PPG Minutes

Present: Hilary Clark, Rosemary Northall (Secretary), Gina Eames, Gerry Palmer (Church Warden), lan Fleming (Parish Councillor), Ted Peachment (Chairman), Dr. Simon Hibberd, Jean Walden, Joanna Mullineaux (Lead Nurse Practitioner),Judith Wood (Practice Manager)

Ted Peachment welcomed everyone, especially Joanna Mullineaux, who was attending for the first time and he also introduced two new members, Hilary Clark and Gerry Palmer.

Anne Sadler, with regret, had withdrawn from the Group, being unable to attend evening meetings.

Ted recalled that the Group began in 2004 and is now stronger than ever. The past year had seen quite a turn-over in Doctors and nurses but all the staff should be commended for coping so well during this difficult period. Patients continued to regret the departure of Dr. Paul Strickland but were gradually adapting to the new regime. There had been potential problems with the status of Swanton Morley Surgery, the PCT and the NHS and now, under a new coalition government, there were fears of a considerable reduction in funding. Tribute was paid to Judith who, as Practice Manager, worked extremely hard to fulfil all her wide ranging duties and responsibilities.

Jean Walden and Maggie Richards were thanked for organising and analysing the Patients’ Survey, which produced some interesting results, summarised under Item 5 in the minutes of the meeting held on 16^th March, 2010.

Ted reported that, regretfully, due to a very sad bereavement in January, one of our members, Janys Turner, had to withdraw from the Group. Sincere condolences were offered and an appreciation of the interest Janys had shown during her time with us.

It had been pleasing that new members from Robertson Barracks had joined us, representing a younger age group and two other new members from the village had been welcomed this evening.

In conclusion, Ted thanked all the members and also the medical and administrative staff, who contributed so much to our meetings. He expressed the hope that the Group will continue to offer positive support to one of the best and most comprehensive surgeries in the country, which had proved to be such an excellent village facility. Ted then stated he was willing to continue as Chairman, if that was what the Group wished.

The present Chairman, Vice-Chairman and Secretary were willing to stand again for re-election. There being no other nominations, it was proposed by Gina Eames, seconded by Jean Walden, that they be re-elected en bloc. Carried unanimously.

It was proposed by Gina, seconded by Jean, that the minutes be confirmed as a true record. Carried unanimously by those present at the March meeting and signed by the Chairman.

a) Elmham Surgery PPG Open Meeting: this had been postponed from April to 14^th. October. Outside speakers were being invited and an interesting evening arranged.

b) Annual Parish Meeting at Swanton Morley on 26^th.April: Judith had attended and given a succinct report on Swanton Morley Surgery, highlighting recent developments. Ted had reported on the PPG.

c) Charges for chiropody it was emphasised again that the chiropody treatment available at Swanton Morley Surgery is provided by a privately run, independent business. The consultation room is offered to the chiropodist, Mr Cummings, rent free on the understanding that this benefit is passed on to the patients. Judith will investigate to confirm that this is so. It was suggested that Mr. Cummings

should perhaps make it clear to his clientele that he is running a private business, quite separately from the Surgery.

d) Patients’ Survey: the staff had been pleased with the positive feed-back.

Requests had been made for physiotherapy sessions to be available at the Surgery as an extra facility but, Judith reported that the physiotherapy department at Dereham Hospital is understaffed and it is not possible to provide clinics at Elmham or Swanton Morley Surgeries.

e) Appointment of a fourth partner at the Practice: Dr Hibberd reported that there had been very little interest shown and the Practice would continue for a while with only three partners. It is possible that another salaried Doctor may be appointed in the meantime.

Judith reported that the various projects begun a while ago, such as the integrated care project and leg ulcer management, continued to be developed satisfactorily. Ultra sound, and neurology clinics were provided and Relate counselling is now available. There was also more liaison with other Practices in the Dereham area and special services, such as routine check ups for patients with glaucoma problems, were being offered locally. This was more convenient than having to attend the eye clinic at the NNUH.

Family Planning facilities were being developed and Dr Jenny Lees has now opened a clinic at Elmham Surgery where implants and coils are available.

The number of patients at Swanton Morley Surgery has now reached over 1800, resulting in more negotiating power with the PCT.

Joanna Mullineaux has been promoted and is now the Lead Nurse Practitioner. She reported that there is an excellent, well integrated team of four highly qualified Nurse Practitioners who also have individual skills and specialities. She specialises in home visits and intermediate care; Michelle Dyball in diabetes; Katie Byrne in palliative care and leg ulcer treatment; Sue Harris in occupational health and mental health problems and she also spends three days a week at the clinic at Robertson Barracks.

There are also four highly trained Practice Nurses and each one has her own speciality.

7. To consider further the possibility of forming a liaison between this Group and a PPG at Watton Health Centre.

While being generally interested in the activities of other local PPG’s, it was felt that attendance at each other’s meetings would have limited value, since every group was unique, with its own particular issues and problems. Gina, however, was happy to accept the invitation to attend the next meeting of the Watton Group, providing the date proved to be convenient and offered to transport Rosemary. It was agreed that exchanging minutes with other PPG‘s was interesting and useful.

a) A few patients had expressed concern to a member that, in view of their particular ongoing health problems, they felt dissatisfied that they had not yet been referred to a specialist at the hospital. Judith emphasised that if a patient was worried he or she must never hesitate to make a complaint and the whole matter would be properly and officially investigated by all the medical parties involved. In the first instance, the patient should contact her, as the Practice Manager, and she would initiate the necessary procedures.

b) Generic medicines: Some patients felt that these were inferior to the specific medication they had received in the past and complained of adverse side effects. Dr. Hibberd advised patients to report

A member commented that a change to generic medicines had not suited her initially and, after a six months’ trial, it was changed again and then this was found to be fine

c. General medical check ups: Earlier this year there had been a Government initiative whereby men aged 40-64 were invited by the Practice to attend for a general health check up. Dr Hibberd explained that this was of limited value and it is preferable for patients to initiate a request to have a check-up, if they felt they needed one. All patients may make an appointment with a Nurse-Practitioner and will be given a general check-up and any follow up advice.

d. Labelling of medication: A member asked why, instead of putting the label on the box containing her eye drops, it had been stuck onto the actual bottle inside. It was explained that some patients discard the box and so inadvertently throw away the instruction leaflet inside. Sticking the dispenser’s label on the bottle ensured that the patient still retained some basic directions. In future, a label may be stuck onto the outside of the box as well as onto the bottle.

These are held on Monday and Tuesday mornings from 7.30am. and patients need to make an appointment beforehand. If a Doctor is away and unable to run that clinic or, no advanced appointments have been made, patients will have no access to the Surgery until the normal opening time of 8.30am.

e) Flies: A patient had complained about the nuisance of flies in the waiting room and corridors and dead ones being left in the lamp shades Judith explained that in this agricultural area fly nuisance was an ongoing problem. Advice had been received from Environmental Health and the areas were efficiently sprayed at the beginning and end of the daily sessions. A ”fly zapper” had also been installed. The ultra violet light attracts flies, wasps and other insects and they are then electrocuted.

As Deputy Co-ordinator, Rosemary made another plea for more people to volunteer as Community Car Drivers .Dr. Hibberd and Judith praised the scheme and offered to provide more publicity in the Surgery waiting room to try to attract more drivers. Jean, a Community Car driver herself, felt that she was being under used and would be happy to do more tasks if asked to do so.

It was reported that in view of recent vandalism and anti social behaviour in parts of the village, there was to be a higher Police presence here during the next couple of months and residents should feel safer and less vulnerable.

A member had recently needed to use the out of hours facilities and had been favourably impressed with the service received but, was surprised that “Swanton Morley Surgery” still did not appear to be officially recognised as a stand alone surgery.

In view of the recent discussions about the merits of generic medication Judith suggested that, at the next meeting, the Group might be interested to have a presentation by the lead pharmacist from the Practice. Members felt this was an excellent idea.

There being no further business, Ted thanked everyone for their attendance and closed the meeting at 8.25pm.

(Minutes confirmed and signed by the Chairman, Ted Peachment, on 20^th July, 2010)

Present: Jane Allinson Ted Peachment (Chairman) Dr. Simon Carroll Karen Purchase

Gina Eames Maggie Richards (Vice-Chairman) Alan Fleming (Parish Councillor) Jean Walden Rosemary Northall (Secretary)

Ted Peachment welcomed everyone, with a special word of welcome to Jane Allinson, who was attending for the first time. Members were very sorry to hear of a particularly sad bereavement suffered by Janys Turner in January. Owing to increased family commitments she had felt it necessary to withdraw from the group. A letter of sympathy had been sent to Janys and also appreciation expressed for her interest and support.

It was proposed by Maggie Richards, seconded by Jean Walden, that the minutes be confirmed as a true record. Carried unanimously by those present at the January meeting and signed by the Chairman.

It was confirmed that over 50 newsletters had been delivered along with the February edition of the Link-Up parish magazine and some had also been given to the school.

This will held at the Village Hall on Monday 26^th April, starting at 7.00pm, earlier than usual. Judith will be contacted to see whether she will be able to give a short report on Swanton Morley Surgery. Ted Peachment will report on Swanton Morley PPG.

In the absence of Judith, Dr. Carroll provided a summary of recent developments.

a) It was reported that Katie Byrne had graduated as a fully qualified Nurse Practitioner and Prescriber. Members wished to send her their warmest congratulations.

b) The Surgery is providing medical facilities at Robertson Barracks for Army personnel. Wives and other dependents are encouraged to register at Swanton Morley Surgery. Consultations at the Barracks are held every week day from 8.00am until 4.00pm, with either Dr. Jennings, Dr. Lees or Nurse Practitioners in attendance. Physiotherapy is also offered. More members of staff have been recruited, including a receptionist, a secretary and two nurses.

c) The early morning consultation sessions at Swanton Morley Surgery are continuing, starting at 7.30am on Mondays and Tuesdays. Despite this facility there are still some patients who would like to see further opening hours such as on Saturday mornings and also later evening sessions. The early consultations are intended for patients proceeding to work afterwards but, are also used by others. It appears that many people are still unaware of these early opening times.

