Transcript

the Adults and Health Select Committee on Thursday, 6th March at 10am, holding the council chambers at Surrey County Council. There is no fire drill expected today. So in the event of the fire alarm sounding, everyone present is asked to follow me and leave by the nearest exit, an assemble at the top car park, reporting to a member of the building management team, staff, will be on hand to guide you to your nearest exit, which is to the left there, and there is also one in the corner there to the right. Please ensure your mobile phones are either switched off or put on silent. In line with our guidance on the use of social media, I'm happy for anyone attending today's meeting, including members of the committee, to use social media if this does not disturb the business of the meeting. Today's meeting is being webcast to the public, and a recording will be available online afterward. I'd also like to mention that this meeting allows for participation by video conference via Microsoft Teams, and that some attendees are participating remotely. For those participating remotely, if the chat feature is enabled, please do not use it. It's used limits of transparency and open discussion we aim to maintain in a public meeting. For those officers who have joined the meeting remotely, please use the raise hand function to indicate that you would like to speak and please mute your microphone and turn off your camera when not speaking. For those officers who have joined us in person, may I please ask anyone presenting to speak clearly and directly into their microphones. When called upon to speak, press the right-hand button on your microphone and start speaking when the red light appears. Please remember to turn off your microphone when you have finished. If you are sharing a desk and a microphone, then you need to press the right or left-hand button, depending on which side of the microphone you're sitting on. I would now like to introduce those witnesses with standing invitations to each select committee meeting. That's Maria Millwood, Board Director for Healthwatch, Sue Murphy, Chief Executive Officer of Catalyst, Patrick Walter, Chief Executive Officer of Mary Frances Trust, Olive Ahern, Area Manager for Richmond Fellowship at Nicky Roberts, Chief Executive Officer of Disabled People and I believe Samantha Botsford is standing in for Maria Millwood today. Apologies for absence have been received from Councillor Caroline Joseph, Councillor Dennis Booth, Claire Edgar, Executive Director of Adults Wellbeing and Health Partnerships with Sarah Kershaw Thank you for joining us on Claire's behalf. And I believe Councillor John Fury is also unwell and sends his apologies and we send him our hope for a quick recovery. Okay. Minutes of the previous meeting. Are we agreed to approve the minutes? Thank you. Declarations of interest. I'll start the round off by saying that I'm a community representative for Frimley Health, which I always do. And I believe Councillor Victoria Wheeler, you've... Indeed. Thank you, Chair. So it's a pecuniary interest in relation to anything to do with an electronic patient from Epsom and St. Helio Hospital. Thank you. Thank you, Councillor Wheeler. And obviously, you'll just refrain from entering any piece of the discussion that mentions the electronic patient record. Yeah. Because we value your expertise in other matters. So it would be good to have your participation, but not in that area. Thank you very much. Any other declarations of interest? Councillor Mawson. Yes, a non-pecuniary interest in that I have a close family member who works at Frimley Park. Thank you. And any more? Okay. I think then we are free to move on to the next section, questions, petitions. None have been received. And so it's the recommendations tracker and forward work programme. Are we agreed to just note and move on? Thank you very much. And I think we have... Next item is Councillor Sinead Mooney with Cabinet Response to Select Committee Recommendations. Do we have Councillor Sinead Mooney on the line? Sinead, if you'd like to go ahead. Thank you, Chair. So can you hear me okay? Yeah, just about. It's fairly quiet, I'm afraid. Okay. Apologies. I think I do have some issues with my microphone. But you very kindly came along to the Cabinet Meeting Chair and presented some questions on behalf of the Select Committee. And there were three questions, four questions, I beg your pardon in total. The first question was around strong and effective risk management, focusing on maintaining sustainable services for our vulnerable residents. The Cabinet Response there I know is set out in the papers, but the areas I think I'd like to highlight to you all is that there is a lot of focus around risk management and mitigating potential negative outcomes and also identifying opportunities for improvement. Lots of focus in the response around data. I think Select Committee members I hope will acknowledge the data that's gathered within the Directorate and how that helps us manage potential risks and also validate the impact of our services on our vulnerable residents. So I'm happy to take any questions on that one. The next question was around needs assessments, making sure that's properly resourced. And the Cabinet did refer to the CQC inspection. Improvements were identified during the assessment process and in the published report. And we're working very hard to deliver those through our transformation project and improvement programme on the back of the CQC assessment. So we would very much welcome the Select Committee's robust scrutiny of those plans to make sure that we do deliver the improvements that we need to. The third question was around technology enabled care. And Chair, I'd just like to say on behalf of the Cabinet and myself as the Lead Cabinet Member for Adult Social Care, how much we have welcomed the scrutiny from the committee and the input. The question really was around supporting the provision of tech, as we call it, technology enabled care with regards to the rollout of that to support and bolster the service that we deliver. So I do believe, Chair, this is on your full plan. We're going to come back to Select Committee within the next six months and show you our plan for rolling this out and welcome your scrutiny there. And the final question was around investment in the tracking of spending. And there is an awful lot of work that goes into the monitoring and the tracking of the adult social care budget, given the significance of the spend. And we discussed that at the cabinet meeting, Chair, and I offered many assurances around that robust management monitoring that's already in place. And that continues and will continue. We're starting to see some downward trends, which is very positive. But there are some areas of risks that we have identified and we will all continue as a team collectively to work to reduce those risks and monitor them as well. Thank you, Chair. That's all I have to say. I'm happy to answer any questions. Thank you very much, Councillor Mooney. I'll just throw in a comment, frankly, which is on the assessments and just to stress the importance that these are robust and move quickly because of the huge impact that they have on hospital bed capacity. And the problem that all of our hospitals face with very large waiting lists, obviously anything that we can do to allow them to improve their bed capacity has a huge impact on the waiting list as well. So I'll just emphasise that. Thank you, Chair. Any questions around the room? I think you've gone off very lightly today, Councillor Mooney. I don't know if that's a good thing or a bad thing, Chair. I think that's because we've already had some very comprehensive answers and therefore they are all areas that we can move on. And I'm particularly looking forward to the tech review session in about six months' time. Thank you very much, Chair, and thank you for letting me join the meeting remotely. So moving on, the next item is a review of patient access to urgent and emergency care across Surrey, which is particularly important with all of the moves that are now going on to, shall we say, move the plethora of different units operating to different standards across the country to a more standardised urgent treatment centre model. And so basically over to team, sorry, Heartlands. Thank you. Thank you, Chair. We're going to do a bit of a small presentation to begin with, which will be a joint effort. We've got different locations, et cetera, for patients in need. We've got our presentation good. So like many systems, we are experiencing really high demand, and it's an increasing demand that's being placed on services to patients. And that's increasing year on year somewhere around between two and a half or six to 6% in our skill sets in terms of commissions and nursing, et cetera, at the right time in order to facilitate a much better patient experience and to be seen very appropriately in terms of that. Just to put some numbers around that, in primary care at the moment, just over half the demand is dealt with on the same day. A thousand people who are seeking urgent care from those departments across the whole of Surrey, Heartlands. If we can just move on. Thank you. As I've said, the issue is around lots of different offerings that are there. And I think it's largely to say dependent on various local wants, needs and desires. The best way to manage that and certainly to provide patients with a list to standardize those offerings as much as possible. We will look to provide much more in the way of service in the community and closer to home for patients in line with the government's left one time. Let's move on to the next slide, please. I won't talk through the detail of this other than to say that we, as I've said, we're standardizing the access to same day urgent care. And that will be done by redesignating the major, sorry, the minor injury units and the walk-in centers and designating those as UTCs or urgent treatment centers. This is in line with national expectations, but those urgent treatment centers provide an enhanced service offering across the existing service offers that we have at the moment. So, as I've said, lots of those walk-in centers and minor injury units have developed over time. And as such, it's down to local knowledge really and how to do those. UTCs, on the other hand, have a very defined and consistent list of services and just making sure that we can navigate through an appropriate time. And we'll come on later in the first instance and then augment them into that. We do anticipate through our modeling process, which we have across the whole system and we manage, we will encompass this activity into that modeling process. And we estimate at the moment that the UTCs will see about 25% more patients than the current MIUs or walk-in centers see today. We do recognize that there is a public transport links barrier, if you like, to get over, especially in certain parts of, sorry, heartlands where there are more economically disadvantaged patients. So, whilst we are engaging with partners of place, this is about looking at different options and mobilizing those options to provide better access for patients. From a national perspective, from April onwards, the emergency care data is moving into a new data in the same way. So, there's much more in terms of analysis and development and lessons learned from other UTCs that go live with similar demographics, et cetera. Pramit Patel is going to now talk through a couple of examples as to how the UTC will operate in practical terms. Thank you. No, thank you very much, Rob. And thank you committee for having us here. Pramit Patel, GP, primary clinical leader for Sari Harlins and partner members of the ICB. And before I sort of just walk you through the examples, I think it's probably a good opportunity to actually talk about access and capacity. They're two different things, fragmented, it's not seamless and it's not joined. Back to your point earlier on, different processes depending on where you access and where you join up here. And this was very much the case on the, in the work, in the tenure plan working groups, which I had the privilege of being on about access, which the Secretary of State asked me to join. And in actual fact, what has become apparent is if we in healthcare don't know how access works currently, how can we expect our residents and patients to navigate the journey as well? And I suppose that is one of the key points that we're trying to address here in making that access journey seamless, but also improving capacity in our UTCs as Rob's already mentioned. And in doing so, a couple of examples how we see the future looking. At the moment, if we have Zach, who's a six-year-old little lad who has an earache, and mum and dad call up 111 at 7.35 in the evening, there are only two options for that mum. One is they're told to go to A&E, or two, they're told to wait for the 111 triage condition to call back, and that could be three to four hours depending on what their demand is looking like. And after that, the disposition could be A&E, because there are no base appointments left. However, what we see is this patient's mum will call 111, who will then be able to see the whole appointment book in UTCs and book that kiddie an appointment more or less straight away. To see an urgent care practitioner, GEP, whoever's running in the service at the time. Therein lies an opportunity. You're not actually prolonging the pain that that child's suffering, but also you're reducing and demanding to ED as well. Another case study, Anna, who's a 74-year-old lady who's had a fall, walking her dog with a friend. Was it a mechanical fall or was it a fall that just led to a knees giving way? In actual fact, she fell, her friend took her to the local UTC. She had a scan, made sure there were no broken bones. However, she also had her urine dipped, which showed that she had a urine infection, which is most likely the cause for her fall in the first instance, and she was able to be treated more or less there and then. The other option would have been take her to the local A&E, or wait for the ambulance to pick her up and take her, wait four hours, and then the infection gets worse. She becomes more poorly, potentially in admission as well. So I suppose the point I'm trying to make here, Chair, is about access, but also urgent care in the right setting, first time out. Next slide, please, Giselle. Brilliant. So I suppose here in this slide sort of just talks through the different options that we have currently. So Pharmacy First is something that has been rolled out nationally across all pharmacies, and fortunately across our heart, 95% of our pharmacies have signed up and are delivering Pharmacy First seven conditions without needing a GP appointment. There is a journey to be had here. I don't think we've socialized it well enough with our residents, and there is a little bit of anxiety and possibly a little bit of nervousness from our residents to use Pharmacy or A&E. So there's