Patient Reference Group

Attendees

PPG members

• Tony Lloyd (Acting Chair) – TL
• Frances Inglis – FI
• Sue Griffiths – SG
• Melanie Fone – MF
• Howard Lamb – HL
• Martin Smith – MS
• Neil Scott (from 19.30) – NS

Practice staff

• Amie Attwood (Practice Manager) – AA
• Dr Aimee Lettis (GP) – AL

Apologies

• Celia Reinbolt
• Barbara Sears
• Ian Cotton

Welcome and Introductions

As there were 3 new members at this meeting, attendees introduced themselves.

Tony Lloyd
Tony was a governor at the RBH for 9 years and is now a public governor at the OUH in Oxford. He is also a director of the Neurological Alliance of England.

Martin Smith (New member)
Martin Smith was a senior research physicist who retired 20 years ago. After retiring he took up the chairmanship of the Twyford and Wargrave volunteer centre and then went on to the board of trustees at Elizabeth Court for 15 years looking after buildings including the surgery.

Sue Griffiths
Sue has been a PPG member for a very long time.

Dr Aimee Lettis
Dr Lettis is one of the partners at the Surgery. She used to work at Cookham and this is her first partnership. She has a background as a paediatrician.
She now deals with women’s health issues and has recently taken over the responsibility for diabetes at the practice.

Amie Attwood
Amie Attwood has now been practice manager for a year and a half and prior to that was the PCN (Primary Care Network) manager at Didcot PCN for two and a half years and prior to that was in various roles in primary care for 16 years

Frances Inglis
Frances has lived in the area since 2004 and retired from a senior IT job in 2009.

Dr Melanie Fone
Melanie was a paediatrician at the RBH (Royal Berkshire Hospital). She has been a patient at the Wargrave Surgery for 45 years

Howard Lamb (new member)
Howard is retired and is now a full-time carer. He has a background as a chemist in the plastics industry before moving into pharmaceuticals with Bristol Myers Squibb.

For the benefit of new members, TL emphasised that the aim of this group is to act as a critical friend of the practice and a conduit for 2-way communications with the local population.

Neil Scott (from 19.30)
Neil lives in Knowl Hill and runs a chimney sweeping business. He used to attend the branch surgery in Knowl Hill before it was disbanded. He expressed the wish to represent other Wargrave Surgery patients living in that area and also expressed concern about proposed new housing developments along the A4 and the impact that this would have on services for current Wargrave surgery patients.

Declaration of interests

None

Minutes of the last meeting

TL proposed that in the interests of time he would try to deal with action points in the April minutes in the corresponding sections of this meeting’s agenda. There were no objections.

Practice staffing – new members and leavers

Dr Clifford is now a fully qualified salaried GP. He works for the PCN (Primary Care Network) at Woodley from Monday to Wednesday and for Wargrave on Thursdays and Fridays.

Dr Puddy retired in August and is no longer at the Surgery.

Charlotte Wilson is the new full time ST3 at the practice and will be at the practice for a year as part of her specialist GP training. (An ST3 is a doctor in the third year of their Specialty Training program in the UK).

The practice is a recognised training practice. Last year we also had an ST3. ST3s can work more independently because they are more experienced but it is likely that the practice will be allocated ST2s for the next two years.

The practice still has a physician associate Kayla who works at the practice on Thursdays and Fridays each week and at the RBH for the remainder. She has a special interest in renal medicine.

The new clinical pharmacist is Annalisa and the new pharmacy technician is Santosh. Kirsty is the clinical coordinator.

The reception staff is unchanged.

Annual GP survey

TL brought forward the Annual GP survey agenda item and circulated a schedule showing the responses to five key questions over the last 8 years for the Wargrave practice.

Although there was some indication of a gradual decline in the scores it was pleasing that the most recent response to the question “Overall how would you describe your experience of your GP practice” was 91.6% positive.

What is more of a concern is that the responses to the question “Overall how helpful do you find the reception team at your GP practice” has declined significantly since 2019 and registered just 25.3% in the latest survey in comparison with New Wokingham Rd at 96.6%, Finchampstead at 83.3%, Swallowfield at 80.7%, Burma Hills at 75.3%, and Woodley at 53.8% but better than Wokingham Medical Centre at 12.7% and Woosehill at 17.5%.

These figures are based on a very complex analysis performed by and on behalf of South Reading Patient Voice covering the entire BOB region which acknowledges the limitations associated with low sample sizes.

In the case of the Wargrave practice the total number of completed surveys was just 129 out of 303 sent out.

In the ensuing discussion, AL and AA pointed out that most practices in the area had adopted a total triage model whereas Wargrave still triages by telephone.

A discussion on the reception staff followed with PPG members describing very variable responses from reception staff.

Premises Update and reception makeover

TL asked about the screens and whether the staff uniform was a PCN or ICS requirement.

AA advised that the uniform was her idea and that she felt it looked more professional.

