Firstly – many apologies for yet another text from the surgery – but this is the most effective and cheapest way to disseminate information to our patients. There is some changes and news that we will need to share with you in the next few weeks, but we will try and keep our texts to a minimum. Patients can opt out of receiving texts from us, but that will mean you get no text messages from us at all, including appointment reminders. We advise against opting out of text messages, but you can email [email protected] if you wish to opt out of receiving texts from the surgery.
We have been thinking about re-launching a new appointment system for some time. We have delayed this process until the new GP contract for 23/24 was published.
Sorry – it’s a long update…but we want you all to understand the thinking behind these changes. We like to keep you informed, because we do see you all as part of our Surgery Team.
You will have seen in the press that the new contract was imposed on GP practices, and that it contains requirements with regards to Capacity and Access. There is much furore in GP land about the new contract, as it not possible to achieve. Yes, there is talk of funding being diverted from elsewhere in our Contracts to devote to Capacity and Access, but when you divide this funding by the amount of GP Surgeries, it is not enough to recruit clinicians to help with our workload.
Alas, we will give it our best shot!
It is important to note that no changes have been made to the appointment systems for the Nursing Team, Healthcare Assistants and Phlebotomy.
The biggest change is around the use of GPs, and other supporting clinical staff, such as Advanced Nurse Practitioners, Paramedics, Physician Associates, Pharmacists etc.
The new contract also stipulates that we need to actively signpost patients to the most appropriate clinician to manage their condition, and that also includes Community Pharmacies. In fact, NHSE is now collecting data on the number of patients we refer to Community Pharmacy. They are actively expecting us to manage our workload by directing patients to the most appropriate service. We are being asked to refer specific cases to Community Pharmacy – please click on this link for more information on which conditions we are expected to signpost to community pharmacies
The contract also stipulates that all patients need to be offered an interaction with an appropriate clinician within two weeks of contacting the surgery, but there are NO stipulations on the format in which this interaction must take place – so it can be via telephone, video consultation, or face to face.
To a great extent, NHS England has given an endorsement of the appointment system we have been using for some time, in that we try to deal with whatever comes in on a daily basis, on the same day. However, we do get stuck when too many prebooked appointments are already on the appointment book for the day, which gives reduced capacity to deal with the on-the-day contacts we have.
Therefore – we are going to try stopping pre-booked appointments, and move to an almost total on-the-day triage system (there will be exceptions – more on this later).
While programming the new appointment book, we have also put a lot of consideration into the wellbeing of our clinical staff, and our need to retain them. GPs are leaving Primary Care in huge numbers, because of an unsustainable workload, so we need to hang on tightly to the ones we have.
It is also important to distinguish between GP Partners, Salaried GPs, and the supporting clinical team. We cannot expect our Salaried GPs and supporting clinical staff to work in the same way as GP Partners. There needs to be a more defined start and end of their clinical sessions, whereas GP Partners have a more “We have to keep going until it’s all done” approach – because they are GP Partners, and ultimately the responsibility of meeting the stipulations of our Contract lies with them.
As Practice Manager, I have to make sure the Partners are working at a safe level, and to make sure they are not overwhelmed or burning out. I cannot expect the Partners to deal with an unlimited amount of patient contacts a day. It is not safe for patients, and it is not safe for GPs. Who amongst us wants to be the 50th patient a GP has seen or spoken to on any particular day? It is not expected from hospital doctors, and that is because it is not safe.
Therefore, I will be keeping an eye on the first couple of weeks on the new system, to see if it is working in a safe way for everyone. If not, we will need to tweak it and try again. We are not so arrogant to believe that we will get it right the first time!
From 5 June 2023, we will try the following
Patients contact the surgery on the day they require input from the surgery, whether it is a new, or follow up matter. If a patient wishes to speak to a specific GP for a follow up, please call on a day when they are in surgery. During times of annual leave, follow ups that cannot wait until the GPs return, will need to be completed by another GP. It is entirely up to patients to decide if they prefer to call us again when a specific GP is back from annual leave, or to speak to another GP on the day of their call. All patients will be required to give a reason for their call. This needs to be as specific as possible. Is it a new issue, or an ongoing one? How long have you had symptoms? What self-care/self-treatment have been on-going? Is your need medical or a social? Please help us to manage your request effectively and appropriately.
