February 2020 Newsletter
Patient Survey Results
The results of our Patient Survey, which we conducted towards the end of last year, were very encouraging again, and much in line with previous surveys. If you’d like to see the full results, please click here: 2019 Analysis Final.pdf.
In the ‘Comments’ section there were some remarks about the doctor’s appointments running late, which is something that also comes up in the responses we get in text form, from the survey which is sent to your mobile phone after you’ve had an appointment. Dr Hindmarsh’s appointments do tend to overrun, largely because he’s reluctant to cut people short if they bring up more than one problem while they’re in with him; and we do try to work round this now by encouraging people to ring in to find out what the queue is like, especially if their appointment is towards the end of the surgery.
The ‘crunch question’ in the survey is Question 5 – ‘How satisfied are you with the overall care you receive at the surgery?’ This time around we scored 94% ‘Very Satisfied’ and 4% ‘Fairly Satisfied’, which is the best score we’ve ever had.
However, although our results have remained so consistent, once again there is quite a lot of change going on:
- Dr Karthika Shanmuganathan (Dr Shan), who has been working as a salaried GP with us on Mondays, and also working two mornings a week at the Old School Surgery next door, is going to be leaving us at the end of March because she is buying into the practice next door and becoming a partner there.
- As Dr Shan’s departure will leave us without a female GP we are hoping to start a new locum called Dr Rachel Hodgkiss on Mondays from April onwards.
- Dr Tim Winch, who used to be the senior partner in the Headcorn Practice but retired a couple of years ago and is now working as a locum, is going to be working with us regularly on Tuesdays, probably about one Tuesday in every two.
- Dr Hindmarsh has also applied to become a trainer again, so we may have trainees working in the surgery again within the next year or so.
Community Centre/Medical Centre on Wilkes’s Field
The Parish Council now owns the Wilkes’s Field plot, which is the rough ground on the left, opposite the public toilets, if you walk up the lane alongside the Sorting Office in the High Street. They are intending to develop it either as a Community Centre, or as a Medical Centre, or both. The West Kent CCG (ie. the Health Authority) are keen to get all three surgeries in Cranbrook working together under one roof, partly because the existing surgeries are too old and space-restricted to handle all the new patients who will be coming to the Cranbrook area when all the new houses are built - and the Wilkes’s Field site seems to be the favoured option for a new purpose-built surgery. If everything comes together, the new site could be operational by 2023, but there are a lot of things that need to be sorted out first.
- The option favoured by the CCG and PCN (Primary Care Network, which is a group of doctors’ surgeries in this part of the Weald) is for the site to be developed by a private contractor, who would then lease it to the GPs who were working in the new Medical Centre: but the Parish Council, having got ownership of the land, are understandably not keen to give it away to developers.
- From our own point of view we have concerns about going into a merger with the other two Cranbrook surgeries, because although there could be some good ‘economies of scale’ to the arrangement, we don’t want our standards of care and our way of doing things to be compromised. For example, when you ring our surgery you get a human being, not an answering service; we process all our incoming mail by hand, instead of putting it into a ‘workflow’; we pay our staff better, and we’re better at keeping them; etc. etc. If and when we get involved in a merger with the other two surgeries we will try to get our Patient Participation Group involved in the merger discussions, to make sure that our services aren’t ‘levelled down’.
- There will be a special edition of Parish Cake magazine devoted to showcasing ideas about the redevelopment of Wilkes’s Field.
- The Parish Council are very anxious to have input from people about what they would like to see on that site, and also any concerns they might have (for example, a lot of people have been worried that a new Community Centre might lead to the closure or selling-off of the Vestry Hall). If you want to contribute email email@example.com, or you can write to the Parish Council care of the Old Fire Station/Parish Office in Stone Street, or you can drop in a letter at the Parish Office in Stone Street.
We’re still getting a lot of comments and queries about Lloyds Pharmacy – ‘They’re always in a muddle’ is probably the remark we hear most frequently. As in previous newsletters, we would ask people to be patient because the staff at Lloyds are working very hard under difficult circumstances, most of which have been caused by Lloyds Head Office. Staffing-levels have been reduced, but what’s probably even more of a problem is that there’s no permanent pharmacist working there. They’ve had some very good pharmacists, but none of them have been there for more than a few days at a time, which makes it very difficult to get any continuity going. It also means that, because locum pharmacists often come from quite a long way away, they can get stuck in traffic on the way there, and then the pharmacy can’t be opened until they arrive.
Please do try to make sure that you order your regular prescriptions at least a week before they’re due to run out.
If you want to contact Lloyds head office about the Cranbrook branch, their website is www.lloydspharmacy.com, or you can write to the Superintendent’s Department, Lloyds Pharmacy, Sapphire Court, Walsgrave Triangle, Coventry, CV2 2TX.
The PCN, as mentioned above, is the Primary Care Network, a group of local practices working together to deliver better services across the Weald area. This is the Government’s new ‘flagship’ programme for improving services in Primary Care (ie. doctors’ surgeries), so there are PCNs all across the country now, and new money is being pumped into them to deploy new services.