something about confidence building within our communities as well. I talk about promoting 111 and NHS 111. I suppose from my point with my GP hat on, if you were to call 111 with a complaint and call your GP or go through the GP surgery with that same complaint or go to A&E with that same complaint, you'll potentially have three or four different person into the right place first time round at the earliest opportunity, and that sort of just brings me onto the front door. It's that consistency that we've heard time and time again from our residents, both from Health Watch Giselle as well. The lack of consistency across practices, across the urgent care setting, and planned care setting is leading to increased demand and increased activity. So we need to try and bring this together in a more joined up and more visible way and make it easy for our patients and our residents. If we... I'm going to hand it over to Giselle, or is it back to you? You're welcome. It's back to me. There we go. Almost seamless. Almost, not quite. But we try. I just wanted to spend a couple of minutes of a major just talking and expanding the way to create these processes and continuous improvement in terms of it. As I have said, and we've repeatedly said that the overall priority is to make sure that patients are seen at the moment, 16 patients a day at Caterham and Dean, and we're expecting a slightly less impact at Ashford and Woking because they also pick up the comms message that goes out and all of those things as we develop through. So over the first three to six months, we will monitor the UTC activity in exactly the same internally to make sure that we're meeting that need and we're providing those services. There may be delays in terms of putting those services live because it's not just equipment and others for that once we get into that time. And it also that process will inform our communication exercise, etc. So over to Giselle. Thank you. Thank you. Thank you, Chair. And thank you to the committee for hosting us today. So my name is Giselle Rothwell. I'm the director of communications and engagement for Surrey Heartlands. And I just wanted to spend a couple of minutes. Sorry, Giselle. Could you just move the mic towards yourself because that's it. Sorry. I just wanted to spend a couple of minutes talking about communications and engagement. I know the committee is particularly interested in this and how we will help people navigate the healthcare system. As we've said, we know it's fragmented and we know people struggle. I think we want to kickstart some communication about the ambitions around the urgent treatment centers, but we have to balance that and be careful not to raise expectations in the first instance. We know that all the services won't be fully up and running from the first of April. So we have to be careful and make sure that the initial messaging is more localized and targeted around the four sites and the detail of what's happening at those four sites. We will do some overarching communication to start with, but then we'll be focused on that localized messaging. And we'll support that through things like leaflets in the centers themselves. And we recognize that, you know, our communication has to cover digital and non-digital channels, which is really important. And then what we want to do is move to a wider campaign around, we're calling it navigation, but what we've been talking about, helping local people understand where to get the right help and support and building on the messages that we already do. But actually we tend to focus that messaging during the winter and we recognize that we need a more sustained and repeated campaign and not just doing it at certain times of the year. So what we want to do is use some insight to inform how we take that campaign forward. We've already spoken, you know, we know that we've got lots of insight from partners such as Health Watch. We have an insight team and we want to really start to understand people's behavior. We know that a lot of people are already trying to do the right thing. They're trying not to go to A&E for simple conditions. But we also know that people don't really understand the bit later on. I would anticipate in the early summer is to develop a wider campaign that is informed by what we hear from people in terms of behaviors and obviously working closely with the team. But to really expand on the campaigns we've done in the past to support people. And that would be across a range of digital and non-digital channels. So subject, of course, to resource, we would like to develop a series of simple animations to describe all the different types of care, right from self-care through to, you know, really why you should call an ambulance. And, you know, that would also include traditional leaflets and looking at areas of high footfall, all the things you would expect that are listed out here on the slide. And actually, I think what's important is that we would want to focus a lot of that messaging with our priority populations. We already do a certain amount of engagement supported through the voluntary community group and the VCSE Alliance and Health Watch. And we'd want to take that messaging out through those channels and also work with our local government colleagues and Surrey County Council in particular. And actually any support from members of this committee when we get to that point would be very grateful for. And we hope that you would support us in our ambition around that camp presentation. It's obviously, you know, very much the right initiative from NHS England to actually move towards a standardized based approach. I think ever since the start of the pandemic probably NHS have attempted to respond to cry in a crisis mode. We've had lots of point solutions, lots of evolving, you know, attempts to fill gaps, produce more capacity, all of those sorts of things. But it is actually very much now time to move to something, you know, you get dissatisfaction, you get all kinds of problems, failure to deliver a seamless service and all of those sorts of things. Some patients are feeling commoditized. We have consistent messaging around it, all of those things. Anyway, I'm going to move on to the first question, which is Councillor Robert Evans. Thank you very much, Chair, and thank you to our colleagues for that presentation. I'd better declare a vested interest, really. I think I've visited over the years all of the, well, pretty nearly all the casualty units and minor injury units with sports injuries. of some sort. And I've got three brothers and my mother, my late mother used to say that when we were growing up, she'd never gone through a full calendar year without taking one of us to casualty for something. So, and my sports club at Ashford is, which is in my electoral division, is right next to Ashford Hospital. So we're a regular supplier of customers to the minor injury units on a Saturday afternoon and other days. So I know a little bit about what's going on and the differences between a minor injury unit and the full casualty emergency. But a few points. I saw that you said that there was going to be a 25% increase in patients. I'm just wondering exactly why that will be. Is it more staff or longer hours? And that leads me to what are the hours going to be when you're fully open? And what happens if somebody arrives just five, ten minutes before you're about to close needing help? Are you going to say, sorry, we're closing in five minutes? You'll have to sort yourself out or go to St. Peter's or whatever. And how do you deal with peak times, which might be Saturday afternoons for sports injuries, or particularly when parents and children arrive at the end of the day when you don't want to have children with hanging around for, you don't want to have anybody hanging around for a long time, but perhaps children with an injury or particular urgent needs. So there's a few points there. Thank you. Thank you. Shall I respond to the council? So there's a number of pickups here. The 25% shift in activity, decrowding, if you like, if that's a word, the process. In terms of hours, at the moment, Cater and Dean, Ashford and Woking all operate 8 to late, 8.30 to late across the piece. The only exception to that is Hazel Mill, which operates on five days. We direct those patients to via either the bookable slots via 111, or indeed if they're walking in a triage process similar to that that you have in EDs currently. In terms of how we manage that demand, the UTCs will be brought in to be seen much quicker than they probably would be at the moment. Your point about coming to the end of the sort of the day, as it were, appointments, they will be obviously booked into slots that are there so they will be seen. But for walk-ins, we would look at triage process. And if it's a semi-minor injury, et cetera, that can be dealt with very quickly, they'll be there. But really at the front door, triage process would be redirected to another service in order to be like the important point with our single point of access will also be a data that follows the patient, repeat the diagnosis, et cetera. Have I covered everything, sir? There was also to deal with children arriving. I also just wanted to ask as well. I presume you have sort of statistics showing peak times when accidents or people are likely to be coming in walk-ins. But I'm just wondering if you can elaborate on that. Absolutely. So typically we see after school hours in the week that happen. And that's sometimes because they're waiting for dad to come home to look after another sibling before and all of those sorts of things. So we do tailor the resource accordingly. But it could be mum coming home and dad going out to work. Absolutely right. I stand corrected. Absolutely right. Thank you. I wouldn't. Yeah, absolutely. A parent. But certainly at weekends, et cetera, we do have a fairly or we do have. Ask a question myself. I think as chairman, I'm allowed. Which is really on the mental health side of it. What provision are you expecting to provide in relation to mental health patients that present at the UTCs? And have you also looked at how you use safe havens for instance? Thank you. So we have a process within ED departments. We do get largely because they are the probably at certain points of time. Certainly for mental health patients. The only open door from a clinical perspective. But yeah. Thank you. Thank you. Great question. Sure. I suppose when you look at the overall demand or mental health related conditions that currently hit the out of hospital area. About 40 to 50%. And I suppose what we need to be better at doing is actually having the access points. What we shouldn't be doing is allowing or having those patients going to UTCs. It's not about allowing patients. It's that may not be the right place for them to go. Patients who have mental health issues actually require continuity of care. And the point being is that if we get that access bit right. We can actually make sure that person is seen by the right walk into UTC. It needs to be a seamless risk assessment and then a referral back to the right teams. And we've got G PIMS already within all of our community settings. It's how do we activate? How do we make that integrated service work without it being fragmented? And I suppose therein lies the beauty of the Surrey care record. Where you can actually have quantitative care through quantitative data sharing as well. Does that help? Yeah. I know. It's yeah. Primarily concerns me that, you know, we actually do, you know, try and deliver mental health issues. It's a seamless service that we, you know, wherever they land in the system. Because, you know, that's an individual who's maybe not going to land in the right place. But also, you know, we've got a, you know, growing problem that we know of in society. So, you know, mental health issues are. Can I take this opportunity to come back with another stat, if I may? Yeah. And we've been doing some work across the team, looking at sort of population health analytics, activity, our certain cohort occupying. And some of the, some of the work we've been doing is looking at regular attendance, which are very different to high frequent attenders or high intention within the system. And some of that is because we're not delivering quantitative care. And when you look at those cohorts, that 4%, a lot of those 4% do have mental health conditions or related. If we know our populations, we can build the right services around. I think there are also areas around diagnosis and reporting as well, because if you look at, you'll see very different numbers from practice to practice. And there's, there are obvious issues of consistency. Okay, so. David wants to. Yeah. Thank you, yes. I'm, I live in the wider Hazelnere area, if you like, and represent a, well, the bigger, wider Hazelnere area. everybody understands what is available at the minor injuries clinic and the title that's what they call it and so people use it and I would be surprised if fewer than 90% of people who turn up have come to the right place because it's a pretty good shot but that's partly because of the title so there's two things here first of all I'm a bit concerned about changing the label because if you've got a label that really is self-explanatory I would have thought that was pretty beneficial but the other thing is how to tell the wider public what you're providing and so as a councillor I had the opportunity to exercise spreading the message if you will through nine parishes oh nine villages eight parishes in the town and in each of those there is a machinery which disperses information that I deem to be useful you know taking my advice on what's useful and so I'd be very grateful if we could and I guess other members would have similar things either in urban areas or in rural areas but you know they make their own assessment of how to market it so speak on your behalf but it does seem to me it'd be jolly useful to have a script from yourselves that we could reasonably use and would be intelligible at any level you know thank you councillor and I agree and I think what we need to do is to build into this campaign that we want to develop messaging that can be taken out that's simple and concise and I think before we embark on any campaign we need to test that messaging really clearly and we have our own mechanisms of doing that but we'd be really grateful for you know we're very happy to test that with yourselves as well and I think you're absolutely right your reach to those local communities is far better than ours and we'd be very grateful for your help and support thank you just ours thank you thank you Jim thank you okay I think we next got councillor Victoria Wheeler followed by councillor Robert Evans and then councillor Abby King so it's all down that end of the table indeed all down the top end so UTCs are staffed predominantly by GPs what impact will this have on GP services and what type of contract is more lucrative for these independent providers what percentage