PPG Minutes - July 2024

Attendance: Didi Go, Bernhard Ehreich, James Boye, Dorinia Campbell, Chinetu Agu, Batya Beverley Wiles, Malcolm Alexander
Staff: Sherry Oriola (Practice Manager), Patricia Noel (Administrator), Joe Larkai (Pharmacist).
Apologies: Peter Barker

1. Automatic Door to the Practice

Batya reported that the automatic door swings back towards her as she enters the practice in her wheelchair. Patricia Noel agreed to have the door checked to ensure it is safe for patients.

2. Plans for Re-development of the Allerton Road Premises

Sherry reported that the upgrading work would be finished by the end of 2024, but quotes for the work are still being sought. The ground floor improvement work will be carried out first, one room at a time, and this will provide more space for face to face clinical appointments. Sherry agreed to provide the PPG with more information about the plans for practice development and timescale, through NHS Property and Hurley (the providers of services at Allerton Road surgery.

3. Access to Medical Records

A leaflet is being prepared for patients to clarify issues around access to their medical records. All patients have a legal right of access to their medical records within 28 working days of requests for records being sent to the Practice.

From October 1st 2024 all hard copy medical records will be copied and converted for on-line access. The traditional Lloyd George cardboard packets for medical notes will be deleted. Patients can either get their own on-line access or request the records from the GP surgery reception team. There is no charge for access to medical records from the GP surgery.

When a patient transfers to another practice, hard copy records are initially transferred to the PCSE (Primary Care Support England) which is responsible for the movement of paper medical records.

Online records are handled by The GP2GP system.

Corrections to patients’ own medical records require a statement from the patient to be added to their medical record. That is a legal right.

4. Recruitment of GPs

Advertisements have been placed for the recruitment of two new permanent GPs. Dr Tom has decided to decrease his working week to one day (Friday). The practice wishes to recruit permanent GPs rather than locums in order to promote better continuity of care. Sherry will provide an update shortly.

5. Joe Larkai, Clinical Pharmacist, Hurley Group

Joe said in the past he had worked for Boots and an industrial pharmacist. He described his work as follows:
I work 5 days a week Monday- Friday and patients can be booked in for appointments between 0830-1530 depending on availability.
Bharat Uppala, clinical pharmacist also works at the surgery once a week on a Tuesday, usually between 8am to 2pm.

Jo said that some of the things he does day to day are covered below: -

Medication reviews for many long term conditions including Hypertension & Asthma.
Drug safety monitoring of high risk drugs such as Methotrexate & blood thinning medication.
Consultations for some minor ailment conditions (though community pharmacies can now do this as well within certain criteria).
Medication queries for both acute & repeat prescriptions.

Joe said that he looks at discharge letters from hospitals & make changes as per hospital instructions for patients, this is particularly important with drugs such as Warfarin and Tramadol.

Takes action when drug safety alerts are issued.
Ensures that NICE guidelines are followed.
Joe said he would be pleased to take any specific questions in relation to the pharmacist role in the Practice.

Joe said that minor ailments can be handled by the community pharmacy using the ‘Pharmacy First’ model and that one of his roles is to increase the ‘green footprint’ and to lower the ‘carbon footprint’.

He said that up to now he has not been able to prescribe, but that he is now qualified to prescribe as an independent pharmacist.

Joe said that which community pharmacy we attend is our choice.

The meeting agreed that more written information and guidance was needed about the use of additional community pharmacy services and information about who the staff in pharmacies are and what their qualifications are.

Regarding patients with hypertension (high blood pressure), Joe said that their details are placed on the Hypertension Register, e.g. patients whose blood pressure is above 140/90 and their BP is regularly checked.

Blood tests. Joe said that patients can book appointments for blood taking at either that John Scott Health Centre or at the Allerton Practice.

Home Monitoring of Blood Pressure - Didi Go described her very poor experience of a 24-hour blood pressure check at the practice, because the device used to measure her data did not collect the data for transfer to a clinician. As the practice does not have a suitable BP 24-hour monitoring device, patients needing this test should be referred to hospital.