- Social Prescribing – There is funding for PCNs to employ Social Prescribers to work across the whole group. The idea of social prescribers is that they can help people who are struggling with difficult social circumstances: they can help out with benefit problems, housing problems and unemployment, but also with isolation, loneliness, low mood, self esteem issues, bereavement and general issues of wellbeing, and they can put people in touch with community activities and support that can help them ‘out of the rut’. We already have one social prescriber working in the area and we’re supposed to be getting another one in April. Research shows that they can really help people, and you can self-refer to them by calling 03000 810005.
- ‘Online Consultations’ – All surgeries are supposed to be implementing some form of online consultations in the next year or so. This doesn’t necessarily mean video consultations – the options being explored by the PCN are more to do with filling out an online form on our website to get help with a problem or query, instead of booking an appointment or making a telephone call. Again, research has shown that this can be very helpful for some people – eg. people who are hard of hearing, or who work somewhere very busy, and who therefore find it difficult to use the telephone.
- Booking appointments online – we already have GP appointments available for online booking, but there are now targets being set to make a percentage of all appointments available, which means we will have to open up Nurse’s appointments too. Up until now we’ve been reluctant to do this because Nurse’s appointments can vary from 5-10 minutes for a blood pressure check to half an hour for a complicated dressing, but we’ll have a Practice Meeting to discuss what we’re going to do.
Dr Hairy’s Podcast
Patients may be interested to know that Dr Hindmarsh and Julian Le Saux are now doing a series of monthly podcasts, mainly to do with medical research but also discussing broader issues about healthcare. The simplest way to find them is on our website, http://drhairy.org ; or you can follow them on Podbean (https://drhairysresearchpodcasts.podbean.com/) ; or if you’ve got a podcast app on your phone, just search for Dr Hairy’s Podcast.
March 2019 Newsletter
Patient Survey Results
The results of our Patient Survey, which we conducted towards the end of last year, were very encouraging again, and much in line with previous surveys. You can see the full results here: 2018 Crane Surgery survey.pdf
However, although our results have remained so consistent, there's been quite a lot of change going on:
- Dr Karthika Shanmuganathan (Dr Shan) has been working for us as a salaried GP since September last year, usually on a Monday.
- Dr Alison Bentley has been doing a lot of locums for us, usually on Wednesday mornings.
- Dr Tim Winch, who used to be the senior partner in the Headcorn Practice but retired about a year ago and is now working as a locum, has been helping out while Dr Hindmarsh has been on holiday, and also coming in to cover some Wednesdays.
- Dr Hindmarsh has been running hypnotherapy courses and a support group for 15 and 16 year olds suffering from anxiety, and has had to take a bit of time off in order to prepare for these extra commitments - hence the locums.
We have also been participating in the Improved Access scheme, which is intended to allow patients to be seen outside of 'normal' surgery hours - for example in the evenings and at weekends. Dr Hindmarsh has gone back to seeing patients early in the morning on Wednesdays (from 7 a.m. to 8 a.m.), which he used to do under the old Extended Access scheme up until a couple of years ago. In addition to this, under the Improved Access arrangements we are now able to book patients into what's known as the Hub in Staplehurst Health Centre on a Saturday morning. When patients are seen at the Hub they don't normally see their own GP (although Dr Shan has worked a few sessions there), but whoever they do see has access to their full medical records via a system called Vision 360, so it's much the same as seeing a locum in your own surgery. This is quite a useful service, especially when we don't have any appointments left on a Friday but still get calls from patients who feel that they need to be seen earlier than Monday.
The new contract
Improved Access was a scheme introduced via the Federation - a group of practices working together across the whole West Kent area to extend and improve services - but it is also the kind of arrangement that is now going to be taken over by Primary Care Networks, which are the new linked-together clusters of GPs being set up under the new GP contract that has just come into force.
Basically Primary Care Networks are going to be much the same as Federations, but with extra funding to encourage them to grow and extend services even more. The new contract has also brought in a number of new requirements:
- We will need to make more of our appointments available for people to book online.
- At least one appointment a day must be made available for NHS 111 to book.
- Online services in general - giving people access to their records online, encouraging them to order their prescriptions online, encouraging them to book appointments online, sending our prescriptions to the chemist electronically rather than on paper, etc. - have been set new targets.
- In the course of the next couple of years all surgeries are going to have to start offering online consultations (video consultations) to their patients.
- It also looks as though, as a result of the new contract, we may have to give up our half-day on Wednesday. We haven't actually seen the small print yet, but there's a suggestion that you can't be in the Improved Access scheme and have a half-day at the same time.
The e-referral system and Prime Provider arrangements
The Crane Surgery has been a keen advocate of the e-referral system, which used to be known as Choose and Book - a system which allows GPs to go online and book their patients straight into hospital appointments. However, the e-referral system has been going through a lot of changes lately which have made it rather less user-friendly than it used to be, mainly because it was so successful that it seemed to be encouraging more and more referrals to be made, which in turn was costing the NHS more and more money.
