Paper Summary Sheet
Date of Meeting:
For: Decision
Discussion
Information to note
Agenda Item & Title:
Your Health, Your Voice - Report of meeting on Thursday 12
February 2015
Author:
Barry Grimes, Communications Manager
Responsible
Director:
Tracey Cox, Chief Officer
Executive summary
and
recommendation:
Suzannah Power, Lay Member Patient and Public Engagement
The paper provides a summary of the feedback received from the
February 2015 meeting of Your Health, Your Voice. The two topics
on the agenda were the Pharmaceutical Needs Assessment and the
Primary Care: Preparing for the Future project.
Your Health, Your Voice is chaired by Suzannah Power.
Who has been
involved/contributed:
Administration and communication with members is carried out by
Barry Grimes, Communications Manager.
Suzannah Power and Barry Grimes represented the CCG at the
meeting.
The meeting was also joined by Joe Prince (Senior Public Health
Research & Intelligence Officer, Public Health B&NES) and Amanda
Simpson (Project Director, BEMS+)
Cross Reference to
Strategic Objectives:
Your Health, Your Voice supports the work of the CCG in meeting the
strategic objectives:

Improving quality, safety and individuals experience of care

Improving consistency of care and reducing variation of
outcomes

Providing proactive care to help people with complex care
needs

Creating a sustainable health system within a wider health and
social care partnership

Empowering and encouraging people to take personal
responsibility for their health and wellbeing
Communications
Issues:
Impact on Quality

Reducing inequalities and social exclusions and supporting our
most vulnerable groups

Improving the mental health and wellbeing of our population
Your Health, Your Voice is a key part of the CCGs public and patient
involvement work but it does not replace the need to proactively
engage with hard to reach groups and other stakeholders on CCG
decisions whose voice may not be represented through Your Health,
Your Voice.
Collecting feedback from the group and responding to it in an
appropriate manner will ensure that the quality of care for patients is
improved in both existing and new services that may be introduced.
Financial
Implications:
The cost of room bookings and materials required for meetings falls
within the Communications budget.
Risk Management:
If the CCG cannot demonstrate evidence of how it has made changes
in response to feedback provided by Your Health, Your Voice then
members may lose faith with the group and stop attending meetings.
There is a risk that Your Health, Your Voice members could approach
the media to complain about CCG decisions if they don’t feel they’ve
been listened to.
National Policy /
Legislation/
The work of Your Health, Your Voice builds on the legal requirements
and guidance about public and patient involvement set out in the
following policies:



