Forum Meetings

Minutes of Langley Neighbourhood Forum Meeting at East Berkshire College on Tuesday 16th October 2018

Langley Neighbourhood Forum’s Autumn 2018 Meeting took place on 16 th October 2017 at East Berkshire College.
Mrs E Cryer (Chairman) introduced as the Forum’s speaker Dr N Adam, the lead partner of the Langley Health Centre practice.
Dr Adam explained that, although he spoke for the Langley Health Centre practice, the practice also gave management support to the Orchard Health Centre. What he would say would generally be applicable to the Orchard Health Centre as well as to His own Langley Health Centre practice. Langley and Orchard Health Centres were the only 2 Health Centres in Langley. They worked together. Two other previous practices in Cockett Road and Trelawney Avenue had closed, while the practice in Sussex Place had moved to Cippenham.
There had been an influx into the two Langley surgeries, which created an issue regarding capacity.
Currently, Langley Health Centre had 19,200 patients registered and Orchard Health Centre had 8,700. Still, more new houses were being built with more proposed across the canal. This was putting a strain on
primary care and other areas such as schools. In Slough there was an extra 50% demand for primary care in comparison with England as a whole or with Ascot and Bracknell, but there was no extra funding. In the early 1990s there was a scheme for extra funding for Slough practices, but the money, ring-fenced for Slough, had since been redistributed.
Dr Adam recognised the problem with obtaining an appointment, but it was a problem they could not solve. The practice received 4-5,000 calls per day. There was therefore a need to work in partnership. They had introduced a new appointment system. Most people phoned, but it was difficult to get through. The receptionists had a difficult job. They asked callers questions, not to pry, but to ascertain reasons for the call to identify who best to see.
Dr Ali had been undertaking an audit and had concluded that about 40/50% of calls could be dealt with by phone. Dr Adam’s message to those present was to spread around calls.
The practice was trying to appoint different types of professionals, but it was difficult to recruit doctors and nurses for Langley (or indeed for all of Slough).
Langley surgeries were working in a federation with other Slough practices. There was a 5-year NHS plan to achieve sustainable development goals. The practices had appointed pharmacists who had had extra training to undertake clinical work on minor conditions or chronic disease management, but were monitored by medical staff. They had also recruited Dr Bashir (a physiotherapist, not a medical doctor) to see, diagnose and treat, where appropriate and would liaise with the medical doctors. The practice had received positive feedback from these new arrangements. There would soon be a -para-medic to be trained to manage minor acute injuries.
Turning to visits Langley Health Centre held morning surgeries and then after a lunch break an afternoon surgery. The change was that there was someone available for visits, which could after the afternoon surgery and after 6 pm. Orchard was similar, but unlike Langley, they did not have a dedicated doctor on call.
A doctor might call back if there was an immediate need, eg prior to a flight. The aim was to call back about 1 or 2 pm.
A new facility was to arrange on line appointments. This required a password to ensure confidentiality with the need for a photo. A patient could request an issue over the phone and can book in advance with an
urgent or routine call, eg after a blood test. Practices would be resolved by surgeries and the public.

