Minutes of Benson Patient Panel Meeting 25 February 2019

Present: John Reid (Chair), Julie Allinson (nurse), Denis De Beger, Sarah Denton, Fenella Galpin, Dr Stephen Harper, Pauline Hoad, John Lant, Doug Miles, Caroline Nathan, Maggie Winters

Virtual Patients’ Group: Yvonne Griffiths, Jenny Grinham, Michael Winton.

Speakers: Sara Travares (Pharmacist) and Nikki Gibbons (Dispenser and Manager) Lloyds Pharmacy, Benson.

1. Apologies: Marion Bradley, Claudia Downing, Mike Mackney, Derek Shaw.

2. Discussion with Lloyds Pharmacy staffNikki circulated a paper (attachment 1) describing the process of dispensing prescriptions from when they are received by the pharmacy to when they are collected by the patient. She described the training process for the different levels of staff, emphasising that the pharmacist carries out a final check of all prescriptions. During discussion a number of points were made (see attachment 1a).

John R thanked the speakers. Following their departure several points were made by members who had received complaints about the pharmacy service, or who had experienced difficulties themselves. It was agreed patients should be advised to make complaints via the Lloyds website rather than to the pharmacy staff, who are doing their best in a difficult situation. It was also agreed that in order to make a strong case for improvements in the service the panel should obtain some hard data from patients to present to Lloyds management (see item 7 below) (Note for information: the pharmacy also provides feedback forms for patients to complete if they wish to comment on the service)

3. Election of officers No nominations had been received for any of the posts. It was agreed to split the secretary’s role into two – a minute secretary and admin secretaryChair: John Reid was re-elected unanimouslyVice-Chair: Fenella Galpin was re-elected unanimouslyMinute Secretary: Doug Miles offered to carry out this role and was elected unanimouslyAdmin Secretary: Maggie Winters was re-elected unanimously

4. Matters arising from the minutes of 26 November 20185b John L had produced four photograph albums of the Matters of Life and Death event, two large ones for the surgery and two small ones. One of the small ones is for Chalgrove patients participation group and it was agreed that the other small one be presented to Janet Burrt in recognition of her service to the panel. John L had secured a discount on the price of the four albums which would cover the cost of Janet’s album. John R thanked him for the work he had done. John R reported that he had bought a pair of binoculars for Alison Richmond as a thank you for her contribution to the panel. It was agreed that the rest of the discount will go towards the cost of this.

5d Fenella had discussed working on health promotion issues with Parish Council members and others (see Item 6c below).8 Fenella’s article appeared in the February issue of the Benson Bulletin.

5. News from the practiceStephen gave an informative presentation on the implications of the new GP contract that had recently been agreed (See attachment 2). He explained that it was too early to know what the impact would be and patients are unlikely to notice any changes before 2021. He thought that our new local Primary Care Network (i.e the grouping of Mill Stream Surgery with Goring and Woodcote and Wallingford Surgeries) would welcome input from patients into any re-organisation discussions at an appropriate time.

JR reported that other surgeries had found that placing health information leaflets in waiting rooms, instead of the usual magazines, had resulted in a good take up. SH and some members were not in favour of this for Mill Stream surgery, and it was pointed out that GPs hand out written information to patients as appropriate. In response to a suggestion for a TV screen with health messages SH thought it would be of limited value and would detract from a more homely atmosphere in the waiting room.

Sarah reported that the new social prescribing worker was Kate Hart. Nursing appointments can no longer be made online and will be dealt with by receptionists until the nursing skill mix has stabilised. An extra GP session is now being held on Tuesday mornings, and a further session is scheduled to start shortly to cope with the increased demand from the new housing development and RAF Benson families. The practice patient population now stands at 5,200. 6. Reports from the Working Groupsa) Carers Pauline reported that the group had held three successful meetings, including one with Louise Williams from Carers Oxfordshire and Donna Mitchell, acting manager at Millstream Centre. The result was that in addition to the library’s monthly coffee morning for carers, a weekly ‘Caring Café’ for cared for people as well as their carers will be held on Wednesday mornings at Millstream Centre. Some useful information on power of attorney had been obtained at meeting with Val Wolsey. This would be helpful for carers attending the library coffee mornings. The library itself is planning to hold an event for carers and would welcome input from the surgery.

