Dr Ahmed & Partners Telephone: 01733 265535
Caring For The Family Fax: 01733 264263
PPG Team: Confidential
To All PPG at Westwood Clinic
Information & Update
Re: Practice information / Recent Update and Activities during Covid19 pandemic
We hope you are keeping well and alert. Due to Covid 19 second phase the Practice has been unable to invite you for its regular PPG meetings. However, Dr Ahmed and I decided to write to you again today to inform you of all the Practice activities since the pandemic started and is affecting our services. We have been very much busy to change the way we operated before, these changes were major but needed to be effective and safe to patients and staff. Especially as we are entering the most difficult period of the year, winter is upon us and Flu campaign is in full swing, as we need to make sure vulnerable, housebound patients are receiving their flu vaccines this year.
As you are probably aware that Pharmaceutical companies have informed Practices of the current Flu vaccines shortage for under 65 years and nationally we are concerned that provisions will not meet current demands. As Practice, we already have set up clinics for 65 years and over patients to have their flu vaccines and so far, it has been a big hit as this is our third week of flu clinics and the Practice has delivered 360 vaccines. We are very pleased with this. On the other hand we are expecting our first delivery of the at risk patients under 65 years this week, all clinics are ready to be carried out. We have adopted a new ways of delivering the vaccinations in order to maintain distancing of patients in the Practice, so, we set up a one-way system, which worked very well for the 65 years and over patients.
We also would like to inform you that we have maintained our successful telephone triage system and see patients as needed to keep risk of infection low in the Practice. Nursing appointments have been fully re-instated and Secondary Care referrals are now up and running but unfortunately with capacity issues due to the backlog from the Pandemic.
We have been approached by the Peterborough PPG Forum asking our Westwood Clinic whether any of our PPG persons interested in joining their Forum to contact me. I am happy to provide you with details of the person to contact at the Forum. This is a good opportunity to find out what the other PPGs within Peterborough are working.
We do realise how difficult to ask you all to attend a PPG Meeting at the Practice in this Pandemic, However; should you have any queries or suggestions to improve the Practice services please call or write to the Practice Manager.
We are very much keen to keep you all updated with our Practice activities. We shall be publishing this newsletter in our website in order our virtual PPG be able to know how the Practice is progressing in these difficult times.
Mr K. Allam
On behalf of Dr Ahmed and Partners
Dr Ahmed & Partners Telephone: 01733 265535
Caring For The Family Fax: 01733 264263
1st July 2020
To All PPG at Westwood Clinic
Information & Update
Re: Practice information / Update and action taken about Covid19.
We hope you are keeping well and alert. Due to Covid 19 the Practice has been unable to invite you for its regular PPG meetings. However; Dr Ahmed and I decided to write to you today to inform you of all the Practice activities since the pandemic started. We have been very much busy to change the way we operated before, these changes were major but needed to be effective and safe to patients and staff.
Please find attached CQC Emergency Support Framework questions that were sent to all Practices to inform, discuss and any action taken. We thought we send you these Practice actions that we took since the lockdown.
On the other hand and since 21st January 2020 the practice has received its CQC inspection report which was very encouraging as the Practice status moved to an overall “Improvement needed”. This is an improvement from previous inadequate status last July 2019. We shall carry on working hard to maintain patient Health and care at Westwood Clinic. Please see attached CQC Reporting Score for Jan2020.
We shall keep you updated with all Practice information by post and email if appropriate until further notice.
We take this opportunity to wish you well in these difficult times and we hope to meet you soon again. Please stay safe and alert and follow the Government Guidelines.
Mr K. Allam
On behalf of Dr Ahmed and Partners
ESF – Questions from CQC & Practice Answers and Action Plan
!- Safe care and Treatment:
- Risks related to infection prevention and control in relation to Covid.
- Practice is managing with IPC prevention and control on a daily basis. Initial IPC review was made as early as Feb 20 – hand wash methods/ regular hand washing advised- discussed with all staff.
- Reviews were then made on a weekly basis and sometimes daily basis as per public health updates. All staff kept informed via emails and when we met for staff meetings to review all emails that were sent to staff.
- Cleaning of areas midday to reduce spread
- Home visit kits- contained PPE, guidance on donning and doffing PPE, double clinical bags
- Staff training – Blue-steam refresher module
- Re-planned Practice lay out by setting up an Isolation Room where a log was introduced for GPs to records and face to face consultations with patients
- Equipment placed in isolation room- wiped down after each use/ room wiped down after consultation, deep cleaning if suspected COVID pt seen
- All deep and non-deep clean are recorded by the team and presented to the Practice
- All rooms with information about donning/doffing PPE, isolation room with how to deep clean
- Main challenge was initial supply of PPE
The Practice identified this Problem and we decided to purchase PPE as early as March 20. We made up a reasonable stock of basic PPE to protect clinical staff and front reception.
