PPG Minutes - 3rd October 2024

Attendees:  Gill Grant (Chair), Heather Murdoch, Tony Murdoch, Moragh Horsnail, Sam McLeod & Adrian Christmas.

Invited Staff from Lakeside Oundle:  Dr Laura Brennan (GP Partner & NED), Kirsty Knight (Patient Services Manager) & Sam Clarke (Business Manager) note taker. 

Apologies for absence received from: Mandy Black (Area Manager Northants) & Jessica Bawden (Chief Executive). 

Subject: Declaration of Interest/Confidentiality
Conclusion: This was a standing agenda item: No declarations were shared at this session. 

1. Minutes from the PPG meeting held on 7th March 2024: The minutes of the meeting held on 7th March 2024 were discussed at length. Gill Grant (PPG chair) explained that previous PPG minutes were amended by and uploaded by the Practice to the website without final PPG approval.
2. Matters Arising:  Dr Brennan (Oundle Practice) welcomed new members Sam McLeod (PPG member) & Adrian Christmas (PPG member). Dr Brennan (Oundle Practice) confirmed the new staffing position at Oundle surgery. A new diabetic Nurse is due to join the team mid-October 2024, and two replacement staff will be onboarding – HCA (Health Care Assistant) and PCN (Primary Care Network) Clinical Pharmacist. She also shared the good news that from today Oundle has a full complement of partner GPs – six in total. 
3. Future Minutes Protocol – (Sam McLeod - PPG member): Sam McLeod (PPG member) shared a draft protocol for PPG minutes. Following review and a request from Dr Brennan (Oundle Practice) to extend the timeline the following format was agreed.

1. Minutes of the meeting will be recorded by a minute taker designated by the Chairperson of the meeting. 

2. Before these minutes are shared with and disseminated to others, they shall be reviewed and approved by the Chair. 

3. Following approval by the Chair, and no later than 5 clear working days after the meeting, these minutes will be distributed by the minute taker by e-mail to each attendee at the meeting and to any other member of the PPG or invitee who presented their apologies for non-attendance. 

4. Any suggestions for additions or alterations to, or deletions from these minutes shall be notified by e-mail to the Chair and to the minute taker no later than 15 clear working days after the meeting. 

5. It shall be in the absolute discretion of the Chair, having consulted the minute taker, whether there will be any additions/alterations/deletions to/from the minutes as previously distributed. 

6. Following the finalisation and approval of the minutes by the Chair, the minute taker will distribute the minutes by e-mail to each attendee and to anyone who presented their apologies for non-attendance no later than 20 clear working days after the meeting. 

7. Unless and until the minutes have been finalised and approved by the Chair, they shall not be posted on the Lakeside Healthcare website. 

8. Following their finalisation and approval by the Chair, the minutes will be posted on the Lakeside Healthcare at Oundle website between 20 & 25 clear working days after the date of the meeting. 

Action: Sam McLeod (PPG member) to update and embed the minutes protocol into the PPG terms of reference. 

Following discussion including historical responsibility for minute taking Sam Clark (Lakeside) kindly agreed to complete the minute taking, for a period of up to six months, this will enable Gill Grant (Chair) to secure a permanent PPG minute taker. Dr Brennan (Oundle Practice) agreed to canvas Lakeside staff to see if anyone would like to be involved in a voluntary capacity & Gill Grant (PPG Chair) will approach a potential PPG secretary.

Action: Gill Grant (PPG Chair) & Dr Brennan (Oundle Practice) to feedback at the next meeting. 

4. Appointments (Tony Murdoch - PPG member): 

1. How many appointments are available? 

Dr Brennan (Oundle Practice) explained this varies each day, with the system weighted to allow more capacity on a Monday. The system is mapped for a minimum of two GP Partners and one ANP (Advanced Nurse Practitioner) on site daily. She noted there may be a loss of one team member to cover care home ward rounds, GP registrars, management meetings, safeguarding & PCN meetings and Nurse training sessions. 

