Notes of Previous Meetings

• Date: Monday 17th November 2025
• Location: Dymchurch Village Hall

Attendees

• Neil McClure – PPG Chair (Chair)
• Peter Webb – PPG Chair
• Chrissie Cooper – PPG Chair
• Helen King – PPG Member
• Brenda Garstang – PPG Member
• Jane Hiscock – PPG Member
• Pip Metclaff – PPG Member
• Craydon Cone – PPG Member
• Val Burley – PPG Member
• Clive Pinder – PPG Member
• Oena Windibank – Chief Executive Officer
• Lisa Barclay – Director of Operations
• Jess Andrews – Head of Primary & Urgent Care
• Sophie Williams – Practice Manager for The Marsh Practices
• Julie Corner – Deputy Practice Manager for The Marsh Practices
• Julie Restell – Lead Practice Nurse for The Marsh Practices
• Antonio Monachello – Clinical Pharmacist for The Marsh Practices
• Abigail Piper – Corporate Administrative Assistant

Welcome and apologies

Introductions from all made.

Apologies from Neil Poplett, however he will be dialling in for a part of the meeting.

Agenda shared, all agree that this should be the standard agenda for future meetings.

At Invicta’s request, the meeting duration has been reduced to 90 minutes due to other commitments.

Staffing

Update on recruitment for Salaried GPs

OH: Recruitment is now complete. There are 2 salaried GPs who are supported 2 days a week by an ANP (Advanced Nurse Practitioner). SW explained that from a budget perspective, it cannot be justified to recruit another full time GP for the other two days but there is a possibility for them to work at OH and another one of the sites.

CL: 8 sessions left to recruit to, adverts are out for this post.

MHC: 2 sessions left to recruit to, adverts are out for this post.

SW explained that the standard BMA structure is that there are 24 patient contacts in 2 sessions, which take place in one day, however GPs may see less/more.

There is some current funding around Same Day Winter Access, which provides additional funding to support additional capacity within GP Practices, this only runs from November 2025 until the end of March 2026.

Orchard House Health and Safety walkarounds

Orchard House Health and Safety Walkarounds – PW has put his name forward to do this however has not heard back. JA explained that the audits for this year have been completed, our Corporate Affairs Manager and IG Lead has created a presentation which will be shared in early 2026.

Quality including patient satisfaction and engagement

Patient Survey – review of outcomes for OH

It is acknowledged that there are challenges in separating the results from OH and BMC. The national survey is managed by the national team rather than IH. JA has contacted them previously to see if the results can be split; however, due to the patients being registered under a single code, this is not currently possible. JA is continuing to pursue a resolution to this issue.

The most recent survey shows a decrease in participation rates for CL. It was noted that this makes it challenging to identify which areas require improvement.

2024 figures are: 295 surveys distributed and 136 received.

2025 figures are: 323 surveys distributed, 124 received back. This reveals that the response rate has decreased.

Working Feedback has been purchased for all sites across the Marsh and allows patients to give feedback following their appointment and is direct feedback to the practices and not a national survey.

NHS GP Patient Survey 2025 – Church Lane continues to be an outlier

The 2023 NHS GP Patient Survey revealed a 29% overall satisfaction for CL. This increased to 57% in 2024; however then dropped to 54% in 2025.

SW explained that careful consideration has been given to this and to the factors contributing to the differing figures. As staff and processes are shared across the three IH Marsh sites so it is unclear why the results differ.

NM suggested that CL have a larger elder population. However, the national practice profile does not support this. The number at the top end for CL is marginally higher than neighbouring practices with better results.

Following on from meeting with the CQC, IH started real time reporting, which is what Working Feedback does. This has revealed that there is not a notable trend difference in the feedback that IH receive. Therefore, it would be helpful to understand from the CL patients themselves why do they not comply with the survey.

Noted that there are also no common trends with incidents and complaints.

Communications: i.e. websites/patient comms/practice Facebook pages

Lack of Clarity of Information on Invicta Romney Marsh surgery websites

It was requested for the website to return to its previous format for staffing due to it being easier to navigate. Noted that photographs of GPs are not necessarily needed on the website, however names of the ANPs and GPs should be listed. JA advised that there is ongoing work to look at the websites, and this will be taken into consideration.

Action: to add a drop down in the staffing section of the website which names the salaried GPs and ANPs at the site.

Noted that error 404 has been resolved. JA advised that if anyone has any queries/concerns about the website, please contact either her, SW or AP and we can get the issue resolved quickly.

