The Elmham Practice has two Patient Participation Groups (PPGs). They both have six meetings a year with the Elmham based PPG meeting in the Staff Room of Elmham School and the Swanton Morley based PPG in Hoe and Worthing Parish Room (next to Hoe Church). Dates and times can be found on the surgery website (www.elmhamsurgery.com). Each PPG meeting is attended by practice staff, usually the Practice Manager, Judith Wood and one of the Partners and on occasions by a guest speaker (e.g. local MP, NHS and/or Norfolk County Council Social Services). Members of the public can attend.
The main purpose of a PPG is to ensure that patients are involved in decisions about the range and quality of services currently provided and those either being initiated by the practice or imposed by Central Government policy via the NHS South Norfolk Clinical Commissioning Group (SNCCG). The necessity to integrate medical care, particularly mental health with social care necessarily involves Norfolk County Council. PPG members are not allowed to discuss their own state of health at meetings although they can usefully provide feedback/suggestions about their own “surgery experience” and comments gained from other patients. In this context GP practices are required by the NHS to consult PPGs on the format of their Annual Local Practice Survey and to discuss the results with them. The most important assessment of the Practice is that undertaken by the Care Quality Commission (CQC). In 2016, the Chair of the Elmham PPG and a representative of Swanton Morley PPG were interviewed and gave feedback on the recent implementation of our two Nurse Practitioner led surgeries.
Just before Christmas 2015 the Practice was notified that three GPs were leaving at a time when recruitment of replacements in rural Norfolk was, as it still is, very difficult. The surgery changed the model of care to a multidisciplinary approach that was already in use at Swanton Morley and elsewhere in the UK. Over the last year, PPG members have reported back their own and other patient’s views on the new system. They have also fed back to management comments given in confidence to PPG members by staff. The new system is working well with a high level of patient satisfaction. A key element is the growing level of patient confidence in a Nurse Practitioner’s diagnosis and treatment of their condition. Most importantly a patients confidence that referral to a Doctor will be automatic if the Nurse Practitioner is in the least doubt with respect to diagnosis and/or treatment. This has now allowed more time per patient for both direct and referred appointments with Doctors i.e. the 10 min appointment per patient has been extended to 13 min with a further increase to 15 min planned.
The current level of staffing at the practice is: Doctors (5), Practice Manager (1), Administration Team including cleaning (13), Nurse Practitioners (6 with 2 in training), Practice Nurses (4), Healthcare Assistants (4), Phlebotomists (1), Clinical Pharmacist (1), Dispensers (13), Receptionists (13). This in-house team is complemented by the Dereham Community Midwifery Team, the Community Nursing and Therapy Team, and the Social Work Team based at Dereham Hospital.
The Practice Nurses are highly trained to manage long term conditions (LTCs) and treatment room procedures. They work at both surgeries. For some problems, it may be more appropriate to see one of the Nurse Practitioners rather than a doctor. Their responsibilities include: Immunisations, management of LTC clinics, Travel advice, NHS health checks for men and women, family Planning advice, Ear Syringing, Cervical Smears, Advice on Healthy Living, Minor Injuries, Smoking Cessation, the removal of Stitches and wound care including ulcers. These clinics help patients to manage chronic diseases for themselves.
PPGs are an important point of contact for the NHS South Norfolk Clinical Commissioning Group (SNCCG) which is the GP led authority that commissions, plans and purchases health care for the 220,000 people living in South Norfolk. This authority allocates NHS funds on behalf of the Government and in the current financial climate decides which areas of healthcare to prioritise and which to cut. (www.southnorfolkccg.nhs.uk). Your PPGs have built up a good working relationship with the CCG by attending workshops e.g. Reducing Medicine Wastage; Integration of Health and Social Care; Mental Health including an attempt to prevent cuts in the Admiral Nurse Service for Dementia patients. New Elmham PPG member Liz Waddy, a recently retired GP from Staffordshire, has been working part time with the SNCCG on improving services for people with dementia. In addition senior Officers from Norfolk County Council Social Services and the SNCCG have given presentations to our PPGs on the Integration of Health and Social Care followed by an intensive cross examination lasting over 2 hours! The North Norfolk MP and former Health Minister Norman Lamb has much appreciated our Practice’s efforts in this area and continues to lobby for further integration of Social Care with an emphasis on mental health and the increasing needs of an ageing population. The Swanton Morley PPG organised a public meeting attended by over 50 persons with the local MP George Freeman to express their concerns over underfunding and cuts in the NHS and local authority budgets (e.g. Norfolk County Council).
Further detailed information can be found on the web at www.elmhamsurgery.com which has provided some of the content for this article. We hope for those readers who do not have access to the internet, the information in this article will be of particular interest.
Roger Thorneley ` Gina Eames
Chair Elmham PPG Chair Swanton Morley PPG