Long time no post

Despite a long period of silence on the blog the practice has been busier than ever. The purchase and development of the premises will not go ahead and we have been looking carefully at our choices.
The government is introducing regulated standards for General Practices and all other care providers through registration with the Care Quality Commission (CQC). This organisation will monitor and 28 essential standards laid down in law with which we are legally obliged to comply. Some of these regulations cover the suitability of premises for their purpose and for both patients and staff. It has been argued that the standards are too onerous and the onset of regulation too quick - as a result the Government has delayed the registration of GP surgeries until April 2013. As you can see this gives us very little time to make changes and makes us feel very vulnerable.
The SE London Sector (who replaced the PCT) as our bosses have told us our project is not "financially viable" and have said that their preferred option would be for us to find a vacant site or a premises that could be demolised and rebuilt tailored to purpose. We think in West Wickham that this is an almost impossible dream, but we will keep our eyes open and we know that you do too.

On a more positive note our two big flu clinics at West Wickham and Shirley Baptist Church have been a big success once again and we are grateful to them for the use of their large and accessible rooms. It is always a pleasure to see so many of our patients together outside of the practice. Our thanks to you also for supporting the Children's Society with purchases of Christmas Cards.

If you haven't had your jab and you should have done we will be running some sessions in the surgery over the next few weeks so phone and book an appointment (but you will have missed out on the tea and biscuits!)

Finally we hope to get the patient participation group up and running properly soon and many of you have been kind enough to share your email addresses with us for this and we will be in touch very soon.

The times they are a changing.

It has been a busy month with holidays and sickness affecting the staffing levels at the surgery but hopefully not impacting on the service you have been receiving. After the disappointment of the surgery development scheme being blocked after a year of hard work (and expense) it is nice to have some good news to share.

Our patients said they would prefer some early appointment times during the week and the BSU approved our application to change our surgery times. From the beginning of August it has been possible to book an appointment on a Friday morning from 7.15am. So far we have been encouraged to see that all the slots have been filled and feedback from patients attending has been very positive.

Our other big change this month has been the start of the refurbishment of the waiting room. We have removed those dark, uncomfortable bench seats which have been a feature of the waiting room for about twenty years and replaced them with some comfortable, bright blue seats some of which have arms to assist those who have grown roots waiting for Dr Young (who is very aware she is almost always running late). There is still a lot of making good that needs to be done. The flooring needs to be patched and the walls papered and repainted. But we are encouraged by your positive comments and will continue to work at brightening the room up.

The flu season is approaching fast and we will once again be inviting those of you who are over 65 or have an illness which makes you vulnerable to 'flu to join us at West Wickham and Shirley Baptist Church for your vaccination, tea and biscuits and a chat with friends. Watch out for your invitations which this year are being sent out by the BSU on our behalf. Help us to achieve the best coverage by booking your appointment promptly.

Finally a  big thank you to all of you who have updated your contact details and given us permission to communicate directly with you. We hope that this will allow much more patient input into the surgery and help us to get things right for you.  We look forward to hearing more from you all.

Multitasking

A huge thank you to all out very supportive patients who have been commiserating with us over the failure of the planned expansion into next door. Last week we had a visit from the head of Estates Management at the new Cluster (Bromley Bexley Greenwich Lambeth Southwark and Lewisham) who have taken over from Bromley Primary Care Trust (PCT). His view was that there were problems with "Affordability and Functional suitability". He felt that a new build was more affordable and more suitable and his suggestion was that we abandon this project and  "keep looking". 


I suspect that the problems are as much to do with the unfortunate timing with regard to the recession and health service restructuring as to the  suitability of the project.

Well the questionnaire did not happen as promised last time but that was because I could not make the software work. I shall have another go later this week. 


The data on appointment demand has gone off to be analysed and our deadline for making changes has slipped slightly. The new way of working is being trialled in a couple of larger Bromley practices already and we hope to learn from them too.


We have applied to the Business Support Unit (the remaining local arm of the old PCT) to change our extended hours.  That is to say the hours we open outside of 8am to 6.30pm. We will keep our late Tuesday evening  (6.30 - 8pm) but have asked to move Saturday morning to a 7.15am start on a Friday. This is in part because of poor attendance at the Saturday surgery and frequent non attenders but also based on the survey we ran earlier in the year where there was an fairly even split between patients who wanted mornings and those who wanted evenings or Saturdays. To date we do not know if this change has been approved.

We are short handed on reception again because of staff illness and looking back realise that our wonderful receptionists have now worked a complete year with one member of staff or another absent on sick leave or maternity leave. In the circumstances the fact that they do their jobs so well is all the more remarkable and they deserve huge thanks for all their hard work.


By the end of the year we should be using an upgraded computer software programme that will eventually allow you to log into your own medical record where ever you are in the world, provided you have your password and security details logged with the system. It is hoped that this will allow you both to check your own record for accuracy but also in case of emergency help you inform any healthcare professionals treating you. It will be a little while before this is fully functional and we will have to work quite hard to make sure we are up to speed with the new software in time for the switch over. Our first training day is in early August.

Pick yourself up, brush yourself off, start all over again.

I have been pondering what people might be interested in hearing about and took some advice from a younger patient who said "just write what you are thinking". That seems more than a little unsafe to me as most of my thoughts at present are around frustrations with the quality of care we are able to provide for our patients and the numerous barriers and hurdles some of our patients have to overcome to get good care. All around me I see people trying to delivery a good service in the face of reorganisation, lack of funds, poor communication and mounting bureaucracy. All around me I see patients not receiving the care they deserve.

