What is the PPG?
The Ryalls Park Patient Participation Group (PPG) is a partnership between us the patients, the medical practitioners, pharmacy management and practice management of the Ryalls Park Medical Centre.
What is the PPG for?
The PPG ensures the voice of the patient is heard when decisions are made about how the Practice is run, how current services are provided and what new or additional services should be provided in the future.
The PPG is concerned not just with medical treatments and the provision of medicines, essential though they are. We are also concerned about the whole patient experience from making the appointment, arrival and check-in at reception, waiting times and receiving your treatment and medicine.
What can we, the patients, do?
As patients, it’s obviously in our interests that Ryalls Park becomes the best medical centre it can be. The PPG provides a route for patients to inform and advise the Practice on what matters most to patients and to help identify solutions to problems. In short, we need to contribute to the continuous improvement of the practice.
The management of the Practice want to hear from us. We need to say what is most important to us, what problems there may be and to help identify solutions.
If you are interested in joining the PPG, wish to make a comment or suggestion or would simply like some more information please call the practice or email us on
Great ideas come when we all work together.
Chairman Ryalls Park PPG
Yeovil PPGs meet with Commissioners to discuss problems with primary care
A number PPGs from Yeovil and the surrounding villages met with the Somerset Clinical Commissioning Group (CCG) to discuss issues of real concern to patients. The CCG is the body which distributes the money from the NHS nationally to all health providers in Somerset. This includes GP practices, acute hospitals like YDH and Musgrove Park, community hospitals like South Petherton, maternity provision and mental health services. So the CCG is a vital organisation. The decisions it makes affects us all in the county.
See below the notes of the meeting.
Approved Notes of meeting between the Somerset Clinical Commissioning Group (CCG) and the Yeovil Patient Participation Groups (PPGs)
Date of meeting: 11 January 2019
Present: from the CCG, Tanya Whittle Deputy Director Contracts, Michael Bainbridge Assoc. Director Primary Care, from the PPGs, John Falconer Chair Ryalls Park, Darryl Stimpson Vice Chair Ryalls Park, Ray Croissant Chair Penn Hill, David March Chair Preston Grove, Malcolm Jefferies Vice Chair Preston Grove, David Staddon Acting Chair Hendford lodge, Lesley Morris Vice Chair Martock and South Petherton.
Agenda Item 1 – The Future of Primary Care
The PPGs began by pointing out that for at least two years they have been campaigning for the CCG to set out how GP practices should develop to meet increased demand and crucially to clarify the level of increased funding to be made available to meet patient needs now and in the future.
The PPGs feel that no clear plan has yet been published and the PPGs require the CCG to urgently set-out its intentions with particular regard to:
Securing a GP appointment within one or two days has become increasingly difficult in recent years. Waiting times are now typically two to three weeks.
Primary Care Strategy
The CCG was unable to commit to a date when the revised primary care strategy will be published. There is a process, mandated by NHS England relating to public engagement and consultation, which has to be followed for major service change proposals. The CCG intended to have a clear plan in place for primary care although this might or might not be a formal strategy document.
The CCG agreed that increased funding for practices may be necessary, especially in urban areas, but no data had been presented by practices which positively supported the case. The CCG point to significant variation in the performance of GP practices despite similar levels of funding. Practices should therefore concentrate on improving the efficiency of their internal procedures.
There has been a change of emphasis in national policy. Previously, the term ‘primary care at scale’ suggested that larger practices provided a better service. Recent evidence however, suggests that smaller, independent practices are equally cost-effective and can provide a more patient-centred service. The CCG predicted that both Symphony Healthcare and independent practices would continue to exist but that a greater degree of working together was required.
The PPGs welcomed the statement regarding large-scale providers and requested that the CCG make this known to all the practices in Yeovil.
But the PPGs were dismayed about the response on funding. The PPGs firmly take the view that GP practices do not have adequate resources, particularly of health professionals, to meet current patient demand. Whilst efficiency improvements are necessary and welcome, the supply/demand imbalance in Yeovil can only be brought into equilibrium by increasing the funds available to practices.
The PPGs were also disappointed with the progress on strategy and felt that clearer plans to improve quality in primary care services were needed.
