Saturday, March 09, 2013

The surgery appointments system debated in the Courthouse

Yesterday afternoon (Friday) the Nairn and Ardersier Practice's appoinments system, the subject of much controversy since its inception, was debated at the NHS/Highland Council partnership meeting in the Courthouse.

Dr Baker began his presentation with an admission, stating: “We didn’t do particularly well at the preceding practice “
 He then went on to say that the new practice offered “ a substantially different and very, very local model of care that we do deliver and we strive to continue to deliver.” He continued: “We’re at the forefront of integration with health and social services, here and establishing a single point of access.”

He then went on to the mechanics of the new appointments system: “In terms of delivering holistic and overall care to the population we are doing our very best. We’ve discussed our new appointments system in the run up to it with patients in the summer of 2012 and in the autumn as well. We implemented our new system on the 5th of November funnily enough and we’ve seen a few fireworks since then.

What we have dealt with since then in the last four months we’ve had twenty four and a half thousand telephone calls, we’ve seen 7,000 patients of which 5,000 we’ve seen on the day , 6.and a half thousand which were seen within seven days of calling. In comparison with our previous model, people were waiting 3 to 6 weeks to see a doctor. So it’s done what it’s said on the tin really which is to improve access. It’s not pleased everybody and we as a practice accept that and apologise that we can’t please everybody. We are working and revising the current system to improve that.

 What we have been surprised with really is the volume. We weren’t quite expecting 10% of the population to contact us every week, which is quite a lot of calls. But we have dealt with that and we’re looking to do a little piece of research with NHS Highland and public health to look at what’s coming in and why and why our contact rate seems to be quite high.”

The meeting also learned that the system was in the process of continued improvement and the practice looking for constructive feedback and are looking at significant changes in the future.

Liz then asked if there had been recent changes to the appointment system.

Dr Baker indicated that they are looking at accommodating people who are at work better. He said that the practice recognises that some people at work are unable to take telephone calls we are looking at that.  He confessed that they had been criticised on their speed of response He told the meeting that there were a limited list of people who can book directly such as people with vision, hearing impairments and those patients with mental health problems and dementia.

Liz continued her questioning and asked “Will there be any more public information going out about the service?

 Dr Baker replied, “We fully accept that we have not been as good as we could have been in publicising the service and we accept responsibility for that and once we have significantly refined what we are doing we’ll be publicising that with more detail.”

Liz then commented, “I’ve certainly not had any complaints from anybody over the last week, two weeks. I think it must be getting ironed out a bit now.”

When asked about what the contact rate was before the new system. Dr Baker said that it wasn’t measured before and he didn’t know where the people that got fed up went. He stressed, “Clearly a lot of people got fed up and just gave up.”
He said the contact rate for the first of January was 12%. He gave a normal contact average figure for other areas of the UK of within 5-10%.

There were a couple of questions later on from the public benches at the end of the meeting. Graham Vine asked Dr Baker, “I noted your point when you say you had some people who had got fed up and you don’t know where they went. Bearing in mind that the Nairn and Ardersier practices are now merged and are a sort of monopoly provider in the town, Where could anybody go who was dissatisfied with the practice in Nairn?”

Dr Baker replied, “I don’t personally know, however some self-limiting conditions get better of their own accord and within some weeks some things improve. We all recognise that. There are other providers of health care in the town, we’ve got the third sector, we’ve got pharmacies[…] It’s not just the GP that provides health care, there’s an awful lot of provision out there and if you are waiting 3-5 weeks you may make alternative arrangements.”

Another comment from the public benches followed. One patient thought that the appointment system was only set up for people who made one off calls and that for somebody with a long-term condition it doesn’t really work.
Dr Baker replied that for long-term conditions they tried to give a long term patient the same GP.
“I tried to get an appointment with my own doctor but he didn’t know who he was,” came the reply from the member of the public.

This observer feels that the heat and intensity that was expressed in recent weeks in the Nairnshire and on the Gurn has faded somewhat. Liz indicated a few weeks ago that she was constantly receiving complaints and now they have ceased. Either the teething troubles with the system are receding or weary resignation has set in with those that have found that the system hasn’t worked for them. The system does seem to have worked for a lot of people however and it is obviously here to stay. What is interesting is that significant changes are promised, we will have to wait and see if these changes placate those still upset with the new system.


Anonymous said...

Dealing with a patient via the phone and maybe issuing a prescription on the back of the phone surgery misses one vital process in the GP's armoury, namely catching sight of a patient and assessing their wellbeing. This can include so many important factors, body language, weight loss etc and even being able to check the likes of blood pressure and temperature which would just take a couple of minutes at the surgery but can't be done over the phone

Some people are not very confident over a phone and may not express themselves very well. Again a GP might miss vital information

Best of luck to the new system and that includes the GPs who are having to make difficult decisions over a telephone wire rather than actually seeing their patients in the flesh. How long before the telephone part of the practice is outsourced to another country in order so save even more money?

Welcome to the new NHS

Jane Harkiss said...

Doom, gloom & despondency! At least we still have an NHS.

Just saying.

P xx

Anonymous said...

It really doesn't work, if you're working. You have to leave work to make the phone call in, then you have problems taking the phone call back. And then, if like me, you work in Elgin, you can't always come in that day. For routine appointments, where the doctors is expecting us to want to see them, we should be able to make those, with reception, in advance.