Everyone Counts: Planning for Patients 2014/15 to 2018/19
The Health and Social Care Bill 2012
NHS Constitution
Your Health, Your Voice will contribute to delivery of the following
National Outcome Indicators:
1. Preventing People from dying prematurely
2. Enhancing quality of life for people with LTCs
3. Helping people to recover from episodes of ill health or injury
4. Ensuring people have a positive experience of care
5. Treating and caring for people in a safe environment and
protecting them from avoidable harm
Equality & Diversity:
All possible steps will be taken to ensure that Your Health, Your Voice
reflects the characteristics of the BaNES population and that we
ensure that hard to reach groups are contacted proactively to give
them the opportunity to participate in the group.
Review
arrangements:
Future meetings of Your Health, Your Voice will be scheduled a few
weeks before CCG board meetings and a feedback report will be
presented by Suzannah Power at subsequent Board meetings.
YOUR HEALTH, YOUR VOICE
Thursday 12 February 2015, 7:00pm – 9:00pm
The Community Space, Civic Centre, Market Walk, Keynsham
CCG Staff (2): Suzannah Power (Chair) and Barry Grimes
Guest presenters (2): Joe Prince (Senior Public Health Research & Intelligence Officer,
Public Health B&NES) and Amanda Simpson (Project Director, BEMS+)
In attendance (11): Richard Blunden, Tony Crouch, Heather Devey, Jenny Flake, Diana Hall
Hall, Ann Harding, Clare Hector, Jeremy Ince, Maureen Ince, Jane Pye, Jim Stone
Apologies (7): Pauline Bell, Dawn Clarke (CCG), Richard Curry, Tina Fletcher, Anne-Marie
Jovcic-Sas, Lyn Juffernholz, Ian Orpen (CCG)
Welcome and Introduction
Suzannah Power, Lay Member for Public and Patient Participation
SP welcomed everyone to the meeting and reminded members of expected behaviour.
BG provided a report on the actions from the last meeting.
AP1 – A response regarding Park and Ride services to the RUH can be found at
Appendix 1. BG to request an update for April meeting.
AP2 – Time will now be allocated at the April meeting to explore examples of
innovative community services that have worked well elsewhere.
AP3 – The April meeting will also include a review of the Urgent Care Centre and it’s
performance over the past year
AP4 - There are a number of communities in Bath and North East Somerset, like
Whitchurch, where people are eligible for services, including social care services, from
B&NES Council but are registered with a GP Practice outside of Bath and North East
Somerset. Any proposed changes to the future design of community health and social
care services following the Your Care, Your Way engagement, will not affect the
geographical boundaries within which health and social care services are
provided. So, those Whitchurch residents registered with a GP Practice in Bristol could
remain registered with that practice whilst also receiving community health and social
care services commissioned by B&NES Council and BaNES CCG.
AP1
BG
Pharmaceutical Services in B&NES: the 2015 Pharmaceutical Needs Assessment
Joe Prince, Senior Public Health Research & Intelligence Officer, Public Health B&NES
JP explained that anyone wishing to offer community pharmacy services in B&NES
must apply to NHS England for permission and comply with their substantial
regulations. The B&NES Pharmaceutical Needs Assessment (PNA) is the document
that determines whether the application meets the needs of local people. The 2015-18
PNA will come into force on 1 April 2015 following a period of consultation that ends on
15th February.
The document will be used by potential or existing contractors to identify what new
services they may be able to provide and is also used by NHS England and the
B&NES Health and Wellbeing Board to guide their commissioning decisions.
There are two types of pharmacy in B&NES. Community pharmacies such as Boots,
Lloyds or independents can be found on high streets, in supermarkets or co-located
with GP practices. In rural areas, where there are often no local community
pharmacies, it is common for GP practices to act as a dispensing practice e.g. in the
Chew Valley. There are also online pharmacy services available as well.
JP explained the wide range of services that community pharmacies can offer, noting
that some are compulsory whilst others are optional.
JP summarised the key findings of the consultation so far which include a gap in
provision in the Chew Valley, a lack of evening/Sunday services in Chew and
Keynsham, accessibility issues, house building creating increased demand and
potential for range of pharmacy services to be expanded e.g. NHS Health Checks.
The following comments were raised (responses are in italics):
> People don’t realise how expensive drugs are and so many are wasted.
> How are community pharmacies paid?
It depends on the services provided. Some are paid per patient whilst others are paid
for by a monthly fee.
> There are no pharmacies open on a Sunday in Keynsham.
> Will new development in Keynsham include a new community pharmacy/GP
surgery? New housing is proposed on the outskirts of Keynsham but all the pharmacy
services are in the centre.
> Somer Valley is also facing new housing and public transport access is poor.
> Pharmacies and dispensing practices require a certain catchment area in order to be
financially viable and many applications never come to fruition.
> If people receive services at a pharmacy this is not recorded on their medical record.
This could be a benefit for people wanting privacy e.g. sexual health services but many
members of the group were concerned that GPs would not be aware of test results or
medication provided by the pharmacist which could affect people’s care. Equally,
pharmacists would not have access to medical records when they provide advice.
> It was noted that sharing patient records between pharmacies is difficult due to data
being commercially sensitive but there could be opportunities with national plans for
people to have access to their medical records online.
> There is a 100 hour a week pharmacy in Midsomer Norton and there have been
requests for a similar service in Bath.
> Pharmacies need to make it clear what services they offer as people are not aware.
The GP contract requires GP practices to produce a patient booklet explaining all the
services they offer. Can pharmacies do the same?
> There are big opportunities for pharmacists to provide a wider range of services but
many are restricted by facilities and staff qualifications.
> People are unsure what level of training pharmacists have and whether they can be
trusted to offer good clinical advice.
> If pharmacies are offering services like childhood immunisation then there needs to
be a way of ensuring this is recorded accurately on their medical record.