Agenda Item 2 – Online Consulting
The PPG described a number of online initiatives which are already available to patients. Some are fairly mature systems, for example My Diabetes My Way. Others are not yet available to all but are being tested in a pilot study. Still more are available as apps to be selected from the library of NHS Digital.
But in all cases practices are receiving little or no guidance or communication from the CCG regarding which systems to use or whether additional resource may be available to assist practices in getting online consulting up and running. Some practice managers feel considerably less well informed about OC than their PPG.
The CCG accepted it needed to do more in this area and announced that Allison Nation had recently been appointed as the Assoc. Director of Digital IT. The CCG suggested that the PPGs may wish to meet with Allison directly to discuss this matter further.
Agenda Item 3 – How to Assess Practices
The CCG accept that the performance of GP practices vary considerably. PPGs are aware of the performance variability, particularly in terms of delays in getting a GP appointment, long waiting times on the telephone, repeat prescription delays and difficulties with reception staff.
But in discussing these issues with practices, PPGs cannot refer to a standard or expected performance against which the practice may be falling short.
PPGs accept that detailed service levels are not part of the nationally negotiated contract with practices and so cannot be made mandatory. Nevertheless, PPGs request a simple set of non-binding service indicators which patients can reasonably expect their practice to conform to.
The CCG made it clear once more that the national contract does not contain compulsory service levels but recognised the problem the PPGs raise. In internal discussions the CCG are considering making available a ‘dashboard’ which may satisfy the requirement but emphasised this was not yet agreed.
Agenda Item 4 – Practices not Cooperating with PPGs
The PPGs reported that in most cases the relationship between the practices and the PPGs is very good indeed. Unfortunately, there are some practices where this is not the case. An example was given where a practice almost entirely controls the activities of the PPG, including limiting the number of meetings, approving the agenda and minutes of the meetings before circulation and requiring to vet applicants for Chair, Vice Chair etc. of the PPG some weeks in advance of the elections. In another example a practice had proceeded to merge with another primary care provider without seeking the agreement of, or explaining the implications to, the PPG.
The PPGs requested the help of the CCG to discuss these matters with practices. The PPGs pointed out that the NAPP require practices to support their PPGs “without seeking to direct or control their activities”. Furthermore, the CQC consults with the PPG during assessment visits.
The CCG agreed to mention this matter to the relevant practices and would reply in due course.
Agenda Item 5 - AOB
The PPGs requested the assistance of the CCG regarding the lack of disabled access at the Martock and South Petherton practice. Funding for a ‘press-button’ door is needed.
The CCG said they would consider the matter and were hopeful that the funds will be made available.
Finally, the PPGs thanked Tanya and Michael for the meeting and the cooperative spirit in which it was conducted.
Ryalls Park practice under pressure from patients - access to GP appointments becomes increasingly difficult
During the autumn and winter of 2017/18 many patients found the process of booking an appointment to see a GP almost impossible. Call waiting times were far too long and even when patients got through to the reception staff the day's appointments were often fully booked. The practice admitted it was unable to keep up with patient-demand and, encouraged by the PPG, issued a public statement on Facebook setting out the problems and requesting the understanding of patients.
The response was very positive. Most patients appreciated being told about the difficulties the practice was experiencing and did their best to seek an appointment only when absolutely necessary. Whilst the PPG fully supports the practice being candid with patients it is clear that the underlying problems must be fixed. Essentially this means making available more appointments. The practice maintains it requires more funding to offer additional appointments. NHS Somerset acknowledge that budgets are under pressure but believe that by being more efficient the practice can do better with existing funds.
The PPG's view is that increased funding for Ryalls Park (and the other Yeovil practices) is necessary in order to bring about a balance between the supply of appointments and patient demand. That said we strongly encourage the practice to continually seek to improve its processes under a general policy of continual improvement.
Over many months the practice has considered how best to respond to these challenges. Among those considerations was the possibility of joining other primary care organisations in the hope that improvements can be made through 'economies of scale'. The PPG were not able to support such a move unless it was clear it would benefit patients. The practice has now confirmed it will remain independent, and the PPG are delighted to support the decision.
The issue of funding in the GP sector remains a key issue. The PPG has held discussions with NHS Somerset in recent weeks and we hope to hear some positive news in the near future.
See below the confirmation from the practice.