- IPC in Practice changed regularly to remain in line with Public Health guidance as communicated via NHSE/ LMC emails, this was communicated to staff either f2f or via emails
- Communication with suspected COVID patient in isolation room- instructions kept in room for patient to follow, mobile phone to be bagged and then provided to patient if they did not have own, instruction re toilet use
- We had no significant events regarding Infection Control
1.2- Sufficient quantities of right equipment
- Currently the practice has adopted a system to maintain a good stock for PPE. Early in pandemic problems in accessing PPE , but we overcame this by placing regular/requirement specific PPE orders. Followed guidance on how to use PPE efficiently in order make our stock can last.
We ordered our stock via Sitrep and GPN- Recently we have been given a better support and info how to access and pace adequate orders to maintain our IPC prevention intact.
1.3- Environment suitable to contain an outbreak?
- Practice was has one patient entrance. To minimise risk Staff using alternate entrance
- To prevent contact between non COVID and suspected COVID patients, front door was locked and patients triaged.
- As per NHS Guidance the Practice appointments changed to remote consultations via telephone appointments and video consultations for all urgent callers.
- Patients informed of pandemic protocol when attending for necessary routine appointments such as Children Immunisations and Patients visiting Practice Nurses for their Dressings, Blood Tests and etc..
-Intercom with camera to inform patient arriving for appointment
-Trained staff (with PPE) to meet patient at the entrance (Reasonable distance is kept)
-Test patient Temperature before entering Practice and ask patient of symptoms (symptoms also checked upon booking and informed not to attend if unwell). Initially were provided with mask, due to supply only staff wearing PPE now.
-Record Temp in patient records.
-Invite patient in to wait in Area (1 minute), patient advised to attend alone, or one parent with child, chairs spaced out
-Nurse to attend and take patient in consultation promptly.
-Advised the non-use of practice toilets?? Unless it is absolutely necessary!
-Availability of hand gel for patient use pre/post appointment.
This system is working well for the practice.
- Not needed to use another site but have availability if needed. Also discussion with PCN re ‘Hot’ site if any escalation required.
1.4- Systems clear and accessible to staff/service users and visitors
- Regular communication with clinical/non clinical staff on how to manage covid and non covid patients.
- We published information on our website and also we signposted information outside our Practices (also in different languages) giving patients as much information as possible.
- Prescription ordering- informed via phone/ messaging system/website that medications can be ordered over phone, pharmacies can deliver medication/ via volunteer service
- Pharmacies were informed re ordering of medication change and delivery if required to make sure patient care and treatment is maintained.
- All our Care Homes were contacted and a new protocol was set up to make sure care is provided to these patients
- Health and safety was discussed amongst all staff and procedures were put in place to follow. These procedures were sent via emails to all staff and further discussions were followed up.
- The Practice explained how to keep themselves safe by using the available and relevant PPE (information verbally/ posters in room/dissemination of info in emails), how to protect themselves when seeing patients and also information was given to all when they go home and be with their families.
- A risk assessment was carried out in the Practice to identify health needs of staff and families
Vulnerable Patients & patients with communication requirements: with this pandemic we have taken into consideration the seriousness of this pandemic and therefore we contacted all our vulnerable patients:
- Informed via letters and our Practice website information.
- Urged our community Teams to attend to these patients when necessary.
- Volunteer’s information in the community was passed on to all patients of this category.
- OOH services were made aware of these patients.
Patients with communication requirements:
- We spoke to their Carers and family members and we provided them with the same information as above. This seemed to have worked within these two categories?
- Visitors were explained the practice procedure before attending/ or upon arrival via phone. Temp testing is carried out before entering the Practice and a Contingency Risk Assessment is shown to all visitors.
However, Video conferencing is encouraged to avoid unnecessary visits eg for GSF meetings etc..
1.5- Medications managed effectively?
