DPPG Newsletter - Spring 2009

1

PARTNERSHIP FOR HEALTH Davenport House Surgery & Patient Participation Group

The Joint Quarterly Newsletter www.davenporthouseppg.org.uk

Issue No 42 March 2009 www.davenportsurgery.demon.co.uk

One week after the date for the Annual General Meeting of the PPG, Harpenden and the surrounding district is still blanketed in snow. Rothamsted‟s decision to close the building and send its staff home for the day made the decision to postpone our AGM a formality, one which I am sure was a relief to any member who had considered venturing out that evening! The AGM will now be held on 11 May, to precede the talk by Mr Williams on „Small Joint

Replacements‟, by which time spring should be well on the way. Nor shall we lose the opportunity to put your questions to a panel of our doctors: „Any (Health Related) Questions‟ will replace the advertised talk on 13 July.

There has been a generous response from PPG members renewing their annual subscriptions at the new rate. A few have written to explain their reluctance to accept the rise in costs, and we shall miss their support. To those who have yet to renew their subscription, may I encourage you to do so? The July Newsletter will be sent to those who have renewed their membership,

together with new subscribers. I should be very sorry if we were to fail any families who had forgotten to renew, or any who were confused by the formalities. Do call any member of the committee to ensure you remain on our mailing list. We should be very interested to hear about your reactions to „Patient Partner‟, the newly installed telephone system that allows patients to make appointments at their own convenience (without losing the opportunity to talk to a receptionist). The telephone system has been a bone of contention for so many years. Do let us know if the change has made a difference to you and we will publish your comments in a future edition.

Roger Gedye

BAD WEATHER DISRUPTS AGM & “ANY HEALTH QUESTIONS”

PPG COMMITTEE MEMBER CONTACT DETAILS Chair Roger Gedye 832374 [email protected] Secretary Rosemary Horne 762620 [email protected] Treasurer Ian Drew 460597 [email protected] Membership Helen Hartley 767462 [email protected] Newsletter John Harris 713246 [email protected] Education Tom Love 766242 [email protected] PCT Liaison Malcolm Rainbow 762590 [email protected]

Recruitment Pam Morris 620306 [email protected]

Surgery Access 2

Out of Hours Service 3

Part time GP Working 4

Surgery Snippets 5

The NHS Maze 6

Letters/Support Groups 7

Contacts & Calendar 8

Inside this issue:

2

ACCESS AND RESPONSIVENESS: THE PPG ASKS WHAT MATTERS TO PATIENTS?

In July 2008 the Department of Health asked the National Association for Patient Participation (NAPP), to which Davenport House PPG is affiliated, to find out what patients value in the area of patient access to their doctors. Their survey generated a number of interesting responses, which this article will attempt to relate to our own Practice. The Editor would welcome reader‟s reactions to the views expressed here. [email protected]

1. Extended hours are widely seen as improving patient access. Davenport House has been running „Early Bird‟ appointments (formerly called Commuter Surgeries) for many years,

and is now offering a limited number of appointments on Saturday mornings too. Are these surgeries helpful to you?

2. Good telephone systems are an essential component for effective interaction between the Practice and its patients. Every recent survey of patient opinion at Davenport House has criticised the frustration of telephone access during the congested hour between 8am and 9am. Now, at last, we may have a partial solution to this problem: „Patient Partner‟, an example of an „intelligent‟ telephone system, has been installed, and patients may ring at almost any hour to make an appointment. There is no need to wait until the reception desk is at work.

There will no doubt be teething problems. Have you tried the new system, and does it work for you?

3. Continuity of care needs to be available and can be delivered in ways other than face to face consultation. The opportunity to make an appointment with a named doctor remains the greatest hurdle to patient satisfaction at Davenport House. The proportion of same day appointments and those bookable up to two weeks ahead has been carefully reviewed during the past year. The Practice is making every effort to create the right balance, and will continue to adjust the system in the best interest of patients. But there are other ways for doctors to keep in touch with their patients. Doctors are using the telephone, and in some cases „e-mail‟, to maintain continuity of care. Patients with chronic conditions may like to discuss these alternative forms of communication. If the doctor feels they are appropriate it could lead to a reduction in the frequency of surgery visits.

