A word from Dr Fowler
For those of you that haven’t heard I’m retiring as a partner at the surgery from the end of June this year. I’ve had the pleasure of working in the surgery for over 28 years. It was suggested I write something for the practice’s website and newsletter. A lot has happened, and changed, in 28 years and with no suggestions on what to write about I hope my pitch is about right. Forgive me if I reminisce a little about the past and add a little about the future, and I could write a whole book on the present!
I count myself extremely lucky in being offered a partnership at the start of 1993. A respected surgery in a lovely part of the country was a dream job. I know there are patients who have been with the practice longer than I have. I’m sure they’ll remember the 3 tiny surgeries we had then, at Long Bredy, Portesham and Abbotsbury, when a GP's life was very different. We had no computers. We actually had time to do home visits, and discovering the quiet corners of our practice area was a delight. A professional highlight came after a few years when the current Portesham Surgery was built. A new surgery designed and built from scratch, and a vast improvement on the old one where we had to play music to prevent the consultations being overheard through thin walls! I didn’t expect we’d outgrow it as quickly as we did. But best of all has been the people. Those I’ve worked with and those I’ve got to know as patients, and in many cases as friends. There is something that really drives home the pleasures of the job when, for example, you recall doing a visit to see a newborn baby (yes, we used to do that) and that grown up baby is now bringing their own children to see me.
In those early days we did our own “on call” at nights and weekends. The routine was established immediately after qualification when you started your first hospital job. You would typically work a day, a night then the following day without any certainty of breaks. I certainly recall once such shift of about 32 hours with no sleep. A typical weekend on call was even worse – 80 hour shifts started on a Friday morning and finished Monday afternoon. General practice at the time was similar for a few years, but became less onerous as we started sharing the night and weekend work with other practices, and finally lost it all together early in the new millennium.
It was never easy to work into the night and be expected to work normally the following day. It always surprised me that it wasn’t questioned more, not just the safety but also the morality. This theme of pushing the NHS workforce to their limits is no less relevant now. In many respects the pressure to work harder and faster I’ve felt over the last decade has been harder than that 32 hour sleepless shift. And that was before Covid! A GP friend recently mentioned that he was thinking of asking the CCG for more computer screens so he could see two patients at once. He was joking of course, but I wouldn’t be at all surprised if a wish such as this is granted!
I’m sure most people have been aware of these issues but, even now, some people seem surprised that we are so busy. I take this as a commendation that our attempts to shield patients from difficult times has had some success. I am grateful to everybody who has shown patience and understanding, and in many instances, tried to help us in various ways. Recently, I’m regularly asked how I am and how are we coping, a change from the norm but very much appreciated.
Whatever your thoughts on the path the NHS has taken it seems to me that the capacity of the NHS has never been more finite. I’d like to think it’s not just the responsibility of the workers to get the NHS back on track but the collective responsibility of everybody. We all have an opportunity to influence the way the NHS is used and evolves, be it through keeping appointments, being reasonable with our requests and even the way we vote in elections. There will always be rogue individuals pushing for their own needs at the expense of others, but I thank the vast majority who, in my experience, don’t abuse the system. From the practice perspective looking after patients should be, in my view, our key role and where the focus should be. Increasingly we have been spending a lot of time dealing with (and sometimes blamed for) a wide range of understandable frustrations, anything from hospital waiting lists to lack of social care to loss of services through financial cuts. Time spent on these issues we can’t control is rarely fruitful and takes us away from patient care. Look after the practice and they’ll be in a much better position to look after you.
As mentioned earlier it is the people who are the tonic that get you through the difficult times. Thankfully, I have never suffered from not wanting to go to work and I put this down to that contact. Whilst the covid pandemic has certainly created clinical and organisational challenges, the reduction in face to face contact with patients and colleagues has been, in my view, the hardest part. It also means I haven’t had the opportunity to see, for the last time, many people I’ve got to know over many years. For them, I would like to say it has been a pleasure looking after you.
Although I’m retiring from partnership it’s likely I’ll be around doing a few locum sessions until I’m no longer needed. Finding new doctors isn’t easy at the moment so Drs Beale and Jones, and Alison the practice manager, should be congratulated on finding two new doctors. I’m sure they, and the rest of the practice team, will continue to put in that extra mile to look after the practice and its patients. As for me, I am looking forward to doing those things you constantly put off for another year, and then realise you’ve put them off for 28 years!
Dr Amy Windsor joins Portesham Surgery
We are looking forward to welcoming our new salaried GP from 21st June. Amy will be covering four sessions on Mondays and Tuesdays each week. When Dr Fowler retires we will have another GP joining us to cover his sessions - more news on this later.
Amy has written the following to introduce herself to us:
I trained in Southampton having completed a Geography degree in Durham. Then most of my training and recent work has been in the Portsmouth area.
I have a specialist interest in Older Persons health and also Palliative Care. I also work at Bridport Community Hospital with my Older Persons/ Palliative Care ‘hat’ on. I am also interested in mental health and have developed an interest in lifestyle medicine.
Outside of work I love walking and being outdoors. When I have time I also a keen cook and am a keen but ‘developing’ gardener!!
General Practice Data collection changes - UPDATE!
General Practice Data for Planning and Research (GPDfPR)
The government announced yesterday that the creation of a central NHS digital database from GP records has been pushed back by two months to 1st September.
As well as using your information to support the delivery of care to you, your data may be used by NHS Digital to help improve the way health and social care is delivered to patients and service users throughout England. From 1 September 2021, NHS Digital will securely extract your information to provide access to patient data to the NHS and other organisations who need to use it, to improve health and social care for everyone.