MF commented that the screens which she felt has sometimes resulted in long delays for patient waiting at the reception counter. TL felt that it made the reception staff more remote and proposed that the front desk should be manned permanently by staff that had good people skills.

Regarding the premises the lease renewal is under way but there is now no prospect of any expansion of the premises.

Appointment system and waiting times

TL raised the recent comments made by the Health Secretary about the availability of online consultations.

AL and AA responded that at Wargrave, online consultations are available throughout the working day and that this will continue to be the case with the new system that is due to be installed though it was conceded that this was not necessarily the case at other practices.

There were no other changes in the appointment system though it was pointed out that appointments could be requested online via the website though the request may be triaged to another medical professional other than a GP.

This online request system will remain the case even after the change of IT systems to Accurx from Footfall.

Vaccinations

There was a covid and flu clinic on Oct 4th for those over 75 or vulnerable. Other clinics for other age groups are planned but use a different vaccine.

There’s been a program running in the background for the last three months where the practice has been vaccinating everybody who's eligible for shingles.

The RSV vaccination program is suspended because it shouldn’t, arguably, be given within a certain number of days of the flu vaccination.

Website

AA made it clear that a new website provider has been appointed and that this is the main reason for the current website being out of date.

Issues that had been raised were:

• Incorrect staff listings
• Out of date PPG minutes

TL also wanted to raise the fact that the practice website states that you can now book phlebotomy appointments directly from the NHS App. It is far from obvious how to do this if it is possible at all.

As well as a new website, a new telephone system is due to be installed together with a new triage system.

Pharmacy issues

The senior pharmacist disclosed that many patients are referred over to the pharmacy by reception staff without a formal digital referral. This means that they don’t get paid for the referral, but this might also mean that there is no formal hand over of clinical responsibility which, in the absence of an audit trail, might result in exposure to litigation. As also recorded in the notes of the previous PPG meeting, TL requested that the practice takes this up with the pharmacy to get a better understanding of the issue. AA made the point that the pharmacy contract should mean that these services should be covered whether the patient is referred or just walks in of their own accord.

Clearly some patients will refer themselves to the pharmacy so there appears to be some ambiguity.

Action: JK to invite the senior pharmacist for a short meeting to discuss their concerns.

Referrals policy

The medical press has recently highlighted the requirement by the Health Secretary that 3 visits to a GP about the same issue should result in a referral.

AL advised that this was already the case at Wargrave though this had yet to be formally discussed at a clinical meeting.

TL asked about the procedures when a GP at Wargrave refers a patient for an MRI or CT scan. AL made it clear that the GPs in Wargrave never see the scans but that the radiographer or duty doctor will review the scans and report any anomalies back to the referring GP.

Complaints and FFT returns

There was a discussion about the confidentiality of the FFT returns with PPG members commenting that many patients were reluctant to be critical when responding to the online requests for fear of the consequences to their future care. AA advised that responses were completely anonymous unless patients include information that would clearly identify themselves.

A review of FFT returns was not available and was deferred to the next meeting.

Membership of the PPG

The last article in the Wargrave News resulted in 2 new members, Martin and Howard. Neil was invited by TL after expressing an interest in the PPG for at least 2 years.

PCN news and initiatives

AA advised thsat the clinics

Issues raised by the Practice

Weight loss

Although Mounjaro can now be prescribed in General Practice, few patients will meet the eligibility criteria and those patients have already been contacted.

The practice would like to remind those people that have taken a privately prescribed weight loss injection (GLP-1 agonist) that it reduces the effectiveness of oral contraceptives and the oral progesterone element of HRT. This should have been made clear by the private provider.

AOB

NS had a concern about the impact of the new housing development on the A4 opposite the large plant nursery and the potential impact on the services offered at the Wargrave practice.

PCN news

TL referred to the Group clinics being offered by the PCN in Woodley and asked whether any Wargrave patients were included. AA responded that these clinics were PCN initiatives and had very strict admittance criteria. No Wargrave patients had yet been enrolled but have been invited.

However, nurse Emma Winkler and either Dr Hext or Dr Lettis would soon be operating twice monthly clinics on women’s health and menopause. TL noted that a recording of a presentation on this topic at the St Mary’s church hall was available if required.

BOB (Berkshire, Buckinghamshire and Oxfordshire) ICS

TL referred to the required 50% reduction in ICB staffing and the consequent restructuring and lack of public consultation. AA advised that the restructuring plans had been drawn up by an external agency and that the ICB would be expanded by the addition of Frimley. (TL note – only part of Frimley)

TL also referred to comments made by Priya Singh, the ICB chair, that providers would in future be remunerated on the basis of outcomes rather than units of work done. AA and AL were unaware of this and felt that it must relate to secondary care.

Regarding neighbourhood groups, the objective is to bring together and integrate a range of services including primary care, social services and some hospital services on a neighbourhood basis to improve the overall quality of primary care. AA advised that there have been lots of discussions but that no plans have yet been agreed.