KVN Forum Meeting 4th December 2007

“Role of GP’s Discussion”

Compiled by

Apologies: 2

The next meeting of the Forum will be held at the Kobler Clinic, Tuesday 5th February 2008 on the 4th Floor of the St Stephens Centre, from 6:00pm to 8:00pm.

This document is a collection of the discussions held by the KVN Forum members at the December meeting of the KVN Forum, which was entirely devoted to the long-planned “Role of GP’s Discussion”, which took place on 4th December 2007 at the Kobler Clinic. These are not strictly minutes of the meeting, but most of the points were loosely captured – apologies for any points missed.

The meeting took the form of a Panel discussion, with primary panellists invited to comment on some principle points - compiled by KVN Forum members - but derived from actual queries raised by patients attending the Kobler Clinic over a number of weeks. Patients were asked to complete a questionnaire, and these were drafted out, and numbers of positive and negative responses counted and added to the discussion as percentage outcomes for or against the central theme. The compilation of completed patient questionnaires was sent to all the panellists and guests in advance of the evening’s discussion.

In the Patients’ questionnaire, patients were asked if they were registered with a local GP, and whether or not this had been a positive or negative experience.

The panellists & guests included:

Judy Hague: HIV programme director, London Specialised Commissioning Group

Stephen Tucker: HIV Commissioner for North West London, Kensington & Chelsea

Frankie Lynch: Director Performance and Primary Care Commissioning 

Dr Simon Barton: Clinical Director of HIV & Sexual Health Chelsea & Westminster Foundation Trust

Debbie Richards: General Manager of HIV & Sexual Health Chelsea & Westminster Foundation Trust

Dr David Asboe: Lead Clinician Kobler Clinic Chelsea & Westminster Foundation Trust

Simon Farnworth: Clinic Manager Kobler Outpatients Chelsea & Westminster Foundation Trust

Jane Bruton: Clinical Nurse Lead for HIV Chelsea & Westminster Foundation Trust

CD introduced the invited guests, set the format and ground rules for the meeting, then chaired the proceedings.

CD opened the meeting by stating the reason the discussion had come about in the first place, saying that it had been triggered by the presentation to Parliament in Jan 2006, of a white paper entitled:

‘Our health, our care, our say: a new direction for community services’

CD went on to state that this white paper sets out the plan to extend the services offered by local GP practices and for a GP to become the central figure co-ordinating every aspect of patient care, and that there was an increasing expectation that for non HIV related problems we should be using our GP’s. The KVN Patients Forum has become aware that some patients were experiencing problems when trying to access care from GP’s or have no GP at all, and so it was thought best to have a direct discussion on the topic of the Role of GP’s with those who could most readily hear the voice of the Forum members, hence the discussion itself taking place that evening.

CD then proposed that the meeting’s format would entail three real-life situations experienced by members of the KVN Forum, where this white paper was having a direct effect on HIV patients “quality of life”. Each of the three members would present their example to the panellists & guests, and would then invite comment from them in answer to the positive or negative experiences. The discussion would then be opened to the rest of the Forum for comment.

