You said, We've listened.
Dear Patients, families and people with loved ones,
Over our 20+ years of working in primary care - there has never been a more challenging time for all of us. Taking over a surgery during the pandemic was difficult. Despite us being open throughout the pandemic, offering a variety of appointments types - to greater than pre-covid levels in some areas, continuing to provide care to patients and their families, it seems that the demand for our services is becoming unsustainable.
We wanted to address our challenges with you and how we're going to come out of this situation, keeping our patients first.
What have been our biggest challenges:
1. Access: Our phone lines cannot cope with the volume of calls. The whole infrastructure on certain days collapses affecting GP surgeries far and wide. Sometimes calls can just ring out, sometimes they do not connect at all. This is equally frustrating for us too.
Our front doors are open, and our reception staff can try to help you if you’re nearby. We have raised this on numerous occasions with local and national bodies.
2. Appointments: Our doctors have to deal with on the day appointments, vulnerable patient appointments, emergency appointments, telephone, F2F and video appointments. We get around 100-200 prescriptions requests on a daily basis that take up the doctors time checking your drugs and their interactions. On top of this hospital letters need actioning, blood test results need reviewing, sick note requests take up time, Urgent NHS 111 appointments need following up, and then there’s all the additional paperwork such as referral letters, X-ray forms, insurance reports, benefits paperwork, and DVLA forms.
We have to ensure these are done safely.
Where possible - patient wishes for appointments types, times and dates are taken into account. F2F appointments have always been available - after initial telephone triage to ensure your, other patients, and staff safety. Due to the challenges above; when our appointments are full - they are full. The same way a pilot doesn’t squeeze in an extra passenger when the seats are full, we cannot squeeze in extra patients to an already full clinic - it is not safe. Our staff are trained to signpost you other viable options to getting your health needs met.
3. Demand: The demand for appointments is at critical levels. We offer same day, prebookable and prebookable for vulnerable patient appointments. Discussing your hospital letters, scan and blood results, also require appointments too.
But why is it worse now? We have more phone calls than ever requesting appointments. We find more people, even on holiday in other parts of the country and even Europe call us for appointments due to the effectiveness of remote consultations. People on waiting lists, or who have had their hospital appointments delayed still require care. E.g a patient on a waiting list for their knee operation still require an appointment to discuss their pain medications. Some patients have kept a shopping list of problems throughout the lockdown which needs addressing too. Sometimes our most vulnerable patients - who too have struggled in the pandemic require double appointments. The impact on our patient’s mental health due to the pandemic has led to a huge amount of mental health appointments and signposting to counselling services. All these factors have meant appointments fill up fast.
4. Staffing: There is a national and stark local shortage of GPs. We have struggled to recruit doctors and don’t see this problem improving in the near future. Our partners and managers often work on weekends and late nights to ensure things run safe and effectively. Furthermore illness and COVID related illness has at times crippled our workforce. Our reception staff have been a major backbone to our service - and the absence of even one staff member has a profound impact. Sometimes there may be a delay in tending to you at reception, and we do appreciate your patience.
5. Abuse: Despite the bleak circumstances, our patients keep us going. The "thank yous", cards, chocolates and gifts have kept our spirits high - and we really value your feedback when we do things right. Things can go wrong - and we have a clear process to make complaints and discuss ways to improve our service. Unfortunately there are a minority of patients who find it acceptable to verbally abuse our staff who are working tirelessly. Factors outside of our control are often blamed on our team, and the level of abuse received on phones is at record levels. We have a zero tolerance policy to protect our staff and people abusing our service may be asked to seek their care elsewhere.
Despite our list of challenges - we aim to be a dynamic and reactive team.
We take on board feedback from patients, family and staff and try our best to make positive amendments to daily practice.
To address some of the challenges above:
1. Access: - we have been in talks with the CCG and IT services to upgrade/ find an alternative provider to our phone services. A call queuing feature will be added to prevent calls disconnecting, but also give patients a timeframe on when they’ll be spoken to. We have explored changing to a completely different system - however this may result in new phone numbers and disruption at the most hectic time of the year. Nevertheless this remains an option for us, if the phone supply needs are not met.
Online access: We will also be adding an “admin requests” section on our website for sick note requests and letter requests saving time on the phone for patients and staff. You will also be able to book telephone appointments using the MyGP App.
2. Appointments: - We have increased the number of available appointments, in a safe and sustainable way. Patients will continue to have a wide variety of appointment types to suit their needs. Trying to recruit more GPs to our area is our goal and we hope to become a training practice in the near future. We have streamlined processes so that emergency and vulnerable patients can be managed and signposted. Furthermore we have once taken on a diverse range of roles who can also help your health concerns.
3. Demand: we know this not something we can instantly solve - but we’re hoping our patients are aware of the challenges we face daily. We will be writing to our secondary care colleagues for their support and understanding of the demand levels in primary care - e.g if a consultant wants to start you on a medication or treatment - they should ideally be having that conversation with you. Furthermore arranging certain tests or referring you onwards to other colleagues can also be arranged by your consultant - rather than the hassle of booking a GP appointment just to be referred. Outside of core hours - We have a weekend service available too which, at times, is staffed by a member of our clinical team. Our Walk in Centre is also readily accessible, and our local pharmacies can now deal with a variety of minor ailments.
4. Staffing: As well as GPs, we now have advanced clinical practitioners, clinical pharmacists, and paramedics part of our team. They work closely with GPs and are aware on how to escalate if they run into any problems. We have continued to do chronic disease reviews thanks to our nurses and wider workforce - and patients due reviews will be called in by their month of birth. We will soon be taking on physiotherapists in our practice to help with joint and muscle problems. We are also engaging in an apprenticeship programme to help support our local workforce develop in primary care.
5. Abuse: Our staff will do their utmost to empathise and be respectful - as per our values. Nevertheless instances of abuse will be escalated as per our zero tolerance policy.
We value your support and input in making your practice be the best it can.
If you have any suggestions or ideas - why not join our patient participation group? If you don’t like the way we run something - joining our patient participation group gives you the opportunity to make us aware and create solutions.
The upcoming months to years will be challenging, but we're hoping together we can make the practice work for all.
The Management Team at Lathom House Surgery