It is anticipated that a new, fourth partner will be appointed in the near future, with effect from 1^st August. At the moment there are three partners, Drs. Hibberd, Carroll and Jennings and four others, Drs. Kaushal, Epstein, Lees and Devar.

A total of 32 patients had taken part in the survey. Jean had prepared a concise summary of the findings and led the discussion, highlighting salient points revealed from the responses to the Questionnaire.

Opinions about the staff: 77% of patients had a very good or excellent experience, with only 7% finding the experience poor.

b) Availability of staff: 54% were seen on the same day; 26% had to wait three days or more

If urgent, however, it appears from the survey that 76% could be seen on the same day. In reality, a patient needing urgent attention will always be seen that day either by a Doctor, Nurse Practitioner or a nurse.

It is usually possible for a patient to be seen by a Doctor of their choice within a week, ie. during the next ten sessions

Waiting Times at Surgery: 88% of patients had to wait between 6-30 minutes to be seen, yet 79% of those found that to be quite acceptable.

Some patients object to a lengthy wait, and feel that appointment times should be reliable. Dr. Carroll explained that a routine consultation is scheduled to last for 10 minutes but, it is not always possible to adhere to that. A patient may produce a list of several health problems and it could be better to deal with them all during that one session, rather than call the patient back for more appointments. Some Doctors, however, are more adept at dealing swiftly with patients and are therefore more likely to stick to their schedules.

Extra facilities: Suggestions were made for additional facilities to be provided such as physiotherapy and NHS chiropody

Improvements: the main concerns mentioned were the lack of privacy at Reception and the lip at the entrance to the Surgery which restricts wheelchair access. Requests were made for longer opening hours and for G.P’s to resume responsibility for covering “out of hours” services.

Thanks were again expressed to Jean and Maggie for their time and effort in organising the survey and analysing the results.

6. To consider an invitation to form a liaison between this group and a PPG at Watton Health Centre.

The Practice Manager at Watton, Mary Osborne, had approached Judith to enquire whether the PPG’s at Elmham and Swanton Morley Surgeries might be interested in forming some kind of association, which could allow members to visit each other’s meetings and exchange ideas. While being generally in favour of the idea, members were unsure as to how useful it would be to attend the meetings of another PPG since the matters under discussion are usually only of relevance to that particular group. It was not known whether the PPG at Watton is only at the fledgling stage but, in any case, it was felt that bodies such as the National Association for Patient Participation would be best placed to give any help and advice that may be required. It was agreed to discuss the matter further with Judith at the next meeting.

The topic of generic medicines was raised and a lengthy discussion followed. Dr Carroll explained that until two years ago, the Practice retained a very wide range of medicines, which included, for example, many commercial brands of HRT treatment, and a variety of painkillers and anti-biotics, varying in cost, popularity and packaging. More recently, strict rationalisation had been carried out to streamline the stock and to minimise the possibility of errors as well as to reduce costs. The Practice has adopted the Cambridge Formulary and the dispensaries are now run much more efficiently. The essential active ingredients in a particular medicine remain the same, but, some patients claim that the generic version is different from the specifically named variety previously prescribed. There have been complaints about side-effects or reduced effectiveness. Any serious problems are discussed at a weekly meeting between the Doctors and the Elmham pharmacist and a prescribing rationale is agreed. On rare occasions, a patient may be given a prescription to take to another pharmacy to obtain his desired medication there. This is preferable to the Practice having to stock a specific item for only one patient.

A member was pleased that the problems she had raised at the last meeting regarding blood test results had been resolved and she was now receiving the information from the hospital on time.

She also reported that she had received four complaints from fellow residents at Woodgate Park, who were concerned at what they felt were unduly high charges for chiropody treatment received at Swanton Morley Surgery. Dr. Carroll explained that that chiropody was being provided by a privately run, independent business, which was quite separate from the Practice. Mr. Michael Cummings is not charged rent for the use of the consultation room but, he is obliged to pass on that benefit to his chiropody patients.

Another member expressed gratitude to Dr. Lees for her swift action in securing a hospital appointment for her son, who needed to be seen at the earliest opportunity.

Finally, members discussed the proposed changes to the way health care records are to be stored and managed, using a national database. Opinion was divided on the issue and at least three people intended to opt out of the scheme. In order to do so, they will need to visit the Surgery to sign a simple form requesting that all clinical data should be withheld from their summary care records.

This will be held on Wednesday 19^th May, 7.00pm at Lincoln House Care Home.

(These Minutes were confirmed on 19^th.May 2010 and signed by Ted Peachment, Chairman),)

Ted Peachment, Chairman, welcomed everyone to the meeting, extending best wishes for the New Year and special words of welcome to Dr Carroll, who was attending for the first time.

The minutes had been circulated well before the meeting. It was proposed by Maggie Richards, seconded by Jean Walden, that they be confirmed as a true record. Carried unanimously by those present at the November meeting and signed by the Chairman.

Eighty copies of the Winter Newsletter had been made available. It was decided that members would arrange for them to be displayed on the school notice board and on the remaining seven notice boards in the village and also copies placed in Swanton Morley Stores and Swanton Morley Butcher’s shop. The remaining fifty or so would be distributed along with the February issue of the “Link-up” parish magazine.

It was confirmed that Judith would bring a Doctor along to each meeting and that she had published a rota, giving details.

c) Patient’s dissatisfaction with treatment received from District Nurses:

Judith reported that she was in contact with the District Nursing Team and the problem was being fully investigated.

Judith was hoping to arrange for replacement batteries to be available at the Surgery, which would be more convenient for local patients than having to attend Dereham Hospital.

The recent severe wintry weather had caused problems, when some staff, including Doctors, had been unable to access the Surgery and some clinics had been restricted.

The various projects mentioned at previous meetings were still being developed and were progressing.

Swine flu vaccinations continued to be offered to priority groups, patients being contacted by phone and invited to accept appointments. A total of around 1,400 patients had been vaccinated already and there were still supplies under refrigeration for 1000 more doses. Nationally, there was only a 30% take up of the swine flu vaccine.

Plans to provide Dentistry facilities at Elmham Surgery were still progressing, albeit slowly, having being affected to some extent by the recession. In future, consideration may be given to extend the facility to Swanton Morley Surgery.

Since 50-100 patients use the Surgery every day, it was thought that there would be a high uptake of questionnaires during the survey period throughout December. One hundred questionnaires were made available at the start but did not need supplementing, as a total of only 33 were completed and returned. 70% of these were from women. It appeared that some patients had taken questionnaires home but had not returned them. Jean would be glad to receive any further questionnaires that are returned late. It was disappointing that the Receptionists had not always been able to draw patients’ attention to the Survey and persuade them to complete the forms while they were waiting to be seen by a medical practitioner. If a similar exercise is carried out in future, perhaps a PPG member could be present in the waiting area to encourage patients to respond.

Jean had done a detailed analysis of the replies and copies were available for everyone to consider.

It was agreed that members would study them and that their conclusions would be thoroughly discussed at the next meeting in March.

She also distributed a list of comments patients had made about the Surgery and the facilities provided and some were briefly discussed.

It was noted that 70% of patients who completed the questionnaire were aged 61-80. Some patients had expressed a request for the equivalent of “well man/well woman” clinics to be available. It was explained that while there were no such designated clinics, a general, basic health check up, or “MOT”, is available to all. Patients simply need to book an appointment in the usual way with a Nurse Practitioner or Doctor. Several patients asked for physiotherapy sessions to be available here as well as at Elmham. The early morning surgeries on Mondays and Tuesdays continue to be supported but, not exclusively by those intending to go on to work, afterwards. Patients here seem generally happy with the opening hours but, there is a significant trend, nationally, for wanting extended opening hours. It is very difficult to provide both continuity of care and access to all medical services, as some patients would like.

The results of the Survey will be made available to the Surgery staff, posted on the Surgery website and also a copy sent to the National Association for Patient Participation.

Warmest thanks were expressed to Jean and Maggie for all their effort and hard work in organising the Survey and analysing and publishing the results.

A former patient of Dr. Strickland’s wished to know whose name should now be given if, when booking in at a hospital appointment, he is asked to identify his G.P.

Dr Carroll explained that an assistant Doctor, Marc Epstein, was currently allocated the Swanton Morley area for daytime home visiting but, when a new partner was appointed towards the end of the year, he or she will take over that responsibility. Meanwhile, it was in order for the patient to give the name of the Doctor he sees most often or, indeed any of the other practice Doctors.

It was also made clear that it is correct for patients to say that their Surgery is “Swanton Morley”, rather than “Elmham Surgery”

Interest was shown in the possibility of attending a public meeting in April if members of Elmham PPG

decided to arrange one. It was confirmed that the Annual Parish Meeting at Swanton Morley would be held on Monday 26^th April. It was hoped that both Swanton Morley Surgery and Swanton Morley PPG would be represented.

A member again reported difficulties regarding the INR Clinic she attends at the Surgery. Efficiency at the hospital has deteriorated during the past six months and there are delays in receiving the results. Appointments to adjust her dosage of warfarin have been missed and seven weeks elapsed without her having a blood test. A Practice Nurse has been able to intervene, at times, and alert the patient. A more sophisticated system is being established at the Norfolk and Norwich University Hospital to ensure there is better co-ordination.

Staff in the Dispensary were commended for having realised that a patient had been taking more tablets than she had been prescribed and was seeking further supplies sooner than ought to have been necessary.

A member reported that friends of hers were very pleased with their new bungalow and the medical facilities provided on site at Woodgate Park. Another member has been allocated a bungalow to be rented but there is a delay in this becoming available.

