Gill Walt, Chair
It is ten years since this PPG was formed, according to the terms of reference drawn up in early 2014, when the chair and vice-chair agreed to take on the roles. Reports on the activities of the PPG have been produced since that time and are available on the James Wigg (www.jameswigg.co.uk) and Queens Crescent websites (www.queenscrescent.co.uk) under Minutes of meetings or Activities and studies.
This report covers the activities of the last three years.
The last meeting before the coronavirus pandemic was in February 2020. However, the PPG continued to meet on-line: 3 times in 2020, 4 times in 2021, 5 in 2022 and 5 in 2023. In addition, an informal evening meeting was held in 2021,2022 and 2023 in the Kentish Town Health Centre (KTHC) garden in July. When we returned to face-to-face meetings in June 2022, it was clear that a number of major factors had affected general practice generally in the UK, but also the JW/QC practice:
The Coronavirus Pandemic
During the lock down stages of the pandemic, patients were seen only under strict conditions, to keep everyone safe. Members of the PPG worked with a local residents’ association to make masks and scrubs for JW/QC staff (and others); they assisted in clearing out books and other material from the KTHC and undertook a small study to ask patients about their experiences during the pandemic (available on website). PPG feedback on a website message about attending the Practice or making appointments led to a change in wording.
Structural and Administrative NHS Changes
Major changes in NHS structures occurred between 2020 and 2023. The Camden Commissioning Group (CCG) was incorporated into the North Central London (NCL) CCG, along with Barnet, Islington, Haringey and Enfield, and in July 2022 NCL CCG became the NCL Integrated Care Board (NCL ICB). All these administrative changes were time-consuming and costly to staff, although most patients were probably not initially affected. They have been since, as NCL has moved services around the five boroughs to provide integrated care.
As a result of these structural changes, the Queens Crescent, James Wigg and Philip Matthewman Practice were merged to form one group practice (JW/QC) as a Primary Care Network (PCN). Patients were consulted through the PPG but the amalgamation had a relatively small impact on patients. As a result, the existing PPGs from QC and JW were joined into one, with continuity provided by the JW chair and vice-chair.
All these changes were reported at PPG meetings, and PPG members attending Camden wide patient and public engagement meetings (CPPEG) provided feedback on the changes and how they were likely to affect services in the borough.
Changing Profiles of General Practice
Primary health has had little financial support during this period, affecting general practices. During 2021, 2022 and 2023 the JW/QC PPG has discussed at most meetings the impact on patients. As a result of patient concerns, several presentations on changes in general and in the Practice were made by Practice staff. These have led to discussions of the difficulties faced by the Practice and its patients and potential solutions. Most exchanges were focused on issues to do with access: telephone waiting times, appointment availability, continuity of care, using e-consult on-line forms, face-to-face versus telephone appointments, among other things.
Attempts to meet demand have led to the introduction of a much wider range of allied health professionals to general practices. Patients today may be seen by nurses, ambulance staff, pharmacists, as well as by doctors. Pharmacies have been given prescribing powers for certain conditions, so patients can go directly to those so designated. As a training practice, JW/QC have large numbers of doctors passing through the Practice, something which patients do not always appreciate. All of these factors have had an impact on patient access to primary care.
Administrative staff have increased in general practice too, as part of the growth in digital systems and Government monitoring policies. In 2023 the JW/QC practice appointed a partner with a particular responsibility in operational matters to deal with an increasingly complex environment.
Activities by the PPG
Volunteers in Reception
A group of volunteers has been working in the Reception area of KTHC since 2022. They assist patients negotiate the building and help to manage the queue which sometimes builds up at busy times. By 2024 every morning of the week was covered by at least one volunteer. One of the volunteers also helps with the Food Bank provided by Creative Health Camden. Through their observations several suggestions have been made to, and taken up by, the Practice regarding other services such as Phlebotomy and In Health, management of the queue, working and positioning of self check-in kiosks, messages on overhead screens, among many other things. Many expressions of appreciation for the work the volunteers do have been received by both patients and reception staff. A number of reports from the volunteers are on the PPG page on the websites.