Discharge from hospital - Joe said that when patients leave hospital they are given two weeks supply of medication. That gives the GP practice pharmacists time to adjust the medications provided through the practice.

Batya Beverley-Wiles shared that she had put a number of questions to the pharmacists and received a rapid response to all of her questions – see appendix

6. Reception – Access for People who are Disabled

Batya, a wheelchair user, expressed her concerns about access to reception staff.

She said that sometimes there are no staff in the lower reception platform, and that she can’t communicate directly with other reception staff. Patricia Noel said she would take immediate action to resolve this situation.

7. Staff Shortages

Sherry said that apart of the current recruitment process for GPs that there are no staff shortages at the Allerton Road surgery.

8. Vaccinations for Children

Sherry agreed to provide data about the vaccination rates for children registered with the practice.

9. Health Fair - 12th May

Sherry reported that a health and wellbeing fair was held on May 12.

It was organised by the City and Hackney Covid Outreach Team in collaboration with Hackney Council, Volunteer Centre Hackney, and Homerton Healthcare NHS Foundation Trust. The event was focussed on increasing vaccination rates, especially for children in order to achieve WHO targets.

10. Quality and Outcomes Framework - QOF

QOF is a national data collection which was introduced as part of the General Medical Services (GMS) contract on 1 April 2004. QOF rewards GP practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care. QOF points are achieved based on the proportions of patients on defined disease registers who receive specific interventions. GP practice participation is voluntary, though participation rates are very high, with most Personal Medical Services (PMS) practices also taking part. Data on GP practice participation can be found in the ‘Data quality annex’ which forms part of this publication.

Visit the NHS website for Allerton Road outcomes.

Examples of areas for QoF evaluation are shown below:

Asthma
Atrial fibrillation
Cancer
Chronic kidney disease
Chronic obstructive pulmonary disease
Dementia
Depression
Diabetes mellitus
Epilepsy
Heart failure
Hypertension

11. Additional Services in Allerton Road – To Be Updated

Staff Member	Clinical Role	Days Worked	Key Role
Sheila Garcia	Diabetes nurse	Fridays	Patients on 3 or more diabetic meds
Rebecca East	Physiotherapist	Wednesday morning / Thursday afternoon	Muscular pain
Suyur Sehriban	Social Prescriber	Wednesday afternoon	Connecting patients with range of community care
Joseph Larkai	Clinical Pharmacists	Monday to Friday	Wide range of conditions, e.g. high BP
Bharat Uppala	Clinical Pharmacists	Tuesday	Medication reviews
James Miller	Paramedic	?	Home visits
Titilayo Oliyide	Phlebotomist	Monday morning	Blood
Miné Aslan	Wellbeing Practitioner	?	Assistance to patients with MH problems
Farah El-Miligui	Clinical Psychologist	?	Mental health problems
Shaqipe Humoilli	Health and Wellbeing Coach	?	Self-managing care and keeping patients motivated
Tabranie Said	Healthcare Assistant	?	Phlebotomist, BP, wound care
Binu Varghese	Practice Nurse	Monday and Thursday	Immunisation and wound care
Arthur Tadique	Heart Failure Nurse	?	Heart problems

12. Home Visits

Under the GP contract all patients in GP practices catchment areas are entitled to home visits if their clinical condition requires that. Patients can be registered outside the catchment area, but are only entitled to receive home visits if they have a disability or other relevant protected characteristic (Equality Act), The practice paramedic, James Miller, may carry out home visits on behalf of GPs.
He will be invited to speak at a future meeting of the PPG.

13. CQC Report on Allerton Road Practice

See the full report here on the CQC website.