A complaint was received on behalf of parents whose child had been given medication which was not suitable for that age group. They had the inconvenience of having to return to the Surgery to have the medication changed. In such a case, a critical incident form is usually raised and the Practice Manager informed so that it can be determined whether it was an error in prescribing or, a mistake in dispensing.

It was confirmed that a regular green prescription form issued to a patient by a dentist may be used to obtain medication from this Surgery. Likewise, someone who is a temporary resident here is able to use a prescription form at the Surgery, even though it may have originated from a totally different area.

The matter was raised about the poor state of the car park area used by the disabled during the recent wintry weather. A grit bin was nearby but, apparently, had not been used and the car park was icy and treacherous. Lessons had been learnt from the snow experience this winter and gritting procedures should be better organised in future.

It was reported that, following a minor stroke, a very elderly local patient was visited by relative s from High Wycombe and they had been very favourably impressed by the excellent care she had received from the medical staff at this Surgery.

This will be held on Tuesday 16^th March, 7.00pm at Lincoln House Care Home.

Ted thanked members, Judith and Dr Carroll for their attendance and the meeting closed at 8.05pm.

Present: Kerry Bell (Robertson Barracks), Ted Peachment (Chairman), Alan Fleming (Parish Councillor), Maggie Richards (Vice-Chairman), Andrea Folan (Robertson Barracks), Janys Turner, Dr. Ian Jennings , Jean Walden, Rosemary Northall (Secretary) and Judith Wood (Practice Manager)

Ted Peachment, Chairman, welcomed everyone to the meeting, extending a special word of welcome to Dr. Jennings and also to Kerry Bell and Andrea Folan, Community Development Workers, representing patients at Robertson Barracks.

2. Minutes of the meeting held on 15^th September to be confirmed and signed.

The minutes had been circulated to members well in advance of the meeting. It was proposed by Maggie Richards, seconded by Jean Walden that they be confirmed as a true record. Carried unanimously and signed by the Chairman.

The Woodgate Park Development: It was reported that Dr Kaushal had shown seven members of the group around the new bungalows and Community Hall on the afternoon of 29^th September. Everyone had found the visit very interesting and had been largely very favourably impressed by the facilities being offered.

Liaison with Robertson Barracks: The post of Community Development Worker held by Fran Sampson is now shared between Kerry Bell and Andrea Folan and they were both interested to find out more about our PPG so that they could provide valuable feedback to Judith. It is hoped other Army wives would like to join the Group in the future.

Surgery newsletter: It had been agreed that the autumn edition of the surgery newsletter would be delivered along with the “Village Voice” to every household in the parish. Regrettably, this did not appear to have materialised. Judith will contact Gina to make arrangements for the next distribution.

Entrance doors to Swanton Morley Surgery: Judith was thanked for contacting the patient who had reported difficulties. Subsequently, there had been further problems with the doors, especially following a power failure. These faults have since been rectified.

Flu vaccinations: Judith reported that the vaccinations for seasonal flu were now complete and that vaccinations against swine flu were now being offered to the group of patients identified as being the most vulnerable. These were patients between the ages of 6 months and 65 years who suffered from chronic respiratory problems and other long term health conditions including chronic disease of the heart, lung, kidney or liver, chronic neurological diseases, diabetes mellitus and those with immunosuppression. They were being contacted by phone and offered appointments and it was very important that patients kept these appointments, otherwise vaccine could be wasted. Only one injection was needed. Health care and social workers were also being encouraged to avail themselves of the vaccination at this stage.

Three other priority groups had been identified and would be offered vaccinations in due course. Unfortunately, patients were ringing the Surgery to enquire about the availability of a vaccination but, this was unnecessary as they would be automatically contacted if they were in a high risk group.

Integrated Care Project: This scheme, targeted mainly at helping elderly people with a range of health problems, was proving to be very successful. The key to this was the appointment to the practice of a dedicated social worker and the opportunity to have weekly meetings with all the professionals concerned, so that an integrated package of health care and practical support could be provided. The underlying aims of trying to reduce hospital admissions in the first place, to track a patient’s progress if he/she had to be admitted and then, trying to ensure as short a stay as possible, were being realised in many cases. Once the patient returned home, it was crucial to provide appropriate care and practical support. There is a shortage of District Nurses, partly because training courses have been temporarily frozen. This means individuals have a heavy work load and may also have to be shared between several practices. Norfolk County Council Adult Social Services department had compiled a detailed investigative report on the North Elmham Surgery Pilot Scheme, in September/October 2009, and this had been made available for PPG members to study.

Neurology Clinic: This is to be available at Swanton Morley Surgery from the beginning of December for all patients suffering from Parkinson’s disease, multiple sclerosis and motor neurone disease, who live in a wide geographical area covered by post codes NR19 and NR20. A Consultant from the Norfolk and Norwich University Hospital would be present, along with a specialist nurse and perhaps an occupational therapist. This clinic is mainly for patients due to have their annual check-up and it is hoped that it will be more convenient for them to attend this surgery rather than have to go to the NNU Hospital. If this proves to be successful, arrangements may be made for similar facilities to be provided for patients suffering from epilepsy.

Dental Clinic: Despite more NHS Dental facilities now being available in Dereham, it is felt there is still a need for further provision and the Surgery plans to open a dental clinic early in 2010.

Owing to a delay in completing the proposed draft of the Questionnaire, it had not been possible to begin the survey on 1^st October, as originally planned. It had now been finalised and Jean undertook to print off as many copies as would be needed, ready to start the survey on 1st December, which would continue for one month. She offered to provide all the paper and envelopes free of charge. Maggie agreed to provide the box to receive the completed forms. The results would be analysed by Jean and Maggie and it was hoped that their findings could be reported and discussed at the meeting in January.

Concern was raised regarding a report that over £5m. are wasted each year in Norfolk alone, partly due to patients “stockpiling” unnecessarily and ordering repeat medication which they no longer needed. This figure represents only the cost of medicines returned to pharmacies and GPs and it amounts to 4% of NHS Norfolk’s annual £118m. bill for drugs. More surplus medication is believed to be disposed of by patients at home. For reasons of safety, drugs returned to pharmacies must be destroyed and cannot be prescribed to other patients. From time to time, patients receive leaflets with their medication, asking them not to re-order more than is necessary.

The government’s announcement that GP catchment areas are to be abolished and that patients could register with any GP of their choice was felt to be a populist idea to win votes. Dr. Jennings thought it was impractical and would not be in the best interests of the majority of patients. While it may sound to be a good idea, it would not be feasible in a Practice such as this one. Since it covers such a large area, it has to be divided into segments, each one being the responsibility of a specific Doctor for daytime home visits. The new proposals could mean, in due course, that all daytime home visits would have to be carried out under a scheme similar to the current “out of hours service,” something both Doctors and patients would not be happy to contemplate.

A member reported on behalf of a patient who had returned home from hospital following a mastectomy. She was subsequently visited by a District Nurse to have the dressing changed. Unfortunately, the patient felt that the general attitude of the District Nurse was disappointing and the standards of hygiene poor. It was not known whether the Nurse was part of the team from this surgery. More details would be given so that the matter may be properly investigated.

The representatives from Robertson Barracks were asked if they had any comments about the service and facilities provided at the Surgery and were urged to provide Judith with any feed back they may get from other dependents at the Barracks. Soldiers there are now able to attend medical clinics at the base which are now run by Swanton Morley Surgery. Wives and other dependents are encouraged to use Swanton Morley Surgery but, are at liberty to use surgeries elsewhere if they wish.

Meetings are held every two months, usually on the third Tuesday of the month. A slight modification was necessary to accommodate the majority of members next January and May and the following dates were agreed accordingly.

WEDNESDAY 20^th January; Tuesday 16^th March, WEDNESDAY 19^th May, (Annual Meeting)

A member raised the issue of hearing aids provided by the NHS. She had been surprised to discover that, despite the advances made in modern technology, the batteries last for only about 7-10 days. A patient is given supplies for about 14 weeks and then further batteries have to be obtained from the Receptionist at Dereham Hospital. This can be difficult for elderly people unless they have transport. The hearing aid itself needs to be inspected and re-tuned every 6 months at the Norfolk and Norwich Hospital but, no specific appointment times are offered, resulting in the likelihood of a patient being kept waiting for a long time. In view of these inconveniences, it was felt to be hardly surprising that many elderly people gave up wearing their hearing aids.

It was agreed that this would be on WEDNESDAY 20^th January, 2010, 7.00pm at Lincoln

Ted thanked everyone for attending, especially Dr Jennings and Judith and the representatives from Robertson Barracks and the meeting closed at 7.50pm.

Present: Gina Eames Ted Peachment (Chairman) Alan Fleming (Parish Councillor) Maggie Richards (Vice-Chairman)

Dr. S. Kaushal Jean Walden Rosemary Northall (Secretary) Judith Wood (Practice Manager)

Ted Peachment, Chairman, welcomed everyone to the meeting and extended a special word of welcome to Dr Kaushal.

Dr. Kaushal explained that the 30 bed care-unit near Lincoln House Care Home was part of the final phase of the proposals for development made three years ago, and agreed at that time, in principle, by the Planning Authority. Since then, slight modifications had been made to the design of the building, which had recently been granted Planning Permission. Building is not likely to begin until about 18 months’ time.

It had been envisaged that this unit could offer NHS nursing care for patients recently discharged from hospital, thus easing the problem of bed-blocking, while providing transitional care for patients until they could return home or enter a Care Home. It now seems more likely that the new unit will be designated for specialist nursing or dementia care. There is an increasing need for dementia care facilities in this area and very limited provision. If patients were eligible they would be able to receive financial help from Social Services to help to defray the cost of their care.

Anglian Water was closely monitoring potential problems regarding drainage and sewage and a special pond had been provided to cope with the increased flows.

While not being obliged to become patients of Swanton Morley Surgery, most of the occupants in this special care unit would opt to do so for the sake of convenience. This could be a welcome boost to patient numbers at the Surgery but, it would also raise challenges and, more staff may be needed to cope with the greater demands on its services.

