The average pencil is seven inches long, with just a half-inch eraser - in case you thought optimism was dead. Robert Brault

Premises:

As you will recall our plans to relocate to more patient friendly premises have been dragging on for some time (more than 12 years!) but with the change in organisational structure to the NHS new people and departments are responsible for making these decisions. There are new priorities and targets for them. This is an extract of an e-mail received from NHS England updating us on their view of our current application for a new surgery premises.

“The vision for future Primary Care provision is that it must be available from:

·         modern fit for purpose buildings under current regulations and guidelines

·         wherever possible practices should co-locate to reduce operating costs and overheads, benefiting from economies of scale

·         multiple providers should operate from single locations to provide a variety of patient services

·         building should support the out of hospital agenda, offering an increased range of services within the Primary Care setting such as diagnostics etc

Additionally, there is very limited funding available for capital projects, and only those classified as high priority, are likely to reach the approval stage of the stringent process. Non-recurring costs will now be considered in line with the new NHS England premises discretionary funding policy rather than the previous Cluster policy.

The business case you are presenting is an anomaly to what I have previously described. If it is to be recommended for approval, it must be the most cost effective option, provide significant added value, and stack up in all areas. This is not currently the case.”

We sought a meeting with representatives of the new primary care commissioners and received the following response:

“I am fully aware of the history which dates back to around 2002 and ****** and I reviewed the Business Case (BC) together. In fact, I still have the historic audit trail! With the greatest of respect to all parties, because of the financial situation and strategic drivers that now impact upon premises development BC decisions across London, and the fact that each BC must compete against a set of London priorities (e.g. New GP premises within the former Olympic Park to serve the significant new population), as ****** says, only BCs that can tick as many boxes as possible will be accepted. As much as it pains me to say it, the historic facts will not make a difference in themselves, BUT, coupled with a BC that responds to as many strategic deliverables as possible, will be something we (senior commissioners) are able to support. I therefore suggest that before any meeting is convened, you consider our comments and seek to amend the BC.”

This week we are meeting again with the Development Executive of GPI who has been supporting our application and a representative of the Bromley CCG. We hope we can revise the business case to "tick as many boxes as possible".

You wait all this time for a blog and then two come along at once!

So much time has elapsed since I last wrote that I hardly know where to begin to bring you up to date with everything.
It is not through lack of intention but rather through lack of time that this has been such an intermittent blog.

Staff:

Many of you will know that Dr Mandy Selby moved on to practice at the Addington Road Surgery towards the end of last year. Mandy had been with Wickham Park Surgery for the

last 10 years and had brought all her skills and experience to her work with this greatly benefiting both patients, doctors and staff. She is one of the clinical leads for the new Bromley Clinical Commissioning Group (CCG) and this role unfortunately clashed with the days that she worked for us. We wish her well both in this role and in her new practice.

We have been joined by a number of part-time salaried doctors who enhance the services that we are able to provide for you by bringing their wide ranging skills and experience to the surgery. Dr ChiChi Ekhator works a full day on Fridays. She is keen on working in a small practice where she can provide continuity and holistic care. Dr Deen Habeeb some of you will know from his previous locums in the practice. He is sharing his time between working in Wales and working at Wickham Park and will mainly be with us on Mondays and Wednesdays. Dr Matthew Young shares his time between South London & Maudsley NHS trust where he works in substance misuse and working at Wickham Park on Tuesday and Thursday.

We hope that the wider range of available appointments sessions will help to ease the pressure when you are trying to book to see us.

Pathology:

There have been a number of quality issues with the transfer of pathology services from the Princess Royal University Hospital to the Queen Elizabeth Hospital Woolwich. There have been strong representations made on your behalf and with the support of Kings College Hospital who are now responsible for the Princess Royal, the service is improving and will continue to be monitored closely.

Pathology Results:

We are aware that accessing your results has been difficult for many of you. To try and remedy this we have changed the system for the giving of results. 

• Where you have given us your mobile telephone number you will receive a text asking you to contact the surgery if there are any issues on your results that need discussion. 
• If we do not have a mobile number for you and the issue is significant we will ask reception to contact you directly.
• From 1 February when you contact the surgery for a result you will be asked to leave the number you wish to be contacted on and one of the doctors will phone you back between 1pm and 2pm (on your preferred number) to discuss your results.

We hope that this makes getting your results less of a frustrating experience for you with less need to call back several times for the results.

I will post separately about the ongoing premises issues.

In the meantime I hope that this has filled in some gaps and answered some questions.

A belated happy New Year to all of our patients.

We need to talk …

We need to talk about access to medical information. I have been putting off writing about this on the blog for some months, whilst recognising that I needed to do it. Why have I been putting it off? Largely because it is complicated and I have struggled with how to explain it clearly.

General practice has led the way with electronic records and computing. Most GPs have been using electronic records in some form or another for the last 20 years. We are streets ahead of the hospital and community services in this respect. What makes the data we have collected so valuable is that the UK signed up early to a coding system devised by a GP called Dr James Read. The Read coding system  contains hundreds of thousands of terms, synonyms, and abbreviations covering all aspects of patient care including signs and symptoms, treatments and therapies, investigations, occupations, diagnoses, and drugs and appliances.

