maple surgery

minutes for the meeting of 27 April 2011 (HTML Version)

Attendance

PPG Members: Brian Burrage (BB), Emilio Ceraudo (EC), Patricia Daniels (PD), John Dowland (JD), David Harper (DH), Margaret Moffat (MM), Terri Pope (TP), Chris Stannard (CS), L.M. Stockman (LMS)

Diana Birley (DB), Nik Barton (NB) and Michael Boughton-Fox (MBF) were absent with apologies.

Surgery Representatives: Dr Brendan Boyle (DrBB), Jenny Moyes (JM), Dr Susan Stanton (DrSS)

Trish Hawitt Palmer (THP) was absent with apologies.

Guest: Joyce Jarvis (JJ)

Invited Speaker: Samantha Wilkin (SW2)

Community First Responders

Lorna Haynes from Community First Responders spoke about the scheme. It began as a Department of Health trial in Essex in 1997, looking at cardiac arrest survival rates. CFRs are volunteers with no previous medical experience assumed. They provide basic life support - airway management, first aid, basic interventions and reassurance, defibrillation - whilst the ambulance is on its way to the patient. Local Cambridgeshire volunteers provide 150,000 hours of cover and are called out approximately 1500 times per year. Bar Hill would probably have around 150 calls annually. The volunteers are supervised and trained by the Ambulance Service.

A local CFR group should comprise at least five individuals so that no one is overwhelmed. There also needs to be a coordinator within each group to, for instance, keep track of where the kit bag is.

What happens when a 999 call is made? The call is taken at the Norwich call centre. The operator provides advice to the caller whilst checking to see if there is a local CFR. If so, a call goes out to the CFR who attends immediately and begins treatment. Simultaneously, an ambulance is dispatched to the patient. The paramedics take over from the CFR when they arrive on scene. CFRs do save lives.

Requirements to become a CFR:

There is also a kit bag containing various life-saving equipment that must be purchased by the community. It costs on the order of £2500 and is passed between the volunteers.

BB asked for particulars regarding the contents and use of the kit bag. LH explained that the community bought the kit bag and it was passed from volunteer to volunteer, depending upon who was on call at that time. Some communities invest in two kit bags to make the logistics of passing the bags around a little easier. Some of the contents:

No drugs other than oxygen and GlucoGel are carried in the kit bag, not even aspirin or an EpiPen.

JD asked who insured the CFRs. LH replied that the NHS covered them through the Ambulance Service.

JD then asked if it was likely that Bar Hill CFRs would be called to the not infrequent crashes that plague the A14. LH said no. CFRs do not respond to all 999 calls, only a few. For instance, a CFR would never be called out to attend

CFRs do not get the kind of training to deal with all of these emergencies and are never expected to place themselves in danger.

CS wanted to know who replaced the contents of the kit after it had been used. LH said the consumables were exchanged with the Ambulance Service. The bag itself is sturdy and should last several years but would cost the community on the order of £100 to replace.

CS followed up with a question about the involvement of the local surgery. LH said that the surgery would certainly be made aware of local CFRs and that it would not be necessary for CFRs to attend any appropriate 999 calls placed from the surgery.

CS then asked about the coverage provided by CFRs. LH replied that whilst a 24/7 (24 hours a day, 7 days a week) service was ideal, it wasn't necessary and that any coverage was a benefit to the local community. CFRs are volunteers and their service should never feel like a burden.

The local Tesco superstore has a number of first aiders on staff and CS wanted to know if they were involved. LH said that Tesco had declined to participate in the scheme or to have a defibrillator in the store.

MM made the point that CFR is not an ambulance service on the cheap. The ambulance was dispatched at the same time the CFR was called. LH agreed and said the CFRs are greatly appreciated by the paramedics and the Ambulance Service.

CFR is working with the British Heart Foundation in their 'Heart Start' scheme in Cambridgeshire. This is a two-hour training programme designed to teach people what to do in the event of someone suffering a cardiac arrest. The BHF also has a 50/50 funding scheme to fund defibrillators in shops, leisure centres, etc.

DrBB asked how long it took to start up a local CFR group. LH said that depended very much on the community but that it typically took six to nine months. It takes this time to find the funding for the equipment and to get enough suitable volunteers who can pass a criminal background check and successfully pass the three-day training programme.

MM said that it would be necessary to have the community fully behind any such project.

MM thanked the speaker on behalf of the group.

Action: MM will contact the Residents' Association, the parish council and the Bar Hill News about setting up a local CFR group to serve the community.

Approval of minutes

The minutes from the meeting of 30 March 2011 were approved.

Actions from previous meetings

Graffiti

The graffiti on the wall of the Bar Hill Health Centre is actually the cleaned up remains of damage inflicted several years earlier and not new vandalism.

Octagon usage

CS confirmed that the Octagon will be available on 20 July for that month's meeting. JM said that the contract for regular use of the Octagon had been signed earlier in the month.

In-house questionnaire

The in-house questionnaire is still on-going. All surgery clinicians (but not outside therapists such as the physiotherapist) are being evaluated via this questionnaire. The results are confidential but there may be recurring themes which are of interest to the group and may be shared at the appropriate time.