The Woodgate Park sheltered accommodation scheme comprises 24, two bed-roomed bungalows and is now nearing completion. Ten units have been allocated, on a long lease or rental basis and it is hoped that residents will start moving in by the end of October. This original, innovative development has created much interest and could provide a model for similar schemes in the future.

The underlying aim is to provide a pleasant, safe environment and to promote independent living for the over 65’s for as long as possible. Should certain health problems arise in the future, various tailor made packages of care would be available, according to the need at any particular time. Flexibility was essential and residents would be offered a wide range of options, including the provision of meals, if necessary. Lincoln House Care Home would offer medical and practical support, as appropriate. Since, by definition, these residents are elderly and probably unwell, it is inevitable that there will be a significant impact on the local Surgery,

Potential occupants would need to obtain a letter from their own G.P. supporting their application and confirming that they have particular problems and would benefit from occupying one of these bungalows. The majority would be sold on a long lease, current prices being in the range of £155,000 - £170,000. Shared ownership is also available to broaden the accessibility for the wider population. Eventually, each bungalow would be sold back to the company at the current market price.

About five bungalows would be offered for rent, with some priority to residents in Swanton Morley, although it was felt that a “post code lottery” was best avoided. The rent would be £595 for 4 weeks, plus a monthly maintenance charge. More details of the whole scheme may be obtained by ringing Tracey at Lincoln House (01362) 637598.

Gina Eames, a member of the Group, is to rent one of these properties. She reported that they are spacious, practical and very well designed and she is delighted with the excellent facilities provided. Different levels of care can be offered to suit an individual’s needs, enabling residents to enjoy a high degree of independence for as long as possible.

Dr. Kaushal was warmly thanked for his talk, which all members had found to be very interesting. There will be an opportunity shortly to look round one of the bungalows.

The unconfirmed minutes had been circulated to members well in advance of the meeting. It was proposed by Gina Eames, seconded by Maggie Richards, that they be accepted as a true record. Carried unanimously and signed by the Chairman.

Liaison with Robertson Barracks: Contact had been made and it was confirmed that a successor to Fran Sampson will be in post shortly and might be able to attend our next meeting in November. Sgt. Braithwaite, Welfare Liaison Officer, advised that we should repeat the communication sent to Capt. Mike Reed in August, inviting representatives of the dependents to join the Group.

Surgery newsletter: The July/August edition had been delayed and was very brief. It was not thought necessary to arrange for its distribution throughout the village. The new autumn edition is now imminent and arrangements could be made to have it delivered to every household, along with the next edition of “Village Voice”. Gina will organise this.

Vaccinations against seasonal flu: During the first three weeks in October appointments will be offered at both surgeries to those patients deemed to be vulnerable.

Proforma: The Secretary had devised a statement, explaining the aims and aspirations of the Group and providing contact details of the members. This would be published in the “Link-up” magazine, and displayed at the Surgery, Village Hall, Post Office and, posted on the Surgery and village websites.

Confirmed minutes of meetings: These will be displayed at the Surgery, Village Hall, and Post Office and, posted on the websites. They are also made available to the Parish Council and Elmham PPG and, Judith will distribute them to the medical personnel at the Practice, as appropriate.

Judith confirmed that Dr. Marc Epstein had joined the Practice in August, followed by Dr. Amreetha Devar early in September. Dr. Jenny Lees will begin on 2^nd. October. Including Dr. Sanjay Kaushal, the number of assistant doctors will then be four. The three partners, Dr. Simon Hibberd, Dr. Simon Carroll and Dr. Ian Jennings, will decide, in due course, when they might begin the process of recruiting a fourth partner. Owing to the doctors and other personnel being away on summer holidays, the past few months have been very difficult, with an increased workload but, the Practice has been fortunate in being able to have the services of some excellent locums.

Since 1^st September, the Practice has extended its services to Robertson Barracks and a surgery for army personnel is open every weekday between 8.00am and 4.00pm. There is a contract with Lloyds Pharmacy in Dereham to supply medication. Various new staff have been recruited and others channelled to support these extra facilities. Nurse Practitioner Susan Harris has been appointed, supported by Michelle Dyball and also Katie Byrne, who will qualify shortly as a Nurse Practitioner. More trainee staff are being employed, including a new health care assistant. A new receptionist, Joan Hedger, has been appointed and also a new secretary, Tanya Steadman.

The ongoing projects are steadily progressing, albeit gradually, and it is thought that dental facilities could be established early in 2010.

6. To agree the format of the Questionnaire and to arrange how it is to be conducted

The format of the questionnaire was agreed and Judith is to send a final draft to Jean Walden. It will be totally anonymous. Some information about the PPG will also be included. It was felt that it was not appropriate to include questions about the out of hours service, as this was run entirely separately from the Practice. Jean will make available sufficient copies of the questionnaire and it will be distributed to patients attending Swanton Morley Surgery from 1^st October. The survey will continue for one month. Jean will also provide the large envelopes in which to return the completed questionnaires, which will be deposited in a box in the Surgery waiting room. The assistance of the receptionist on duty will be appreciated, as she will be required to invite patients to complete them while they are waiting to be seen.

Two members had experienced problems regarding the dispensing of medicines. One had collected a box of drugs for a friend and it was discovered later that one packet was missing. The other collected what seemed to be her repeat prescriptions, since they bore her name but, it was found that she had actually been given medicines allocated for another patient. While such errors are rare, they are regarded very seriously and full investigations are always carried out to try to ensure that similar mistakes do not occur again.

Another member expressed appreciation at being seen at the Surgery straight away when she became ill suddenly and there was no time to make an appointment.

The question of regular medication reviews was raised and it was explained that all patients do not necessarily need to be checked periodically. If it is necessary to monitor the effectiveness of a particular medicine or, if patients are taking potentially dangerous or addictive drugs, or those which need to be gradually withdrawn, they are asked to see their doctor for a review every six months.

A member was very disappointed that a pin-prick surface test was still not available to patients at the Surgery to ascertain correct levels of warfarin. Instead, they had to undergo often painful blood tests, the sample of blood being analysed later at the hospital and there was often a delay in the results being made available. Apparently, the PCT is not able to fund this pin-prick facility.

It had been reported to Judith that a patient recovering from a knee replacement operation, and using crutches, had felt disconcerted when the doors at the patients’ entrance to the Surgery threatened to close in upon her too soon. Her husband had jammed his foot hard against the door to allow her safe passage. More recently, the doors closed in again too early and made contact with her stick. Judith is to discuss the matter with the patient and reassure her about the safety of the doors.

It was reported that the unconfirmed minutes from the meetings of Elmham Surgery PPG and Swanton Morley PPG are being exchanged soon after the respective meeting, otherwise there is a time lag of two months. Once confirmed minutes are available, they, too, are then subsequently exchanged and are proving to be of interest to the members of both groups.

Dr Kaushal had offered to show members round one of the new bungalows and the afternoon of Tuesday 29^th September seemed to suit most people.

It was agreed that the next meeting will be on Tuesday 17^th November at 7.00pm

(Minutes confirmed and signed by the Chairman, Ted Peachment, on 17^th November 2009)

Ted Peachment, Chairman, welcomed everyone and also expressed regret that several members were unable to be present this evening.

1. Apologies for absence: Alan Fleming, Dr. Jennings, Karen Purchase, Anne Sadler, Jean Walden.

It was noted that Fran Sampson from Robertson Barracks had returned to live in Wiltshire. Contact will be made with the Welfare Liaison Officer to see if anyone else would like to join the Group to represent the families from the Army base.

Apart from two minor points raised, which were corrected, the minutes were accepted as a true record. Proposed by Judith Wood; seconded by Maggie Richards.

Surgery newsletters: There had been a delay and the newsletters had become available only this week. Arrangements will be made to deliver them to all households in the village along with the August edition of the Village Hall bulletin.

Early morning appointments: It had been decided that it was not necessary, at the moment, to display a notice advising patients that repeat prescriptions will not be available for collection until after the normal opening time of 8.30am.

Invitation to Dr Kaushal: It was confirmed that a letter had been sent to Dr Kaushal, inviting him to attend our meeting on 15^th September. A reply is still awaited.

Elmham News: A copy of this magazine is being sent regularly to Swanton Morley Surgery and the Link-up magazine is delivered to Elmham Surgery, for the interest of patients in both villages.

Polyclinic: It was reported that the Polyclinic has been opened today, at Timber Hill in Norwich.

Judith reported that this pandemic was now into the third week and would be likely to last for a total of 9-12 weeks, with incidents rising to a peak and then dropping off. It was estimated that about one third of the population would be affected during this period. The illness was generally not as severe as the usual seasonal flu normally experienced but, vulnerable patients could be more adversely affected. Young people between 10-19 years of age appear to be more severely affected, rather than the older generation, who may have built up some immunity.

The policy for coping with the illness has changed from being one of “containment”, whereby every effort was made to prevent the spread of the virus, to one of “treatment”. The illness presents similar symptoms to the usual seasonal flu or other common viruses, such as a sore throat, aching limbs, headache, feverishness but, the temperature is usually much higher, at around 38C. At present, patients can ring the Surgery and describe their symptoms to a medical practitioner. The key to diagnosis was the very high temperature, plus two other typical symptoms. If it was thought that the patient was suffering from swine flu, arrangements were made whereby antiviral medication could be collected by a friend of the patient from a designated pharmacy such as Lloyds Pharmacy in Dereham or Matttishall. The Practice, as a whole, had been receiving about 15 calls of enquiry a day recently, with only 3/4 Tamiflu prescriptions thought to be necessary. This was out of a total of around 8,500 patients.

