GP appointments to change

PATIENTS in Brechin are being prepared for impending changes to the appointments system at the local health centre.

GPs hope the changes to the system will not only improve the ability of patients to gain access to appointments, but also improve their chances of booking appointments in advance and save them the trouble of having to call the health centre back a few days later.

Health centre spokesman Dr Ross Duff explained: “There are two types of appointments. Those that can be booked in advance, and those that can only be booked on the day, for patients with urgent conditions.

“Currently, we have to ‘keep back’ a large proportion of the total appointments available, so that we can offer them to patients who feel that they need to be seen on the day that they ask for an appointment.

“As there are only a certain number of appointments, this inevitably reduces the amount of appointments that are available for patients to book in advance.

“These advance appointments are nearly always booked up well in advance, creating the situation where patients are unable to book an appointment within several days of asking, and so have to be advised to telephone back at 8 am next day to ask for an ‘on the day’ appointment instead.

“There is then a rush of calls every morning, resulting in ‘first come, first served’ getting an appointment. The unlucky ones are then asked to phone back again the following day! This is clearly very unsatisfactory, and understandably leads to many complaints.

“After much discussion, analysis, and consultation, we have decided to stop withholding these appointments, so that there will be many more GP appointments available to book in advance.

“Clearly, this will also mean that there are far fewer ‘held back’ appointments, meaning that patients who feel that they need an immediate ‘same day’ appointment, will be given an appointment with the nurse practitioner, should the GPs all be fully booked.

“The nurse practitioner will either be able to deal with problem, or arrange for a GP to give an opinion, according to the urgency of the problem.

“Firstly, any patient wishing to book an appointment with a GP, should find many more advance appointments available.

“This should greatly reduce, or hopefully, eliminate the need to have to phone back the next day, as currently happens. You should be able to secure a GP appointment on first contact.

“With our highly trained nurse practitioners now assessing those patients requiring more urgent attention, ie ‘same day’ appointment requests, this frees up even more GP appointments for patients with more complex conditions.

“This is similar to the way in which most A&E, GP out of hours, and minor injury units now work, with all patients being first ‘triaged’ (assessed) by experienced specialised nurses, prior to, or instead of seeing a doctor.

“Patients may also be familiar with the many ‘nurse led’ out patient clinics.”

Dr Duff also revealed that an attempt to get patients involvement in the decision making process on appointments had met with very little enthusiasm from the local community.

He continued: “We do not currently have a patients’ association in Brechin, and several previous attempts that we have made to form one have met with little success, including recent appeals through the local newspaper.

“Now, this may either mean that our patients are generally happy with the service that we provide, or that patients expect, and trust us to make responsible decisions on their behalf.

“Whilst I would like to believe the former, I suspect that the latter explanation is more likely! I doubt if apathy alone explains this lack of response.

“To be fair, the responses that we did have (less than a handful) strongly criticised our current system, not surprisingly.

“One patient did suggest a return to ‘the old days’, where you just turned up in the morning and waited your turn. Sadly, times have changed and most patients would find this quite unacceptable now, given the hugely increased complexity of modern general practice.

“With an unlimited demand, but limited time, and appointment numbers, we need to explore new methods of trying to ensure that the patient is able to see the right health professional, at the right time.

“We have three very experienced nurse practitioners, and have been at the forefront of the development of this role, in Angus.

“These nurses undergo advanced training and can diagnose and treat (including issuing prescriptions) a wide variety of problems, including fevers, coughs, sore throats, chest infections, cystitis, back problems, rashes, and many other issues. They are also very experienced in knowing when to call in the opinions and skills of a GP, when required.

“We are confident that this major change in the way that we offer appointments will improve the ease and speed in which patients can arrange to see their GP, whilst ensuring that patients requiring urgent attention, can get it.

“We will, of course, be monitoring the new system carefully to ensure it is producing the intended benefits.”

Dr Duff also stated that the UK Government’s present restructuring of primary care services south of the border has little relevance in Scotland.

“The main changes in England involve a shift in responsibility and decision making for clinical service development back to GPs (commissioning), with subsequent reduction in middle manager numbers.

“We partook in a similar, but more limited, scheme many years ago (fund-holding).

“This worked very well for us in Brechin, allowing us to commission extra services (physiotherapy and counselling) for our patients, reducing referrals out of the area, waiting lists, and benefiting our patients.

“I think that, compared to many countries, we still have one of the best health care systems in the world.

“I do often feel that our politicians and managers, despite their public utterances, greatly underestimate the quality and value for money of Scottish Primary Care. If this had been appreciated and acted on many years ago, there would have been little need for the ‘new contract’ of six years ago, with the subsequent destruction of 24 hour care, and fragmentation of the ‘family doctor’ concept.

“There finally does appear to be an emerging recognition, however, that patients do want to be treated in their own communities, and avoid having to go to huge impersonal city hospitals, unless absolutely necessary.

“This will require a major shift of funding to develop community services, including community hospitals like Brechin Infirmary, and less emphasis on centralising everything as was previously done.

“The future will see a shift of responsibility for such funding redistribution to clinicians and GPs in particular, as it is being recognised that they, along with community nurses, are uniquely placed to understand the needs and wishes of their increasingly complex patients.

“What currently isn’t working well here, is the huge number of frail, elderly people being taken to major hospitals, usually overnight and at weekends, when they could often be treated either at home, or in the local infirmary, If the resources were there to support this.

“This situation can only improve when real funding is reallocated to community health services. We have an excellent work-force, starved of resources.

“However, the proposed shift of funding allocation responsibility will likely depend on the political picture after the May elections.

“I personally think that will be a very good thing for Scottish service users, with future service provision and distribution based more on local doctors advice, rather than the current system of management, which, as you know, North Angus GPs have had great issues with recently.

“Although we have chosen to air our views publicly, we are far from alone in our views in Scotland.

“I have been working in the NHS for 33 years now, and still think that it is hugely successful and serves our patients very well.

“There are many frustrations though, and nearly every one has been due to poor consultation, and bad decisions made by inefficient management, aggravated by short sighted political interference.

“We all face challenging times ahead, but the NHS will survive, as it is driven by very dedicated and hard working professionals.

“The goal will be to treat people as near to their homes as safely possible, and I believe that this will be achieved, with good management and proper allocation of resources.

“For Brechin, this must mean a new, fit for purpose Primary Care Resource Centre, incorporating GP surgeries, nursing, Social work, pharmacy, dentist, community in-patient beds, palliative care, day care, minor injury and illness unit (out of hours), community education, and possibly Police office all on one site.

“It must also mean the ongoing development of Stracathro as an abulatory care and investigation centre. Dialysis and chemotherapy ought to be available locally. More and better support services for the frail elderly and housebound, who wish to remain in their own homes, and more supported (sheltered) housing for the increasing number who will require it, will need to be available.