Hebden Bridge Group Practice Manager Tony Martin has told Calderdale and Kirklees 999 Call for the NHS that routine and urgent home visits are still available and established treatment plans will not be adversely appointed by changes to the urgent care appointments system.
After Hebden Bridge Group Practice ended its telephone duty doctor system for urgent appointments and replaced it with a Monday- Friday 8am-10.30am walk-in session at the Mytholmroyd surgery, many patients have complained on social media, with good reason.
Calderdale and Kirklees 999 Call for the NHS asked the Hebden Bridge Group Practice Manager, Tony Martin, what exactly was going on.
“Where a patient is unwell and is unable to attend the surgery, our clinicians will visit them at home. This applies to both urgent and more routine cases, has always been the case and will remain so. This is a part of contract with our commissioners. If the condition is significantly urgent we would call an ambulance.
“Similarly, I can assure you that no established treatment plans will be adversely affected as a consequence of any system change we might make.”
He confirmed that there is no change to the arrangement that allows for patients with chronic conditions to ring reception to speak to a GP to have their symptoms recorded or have their medication adjusted, as a part of their care plan. He added,
“I entirely agree that a telephone call is often a more efficient use of time for both the GP and the patient and we still offer routine telephone advice every day.”
The Practice Manager also said,
“In the event that a patient presents with an immediate life threatening condition a clinician will leave their surgery to see the patient. This can occur at any time irrespective of our access arrangements and has not changed. We have specific policy for patients presenting with chest pain, head injury and sepsis.”
In response to our question about whether ANY patients would be eligible for a home visit, who are unable to get to Mytholmroyd for the walk in urgent care appointments for what ever reason – including lack of timely public transport, Tony Martin said,
“The Practice cannot be responsible for any transport arrangements our patients may have or choose to make. Where a patient is unwell and is unable to attend the surgery, our clinicians will visit them at home where this is appropriate. This applies to both urgent and more routine cases, has always been the case and will remain so.”
Patients’ complex conditions,more patients, national shortage of GPs and flat GP funding
Hebden GP numbers recently fell substantially – by the end of October, five GPs will have left this year. They are being replaced by Advanced Practitioners and Locum GPs.
Tony Martin explained:
“It’s probably appropriate to describe the circumstances under which the Practice is working, which are influencing many of the decisions we make. There are a number of factors which have been impacting on Practices across the country for a number of years which are now being felt in Calderdale.
Patients are living longer and there are more of them- our patient list has grown by almost a thousand in five years.
Patients are presenting with more complex conditions, many of which are managed by Practices rather than in hospitals as was previously the case. Therefore many patients need longer appointments or more frequent or repeated appointments.
There is a national shortage of GPs which is now impacting upon us. The Royal College of General Practitioners has recently published a national survey which demonstrates that a thousand GPs have left the profession in the past year. In addition, 39% of GPs have said that they intend to leave the NHS within the next five years.
By the end of October, we will have lost five GPs this year. Although I cannot go into the personal details around their decisions to leave, I can state that without exception they have not left because there is an underlying problem at the Practice but that in the main, their personal circumstances led them to jobs nearer to their homes and their families or for career opportunities which we were unable to offer. Given the number of GP vacancies across the country, the opportunities to move jobs are much more readily available than they ever used to be.
Two years ago when we advertised in the local and national medical press for a GP, we had two applicants where four other Practices at the same time had none. The shortage of GPs and the unwillingness of the remaining potential applicants to commit to a salaried or partnership position in favour of locum jobs makes recruitment very difficult.
Despite what you may have read, funding for general practice has at best stayed flat for a number of years while costs- utilities, rent, insurance, consumables etc have all increased. Our staff and GPs haven’t had a real terms pay rise for at least four years.
We discuss these issues with other Practices, our commissioning organisations and many others on a regular basis. I’m absolutely certain that this is a picture affecting all Practices.
We work with our colleagues in both informal and formal networks and collaborate when we can to manage the impacts.
I believe that despite all this, we still provide an excellent service to almost 19,000 people. The changes we have made recently are driven by the pressures we are experiencing and the desire to continue to provide an excellent service to our patients.
In recent weeks, we have successfully recruited two Advanced Practitioners, two long term GP locums and are about to interview for more Advanced Practitioners in permanent roles.
We have and will continue to do as much as we can to maintain our service and ensure that we deliver what our patients need. This includes recruitment, retention, management of costs etc.”
Tony Martin also responded to these additional questions:
It’s come to our attention that a patient attended the morning surgery and saw a Health Care Practitioner who was unable to treat the patient, despite having been assured that the appointment would be suitable for the patient’s needs. They had to make another appointment with a GP for a later date.
“I’m sorry to hear this but again cannot comment on the specific circumstances.
Unfortunately this can occur irrespective of the system we have in place particularly where the presenting symptoms may mask other underlying conditions or the patients perspective may be different to the actual condition. This is sometimes only established during consultation.”
How will the new Integrated Urgent Care Service affect your urgent appointments system?
“As I understand it, this is a scheme aimed more specifically at “out of hours” providers of care such as NHS111 so currently has no impact on the service we offer. Where in the future there might be greater connectivity with general practice we will endeavour to ensure that any changes only have positive impacts upon our patients.”
He explained why the walk in surgery is based in Mytholmroyd
“Firstly, it’s central to the Practice geographical area and there are easily accessible and plentiful parking spaces, especially in the light of the recently implemented parking controls.
Secondly, having analysed activity data, we estimate that the level of clinical resource allocated to the walk in service will be sufficient to cope with demand.
Thirdly, we do not have the clinical resource to be able to offer this service on more than one site. We did consider rotating the site from which we ran the walk in service, but were concerned that this would be confusing to patients.
The system we have implemented is in place in a number of Practices both locally and nationally. A number of clinicians who work with us have used this way of working in other places with success and their experiences were instrumental in our decision to provide the same thing.
I discussed the proposed new system with our Patient Representative Group at our meeting in July. The group was very supportive of the idea.
Although the system has only been in place for a short time, we have already received a number of written compliments from our patients and many others who have used the service have expressed a great deal of satisfaction to the clinician they have seen and to our reception staff.”
Update 21 December 2018
However, since this correspondence took place, we have heard from patients that the Practice is not honouring the Practice Manager’s commitment that “there is no change to the arrangement that allows for patients with chronic conditions to ring reception to speak to a GP to have their symptoms recorded or have their medication adjusted, as a part of their care plan.”
And that at the Mytholmroyd walk in centre, there are often long waits to be seen. And when seen, patients may find themselves in a consultation with a Community Pharmacist who seems to struggle to follow some kind of diagnostic questions checklist and to be well out of their depth in terms of reaching a diagnosis and appropriate treatment.
We will be following up these issues with the Practice Manager asap. If there are any other issues you would like ck999 to raise with the Practice Manager, please let us know by email or in the comment box below if you prefer.