There is also a national health questionnaire which runs constantly. Everyone in the NHS is subject to being chosen at random to participate in the questionnaire that evaluates local services. The surgery gets quarterly reports from these national questionnaires and league tables will eventually be published.

DrBB said that according to previous results, patients are generally happy with the service they receive at the surgery but there are three items that stand out:

Action: The group is to consider these questions. THP will discuss this further next time.

New patient brochure

DrBB passed around the current draft copy of the new patient brochure for evaluation by the group.

Action: The group will proof-read the document, commenting on editorial issues such as grammar, spelling and punctuation; whether the explanations are clear; which areas not currently covered need inclusion; and any other issues.

Patient transport document

LMS provided an updated copy of the How to get to hospital by bus leaflet that reflects the recent changes to the local bus schedules. DrBB commented that he would like to have directions to Hinchingbrooke Hospital added since many patients are sent there, particularly to the walk-in radiology clinic. JM said that the reception staff had already given the leaflet to a number of patients. MM asked DH to minute the group's thanks to LMS for her hard work in producing such a useful leaflet.

Action: LMS will revise the document to include directions from Bar Hill to Hinchingbrooke Hospital.

Reproducing PPG articles from the Bar Hill News

DH has enquired but has yet to receive a response.

Action: DH will contact the editor of the Bar Hill News and the chairman of the Bar Hill Residents' Association again.

Handling complaints

DH and MM put together a response to an email complaint received shortly before the last meeting. A reply, detailing yet more complaints, was received soon thereafter. There is nothing more that the group can do with this particular matter so no further correspondence will be entered into. DH and MM showed the (anonymised) complete correspondence to the surgery representatives and DrBB said in future to forward all complaints on to them.

Some specific issues raised in the original complaint:

Intrusive music
The music is meant to help mask conversations held at the reception desk in order to provide patients with some privacy. It is meant to be soft and very much in the background. Obviously it is impossible to cater to everyone's music tastes. LMS commented that if the music was greatly disliked by the patients, there were white noise/nature sound devices such as those used by tinnitus sufferers that might also work.
Chairs
The number of chairs has not changed. The chairs have simply been rearranged to make it easier for the reception staff to keep an eye on everyone. There are rarely too few chairs available but this depends on the clinics being run at the time. Giving up one's chair to another who has greater need of it is common courtesy and is expected of all patients.
Action: DrBB will ask reception staff to keep an eye on waiting room numbers to see when there are particular problems with lack of seating.
Appointments for future visits/on-going care
Sometimes the diary is not up-to-date very far in advance so making appointments weeks ahead is not possible.
Appointment waiting times
If a patient want to see a particular doctor rather than the first available physician, then that patient may have to wait a week or more since some doctors only attend the surgery once a week.
Who does what
DrBB and DrSS explained some of the specialities of the physicians at the surgery, including men's and women's health, contraception and even acupuncture. Several of the doctors are GP trainers. Every doctor will see every patient but patients do tend to gravitate to the physicians who specialise in their particular problem. Perhaps forty percent of the health concerns are psychological. MM asked if the reception staff was streaming patients with specific complaints to specific doctors. DrBB and DrSS emphatically said no. There is a lot of intra-staff communication and with past medical records being digitised, the doctors have a good idea of a patient's problems. JJ said that she was an old lady and she wanted her doctor to know her! DrBB said that this was an ongoing issue because the service in Bar Hill is provided by several clinicians. However, at the Acorn Surgery in Huntingdon, the staff pretty much knows everyone. DrSS added the the maple surgery was a work in progress. DrBB then concluded that he wanted the group to be the surgery's 'critical friends'.
Staff changes

DrBB reported that Dr Susan Gillard is leaving the surgery this summer to take up a partnership in the surgery in Over. Two new doctors will be joining the maple surgery, both of whom were trained there. However, in the meantime, both DrBB and DrSS will be holding clinics more often in Bar Hill. The surgery is also losing one nurse practitioner.

The practice is moving towards having clinicians in two to three days a week rather than one day here and there.

NHS budget changes

MM asked about the effect of the budget changes on local services. DrBB replied that he was nervous about it because it is not yet clear how it will work or who will actually administer the new system. If the surgery was operating under the new system now, it would quite likely be over-budget as it tries to clear up a backlog of issues that it inherited from the previous practice but once that is accomplished, the surgery should be within budget.

Evening medical lectures

DrBB said that the surgery would help to facilitate these. Dr Emma Tiffen is involved in mental health issues and medical education, so she might be interested in speaking. There are many specialities represented in the surgery and it should also be possible to bring in outside speakers. The surgery is happy to respond to ideas from the group. JD mentioned that he had attended a diabetes programme and thought it would benefit others.

Action: The group will come up with ideas for evening lectures.

New business

New business was deferred until next month due to the lateness of the hour.

Next meeting

The meeting adjourned at 8:00 p.m.

The next meeting of the PPG will take place at 6:30 p.m. on Wednesday, 25 May 2011, in the Octagon. Tea and coffee will be served before the meeting, from 6:00 p.m.


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