It was raised that the majority of the patients at CL are elderly and therefore less likely to use the website due to lower levels of IT literacy. With this in mind, it was suggested that a notice board in the practice displaying the staff working on the day would be beneficial, as this is not always available. JA explained that while it is difficult to publish this information in advance (e.g., for a week or two at a time), a commitment can be made to display the staff working on that day.

Action: Staffing structure for all sites to be available within the reception waiting area.

Action: Noticeboard with which staff are working each day to also be available within the reception waiting area.

In addition, we can display the organogram for the three Marsh practices, which outlines all salaried staff within the organisation that work across the three sites. Furthermore, AM suggested that the PPG members engage with the wider patient population to gather their views on how else they would like us to address this concern. They can then feed this back to us so we can consider how best to support any required changes.

Confusion on how BMC and OH are linked: OW explained that there are a variety of different ways contracts are held under the NHS. OH has a contract that is a subcontract from the BMC contract; which therefore means that everything in the NHS system is recognised being under BMC.

The PPG requested for communication around this to improve as patients are confused about the link between BMC and OH. The PPG expanded on this and said that when booking a blood test on the OH website, there is the option to book into BMC too. JA confirmed that BMC have now changed the name of their slot types to say ‘BMC only’ so this is much clearer.

Noted that OH’s website is now completely separate from BMCs. All agree that there is a need to find a mutually satisfactory process going forward for all BMC/OH patients, and for IH to communicate any possible limitations to this that may arise.

Raised that Working Feedback’s last comments are 3 weeks old. JA explained that Working Feedback is currently on a 3-weekly rotation for the IH Marsh sites, as the upload following the appointments does not happen automatically, and has to be manually uploaded. The new Deputy Practice Manager is picking up some of this work and we are working on how we can increase the number of feedback received.

Problems in Communication on FLU and COVID vaccinations

Confusion has arisen in relation to patients being called in for different vaccinations. It was advised that this has been due to NHS England changing the criteria this year.

People under 75 no longer meet the criteria for the flu vaccines, however the automatic reminders cannot be altered. There has been mixed communication inviting patients to come in for Flu and then reminders were sent saying these were COVID.

SW assured that she has raised this with Accurx.

Clinical Consultations

Concerns regarding locums and patients understanding the doctor’s accents

NM raised a concern that some patients with hearing impairments may struggle to understand clinicians when there are strong variations in speech or accent, particularly with telephone consultations.

This concern has been raised in the past and there was a request for video consultations to be introduced. OW explained the issue we have with video consultations is that if someone needs to be seen visually, they would be asked to come in for a face-to-face appointment. However, it is understood that there are some cases where this is not possible, for example it is not appropriate for palliative patients to come in for an appointment.

Furthermore, appointments are clinically driven, so in terms of the style of consultation it depends on the individual clinician. If the decision is made by a clinician to offer a telephone consultation but the patient wants to be seen face-to-face, this is not always possible.

NP joined the meeting via telephone call. NP confirmed that if it is clinically appropriate and a face-to-face is not possible, video consultations could be offered. In addition, if a patient is housebound, a video consultation over a telephone may be preferred and offered.

Availability of Appointments

Anima has replaced eConsult, which from a patient perspective is slightly better to navigate. From a clinician’s perspective, it requests more detail, so they therefore get more clinical information to triage the patient with.

Patients are currently invited to book appointments and directed to specific clinics. The reason Anima has been introduced is because of how it triages; it ensures people who need an urgent appointment get one based on clinical need. Noted that this is being challenged by the BMA and updates will be provided should anything change.

NM noted that the appointment diary appears to be lagging. SW clarified that GP appointment are routinely scheduled six weeks in advance, and nursing appointments are generally released on the same basis. NM has previously been informed that appointments were not available within this timeframe.

Action: SW will follow this up with the reception team.

The PPG also raised that there are limited NHS Health Check appointments available and there has not been clear communication on when the best time to call up for one of these appointments is. JR clarified that these are 30-minute appointments and can be booked into any clinic. The national programme offers NHS Health Check appointments to patients aged between 40–74 that have no other underlying health conditions. However, anyone outside this age range may also request a health check appointment if they wish. Request for this to be communicated clearer.

Action: NHS Health Check information to be added to the websites.

CC raised concern regarding an incident where a friend called after 10am for a non-urgent appointment and was advised to call back at 8am the following day.

Action: SW will address this with the reception team, as it highlights a need for further clarification around the process for urgent and non-urgent appointments.

CC also highlighted that when calling at 8am for an appointment, there is not always availability. OW explained that the phone lines go live at 8am and the queue fills within seconds, meaning appointments are taken very quickly. This is one of the reasons Anima is being implemented, as part of a national initiative, to help resolve this issue.