To all patients, their families and friends of Ryalls Park Medical Centre (RPMC)
You may have seen the recent statement we made via social media, followed up by press reports, regarding the difficulty to access GP appointments at RPMC. We are determined to improve the service we offer to our patients and have been considering how best we can achieve it. Various options have been considered including the proposal to seek a merger with other practices or to join a large-scale primary care provider. After careful consideration we are pleased to announce that we will remain an independent practice. We firmly believe this is in the best interests of both the practice and its patients. We are also pleased to announce that Dr Richard More has agreed to join us. Dr More has many years’ experience both as a GP and in Chairing and managing a wide range of businesses and will be the Chairman at RPMC. Daniel Vincent remains as Managing Partner focussing on strategic improvements to the practice. In conjunction with NHS commissioners Daniel has been examining how to improve working arrangements in order to best serve our patients. Funding, of course remains a crucial issue. Our PPG (Patient Participation Group) has been pressing Somerset NHS to increase funding for GP practices. We hope to say more about this in the coming months.
Our doctors, nurses and admin team are committed to improving access to the excellent patient-care at RPMC.
We will be setting out further changes and additions to our team in the near future to improve our performance. We know it has been a very difficult winter period for all and we wish to thank you for your understanding and forbearance during often challenging days.
PPG Meeting Dates: PPG meetings are held approximately monthly. If you wish to attend perhaps you could email the PPG at firstname.lastname@example.org. See below the minutes of the three most recent meetings.
Notes of the Ryalls Park PPG Meeting held on Wednesday 19 December 2018
Present: Daniel Vincent, Darryl Stimpson, Karina Parsons, Lesley Hudd, Jan Yates, Steph Puddy, Roger Brown, Joanne Childs, Mike Freestone, Richard More, John Falconer.
Apologies: Claire Mallinson, Brenda Axe.
The minutes of the meeting held 21 November were approved as a correct record.
Volunteers – There remains some uncertainty about who may be available to begin the volunteering pilot. DBS checks are largely complete so it is dependent on who is available in January. The PPG prefers that the pilot uses members of the PPG committee only. This is an important means of communication with patients and the committee should receive valuable feedback from the volunteers.
No team changes since the last meeting and the practice remains at full staff capacity.
EMIS registration continues grow steadily. The number now using EMIS has risen to 33%, about 2000 patients. This is an excellent improvement since the summer of 2018 when only 5% of patients were registered.
The prescription process continues to improve. The average time from prescription request to medication dispensed is now approximately two days, down from five days in June this year. It should be noted that the improvement mainly relates to standard repeats or run-of-the-mill requests. When a patient’s medication is due for reassessment, a change of dose or other complication, delays still occur. About 5% of prescriptions fall into this category. Daniel reported that a member of staff will be appointed as liaison officer to deal specifically with these irregular problems.
Darryl has been closely involved with practice staff in bringing about the recent improvement, especially in understanding and mapping the process. But a GP must still review and authorise every prescription request. In this regard Dr Helen Day has greatly improved the approval rate of prescriptions.
In approximately six months the management of prescriptions has been transformed for the better. The committee wished to record their appreciation of all the staff who have contributed to this improvement.
There are now a number of initiatives considered as online consulting. Darryl is leading for the PPG on this issue and stressed that although OC provides a great opportunity to improve the service to patients, it must be managed carefully by the practice.
It was noted that the practice has made more appointments available to book online. Joanne has monitored the situation in recent months and she confirmed the position is noe greatly improved.
There was a short break in proceedings at this point and the staff were invited to join the PPG members for a festive mince pie, a coffee and to distribute the ‘Secret Santa’ gifts.
The Chair of the practice, Dr Richard More, joined the practice in summer 2018. Having now been with us for six months he gave the committee his views and observations to date.
He said the first few weeks were spent firefighting a number of problems, some relating to training and some to shortage of resources and he confirmed that performance was improving. The CCG is giving support during the transition and the practice is financially stable.
A staff away-day took place where everyone was given the opportunity to contribute. There was excellent feedback and many good points for improvement were made.
The plan in the immediate future is to make quick-hits for improvement where possible and in addition to formulate a long-term plan for improvement.
However, he remains concerned about the future of primary care in general. There is no clear strategy coming from commissioners regarding long-term funding or how GP practices should be organised.
Finally, he thanked the PPG for their continued support.