- Medication alerts actioned as per protocol by practice pharmacist. Updated tracker also distributed in clinical meeting details. Alerts also highlighted via NHSE pandemic updates
- Practised reverted back to receiving medication requests over phone otherwise online use encouraged. Collection of paper px discouraged with token numbers provided when needed/ if unable to send by ETP
- Contraception reviews- guidance distributed on how to do reviews remotely/safely, relevant checks so provision of contraception could continue
- Ongoing pharmacy work to switch patients to oral medications such as for B12
- Anticoagulation reviewed and changed to DOACs so regular blood monitoring not required ( for eligible pts)
- High risk drug monitoring continued with support from District nursing and HCA visiting team
- Medication shortages dealt with support of practice pharmacist and information on supply via netformulary/ email updates, patients provided alternatives when needed
- Medication queries dealt with Dr on-call/practice pharmacist
- Routine medication reviews continued over phone
- Use of Diabetes helpline for insulin specific queries
- Continued to action eclipse alerts
Local Pharmacies were very helpful in supporting the Practice. We worked very closely in delivering the service within a well-timed turnaround and supply provision.
All High risk patients were identified and informed of delivering medications to their home addresses by the Pharmacists courier and local volunteers in the area.
1.6- Risk management systems able to support existing/ COVID-19 related risks?
- Minor verbal complaints relating to pandemic, these complaints were received when delivering telephone appointment system to patients that wanting to have f2f appointments. Staff current protocol.
- Mod/Low risk patients with medical conditions not meeting extremely vulnerable criteria. Signposted to 111 for sick notes/ advice on distancing. Initially informed those groups would also receive letters but was not followed through by NHSE. Provision of sick notes related to Covid19 via 111
- Discontent patient about restricted access to the practice. Patients advised on risk management and triaging and essential care still being provided. Routine/ non urgent care to be placed on waiting list and dealt with post pandemic.
- As per Government and NHSE guidance some services suspended eg spiros, routine checks, bt etc. Patients placed on waiting lists appointments and will be recalled in timely manner with adequate time and spacing.
- Referrals being triaged via a&g and referred in when advised, otherwise placed on waiting list to resume referral pathway post pandemic. Patients encouraged to book discussion with GP if clinical concerns worsen to reassess.
- Managing risks;
-Remote services - variety of options –telephone, with interpreting services with conference call, Doctor link online, video consolation ( with consent), review of 111contact ( restricted supply of cameras)
-F2f/home visits- triaging for essential contact, temperature check before entering building, use of PPE, use of video consultation, use of JET
-Care/nursing homes- details given to homes on provision of care, access to calls, f2f visits when essential, and support from community teams
-Shielding patients have access to remote services, identified patients were given information on phone and sent letters on how to contact and receive care from the practice and access to national support eg volunteer service
2.1- & 2.2- Enough suitable staff/ managing staff levels
- Westwood had a minimal setback as far as staff levels are concerned. Worked very well as a team to stay safe while working together. Distancing within office, use of PPE, temp checks of staff on arrival to practice
- Prompt action to isolation and testing if any clinical concern, to minimise risk of contact and spread.
For example: Members of staff were isolated in a period between March and June 2020. We recruited 2 members of staff (Admin) as it was planned and that also gave us strong hold in our staff cover.
- Training on Doctor Link
- Regular communication on practice/local changes to help support roles and care of patients efficiently. Information provided verbally or through emails Provision of up to date information to patients and available support.
- Information on staffing provided with CCG Portal submission.
3- Protection from Abuse:
3.1- Protection against abuse/neglect/discrimination
- Strive to protect and ensure dignity of patients irrelevant of type of consultation
- Quality care to prevent neglect and discrimination such as doctor’s able to speak alternate languages, use of interpreting services, maintain confidentiality
- All our clinicians are fully aware of their conduct of responsibility and decision sharing/ confidentiality with patients when face to face, telephone or Remote video Consultation.
- New service provision for care homes - Specific weekly sessions are set up to review all patients , this service will be run by GP- ANP-Pharmacist to make sure patients are safe in Care Homes. Also there will be MDT meetings to discuss patients monitoring and improvement in the Care Home. Discuss further about Protocol.
- Support provided through specialist community teams/ SPA/ Volunteer service/ ongoing in-house vulnerable patient meetings to prevent neglect
- Patient tailored care/ individualised assessments via community teams, a&g, choice of when to receive care according to risk ( eg: post pandemic apt), ongoing 2ww referrals
- Use of BSL health can also be used
- Over 65 toolkit- on how to keep active (sent in email 7.6.20 to add to website)
- Resources that can be provided to patients with learning disabilities/autism on ccg website, also in email 29.5.20)
- Video resources to help people with disability to help understand anxiety
3.2- There has been no concerns of any safeguarding during the Pandemic and up to now. The Practice has reviewed and managed to carry out its safeguarding Registers as it did before.