CC asked about the timeframe for non-urgent bookings and noted that he had previously been advised that the wait for a non-urgent appointment could be just under a month. AM confirmed that the waiting period depends on the nature of the non-urgent request; for example, a four-week wait for a blood test could be considered clinically acceptable. OW added that this is a national issue and not something unique to the Marsh practices.

OW elaborated that the priority is to ensure patients with an urgent clinical need are seen within an appropriate timeframe. It is essential that our systems and processes guarantee it is safe for patients to wait up to a month for an appointment if they are faced with this timeframe. This again highlights the importance of effective communication.

Booking x-ray appointments

Clarified that patients can go directly to book these via the EKHUFT portal. Must ensure this is on the website so patients are aware.

Action: Add a link to the website to the EKHUFT portal for booking x-ray appointments.

PSA tests and Clinical Pharmacist engagement

The availability of PSA tests for patients and whether a GP or phlebotomist appointment is required was discussed. NP and SW have previously considered ways to clarify this. NP explained that the current challenge with PSA tests is their limited reliability, although a more advanced test is expected in the future. It is important to inform patients that the test can occasionally produce false positives or negatives.

A clinical query was raised regarding the Clinical Pharmacist and the difficulty in getting proactive action from them. AM assured that a national medications alert system in place.

Some prescriptions indicate that a medication review is due on a specific date, but patients are not always contacted for a review. AM advised that patients expecting a medication review can call the practice to have it scheduled.

Contract issues

PW presented a document which is a proposal for the service under the GMS contract to improve.

Action: PW to share the proposal document electronically for IH to feedback.

OW summarised the three contracts held for MHC, OH and CL:

• OH: This is a rolling contract and is part of a GMS (General Medical Services) contract. Unless something is done to breach the contract, it will continue to roll on year to year.
• MHC and CL: AMPS (Alternative Provider Medical Services) contracts. These contracts are historic and are being phased out. They are more expensive, and there is also a national/regional push to not have any more GMS contracts and an alternative push to implement neighbourhood contracts for GPs in the next few years. With AMPS contracts, there are set contact terms, and there is usually a time period of between 5–7 years. There are extensions, however MHC and CL have both had all of the extensions allowed.

MHC: AMPS contract expires in 2032.

CL: AMPS contract comes to an end in November 2026. The Kent and Medway Integrated Commissioning Board have put out an expression of interest to see if any other providers who hold GMS contracts would be interested in running CL as a branch surgery, this is part of their strategic direction of travel. This has been published across the whole of East Kent.

OW questioned this with the Integrated Commissioning Board and suggested to change to a GMS contract; in which we have been told this is being considered as an option and are taking it to their Board. The other option they are considering is to wait until the National Neighbourhood Contracts are out. IH have put in an expression of interest. OW has chased this and has been told they have not yet made a decision. If IH were to get this contract again, we may have to utilise another IH site which holds a GMS contract and are suggesting St James Surgery in Dover, for geographical reasons. There would be a procurement document that would have to be published most likely at the beginning of next year.

NM has also written to the ICB to see if the PPG have any role in the process, once a reply is received NM will let everyone know.

OW stated that IH has a commitment to this population, and she will continue to communicate with the ICB for what is right for this population.

This is going to be an item on the agenda for the New Romney Council Board meeting.

Neighbourhood programme

A Primary Care Network (PCN) is where surgeries come together at scale and provide one another with additional resource to drive efficiencies.

OW sits on the East Kent Partnership Board.

Integrated Neighbourhood Teams: IH are part of a National Pilot for the Folkestone and Hythe District Neighbourhood Teams. IH submitted a bid aimed at enhancing services such as social care, hospices, and community wardens for patients in the Hythe and rural area, as well as the Total Excellence PCN and Hythe and Rural PCN. An acknowledgement of the bid was received approx. four weeks ago, and we were one of 42 to be selected as a pioneer nationally. Local stakeholders are working together to design a strategy that meets the needs of their population. With support from a national coach, our PCN, along with two other PCNs, is collaborating to improve these services for patients, sharing expertise and determining priorities.

This is driven by the Health and Care Partnership, and the New Romney Town District Council were identified as key members. Whilst there is no funding attached to this currently, at the moment it must prove to be effective.

In a previous pilot that the Marsh PCN were involved in, we chose to look at breast screening and education for patients in the area. Total Health Excellence have also carried out some other work which we can learn from.

In the last 2 years there has been very little capital money. The premise of creating integrated hubs and the model of integrated neighbourhood working will only support this.

AOB

OW noted that IH are keen to work with the PPG and advised the PPG to give feedback. The PPG are also advised to contact SW, JC, or JR if they have any issues.

Next meeting(s)

TBC, AP to organise.