  • First up, was Scott, who relayed the following: He had recently contracted Bell’s Palsy, and tried to get seen by his GP as soon as possible. He ended up having a very negative response from his GP’s surgery, both from the staff and from his GP – due to a seeming lack of urgency over his problem - ended up being treated for neither the symptoms nor the cause of his ailment. Scott then had to go back to the only safe and reliable treatment centre he known – the Kobler Clinic – where he was treated within hours of arrival at the clinic and is now on the road to recovery.
  • • The panel’s reply was to firstly state that Scott’s initial treatment (or lack of) whilst deplorable was not indicative of GP treatment as a whole. It also raised the issue of how we define HIV-related conditions – in this case Scott’s case of Bell’s palsy. The panel suggested that Scott’s treatment consultants should probably have been his first port of call in this instance. The other issues of disclosure and appointment access had already been the subjects of recent government legislation, and though not proving as effective as desired, the wheels had been set in motion and should soon be seeing positive results.
  • • There was a general feeling from the forum that in all instances of such a serious nature, the patients, first, will know the seriousness of the emergency, and will more likely than not be able to assess whether a visit to the GP is enough or if treatment by specialists in the Kobler – or onward referrals from those Kobler specialists – are necessary. Having to spend time in the “preferred” process whereby GP’s must be seen first and prognosis delivered before onward referrals and further testing takes place. This additional time-period serves only to delay treatment of the seriously ill, and in the long-term will not be financially viable for the NHS.
  • • Many similar examples were forthcoming from the forum, and it was felt that only further detailing of this kind directly to the HIV commissioners would help to discount the parliamentary white paper’s insistence on role of the GP being the first place any patient must go to for any and all future ailments. It was hoped that they would/could attend more local Patient Forums and see for themselves what was happening at the coalface of Health-Care.
  • • Robin then presented the second forum experience. Robin is one amongst the estimated 34% of patients currently being treated by Chelsea & Westminster’s HIV treatment centres that are not signed up with a GP. Robin’s reasoning’s for not being signed up to a local GP were centred around those of Disclosure and related Stigma. Robin moved to secure housing post to suffering a serious HIV-related illness. The housing community were known locally as housing for HIV+ sufferers. This meant that the entire local community were made aware of Robin’s status, and he was also made aware that patient information from the local GP’s surgery was being disclosed to the wider community – he had experienced this first hand. Thus he would not – will not attend any of the GP’s in his catchment area as he is sure that his medical records would be disclosed to those who were not authorised to have access to them. Robin also raised the issue that he would not feel comfortable with his local GP Practise being able to effectively treat or manage any HIV-related illnesses.
  • • A general comment was raised at that point that there had been some unsubstantiated evidence that Health funding is directly linked to list of GP-registered patients – namely that Foundation Trust treatment could soon be refused to those patients who were not registered with a GP, because the Trust would not be able to recharge the NHS for any treatment or services given to the unregistered patient by the Trust.
  • • The Panellists stated that this was not the case at the present, but they did not confirm it would not be so in the future.
  • • There was a point raised by the forum at that time that it would make much ore sense to have a GP “implant” positioned in the Kobler Clinic – and in fact in every HIV treatment centre – to circumvent all envisioned problems with HIV patients being forced to be treated by local GP’s. It would maintain complete patient confidence over receiving correct and suitable treatment, Confidentiality and disclosure issues, as well as addressing the difficult issues over Stigma.
  • • The panellists stated that this would be difficult to instigate as long as the primary care condition of treatment stated that all those who can walk, talk and don’t arrive in an ambulance should be treated by local GP’s and not by specialist treatment centres.
  • • Other members then commented that this doesn’t really tie up with current thinking of Long-Term HIV survivors, for whom, as they get older and suffered more HIV and treatment-related side-effect ailments, were more likely to be in receipt of regular ongoing treatments, that local GP surgeries could never provide.
  • • This also did not tie up with the dependence of local GP surgeries to be supported with up-to-date HIV treatment information and practices – this information and practise trickle-down has not been in evidence thus far, and was not likely to greatly improve in the near future.
  • • The third and last presentation from the KVN Forum was from Paul. Paul’s experience was all in all a positive one, with his local GP being very aware of HIV treatment issues, and there were no problems with disclosure or Stigma. However, even with all those barriers crossed, there were still issues, which made the use of the GP as first port of call as undesirable, and in the long-term unsustainable. There was a very poor record of correspondence between the Kobler clinic and his GP surgery. Despite repeated requests from Paul to administration staff to ensure any changes to his treatment or medication were forwarded immediately to his GP, this had not happened. There was also a “ping-pong” effect happening every time Paul did require onward referrals, as he would first go the HIV treatment centre, only to be told to go back to his GP for referrals and giving out of prescription medications, then once back at the GP’s told to go back to his HIV treatment centre because his GP was not able to safely advise on medication contra-indication or advanced treatment practises.

Recent poles shown that 4 out of 5 Britons would not knowingly deal with anyone HIV, while 6 out of 7 have said they would not stay in a house where someone with HIV was living.

The discussion continued until 9pm, and much was talked about – not all of it was noted as the Chair was involved in much of the discussion. CD then brought the evening’s event to a close and thanked all the participants and forum members for their attendance.

On the whole the meeting went very well, and all were happy with the responses given by the panellists and guests.

Please forward all points/suggestions for next meeting to the online forum, or directly to CD at declec@hotmail.com and the Agenda will be posted to the online Forum, with any additional points added to it as they are sent in.

The meeting dates for the Year 2008 are as follows:

  • Tuesday 5th February
  • Tuesday 4th March
  • Tuesday 1st April
  • Tuesday 6th May
  • Tuesday 3rd June
  • Tuesday 1st July

Others TBA.

The next meeting of the KVN Forum will be held at:

The Kobler Clinic

4th Floor,

St Stephens Centre

Chelsea and Westminster Hospital

6:00pm to 8:00pm

On Tuesday 3rd July

Refreshments provided.