- SG children and consultation meetings continued with HV input
-GSF meetings continued, video consultations/HV arranged as needed
-Patients still referred for support via SPA/SS/Volunteer service
-patients at risk of DV contacted/ if pts voiced abuse support signposted
4- Assurances & risk assessment management.
4.1- Had the provider been able to to take action to protect the H&S and wellbeing of staff.
- All staff have been updated on a regular basis regarding Covid19 and staff were emailed how to access to covid testing.
- We had so far 3 members referred themselves to testing with negative results
- All staff have been risk assessed and managed via a risk Assessment template, stating all symptoms to report to manager in order the Practice can manage staff adequately.
- Some of our staff has health concerns and therefore after an assessment we decided that they remotely work from home. ( 2 members of staff) We managed to provide staff with laptops that gave them the opportunity to carry out their work remotely without any concerns as current IT is fully confidential and secure as per CCG provision
- Staff have access to Psychological support - this information was/is emailed to them as part of staff - Covid Health and Safety prevention and advice. Through MIND/ #looking after you too coaching
- All staff with underlying health conditions /Pregnant women, black and Asian and minor Ethnicity have been risk assessed, managed and advised to work remotely and others also agreed to work different shifts to allow work distancing and risk free of Covid.
4.2- This been mentioned in previous questions
- Quality of care not affected, triaged efficiently clinical risk with safety netting, effective response and working
- Pandemic has affected provision and access to secondary care services, delayed referrals and follow up care.
- Delivery of care and treatment in the Practice is up to date with relevant standards and guidance via NHSE- distributed to all staff in timely manner and changes highlighted and discussed
- Practice has a methodology of business as usual. Since the beginning of April routine care adjusted to safety measures;
- -Baby immunisations and baby checks- timed/spaced appointments, 1 parent attendance, ongoing medication reviews and LTC, waiting lists set up for recalls, booking of QOF patients that can be accessed via telephone, continuation of 2ww and appointment checks
- Remote access as before- phone, doctor link, video, f2f when needed
- Communication- interpreting service, BSL, multilingual Drs
- For elderly patients without computer- phones – tablets etc… we wrote to them if they were high risk and also wrote to non- high risk informing them of volunteers information in the community and advice what to do if they feel lonely or depressed due to covid & lockdown. Face to face appointments provided if no other access. Also availability of DN teams
4.3- Support of staff raising concerns during pandemic
- Continual support to staff during this pandemic.
- Staff are encouraged to raise any concerns regarding health and safety to PM/Partner/during meetings. Whistleblowing policy and training provided.
- Also the Practice managed to promote team working via monthly meetings (work distancing is maintained at all times and adequate PPE is provided to staff in Practice), volunteering to provide support and cover during BH
- Feedback re ongoing effective processes encouraged/better practice/continuing change
4.4- Care and treatment recorded during pandemic
- No changes are made to recording patients’ information on systems. Detailed consultations continue. Risk identified it is recorded, type of consultation coded, if any restriction in consultation- detailed and recorded as seen during pandemic.
- However; we have experienced barriers to sharing and accessing patient information from other providers ie:
Patient registration details (PCSE Portal) emails were not answered- information was not accurate from NHS – CCG and CQRS etc…. when a request was made by Practice.
- Limited access to mental health specialist care, CPNs, MDT disseminated, patients discharged and advised re referral.
4.5- Coordination with system Partners
- We are coordinating very well with our PCN Partners. We worked very closely to achieve projects to improve care and treatments. Regular meetings to discuss provision of commissioned care
- Care homes have been approached recently due to recent Care Home LES to improve patient’s health and service in CH.
Patient Participation Group (PPG)
18th February 2020
- PPG Attendees: Confidential.
Practice Attendees: Dr Naila Ahmed & Mr Karim Allam PM
Welcome & Introductions
Summary of Discussion
· Practice Team changes & Departures ( New members of staff)
Dr Ahmed informed the members of the clinicians that left ( Lucy Davis ) and also informed them of new recruits ( Jacinta Scott-Fordah )
· Lucy ANP Left
· Jacinta ANP started Feb20
· New Locums introduced to Practice : Long term :
( Dr Nunkoo – Dr Ray- Dr Hussein )
National Pandemic & Practice Action.