From 24^th July, the Surgery would be taken out of the equation as new arrangements, managed by the Government, would come into force. Chief Medical Officer, Sir Liam Donaldson has announced details of a National Pandemic Flu Service for England. This telephone and internet-based service will enable people to get a diagnosis of swine flu, if appropriate, obtain a unique reference number and will then be able to access Tamiflu from various other designated centres, which might include town halls and libraries. People may be diagnosed over the telephone or, can follow a questionnaire on the internet, which will give them a diagnosis. Leaflets giving details about swine flu are to be distributed to every household.

Efforts are being made to develop a safe and effective vaccine. The Government has already ordered 60 million doses from a company, which is, as yet, not licensed to produce the vaccine. It is unlikely that a vaccine will be available before the beginning of 2010. Each patient will have an initial injection and then a second one two days later. The groups to be targeted may not be the same as those given priority for the prevention of the usual seasonal flu.

The Practice is planning to offer vaccination against seasonal flu, starting early in September and, sessions will be held on Wednesdays and Saturdays for a month. Details of the arrangements will be issued soon.

Members had received very favourable comments from those patients who had been seen by Dr Sri- Ganeshan, and expressed much regret to learn that he had already left the Practice. He had been appointed in April as a potential partner but, following a period of mutual assessment, with lengthy meetings and much discussion, it had been decided by mutual agreement that he would not remain here. Efforts to recruit a replacement partner would be deferred until the end of the year.

Meanwhile, Dr. Simin Hussein has resigned and will be returning to Croydon in September and,

Dr. Chilenge has returned to Egypt. Three new salaried Doctors have been appointed: Dr. Mark Epstein, who will start early in August and will work at both surgeries for a total of four days a week. It is likely he will take on the responsibility for home visits in Swanton Morley, Worthing and half of Beetley. Dr. Amreetha Devar will begin on 1^st September and Dr. Jenny Lees on 1^st October.

Deborah Fairburn, a nurse specialising in diabetes, has left the Practice. Two new nurses, Tessa Thatcher and Clare Thatcher have been appointed and they, too, specialise in diabetes and will form a team with Nurse Practitioner Michelle Dyball. It is expected that Practice Nurse Katy Byrne will qualify as a Nurse Practitioner shortly.

The Practice has been awarded the contract to be responsible for running the Medical Centre for Army personnel at Robertson Barracks from 1^st October. A comprehensive service will be provided, with three consultation sessions a week, where Doctors are in attendance. Wives, partners and dependents are encouraged to use Swanton Morley Surgery. Posts for more nurses, physiotherapists, clerks and receptionists have been widely advertised.

Maggie Richards proposed that a message of support and thanks should be conveyed to the Practice, expressing our appreciation at the positive way the partners and all the medical staff had coped during a particularly difficult and challenging period, now exacerbated by the onset of swine flu. These sentiments were unanimously endorsed by all present.

Plans for a Dental Clinic are still being discussed and the Home Care Project is developing, albeit slowly. The Practice has been in discussions with consultants and nurses from the Norfolk and Norwich Hospital and a Neurological Clinic is to be established at Dereham Hospital. This will be available from 1^st October.

Judith explained that the Practice carries out a Mori Survey each year whereby a number of households are selected at random and patients invited to respond.

Members felt it could be useful if our Group organised a survey specifically to gauge patients’ opinion of Swanton Morley Surgery. This would also promote our Group and, if people felt we could usefully liaise between them and the Practice, they could contact us in future with their comments and queries.

Jean and Maggie had devised a draft questionnaire based on one produced by the National Association of Patient Participation Groups and this had been circulated before the meeting for members to consider. Judith agreed that a survey would be a useful exercise and that the Practice was happy for us to conduct one. Co-operation would be needed from the staff at the Surgery, particularly the Receptionist. It was suggested that the questionnaire needed to be to relevant to Swanton Morley Surgery, reflecting the particular facilities provided there, for example, indicating that it was a Nurse-led Practice, with Nurse Practitioners available, as well as Doctors. Judith offered to modify the questionnaire accordingly and this would be circulated to members for their comments. It was thought it could be useful to include a question asking for comments about the out of hours service.

The survey would be completely anonymous, with comments being returned in sealed envelopes. It was agreed that final arrangements for conducting the survey should be completed at the next meeting on 15^th September and that it could be carried out from early October.

Meanwhile, it was suggested that the Chairman should devise a proforma, explaining the aims and aspirations of the Group and providing contact details of the members. This could be displayed on notice boards in the village and inserted in “Link-up”. It was also suggested that copies of the confirmed minutes of meetings should be displayed at the Village Hall, in the Post Office and at the Surgery, as well as being posted on the Surgery website and the village website. This should raise the profile of the Group and we could become more effective.

Some patients suffering from psychological problems had been upset and distressed upon returning for a follow up appointment, only to discover that their particular Doctor had left the practice in the meantime.

Very occasionally, staff make a mistake when appointments are being booked over the phone and this can cause much inconvenience to a patient. An example was cited where a patient had made special arrangements to attend Swanton Morley Surgery but, upon arrival, found she had been booked, in error, to attend Elmham Surgery the previous day.

It may not be clear to new patients that appointments with Doctors are available daily at Swanton Morley Surgery. Some had the impression that if they wished to see a Doctor, they could only do so at Elmham Surgery.

A member reported a problem in obtaining results after attending the INR Clinic. On one particular occasion, since no letter had been received from the Hospital, she, fortunately, rang through, and was given the date and time over the phone for her next appointment for a blood test.

A member reported that a few bungalows on the Woodgate Park sheltered accommodation scheme will be available for rent at £595 per four weeks, with a deposit of £750 and a monthly levy of £10 for general maintenance. Otherwise, at the moment, the cost of purchasing a bungalow would be £155,000.

(These minutes were confirmed at the Swanton Morley PPG meeting on 15^th September, 2009

Ted Peachment, Chairman, welcomed everyone, with a special word of welcome to Dr Sri, Judith Wood and, Alan Fleming, who had been appointed to represent the Parish Council.

1. Apologies for absence: Gina Eames Karen Purchase, Anne Sadler, Fran Sampson

Ted reported that 2008/09 had been fairly uneventful for Swanton Morley PPG. One notable and sad event was the loss of our member, Jean Purchase, who passed away on 20^th November, 2008. Jean had been a founder member of both Elmham and Swanton Morley PPG’s and held strong views as to the nature and operation of such a group. After Penny Louch left the Surgery late in 2007, we had a long period with virtually no input from the Practice. The meetings degenerated with internal, and sometimes trivial, discussions among members and the purpose of the group had become less clear. Ted had considered resigning but, having aired his concerns to one of the Doctors, there was then a considerable improvement in the situation, with the Practice Manager and a Doctor regularly attending most of our meetings. There was a more professional approach to our role, as a liaison group between patients and the Practice and, we became more effective in influencing matters such as dispensing, appointments, patients’ confidentiality and problems with the telephone system. We also developed a closer relationship with our Elmham counterpart and minutes of meetings are exchanged. In September, the duties of Group Secretary were transferred to Rosemary Northall, after the sterling work put in by Karen Purchase since the Group began in September 2004. Both were thanked for their help and Ted concluded by thanking all members for their support during the year and confirmed he was willing to stand again in the election for Chairman.

Ted Peachment, Maggie Richard and Rosemary Northall were willing to stand again as Chairman, Vice-Chairman, Secretary, respectively. There were no other nominations.

Jean Walden proposed, seconded by Janys Turner, that they be re-elected en bloc. Carried unanimously.

Maggie Richard proposed, seconded by Janys Turner, that the minutes be accepted as a true record. Carried unanimously and signed by the Chairman.

a) Request for more drivers for the Community Car Scheme: It was explained that demand fluctuates and that, ideally, a larger pool of drivers is needed to cover for those times when some may not be available. Drivers are free to undertake only those tasks that are convenient to them and should not feel obliged to respond to every request. It was noted that North Elmham runs a Community Car Scheme and that Bawdeswell has established one recently.

b) Surgery newsletters: Jean volunteered to organise the distribution of the next edition along with the programmes for the village carnival week. They will be delivered to every household in the parish.

c) Surgery website: Judith will post the confirmed minutes for the meeting on 17^th March and update the list of officers.

d) Opening of Surgery doors at 8.25am. This normally gives sufficient time for patients to report to reception and be ready to attend their appointments promptly.

e) Early morning appointments from 7.30am. at Swanton Morley Surgery on Mondays and Tuesdays: Most slots are usually filled. The Surgery is not fully staffed until 8.30am. and requests to collect repeat prescriptions by other patients should not be made until after the official opening time. A notice to that effect is to be displayed.

f) Polyclinic in Norwich: This walk-in centre is being been established in the Castle Mall area, staff recruitment is taking place and the clinic should open soon.

g) Dr. Strickland’s retirement from General Practice: It was noted that in recognition of Dr. Strickland’s service to the local community, several patients had made donations to the Friends of Elmham Surgery Charitable Trust. A replacement E.C.G. machine had been purchased recently.

Members agreed with Judith’s suggestion that in future it might be a good idea to open the annual meeting to members of the public and arrange a guest speaker. Rebecca Champion from the P.C.T. or the national group could assist.

There was little to report apart from the fact that the dentists have visited the Elmham site, where there is already a lead lined room .Surveys and plans have been done and the project costed. There could be dental provision at both sites but a lead lined room would be needed at Swanton Morley Surgery. There are still some concerns about the possible difficulties regarding extra car parking, queues at reception, and more people in the waiting rooms but, there has also been positive feed back about the project. The implications of further NHS dentistry being established in Dereham are not seen as a problem.

A dedicated social worker was appointed over six months ago and the Practice has been chosen to run a pilot scheme, along with 15 other sites in the country, to establish an integrated Home Care Scheme. This has been approved by the cabinet of Norfolk County Council. There is an acute shortage of carers and it is difficult to provide continuity. The Practice has now registered the integrated care project and submitted its proposals to the CSCI (Commission for Social Care Inspection) and these will have to be validated by Norfolk County Council.