Twenty years of Read coded data potentially holds information that will assist research; improve pathways of care for patients; reduce prescribing errors; reduce duplication between services and assist information gathering for disease outbreaks and epidemics.

For all these reasons lots of people want permission to access to this information. I have already written about the summary care record on a previous blog and this is possibly the best publicised scheme and the easiest to see direct patient benefit in. Here limited data including drugs and allergies will be shared with other health care providers such as district nurses, accident and emergency and hospital outpatients. You can opt out of sharing your data by telling us so that we can code your wishes on the clinical system and prevent data-sharing.

In the course of the next few months it is proposed that data will be shared in another scheme with the local community services provided by Bromley Healthcare. Patients will have their consent to this sought by the referrer on an individual basis. The district nurse, health visitor, podiatrist, diabetic nurse or other clinician will then be able to view a read only medical record with information limited to patient demographics; (possibly) a summary medical history; medication; allergies and recent investigations. No information will be extracted from the record and your GP will be able to view a parallel record documenting the care that you have received from the community services. This has not yet been finalised but once the details are ironed out the benefit to patients care is easily appreciated.

So far so good I think, but now things get a little more complicated.

This information is taken from the NHS choices website it is not me talking:

“A modern information system has been developed, which will make increased use of information from medical records with the intention of improving health services. The system is being delivered by the Health and Social Care Information Centre (HSCIC) and NHS England on behalf of the NHS.

It is important that the NHS can use this information to get a complete picture of what is happening across health and social care and to plan services according to what works best. The new system will provide joined-up information about the care received from all of the different parts of the health service, including hospitals and GP practices.

Your date of birth, full postcode, NHS Number and gender rather than your name will be used to link your records in a secure system, managed by the HSCIC. Once this information has been linked a new record will be created. This new record will not contain information that identifies you. The type of information shared, and how it is shared, is controlled by law and strict confidentiality rules.

The new system will also provide information that will enable the public to hold the NHS to account and ensure that any unacceptable standards of care are identified as quickly as possible. Information will help to:

•find more effective ways of preventing, treating and managing illnesses

•guide local decisions about changes that are needed to respond to the needs of local patients
•support public health by anticipating risks of particular diseases and conditions, and help us to take action to prevent problems
•improve the public’s understanding of the outcomes of care, giving them confidence in health and care services
•guide decisions about how to manage NHS resources so that they can best support the treatment and management of illness for the benefit of patients”

The changes make it a legal obligation for GPs to share your information. The proposed benefits of sharing identifiable data are to help to plan and monitor effective patient services, especially where patients receive care from several different organisations. This is not your direct care but the management of the health of everyone.

There is a very clear and balanced explanation of what is going on provided for patients by the National User Group affiliated our computer systems supplier:

http://emisnug.org.uk/article/patient-information-caredata

Please use the link below to read the official information and decide whether you wish to opt in or out of this data.

If you do not wish your information to be used you have only a few weeks to let the surgery know so that we can code it on your medical records.

NHS England decided not to have a national publicity campaign publicising this and have left it up to GPs to inform their patients. For more information, please see here:

http://www.nhs.uk/NHSEngland/thenhs/records/healthrecords/Documents/nhs-england-care-data-paient-leaflet.PDF

The legal situation is this NHS England have said that under the Health and Social Care Act, practices have a statutory duty to share information with the Health and Social Care Information Centre. However, GPs also have a duty under the Data Protection Act (DPA) not to share confidential patient information. The Information Commissioner's Office (ICO) have said that if practices do not take ‘reasonable steps’ to make patients aware of the changed, they leave themselves open to legal action from patients under the DPA.

I would value comments and feedback, giving me your views on all the aspects of data sharing by letter, email, comments on the blog or face to face. If I have not explained this clearly please ask Dr Mustapha or myself to talk it through when you see us.

Thank you

We held the first flu clinic of this season at the West Wickham and Shirley Baptist Church Hall yesterday and it was a great success with 400 vaccinations given.

I want to thank all of you who attended for your kindness and generosity. Through your generosity with the purchase of Christmas Cards and your donations you raised over £75 for Freedom from Torture (previously know as The Medical Foundation for the Care of Victims of Torture)^[a charity which is the only organisation in the UK dedicated solely to the treatment and rehabilitation of survivors of torture. They are, like many charities suffering cuts to their funding and will be extremely grateful for this support.

Electronic appointments and prescriptions

Patient Access

Some of you will already be aware that it is possible to book and cancel your own appointments online using a unique pin number and password provided to you by reception. You can do this wherever you can connect to the Internet and it is available 24 hours a day. This facility was previously called emis access but has now changed its name to Patient Access. Patient Access is available to any patient who is registered with this practice.

We are now expanding the Patient Access service as online booking has proved so popular. It is now possible for patients who have registered with the service to order their own repeat prescriptions and use a secure messaging facility to communicate with the GPs. You can also notify us of changes of address and in a few months time we will be able to preregister new patients wishing to join the practice using this electronic portal.