Our Reception team will book a face-to-face appointment with either a Salaried GP, or a supporting member of the clinical team, depending on the patient’s clinical reason for calling. If the patient prefers a telephone consultation, this will be accommodated. There is no need to attend the surgery to arrange clinical contact, and patients cannot specifically ask for a face-to-face appointment. Please trust the team to manage your requirements.
The supporting clinical team will be seeing the more routine medical matters, like sore throats, sore ears, cough ect. Conditions that cannot be managed by the supporting clinical team, will be booked for a face-to-face appointment with a Salaried GP (again, if telephone appointments are preferred, this will be accommodated). These appointments will be 15 minutes long. This puts less pressure on our Salaried GPs to try and stick to the 10 minutes appointment time dictated by NHSE. There is also evidence that shows that more time with a GP means that patients have less need to return to the GP for the same matter. When this capacity has been saturated, all patients will be telephone triaged by a GP Partner first, and either managed over the phone, or brought in for a face-to-face review if clinically indicated. This face-to-face review does not have to be within the 2 week stipulation, as triage has already happened, and the follow up becomes “planned care”. It is likely that all these appointments will be on the same day, but there may be cases where they are not.
There may be times when illness or annual leave requires us to revert to total triage (as we are doing now), but we will always make capacity to see patients face to face if clinically required. This does meet the requirements of the new contract.
All the clinicians have capacity in their sessions to book follow-up appointments for patients who require it (but these will be via telephone unless otherwise stipulated).
GP Partner working days:
Below is their usual working pattern, but the Partners often move sessions around to accomodate the needs of the surgery, or work additional sessions when needed. The may also be supervising students or registrars. The Reception Team will know their location and movements every day
Dr Leeman Mon to Thursday (but has care home ward round on Thursday afternoons)
Dr Henderson Monday morning, all day Tuesday (but Care Home Ward Round on A Tuesday afternoon) and Friday afternoons
Dr Andrei Tuesday morning, all day Wednesday, all day Friday (Care Home Ward Round Friday afternoon)
Dr Bata Monday, Tuesday, Thursday, Friday all day (Care Home Ward Round Thursday afternoon)
Salaried GP working days
Dr Davidson Tuesday mornings, all day Wednesday, all day Thursday
Dr Malawana Monday all day, Friday all day
Dr Berrocal Dr Berrocal’s hours are variable at the moment, pending going on maternity leave
Supporting Medical Team – South Uttlesford Primary Care Network
Emergency Care Practitioner (Paramedic): Georgia Carroll – based in Surgery AND Stuart Miller and Louise Hammond (Home Visits)
Physician Associate: Sekinat Lawal, Priya Mistry (Maternity Leave)
Clinical Pharmacists: Dr Ellie Dann-Reed and Ravin Fernando
Integrated Mental Health Practitioners: Sarah Sylvester and Charlotte Steer
Physiotherapists: Michael Clements and John Chaffey
Care Coordinators: Anna Noone and Maria Applebee
Social Prescriber: Aaron Willis
Health and Wellbeing Coach: Dan South
Dietician: Alex Ballard (Maternity Leave)
Please be patient with us while we test this new appointment system, and – as always – thank you for all your support
Appointments that will still be prebookable
- All Nursing Team appointments
- Minor Surgery (on instruction of GP)
- Contraceptive coils and implants
- 8-week baby checks
- Medicals
- Long Covid
- Long Term Condition Reviews (recall managed by our Clinical Admin Team)
- Spirometry
- (There is no requirement to offer these appointments within 2 weeks, as these appointments are “planned care”)
How to contact us?
Via telephone
Or on-line, via https://florey.accurx.com/p/F81053
Teresa Buglass, Practice Manager