The Chair of the PPG thanked Richard for attending and giving his candid assessment. The committee is delighted that he chose to join the practice and is confident that Ryalls Park is on a positive path to continuous improvement under his leadership.
Next meetings: 23 January at 5.30
20 February at 5.30
The Chair wished everyone a happy Christmas and adjourned the meeting.
Minutes of the Ryalls Park PPG Meeting held on Wednesday 21st November
2018 at 5.30pm in the Meeting Room at Ryalls Park Medical Centre
Present : Claire Mallinson (CM), Daniel Vincent (DV), Darryl Stimpson (DS), Lesley Hudd (LH), Jan Yates (JY), Steph Puddy (SP), Roger Brown (RB), Joanne Childs (JC), Mike Freestone (MF)
Apologies : John Falconer (JF), Karina Parsons (KP), Brenda Axe (BA)
The minutes of the meeting held on 25/10/18 were approved as a correct record with the addition of clarification on the meaning of U3A.
Volunteers – DV advised that the PPG volunteer had completed the relevant DBS checks and a member of his low carb group was hoping to become a volunteer also. Still awaiting the relevant clearances and hoping to start this in the New Year.
DV presented his update as follows
No team changes since the last meeting and the practice was up to full capacity with staffing.
Dr Day has started work and has already implemented processes to make things more efficient, primarily with regards to prescription turnaround times which had now decreased.
RM had undertaken some clinical sessions.
No complaints had been reported.
EMIS registration was slowly increasing and DV and DS had recently attended an NHS efficiency meeting which covered this as well as repeat prescription request improvement. Use of this system had increased from 10% in August to 23% in September which was positive.
Online consultations were discussed and DV reported that himself, JC and JF had attended a meeting with Annie Paddocks from the CCG who reported that online consultations were already being offered in some practices. It was reported that this had not created additional demand and were not being offer3d as an alternative to a face to face consultation with a GP, just offered as an option. DV advised that a further meeting would take place in early December with a view to implementation in January 2019. DV to circulate video giving more information regarding this.
The incoming calls had remained static since last month with less people calling in as more outbound calls are being made to prevent this.
DS is still waiting to hear when the Genome project is going live.
It was reported that the prescription process was much improved and they were on the right path to reducing this further. Next meeting on 13/12/18 to discuss the process in more depth.
JC and DV had a productive meeting regarding EMIS and DV reported that blood tests were now bookable online and they were also looking at making other appointments bookable online including asthma checked, diabetes checks, flu jabs, phone appointments and three monthly contraceptive appointments.
DV asked whether the group had heard of Fit for the Future and DS confirmed that an email had been circulated to the PPG giving details of the next local event at Abbey Manor Hall.
MF raised the ongoing issue of long waits at reception during peak times. DV responded to say wait times were reducing and it was hoped they would reduce further with the appointment of the volunteers.
JY reported that she had noted on Facebook that the surgery was closed on Friday between 10am and 3pm and DV confirmed this was the case.
EMIS update – patient records are available but less than 100 people have signed up for this service. DV advised process very simple and patients just have to email in to request this.
Date of next meetings
Future meeting dates were discussed and the following agreed :
Wednesday 19th December 2018 – 5.30pm – Xmas meeting with xmas nibbles to be brought along.
DS thanked all for their attendance and closed the meeting.
Minutes of the Ryalls Park PPG Meeting held on Wednesday 24 October 2018 at 5.30pm in the Meeting Room at Ryalls Park Medical Centre
Present: Steph Puddy, Mike Freestone, Christine Hunt, Daniel Vincent, Darryl Stimpson, Joanne Childs, Jan Yates, Roger Brown, John Falconer (Chair).
Apologies: Claire Mallinson, Brenda Axe, Lesley Hudd.
Two new patients joined the committee this evening. Christine Hunt and Roger Brown were introduced and welcomed by the Chair.
The Chair informed the committee that regrettably Karina was unable to attend due to a serious ill-health condition and for the time being would step down from attending meetings. The committee expressed their distress at the news and unanimously sent their best wishes to Karina for a complete and rapid recovery.
This is an additional item which Mike Freestone asked to be added to the agenda and agreed to by the Chair.