Dr Brennan (Oundle Practice) confirmed Oundle implemented a new Dr Triage system on 23rd September 2024 with the aim of removing or at least reducing the early morning queue, in all weathers, outside the surgery ahead of the doors opening at 0800am. Dr Triage operates a GP telephone call back system. This should result in shorter reception calls, freeing up telephone capacity resulting in a reduced wait time. GPs will call patients back between 0800am & 1000am and direct them to an appropriate service, deal with their condition over the phone or call them into the surgery for a face-to-face appointment. This is complimented by the on the day duty GP who deals with the emergency on the day appointments. Patients may still attend the surgery in person to arrange for an appointment with a doctor should they wish to do so.

Tony Murdoch (PPG member) asked why there are three Partner GPs in on Monday (the busiest day) and six on a Thursday. Dr Brennan (Oundle Practice) explained Thursday is when all the meetings take place (business meetings, PCN meetings etc.) and wherever possible Partners are required to attend. 

Adrian Christmas (PPG member) asked how the surgery prioritise staff back up at busier times. Dr Brennan (Oundle Practice) confirmed other admin staff and managers assist the reception team where there are spikes in demand. 

2. Education of patient pathway 

Dr Brennan (Oundle Practice) confirmed the new pathway is via the telephone Dr triage system. She explained we are only in week two of the new system. Once it is established, we will advertise it via our comms team & Facebook, and she hopes to provide an update piece for Oundle life. Moragh Horsnail (PPG member) shared positive feedback on the new Dr Triage system. 

3. Care of elderly (non-digital)

Tony Murdoch (PPG member) highlighted the difficulty facing elderly patients in accessing clinicians in the practice via digital systems such as Anima.

Dr Brennan (Oundle Practice) explained the GMS (General Medical Services) contract requirement that 25% of our offer must be completed via a digital platform. She went on to confirm that in implementing the new Dr Triage system we have kept our digital commitment to a minimum. 

Oundle has two dedicated ANPs (Advanced Nurse Practitioners), one provides care to patients in their own homes and follows them up after hospital admissions and a second who works with care homes and patients at home. Oundle also has capacity for one or two GP home visits per day. 

The PPG noted there is a lot of activity going on in the background that they are unaware of, going on to explain their willingness to share the positive activity which is being completed. 

4. How do you book in advance

Dr Brennan (Oundle Practice) asked the PPG to trust the new system and use Anima or the telephone Dr Triage system. She noted this is a newly implemented system, which the partners hope will benefit patient’s needs. Once the system is embedded, she will share wait time data and anticipates this will be an improvement. 

Action: Dr Brennan (Oundle Practice) to share telephone wait time date post 23.9.2024. 

Sam McLeod (PPG member) observed that the Anima system opens at 0700am and has frequently reached capacity by 0800am rendering it inaccessible once capacity has been reached. He also suggested that, given that it was the Anima triaging Doctor who would usually arrange to take any face-to-face appointments on that same day, it was essential that he/she was fully conversant with the details posted on Anima by the patient ahead of seeing the patient, otherwise valuable clinical time would be wasted at the appointment.

5. Lakeside Funding Structure (Adrian Christmas – PPG member)

1. Contracts with NHS Commissioning Authority 

Adrian Christmas (PPG member) asked about the funding structure and head office involvement. 

