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Welcome ,
Welcome to the Spring newsletter 2023 which marks a milestone for me…I can’t quite believe that I have been a GP at Ivy Court for over 20 years now!
It always has been and continues to be a privilege to be allowed into so many of your lives as your GP. The time spent in my consulting room seeing you is by a country mile the most rewarding and enjoyable part of the job.
However, the job of being a GP, and more specifically a GP Partner has changed significantly over the last few years. The pressures on the NHS which I have written about in previous newsletters, and you will all be aware of every day in the news, continue to bear down on General Practice.
A key issue is that there just aren’t enough GPs out there to deliver the speed of service of yesteryear. It is for that reason that all GP practices have had to change the way they deliver their services to ensure that the most serious of cases are prioritised, whilst ensuring that all our patients are cared for in a way that doesn’t impact on clinical care.
We can’t fix the national shortage of GPs but we will not be beaten. We can and will continue to re-evaluate how we can best care for you all, within this landscape.
And we provide a LOT of clinical care.
Did you know for example that in the first 10 weeks of 2023 we provided 24,303 booked appointments across the practice of which almost 18,000 were face to face appointments and 2,498 were telephone calls, 609 appointments were DNAs (Did Not Attend).
The responsibility of the GP Partners at Ivy Court is as it always has been- to ensure delivery of the best possible Primary Care Services to you and your family. The difference is that now the increased demand, the complexity of care delivery combined with the ever increasing red tape burden from above increasingly is taking us away from the consulting room seeing patients. This is where we want to be, where you want us to be and we get to do the job we were trained for, but there are roles which need doing and for which we just do not have enough GPs available.
One of these roles is the Duty GP roles. When you call to see your normal GP you may be told by our receptionists they are unavailable as they are Duty GP. So what is that GP doing when not seeing you?
20 years ago the extra telephone calls and visits requested beyond the booked face to face surgeries could be written into a 2 inch section of a leather bound red diary that sat on the upstairs telephone desk of the old surgery. Times have changed! There is now a tsunami of extra work that flows into the building every morning through multiple channels as soon as the phones, doors and computer access opens. These include prescription queries, sick note requests, queries from our own nursing staff seeing patients, district nursing and social care queries, hospital enquiries and referral requests. Walk in emergencies as well as all the requests for urgent appointments when our available appointments are fully booked all need to be dealt with by the Duty GP. There is incredible day to day variation in this demand but will always exceed 100 extra patient contacts per day.
When I joined the practice I could do up to 3-4 home visits in the middle of the day between surgeries and still have time for a lunch break. I look back fondly on those days. Even one visit now puts pressure on an already packed day.
There used to be space in the day but the sponge is now full. The demand simply exceeds the available capacity, despite continued efforts to provide attractive packages and exciting opportunities for GPs to join us. We just have to be realistic that currently there just aren’t enough GPs to go round.
And that is why there are limited numbers of appointments available.
I think it’s helpful to reiterate about our appointment system as every GP practice is different and the reasons for this are complex. There is no one size fits all and the system we have, believe it or not, is constantly reviewed and tweaked to be the fairest and most accessible it can be. But it’s not perfect and we can’t provide unlimited appointments when there is simply not the capacity.
The majority of our appointments are released on the day at 8am for the morning appointments and 11am for the afternoon appointments. These can be for anything for which you would like to see a GP about and does not need to be for urgent problem. Advanced bookable appointments can be booked at any time for afternoon surgeries, though these are fewer in number.
One of many reasons why we do this is that if a GP calls in sick on the day, to rebook all those appointments into a system where there is no extra capacity to call on is just not possible. And that was exactly what happened last Friday when we had 3 GPs off sick and a national NHS IT outage to throw into the mix. It was a difficult day.
So we try to deal with, as best we can, today’s work today.
We know there will be times and situations where this system doesn’t work for you but please speak to our receptionists who will do their best to help and give you options.
It is with regret that I inform you we will shortly be losing 2 of our regular GPs. Dr Awais Ahmad has been with us over 6 years but is stopping working as one of our salaried GPs to focus on a completely new project away from medicine completely. And Dr Rebecca Stone is taking on a new role elsewhere in General Practice. We wish them both well and are actively recruiting to replace them …and crossing all our fingers and toes!
A key part of these newsletters is to inform you of the challenges the surgery faces. Whilst these pressures will not impact on the quality of care that you receive, it does impact on the availability of immediate appointments for non-urgent matters or to see who you want when you want, which we know can be frustrating for you.
Please believe me that it is just as frustrating to every one of us at the Surgery whose aim is to deliver an A* service but are trying to do so with one hand tied behind our back as we witness the decline of an NHS that we all cherish. You are the reason we are here after all.
But despite all of this, we have not stopped doing what we can and there is much to be positive about at your surgery…..
Your GPs are offering more appointments than ever before, and the vast majority of these are face to face.
We have expanded our joint injection and minor surgery service which is now offered on Saturday mornings to allow more weekday appointments and access for working patients. These appointments can be booked directly through reception.
Your Nurses continue to support the management of our Diabetes, Asthma and COPD patients in dedicated chronic disease clinics. They co-ordinate the Covid vaccinations across our local GP Practices and will again be involved with the Spring Booster programme to improve uptake for our vulnerable patients close to home, whilst also delivering the national Child and Adult Immunisation programme.
Your trainee GPs and Nurses, working as part of an expanded training programme, are providing welcome extra capacity now whilst providing a steady source of your future clinical staff.
Your Paramedics and Social Prescribers support the care of complex housebound patients.
Your expanded Children’s Health and Well-Being Team are improving the care we deliver to vulnerable children and young people with mental health issues.
Your Clinical Team perform investigations that many patients elsewhere have to go to hospital or specialist clinics for such as blood tests, ECGs, Lung Function Testing, Coil Fitting, Dermatology photos and Ultrasound and Echocardiograms.
Your Dispensary Team is managing your prescriptions and delivering medications to more of our patients than ever, and turning around requests in record time usually within 24 hours. This is despite the understandable frustrations they have to deal with at the hatch due to national shortages of medications which are out of our control yet means switches need to be made on a regular basis.
Your Prescription Team are processing more prescriptions than ever before and having to deal with these same issues which affect our struggling high street pharmacies. Our Clinical Pharmacist continues to see patients for medication reviews.
Your Administration Team are scanning hundreds of letters per week and working behind the scenes to ensure the smooth running of the Practice.
Your Secretarial Team continue to deal with referrals and the extra workload from the many more of you still on waiting lists for hospital procedures.
Your Patient Liaison Officer Team - receptionists and telephonists - are working really hard to help you receive the care you need. They not only have to deal with queries from our own patients but are relaying information between hospital, clinical and prescription teams regarding results, follow-ups and management plans - a very busy multi-tasking job.
Your Practice Manager and her team are overseeing it all…not an easy task!
And my Partners and I are working harder than ever to provide clinical leadership to our amazing team.
Some of you will know that when I joined Ivy Court 20 years ago, I replaced Dr Crawfurd who delivered my wife Zoe into the world at Kench Hill right here in Tenterden.GP Services in Tenterden mean a lot to me. There have been a lot of changes for me personally and professionally over this time, as there will have been for you.
But what has not changed has been the commitment of the whole Ivy Court Surgery team to do our best so that you can trust in us to deliver a safe, high quality and sustainable NHS Primary Care service for you and your family.
Thank-you,
Dr Neil Pillai |