NHS Digital will primarily use your information in a way that does not identify you (your information will be pseudonymised). However, they will be able to use their software to identify you in certain circumstances, and where there is a valid legal reason to do so. NHS Digital may also share your information with third parties such as Local Authorities, Primary Care Networks (PCNs), Clinical Commissioning Groups (CCGs), research organisations, including universities and pharmaceutical companies.
At the time of publication (May 2021), patients who have a “type 1” opt- out, will be excluded from this programme and will not have their data extracted for this purpose. Further information about GPDfPR can be found here: https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/general-practice-data-for-planning-and-research/transparency-notice.
We will rely on Legal Obligation (Article (6)(1)(c)), Health and Social Care (Article 9(2)(h)) and Public Health (Article (9)(2)(i)) as the legal basis for processing your data for this purpose.
If you wish to opt-out of this new data collection please download the opt-out form here and return it to Portesham Surgery or, if you have the NHS app go to "My Health" (at bottom right) and scroll down to "choose if data from your health records is shared for research and planning." We also have paper copies in the surgery.
View from Portesham Surgery
You may have seen or heard recent media coverage about the struggles being experienced up and down the country in General Practice.
We have had many lovely supportive comments and gestures from our patients over the least year, for which we are extremely grateful. Unfortunately, more recent we - and other practices both locally and nationally - have seen an increase in abuse towards our reception teams.
Whilst we understand that life is currently challenging and frustrating, abuse is not the answer. The words that you say to our staff stay with them long after they have finished their shift. Some become hardened to it, some think it's part of the job. Others go home and cry, and some might leave because they just can't face another day of rude and aggressive language.
Click here to view this nationally produced 4-minute video which highlights some of the shocking experiences GP practice teams around the country have been exposed to: https://youtu.be/3rd4QhVZ2a8 .
We ask you all to think about how you speak to anyone, whether they work in a GP practice, pharmacy, shop, pub or restaurant.
In a world where you can be anything, be kind.
Why are we getting these reactions from patients?
We are increasingly being told: "you're not busy, why can't I book an appointment?" "When are things going to go back to normal?" and, most distressing for all of us who care deeply about this surgery and the service we give to our patients: "Portesham Surgery is not what it used to be."
What patients mean by this, usually, is that in the good old days you used to be able to ring us and get an appointment within a day or two. Now it seems there are barriers in your way - busy phone lines, queues outside, and no pre-bookable GP appointments. Our staff have to spend time exploring your query and finding the best solution for you, instead of just booking you quickly into an appointment as we used to be able to do. And this can feel confusing and obstructive to you at the end of the phone. We understand this, and would like nothing more than to return to the good old days ourse
What is happening?
First of all we have been open throughout the pandemic, and we are here to help those who need us. The only difference is that every single request has been triaged (assessed) by the GP throughout the pandemic, at first for safety reasons (to make sure patients were not bringing COVID into the surgery) but now to ensure that we can prioritise the most urgent problems because of the overwhelming workload.
This is not unique to Portesham Surgery. It is the same everywhere; we are working longer hours than any of us have known, and still the workload piles up.
Take a sadly typical day at the moment: our duty doctor has had as many as 63 patients on their triage list. This is for urgent queries which have to be assessed the same day. Each assessment requires the GP to look at the patient's record, telephone them for more details, assess the problem, discuss treatments and solutions, change or issue a prescription, make a referral or call the hospital for advice, and update the notes on the medical record. Even for the simplest of queries this can easily take 15 minutes, more if the patient is not around to take the call and the GP has to try them again several times during the day. The BMA (British Medical Association) guidelines for safe clinical practice is for a GP to deal with no more than 35 patients per day. At 15 minutes per patient this is still more than 8 hours work, without allowing time for all the other tasks - checking and filing lab results, reading and acting on hospital discharge and clinic letters, signing scripts etc.
Clearly, nearly twice that number of contacts does not fit into any kind of working day. So our GPs carry on working from home late at night, at weekends and on their days off.
This is not sustainable.
We are trying to understand what has precipitated this huge increase in workload. It could be partly down to the increased anxiety we have all felt over the past year, and to the feeling that now "things are back to normal" people are looking for quick fixes and solutions to problems that have been building up for months.
We want to make sure we don't miss anyone who needs help. Please don't delay contacting us; those who apologise for bothering us are often those who most need our help!
There is plenty you can do to help:
- Be understanding about the lack of bookable routine appointments. If we returned to this system while the workload is so great, many patients in crisis could get missed. We know you will understand that we have to give priority to the most clinically pressing needs. We cannot be in a situation where we help those who shout the loudest, so if we assess that your query can wait, please respect our judgement.
- Use Minor Injuries Units for treatment of small injuries (within the last 48 hours)
- Use your local pharmacy. Many topical treatments can be bought over the counter
- Use eConsult for simple, non-urgent queries, and if you can, try the "I want to help myself" option first.
- Order your prescriptions a week before you need them - this gives us time to sort queries with the GP and order stock (there are still periodic post-Brexit shortages)
- Be available on the phone, if you request an urgent consultation, and be brief. Don't add several non-urgent problems - mention them so we can assess whether they are related to the main query, but expect to be given a routine appointment to discuss routine problems.
- Ring the hospital, not us, with your queries about appointments there or prescriptions from your consultant
- Be kind to our staff who all want nothing more than to help you.
We very much hope things will return to "normal" but we can't get back to those calmer, more responsive workdays without your help. With patience and understanding on both sides we can continue to help all our patients and keep you and our staff safe.