Online consultations provide a potential means to increase patient access to GPs and other health professionals. However, as Mike pointed out, it is not necessarily appropriate for all patients. Some do not have a computer or tablet and in any event may not be confident when using digital equipment. Mike was concerned that online consulting might replace face-to-face consulting in future – a backward step. (See attached note)
The committee discussed the issue and agreed that although there were potential problems online consulting should be explored further.
The minutes of the meeting held on 26/09/18 were approved as a correct record except as follows: Lesley Hudd was recorded as present in error. She was unable to attend and had submitted her apologies.
Volunteers – Regrettably, Jan and Karina were unable to continue as volunteers, at least in the short term. It is intended that the remaining volunteers should begin in the 2nd week of January 2019.
Daniel began by announcing that new starters, Rose and Hannah have joined the Patient Liaison Team and Sian has joined the Nursing Team.
Also, as mentioned last month, Dr Helen Day has joined the practice. Taken together, this gives the practice a full complement of staff - not seen for a very long time.
Daniel read the main points raised in a letter received from Marcus Fysh MP. The letter was well balanced with a request to understand what we are doing to improve access, that the government is looking at further funding and that the patient who had raised the concern had said how excellent both the GPs and reception team were.
The prescription process was again discussed. Many patients continue to experience problems and improvements to the process are still being considered. A further meeting is planned to take place on 20 November to review progress to date and to discuss next steps.
John and Darryl attended the October meeting of the Somerset Chair’s Network.
Items of note for discussion:
The SIDeR Programme.
The Somerset Integrated Digital e-Record is intended to improve end of life care by giving hospices and other care organisations access to patient records. Unfortunately it is a stand-alone initiative and is not integrated with other NHS platforms, for example EMIS.
Not sure who came up with the silly title. Cider is not the first thing that springs to mind for health or memory! JF
Winter Planning for Community Hospitals.
Last year the number of staff available in some community hospitals fell below the minimum safe level which resulted in the hospitals having to unexpectedly close for a period. To avoid this happening in the coming winter, Lucy Nicholls, of Somerset Partnership NHS Trust has decided to close some hospitals early!
The obvious idea of getting more staff on stand-by seems not to have been considered.
Health and Care Stategy
Michael Bainbridge (Head of Primary Care at the CCG) explained that the ‘Health and Care Strategy’ had been superseded by the ‘Fit for my Future’ Strategy. Michael made it clear that the FfmF strategy is no different from the HaC strategy. (no different from the STP strategy before that either!)
Essentially, the CCG will be conducting a number of ‘road-shows’ around the county to gather views from people as to how the CCG should proceed. In the meantime the number of GPs in Somerset continues to reduce making it ever more difficult to get an appointment.
The Genome Project
Darryl explained this important development which is gradually being made available to doctors. Occasionally, clinicians are unable to diagnose certain conditions which do not respond to treatment. In these circumstances it may be that the patient in question has a genetic defect which is the cause. In future it will be possible for GPs to check if that is the case. Darryl will circulate separately the presentation material given at the CN meeting)
As it is not practical for the entire Chair’s Network to engage in detailed discussion with the CCG, the idea of forming an executive committee of five or six people to represent the CN was approved in principle.
John Falconer has been invited to join the executive committee.
No progress regarding to Mens Shed. A suitable location is being sought.
It was pointed out that there are similarities between the Mens Shed idea and the UTA, the University of the Third Age.
Jan pointed out that messages left online were not always followed up. Daniel replied that the situation should improve now we have additional staff.
Mike confirmed that men aged between 65 and 70 were being invited for a scan to check for aortic aneurism. However, men over 70 must request a scan via the practice.
John thanked everyone for their attendance and closed the meeting.
Wednesday 21 November at 5.30
Wednesday 19 December at 5.30
I have received an email concerning the use of online video consultations.
I feel the PPG need to discuss this. Apparently it is in trial operation in some parts of the country and could be rolled out nationwide.
1st. My first feeling is what about the elderly and frail persons who may not have access to a PC.
2nd presumably there would be no extra doctors, so whilst a doctor is spending time answering a video call what happens to his patients personal visit.
3rd Somehow it seems to be a method of shifting appointments from the patient visiting the surgery to the patient sitting at home on a PC, the same thing applies to telephone appointments. A doctor cannot be having a video consultation and a normal visit of a patient at the same time.
Is this the thin edge of the wedge to completely do away with a surgery (building) much the same way as retailers are shutting shops due to online sales. Food for thought.
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