Corona Virus Practice Plan and Action:
· Corona Virus: Practice Information was published on its website – Telephone messages were created - Post signs in Practice are set and
currently Practice is sending texts to patients (5200 Patients) informing them how to proceed with this virus
· Policies and protocols were put in place and all staff are aware how to proceed in helping patients
CQC Recent Visit to Practice
CQC Re-visit and Inspection in Jan 2020
· Recent CQC re-visit 21st Jan 2020 – PPG to be informed of CQC feedback and discussion.
· The Practice presented a clear vision to CQC team by establishing the care and the service to patients in Westwood Clinic. This presentation covered all aspects of holistic and clinical services. CQC were pleased to see such an improvement within the Practice. However; the Practice is adamant to continue to monitor its progress to make sure service levels are maintained and patient care is not compromised.
Practice Current and Future Implementation and projects.
- Practice current & Future Implementations:
- Practice Change of Patient Appointments System – recent feedback from patients is positive
- New telephone system is to be introduced in March 20 to facilitate patient access.
- Patient DNAs in Practice? Practice to advertise monthly DNAs numbers in the practice and website to raise awareness and to inform patients of the high number of wasted appointments when patients do not cancel their appointments
Next Meeting Date;
Next Meeting Date: Quarterly: Tuesday 19th May ( to be Confirmed)
Patient Participation Group Latest October 2019
Patient Participation Meeting
Chaired by: Dr Ahmed & K. Allam PM -
Date of Meeting: 15th October 2019 1PM
Minutes of the Meeting
Discussion & Action Plan if any?
Welcome & Introductions
Introducing each other and explaining the aim of the meeting
All was welcomed and introduced by the PM – Dr Ahmed briefed all about the purpose of the PPG at WW.
Practice Team changes & Departures
· Senior partners,
· New PM
· GP left Practice
Dr Ahmed also informed the Newly formed PPG about her role in the Practice. Also informed the PPG of the introduction of New PM at WW following the leaving of H. Pinder. Also informed the PPG of recent departure of Dr Koneru in Sept 19.
Dr Ahmed informed the PPG there will a regular set Agenda to inform and discuss practice issues and development with PPG in order to improve Practice performance.
PPG Implementation within Practice
· Possible selection of a PPG Chair
The PM and Dr Ahmed informed the PPG, this is the third time WW organised of selecting a group. The Practice believes that it will ask patients on a quarterly basis to join the meeting to inform & discuss Practice developments. This way many patients will have the opportunity to listen and to have a say in their Practice. We also asked the group of any person becoming a PPG chair (Mr Goate) ?
Practice latest New Letter
What’s happening in the Practice this month?
· Flu Vaccines to all
· Pneu Vacc over 65
· Shingles vac
· Patient overall Health reviews
Dr Ahmed and PM informed PPG of WW Newsletter that was set up by the PM to inform all patients in the Practice and in its Website. See attached. We also informed PPG of services currently under way and how they are run and monitored to achieve patient safety and satisfaction.
Recent CQC Rating discussion
· Practice scored inadequate
· Practice needs to improve
Dr Ahmed the PM wanted the Practice to be transparent about WW and informed PPG of its current situation as far as CQC inspection is concerned. We discussed the CQC reporting and the recommendation made by CQC and also we discussed the WW action plan to improve patient safety and leadership in the Practice. The Practice will keep the PPG aware of its action plan and also ask PPG to approach patients in the Practice to inform them of this practice progression so far.
Current Practice Implementations
· New PM
· Introduction of extra patient appoints
· Patient annual reviews
· Patient Surveys
· Customer care and service
Pm informed PPG of current implementation such as: increasing patient appoints – creating patient survey in WW and obtain feedback to improve – also informed of current Patient annual reviews – especially concentrating on patient registers. We also informed PPG about staff customer training ( In House) Staff are aware of regular online training
(Bluestream) to adhere by and they are monitored by the PM.
Future Practice Implementations
· Encourage patient feedback
Pm informed PPG of creation of monthly Patient Feedback after they visit the GP. This survey has started in Aug 19 and we had a good response and a good feedback from patients – there will be regular surveys in the practice to maintain patient safety and very good service at WW.
We also informed the PPG of a new creation of a Anonymised patient feedback BOX, where is going to be in the Reception for all patient feedback and comments about improving overall practice services. Results will be discussed in the next quarterly meeting.
Next PPG Meeting
· January 2020
Dr Ahmed has asked PPG that the Practice will be contacting to ask for their attendance next Jan 20, however if any persons that cannot attend to inform the Practice as early as possible in order to invite another patient to the Meeting.
(This PPG persons cannot commit to regular meetings due to personal issues, we were informed )