of staff have already been recruited and how do you intend to ensure that you cover absences and the workflow between EDs GPs and UTCs I'll take the GP thank you very much councillor and I suppose in response to your first question how will we make sure we're not seeding from Peter to people because as quite services when that's where the need is needs to not be harmed and I suppose when we're looking at our capacity demand modelling and we're looking at our sort of move their own careers and their own portfolios it's being adaptive and agile and we're seeing especially newer GPs wanting that portfolio approach so having some time in general practice but also having some time in UTCs would actually fulfil their ambitions we have to be cognisant that we're not just putting all our GPs in the UTCs at the expense of general practice and that will be incumbent on the provider as well as the local GPs more often than not we've got quite a good retention of general practitioners within Surrey it's the skill mix which I think is going to be really important here such as having a GP in a family consultant or a general practice consultant position with a skilled mix of nurse practitioners clinical practitioners paramedic practitioners working alongside I think that's where the trick's going to that's where I think the gains are really going to be made without harming the traditional GP element if that makes sense if I could just come up with a follow-up question I know that my local GP practice I live in the rural part of Surrey lost two GPs in a row to the urgent care centre in Woking because it was a much more lucrative contract for them so anything you can do in terms of a shared contract whereby there is an expectation that there is maybe outreach work you spoke earlier about continuity of care so if there is outreach work to those particularly those more rural practices like Hazelmere that we've already heard about yes and no I suppose the question is why are GPs wanting to work outside of general practice and I suppose it's but maybe having a nice mix whereby when they're back in their general practice role they're more productive because they've had a slightly less pressured job in the UTCs I kid you not being a GP at the moment is quite tiring at times It's me again thank you where patients arrive at the UTC and it's felt that they should be dealt with by another service or centre how will you make sure that any put the patient to a disadvantage So we will have an integrated system to understand where demand is Trapped up to a UTC and I couldn't be treated there you tell me to go somewhere else Yes but we would do that in an appropriate way so rather than some instances Thank you I'm just going to come in there with an extra because transfer is also a physical location so what provision from one location to another So at the moment we will talk to local public transport links etc we don't commission more challenged in terms of as you say the location than in terms of where they are I was thinking of a 95 year old lady who is not in a state of being able to actually take herself No absolutely this is about engaging with the various partners that are there so whether public transport whether it is a separate type of transport we will work with partners in order to come to a solution it's not something that we commission and provide at this moment in time separately Thank you Councillor Evans Thank you very much I'd just like to ask will the UTCs have full access to all the necessary data across the different services GPs ambulance and how will this work in areas where you're right next to other authorities I mean like for example very close to West Midlands West Middlesex Hospital or Hillingdon will you have access to their databases as well or not I'll do it again so all of our providers within Surrey should have access to the Surrey care record so that's all residents living in Surrey should be on that one portal will be those boundaries Sussex London South West London Hampshire again it's really about how do we ensure that whatever we're doing in the UTCs is flowing back to the patient's own practice or medical records so there's a seamless journal in terms of their journey and that should be seamless anyway so all discharge notes should go back to their own general practitioner that then gets fed back into the NHS app but also it then feeds into Surrey care record but the point you're making is how will we have access to their medical records I would say this is where the NHS app will actually be really helpful so if a patient does have the phone and they do have the app on their phone any clinician can access their medical records if we've got access at that point in time This is perhaps going slightly at a tangent I'm sure the chair will allow me what happens if somebody comes into UTC for whom you have no records at all they may be a tourist or they may just never have been registered in the system they've come in needing care and you've got really no idea who they are I know the National Health Service will still deal with won't tell them to go away but I just wonder how you cater for that So we have certainly if I can take the more localised patient that's on a border for example we operate a process which we will assist them deal with those patients and put them on and then understand from there what we do re-process that's been since you know since that's a process we have the difficulty is reclaiming often that cost to the insurance issues and others but that's a completely different session I would suggest we can go for ages that's alright that aspect of NHS finances is I'm sure particularly exciting I believe Councillor Helen has a question on the same area as well thank you yes good good morning to all of you it was a very interesting presentation and really helpful now I represent an area which is the very southern part of Surrey East Surrey Hawley and the villages in the south and our UTC is Crawley Hospital which is part of SASH it's been in existence for quite a long time was a walk-in centre and now is a I think it's an UTC now so a lot of my residents would go to Crawley with an urgent treatment are you saying they wouldn't have our records in Crawley because it's not part of or do they because it's part of SASH which is part of Surrey Heartland ships going to be sorted because it's it's it's as Robert was saying in the north it's going to be the same issue on all the borders they're going residents walk consistent users etc or people that come to UTC if they go to Crawley it's exactly the same process that we would adopt in terms of going into a single point of access and pushing those things through so there may be a little bit more of a time delay in terms of getting some of that information through but nevertheless they're a process patient time sensitive and patient care sensitive if that makes sense I mean not least because of the Gatwick airport you know the public transport system favours you know those southern really patients across the borders sorry I'm so assured it's not as though they haven't got anything on their plate right now is it right thank you it is it is it is it is they'll just go to the emergency department which is already clogged up beyond leave yeah and it is about the communication process to you service provision to you so thank you yeah my selling point to the Bracknell minor injuries unit is it's got free parking councillor councillor Abby King thank you and I second that about Bracknell living in Angleville Green it's one of our closest ones as well just on the bookable appointments and it was really helpful to have that case study I think it was that the child and how that would work in practice I'm a bit of a data nerd so I just wondered if you had any KPIs or anything meaning that you're going to measure that wait time the answer is yes so there's an integrated system at the moment where you can imagine this number will be identified based on the data that we have so it won't be the whole of that session if you will because we still have to account for the walk-in type activity coming in I'd like to understand a little more what the benefits and the challenges have been for Surrey Heartlands in working with local partners and stakeholders specifically to develop the current MIUs and the walk-in centres and turning them into urgent treatment centres particularly interested in the standardisation and improvement of availability of services that are being offered thank you you know equipment diagnostic equipment etc so we understand in the process of the designation process that we're going through with regions there are Councillor Helen Clack yes I think when you're setting these up and it sort of relates a little bit to what I was saying earlier but generally you have to consider the public transport system in the area don't you and I mean have you been working with sort of the public transport operators to make sure that a similar time to your clinics being open and are accessible I mean I'm quite concerned about you know particularly rural areas for example how patients can access the UTCs in the first place but where there are bus routes and other times of public transport is that something that you're taking into account when you we're going on to messaging specifically regarding carers I think you all agree with me that we do need clear messaging just to make sure that carers or residents understand what choices there are because their time is often extremely stretched and I was just wondering how you're going to look at this are you going to produce leaflets or any other communication use the social media platforms or even your local counsellors to help spread the information more widely within sorry I think you've already touched upon that in earlier conversations but I think it's specifically regarding the unpaid carers that I'm interested in thank you thank you so we do have good links with the caring community through the carers partnership board and in developing this campaign I would absolutely want to engage the board so that we get that kind of communication right that we understand how to best communicate with that really important cohort of people and I think we absolutely recognise that you know I said before we won't just do digital online communication we you know old fashioned leaflets prints advertising is really important and I think occasionally it has to be repeated and repeated and I think that's what we recognise is that sustained communication that sustained campaign that we need to do across all those different media closely with our voluntary sector community partners and so on but I think working with the carers partnership board in particular to understand the best ways of reaching and and thank you chair my original question was going to be along the lines of how are you going to communicate the changes to residents so so that they understand the range of services and what the best route is into the health system which is there in their particular case I'm going to change that slightly because obviously communications has been discussed a lot today and there have been lots of solutions I mean Councillor Goodwin just mentioned unpaid carers Councillor Harmer mentioned using us now I've been on this committee since 2023 sorry no 2021 I believe and we have always offered our assistance with communications now I've kind of looked at what you've just put up on the screen and you've got I'm going to have to say it you've got some very old stuff there using doctor's waiting rooms now whenever I don't go to the doctors very often but when I do there's nobody in the waiting room nobody's watching those screens if you don't use us you're not using community groups or not that I can see they are there there's no innovation in that communication plan and I would love to see some of that I mean there's a lot of expertise around this table which is just one forum about communicating with our residents because we know them very well and I do have concerns that leaflets in centres which is another of the options up on that list if you don't go to the centre how are you going to get the leaflet a lot a lot of my residents they don't look at anything that you're putting out until they need it and nine times out of ten what they do is they go on to Facebook and they say how do I do this I need help for my child and some other individual on Facebook who hopefully knows a bit more goes okay go to this website go to that website but if you haven't got the website then we'll take them through it do you recognise what I'm saying as an issue I do recognise what you're saying and I think the first thing to say is if we're not using you in terms of helping us with our messaging then we should be and I'm looking across the table we're not so we have started to really think through recently about some different channels and you're right my doctor's surgery doesn't have any we do have the panels and actually where I actually don't live in Frimley so sorry about that but you know we do have the panels and there's quite often quite a few people in our waiting room actually but I digress so I think we absolutely need to learn what we're hearing and I think we would be very great I am very grateful to your offer of support I think we are starting to look at some of those social media groups so next door as an example it has really good take up with our messaging and Facebook and Facebook in terms of social media platforms it's a little bit harder to infiltrate than next door it's much easier to put our own messaging onto next door so I think your reach in all of those local community groups will always be greater than ours and hence our other local government colleagues as well so we do need to do that and we will try and we do need to be more innovative you're right and I accept the challenge I think that word of mouth is really important so we do actually go out to community groups and we do have some good connections with community groups and we probably need to expand that but we are developing some really positive relationships and we need to use those as well but we also need to utilise some of the council engagement community link officers and those kind of people but we have tried to engage actually with them so we need to perhaps try harder but we have certainly tried to use so during the winter we definitely looked at all those groups to try and get our messaging out wasn't always successful but actually this time we want to put a bit more this needs to be a much more sustained campaign and I think testing the messages is going to be really important so I'm very happy to have a chat with you separately if that's helpful so thank you that would be very useful I mean it's just adding other avenues into it and it's about evaluating those avenues isn't it absolutely because we're going to go on now my next question relates to measuring success in providing patients with the knowledge and understanding of where they should go this is particularly important