As regards recent changes, funding arrangements introduced in July 2014 provided for evening and weekend appointments. Langley went ahead with this and was the first in England to do so. There was access up till 8 pm or 5 pm at weekends. Demand on Saturdays and Sundays was not level.
The Clinical Commissioning Group (CCG) had proposed a central service in Slough despite objections from surgeries. There would be a single site with hosting of a walk-in centre. The site was Bharani Medical Centre in Lansdowne Avenue. Dr Adam said that the site should be accessible to persons without their own transport.
The current walk-in centre at Upton had a useful purpose. 44,020 calls were made per year. Callers came from throughout Slough and South Bucks, but also from Windsor and even Hillingdon.
Following talks present arrangements would continue until 2020. There have been talks about decommissioning so that at some stage in the future the walk-in centre would be replaced by an urgent treatment centre which was supposed to have facilities for x-rays and blood tests. The CCG had “not
decided” the site for the centre. It could be at Wexham Park, instead of in the centre of Slough. This would be a problem for Langley residents, especially the elderly, as to get from Langley to Wexham two buses are
needed. Langley’s population is getting older, but there are younger people moving into the new buildings being erected. Older people suffer from more illness. Langley residents need to make the case for the
centre to be accessible, and to do so before the CCG makes its decision, as once the decision is taken, the CCG will go ahead. The centre will merge GP access over weekends. Details of the CCG are on the CCG’s website. Dr Adam believes that there should be a separation between primary and secondary care and that Wexham was not a suitable venue for the primary centre.
Turning to cancer prevention, Dr Adam said 40% could be pre-treated. The No.1 cause was smoking and the no.2 was obesity which was rising and which can lead to heart disease and chronic pulmonary obstruction. This led to increasing demand.
It was not easy to get into and out of a career for doctors and nurses. Pressure causes some to decide to throw in the towel.
Dr Adam then answered questions raised by those attending.
Q. I start work at 8 am. Can I book an appointment in advance and, if so, how?
A. Yes, advanced appointments are available. They can be booked up to 3 weeks in advance. Unfortunately, some booked 3 weeks in advance lead to non-attendance. Some are booked 3 weeks; then others 2 weeks and some on the day. When all the advanced bookings have gone, a GP can be booked at the GP hub at the Bharani centre.
Medical information can be shared with that centre with consent.
Q. A patient is told that the doctor wishes to see them in 3 weeks’ time, but the patient cannot get an appointment for 3 weeks’ time. What should they do?
A. They can produce a slip of paper – there is this facility, but it is limited. The surgery is on line from 7 am, but please try to avoid Mondays.
Q. Should they avoid calls at 7 am?
A. The practice is from 8 am, but they don’t have an answer to the problem.
Q. What is the scale of non-attendance and what is its impact on others?
A. About 150/200 a month, which equals one extra doctor per week. The impact is on the taxpayer, not on the practice.
Q. Could a way to stop non-attendance be by having a financial penalty?

A. The non-attender could have had an accident. If someone does not attend for 3 months, the practice will write to them. The practice will strike them off their list only as a last resort. The Government wants to introduce a
penalty.
Q. What about people who come in with leg pain?
A. No answer.
Q. There were plans for a community centre including a surgery on Meadow Road. What is the current position?
A. The demand for housing is so high that it was decide to use the site for housing instead.
Q. Why are you still recording if you can’t cope?
A. Where would patients then go? The practice cannot just close. There is a difficult procedure to follow. The NHS and the CCG are required to provide medical service. They can’t just leave the site. Approval is needed from the
NHS, CCG and the Council. A surgery needs a licence to practise.
Q. There seems to be no method for adjusting financial supply and demand. In 1948 my health card stated that I could get a free appointment and I could be charged if I didn’t show. The results should be publicised so people can read the number.
A. Dr Adam will take the suggestion on board. He will put the details on the web site. People will be able to register to get the results on line.
Q. A clinical pharmacist picked up the wrong hospital prescription. Is the web site working as it should?
A. I will raise it with the practice manager.
Q. Comment. May I compliment the surgery team.
Q. You no longer do blood tests at the surgery. I now have to go to Wexham, but I can’t afford the bus fare.
A. We have done some blood tests at the surgery, but the surgery is subject to a contract, but that contract does not include blood tests. If it did and blood tests were taken at the surgery, the service would be slower.
Currently, the practice does not have resources to do so. It would need someone employed just to take blood samples. There would be a problem if staff were on leave or were undertaking flu jabs. It can be done at Bharani.
Q. What about out of hours at the surgery?
A. Out of hours surgery has largely stopped. The surgery is open from 8.00 am to 6.30 pm, but there is a small number of extended hours, but that may cease next year. Telephone consultations out of hours can still happen.
Q. As regards telephone calls, elderly or disabled patients cannot always verbalise what is wrong with them. How is the doctor to know?
A. No answer.
Dr Adam would welcome feed back on what he had said and on Langley practices.
Dr Adam was thanked for attending the Forum, speaking and answering questions.
Other Matters
Minutes
The Minutes of the Forum on 19 th June 2018 were agreed and signed.
Forthcoming Events
1. Remembrance Sunday

Langley Neighbourhood Forum would be represented at the War Memorial on Remembrance Sunday, 11th November 2018, and would lay a wreath.
2. Langley Christmas Lights – The switch on of Langley Christmas lights would take place at Harrow Market at 6.00 pm on Monday 3 rd December. It
was proposed that Dr Adam be invited to switch on the lights.
3. The next Meeting of the Forum – The next meeting of the Langley Neighbourhood Forum would take place on 19 th February 2019. Suggestions for the topic included “Recycling” and “Anti-Social Behaviour in Langley”

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