• Dr Brennan (Oundle Practice) confirmed the funding streams.
• Global sum payment – Dr Brennan (Oundle Practice) explained the Carr-Hill formula, Oundle are weighted favorably due to the elderly patient demographic. 
• Quality and Outcomes framework scheme (QOF) – Dr Brennan (Oundle Practice) explained the QOF payment system, a framework based upon achieving a range of clinical targets. 
• Investment and impact fund (IIF) – Dr Brennan (Oundle Practice) explained IIF was introduced initially to help practices manage the demands of C19 and was then extended to incentivize practices to meet goals set by the government. In 2024/25 there are two indicators – Disability health checks & cancer diagnostics. This funding stream is paid into PCNs – Oundle sit within the Rockingham Forest PCN (with Headlands & Corby). 
• Capacity and Access Payment (CAP) – Again this funding is paid to PCNs, its purpose is to enable PCNs to focus on improvements, manage demand and improve our patient’s experience. Dr Brennan (Oundle Practice) explained these are services we deliver jointly with our PCN colleagues at Corby and Headlands, providing extended access in the evenings and at the weekends. 
• PCN Contract – Dr Brennan (Oundle Practice) explained money which goes into our PCNs to deliver care to meet local needs. Oundle benefit from the services of a first contact physio on Friday (working for Corby & Headlands as well). 

Adrian Christmas (PPG member) asked why Yaxley seem so far ahead of Oundle. Dr Brennan (Oundle Practice) confirmed Oundle surgery is in the lowest 2.5% performing practices based upon national patient survey data. She confirmed Oundle had been understaffed and using costly locum cover. Now with a full complement of Partner GPs Oundle are working hard to make improvements – Dr Triage being one of the first steps. She confirmed NEDs (Non-Executive Directors) share best practice, and she frequently works with the Yaxley NED. 

2. Who runs the Practice?

• Dr Brennan (Oundle Practice) confirmed she is the NED (Non-Executive Director) for Oundle, and she runs the practice with her fellow GP Partners and the management team.
• Mandy Black – Area Manager 
• Kirsty Knight – Patient Services Manager 
• Polly Jackson – Management Support 
• Six Partner GPs. 

Dr Brennan (Oundle Practice) suggested PPG colleagues look at https://www.kingsfund.org.uk/ for fuller information. 

Action: PPG members to look at the Kings Fund. 

Tony Murdoch (PPG member) asked for clarity about Oundle funding. Dr Brennan (Oundle Practice) assured PPG members that Oundle is part of the Lakeside Healthcare partnership and receives all its allocated funding. 

6. Named GP (Heather Murdoch - PPG member): 

Heather Murdoch (PPG member) reminded the meeting of government guidelines that all patients must have a named GP who is responsible for the oversight of their care to ensure continuity of care. Many patients are not aware of this or that they have a named GP. Patients need to be informed who their names GP is. 

Dr Brennan (Oundle Practice) confirmed Patient lists are randomly allocated, where capacity allows, patients can request to move partner list however it is necessary to maintain equitable patient numbers. 

Action: Kirsty Knight (Oundle Practice) to speak to the comms team to create a named GP summary. 

7. Suggestions from GPs/Nursing Services/Admin Services as to improvements (Sam McLeod -PPG member): 

Sam McLeod (PPG member) asked about the implementation of the new continuity of care requirements included in the new contract by paragraph 20 of Annex 1 to the 2024/2025 contract which came into force on 01 October 2024. 

Dr Brennan (Oundle Practice) explained where possible the reception team book patients in with their named GP. Going on to advise there is a section on the clinical system front screen which lists the named GP. She added that whilst there at six partner GPs they work 36 sessions per week (4.5 full-time equivalent). 36 GP partner sessions is the maximum available in the Oundle workforce budget based upon the NHS funding which Oundle practice receives for its list size which is approximately 10,600 patients including around 800 Oundle school pupils.

8. Update from Surgery (Dr Brennan - Oundle Practice): 

Dr Brennan (Oundle Practice) confirmed the PPG noticeboard is in a central location in the waiting area and GP photographs have been published in the local Oundle Life magazine. 

9. AOB:

Future meeting dates:

• Thursday 5th December 2024 at 12 noon
• Thursday 6th February 2024 at 12 noon

10. Date & time of next meeting:

Oundle PPG Meeting:

• 5th December 2024 at 12 noon, Oundle Surgery.