while you're in the transitioning centers towards the full UTC model so again what communications and marketing is there anything specific to that situation to in terms of evaluation and monitoring do you mean no that's on that's on communications again just how are you going to see what is important to everybody whilst you're in this transitioning phase so I think we need to work with our partners and we need to understand what people are telling us so using insight to inform how we communicate so measuring locally and I think that's where you could also help us in that first instance so if we're starting to put out messaging we've got to be really careful how we do this because and this isn't by no means I would love to do a really big campaign and really get people to understand how to use services but we know that in the very first month or so the UTC is going live they won't all offer the same crafted but I think in how we do that and how we work with some of you around the table in sort of I think we can work with you to really understand how some of that messages is landing and then we also need to look at the update in the centres themselves and actually go and ask people and talk to people why are here how do they hear about it and I know Healthwatch have done some of that work already or they do that work on an ongoing basis but we do effort where everybody is talking to each other okay so final question for me your report refers to the activity impacts being monitored in the initial phases following the redesignation to ensure that the expected shifts are within the expected levels and to monitor the impact of the communications and engagement work that will have been undertaken ahead of this phase of the programme so how would you how will you understand how well the service is working and will you monitor the statistics in any way that shows you data on peak or slower days I was mentioned in the slide earlier but how so I think there are two things there so I think there is trying to evaluate the impact of the communication and I'm going to be really honest here evaluating communication is really hard and I talk about this a lot with communication colleagues in other parts of the country it's really difficult but there are some things we can do QR codes and access to websites it's a quantitative measure but it is a measure so we can do a certain amount of that and we can certainly as I've just said we need to go to centres we need to talk to people we need to understand how any behavioural change if it's happened how why are they there were they referred into the service or did they come through from learning about it in a different way or would they have gone there anyway there's all sorts of answers to that question so I think we absolutely want to do that and we intend to do that but it's not a finite science and I don't think I just know through my work it's really difficult to really understand but we can get an idea by doing all those things and then I suppose I think part of your question referred more to evaluating the service itself which I'll hand over to Rob I place place level and then the assurance function where my team pick up is to thank you for that response to Councillor Mawson it really brings to mind I think that we need to measure not only do we need to measure we need to set objectives measure whether those objectives are being achieved and use the measurements actively to take corrective action when necessary one area that I would really bring to fore is around digital exclusion this is a large and complex organisation with many parts and many entry points some of which lead somewhere and some of which don't and it is really hard for people externally to understand so it is going to be very very key there are two parliamentary select committees both in last year talked about exclusion and the effects of exclusion and also that actually health inequalities tend to be concentrated in those groups who tend to be excluded for one reason or another as well so it really has to be a point of focus so I'd really like to hear what you actually doing I can use an example with renal units it's massively important that we have anybody that's in a newly diagnosed dialysis that you would want the patient to see is this me in five years or ten years time so we work on that basis as just as an isolated example to cohort patients not just the physical act it's also the very elderly and those who aren't technically savvy to actually use the NHS app maybe don't even have a mobile phone and you have to actually somehow pick those up it's just that I think residents will look to see what's most convenient for them and then get transport to or drive to or have free parking at as the chairman said these things will all be considered it would be great if you as part of your promotion of this developed I mean obviously there are people who don't use digital platforms but there's an awful lot of people who do and certainly things like kind of map or even working with google maps and saying where would I go where's the nearest place that I can go to to get treated now rather than you know so you've got clear directions and then you can sort of drop down and say can I get this done here or shall I go to pharmacy we talk about community pharmacies in your paper you know they're really important how is the take up you know then how can we encourage more people to go you know to a pharmacy and not get there and be told well actually you need to go to hospital you know that sort of thing so it's about mapping and offering people opportunities to go elsewhere once they've gone to a place and been treated I think you've got them hooked haven't you then and they'll go back it's that you know opening up these new centres it's getting the patients to go there instead of the EDs all the time it's very much about making sure that people access the services and don't end up not accessing them for an outcome I think you make a very good point Councillor Clack and I think how we do the comms will be really important but I think there's also a wider piece that we are very cognizant of and looking to do in terms of we need to get people to have trust and confidence in the NHS more broadly so some of this is about direct comms and marketing about these centres and wider services but I think there's something else around looking at those more disadvantaged groups and our priority populations and how we engage with those so we also have it's not huge because we're not a big team but working with our voluntary sector partners I think it's around engaging some of those groups and communities to understand more about the NHS as a whole so this is part of it but it's that wider confidence and I think we've got some work to do there but I absolutely take that challenge because it's really important to do moving forward you've just touched a point which I was going to elaborate on in fact communications isn't about broadcast it's about dialogue and how do we create the right forms for that dialogue and the other thing my colleague Nina has just joined the chambers who will be talking about the digital primary care stuff but it's about user experience and making sure the tools that we procure are easy to use and they're simple and they're not complicated and I think that's one of the things that we have to make sure we get right and working with our residents and our patients and service users is going to be critical to that success I think we're done with the questions for now so thank very much for the presentation and all of the time and effort that you put into answering the questions I think we're now on recommendations and so I'm looking around anyone that wishes to join in on this okay the recommendations that we do have well first off is the obvious one that the ongoing work of the Surrey residents we recognise that further work is planned across Surrey Hartlands ICS to continue to develop the urgent care pathways and to provide the most often care system to deliver the best outcomes but while we do also recommend that measurement and Republic reporting of that measurement is very much on your agenda we we see we see that as vital to show that there has been an improvement that you demonstrate it and so where things don't quite work out as planned as with every plan then how you're going to make those improvements needs to be something and then I think Councillor Victoria Wheeler wants to weigh in here and probably Councillor Robert Evans I suspect as well and thank you with no wish to delay people any further I think the second one needs to be split into two parts because it's one very long convoluted phrase which doesn't quite give the desired impact doesn't have to be done now together but I think it just needs to be split into two recommendations rather than one long one with and and and and and and and and yeah I consistent and grammatical and then we'll approve them around the committee and send them on to yourselves Chair I just wanted to just say before we go to say thank you for your thoughtful comments and questions because they're really really helpful but I think just reflecting on some of the conversations we've been having today around staff around supply side and experience I think two really important KPIs moving from this would be patient satisfaction and patient experience workforce experience because they go hand in glove and I think if we can measure those as well that would be amazing yeah I absolutely thank you for coming along we've liked it so much we'd like you to come back in a year's time as well tell us how it's gone okay we're now going to take a short 10 minute break and then move into the next item second major item which is item 9 on the agenda managing demand in primary care and particularly using new tools is gradually being rolled up in friendly title I've got on the paper in front of me says AI tools but I understand it's not really AI it's a logic model as opposed to AI so let's be correct about this but I think access to primary care making it simple and easy has got to be the one thing that I hear most about in my complaints about in my postbag of patients who have been asked to do things that they find difficult that they don't understand why and that they're faced with an awful lot of computer says no so I'm really going to listen with interest to this and I think you're going to get quite a few questions so over to team friendly I hope some of those questions help us think about how we keep developing our messaging as well so thank you I'll also note that we've got Dr. Mark Pugsley remotely as well thank you in some ways a fat side of the fence as it were as a patient yeah by all means how's that okay I don't actually practice in Cambly I actually practice sort of over the border in Blackwater and Yately which sits on the sort of trivium of three of counties Berkshire Hampshire and Surrey but in my role at Frimy ICB I am in regular contact with my colleagues such as Mark and David Brown and Farnham of course and everybody is on the same page as it were with the sort of direction of travel for primary care and that is something that has been enshrined in the latest revision to the GP contract as well everybody knows that we are under increasingly relentless pressure and it really is the worst of my career going back to the 20 odd years I don't think it's fair to blame increasing patient demand entirely there's a lot of issues as it were accelerated intensified by the impact of COVID waiting lists a lot of focus is on the hospitals to work off their waiting lists I mean if a referral made to dermatology for example might wait 14 months and you can imagine that if a patient is being looked after in primary care whilst they're waiting to see a consultant they may interact more and that simply adds to the workload you'll hear Wes Streeting talking about a left shift into primary care the idea being is that more work is being done outside of hospitals and I welcome that I think that's a great opportunity and I think we know that patient satisfaction can be enhanced if they're cared for close to home and it's sort of convenient but we do need the resources to follow that so we have to be clever in how we manage the demand and in order to do that I feel it's very important that we achieve consistency of access regardless of the channel used whether it's a patient going online telephoning surgery or simply turning up at the front desk and I think it's fair to say for all of us it's work in progress it always will be perhaps the controversy around online consultation is similar to the controversy that was around telephone appointments but we've been using them for decades with some success and some convenience and I think whilst we've improved access for certain groups we need to work on the access for certain other groups so I think those that are benefited are those who are of working age with young families who can have what we term an asynchronous consultation so they can put their concerns down through the portal and we can answer them we can ask more information photos pick up the phone any of those things and what I particularly like in my practice is the ability to be able to tee up investigations point people towards resources for them to be able to help themselves divert them to the pharmacy because that really is ramping up its activity and I think above all giving that sort of power to the patient to be able to look after them themselves as much as possible and we're there to support them for anything that they truly need from us now I recognise that the distinction here is between patient needs and what the patient may want and there is a perception that the service is failing because it's simply not meeting what the patients expect of us and that's always going to be difficult I don't think it's anything we'll ever solve I recognise I think there is work to do in the way that we handle online consultations and we will continue to do so it's a sort of cycle of development something which has been going on since before COVID of course COVID accelerated the essential use of remote consultations but it was something that was already happening as well any questions or thoughts so far about that or anything you'd like to add sorry I think what Carl is describing is that the foundation of what practices are doing they're trying to find ways to meet the need bring patients along and what we have seen is online consultation is at me we've got an evolving market of capabilities that allow practices to make sure the right tools support their model their capacity gets released to where they need to best support patients we know that there is patient need there is patient preference differentiating that is sometimes quite hard so having the equity of no matter where you go you will have the same story that we will have as much information about you to reduce the number of touch points in the practice is all being supported by the new digital capabilities coming in and what we're seeing in