4. Communication is vital and is currently underplayed in most Practices. Information screens in surgeries, newsletters, websites, peer support groups and emails are all part of the future picture. This PPG believes that its Newsletter is of paramount importance. For the first time, in December 2008, an edition was sent to every family of patients in the Practice - a truly comprehensive form of communication. This allowed the Practice to circulate information on „Patient Partner‟ to prepare for a smooth integration of the new telephone system. The PPG website is linked to the Practice website, and its design and function are under review. It is not yet as good as it should be, and if any PPG member has the expertise and interest to offer his or her services as a future „Webmaster‟ we should love to hear from you! The PPG is compiling a data-base of e-mail addresses, and it should be possible to begin using this as a communication tool before long. We do not have a screen in the surgery,

nor do we promote peer support groups, although some practices do have both of these. Do you have an opinion to share in favour of either?

5. PPGs should be able to discuss access and responsiveness with their Practices and identify solutions together. This PPG is fortunate in having an excellent relationship with the Practice. A Practice partner and one or other of the two practice managers attend every meeting. Dr Alan Stranders, senior partner of the Practice, is an ex-officio member of the PPG committee. There is no shortage of good will, nor of good intentions; it is the intractability of the problems that confront a free Health Service at Practice level that make them so challenging. We shall continue to work together to improve the quality of patient care – perfection may prove elusive!

3

WHAT HAPPENS WHEN I CALL HERTS URGENT CARE

(HUC) THE “OUT OF HOURS” SERVICE?

4

THE IMPACT OF PART TIME WORKING BY GPs A personal view by Dr Alan Stranders

I retired from full-time Medical Practice in October 2007 having been a full-time GP with my Partnership since 1974 – in other words 33 years! When I first started, the Practice was still sited at Kirkwick Avenue, „The Red House‟ was a fully functioning GP run „Cottage Hospital‟ providing Maternity, Surgery, Gynaecology and full Minor Injury Services, as well as providing in-patient care for the elderly, the dying, and convalescent patients after orthopaedic surgery etc. How times have changed! GPs used to be “on-call” 24/7 for all the patients on the Practice List and this was an onerous responsibility. I worked full-time providing this service with my Partners and regularly worked overnight, and at week-ends, on a Practice Rota basis. The hours worked were thus considerable – often more than 100 per week! Since my retirement, I have returned as a part-time GP whereby I work the equivalent of 3 days a week, but one of my 6 „sessions‟ remains as a type of Specialist called a Hospital Practitioner in the Department of Haematology (Blood Diseases such as leukaemia and anaemia) at the Luton and Dunstable Hospital. Even with my part-time status I continue to work in excess of 40 hours a week and (with my Partners‟ agreement) remain in the role of „Senior Partner‟ for the Practice – sadly, a reflection of my age as well as experience! Interestingly, more and more Doctors who are entering General Practice are choosing to work part-time from the outset. The main explanation for this phenomenon is that the majority of new GPs are women - and they have a much greater awareness of achieving the correct “work/life” balance – often having to juggle the requirements of home and family with those of a medical career. Many newly qualified GPs, both male and female, choose to work part-time, thus enabling them to pursue other career aspirations – whether they be medical (for

example working for Private organisations such as BUPA), Educational, e.g. as Lecturers in Medical Schools, involvement in GP Medical Research or as writers and journalists e.g. Tony Copperfield, an Essex GP who recently gave up writing a weekly column in the Saturday Times. Some GPs combine their medical work with completely different outside interests e.g. Phil Hammond who is an author and humorist who occasionally appears on „Have I Got News For You‟ as well as radio broadcasting. Also, there are almost daily appearances of GPs on our TV

screens commenting on Medical Politics or the latest medical stories – usually some “scare” or other. Thus, many GPs have taken on a so-called “Portfolio” career and only devote a proportion of their time to „traditional‟ General Practice. Moreover, the demands of being a modern GP require considerable knowledge of Practice Management and running a business, as well as keeping up to date with the ever-changing pace of NHS reform and bureaucracy. This inevitably means less time

