07 04 11 - cw - NCT forum public meeting minutes

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					                 Patient and Public Involvement Forum
                               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
ppifnorthumberland@notpv.org.uk                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
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
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
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
(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
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
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

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.