Frimley is we're not being overly kind of we can't standardize everything every population every practice is slightly different in what it has but we can make sure the consistency is there our practices are able to choose the best tool that supports them in doing that and then the approach we've taken is how do we make sure and it's a work in progress as Kyle said that we take our patients on the journey so we've and the paper summarizing the high level steps we've done starting at a really global level of every patient knowing the change is coming when you've introduced something then being able to do really targeted bits of engagement and comms and training because they're all an engagement and a conversation with our population so we've sort of trying to bring everyone along so that they understand and hopefully we can explain that you will still have the same experience you'll still get to where you need to these aren't seen as barriers but we also use these tools to create the capacity to see the patients who can't come in by our other route the right clinician for the patient or not always a GP wider workforce and having sufficient information about the patient to make an informed decision at that point so I think that's sort of where we're at and that's hopefully summarizing the paper so I might just ask on the next slide if that's okay and it's a really high level the thing that we didn't touch on in the paper in detail was some engagement that's been happening so there's every practice had a cycle of comms engagement using all the possible routes to communicate that out some of our practices held face-to-face sessions so had I think Park Roadmark had about 60 patients over two sessions come into the practice to really break down the worries because we know you can't do digital engagement for patients who can't come in digitally right so bringing them in face-to-face is really important our practices have tried to embed regular ways of feeding in and also feeding back how we've taken on board the feedback and we are hearing really positive feedback from and there's a graph at the bottom from one of our practices that 50% of patients who use one of the tools will hopefully use that route when it's appropriate and you've got patients who can then be seen who probably couldn't get through the phone because everyone else was on the phone as well so it's about just creating that capacity and we'll stop there for a second I think it's mapping out that we've done lots of bits and it's still a journey we've got to keep tailoring our conversation as a guy I think also one of the things that's coloured the conversation shall we say in the last few months has been the industrial action by many GPs where they've rationed services cut down on how they interact with patients and things like that I'm very hopeful that the newly agreed GP contract and the that's gone in makes a big difference but I think it's generated a situation where many patients are feeling very dissatisfied particularly they try and go and use the e-consult but it's only open for half an hour of the day and that sort of thing is to get over just to pick up on that I think and to be a slight pedant I'm not a politically minded person nor am I a member of the BMA but my practice with action and it's important the distinction is that it wasn't industrial action in fact we didn't go on strike okay yeah the GP that I talked to referred to it as industrial action they shouldn't be doing so it's actually when you look at it it's working to rule it's simply interpreting your contract to the letter I think my problem is that there's a couple of things that have happened I think the media does tend to propagate the problem to an extent because it's creating the language that we use as currency in these conversations such as on the radio and that's across all channels of the media I'm finding as well the advantage for me sitting in my practice is that I can visualize the demand so that I have a dashboard that will show categorized by severity those patients that I need to prioritize so it's not simply fastest finger fast on the phone in the morning it's fastest finger first on the computer perhaps but at least there's a chance that we can put the so-called green rated cases to one side and focus on the reds and the ambers the other thing is and I encounter this challenge from colleagues in the profession is that this is going to take away continuity and I argue the opposite that we can't achieve continuity for everybody people need continuity of care and access to care continuity becomes very important when you've got very complicated patients and they just become the sort of three pipe problems and they're actually the ones that are in some ways the most challenging but the most rewarding to look after and they absolutely need the continuity whether it's with the GP or with the specialist nurse for their sort of dominant conditions such as diabetes or heart failure or the integrated care team paramedics and community matron mental health workers all of those are co-located in one of our sites and it almost takes me back to the good old days where I could simply wander across on my way to coffee and bump into somebody and have a chat about a patient that I'm concerned about so you know that's complementing the sort of digital access that we have and that we're providing so the other analogy I think is an important one is that of the bank manager if you in the old days when you would write a letter to the bank you'd address it to the manager knowing full well that he most likely wouldn't be answering your inquiry it would be fielded by the most appropriate person in the organisation and I view this as an opportunity to do the same and for that reason I think the language needs to change subtly from the return of the GP as it were getting the family GP back or if there's a problem and it's talked about on the radio or on the telly you know if they rounded up saying go and see your GP about this they should be saying contact your surgery about this and it's just a subtle change but it kind of helps adjust patient expectation and one thing I think we're learning from online consultation is that sometimes in its eagerness to appear as straight away and we simply can't do that we have to prioritize so I think the project for us and certainly my own practice is to manage that patient expectation from the outset and say you know we know you've contacted us we're going to have to pardon if there's any sort of further concern contact us if you're worried your condition is deteriorating or we don't fully understand and I think trying to sort of enable that sort of dialogue I think is terribly important Mark's coming in sorry Yeah could I just hello hello everyone could I just come in to the point about e-consult you mentioned Trevor that e-consult wasn't switched on all day at most surgeries there is a proof in that it depends I would think it did depend on the surgery but this is one of the joys of rapid health is that we're finding because it offers appointments to patients we can leave it on throughout our core hours in fact many surgeries are opening it ahead of the eight o'clock scram so that people can before work go online and access appointments so rapid health is proving positive in that respect that we won't have this lottery of when the digital front door is open Yeah thank you and one of the things you brought out Carl is actually the there's a range of people in a GP practice and I think this is a message very key message to get across to patients it's that it isn't just a case as the GP you know we're not actually in the you know 1950s service where it probably was just the GP you know things have moved on somewhat but I think the other thing I've just picked up and it's something we have to think about as well as every practice is on a different transformation journey so the model mark has been able to achieve has taken time but it's telling patients what we're trying to get to at the end of it so I think part of what you've described is people think it's an incremental or the change we're putting barriers in what we hear is we're not being consistent with our story and we're building that because it takes time and I think Rapid Health and the story in Surrey Heath has been a really good example of trying to bring our patients on that bigger longer term journey with us One of the other things you know that again we come across all the time is you know unequal access the problem being that those people who struggle with IT and access to IT to language issues to literacy issues tend to also sadly across Surrey patient experience when meeting at the front door is not always the same some receptionists are more helpful than others some people answering the phone are more helpful than others there is a massive culture change thing that you know has got to happen internally as well Hi yeah so just picking up the point about that access experience one of the areas and concepts that we've been very keen on within Surrey Heartlands is around that channel agnostic access and Nicole just talked to some of that that area a large part of some transformation work that we've been doing with GP surgeries across Heartlands over the last two years we started it last year and it's continuing now is to have face-to-face workshops and to really engage with the GP practices and to get them working together as peers to really understand some of these challenges and actually when we were having the conversations in the first round of these workshops that we held last year patient communications was a key challenge a key area of challenge and and and also opportunity that they were keen for us to support them with and and focus on and coming out of that work we've been producing and I know friendly colleagues have similar is is communication material that the practices can then use so we're now hosting that on a central platform that the practices can can download and then share on social media template messages that they can share and and template a newsletter content those kind of items really just to try and help support that messaging we're also continuing that with some more we're procuring some social media support so some pay for resource that will produce materials really picking up those points about the new roles and and the opportunities and benefits that they offer patients and and you know likewise to Carl's point around patients that have got more complex needs really focusing on the benefits to them and the continuity opportunities that come with this new channel agnostic access so when we assess need actually for a more complex patient when that request comes in they can be supported in a different way to someone that hasn't got any complex needs and might just need support for an urgent acute issue so it allows that flexibility the tools allow us to manage things in a different way thank you and counselor Abby King yeah I think sort of largely covered and what I was going to talk about but just moving on to sort of the specifically digitally included populations and how we how we can help them access the support and come in on that one if that's all right so I think part of it on this frame it is I think I think the assumption is always we wait until a patient hits and can't hit and there's problems and they have challenges trying to get in but Mark there is work that we do practically on health inequalities isn't there and reaching out to those sort of populations do you want to touch on those a little bit yeah absolutely there's a lot of work going on around health inequalities we've got an awful lot of data so we know exactly our patients and we know their postcodes we know everything about them so we can we can reach out to them in different ways we can be proactive in some of our approaches we've got an approach to health care alongside the reactive you know patients contacting us which is a population health approach so we can absolutely reach out to cohorts of people and we're going to be doing this over the summer with blood pressure across Surrey Heath so that we can take the work out to people where they are having trouble accessing so absolutely we know we know so much more and if people can't use digital then the front doors of surgeries and the phone lines of course remain open and in fact what we've done at Park Road is we am at the main site is we've created a small room where patients can go with a receptionist and we talk through the rapid health and come out with their appointments so if people are struggling we will help them as to the best we can either on the phones or in person and and just to say we're having a lot of converts a lot of people who thought they couldn't be digital are really getting to grips with it and it's perhaps surprising themselves so it's it's a very big learning curve for people and we're taking them on that journey and there's another practice in Surrey Heath who have sort of been using like exactly what Mark has described for in his practice for someone you get a complaint or someone who's unhappy they're making sure someone contacts that patient has a conversation with them and they have seen just having a conversation taking that tailored training approach has actually converted them and building the confidence and sometimes it's not the you have the genuine inequality and inaccessibility but the confidence is just as strong and having that one-to-one for the people you can alongside the global stuff we've done for a really nice story and that's why we've got these staggered go lives we can keep taking the learning from one and the other and so yeah I'm really encouraged to hear that sort of one-on-one training is happening to actually pick up on the people that are struggling with it and it's a really good thing to be doing get the more converts you get the easier you'll give and find the whole thing Councillor Robert Evans I was going to say if I could just come in very quickly on that it's a follow-on I'm waving at you Trevor and we've talked about a lot of digital inclusion with our patients what are you doing to ensure our GPs are able to deal with this appropriately I will share a very recent experience with a practice nurse who was running an hour late because she was not digitally able in any shape or format and obviously had not received appropriate training or had the appropriate skills to be able to record in a digital manner the other thing as well is that they have a lot of forms you said there's a lot of forms that are coming in for them to review how are you monitoring the impact of that on the consultants consultants workload I appreciate there's a quick rapid triage but I should imagine the pile of no immediate action is growing on a hour-by-hour basis so how are you managing that and how are you monitoring the impact on our GPs and their workload I can speak from personal experience because the population we serve is just under 30,000 in our practice which is three sites formerly three separate