NAPP e-Bulletin January 2018 (click this link to download)
Report on NAPP Annual Conference 24th June 2017
by Ian Edmundson (firstname.lastname@example.org)
NOTE: All presentations should be available on the NAPP web site, together with video of the proceedings in the main conference room. If you need help finding them please contact Ian.
Keynote Speech 1 by Professor Pali Hungin, President of British Medical Association (163,000 members).
This was a fascinating insight into the changes taking place within medicine world-wide including in the NHS in England. Professor Hungin asked how we can cope with these changes but apart from saying that power needed to come from the public he did not really answer his own question.
He listed the following symptoms of the “disease”: doctor burn-out, early retirement, recruitment and retention problems, reducing numbers in medical schools, mental health issues leading to increasing suicide rates amongst doctors, and “presentism”, meaning attending at work but not being committed to the job. He said that the UK is better off than many other western countries but that the number of our medical students going into jobs outside the NHS has now reached 50%.
Where corporations are involved in providing healthcare there is a tendency to block whistle-blowing and hence improvements in service. Continuity of care has been shown to be beneficial to patient outcomes but he questioned whether it was possible in a system where part-time working was so prevalent. He cited doctors in China being killed for missed or late diagnosis leading to lack of incentive to engage with patients.
His conclusion was that patients need to take responsibility for their own health. We need to the public and the government to understand the new situation and involve MPs and the Department of Health to get changes made by the government.
Keynote Speech 2 by Ruth Rankin, Deputy Chief Inspector of Gps, Urgent Care and Digital Services at the Care Quality Commission.
Ms Rankin told us there are over 50,000 providers covering primary, secondary and social care in England and all of them, including private providers, must register with CQC. Practices are required to display their ratings in a prominent position. CQC has completed it's first round of inspections for General Practice and they found that an open and honest Patient Participation Group tens to be associated with a good or outstanding practice. She said PPGs need to act as an objective, critical friend and try to represent all the patient population. We need to help the practice to assess the outcomes of changes made and monitor improvements. The practice needs to make the PPG aware of the challenges they are facing so that they are able to perform these functions and assist.
There is a guide on the CQC web site of what an outstanding practice typically looks like.
Workshop C: Social Prescribing
Definition: A way of linking people with social and physical activities and community support to improve their well-being and independence.
Several models for social prescribing were discussed but they all involve a referrer (e'g. A GP), a connecting link worker and a supplier of the prescribed activity who may be volunteers or paid agencies. Examples of activities which may be prescribed are singing, dancing, walking, exercise, or peer support groups. The key thing is that it needs to be something the patient has an interest in.
Group working is required between all involved to define what can be offered but it is wider than the NHS – working with local voluntary groups and councils.
Workshop C (continued)
Benefits for patients include improved well-being, physical activity, self-confidence, reduced loneliness and better relations with practice staff.
Benefits for the practice include more “time to care” concentrating on health issues with other patients, improved patient relationships.
Benefits for the wider NHS include reduced pressure on primary care, reduced cost as some work is done by voluntary agencies, puts patients at the heart of their own care.
Workshop A PPGs and Social Media – building communication
This was a discussion around the various forms of social media and what they can be used for in the context of NAPP and PPGs. NAPP is starting a blog, using Wordpress, to inform members and others of important messages and get related feedback. They have a Facebook page and use Twitter.
One of the issues in any of these is how to ensure that patients access the chosen media, and in the case of a PPG how to ensure that inputs received are from members of the practice, if this is felt to be a requirement. As you might expect the majority of the attendees were not of a younger generation and it was felt that one of the main advantages of using social media might be to engage with the younger patients in a practice who do not attend PPG meetings and rarely visit the surgery.
It was suggested that the practice can collect patient email addresses and send out direct messages to patients as required. One PPG had spent two years collecting email addresses as they were not allowed to get them from the practice and now did this themselves. One PPG used schools, via the head teacher to send messages on their electronic newsletter and to engage with the school council so that these students passed messages to their peers.
For our purposes, if we want to engage more with the younger generations of our patients it would be possible to set up a closed Facebook user group, for patients of Wheatbridge only, with defined rules of engagement. We would need help from the practice to notify patients of its existence as we don't have access to emails, and, probably, also an adjudicator from the practice staff to ensure anyone applying to join the group is actually a Wheatbridge patient. An adjudicator from the PPG would also be needed to be able to remove any posts which break the rules.
Group of 100 by Paul Devlin, NAPP CEO
NAPP is trying to set up a Group of 100 PPGs who are able to respond urgently and frequently to questions from NAPP in order to allow them to take a greater role in national engagements, where they are asked to provide a patient perspective. In view of our lack of frequent meetings I think we are not suited to volunteer for this role.
Soap Box by 14 PPG representatives
This is an opportunity for individuals to speak for 90 seconds on a subject important to them. Unusually 14 were allowed to take part this year and they spoke on a variety of topics. If anyone wants details the video should be on the NAPP website or Ian has brief notes.
These awards were presented to Ashley Medical Centre, Ashtead, Surrey and to Basset Road Surgery, Leighton Buzzard, Bedfordshire.
The former have 2 to 3 projects at a time run by PPG members in their own time, reporting back to the PPG when they meet. They had an autism project in which they worked with GPs to contact patients in order to improve services. They have developed a newsletter which is now 12 pages and produced twice per year, funded by local advertising and distributed through pharmacies, schools and by hand delivery. It has a circulation of 3500 from a practice population of 20,000.
The latter have worked very closely with the practice, involving as many staff members as possible in the first agenda item at every meeting. They have been able to improve the patient appointment system. The PPG chair, or deputy, sits on all staff appointment meetings. They have an action plan, based on an annual survey, which is monitored regularly. They meet every 2 to 3 months but have working groups which meet in between to develop specific ideas. They have started a walk for health with three levels of ability, produced a booklet for older people, working with their PPG network. This is updated every two years and is distributed via U3A and available on their web site.
Closing comments by Professor Sir Denis Pereira Gray, NAPP Patron and chair
Sir Denis gave his usual interesting summary of the day and his own reflections on what we had heard. He pointed out from the CQC presentation that good leadership is key to a good or outstanding GP practice. In England 4% are rated outstanding and 86% are rated good. He drew some opposite conclusions to Professor Hungin from the same facts, pointing out that continuity of care had been proven in research to be beneficial in 12% fewer hospital admissions, better outcomes for patients, longer life, and patients are more likely to follow advice. He agreed that continuity of care is reducing nationally but insisted that patients should be pushing for it, not accepting that it is no longer possible.
He said no British medical schools teach the principles of General Practice, but it has now been requested that they do so by the government.80% of students currently say they don't want to be a GP. He said that locums in General Practice are unable to replace the knowledge which a GP has of their patients and patients should be pushing to reduce the number of locums employed.
Annual General Meeting
The business of the AGM was conducted quickly and without controversy. The minutes of the previous meeting, trustees and accounts reports were all accepted and the trustees seeking election were all agreed.
In any other business it was announced that the NAPP constitution no longer reflects the work done and needs to be re-vamped. This is being worked on and may require an Extraordinary General Meeting before the next Annual General Meeting.