The CQC Report found services at the Allerton to be good, but improvements were needed in the following areas:

Improving childhood immunisation and data about progress – progress report awaited.
Practice nurse role specific training - completed
Staff training and fire risk assessments - completed
Reviews of Practice Nurse prescribing - completed

14. Ear Wax Removal in the Over 65s

The GP contract does not require the provision of ear wax removal, but GPs are free to provide this services. The service was provided at Allerton Road and a new machine purchased two years ago to provide a better service. Unfortunately, the practice is not prepared to provide this service. To get access to this service costs £60-00 at Specsavers which is too much for many local people, especially the over 65s.

Consequently, there will be many local people who will experience an increase in deafness because they cannot afford the private service at Specsavers, but may not have a loss of hearing condition serious enough for referral to ENT, e.g. at the Lawson Practice near St Leonards Hospital.

The clear solution is for a practice nurse or Health Care Assistant (HCA) to be trained to use the wax-removal machine stored at the Allerton Practice.

15. Next Meeting of the PPG – Tuesday, September 16th at 6pm

Appendix - Pharmacy Questions - June 2024

1. Are there different processes available to set up ‘repeat prescriptions’? What are they? How do they differ? Can the patient determine which process is best for them? With whom can the patient agree the most appropriate process for access?

When a patient is stable on medication and needs it to treat a long-term condition, the clinician will discuss with the patient and plan to add to repeat. Practice pharmacist will be able to help you with that.

2. How often should a repeat prescription be repeated? Its normally every two months, but can this be varied if that would be of benefit to the patient?

To minimize wastage, the duration of repeat prescriptions is set to be every 2 months. But in some cases, we can discuss reducing or increasing the duration.

3. How often are repeat prescriptions reviewed and by whom?

Repeat prescriptions are usually reviewed once a year or more frequently (for patients on certain drugs). This can vary. Medication reviews are done by pharmacists in practice. GPs will be involved if needed.

4. Are any changes always made with the agreement of the patient?

Any changes to medication will be discussed with the patient, unless the change has been recommended by secondary care(hospital).

5. Are the Practice Clinical Pharmacist legally able to prescribe medication and make changes to repeat prescriptions?

Pharmacists need to be accredited as independent prescribers to prescribe medication. They always need to work in their area of competency and will make changes to repeat within their competency.

6. How are patients taking Protein Pump Inhibitors, e.g. Lansaprazole, monitored by the Practice?

During annual medication reviews, or when patient’s symptoms change.

7. Where a patient has a physical disability, what action can be taken to enable them to access their medication more easily? e.g. some strips of tables can be difficult to open for people with severe arthritis and other disabilities. Can medications be provided in liquid form, e.g. Codeine?

Medication needs can be discussed with the practice pharmacist and necessary changes will be discussed in line with national/local policies.

8. If medications are provided in bottles, but the patient prefers supply in smaller bottles to enable easier access during work or study, should they be easily accessible?

These can be requested from community pharmacies. If cost effective pharmacies will be able to supply in smaller bottles. For example, a patient was prescribed a 500gram cream and if they want it as 10x50grams, this may not be cost effective and pharmacy might refuse. Please contact practice pharmacist to discuss individual needs.

9. Why is the supply of medications provided to the patient sometimes different from the number of tablets on the prescription? E.g. 10 on the prescription, but only 8 provided, or 56 on the script by only 30 provided (Movicol).

Unless the medication is packed in a special container, pharmacy should supply medication as per prescriptions. If they cannot fulfil the whole prescription because of supply issues, pharmacies should give an “Owing slip” for the rest. Patients should go to the same pharmacy with owing slip to collect the rest.

10. In relation to the speed of access to repeat prescriptions, should there be any difference between requesting them by using: paper request, phoning the practice, on-line, or using the app?

Online requests or using the app speed up the process as they can be streamed into workflow faster than paper requests. Requests over the phone are not accepted unless patients or housebound.

11. What is the procedure for getting patches of Buprenorphine as a repeat prescription? Why isn’t it possible to use the NHS app to request repeat prescription of Buprenorphine?

It depends on the way patches are added to the medication list. Please contact the practice pharmacist.

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