surgeries but we merged over the course of about four or five years and it's fair to say that the aptitude for digits between the doctors in my surgery and the nurses and we freely admit that and we support each other we have a fortnightly clinical meeting which increasingly involves hints and tips and how to use this I mean we've all been using digital clinical systems for many years and they've not changed for most practices in all aspects of practice including operating the computer and and the other advantage of collaborating on our experiences with this is that we can start to set up the sort of standard responses if you like which are way more comprehensive than I would probably have managed in 10-minute consultation I mean I can't be the jack of all trades I'm not a master builder I do need my team around me because of the 10-point plan on how to use their nasal spray or something like that it's very helpful but there's a key difference between rapid health which tends to sort of almost automate the clinical triage process to a point it's very very risk-averse and the system that I use which is called Anima which which actually makes it easier for the admin staff and actually puts more time aside for the clinicians to be triaging and that's where I get that I'm a little bit of a micromanager so it suits me very well to be able to to see right okay this person so it's not an emergency but they need these tests done and I can just manage everything I can and I can also think well they've got diabetes as well are they due their check let's try and get everything done together in one go to make as most as we can out of that single interaction be as efficient as we possibly can but what I'm noticing is amongst my 18 doctors there are some that are absolutely on top of it that have got access to be hopefully a bit more proactive and it's a slow process I'd say there is a need for the profession as a whole to embrace the future and the training required I was gonna say we've not how are you monitoring burnout we do regular appraisals for our colleagues we look to see if because we have a global view of each other's tasks and if they're mounting and mounting and mounting we can take somebody aside and say look should we block out an afternoon for you to be able to catch up with your paperwork and things like that so we're trying to be as proactive as we possibly can again coming out of the pandemic has been extremely high pressure for us it's all what was going on he was actually amazed by by how busy we all were so yes it's a very good question and I think it's probably something which doesn't necessarily come into what we do in the digital the the same change curve the confidence credit about our patients that's also what our staff need and we are now starting one we know if it comes top-down some workforce off so we're starting we're creating space for peer-to-peer engagement learning about the change we didn't sorry Heath was and create that space to kind of share experiences things that went wrong the space thing that you worry about sometimes the peer-to-peer things really strong as well but we are starting also to kind of understand what the next level of development in terms of digital literacy is for our workforce and because things have changed the same journey we're describing for our patients has changed for our our workforce so how do we map how do we capture that how do we share some of these what went wrong what went right word how do we build the confidence there's a bit of what we're looking at something to burn out but that bit and then we are trying to do the exact same thing probably a little bit slowly off our patients for our workforce as well so how do we just create that program of support but we are hearing the peer-to-peer bit is one of the strongest things we can do in that space I actually you know I take the view that some an empty waiting room is a sign of a properly managed system where patients are seen at the appointment point in time because I'm always reminded of growing up in the 1950s and the doctor's appointment system consisted of going into the waiting room and sitting down whatever vacancy there was on the end and as one patient was seen we all moved a long one so yeah I'm quite glad that times have changed on that one because sometimes you could be sat there for hours I think Helen Clack's got a little thing and then Robert wants to come in as well so Robert can we move on for the next question I mean I obviously I don't remember the 1950s Trevor so it's interesting to hear your nostalgic trip down memory lane there um Councillor King doesn't remember I don't quite remember all the way back to the origin the the origin origins of the NHS but I was born just four years after it started so I kind of um oh come on right let's move on come on come on come on let's have a bit of order here right um uh I understand that that I've read all the the paperwork that the rapid health is a sort of automated triage and workflow system um but at one stage it says uh use our intelligent software but it also says it's not going to learn it's not artificial intelligence um how are you going to make sure that the patients understand that you know some patients will be concerned about using something that's um taking details on how are you going to um make sure that patients are clear on that and Gurpreet you said that different places are on different stages in the journey uh and uh Dr Bennett you spoke about in individual GP practices how some GPs are further ahead and others how are you going to balance the fact that it looks to me as though that some practices will start using or be using rapid health and others won't how are you going to marry all those two together Mark shall I start and hand over to you for some of that or do you want to start you know surely go ahead Gurpreet I think um I guess my view is it's we've got to make sure we keep talking so one of the things that is happening is we are learning so this is a big change I think that's one of the reasons we're having this conversation it is a very large change for everyone so taking a very considered staggered approach means to take the learning get the messaging right and I think the work in Surrey Heath in particular has tried to paint patients it is the entire um sort of shift altogether where we're trying to get to um but just and I guess I'll kind of hand over to you Mark but one of the artificial intelligence versus intelligent bits is being really honest we've also got a it's a marketplace suppliers are quite um it's their branding so we are feeding some of the challenges you have back to our suppliers as well so I think one of the things here is we are also holding our suppliers to account to make sure we don't have mixed messaging that we can be really consistent because we have patients who will google because we all google in our day-to-day lives they will look at what they're talking about and so we are making sure that we use this feedback back to our suppliers and all of this as well goes back to again while we're doing a phase rollout but Mark I might hand over to you more around the wider sort of approach if that's okay yeah there are there are seven practices in Surrey Heath and the phase rollout was also working with Rapid Health so it was a manageable time frame for them so we started in December um another practice the sixth practice comes online next week and then the final one the 25th so all seven practices will then by the end of March be at the same at the same position with you with using Rapid Health um as their digital front door um having moved away from e-consult so but that was just working with the company to be able to allow the logistical time frame to be to be right and to also do that learning as we go as well um and there were early adopters and people who are slightly um the latter few practices um it's proving very popular with the clinicians of Rapid Health I was just going to come back to the previous point about burnout and um when you look at what a total triage model in a practice was doing certainly in my practice we would be triaging 500 plus a day now because patients are finding their own appointments through Rapid Health that has gone down our first month's data by 59 percent so um that allows the clinician to spend more time um doing the work that is needed for the patients who can't find an appointment and that has been very popular because that is helping avoid burnout I would say as well just talk to that previous point if I can add to that I think um obviously it's great that you're asking us about the clinician's health because I'm and it so it's it's it's very touching to have that um I would say that with Rapid Health absolutely um I agree with what Mark is saying with the caveat that it's early backlog of appointments and have your books completely empty um in order to then progress so I don't know if there's a honeymoon phase at the moment but I'm very very interested to see how this is going and I'm not wedded to a particular product and actually in my position in the ICB I've always encouraged practices to to look at the style of practice you want to offer involve your patients with that and then see sort of what best suits your requirements so the the system that I use is more um sort of triage heavy as it were from the clinician's point of view but it does give me more control over the messaging um back to patients and and very simply and where we've got quick at it is you can very you know without overthinking it you can think right okay I need enough information in order to make a diagnosis or form a plan um if I don't have that how am I going to get it and how urgent is it so they either need to see a doctor or they need to see one of my colleagues um or they need to see one of us or speak to one of us and have some tests done first or we reassure them or we signpost them it's it's that simple on the face of it and as long as we stick to that then we can get quicker and quicker at doing it the other thing I think that might change is that traditionally GPs have all done the same job they might have a special interest but they kind of do the same hours they have the same patient um load it's about 270 patients per session so per half day um that we work um and um and I think it's changing or it needs to change that particularly in some of larger organizations you might have a core of doctors that are particularly good at triage and I know of some some models where you've got doctors and paramedics working alongside each other in the room together or say about four of them all on their separate workstations um discussing ideas discussing the sort of responses in order to um manage uh that effectively and there's a lot of cross-pollination a lot of mutual learning that that takes place in that and similarly other people you can't fit a square peg in a round hole they they are simply brilliant at the face-to-face aspect of of general practice and that's probably where they should be um so I think we might see some changes in the future in the way that um my colleagues are deployed um just want to ask you will you we're all familiar all too familiar with the horizon the flawed software of horizon and the disaster that created for the post office uh and the horrific outcomes there what have you got any um checks and balances in this I know it's not not the same it's not comparable you're not dealing with money and everything but you could have a flaw in the system that allows somebody who's coming in with symptoms of sepsis and I'm not a medical person at all sepsis at all but because there's a flaw in the system they fall through it have you got checks and balances or people constantly monitoring this um to make sure that it's working and there aren't going to be I mean I'm sure there will be errors and flaws but there aren't going to be major problems that are pushed aside because everyone thinks the software is wonderful um yes we do have a cycle you know we have a quality lead who's non-clinical but she sort of marshals the rest of us into into action um I think if a problem occurs it usually occurs because it's not being used correctly um so you're familiar with the phrase god um well I'm not familiar with the detail of that but all I all the evidence was people were told you're making mistakes the software there's nothing wrong with the software it's used making mistake oh no absolutely and they sided with with the with the developers on that absolutely and that was that was wrong um no in I can think of a case where um a gentleman who presented with a rash um was classified as green um and I didn't actually look at the photo for a couple of days and then discovered it was shingles and shingles is a rash which you need to treat as soon as you possibly can usually within 72 hours no harm was done I still got a mistreatment within the 72 hours but I was looking at it thinking why was it green and it was to do with the information that had been submitted was was quite generic was quite general in that respect but the fault was on me and not with the software in the and what I've been doing since is say I've got 20 to look at I'll zip through them all very quickly just to make sure that the the red amber green rating is is accurate um I'll reassign it if necessary and then I will start on prioritizing um as well so there have been cases where um people filling in the forms might um underplay their symptoms because they don't want to go to any or to call 111 and the software is simply responding to the information that they provided so again the software isn't at fault there it is very much about the information that is put in and I think an area where um we need to achieve absolute consistency is in the best case somebody can put in a wonderful amount of information and the system I have gives me a sort of AI summary um with a list of sort of possible causes some of which I might um pull uh somebody who might have um exposure to carbon monoxide and it doesn't often occur to me that if somebody's got these breathing symptoms or difficulty of concentration I can simply ask well when was your boiler with that um um identification I think I would say that rapid health is very risk averse just just to come in it is very risk averse um and patients do have the ability to um reject the outcome that it offers them and we as clinicians can see all the um use on our dashboard coming through so we're able to see if people are being sent to A&E and we can even then ring them and and suggest a different pathway for them uh patients can over override the uh uh offer of going to A&E by saying that they're not that unwell at that point and then that will that will flag up to the clinicians so we can then help with the triage so it is quite it is quite risk averse um and we found that within moments of it starting that it was it was being very appropriate with a number of patients I think as well I think markets it was a really considered move wasn't it as well as we did our kind of