actually seeing patients and dealing with their medical problems (“Doctoring”) and more time dealing with NHS paperwork, liaisons with our Primary Care Trust (PCT) and the other general red tape requirements of this vast Bureaucracy (“Administration”). I certainly continue to enjoy my work as a GP, but I do recognise that some patients may have difficulty seeing me since I reduced my commitment – one gentleman even stated that “You are more difficult to see than the Pope”! Please remember that all the Doctors at the Practice are ready and willing to see any patients promptly, but it may take a little longer to see the Doctor of choice – particularly if that Doctor works part-time. At least my wife gets to see me more often, my tennis has improved, and I have lost weight – so for me working Part-time has definitely been worthwhile.

5

SURGERY SNIPPETS By Anthea Doran , Practice Manager

PATIENT PARTNER – The new automated telephone booking system After some early hiccups, the system is now operating well and patient feedback is generally good. During the first week of February 390 patients successfully used the system as follows: 123 booked an appointment 111 checked their appointment details 76 did not find a suitable appointment 61 cancelled appointments 15 failed to book their chosen doctor 4 changed their appointment.

It is hoped that the significant number of callers who hung up without entering their details or were unable to use the system as their details did not match our database will gain confidence in the system as it "beds in". If details cannot be matched patients are invited to leave their date of birth and telephone number so we can compare to our database and update any incorrect information. Please refer to the guidance note sent to all patients with the December 2008 PPG Newsletter. Most calls are to book GP appointments but please also use to book blood tests and specialist nurse appointments such as asthma reviews, diabetic checks, well woman appointments and even private chiropody appointments. Currently we have allocated 25% of the available appointments to Patient Partner, but we will monitor usage and adjust this percentage if appropriate. The system enables appointments to be booked, checked or changed outside of Surgery hours so please use throughout the day, in the evening and also at week ends. This will free up telephone lines for those who wish to speak to reception. For those that do not wish to use the system, please press option 2 on the main telephone menu to speak to a receptionist between 8.20am - 6.15pm Monday-Friday. EXTENDING SURGERY HOURS We have increased the availability of our early bird surgeries (7-8am Tuesday, Wednesday and Thursday) and also introduced a Saturday morning surgery on the second Saturday of each month. These surgeries will be doctored on a rota basis and appointments can be booked via the automated system or reception. All extended hours surgeries are pre bookable for routine issues. Emergencies will be re directed to the out of hours service- HUC who may be contacted on 03000 33 33 33. (See page 3)

PATIENT SURVEY If you visited the Surgery during November 2008, you may have been asked to complete a survey about our services for which we are most appreciative. The results have been received and synopses of the comments made are posted on the notice board opposite reception. The results will be published in full in the next newsletter after discussion with the PPG. CONTACTING YOUR GP BY TELEPHONE Requests for GPs to call are made via the receptionists who record the patient‟s name and contact number on the GPs visiting screen for that day. As the receptionists are not fully aware of the GPs commitments, they do not confirm a time when the GP will return the call. Most GPs will try and call between 1-3pm however; they may not return calls until after evening surgery at 6.30pm or later. As GPs will only call once, it maybe appropriate to leave a mobile number if you are likely to go out in the day. During the first week of February the GPs responded to 67 telephone calls from patients dealing with a variety of issues: medication queries, concern re worsening symptoms, requests for sick notes etc. This equates to 4 extra surgeries. We are anxious to be flexible in the type of appointments we offer and would welcome suggestions direct or via the PPG on how we can improve access to GPs via telephone without extending their already packed working day. IN HOUSE CLINICS (For details see back page)

Accessing the right clinician allows you a greater choice of appointment times. Our nurses are highly qualified and regularly attend update courses on their chosen areas of special interest. This allows them to adopt best practice and ensures the delivery of best care to patients. Current clinics are shown on the back page. We also have specific slots reserved for baby immunisations and all nurses can offer up to date information on vaccinations recommended for travel to certain countries. A receptionist can advise if another practitioner rather than a GP is available to discuss your health needs. We also work with other local providers to provide midwife appointments, dietetic consultations and a variety of counselling and psychological interventions: all these services are accessed via referral so please discuss with your GP.

