Huntingdonshire Patients Congress

1. Huntingdonshire Patients Congress Moat House Surgery patient representative: Mr Richard Watson Email: rnj.watson@mypostoffice.co.uk

2. Huntingdonshire Patients Congress “My name is Richard Watson. I (and my family) have been patients of the Moat House Surgery since moving to Oldhurst in 1966, then to Upwood in 1968, when Dr H A Warbrick-Smith ran the practice alone! I was recently asked by the Practice Manager, Kathryn How, to represent the practice on the Huntingdonshire Patients Congress (HPC). No, I didn’t know what this was either! The HPC was set up about three years ago, apparently to give Huntingdonshire patients a voice or a channel into the Cambridgeshire NHS Trust. The idea is that you the patient can raise any concerns or questions you may have, not about the practice, but on a wider, county scale. It is not a way of complaining about the practice, any concerns you have there should be raised directly with a member of staff. For instance, the meeting I attended on the 20th May gave an update on the progress of the new management “take-over” of Hinchingbooke Hospital and how it will affect the running of the hospital. If you have any concerns about health care or what is happening in our area, it may be that I could raise these at future meetings and hopefully resolve any questions you may have.” Richard Watson

3. Huntingdonshire Patients Congress • Meeting Dates 2011 • Monday 24th January • Tuesday 22nd March • Thursday 5th May • Tuesday 19th July • Thursday 22nd September • Tuesday 22nd November

4. Huntingdonshire Patients Congress My plan is to keep the patients of the Moat House Surgery updated via this website. Following attendance at these meetings I plan to update this page. I will also give you notice of the planned agenda items. If you have any particular queries you which me to raise then please let me know before the meeting date via my email address. I would again reiterate that this is not a meeting to discuss particular/specific concerns about the care you receive from the surgery as these should continue to be referred direct to the practice to be resolved.

5. Meeting Dated 21st September 2010 • I attended the above meeting on the 21st to find that the subject on “Older Peoples Mental Health Services”, which was to be the “headline” presentation this time, had been relegated to third place in order to allow a presentation “Community Pharmacies”. It appears that there are some 43 dispensing doctors, such as we enjoy at Moat House, plus an additional 139 pharmacies/chemists within the county. • The presenter, Kelvin Rowland-Jones, is the Principal Pharmacist, NHS Cambridgeshire. He and his team have been charged with producing a “Pharmaceutical Needs Assessment” which has to be published by 1st February, 2011. “Consultation” is presently in progress and runs until the 25th November:- you may see a green edged document in the waiting room which invites you to take part by contacting :- www.cambridgeshire.nhs.uk/haveyoursay or by telephoning 0800 279 2535 in order to obtain a consultation document and questionnaire. • After the presentation was concluded questions were invited. I asked if there was any mechanism being put in place to enable the return of unused drugs to the issuing pharmacy to avoid waste. The reply was to check your medications before leaving the surgery, any not wanted could then be handed straight back. I responded that that didn’t cover instances such as in my case, where my medication for the month was collected on Monday, only for my medication to be changed on the Wednesday by my consultant at Hinchingbrooke, resulting in the waste of a whole months supply, and that I can’t be the only person for this to happen to, which was borne out by two other members of the congress saying exactly the same had happened to them. No suitable answer was given. Another question on the same theme confirmed that such drugs/medication is simply destroyed by incineration. Mr Rowland-Jones was asked why didn’t he and his team go out to dispensing surgeries and speak to people direct to get realistic answers? The response was that it was not possible to build this into the teams schedule. • Item two concerned the resignation of the present Congress Group chairman and the forthcoming Annual General Meeting. • Item three was the “Consultation on Older Peoples Mental Health Services”. The gist of this presentation was that Rowan Lodge at Wisbech and Hawthorn Ward at Hinchingbrooke “may” be closed (in order to make savings of £600,000.00) following a proposed public consultation period, which is to be from 4th October to 31st December – no indication was forthcoming on how to take part! • The proposals will include improvements to Day Therapy services in Hunts as well as a plan to improve access to local respite beds, with NHSC providing funding to train staff in care homes in Hunts and Fenland. • As the meeting was running over time, a short question and answer session was allowed. • One question asked was on advice and benefits to carers. The reply was that when an assessment is carried out for the patient, there is also an assessment for the carer. Another questioner asked how the franchising of Hinchingbrooke will affect staff and care for patients – the response was that the franchise is about management change but the services will stay. I asked how the government spending cuts to be announced in October are expected to impact on these proposals – the reply was that the governments investment in the NHS is “ring fenced” so - and I quote this verbatim - “this all feels to be safe”! Hmm, tell that to the nurses facing pay freeze and cuts in job numbers. • Relating to the closing of wards already mentioned, a questioner asked would there be appropriate wards? Answer – Wards at Edith Cavell (Peterborough!) were purpose built and new. They are mixed sex but with separate gender facilities. Subsequent question was - had the fact that Edith Cavell is a long way to travel for patients, relatives and friends been taken into account? The presenter replied that “These are tough decisions that have to be made, they have to balance against plans to incorporate day centres etc which will benefit many others”. A congress member argued that the point is that Peterborough is a long way away for many. The presenter responded that while he “totally understands, they have to look at the bigger picture”. • At this point the meeting was drawn to a close, with the presenters on this subject being invited back “at some time in the future” as their presentation had been cut short.. • The next meeting is to be the AGM on 9th November, so no headline discussion subject was proposed. Richard Watson

