Patient and Public Involvement Forum Northumberland working for primary care patients in Northumberland Minutes of the PPI Northumberland Care Trust Forum meeting (Public) Held on Wednesday 11 April 2007, 10am at Northumberland County Blind Association Present: Joan Thomas Sue Talylor Roland Peveller Heather Abrahams Carol Chapelhow In attendance: Anne Paton Astrid Adams By invitation: Duncan Clark – Northumberland Care trust Apologies: Cynthia Atkin Margaret Richards Grace Haigh 1 Introductions Heather welcomed everyone to the meeting and introduced Duncan Clark. There were no members of the public. 2 Minutes of the Previous Meeting in Public Matters arising – a. Morpeth Cottage Hospital still on-going. b. Out of Hours still on-going. c. Annual Report on the agenda d. Hexham trauma Unit still a concern 3 Presentation on Commissioning toolkit for eye care services by Duncan Clark Duncan explained his background and the implications of his role of the three commissioners coming together for North of the Tyne (less development, more commissioning). PPI Forum Northumberland is supported by North of Tyne Patients’ Voice Old Stables, Greys Yard, Morpeth NE61 1QD Voice phone 01670 504 562 firstname.lastname@example.org Fax phone 01670 504 071 Toolkit in six parts (Anne has copy of the presentation and can email or send on if members wish). GOS (General Opthalmetic Services). (Was a ten point check list, but not quality care and more about basic equipment and premises.) Anyone new can operate as an opthalmetic operator as long as they qualify the GOS contract. Now in review and contract is for 2007/2008 GOS review – Duncan felt was disappointing. AOP ass. opthalmetic professionals. Fed of Desp BR - ? association. ABDO ass British dispensing opthalmetic Health Act 2006 – Commissioning abilities. Ie. For pharmacy have two comply with care contract. For opthalmetic services you don’t have to comply with care contracts, only have to satisfy, although you have to employ qualified professional staff. Duncan seems to feel that there is a move away from selling to eye-care. Rolland queried why some opticians take tem minutes and other maybe forty five minutes. Duncan said there was nothing currently to be done. Optometry is not seen as healthcare, just a place to get glasses and public don’t complain and optometrists don’t advertise complaints procedures. Many members of the public don’t know what to expect and if the test is free, they seem to accept poor treatment. Most complaints is cost of appliances (specs) of failure / late diagnoses. Lots of ethical issues about how long a sight test should be, Scotland have a cap on numbers of tests, and two types of tests. General Public tend to ask about cost of sight test, not the quality or qualifications of the optometrist. Collage of optometry have a leaflet which explains “what to expect from your optometrist” but the collage charge for it and the optometrists don’t store it. Action: Anne to write to the collage and say that the forum is concerned its not available to the public. Private Sector, Retinal screeners, have got contract from optometrists, and not optometrists. Virgin – health – moving into commissioning and will provide NHS services. Domilicaly eye care – go into rest homes and see 50/60 people and change and not high standard. Level two commissioning services tends to be a needs assessment analysis not needs driven, more of an open market, but not new standards for the new contract. Issues around patients who have dementia / capability etc. with optometry eye care not necessarily needed and charged for. OCCS – also deals with private complaints GOC – complaints. Heather asked about Healthcare Commission, they have not attended visited an optometrists just laser clinics. Sue mentioned Gout. is out of hospital and into high street. This is scary, Duncan stated that there are standards for better health, but it is weakly enforced. Northumberland Diabetics rectal screening Eye triage – doing the training under GOS prescribing and provide an open access service and monitored electronically over website. Links with RVI and telemedicine, but service was pulled. Trying to streamline patients not going to Wansbeck and the onto RVI. Low vision services Cinderella Services, resistance from politics and rather than practical WET AMD – any due to get approved and patients need to be triaged, due to age related eye disease. In primary care, low diagnosis, as optometrists don’t have a lot of experience. Setting up a referral clinic and also referrals onto RVI and ? on a clinic at Wansbeck walk-in-centre for triage (muscular problems). Hopefully reduce false positives (82% referrals not having wet AMD at £100 per patient). So triage will hopefully save money and referrals into low vision services. Sue asked about late diagnosis, Duncan replied that the current system can have delays and optometry professionals don’t always refer quickly enough. (Optical coherence photograph) hoping to trial a business case in conjunction with base phototherapy restructuring (North of Tyne) has lead to a longer timescale. Specialist commissioners also want RVI to retain centre of excellence, satellite clinic, but specialist commissioners are concerned, now have to get PBC commissioning press for business case and cost effectiveness. Eye health GP now into third year, to discuss pathways Northumberland added children’s services and Glaucoma. Looking at community lead projects, optometrists questioned about types of equipment, in ISO practices on two had the equipment to undertake the work. Supermarkets and big businesses looking at optometry because the contracts are not stringent. Opthalmology relatively small budget is shown as a lower priority, PCT looking for value for money. Optometry services is actively ie, how many you do is how much money, but not quality based. Duncan would like expert patient programme inputs. Conflict of interests between contractors and commissioners. Pathways – see slide. Northumberland have seven PBC groups in four areas and not equal in all areas. Building capacity - ? unclear and I.T. systems are not currently compatible. Only five practitioners being trained to be prescribes. Concern PBC wont use the “specialists” how Vision Project, very little holistic working, really look at the patient as own diagnosis ie. Eyes, care needs etc. Vision 2020 Number of people partially sighted will have doubled by 2020. UK lowest ratio of optometrical consultants in Europe and wont be able to cope and the staffing out there not being utilised. GP Specialists tend to look at CHD rather than eyes. Training an issue to optometry. Lack of standards. PCO’s not meeting GOS contract. Optometrists – ethical advice rather than standard. Information sharing very difficult, accessibility an issue. Optometry I.T. consultant very expensive due to rurality, but have set up difference. Carol asked about the development responcibility being taken away, is there another way of pushing development of services. Duncan said, it would be helpful if patients could identify the gap or need. Opp. To develop as an in case service has gone. Sue asked about resistance by RVI i.e. reducing activity from Care Trust, payment be results meant that RVI only get the money if they go across the door. Duncan also explained MIV (Minor Injuries Unit) and OPD (Out Patients Department) and the funding that follows. Aspects of the new mental health act Very good presentation, new mental health moving to formulating an new patient led. Disability away from inst to the community. Rolland’s concern that advocates need to be provided and currently provided by charities. Concerns about excessive advocates. Complex presentation – nearest relative can represent you. This can have huge implications under new act, nearest relative may not be the previous person, could be civil partners. “how the government wants to change the laws” the new Mental Health Act Intention to visit second wave diagnostic sites, Jackie sent Intention to visit new BUPA site when complete Any other business Durham pilot LINks meeting a 32 page document available. Early adapter being set up by local authority rather than the commission. LINks and Northumberland – no real movement, only asked for a lead name. (Councillor Tony Reed.) Carol – have office opened public consultation of extended Nurse providers to prescribe controlled drugs on BNF. Especially for LTC, palliative care etc. on a website. Sue asked about the paramedic dec. Action: sue to write some comments in response. Action: Anne to write to Northumbria Hospital about transport requirements and also how the transport been refused in Otterburn on the basis of a supposed Newcastle Postcode.