Don't get me wrong it isn't all the fault of others - sometimes it is us that gets in the way of a smooth pathway. For example by sending a Bromley resident to a Croydon service or sending a Croydon resident to a Croydon service which they are not entitled to because their GP has a Bromley postcode. Sometimes our staffing levels are too low and we cannot deal with our problems and queries as fast as you (or we) would like. Sometimes you cannot see the clinician of your choice. Sometimes we have forgotten to share with colleagues changes in services that we have uncovered so they cannot take the quickest route to getting a patient treated. We try to meet regularly formally and informally daily to ask each other's advice, to share and  solve problems and iron out frustrations. We apologise for those times when it does not work and try to learn from them.

Today we had most of the computers in the practice upgraded in preparation for a software upgrade to the clinical system in the autumn. I am sure anyone who attended the surgery today did not receive the best service but I hope that soon they will benefit from today's confusion. (Just to make it more fun one of our phone lines was out - so the telephone engineer had to work around us , the IT team and all the boxes and hardware).

One good thing came out of having the IT team captive for a day - we might soon be able to allow patients to register with the practice electronically, which will improve access for some prospective patients at least.

It looks as if the premises expansion is a dead duck, though we are having one last attempt at resuscitating it! We are trying not be too miserable or angry about it but all feel pretty let down by the process and the lack of anything other than verbal support from the powers that be. As with all knockbacks, you have to dust yourself off, get up and start again so we are looking again at what the alternatives might be and your ideas are welcome.

This has been a mixture of a rant and a ramble. I will need to post more frequently but also more concisely.
Finally what about the patients opinions and feedback - well I hope to have our first online survey up on the blog later this week.

The merry go round

The surgery has been busy in part due to unseasonal coughs and cold but also because of short term absences for training and education. This is a brief summary of the behind the scenes activity (the merry-go-round) in the last three weeks.


Most of the staff successfully completed their annual resuscitation training (a few who could not make the session will catch up on it in the coming months). The surgery hosted a multidisiplinary Gold Standard Framework (GSF) meeting - (GSF is a systematic evidence based approach to optimising the care for patients nearing the end of life and is concerned with helping people to live well until the end of life with any end stage illness and in any setting.) All our clinical staff met for a clinical case review and met again separately for a management meeting to decide how best to meet the new care targets for this year's Quality and Outcomes Framework (QOF). 

Dr Mustapha attended an academic half day with a session to introduce GPs to the new Stroke Service at the Princess Royal University Hospital as well as updates on sexual health and HIV. Dr Young attended the Royal College of General Practititioners Annual Conference on Drugs and Alcohol - with some very interesting debates around the changes in emphasis coming from the coalition government (stabilisation vs abstinence). Dr Selby and Dr Young attended the launch of the new Bromley Healthcare, the social enterprise that provides our district nurses, health visitors, occupation therapists, community dentists, and numerous other community specialists who help to provide care for patients in the community.
Our manager, Sue Robinson has attended the local Practice Manager's Forum to discuss and debate, more efficient and better coordinated provision of services.
Dr Young has attended the selection meeting for the new Chief Executive Officer of Bromley Healthcare and the bimonthly Local Medical Committee meeting, while Dr Mustapha and Mrs Robinson will attend the Practice Based Commissioning (Unity) Cluster meeting for our locality tomorrow night.

The current pace of change is frightening and the future of the NHS uncertain but we are trying our best to keep pace with the change; representing the best interests of patients and keeping ourselves up to date clinically too.  We hope that on balance all this activity is beneficial and not detrimental to patient care.  

Maytime

It is hard to take in how fast this year seems to be disappearing. May already. The run of bank and public holidays has not helped the smooth running of the appointment system and while our audit continues (giving us a good picture of demand outstripping supply) we are trying to offer some extra capacity in the short term to ease the pressure on appointments.

Today is a training day and at lunchtime all staff will be getting their annual refresher course in resuscitation training.

Other changes include an alteration to the late night Tuesday surgeries - reception is now open for business as usual until 8pm on a Tuesday night. In addition there are also appointments available with the nurse between 6.30 - 8pm on Tuesdays and Mary our healthcare assistant offers vascular screening checks to invited patients on Tuesday evening too. Reception will also be open on alternate Saturday morning during the 8.30-10am surgery.

I hope shortly to ask for guidance from you about the issues you think it is important for us to address. Look out for a questionnaire, coming soon.

Finally, despite news elsewhere to the contrary, I am sorry to say that we have not managed to purchase the adjacent building. We continue to explore all options to try and make this happen but things look less hopeful.

First Post

Where shall I start? Well here goes. This April the surgery celebrated 30 years in the present building. Of course it has a long history before that and has seen many changes. The coming years are likely to bring great changes to General Practice and we would like you to be involved with the way this surgery evolves. We had hoped to give good news of expansion into the adjacent semi, but as many of you will have seen the "For Sale" sign is back up. We are still working at finding a solution but it looks increasingly unlikely that we will succeed.

Lack of space does not mean lack of development, in fact quite the opposite. We are having to look closely at making the space work better for you and this month we are running an audit of demand and capacity, with a view to altering the way the surgery receives calls and books appointments. We hope that it will make it easier for you to book appointments at a time that suits you, as well as reducing the delay between phoning and being seen. The system we are looking at has been used in other areas of the country by about 28 surgeries and extensively researched. It is called "Doctor First".

Please let us know if you have ideas about this or views on things you would like us to focus on.