6. Meeting Dated 9th November 2010 • I attended the above meeting on the 9th, which was billed as the AGM. As usual, items 1 and 2 were apologies received and minutes of last meeting /matters arising respectively. • Item 3 – “Brief Up-dates”. On the Patients Congress, by deputy chairperson Sandy Ferrelly, confirming the resignation of the previous chairman and that the AGM would elect a new chair and deputy chair, Ian Weller on the franchise, to be explained in more detail further into the meeting and by Liz Sargeant on “Hunts Health” were aired. • Item 4 - Ian Weller (NHSC Hunts Office) then gave his “more detailed” up-date on the franchising of Hinchingbrooke Hospital. Final evaluation of bidders to run the franchise (reduced from 8 to 2) will be held in February, 2011, and take-over date for winner to be 1st June, 2011. The PCT are to produce a “White Paper” which will include the creation of a Training/Education Programme for “Issues viz health and well-being”. There is to be team “at the door” on duty at A&E to assess dementia patients and their need to be admitted to hospital or not, as often admission is more stressful for them. There is also the possibility of a questionnaire to be available on wards, asking the patient (in confidence) to give their experience of their stay in hospital. A meeting is to take place on 8th December with GP’s in order to “Standardise certain areas”. • Item 5 – refreshment break followed by • Item 6 – Advanced Decisions. The new name for Living Wills. A long presentation by solicitor Nigel Ashton from Woodfines LLP Solicitors, Bedford, was given, which included:- • 1. The Mental Capacity Act, 2005. • 2. Capacity (a persons mental capacity to draw up their own Living Will – sorry- make an Advanced Decision. • 3. Advanced Decisions themselves, ie, what you can put in it. • 4. Health and Welfare Lasting Powers of Attorney. • Obviously, far too much discussion to be reproduced here. It boils down to the fact that should you wish to make an “Advanced Decision”, you should ideally approach you solicitor, as this is a legally binding document which has to be registered with “the appropriate authority” – your solicitor will know who this body is and how to register with them!!! Nigel put a lot of work into his presentation and though far be it from me to advertise his company, they can be found of the internet and have branches all over East Anglia. • Item 7- Use of NHS League Tables- Talk was to be given by Roy Stafford, Patient Rep from Rainbow Surgery, Ramsey, but he unfortunately was currently an in patient at Hinchingbrooke! Talk given instead by John from same surgery. He went on at great length about the importance of league tables. When he had finished, Liz Sargeant reminded delegates that all League Tables should be viewed, by the viewer, with an eye to their local content and what they themselves experienced in their own surgeries. • Item 8 – The AGM. Ian Weller took over this portion of the meeting. My understanding of his position was that he was in charge of the aforesaid franchising procedure, so how he could take control I wasn’t quite sure. However, he went ahead and said that those standing for the Chairmanship were Sandy Ferrelly and Roy Stafford (currently in hospital). He asked Sandy Ferrelly to leave the meeting whilst voting took place, which of course she did. He then said that he thought the congress should vote for a joint chairmanship, without a deputy. The two representatives from St Ives objected to this, saying that the constitution states that a chair man (woman) and a deputy chair man (woman) had to be appointed. Ian Weller replied that we don’t have a constitution, just a protocol, but if we still wanted a separate chair and deputy, so be it!! He then went on to say that as Roy Stafford was unable to attend the meeting and therefore could not give his address to us, voting should go ahead! I asked how was it possible for us to make an educated decision and then vote if Mr Stafford wasn’t there to make his presentation? I was told that if I didn’t agree, I would have to abstain! I asked if that was how things were done in the NHS – I didn’t get an answer (I bet that doesn’t go in the minutes)! and the voting went ahead, with me duly abstaining. Sandy Ferrelly was then appointed as Chair person and Roy Stafford as deputy. • There being no other business, the delegates were advised that the next meeting would be held at 2.30pm on January 24th, 2011, at the Oak Tree Centre – and we all went home!. Richard Watson