The longer term plan is that eventually all patients will be able to access their NHS general practice medical record securely and online wherever they are in the world. This last objective will take us a little longer to realise but we are working towards it.

You can read more about this or register for the service using on of the links below:

http://www.patient.co.uk/patient-access.asp

http://cdn.patient.co.uk/resources/IF3091.pdf

Summary Care Records

After a much longer pause than I had intended, I'm writing today's blog with a very specific purpose in mind. Some of you may remember that back in 2010 you received the letter about something called the Summary Care Record (SCR). This letter gave you information about what the summary care record was and allowed you the choice of registering your dissent with your general practitioner if you did not wish your medical information to be shared.

This practice along with others in Bromley, will be working towards introducing SCR in the next couple of months. My reason for writing is that you will not receive any further information about this other than what is displayed in the surgery. The powers that be feel that everyone had the opportunity in 2010 to register dissent and for most patients no further letters will be sent. Anyone who has turned 18 in the intervening three years will receive a letter and an opt out form. Any patients registering for the first time at the surgery will receive information and an opt out form.

Just to recap the SCR is intended to support patient care in urgent and emergency care settings. The SCR will store a defined set of key patient data for every patient in England (except those who elect not to have one). This data will make a summary record created from information held on GP clinical systems. A patient's SCR will contain key health information including details of allergies, current prescriptions and bad reactions to medicines. Your Summary Care Record will also include your name, address, date of birth and your unique NHS Number to help identify you correctly. It will not contain any information beyond this. This summary record will help in ensuring continuity of care across a variety of care settings such as the out of hours service and accident and emergency.

Staff with access to the SCR will ask patients if they can look at their SCR every time they need to. Not everyone involved in the patient's care will be able to see all of their records. The amount of information staff can see will depend on their job. NHS staff who do not need to see information about the patient's treatment will not be able to view it – for example, non clinical staff will not have access to clinical information unless it is necessary for them to do their job.

It is your choice whether you have an SCR. If you choose to have a Summary Care Record, you do not need to do anything, this will happen automatically.
If you don't want an SCR, you need to let us know at the practice by filling in and returning an opt out form. These will be available in reception for you to collect and complete. Opt-out forms are also available at www.nhscarerecords.nhs.uk/options  and you can ask to be sent one by phoning the Summary Care Record Information Line on 0300 123 3020.

For more information about Summary Care Records and your choices:
• phone the Summary Care Record Information Line on 0300 123 3020;
• visit www.nhscarerecords.nhs.uk.

Please remember, which ever way you decide you are always able to change your mind and let us know so that your current decision can be recorded and your choice honoured.

Having used this blog with a very specific message to communicate I hope in the forthcoming weeks to share some thoughts on the recent changes within the organisation of the NHS and what that means for us as a practice and you as our patients. A wise patient advised me to give it a little while before trying to write coherently about it and I am following their advice.

"It is not the strongest of the species that survives, nor the most intelligent, but the ones most responsive to change." Charles Darwin

A big thank you to all who responded to our request for views on a possible surgery relocation.

The results of all your letters, comments and e-mails have been analysed and placed in a report which will go to the PCT and be posted on the practice website.

Summary of evidence from the practice survey:

The 384 members of the Patient Participation Group were asked by email and through the blog to respond to a qualitative survey regarding the possible practice relocation to the Eden Park area. We received 54 responses by email and 11 written responses. (17.6% response rate). The overwhelming majority (49 respondents) were positive about the move and only 6 opposed it.

Responses were very affirming of the style of practice that the surgery delivers “we would want the surgery to keep the professional but friendly family practice atmosphere with a personal touch that exists today” four of the responses expressed concern that moving the practice would change the “style of the practice”

Thirteen respondents were explicit in staying that moving practice would allow an improvement in facilities including reception and staff facilities. Nine respondents suggested that the move would also improve parking facilities. It was also recognised by two respondents that moving would improve disabled access.

There were specific concerns raised that the move may be detrimental, thirteen respondents suggested that bus access would be more difficult and this would affect those who did not drive. Three respondents were concerned that there would be no pharmacy close to the proposed new location while a further three were concerned that the practice catchment are might change and exclude them.

Respondents offered practical suggestions about re-routing existing bus routes to facilitate access to the new site. This builds on a longstanding campaign to improve bus access to the Princess Royal University Hospital from West Wickham.

Four respondents were concerned that moving to a new larger practice may change the personal approach and ease of access to the doctors currently experienced. 

As a result of the findings we have begun to formulate an action plan:

• It has been suggested that we engage with the local Residents Association to support their existing campaign to re-route a local bus route. This would improve access to the local district general hospital for residents of West Wickham as well as serving the possible new practice premises.
• The possibility of developing a contract with a local taxi company to provide subsidised access to the surgery for elderly and infirm patients will be explored
• It is hoped that further developing the uptake of electronic prescribing will reduce the concerns around the lack of a local pharmacy near the proposed new premises.
• We wish to reassure all our patients that have no plans to change our boundary or to exclude any existing patient should the move happen.

 Further discussions with our patients will allow these plans to be developed further.

Thank you again for your help and views.