b) IT group. Fenella had contacted the group and will convene a meeting shortly ACTION: Fenella.

c) Planning for national and local events. Fenella had held discussions with various local groups about organising a Get Active event in the spring to encourage people to take up some physical activity. They had been enthusiastic about a joint project that could be linked to the green spaces initiatives being planned by Benson Nature Group and the Parish Church on 8 June. It was agreed the patients’ panel should work jointly with these groups. ACTION: Fenella and Maggie to arrange a meeting with relevant groups

7. Making better use of the virtual patients’ groupMaggie reported that she and Sarah D had discussed making better use of the virtual patients’ group email list of 200 or so members. Their email addresses are confidential and can be accessed only by surgery staff. Sarah agreed that the panel could use the list (for a maximum of once a month) with the help of Sarah Tipple from the admin team to seek patients’ views, and for passing on information about the panel’s activities. The panel agreed that the list could be used in the first instance to gather information on patients’ experiences of local pharmaceutical services. Subsequently we could ask members what sort of topics they would like us to cover in the Benson Bulletin. ACTION: the officers

8. Report from SE Locality Patients’ Forum (SELF)

John R had circulated a report in advance of the meeting (see attachment 3). He added that he had given an interview about the CT-PET-SCAN privatisation issue to the Oxford Mail and had contacted Polly Toynbee of The Guardian. Like him his colleagues from the other Oxfordshire localities had also written to their MPs and would be discussing the issue with the Clinical Commissioning Group. Doug thanked John for taking this initiative.

9. 2019 Annual Open MeetingIt was agreed that Hendriette Kounds should be asked to speak She is the Go Active coordinator for South Oxfordshire District Council. ACTION: John R

10. Items for Benson BulletinMarch edition: Maggie had submitted a piece about social prescribingApril edition: Fenella will prepare a piece about the proposed Get Active event (see item 6c above) ACTION: FenellaMay edition: Agreed to seek the views of the virtual patients’ group ACTION: Maggie.

11. Dates for future meetingsIn view of the desirability of having a more accessible meeting place the practice agreed to fund the hiring of Millstream centre for the meetings in 2019.

Monday 10 June at 7.30 pm at Millstream CentreMonday 9th September 7.30 at Millstream Centre (Annual Open Meeting)Monday 25th November 7.30 at Millstream CentreACTION: John R to book the Centre

10 AOB NAPP Annual Conference in Chelteham on Saturday June 15th. Yvonne Griffiths agreed to attend.ACTION: John R will ask SELF if any other PPG is sending a delegate who might share transport with Yvonne.

The meeting closed at 9.35 p.m.

Attachment 1

Attachment 1a

Points arising from the discussion with Lloyds Pharmacy staff

Clear directions for patients on the script coming from the surgery mean that when labelling the medication pharmacy staff do not have to re-word the directions into simple language;

medications are ordered from the suppliers on a daily basis, arriving at the surgery at about 3.30 pm

patients are asked to allow a minimum of three days for medications to be dispensed, longer on Fridays and Saturdays – this timescale does not present a cluttering/storage problem;

delivery of a second computer is expected shortly. This will speed up the dispensing process;

the percentage of medications needing to be re-ordered daily from the suppliers varies according to how ‘popular’ they are, averaging about 40%, but stocks are always kept up to date;

there have been difficulties with the suppliers (Lloyds uses two main suppliers) with some medications not being available for as long as two months, in which case patients are directed elsewhere. The reason for these problems is not clear - possibly changes in packaging requiring alterations in the supply system or Brexit.