you've reached out to the practices who were live there's been loads of learning in every setting so being able to look at dpias like understanding how they handle the data creating the space to keep looking at things as they were going live as well so where things like the quality conversation mark and carl from you guys as you're alive there were conversations to look at cases that probably aren't as like just sense check ahead of time and also understanding all the ig elements of it where data is processed how it's processed what other systems may have had issues just to really learn from it again so it was a really considered approach so putting that data security data in front of everything else as well absolutely there's also within there's also within rapid health if I could just say a button that the clinician can advise a different outcome so we can tell the software what we did with the patient that might have been different that we contacted them or we did something different so in that way there is feedback going through the software as well it's not AI learning but it is clinician informed changes that we are giving it in that live environment every day okay counsellor abby king yeah just to come in very briefly on that point as a woman it sometimes happens when you present with certain symptoms you're automatically presumed to be you go down the pregnancy on your period etc pathway and things are often missed or misdiagnosed i just wonder how you can prevent that happening with with the system i guess you have sort of briefly touched on that there um dr foxley but um yeah any any thoughts on that i i think obviously the system is dependent on what information it is given and how the questions are answered but um at the end point of the rapid health journey for a patient if they're not being offered what they think and feel is the right thing um they don't have to take the appointment and they will come through to the triage the human being triage and we can then contact them because we now have a bit more headspace uh within the triage room uh we can contact them and and and have a further conversation and get more information so um in that way it it is allowing the clinicians to doing the triage more time um to to take them on that journey as well so you don't have to take the appointment if it's not something that you feel is appropriate it's with the wrong clinician it's not with someone who you wanted to see then it will come through and we will we will look at what we can do to help are you asking a slightly different question that sometimes it might just take you down the wrong direction and and that you sort of think oh gosh i've got yeah and i did have a comical about chlamydia but he had a painful knee and every single question was i don't have chlamydia my knees and it sort of went on and on and on it was poor guy i rang him up and we had a good laugh about it but i mean when it works well um it can save everybody time um in the sense that if i've got enough information to get me at least 70 of the way there i've only got to ask a couple more questions and actually the patients feel more valued if i acknowledge the fact that they've gone to the effort to spend half an hour in front of the computer filling these things in there's just a couple of things i'd like to ask and i know your concerns are um the technique used in general practice which is sort of discovering people's ideas concerns and expectations and that's very very important starts a very honest conversation earlier than i might have managed face to face um the other thing about the sort of asynchronous nature is that somebody might sort of build up the courage to reach out about a problem that they are very embarrassed about um all sorts of things and you can imagine what they are but they kind of sum up the courage i can only imagine what it must be like to ring up and try and get an appointment to go and see somebody face to face and yet to do it online it seems so much easier and it kind of breaks the breaks the ice and i think that's one of the things which we've seen more uh people approaching us about you know sort of vaginal discharges or rectal bleeding or whatever but all of which may have profound health consequences not to mention the psychological aspect as well um so i think one area in which we can help the residents feel more valued and supported is acknowledging the effort they've gone to to provide that detailed and in for us uh nina in a in a second but yeah thank you yeah things that you don't want to um you know say to the receptionist thank you chair um yeah i just wanted to flag in relation to to surrey heartlands if be helpful um just to highlight that there are four practices within surrey heartlands that is also that are also using the rapid health tool um but the majority so 94 of our practices are on uh an open text platform which it was kind of used the kind of ideas expectations concerns kind of model um that cole just mentioned which are are not using that that algorithm of tools so i just wanted to to highlight that to the committee um we are in a slightly different position in terms of as as you'll i'm sure be aware we have a procurement cycle so we procured uh this specific product which is accurate that's in used uh across the majority of surrey heartlands um and rolled that out in the summer of 2023 so we are partway through a three-year contract we're in the process of understanding and doing some transformation and learnings around how that's been going as we plan and understand what our needs and requirements are moving into our next procurement cycle and i think it's it's fair to say the market has changed from when we were doing our our learning speaking to patients prior to the previous procurement the technology available is now very different and tools such as rapid health and several others on the market provide different opportunities i think like friendly colleagues it's just about understanding what the impact of those changes might be so uh you know surrey heartlands patients are very used to having that open text approach so to actually then move to something which might be asking more questions would have an impact um and i think before before any changes were to be made we will be looking at trying to understand and test out some of the new tools that are available have an ongoing dialogue both with our workforce and the practices but obviously with citizens patients across the area as well as we move forward so we'll be happy to keep members abreast of that and samantha boxwood from healthwatch is on the line hello thank you yes i'm the contract manager at healthwatch sorry um i just wanted to go back to the earlier point um saying that this can really help people who may not want to talk to receptionist face to face about um intimate issues um but i was wondering as well for from the perspective of some people who may be experiencing domestic abuse and may be wanting to reach out to the gp practice for support and quite often if they're experiencing coercive and controlling behavior in the home that actually they wouldn't be able to kind of explicitly say that and how they might navigate a system like this to so that the door wasn't kind of closed to them so that they could that could kind of be overridden perhaps that they could um still be able to get to that face to face um appointment if they need to as we often hear that actually that will be where they initially raise a lot of concerns and i guess i'm just concerned that um this may be taken you know just at face value of what people are sharing and maybe a bit of a barrier for people being able to come forward and seek the help that they need i think that's a very good question and i think the um there are ways sometimes where um the patients may not use it as fully intended but it is ultimately to their benefit so they might sort of contact us with concerns about anxiety as such and there'll be some my interest and i might the system i use anima i can i can send them messages now obviously in that context i've got to be very careful if if for example they've got a coercive partner extensively during the pandemic um is video consultations as well um and telephone calls are all very well but i can't see the patient they can't see me we can't gauge each other's non-verbal communication um as well and i think mental health um non-verbal communication that's prevalent in a face-to-face consultation as well so how do we sort of balance their needs with the access challenge if you like um as well and i think one one sort of idea in the back of my mind is perhaps we need to sort of think about supporting practices with proactively um promoting video consultation for certain patient groups um and um it's kind of an example of if you like a refinement of the use of a tool um which we're still getting to grips with so it's a learning process um there's also we do publish on our websites um information about access to refuges and helplines as well um not not i imagine a small proportion of our population actually use our websites and we do promote them um as as well but is there anything you would add to that at all or anything i've not answered i i would just come in if i may and say that rapid health also samantha has an admin function um so we do get um non-pathway approaches from patients so if if there isn't a pathway a clinical pathway that suits their their need or gets them to what they need they could in theory just write you know i need help um with a domestic issue in an admin task and it would come through to the clinician and that would prompt us to call the patient and or to get you know help with an appointment so there are we do get a number of um other approaches through the system that say there isn't a clinical i couldn't find a clinical pathway for my need i'm not sure what to do but please i need some help um and we would we would deal with that in the same way that we would any any of the approaches to the surgery and and get hold of the patient to contact the patient yeah and one suggestion i would make here is that um the equivalent of the ask for angela in the pub would be a good thing to add to the system um no that's excellent and we can take that back to the suppliers um and uh and see i think that is okay uh counselor helen tack yes if anybody's uh there's a sort of code word isn't there in public um houses in pubs that if somebody says is angela here um receiving and you want someone some help so just to explain that um this is amazing i'm so glad you're here today actually because i didn't really understand any of this from the paper particularly exactly what you were really referring to i i you know hear what nina said about most of us in surrey uh we have the text system you know and if i want an appointment i with my gp you know i go through the nhs app and i fill in the boxes and say you know got a spot or something or whatever and you know and and generally they're very good they come back and say come and see me on thursday and stuff like that but this you know before i've done all that i've been on google and to research my problem from minor issue to sudden death you know that you get from google don't you then you're gonna die go so you really need to um this sort of idea it offers uh i think uh patients an awful lot of reassurance actually and i i just wonder how we get this out to people that this is actually happening so it's not happening everywhere but where it is happening i mean we don't have e-consult we don't have this either um but it's reassuring to know that if you fill in the you know if you go through the process and i don't know what that process is so another point might be that we would quite like to see a demonstration for example at some stage not in a public meeting like this but maybe on a on a member's briefing or something like that of actually what you're really talking about and what happens once that person has filled in that detail how is it triage you know how do you make those decisions because i don't i think that would offer patients a lot of reassurance and i don't think they know i wouldn't have known except i'm here today listening to you and thinking that actually at the moment what happens is i write in and say on my on my nhs app that i want to see a doctor because of you know i've got headache or something and then he rings me up and i go along and see him and he doesn't know or her in fact there's there's an article this morning that says most doctors are female these days um but never mind um uh so it's very nice to see a male doctors too you don't you don't think so you don't know what i'm like robert i might be very needy medically i don't know um but i just feel we should we should be sharing this with people i don't think people appreciate this i mean you know you you talked about the eight eight o'clock in the morning scramble which is still you know the appointments i i haven't had a problem getting a gp appointment for years but it's down to your local surgery or is it down to what the money how they manage this i think it would be really helpful for us to understand much better exactly what you're talking about in layman's terms i mean so um that way perhaps i think you would offer patients reassurance about how they proved i'm so pleased to hear about this today it makes such a difference because those that can you know do a bit of research and understand what's going on obviously uh are not going to be quite as needy as those that can't and those that you know and those that you can recognize with oh my goodness we must get this person in now they've got something that's really important and that person isn't so they can wait that's that's something i think um people need to understand more i'm not a question really but an invite if you know well i think mark would be really happy to host a demo of um yes that's right you always yeah absolutely um what you've done i know i know councillor hogg if if if you sorry sorry go but if you wanted to reach out you're very welcome to come and have a demonstration and have a look at how it works in surrey heath of course yes we'd welcome you yeah i'm well mark i'm going to take taking you up on that one that's for sure um but yeah but i think we might also um in the previous session um you know we did talk about using your councillors as you know a communications route to actually reach out and you know because you're generally speaking i've got pretty good networks that's how we got elected um and you know we can you know give you some serious help with your communications and get them sort of reach that you need so please do actually make use of us because um we're happy to help yeah i think that'd be really welcome wouldn't it mark it'd be a bit of homework after a demo from um yourself so yeah and i think that's that mirrors our patient as well i think you have done demos and it allows you to keep doing interactive sessions when you know which patients you have to focus on but mark i think you're