Volunteers in the Garden
The garden at KTHC is much appreciated by both staff and patients. A few PPG volunteers kept the garden going through the Pandemic and after. In mid 2023 FreeSpace (now Creative Health Camden) arranged for a professional gardener to provide regular input to the garden. Patients are welcome to join the gardener on Thursdays. Contact: [email protected]
End of Life Clinic
One of the PPG volunteers with special interest in end of life issues sees patients referred by GPs to discuss issues of concern towards the end of life. The service was short-listed for a British Medical Association General Practice Award in 2023.
Raising Awareness of Dementia
One PPG member has run a few sessions with reception staff to raise awareness of dementia, especially among patients coming to KTHC. A session was held in April this year and more are planned. PPG members are also exploring the extent to which patients who are carers of people with dementia would like to establish a support group.
Signage at Kentish Town Health Centre
Studies undertaken by the volunteers established that patients coming to the Kentish Town Health Centre were from all over London, and only about 40 percent had appointments with the James Wigg Practice. It also became apparent to the volunteers that the signage in the KTHC was very poor, and that this led to considerable stress among some patients, already anxious about their health and impacted on reception staff.
A PPG member undertook to do a survey of the signage system in the KTHC and in early 2024 produced a report outlining the problems and potential solutions for improving waymarking. It is available on www.jameswigg.co.uk and www.queenscrescent.co.uk websites, under Studies and Activities. The report was presented to Community Health Partnerships Ltd who run the building in February 2024 and they are due to report back to the PPG in July.
Communication Between PPG and Practice Staff
The volunteers have met on a few occasions with reception staff to discuss issues pertaining to patients’ experiences as well as to learn from staff. The meetings have been useful exchanges, providing insight into the work of the reception staff, who do much more than front-of-desk tasks. They have also provided an opportunity to present problems that patients face when coming to Reception.
The PPG runs an email list and sends out messages to patients about meetings, including agendas and minutes, as well as informing patients of Camden wide health issues which may be of interest. The email list is independent of the Practice and managed through [email protected] which can be used by patients to raise issues important to them. A new initiative has been suggested to produce a biannual newsletter for patients, the first issue of which should be available in July 2024, in both paper form and on the website.
Open face- to- face meetings are held every two months, with a more social meeting in the garden in the summer. All these meetings are attended by and are open to JW/QC doctors and other staff as well as all patients. Agendas and minutes are uploaded on to the website under the Participation site.
The volunteers meet separately every two to three months, and report to the PPG meetings. Two representatives from both JW and QC meet with the link doctors from each Practice (JW and QC) as well as the partner in charge of operations. Three PPG members who regularly attend PPG meetings also attend CPPEG (Camden Patient and Public Engagement Group) meetings and feedback to the JW/QC PPG any items of broader health interest.
Broader Health Activities
The PPG has supported the Caversham Practice PPG in its 2024 campaign to retain the Peckwater Centre for primary health services.
The PPG also signed a letter from Camden PPGs to the Secretary of State for Health and Social Care in 2021, expressing concern about the commercialization of primary health care and the lack of transparency of NCL CCG (now NCL ICB) in the transfer of AT Medics to Operose, a company owned by US group, Centene.
Dr Jacky Davis attended a PPG on-line meeting in 2021 to give a talk on assisted dying, and a bill which was then getting its second reading in Parliament. The PPG has also circulated information about health activities at the NCL level, some of which have invited patient participation in specific policy exchanges or have sought experience for particular conditions.
Summary
The PPG has been very active as ‘a critical friend’ to the Practice, particularly through its volunteers in Reception. More broadly it has also disseminated information from NCL or NHS England, as well as acted as a conduit for such bodies seeking patient experience. While there is much to commend the level of participation, PPG members recognize that they are a small group, not representative, either ethnically or demographically, of the very diverse set of patients registered at JW/QC – a common failing of many PPGs across the country. Two challenges for 2024 are to recruit a new Chair and Vice-chair during the year and to broaden participation of patients in the PPG.