7. Meeting 24th January 20111 • The meeting was opened and chaired by Roy Stafford, (elected Vice-Chair at the AGM in November, 2010). He informed us that Sandy Ferrelly, elected Chair at said AGM, has suffered a stroke, but is responding well, to such an extent that she sent us her good wishes!! Roy was asked to return our good wishes for a full and speedy recovery to Sandy. • Apologies and minutes of last PCM were read and accepted as a true record. • Item 3. Presentation – “Medicines Management – Why and How” - by Jeremy Liew, Principal Pharmacist, Clinical Services and Training (Hunts) NHS Cambridgeshire. • Mission Statement :- “ The entire process by which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution they make to provide informed and desired outcomes of patient care”. • Jeremy then gave a long talk backed up by slides and graphs of the groups work in ensuring, basically, that the right medicines are prescribed for the right patient in the right dosages to help that patient, and to ensure that GP’s stay somewhere within the bounds of their budgetary limits. • Questions from the floor • Q. Attendee queried role of “MM” involvement in monitoring GP prescribing. • Jeremy stated that role is to promote prescribing that is based on good evidence and safety (of drugs) data. Group were reassured that stringent monitoring takes place by various bodies to ensure safety. • Use of Statins – attendee asked if the aim of a statin was to lower cholesterol? • Yes, but ultimate aim is to prevent a “cardiac event” – a heart attack. • Are they more beneficial to someone suffering diabetes? • Yes, definitely. • Q . On GP Budgets- If a GP wants to go above and beyond “MM” advice, and goes over budget, what happens? • A. Usually the “”MM Team” will provide feedback to the GP and discuss subject. Long history of co-working between GPs and “MM” to keep in line with budget, also ensure budget reflects needs. • General questions. • Q. Why can’t pharmaceutical industry standardise on shape, size and colour of tablets, as each time prescription filled, tablets can be very different in appearance from previous prescription (for same drug). • A. This is down to safety and business reasons. All of the above may be subject to patents law. • Q. Pharmacy does not seem to dispense quantity prescribed. • A. Go back to dispenser and check. It may be pharmacy is out of stock and will fulfil prescription when stocks are in. May also be an error!! • Q. Some packaging identical. I stated that my wife has two totally different drugs in almost identical packaging – why? The last answer implied safety was paramount, so how can it be safe for this to happen? • A. Agreed, this is an issue and patients must check carefully before taking their medicine. There were big issues between Health Products Agency and manufacturers, prohibiting variation in design due to pharmacists and nurses maybe not paying attention to names and strengths of medication. (All the more reason for clearly different packaging, I would have thought). • Session brought to a close by Chairman due to time. Jeremy said he is happy to answer any further questions and can be contacted at Jeremy.liew@nhs.net • Item 4 – refreshment break. • Items 5. Brief updates.