hosting something yeah well we did yeah we did some live demonstrations for patient groups in our waiting room absolutely before we went live on the large screen so we invited people in and they they would they they could ask us questions and they they they enjoyed that very much and we had sort of two groups of 30 um the waiting room won't hold more than that um and that's something that we would be very happy to do again with the patients and our ppg and um absolutely but it is gaining traction people are are using it and as i say there are more people being converted to this digital front door where they didn't think they would embrace it before so that's really promising can i just can i just ask also you know obviously gps that are being trained through now you know going through training this hopefully will be part of their course as a matter of you know normal sort of learning i hope so now i'm not involved directly in training um i've got three partners at the surgery who are um and i suspect part of it may be a matter of chance as to what kind of surgery uh just as there is sort of in in in uh north east and st farnham as well um so i think we'll see more and more of this and the future direction of travel appears at least a new contract revision is is is sort of indicating this approach mandating to be open during core hours for example so um as i said earlier i'm not a political person i'm not a bma member i'm not here to defend um the traditional model of general practice i'm i'm kind of trying to help my colleagues evolve towards a future for our sustained viability and that's not our true older and i'm going to need general practice in a few years time when i can pop over to mark surgery down the road um and and and i need a sort of a happy uh sort of vibrant community of gps enjoying themselves thank you yeah i would add to that and if i may that absolutely gp trainees i am a trainer and in our practice they get to experience every bit of practice life before they qualify so they absolutely learn about triage and the software that we're using um and as carl said they do often go to other surgeries as well in their formative years so they can experience a wealth of different approaches but yeah it's part of their training on their vocational training scheme thank you mark and uh councillor david harmer yeah thank you chairman yes i have to say that i fancy that you and your colleague mark are creative thinking gentlemen who i i think you know you're doing the right things but the issue is much wider than that isn't it because it's all the other gps and how do we reach a point where they're thinking along the same tracks as you guys are and and then yes okay so the new ones are fine coming in but of course actually the people the gps of experience are very valuable just because of that experience but they're not thinking along the same lines that you are and so how do we put the get the two advantages you know the the creative thinking and the experience i think i've come back to the earlier point about what's emerging in my thoughts about the future is that we won't have a sort of um a facsimile of what you've got gps that have a special interest in dermatology for example or women's health you will have gps with a special interest in access we have gps that especially is 15 years younger than me and better at it than i would ever be and and it's just identifying the aptitudes of amongst your colleagues and deploying accordingly there's probably nothing's been broken if we simply rely on on um online consultations or remote consultations if you like um i know from our experience during covid that we did build up a rapport with certain patients before we even met them and there are some patients i've met for the first time in two years you know that we're still getting to know so um i mean doctors are all different and we'll need to be different um and and that's i think is what helps to future proof of service um it would be a very done environment if we if we were all exactly the same as each other yes that's true could i come back and say that that's fine i agree with everything you just said but how do we how do we get it to spread across the whole doctor set if you will gp set for the for the area we're concerned with and i think part of that's the environment we create so you've obviously got examples of mark and carl who are doing things a bit further ahead we know the contract will bring in some must-dos but how we um like the fact we haven't gone as a blanket single system move is we know it takes time you want to be bought into the change what they need and it fits for them so what we have been doing is creating and i saw it's a lot it's creating the space to have the conversation people to learn from peers because if we come down as a system to do it or if it's contracted people don't buy into it if you don't buy into it you're not going to put you're not going to get your patients on board with it so we've been trying to make sure that the likes of practices like uh carl's and mark's can share back with others so when they are ready when they know the work that they are doing has got as far as they can and they have to change the tool to fit where they're going we create that space so they know they can ask for help and we know that it will be a curve of change so um some will take a little bit longer but as long as they are maintaining the actual level of access whatever tool they are using that's what we're really trying to get to um because if you're believing and i think i don't know if that answers your question thank you also just building on gerpreet's point and from surrey heartland's perspective to to that question um building the case for change and bringing people along with you on on a what is effectively a bit of a transformation journey is really fundamental and it is really important um the the series of workshops i mentioned earlier we had the first of this year's were were held over two days in cobham at the end of january and we we had um four workshops each had 25 practices with gp leads and and business kind of uh practice managers joining and we had two very important sessions as part of that one was talking about some of the the work we've been doing together to empower patients and to to do some of the digital transformation and and and enable the the channel agnostic access we talked about earlier so supporting patients who wanted to to access digitally whilst ensuring that people that wanted to walk into the practice were able to do that so we reflected on some of that and some of the technology and we also had an opportunity to talk about some of the proactive approaches and how we can support continuity for those more complex patients that need it and actually that those kind of peer-to-peer sessions and i think gurpreet talked about similar learning opportunities peer-to-peer that's been really effective at avoiding just relying on a contract change to enforce if you like because that's quite a blunt tool it really is about building that awareness of the opportunities as well as understanding the challenges and working together to kind of co-design and then bring the the kind of the momentum if you like and sustainable change then across general practice thank you and council victoria wheeler thank you chair um my original question has been asked and covered i think um however i do have a slightly different question um based on the conversations that we've had um sitting here as a patient in surrey heartlands i have to say i'm feeling a little bit like a second class citizen um i'm assuming that with open text you don't have the benefits of the automation of some of that those triage elements um and actually in terms of building the the case for change you seem to be quite a a limited you've got quite a limited rollout of of accurate from what you were saying um earlier on today and i wondered if if maybe this is the point to say actually we don't continue with that rollout that the digital market has moved so quickly that now is the time to re-procure rather than potentially rolling out something that doesn't have the benefit for our gps or for our patients would it be possible to possibly bring up one of the slides sally so in the slide pack i summarized so just to highlight the the digital rollout and the take up of of digital access in surrey heartlands is actually very high and nationally is very high so um as so if i just if we could go to slide four i think please um essentially in 2023 the rollout that i mentioned moved us from the the online triage tool that we rolled out as part of the covid response into a new approach so we wanted to create a consistent digital front door across surrey heartland so we rolled out um nhs branded websites so they can be personalized by the practice but effectively the the look and feel was very similar to the nhs app that you talked about so that that the reason for doing that was to allow people to choose which way they want to contact the gp practice so whether they come in face to face and talk through the problem with the reception member staff will enter it on a form whether they phone and they do the same thing or if they go to the gp website or the nhs app they have the same needs assessment by the practice a lot of that triage in the same way as is friendly colleagues have described that's all managed by the gp team so we've got a very well-evolved um triage model within within surrey heartlands so when um we talk about the usage nationally um of digital access surrey heartlands has got 18 so nearly a fifth of the top 100 practices in the country and that's uh i think there's over 5 200 or so that are sharing data so our population we know are very keen and very encouraged to to utilize or keen to utilize the digital access we just move on to the next slide please sally um we we do we are now in a position where two-thirds of our population aged over 13 in surrey heartlands are registered for the nhs app which is fantastic and that gives an opportunity for the forms you described helen to to be made available to patients rapid health isn't yet in uh integrated into the nhs app and actually when we did our previous procurement that was one of our red lines because we we have so many of our patients that use the app for other aspects of their care we were keen to make sure that the gp contact was also available through that um rapid health are nearly there and i'm sure that will be coming really soon um but that was why we went for that access also we learned and uh sam is on the call with health watch colleagues we did find when we had some of the more algorithm based question online consulting forms that that that's not always easy for some people to to follow versus being able to just put in your own words what the problem was uh in terms of from an access perspective so there's there's a few areas of challenge where and we're really keen on exploring the opportunities that the automated solutions offer because of the the points that that carl and others have raised earlier but there's some challenge and we need to kind of bring our population along with us and understand what impact that change will will make for people uh in surrey heartlands who are used to being able to go on and just type their challenge their their issue without having to answer quite a long series of questions that might take a little bit longer than it would do at the moment thank you for that reassurance and assurance um i'm lucky i have both because i have my nhs my friendly health app um so you know i sit and it does underline how this is evolving and rapidly changing um piece of the landscape um and at the same time of course yeah there are huge patient concerns about access to gp services um you know because of the rate of change many do not understand what is going on how it works um many are still wedded to a traditional model of gp service which is you you phone up you book you see your gp and you know the wider range of services variable the different approaches um the you know more effective use of triage because demand is you know for health services or fundamentally an economist would tell you that it's infinite um and you have to actually manage infinite demand to what you can deliver so um you know you're stuck in a different picture so um in terms of the recommendations i think you know we'll start with one uh which is we want to see you in a year's time um because we want to see how this has changed and you know where we've got to in a year's time um i think um there's a very key recommendation about needing to uh you know measure um provide the data publish the data about what's what you're seeing and also to set objectives and measure against those objectives and if need be change what you're doing um there's an obvious thing um but i'm going to go around the committee and i can guess that robert is going to come in with something thank you without wishing to delay i would like to propose an extra uh recommendation along the lines of my comments that uh that the software including the rapid health system is continually monitored to ensure that any flaws or bugs are eliminated i'm sure you would be doing that anyway but i want to have it on record that we've asked and i would like to put i would like if anyone else is interested i certainly am anyway thank you yeah i would suggest that continuing demonstrations uh maybe even putting a video up um you know youtube's really good for this sort of stuff um just so to be able to share with the public this is how it works this is what it looks like um go and you know see you know how they get on uh and maybe you know this is how somebody who's not very it gets on this is how somebody who is gets on happy mediums in between probably um but it's you know just you know all the comms around this is going to be really and really important um and i would also in the gp environment um as to how they approach it that they make sure um that whatever the patient's position is their experience is seamless they get looked after they get helped through the service for working on this and actually you know this is what everybody's waiting to see isn't it really so thank you consistent easy to use access to gp services absolutely it's what everyone wants it's what they're struggling with at the moment please do more of it yeah no that's reassuring to know we're on the right path um i don't know if other colleagues would agree but it's given us great conversation to take us back and think about how we keep having the conversations we're committed to it's not once we've gone live we're constantly going to have a conversation with our patients with all of this as they go so thank you very much and i found it really useful and others have as well thank you and we'll get in touch i guess to arrange something with mark and the demo so yeah thank you so yeah thank you for you know your participation in everything you do and um final item today date of the next meeting friday the 11th of july 2025