The early signs of dementia and memory loss need to be better assessed and a specialist nurse, Miranda, now liaises with psychiatrists from the Mental Health Trust.

On 2^nd June, Judith will meet with neurologists and consultants specialising in Parkinson’s disease and it is hoped that patients in this area will be able to be offered consultations at Dereham Hospital, which will be more convenient than the Norfolk and Norwich Hospital.

It was regretted that Deborah, a nurse specialising in diabetes, had taken up a similar post at Hingham Surgery, closer to where she lives. Members were also sorry that Dr. Chilenge planned to return to Saudi Arabia and would be leaving at the end of June.

During the weekend of 18^th/19^th April, patients could not be directed to the out of hour’s service and a local patient with a sick baby sought the help of Ted Peachment. Judith was contacted and then a Doctor, who was able to allow B.T. engineers to have access to Elmham Surgery. It was another 48 hours before the fault was rectified and patients found they still could not access the Surgery on Monday morning. B.T. was able to divert the calls to the out of hours service and they successfully dealt with the situation until the problems were resolved. The support of out of hours service staff is much appreciated.

Five minute appointments had been tried to deal with the increased demand for blood tests but, this was found to be insufficient and they have been reverted to the former allocation of ten minutes.

Owing to the building work near Lincoln House the surgery car park had been used by Care Home staff, creating a shortage of spaces for patients attending the surgery. The situation is now improving as staff members are being encouraged to park elsewhere.

Changes to medication: A member was unhappy that her medication in repeat prescriptions had been changed several times recently, sometimes with adverse consequences. There had been no note of explanation included, as would have been expected. It was explained that changes are not always made for economic reasons but due, perhaps to an availability issue. For greater efficiency and safety, attempts are being made to streamline and simplify the variety of drugs being prescribed but, a patient should always be notified and asked to seek advice if there are any problems with the new medicines. The Practice reviews prescription issues every Monday.

Invitations from private companies offering screening: Members were still being offered screening for a variety of medical problems such as brain tumours and strokes. It was thought to be quite unnecessary for patients to avail themselves of these procedures which could also be expensive.

“MOT” check ups: If a patient feels it necessary to have a general basic health check up, this can be arranged by making an appointment with a Nurse Practitioner.

Questionnaire for patients: Jean raised the matter of the lack of feedback between the patients and the PPG and suggested that an appropriate questionnaire should be devised, seeking patients’ opinions on a variety of issues. Once agreed, the questionnaires could be available at reception for patients to complete and these would be discussed at the following meeting. Jean and Maggie will work together to organise this.

Lack of privacy: It was regretted that owing to the design of the reception area it is difficult for a patient to discuss matters with the receptionist, without being overheard by others in the queue.

Magazines and newsletters: It is important to ensure that the magazines in the waiting areas are of high quality, with a general, wide appeal and are up to date. A good variety of magazines are bought for the surgery and frequently checked. Patients are welcome to contribute suitable material but it is suggested that Judith sees it first. The Elmham Newsletter does not appear to be available at Swanton Morley, whereas our Link-up magazine is sent there every month. Judith will investigate. Members had been interested to learn there is a National Association for Patient Participation and their leaflets are available on line.

Labels on medicines: A patient was finding it more difficult than previously to remove labels from empty boxes before putting them in the recycling bin. A member of the Group reported a similar problem and it was suggested that using a black permanent marking pen would obliterate the name effectively and maintain the patient’s privacy. The telephone number for Elmham Surgery is used on these labels since the main dispensary is based there.

This was confirmed as being on Tuesday 21^st July, 7.00pm at Lincoln House Care Home

Team Leaders, such as Vanessa Whitwood Lead Secretary, Alison Gee Lead Dispenser,

Michelle Dyball Lead Nurse and, Melanie Day, Lead Receptionist, will attend from time to time.

It was agreed that the Secretary should write to Dr Kaushal, inviting him to our meeting on 15^thSeptember.

There being no further business, Ted thanked everyone for attending and the meeting closed at 8.35pm.

(These minutes were confirmed at the Swanton Morley PPG meeting on 21^st July, 2009 and signed by the Chairman, Ted Peachment)

(Dr Paul Strickland sent advanced apologies that he was unavoidably delayed but would arrive later)

Ted Peachment, Chairman, welcomed everyone and opened the meeting, hoping that Dr Strickland and Judith Wood, Practice Manager, would be able to join us in due course.

2. Minutes of the meeting held on 20^th January 2009 to be confirmed and signed:

These had been circulated in advance and it was proposed by Maggie, seconded by Fran and unanimously agreed that the minutes should be accepted and they were signed by the Chairman.

b) Distribution of Surgery newsletters: The Spring issue had been available in the Surgery but, none had been sent to Gina for distribution throughout the village, as had been arranged.

c) Surgery and village websites: These need updating to include confirmed minutes of recent meetings and other information. Alan McKim has submitted contact details and dates of our future meetings to the new Elmham village website.

d) Further details of the proposed affordable dentistry services: these had not been received by the Secretary, as hoped, nor had the price list of typical charges, so members had been unable to consider the implications.

e). Opening of Surgery doors at 8.25am: it was felt this did not always happen, and that there was still likely to be a melee of patients arriving together, causing difficulties for the receptionist.

f) Parish Council representative: a letter of request had been sent to the Chairman, Roger Atterwill, and it is hoped that a Councillor will be appointed at the Parish Council’s Annual Meeting in May.

4. Discussion of any matters raised in minutes from the Elmham PPG meeting on 12^th February.

Members were interested to hear of the progress outlined concerning affordable dentistry, and also in the various questions raised by the members. They, too, would welcome more information about the bungalows at Lincoln House and to know whether there may be any available for rent.

Dr Strickland arrived and provided further information, outlining the progress made so far. Dental treatment is an important aspect of a patient’s health and well-being and it has long been the intention of the Practice to try to provide part time NHS dentistry facilities on site at Elmham Surgery. Over the years patients had been strongly in favour of such a development but it had never proved possible to acquire the services of an NHS dentist. Now there was the possibility of a compromise, whereby a private dental company, “Tooth Doctor,” working under the auspices of a Community Interest Company, based in Yorkshire, might be able to provide affordable dentistry. The costs for basic treatment would be largely comparable with the contributions patients make under the NHS but would be higher for more complex procedures. There could also be difficulties in providing free treatment to those who normally would be eligible, under the NHS. Since the Practice would be providing all the infrastructure, and facilities for car parking and reception, however, it is hoped that the “Tooth Doctor” company may be able to agree to offer free treatment to those patients who would normally qualify for such concessions. There are still many details to be considered, such as the implications of shared facilities, whether dental services could be provided at both surgeries, how much control the Practice would have over future charges made by Tooth Doctor and all the legalities, guarantees and insurances have still to be agreed.

The opinion of patients is being sought and a full consultation may be carried out before final decisions are taken. While some patients may find it unacceptable that a private dental company could be operating from an NHS medical practice, perhaps indicating “creeping privatisation”, others would welcome the convenience of having dental services provided at the same site and would be willing to pay extra, if necessary. It would also make good integrated care possible, whereby the dentist and G.P’s could more easily liaise and, for example, help a patient to stop smoking. If a decision is made to go ahead, dental facilities could be established within a year.

Polyclinics: are more appropriate for towns and cities than rural areas. One might be established in the Norwich Castle Mall region which could serve a wide range of people seeking prompt medical help and advice, some of whom may not have fixed abodes, or may have drug related problems. It is thought to be unlikely that local GP practices would be adversely affected.

Publicity for the Surgery: Gina was anxious to make information about the Surgery available to more people and leaflets are on display at the Village Hall. She offered to photocopy Surgery newsletters and indicated she would organise their distribution to every household in the village.

Provision of Occupational Therapy: Following an orthopaedic operation and a spell in Lincoln House last year, a member reported she had received no practical help afterwards, on returning home, and had been unaware that any support was available. Pending a forthcoming knee replacement operation, however, she has appreciated arrangements being made in advance to assess her post surgical needs, the suitability of her home and the possibility of the provision of physiotherapy.

Provision for patients suffering from Depression: Dr Strickland assured members that all the Doctors and Nurse Practitioners at this practice are well qualified to treat patients with problems related to depression and anxiety. Guidelines laid down by the National Institute for Clinical Excellence (NICE) are closely followed, and a range of treatments are available, as appropriate, including Cognitive Behavioural Therapy (CBT)

Army Welfare Service: Fran requested that leaflets should be put on display in the Surgery and this was agreed. Personnel serving abroad are not normally given leave to attend the birth of their child and some expectant mothers from the Barracks may need guidance to ensure that a “birthing plan” is in place well beforehand and also that a birth partner has been arranged. This practical advice could be given during routine ante-natal clinics at the Surgery.

Availability of prescribed medication: A patient had complained that sometimes, following a consultation, the medication prescribed had not been available at the dispensary and he was asked to call back later that day, only to find it still had not been delivered. This could be serious if it occurred just before a weekend. Dr Strickland replied that all such complaints are taken very seriously indeed since every effort is being made to provide an excellent, efficient service to patients. Failures are unacceptable and patients are asked to report any problems to the Practice Manager, Judith Wood, who would thoroughly investigate to find out what had gone wrong and why.

Request for more Community Car Drivers: The village needs more Community Car drivers and Dr Strickland happily agreed to a notice being put on display at Reception, urging more volunteer drivers to come forward.

Ted Peachment commented that this was the first occasion when we had had the pleasure of Dr Strickland’s presence at one of our meetings and that sadly, this would also be the last, since he was leaving the Practice at the end of March. Rather than make a formal speech in recognition of the Doctor’s 22 years’ service to the local community, Ted announced he had composed a poem of appreciation which he read out, and then presented to him, along with a card of good wishes, signed by all the members of this Group.

The dates of meetings for the rest of the year had been fixed at the previous meeting, on 20^th January, partly so that Judith could arrange for a Doctor or Nurse Practitioner to attend each time.

