Dr Squire will be in attendance to discuss local issues.
Minutes:
The Chairman introduced Dr James Squire, GP and Ms Zillah Morris, Practice Manager from Castle Place Surgery Tiverton to the meeting.
Dr Squire set the scene for his visit, explaining that he was keen to be involved in community discussion regarding new ways of working in Mid Devon. He informed the Committee that silo working was not efficient and that the public health element of their work needed to be carried out alongside the public sector, with increased communication. With regard to winter pressures, which were also an agenda item for the meeting, he explained that he was only a GP and could not be held responsible for general strategy, but could give a local opinion.
The Practice Manager talked through a presentation *, explaining that 90% of patient contact in the NHS was through primary care and that general practice was changing and being challenged. There was an aging population, a complexity of health issues and a decline in the number of GP’s available. The current level of primary care access varied per area but was generally satisfactory at Castle Place at the moment. It was agreed that ‘own GP’ continuity was regarded as most effective for long term care but that any GP or healthcare practitioner could see episodical patients depending on their issue. She continued by explaining the need for collaborative working in the area which should include patients, health, social, community, voluntary and local services and that together they needed to set and manage expectations, prioritise need and design solutions. Castle Place Practice had approached the Tiverton Health and Well-being Forum in order to raise awareness, better engage, navigate, signpost and expand local prescribing. A meeting was taking place on 27th March 2018 at which it was hoped Tiverton organisations would get together. The aim was to discuss what was being done well and what were the gaps/needs in order to work more collaboratively to ensure that we became an active, smartly resourced and connected community.
Dr Squire explained that the Practice did not have experience of bed blocking issues as their involvement was post discharge. He informed Members that the Single Point of Access (SPOA) service was working well. This service allowed the practice to organise care packages for patients with a single point of call. A first responder would then visit the patient and a package be put in place. He commented that they could not always get all of the care requested but that the number of carers available was increasing and that they could get some care, if not the whole package. He informed Members that care packages for rural areas could be difficult to put in place but that Exeter was currently suffering from a shortage of staff due to wages being low in a city where there were other jobs available. GPs would like to be involved at an earlier stage regarding patient discharge as they knew the patient and could provide background to the case. Lines of communication were not currently good but work was being undertaken to establish this.
With regard to the winter crisis, Dr Squire informed Members that flu had caused some issues but the general impression was that this had not been a major crisis.
Dr Squire provided a case study which demonstrated procedures that were in place.
Discussion took place regarding:
· Mental health provision for young people and a pilot that had proved successful and had been extended;
· Castle Place Practice had joined the Royal Devon and Exeter Group who were the acute community and social care provider for East Devon in January 2018;
· ‘Do not resuscitate’ plans and living wills which needed to be continually updated to reflect the current situation the patient was in;
· Local Authorities could help to reduce the load on GP’s by highlighting the impact on health from diet, obesity, smoking and housing. Dr Squire explained that obesity was causing a huge problem with increased numbers of patients suffering from diabetes. He understood that weight loss was hard to achieve and that this was a society problem. In an ideal world everyone in the community would be involved in improving health – local markets, colleges, restaurants, gyms and schools for example. He informed Members that in Frome trained ‘care navigators’ had been put in place to keep an eye on those that lived around them. This could help to identify issues such as depression and early intervention could improve outcomes. There was a need to develop the ‘Big Society’. He agreed that it would take a lot of enthusiasm and a lot of volunteers to achieve this but warned that we did not have the resources to carry on as we were and needed to put preventative measures in place now;
· Doctors carried insurance for Good Samaritan works.
It was AGREED that discussions with the GP and Practice Manager had highlighted further areas of policy that needed to be looked at regarding health, exercise, loneliness and housing to help prevent ill health in order to reduce pressure on the NHS. It was therefore RESOLVED that Cllrs Mrs J Roach and N A Way compile some questions that the Scrutiny Officer could follow up.
(Proposed by the Chairman)
The Chairman thanked the GP and Practice Manager for attending the meeting.
Note: - * Presentation attached to Minutes.