6

THE NHS MAZE In this second article, Dr Mark Sandler explains

CHOOSE & BOOK and CATS

CHOOSE AND BOOK was introduced by the Government 3 years ago to provide two main changes to what the patient can expect when being referred by the GP for specialist advice or treatment. Early experiences were unsatisfactory as the technology required to support the new system was not ready. However, the system is now far more reliable and gaining momentum .

First is the CHOICE of which hospital or other provider to refer to. This is not a new concept as we have always been able to refer patients to whichever is the best hospital for a patient‟s particular problem. Then BOOK the actual hospital or clinic appointment either face to face in the GP consultation room or alternatively via a booking telephone number or internet link. For example a patient might describe a lump or swelling in the groin area which on examination I diagnose as a hernia. I then discuss with the patient the likely need for a simple surgical repair operation. We then look, via my computer screen, at the Choose & Book system which shows all local hospitals and clinics providing this service. We can then CHOOSE which hospital and then click straight into BOOK a particular appointment on a particular day. I then print out the hospital appointment letter

and give it to the patient to take home. There is an option to change the appointment if for any reason this is necessary as each referral has a unique booking reference number and password printed on the appointment letter details.

So, in summary, the patient arrives at 10am to see me and comes out of my consultation room with a confirmed hospital appointment 10 minutes later!

CATS is another new development in the past 3 years. CATS is an acronym for Clinical Assessment & Treatment Service. These are clinics which are held outside a hospital setting in Primary Care. The idea is that they act as a referral centre run by GPs with a special interest in a particular field working with hospital consultant specialists to assess and treat conditions which in the past were routinely sent to hospital. This often meant travelling much

f u r t h e r f o r patients. This is very much in keeping with the g o v e r n m e n t a g e n d a o f moving more services out of hospitals and into primary care.

There are a number of CATS now running (see details on back page) for our patients including

Dermatology

Musculoskeletal

Urology

Gynaecology

ENT

Ophthalmology

Others are planned for the future including Cardiology and Gastroenterology. Running these clinics outside hospitals has been more financially efficient as they do not carry such large overheads producing substantial savings for the local health economy. This contributes to a much healthier financial position for the PCT enabling service developments in other areas neglected for many years e.g. recruiting more district nurses and health visitors.

7

LETTERS TO THE EDITOR

An opportunity for patients to raise health related matters via the PPG SUPPORT FOR ALZHEIMER‟S SUFFERERS AND CARERS

Editor: The Practice has provided details of the St Albans Alzheimer‟s Society, which have been forwarded in response to this letter as below. Direct link email facilities will be introduced to both websites in due course and PPG members will be advised.

Sir, We welcomed the “hard copy” of the PPG Newsletter into our home, which is a superb and useful production. It is my intention now to join, particularly after taking time to visit both the Davenport House Surgery website and that of the PPG. (Both were very good and easy to use. A direct link email facility would be useful to both sites in order for you to gain spontaneous feed-back). Maybe I am not searching correctly, but no where do I see any mention of care or guidance for Alzheimer sufferers and their supportive spouse/family members/friends. My husband is diagnosed as an Alzheimer sufferer. The official diagnosis was eventually confirmed during

2008, although I personally feel that the deterioration has been overtaking him for almost a decade. With due respect to our excellent Doctors in the Practice, this area of mental health (specifically age-related deterioration) and a true appreciation of the implications for the closest people to the sufferer, appears somewhat neglected. Where are the specialist people for senior medicine”? So, what about it? With an aging population, this issue needs addressing. (Name and address supplied)