8. Roy reported that Hunts Health have now been awarded Pathfinder status. One positive outcome of this, he said, is they are working closely with Hinchingbrooke, and • have already achieved a reduction in length of stay by one day. • Hunts Health are undertaking a pilot study on Dementia, which is being set up at Ramsey Health Centre and in the Ramsey Area. • He is covering for Sandy by working with Hunts Health Board while she is off. • He requested that NHSC refrain from using acronyms! (Some hopes). • NHS Cambridgeshire – Ian Weller introduced himself – “NHS Cambs Practice Based Commissioning Development Manager, Strategy & Delivery, Hunts and EC&F areas” and went on to say:- • He represents 23 practices across Huntingdon from both clusters – Hunts Health and Hunts Care Partners. There are 10 practices within Hunts Health and 13 within Hunts Care Partners (our practice is in this last “cluster”). • GP senate being formed – this is a group of GPs who have come forward through elections to represent all Cambridgeshire practices to help manage the “transition to GP consortia”. • For Patient Congress, as we move through the transition phase, Public Health will move into local authorities under HealthWatch UK and groups such as ours will have a greater voice in the development of patient services and choice. • Q. An attendee asked him “ Talk in the press is that policy is being rushed through- do you have a lot to do or are things emerging at a leisurely rate – are the press magnifying the issue”. • A. Ian replied - “Things are not being rushed through; however PCT have obligations and various bodies will be involved in the process. We are in challenging times and, yes, it is busy but we want to de-centralise functions effectively and have the local needs of patients at heart”. • Q. How will budgets be managed? • A. Financial accountability will in the future be devolved to GP consortia (Hunts Health already have an indicative hard budget). • Q. What is the future of this group bearing in mind there are now two clusters within Huntingdonshire- should we have two patient congress groups? • A. As Huntingdon Patient Congress represents views of the Hunts people (he) would advise that we stay as one group, but this would be up to members of the group ultimately. Roy Stafford added that he felt it would be more beneficial to stay as we are. • Q. Do the two groups have a geographical area or do they overlap? • A. (by Marilyn Long, (Practice Manager, Cromwell Place) They overlap completely. • Q. HealthWatch is moving into local government and will be part of CQC (those acronyms again) – how will this work? • A. Local authority will take into account Public Health but there is a great deal still to be determined and who will be a part is still to be sorted. • HealthWatch is to become a regular HPC agenda item. • Item 6. Update on Hinchingbrooke Hospital franchise – Ian Waller. • Group informed that Franchise Company intend to sign contract on 1st March as long as everything is in place, at which time a 10 year lease can be operated under a private company and the government will sign this off by way of an intervention order. If this goes to plan, they are due to commence services on 1st June. • Discussions are under way with various groups to ensure needs and functions of local population will be taken forward and catered for. • Item 7. Adoption of HPC Protocol. • Ian Weller asked if anyone had any objections to revised edition of protocol. One member was concerned that para 10 says “however they will not have voting rights on that body” implying that Chair/Vice Chair will not be allowed to have a vote as a lay person at any given GP consortia meeting. Following discussion Ian said it should be minuted that we let those forming new leadership councils know that a lay person holding role of Chair/Vice Chair should be allowed to vote. Therefore it was agreed that para 10 be changed to “may not have voting rights” • Then agreed that HPC Protocol be adopted with the amendment to para 10 as above, to be reviewed in 6 months time as there are currently so many changes taking place. Item to be added to July’s agenda. • There being no further business meeting was closed – next meeting to be 22nd March, 6:30to 8:30 pm, at Oak Tree Centre.