Easter Greetings

Easter is a wonderful time of year all about love, forgiveness, redemption and new beginnings. We wish all our patients a very Happy Easter.

The surgery has come through a difficult year and survived the challenges and disappointments. We have weathered what has felt like a fierce storm, submitted the end of year returns (more onerous than ever before), coped with a new computer system and have achieved better ratings in the quality of care targets than last year. Although we are all tired we are girding our loins to start all over again this year.

We want to thank all of you for being so patient with us when things have not gone so well - we know our electronic prescribing (Pharmacy 2 U) has not been working well since the new computer system was installed. It should be back on track by May and in the meantime we are working hard to shorten the turnaround time. We also hope to pilot an electronic prescription service with local pharmacies from May so that your paper prescriptions for repeats will no longer have to be collected but can be sent securely electronically to your chosen pharmacy where the dispensed medication can then be collected.

 We recognise as well that the new system has made us slower in responding to queries and that there are problems for those of you who book your appointments on line. Please keep telling us about the problems and we will try to fix things.

Thank you also to all those who agreed to be members of our virtual patient participation group and those who responded to our questionnaire seeking your opinions and suggestions. The results are available on the practice website. If you would like to join this group please drop in and pick up a form or email us on:
 bro-pct.wickhamparksurgery@nhs.net and we will send you a sign up form & add you to the group.

We have had our premises inspection and are waiting to hear what the CQC expects of us. We are not expecting good news and with that in mind have started to explore the possibility of relocating the surgery to a new build site within the practice area. This is at a very, very early stage of discussion and would be a long term plan with no move envisaged before 2014 or 2015. We will keep you posted with news as conversations progress.

On a personal note I completed the first part of my training to be a GP at the Paralympics and had a wonderful day meeting new colleagues from all areas of healthcare who will be involved in this very special event. I have to admit I was slightly relieved to hear that the dentists are usually busier than the doctors! I am waiting to be called for my uniform fitting (so its back to the diet) and then further training (medical not exercise).

Finally some publicity for the Diamond Jubilee Manor Road Street Party which a flyer tells us is to be on Monday 4th June from 2-6pm (with the road being closed from 8am to 9pm). We look forward to more details from Candy and Doreen who are organising the event.

Bells and Shovels!

I am not sure that writing this at the end of a long week and after a glass of red wine is the best timing but here goes. We have survived our first full week with the new computer system and that in itself is cause for celebration and bouquets all round. Our receptionists have been magnificent coping with the new system admirably and the back log of tasks with good humour and perseverence. Patients too have been very tolerant of our hiccups and glitches for which we thank you. We also thank the marvellous trainers who supported our transition with infinite patience and kindness, hovering near at hand so that we could shout for help when we got stuck. Doubtless we will have to make a few more calls on their expertise over the next few weeks as we discover things we cannot do. Every day this week has had challenges and rewards and I for one have found the stimulus invigorating.

In other news - we welcome Manisha our new receptionist who is filling the vacancy left by Amy. Manisha brings with her a wealth of experience in other surgeries. She has survived an induction of fire and we hope she will get a chance to settle in more gently over the coming weeks.

We were relieved that our first fall of snow was both light and short lived. The surgery has registered for the council's "Snow Friends" scheme. Snow Friends are local residents who volunteer to clear snow and ice in their street. We now hold some salt supplies and a big snow shovel at the surgery provided by the council. Some of you will have witrnessed our practice manager Sue shovelling snow and gritting pavements on our side of Manor Road earlier this week. If any able bodied among you would like to lend us a hand so we can clear more of the road please make yourself known to us at reception and we will be only too happy to sign you up to help with any further snowfalls.

Almost a year after being interviewed I am delighted to report that I have been selected as a volunteer to work as a GP at the paralympics and will be taking leave from the practice in late August and early September to do this. I start my training next month and am looking forward to being part of this wonderful event.

Finally our sincere apologies to those of you disturbed by the surgery alarm in the early hours of Monday morning. Dr Mustapha was there along with the Police as soon as he was alerted by the alarm company, we still do not what triggered the two zone breach that disturbed you all. Fortunately it has not recurred.

No pain, no gain

Everything will look the same on the surface (though possibly not the composure of the staff) but underneath lots will have changed. We are all on tenterhooks as tomorrow we switch over our software computer system from the one we have been using for the last 10 years (and know pretty well) to an all singing, all dancing, upgraded system from the same supplier. It is called EMIS web and will set us up to cope with all the new electronic cleverness coming our way.


Image by  Dixie Allan



You may experience some initial delays due to our unfamiliarity with the system but we have all had training and hope that once the system is live we will get up to speed fairly quickly. Our engineers arrive at 7am tomorrow and have promised to have us functioning in time for the first appointment at 8.40am. Training staff will be on site to bail us out if we run into any major difficulties.

So what will it improve? It will make record keeping, data coding and searching for information much easier, will flag up overdue tests, will update and backup in real time to a secure remote server so that we will hopefully never lose access to your records because of server failure. It will allow us to show you trends in results in  graphic form and will link conditions to information sheets and other information.

Eventually (in about 10 to 12 weeks) we hope to be able to send your prescriptions electronically to which ever pharmacy you nominate, so no one has to collect a paper prescription unless they wish to. In time we will also be able to send your pathology tests directly to the laboratory so you won't need to remember the paper request form. We hope that it will also allow us to look at blood tests ordered by the consultants who care for you and by people like the warfarin clinic so that we do not duplicate tests and you will not have to bring your warfarin results too us before we can issue your prescription.

In some areas of the country where this system is used limited records are being shared (with permission) with the out of hours doctors, community services such as district nurses and physiotherapists and palliative care teams, making care safer and smoother. You will always have the option to say you do not want your records shared in this way on the national spine and we will code your notes accordingly which automatically prevents them being shared. 

Further in the future you will be able to use the same system by which you book appointments electronically using your password and pin number to request medication from your repeat prescription list, to register with the practice and one day to read your own medical notes.

We ask for your patience with us over the next week or so as the system beds in and we adjust.

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.