Maggie and Karen gave apologies that they would not be able to attend the next meeting, which will be on Wednesday 20^th May, 7.00pm. This will be the annual meeting of the Group, when the Chairman, Vice-Chairman and Secretary will stand down but, may stand for re-election, if they wish.

Rosemary Northall (Sec.) Maggie Richards (Vice Chair) Judith Wood (Practice Manager)

Ted Peachment, Chairman, welcomed everyone. Members were saddened that only two days after our last meeting, Mrs. Jean Purchase had died suddenly on 20^th November. Ted reported that he had attended the funeral service at St Nicholas’ Church in Dereham but, as names had not been taken he had been unable to represent our group officially. He remarked that Jean had been a founder member of our Group in 2004, having also previously been a founder member of the Elmham Surgery PPG. She had been very committed and determined and, despite health problems, always strove to faithfully attend meetings and to make a positive contribution.

2. Minutes of the meeting held on 18^th November 2008 to be confirmed and signed:

It was proposed by Jean and seconded by Fran that the minutes be accepted and they were signed by the Chairman.

a) Glossary of acronyms: Judith will send Rosemary a comprehensive list which could be edited, as appropriate, before being distributed to members.

b) Distribution of Surgery newsletters: Gina had received only 100 copies but had distributed these judiciously. In future, 670 will be needed, to include Robertson Barracks. An early Spring newsletter is being produced and these will be distributed throughout the village.

c) Surgery and village websites: Judith undertakes to put confirmed minutes of our meetings on the Surgery website. Rosemary had submitted them to the village website but, as yet, they are not on view. It was pointed out that not everyone has access to the internet and it is important to maintain other means of positive publicity as well. Judith will attend the Annual Parish Meeting on 27^th April and give a report on the Surgery.

d) Future of dispensaries in surgeries: It would appear that following the recent consultation period on the Pharmacy White Paper the Government had taken heed of the widespread vehement opposition to any proposed changes to the present system. Health Minister Phil Hope had recently announced in the House of Commons “that there will be no change to the current arrangements for G.P’s dispensing medicines to their patients”. It is hoped that no further changes would be envisaged in future and that the matter can now rest.

4. Discussion of any matters raised in minutes from Elmham PPG Meeting on 11^th December:

a) Home Care Project: This was still progressing, albeit slowly. The social enterprise company has to re-submit its proposals to the CSCI (Commission for Social Care Inspection) and these will then need to be validated by Norfolk County Council.

b) Early Morning Appointments: While there were some concerns that it could be detrimental for the Practice not to advertise its early morning appointment facilities in publications such as, “GP Services in your Area”, the current policy of the Surgery is to prefer to remain flexible, rather than be obliged to formalise its arrangements with the PCT. It was regretted that so many patients were still unaware that these early appointments were available and it was felt that better publicity is needed.

a) Discussions are ongoing to explore whether it might be feasible to establish a Dental Practice with facilities for treatment available at both surgeries, for two days a week at each venue. Ideally, an NHS Dental Practice would be preferred but this is not possible at present. The alternative compromise is to consider an application from the Genesis company which works in conjunction with the Social Enterprise Company. It is able to offer dental treatment at costs which equate approximately to those of the NHS. The disadvantage is that, regrettably, no free treatment can be offered, for example to pregnant mothers or young children. It is hoped, that in due course, some NHS funding might become available to allow free treatment to those normally exempt from charges. A purpose built room with lead lined walls is already available at Elmham Surgery and, if the project is to go ahead, the company would form a partnership with the Doctors. Genesis will have to provide all its own equipment, costing over £40,000 and also consider the provision of additional services such as a dental hygienist. Negotiations are still in the early stages and no decisions are likely before April. Judith is to send further details to be distributed to members and a sample price list of typical charges will be available for the next meeting.

b) A new partner has been appointed to take the place of Dr. Strickland, who leaves the Practice at the end of March. Dr. Murali Sri-Ganeshan is working in Kent at present but will have a short induction period before he takes up his new post officially on 1^st April. He will probably inherit from Dr Strickland the same geographical area for home visiting, based on Swanton Morley and nearby parishes.

c) Judith reported that there are still negotiations continuing with the PCT regarding the PMS Contract and more meetings and discussions are to be held in February. The main concern is based only on the provision of medical services.

The problems of mud, debris and potholes on Swanton Morley Surgery car park were not completely resolved but there was some improvement.

There was a request that the Surgery doors should be opened at 8.25am. in future, before the official opening time of 8.30pm. This was agreed by Dr Hibberd.

A passionate plea was made for more positive publicity for this excellent Surgery. Gina offered to make information available at the Village Hall and will liaise with members of the Friendship Group. Application packs to join the Surgery would be available for distribution, and PPG members would use “word of mouth” recommendations, as appropriate.

It was reported that many patients in the village were dismayed to hear that Dr. Strickland had decided to retire from General Practice and the Partnership and they had expressed warmest appreciation for all his years of devoted service. He is to continue working as a doctor in Norfolk and as a lecturer at the U.E.A. medical school.

It was confirmed that Practice Nurse Katie Byrne had completed the module on injuries and during the summer will undertake one on prescribing. She should qualify as a Nurse Practitioner in the autumn.

It was stated that patients should not need to avail themselves of the opportunity to be screened by private companies for potential health problems, such as brain tumours and osteoporosis. This was thought to be unnecessary and could be expensive. Members were concerned that vulnerable patients could be targeted.

It was reported that new personnel posted to Robertson Barracks are automatically sent the Swanton Morley Surgery Information packs even before they arrive on Camp, inviting them to enrol here. Only a few personnel from the past are still registered with the surgery in Toftwood.

It was agreed that a request should be made to the Parish Council to see whether it might be possible to provide a representative again to attend our meetings.

It was hoped that the Surgery might be represented in the Carnival procession, heralding the start of Swanton Morley Festival on 4th July.

Members agreed to fix the meetings to be held at 7.00pm. on the third Tuesday of each alternate month, where possible. The following dates were confirmed:

Judith has compiled a rota, to ensure that a Doctor or a Nurse Practitioner will attend each meeting.

It is hoped that Doctor Strickland will be able to attend the next meeting on Tuesday 17^th March.

(These minutes were confirmed, and signed by the Chairman, Ted Peachment, at the Swanton Morley Surgery PPG meeting held on Tuesday 17^th March, 2009)

Ted Peachment Chairman, welcomed everyone, and was pleased to note that, after missing several meetings owing to illness, Mrs Jean Purchase was now well enough to attend again.

2. Minutes of meetings held on 8^th July & 23^rd September to be accepted and signed:

Subject to the correction of a spelling error the minutes were accepted and signed as being true records. Minutes from 8^th July proposed by Rosemary, seconded by Jean Walden.

b) It seems likely that there will be a long delay in establishing the NHS Databases. It was confirmed that, at the appropriate time, all patients will be consulted in due course and given the opportunity to opt out if they wish.

c) Gina had organised the distribution of the Surgeries’ autumn newsletter and had offered to deal with the winter issue. She had also offered to arrange the distribution throughout the village of the updated Swanton Morley Surgery information leaflets to be produced next March.

d) Same day appointments: It was reported that in the past two weeks more patients, who rang to book a same day appointment, were choosing times in the afternoons, with the result that there were several empty slots during the morning sessions. With an overload of patients to be seen during afternoons medical staff were sometimes kept working late into the evening. This is clearly unsatisfactory but it is hoped it could be a temporary problem, caused by the onset of darker mornings. The surgery is committed to providing same day appointments, as required, but may need to encourage more patients to attend during the morning sessions.

The early morning appointments on Mondays and Tuesdays have also been less popular recently, and the Doctor’s time is not being used economically.

e) Flu Clinics: There had been a large uptake of flu vaccinations at both surgeries in October. Patients who are eligible but, who have not yet been vaccinated, may still make arrangements to do so and should ring for an appointment as soon as possible.

4. Discussion of any matters raised in minutes from Elmham PPG Meeting on 15^th October

a) It was agreed that it would be helpful to continue to receive copies of the minutes from Elmham PPG meetings and a request should be made to their Secretary, Mr Ted Sansom, asking if he could kindly e-mail copies to Rosemary, who would then forward them to our members. Similarly, copies of our confirmed minutes would be e-mailed to Mr. Sansom.

b) The poor state of the gravel car park at Swanton Morley Surgery was still causing problems for patients, with potholes and puddles causing difficulties, especially for wheelchair users. Vandalism was thought to be partly to blame and also the extra vehicles needing to park there while the ongoing building works at Lincoln House continued. Patients approaching the Surgery on foot had also complained about the surfeit of mud to be negotiated. Dr. Kaushal has been informed about the complaints.

c) Members welcomed the news that a dedicated Social Worker had been appointed to the Practice, starting work on 13^th October. She liaises between Doctors, patients and Social Services and provides a vital link in helping to ensure that the most appropriate care can be provided.

