar wards, there were some problems. Since the
new matron took over Mayflower it was more clinical but cleaner and discipline was stronger.
Tom said that High Wood patients felt they got a good service.
Marc asked how we should move forward.
Charlie said that the forum will let him know of issues and he is welcome to raise issues with
the forum, it would be useful if he kept the forum informed as to what was happening with PBC.
Ted said a monthly report would be good.
Marc said he would send a regular update beginning in a few months time, either he or Sara or
William could attend meetings.
Charlie said that every 3rd forum meeting was in public with a speaker, we could have a
meeting about one of the PBC ideas like arthritis.
Thanks to Marc for attending and we will keep in touch.

Any other business
Ted asked for copies of other forums meeting notes to be circulated
Ted said all BBW PCT reports presented to the Board included an acknowledgment that
consideration had been given to PPI impact and this seemed a good idea but SWE PCT
reports do not have this feature. Charlie said he would take this up with the new PCT.
Ideas to be circulated re suggestions for the Forum’s commentary on the PCT HCC
declaration.

We had run over the meeting time and had to leave.




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Actions
Improve the February notes (Zelda, done I hope)
Send Duncan Wood and Marc Davis information about forum meetings (Zelda, Dates sent)
Send June a copy of the letter from Queens Hospital about the phone system. (Zelda Done)
Circulate QOF headings (Charlie)
Circulate Hypertension information as an example of what GPs can print off from their
computers for patients. (Zelda done)
Circulate information to GPs about how to refer to OTs (June)
Send copies of letters about patients copies of Drs letters to Marc (Zelda done)
Ask Sue M-N for a list of SWE PCT contacts (Zelda done)
Circulate the meeting notes of other SWE forums (Zelda in progress )
Suggest acknowledgement of PPI impact in PCT reports (Charlie raised at March Board
meeting).




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