> It’s important that the PNA clearly states these gaps in provision so that we can
attract contractors to provide these services.
> The CCG is in favour of co-location so that community pharmacies are located near
to GP practices.
> There have been many problems with the rollout of electronic prescribing. It is
frustrating that you can only go to one specific pharmacy to collect your script.
Primary Care: Preparing for the Future
Amanda Simpson, Project Director, BEMS+
AS explained that all GP practices in B&NES are part of the provider organisation,
BaNES Enhanced Medical Services (BEMS+). They used to operate the GP out-ofhours service but now provide other community services such as the fracture clinic, a
vasectomy service, DVT service and a referral support service.
BEMS+ have been awarded funding by B&NES CCG and the NHS England Area
Team to run a two year pilot scheme to help primary care adapt to meet the needs of
local people in the future. The pilot scheme is looking at four different areas:
1. A 24/7 telephone appointment booking service that will allow people to book
an appointment through an automated process at any time of the day or night.
This will avoid problems of people not being able to get through at busy times
e.g. Monday mornings. It will be piloted at four practices before being rolled out
across all 26 practices in B&NES. The system will identify you by phone
number and date of birth and all data is secure within the NHS N3 network.
>It was requested that practices will need to offer appointments over a longer time
period. At least 4 weeks as a minimum.
> Will all the urgent appointments be taken up by people calling days before? It could
favour people with chronic conditions over those with acute needs.
No, practice managers will manage the system carefully and reserve a range of slots
for people needing same day appointments, for booking online or over the phone.
> Will 111 be able to put people through to the phone booking system?
Not currently but we will explore the feasibility of this.
2. Supporting vulnerable patients at weekends. A team of 3 GPs will be
available at weekends to visit patients who have been identified as at risk of
admission or who have recently been discharged from hospital. Patients will be
called on a Friday afternoon to let them know that a GP will be visiting or
telephoning over the weekend. The GPs will be able to access medical records
through electronic tablets which is a ground breaking project in the UK.
> Will it be local GPs?
Yes. Initially there will be 2 doctors doing visits and 1 making calls from a base in
Paulton or Bath. They will operate 9-5 on Saturdays and Sundays. As the pilot
develops we may need to swap doctors for nurses depending on the kind of cases
being referred.
> Are you working with the discharge team?
Yes. We will link with the Acute Care of the Elderly (ACE) team at the RUH and in the
future referrals could be made from a variety of other health and care services.
AS asked how patient feedback could best be collected to evaluate the service:
> A follow up phone call from the service manager would be the best way. Many of the
patients will be frail and elderly so their carer may provide the feedback.
> People will be unlikely to complete paper feedback forms and would not want to
provide negative feedback to their own GP.
3. Working better together. BEMS+ will be working with Skills for Health to
support GP practices to work more closely together e.g. working in clusters so
that a group of practices could offer clinics with specialists without the need for
people to travel to hospital
4. Workforce Review. GP recruitment is difficult and B&NES faces a looming
crisis with many of our GPs being part-time and nearing retirement. This piece
of work will identify what skills we need in general practice and how we can offer
career progression and the opportunity for people to specialise.
> Why is GP recruitment so hard?
The workload is really high and makes it very hard for GPs to work effectively on a full
time basis. There is no clear career progression and limited opportunities to specialise
in areas of interest.
> The community services review has found a clear need for a “navigator” role within
primary care. Will this be included in the workforce review?
The primary care workforce review will be aligned very closely with the community
services review to make sure that all the pieces of the jigsaw puzzle fit together. There
are already plans emerging to pilot the use of navigators.
Next meeting
The meeting dates and locations for 2015/16 will be confirmed by 28 February.
Appendix 1
The following question was raised at the December meeting:
Why does the Hospital Park and Ride only operate from Odd Down and not the other Park and
Ride car parks?
The following response has been provided by Nicholas Reed, Head of Security & Safety
at the Royal United Hospitals Bath NHS Foundation Trust:
As far as Odd Down Park and Ride, this was the only P&R that was able to operate a bus
service via the RUH, so suitable for staff use. The RUH subsidises this service and
encourages all staff from the catchment to use this (in keeping with our Travel Plan and
supported by our Parking Policy)
At the time neither Newbridge nor Lansdown P&R operators were able to facilitate a bus via
the RUH. This would make it counterintuitive for staff to park at a location on route and then be
transported to a location further away (city centre) and have to catch a second bus back again
to the RUH.
However, since the expansion of Newbridge, I have been meeting with B&NES
Transport/Travel and have been engaging in talks that might bring about a suitable bus route
and similarly, B&NES were interested in exploring with me the possibility of providing a bus
to/from Lansdown. These conversations are currently taking place, so I do not know the
outcome, however I know they fit with the overall BANES travel/transport plan, so the will
appears to be there although the feasibility and diligence work may or may not make this
practically achievable.
I am however hopeful as this would provide a very logical solution to alleviate some of the
travel and parking congestion issues experienced, with the benefit of being a service available
for patients to use from all three P&R. The added benefit would the corresponding reduction in
parking pressure at the RUH site, making parking easier for those who do need to travel by car
and also reducing parking in the nearby streets.
I hope that brief explanation helps.
Regards,
Nicholas Reed
Head of Security & Safety
Local Security Management Specialist
Security Management Offices
Estates & Facilities Directorate
Bath & Wessex House
Royal United Hospitals Bath NHS Foundation Trust