Dr. Hibberd commented it was difficult to understand the reasoning behind the Government’s ideas in considering changing the way medicines are dispensed, since no one seems to be in favour of any changes to the present system The doctors, running in-house dispensaries, do not want to lose their right to dispense and, neither do patients wish to lose the convenience of being able to collect their prescriptions at the surgery, or have them delivered to their homes. Even commercial pharmacies are not altogether in favour of these proposed changes, although they could benefit if their roles were further developed to include chronic disease management and management of acute presentations. Many patients in this rural area are worried about the possibility of losing dispensary services within a surgery, causing inconvenience and hardship. Strong letters of protest have been written to Gillian Farnfield, MPI Community Pharmacy Policy, and also to local Members of Parliament. Dr. Hibberd also recommended using the internet to register protest on line.

a) Judith reported that Michelle Dyball has arranged that a Health Visitor and a Nursery Nurse will now run monthly clinics at Swanton Morley Surgery.

b) Members heard with much regret that Dr. Strickland will be leaving the Practice next April. He will be especially missed here as he has been responsible for all the home visits in this particular area. He is to do University teaching and some further G.P. work. Interviews are being conducted over the next two weeks to appoint a new partner and, following shortlists and further interviews, the name of the successful applicant should be known in December or January.

a) The Surgery had been one of the first in Norfolk to provide the option of early morning appointments and, at the time, had received good publicity on Radio Norfolk. The Practice wished to retain flexibility, however, and had not signed a formal agreement with the PCT. This explained why this Surgery was not named in a recent EDP item, listing surgeries in the area which were offering more convenient appointment times.

b) It was explained that “Norfolk PCT” and “NHS Norfolk” mean virtually the same thing. A Breckland edition pamphlet, “looking after your health” has just been published and distributed to every household.

c) The Norfolk and Norwich University Hospital is carrying out a survey to identify patients at risk of developing Type 2 Diabetes.

d) A member, taken ill during an out of hours period, had been given the option of a Doctor’s visit, which could take up to six hours or, choose to await an ambulance. She opted for the latter and had been impressed by the good service she received.

e) It was confirmed that families of personnel at Robertson Barracks could avail themselves of the Health Visitor and Nursery Nurse Clinics provided at Swanton Morley Surgery if they wished.

f) The problem of lack of co-ordination between the hospital and the surgery was raised. A patient had been admitted to hospital but, the surgery and dispensary were unaware of this and two lots of repeat prescription drugs had since been delivered to her home, as usual, and posted through her letter box. It was reported that, sadly, this patient had died recently.

It was explained that the “out of hours” and ambulance services are usually efficient in informing the surgeries about patients but, there are difficulties with the A/E Department. After a visit there, it would be helpful if patients could inform the surgery what has happened. There is also sometimes quite a time lag between a patient being discharged from hospital and the surgery being informed and it is not always possible to arrange an immediate resumption of the care needed. The surgery is doing its utmost to track its patients but there are still some gaps in information.

g) The care of patients suffering from mental health problems was discussed. Mental Health Care Trusts are structured differently and seem to run as a parallel universe. G.P.’s have no direct contact with a psychiatrist but they do have access to a link-worker, who can refer a patient to a Community Psychiatric Nurse. There can be problems when patients are discharged from treatment in a psychiatric hospital, back into the community, unless there is appropriate monitoring of their progress. The prompt and effective action taken by “crisis teams” was praised. One member of the group had witnessed at first hand how skilled they are in averting a tragedy, if a patient is threatening suicide.

a) It was agreed that Rosemary would forward by e-mail a copy of the confirmed minutes from the meeting held on 23^rd September for Judith to put onto the Surgery website. A copy would also be sent to John Thomas for the village website.

b) The list of items bought from donations to the Friends of Elmham Surgery Charitable Trust will be updated.

c) Judith reported that Sandra Butler, Operations Manager, had left early in November, to take up a post nearer to her home and family.

It was agreed that the next meeting shall be held on Tuesday 20^th January, 7.00pm. at Lincoln House.

Ted thanked everyone for attending, especially Dr Hibberd and Judith, and the meeting closed at 8.30pm.

Present: Gina Eames, Dr. Simon Hibberd, Rosemary Northall, Ted Peachment, Karen Purchase, Maggie Richards, Fran Sampson, Jan Turner , Judith Wood

AGENDA

Ted Peachment, Chairman, welcomed everyone, introducing a new member, Gina Eames and noting with pleasure the presence of Dr Hibberd. He announced that Karen Purchase wished to stand down as Secretary and that Rosemary Northall had agreed to take on the task. Maggie Richards had offered to assist. Warm thanks were expressed to Karen for her hard work as Secretary since this Group began in September 2004.

1. Apologies: Apologies were received from Jean Purchase, Anne Sadler and Jean Walden

2. Minutes of meeting held on 8^th July to be accepted: Since these were available only in draft form, acceptance and signing were deferred until the next meeting.

3. Matters arising: Judith Wood, Commissioning Manager, answered a series of queries raised by members at the last meeting, under Item 5, “Swanton Morley Surgery Matters”.

a) North Elmham Surgery It was confirmed that Elmham Surgery is the correct title, the word “North” no longer being included.

b) A glossary of abbreviations and acronyms being used will be produced for the convenience of members.

c) Regarding the NHS Database proposed by the Government, concerns have been expressed that there could be problems with breaches of confidentiality. In the first instance a summary care record would be uploaded onto the NHS spine, detailing patients’ current prescriptions and any allergies. Detailed care record information would be submitted later. Forms are provided at the surgeries for patients who wish to opt out of the system and a register will be completed well in advance of a national spine being established. All patients will be informed beforehand and given the opportunity to opt out. No information will be uploaded before a full consultation process has been completed.

d) Surgery newsletters: These are produced quarterly and include information about both surgeries and are available in the surgery waiting rooms. Gina’s offer to arrange for the autumn issue to be distributed to every household in Swanton Morley was gratefully accepted The surgeries are not allowed to advertise but may give details about the facilities offered. Updated information, news items and letters can also be found on the website: elmhamsurgery.com

e) Multiple enquiries within one appointment: It was confirmed that Doctors are happy to deal with more than one health problem during the same consultation, since they are often inter-related. Time constraints might mean that, in some instances, a second appointment would have to be sought.

f) Emergency Appointments: The terms “urgent” or “emergency” are no longer used and appointments now fall into one of two categories

i) Routine appointments – can usually be made up to 6 weeks in advance, with a Doctor, Nurse Practitioner or Practice Nurse of the patient’s choice. Two popular Doctors are often booked up well in advance.

The early morning appointments from 7.30am on Mondays and Tuesdays still continue, mainly for patients at work but others may use them if slots are available.

ii) Same day appointments - these are not necessarily for urgent matters but, if a patient wishes to be seen that same day, this will always be possible, even if this has to be at the end of a list. The patient may be offered any of the medical practitioners available and may have little choice but, it is guaranteed that they will receive attention that same day. Patients ringing during a morning will be offered sometime that day and will no longer be asked to phone back at 2.00pm. Any problems should always be reported to Judith for investigation.

g) Dispensary problems: In the interests of simplicity, safety and efficiency, efforts are being made to reduce and rationalise the variety of drugs being prescribed. Over 20,000 items are prescribed by the two surgeries each month, with 1600 different medication products. Drugs are ordered twice daily and there are two deliveries each day to try to ensure they are available on time. Patients are now being asked to give two working days notice between ordering and collecting, not 48 hours, as previously. Sometimes, due to problems procuring a particular drug, there may be an unavoidable delay in receiving it on time. It was noted that for a variety of reasons, some repeat medication is never collected. Since it has not left the surgery, it can still be used in future.

h) Choice of GP surgery: The Practice covers an extensive, rural area, stretching from the northern outskirts of Dereham to Swanton Novers and from Tittleshall in the west to beyond Bawdeswell in the east. It is divided into four segments, with a Doctor assigned to each one for the purpose of visiting patients at home. The boundaries are governed mainly by practical considerations to ensure it is feasible for a Doctor to travel those distances to reach particular patients, within a time schedule.

Ultra-sound services continued to be provided and would extend to obstetrics in about a year’s time. Health visitors hope to hold clinics soon.

“Disabilities Rights Norfolk”, led by Tricia Hyde, is being hosted at Elmham Surgery. Help and advice is given on matters such as benefit claims, disabled living allowances, applications for blue badges and people can be visited in their own homes, if necessary. Patients should contact either surgery for contact details.

Flu clinics: Patients are being contacted by phone and offered vaccinations at either Elmham Surgery on Saturday 11^th or 18^th October or, at Swanton Morley Surgery on Friday 10^th or 17^th October. Representatives from Age Concern will be on hand on both days at Elmham Surgery to offer practical advice on matters such as staying safe and warm in the home, lighting and security.

It might be possible also for Breckland Council staff to attend to offer similar advice, if there would be room in the car park for their large vehicle.

0845 Phone numbers: These cost callers more money than the usual phonelines. While some income could be generated for the surgeries, it was felt not to be best practice and it was confirmed that this system would not be adopted here. It was noted that Elmham Surgery receives about 700 phone calls early on Monday mornings and patients are encouraged to wait until later in the day if their problems are not urgent.

The Government’s consultation process regarding G.P.’s running dispensaries: While it was felt there was some logic in not allowing G.P.’s to dispense medicines if there were pharmacy provisions nearby, as in towns, members felt strongly that in rural areas it was essential to continue to offer this service for the benefit of the patients. Owing to transport problems, inconvenience, hardship, and delay in obtaining vital medication could result if patients had to obtain their prescriptions elsewhere.

Out of hours care: A member highlighted the difficulties of trying to procure a carer or a Doctor or, to obtain transport to take a chronically ill neighbour into hospital during the night. Despite being unwell herself, she felt she had been made to feel obliged to remain with the patient for an indefinite time until professional medical help could be provided. There is an acute shortage of out of hours carers and it is hoped that a new care system will be established in the practice to alleviate the problem.

Leaflet giving updated information about Swanton Morley Surgery: It was reported that the Parish Council was willing to arrange distribution of leaflets to every household, along with their quarterly Mardler newsletter. It was agreed that Judith would organise an updated leaflet to be produced to coincide with the publication of the Mardler, next March.

A request was made that the list on display in Swanton Morley Surgery detailing the items purchased by the Friends of Elmham Surgery Charitable Trust should be updated to include more recent acquisitions.

It was agreed that the next meeting should be held on Tuesday 18^thNovember, at 7.00pm.

The Chairman thanked everyone for attending, especially Dr Hibberd and Judith for giving up their valuable time, and remarked that the meeting had been very informative and satisfying. The meeting closed at 8.30pm.

These Minutes were confirmed at the meeting on 18^th November, 2008 & signed by Ted Peachment. Chairman)

Elmham Surgery and Swanton Morley Nurse-Led Surgery

AGENDA