Lloyds are moving to off-site dispensing which should save pharmacy staff time. Medications will arrive at the pharmacy ready packaged and will only need to be checked and labelled by the staff.

there has been an increase of approx. 1500 prescriptions per week(?) since January. 219 were dispensed on the afternoon of this meeting;

no extra staffing has yet been provided to meet the extra demand arising from the new housing development and transfer of MOD dispensing to the Benson pharmacy. Space is at a premium;

80% of the business in Benson relates to the pharmacy’s NHS activities If the pharmacist is unable to attend, a locum is provided as soon as feasible after Lloyds

regional office are notified – usually the same day Urinary tract infection service for women is provided free on the NHS at the surgery. A

charge of £5 is made for private patients. The pharmacist carries out medication reviews, blood pressure measurements, provides

advice on minor problems, flu vaccinations etc.

Attachment 2

Attachment 3Report from chair of SELF (SE Oxon Locality Forum)

John Reid, 20 February 2019

SELF officersI have been appointed as Chair for a further year, but the Vice-Chair Jeremy Hutchins (Goring & Woodcote) is stepping down. He took a lot of strain from me by attending all the meetings in Oxford with the other locality Chairs and OCCG (Oxon Clinical Commissioning Group). He was frustrated by not achieving as much as he wished. He have a new Vice-Chair, Peter Woolsey (Sonning Common). He will not be as active as Jeremy was, but is willing to stand in for me when I am not available. To reduce the pressure on me, I have persuaded the other Chairs to seek a reduction of meeting frequency to every 3 months instead of 2. OCCG have yet to agree to this.

Co-productionThe Chairs feel strongly on the importance of co-production, but have not agreed on a definition of the term. I have suggested "A joint production; the process of producing something jointly by two or more parties", where the parties are clearly stated. They might all be organizations, for example, two PPGs working together, but the other Chairs mostly mean that one party consists of the patients involved. In any case, we see too much top-down decision making with those involved being told afterwards. This was the main top of discussion at the December meeting with OCCG and Ally Green (OCCG) has produced a first draft in note form, but the Chairs have not worked on it. NHS Long-term PlanA very important element of the NHS Long-Term Plan is that most if not all new money will be routed through groupings of practices into neighbourhoods, otherwise known as Primary Care Networks (PCNs) each with 30-50k patients, with an emphasis on collaboration between different services. Ours will be Wallingford and Surrounds: Benson, Wallingford, Goring and Woodcote (32,052 patients) A new PCN contract will start on 1 July as a Directed Enhanced Service (DES). It will be technically voluntary, but NHS England expect 100% take-up. There will be financial support of £1.50 per patient per year for administrative costs and about 60p per patient per year for clinical leads, which will be required. The extended-hours contract will be transferred to the PCNs and reduced to £1.45 per patient. Perhaps I am getting too old and cynical, but I see the immediate effect as adding extra bureaucracy and reducing patient access to GPs. Note, too, the lack of co-production.

MSK (Muscular Skeletal) serviceSELF remains concerned about the adequacy of the MSK service provided by Health Share.

PET CT Scan at Churchill HospitalThe Churchill Hospital has a world-renowned scanning facility for assessing suspected cancers and cancers under treatment. The Trust’s tender was considered financially unacceptable by NHS and the contract will go to a private company called InHealth. The equipment will leave the Churchill’s specially designed accommodation and will be manned by a less qualified team. Our NHS is being dismembered piece by piece.

Earwax RemovalMany surgeries (not ours) have discontinued their earwax removal service because it is not being funded explicitly. SELF (and the other Localities) is horrified by this and has protested to OCCG

who say it is being reviewed. There are suction machines in Henley and Wallingford, purchased by the Locality when it was a Primary Care Trust. Previously they were used by a number of Surgeries in the Locality, but now they are used only by the Surgeries where they are based.

Leaflets in SurgeriesSome surgeries have replaced all magazines in the waiting room by piles of leaflets on various subjects of relevance to patients and have had a very good take up. It sounds as if this is worth pursuing.

HealthWatch PPG (Patient Particiption Group) workshopsHealthWatch held two workshops in January, which were a success, mainly because of the exchanges of ideas between PPGs. Each was attended by more than 50 people. I am hoping that someone from Nettlebed will attend SELF meetings in future.

Vasectomy serviceBoth SELF and the Chairs have discussed the proposed reduction in the vasectomy service and agreed that it was desirable to continue it. I have volunteered to join a focus group.