ALZEIMER‟S SOCIETY There is a branch of the Alzheimer's Society in St Albans with support groups for carers covering St Albans, Harpenden and the villages, details as follows: Contact: Bernadette Simpson, Office Administrator Address: 22 Catherine Street, St Albans, Hertfordshire Phone: 01727 855320 Email: [email protected] Other Contact: Mrs Viv Roberts, Support Worker Phone/Fax 01727 812035 Email: [email protected] The Society meets at the Alzheimer's Centre, Catherine Street, St Albans on the last Friday of the month at 12.00pm - 2.00pm offering light refreshment. In addition it meets on the 2nd Thursday of the month at 1.30pm - 3.00pm alternating between Willow Court, Aldwickbury Crescent, Harpenden and lunch at Aldwickbury Golf Club, which is arranged at the previous meeting. The parent organisation is: The Alzheimer's Society, National Office, Devon House, 58 St Katherine Way, London EJ10 1JB, telephone 020 7423 3500, website www.alzheimers.org.uk

OTHER SUPPORT GROUPS (Previously featured in the Newsletter) St Albans & Harpenden Stroke Society (June 2008) – Contact: Joan Towle 01582 760726 Harpenden Phoenix Holidays (Sep 2008) – Contact: John Favell 01582 764179 SOURCE OF INFORMATION ON A WIDE RANGE OF SUPPORT GROUPS www.hertsdirect.org click on site map, then on Support Groups and Self Help Groups under the heading Care & Support. Alternatively contact the editor [email protected]

8

CLINICAL ASSESSMENT & TREATMENT SERVICE (CATS) CURRENT CLINICS IN THE AREA (see article on page 6)

Your GP will refer you and arrange an appointment at these clinics

SPECIALISM LOCATION OF CLINIC DAYS/TIMINGS

Dermatology Davenport House Mondays 2-6pm

Musculoskeletal (Consultant) St Albans City Hospital Friday mornings

Urology The Elms Monday, Thursday, Friday

Gynaecology London Colney Tues, Wed, Thurs, Fri 2-5pm

Ear, Nose & Throat (ENT) The Elms Mon, Tues, Wed, Thurs

Ophthalmology Various Ask for details

DAVENPORT HOUSE REGULAR IN-HOUSE CLINICS

MEDICAL AREA DAYS/TIMINGS

Well Woman Mon 8.30-10.00am, Tues 9.15-12.00, Wed 4.30-6.00pm

Asthma/COPD Tues 8.30-12.00 & 3rd Mon of each month 2.00-6.00pm

Diabetes Wed 8.30-12.00

Heart Mon 2.00-5.00pm

Hypertension Tues & Wed 2.00-6.00pm Fri 9.30-12.00

L&D midwife Thurs 1.15-3.45pm

Watford midwife Wed 1.15– 3.30pm

PPG FORTHCOMING EVENTS 2009

DATE TOPIC SPEAKER/PANELLISTS

Open Meetings Fowden Hall, Rothamsted Commencing 8.00pm

Monday 11 May AGM & Small Joint replacement David Williams –Orthopaedic Surgeon

Monday 13 July “Any Health Related Questions” Panel of Practice Doctors

Monday 19 October Children‟s Issues To be announced

Small Group Meetings Held at the Surgery by application Commencing at 7.30pm

Tuesday 28 April Back Problems Matthew Tant

Tuesday 2 June Managing Infections Dr Kirsten Lamb

Tuesday 3 November Respiratory Disorders Dr Alka Cashyap

Tuesday 1 December Weight Control Dr Alan Stranders

WHAT IS HAPPENING BEYOND THE PRACTICE BY Malcolm Rainbow

Our newly set up St Albans and Harpenden Patient Group had its second public meeting with a presentation from the Chief Executive of the local Practice Based Commissioners. He confirmed their willingness to work with patient groups. Our first activity is to look at transport issues, especially associated with the move of the trauma services to Watford from Hemel which will have occurred when you read this. So if any of you have experienced transport problems please give me ring (762590). Whilst the PCT are leafleting everyone in Dacorum about the changes, they had not made any arrangements to let St Albans people know. On behalf of the LINks I have asked them to do something and we shall see how successful they have been. John Harris was/was not successful in standing for election for the vacant governor seat at Luton &

Dunstable Hospital.