To slow down the flow of referrals there are now a lot of specialities where we can no longer directly book appointments for our patients - instead we have to send them to a triage system, where all the referrals are evaluated to see what is the most appropriate way of dealing with them, and the patient is then contacted to let them know the outcome. Orthopaedics is a good example: if people come to us wanting a knee replacement or a hip replacement we can no longer book them straight into an appointment with an orthopaedic consultant: instead, we have to send the referral via a Single Point of Access, which often results in quite a long delay.
On top of this the Maidstone and Tunbridge Wells Trust (which consists of Maidstone Hospital and Tunbridge Wells Hospital) has become the Prime Provider for our area, which means that all NHS referrals in this area now go to them by default.
Again this has been quite a big change to the e-referral system, because previously if you looked for an appointment for something like a knee problem, the first available would often be at one of the private hospitals, such as the Benenden Hospital or KIMs Hospital in Maidstone. As a result of this, patients usually wanted to be see at the private hospitals, because they got seen more quickly that way and in the case of Benenden it was often a lot more convenient; but in effect the private hospitals were 'cherry picking' all the easy procedures and leaving all the difficult and complex patients to be dealt with by the 'big hospitals', which put the 'big hospitals' at a serious disadvantage.
Under the new 'Prime Provider' arrangement, we can no longer book NHS patients directly into any of the slots at any of the local private hospitals; if patients want to be seen at a private hospital for their care they have to go into another triage system, and wait to hear what has been decided. This will undoubtedly make it easier for the Maidstone and Tunbridge Wells Trust to make ends meet and manage their workload, but it has already led to delays in patients being seen and a certain narrowing of patient choice.
Lloyds Pharmacy have got a new manager called Alice, and they seem to have got their workload much more under control, now that Head Office have finally recognised their understaffing problem. They've been having some difficulties with their home delivery service, though, because their two regular drivers have been off, and they have had to replace them with a courier service which doesn't have the same degree of flexibility. On the other hand we're very lucky to have home deliveries in this area at all, because not all pharmacies provide such a service - the one in Goudhurst doesn't, for example.
The reports from the Parish Council are that Cranbrook has now been earmarked for even more new housing than was previously planned. Sissinghurst has already had quite a lot of new houses built, and further developments in Benenden and Brick Kiln Farm will be under way in the near future. At the moment it's being debated where the additional housing can go.
Once all the houses are up and people are living in them, as we have said in previous newsletters, it's going to be difficult for the Cranbrook surgeries to cope with all the extra patients unless they make some big changes, possibly sharing work and staff with each other. But apparently the land between Stone Street and the Co-Op, which has been touted for quite a few years as a potential site for a Community Hub, finally looks set to be released for that purpose - and if this actually does go through, then one possibility is that all three Cranbrook surgeries could move into the Hub, which would save a lot of overheads. It's all just talk at this stage, though - watch this space!
July 2018 Newsletter
From September onwards Dr Shan will be working all day on Monday instead of Thursday morning. Initially Dr Hindmarsh will be here on Mondays as well, but later in the year he plans to start taking off Monday afternoons, or perhaps the whole day if the workload permits.
From the middle of August onwards we will be starting a procedure called Patient Signposting, otherwise known as Care Navigation. All the surgeries in West Kent are involved in this initiative, and basically all it means is that when we book appointments for the Doctor we will be asking patients if they would mind telling us the reason they want to be seen. Apparently research elsewhere in the country has shown that this simple measure can save both doctors and patients a lot of time, because it often turns out that the problem can be dealt with by someone else, or over the telephone, instead of a doctor’s appointment being required. For example, if the patient has a suspected urine infection there’s not much point in seeing the doctor, because what we need to do is get a sample of urine and send it to the lab for analysis; and if the symptoms are severe, we can usually prescribe antibiotics on spec. Similarly, people sometimes come and see the doctor about things like verucas, ringworm and threadworm which need to be dealt with by the Chemist; or about dental problems, which have to be seen by a dentist; or about housing problems, which we usually redirect to the Health and Social Care Coordinators. By getting some information at the outset we can make sure that patients go straight to the right place; and even in cases where a doctor’s appointment is the most appropriate thing, it often helps to know in advance what the appointment is about, so that the doctor can have a look at any relevant results and letters beforehand, instead of having to go searching for them during the consultation.
It should be emphasised that this entire exercise is voluntary and ‘light-touch’. If patients don’t want to give reasons why they are asking to see the doctor, they don’t have to; and if we suggest to them that they could actually see somebody else instead, but they still prefer to see the doctor, that’s fine as well. This is supposed to be a way of helping people and making our service more efficient, not a means of preventing people from getting appointments.
Group therapy for 15 and 16 year olds with anxiety/low mood
Dr Hindmarsh, along with a psychotherapist called Caroline Elliott, is planning to start some group sessions for 15 and 16 year olds with anxiety and low mood on Wednesday evenings here at the Crane Surgery. Increasing numbers of adolescents seem to be suffering with these problems, and NHS provision for them isn’t always suitable. Dr Hindmarsh has lots of experience of group work and hypnotherapy, and Caroline Elliott has lots of experience working with people in this age group. If the experiment proves successful, they are hoping to continue on a more permanent footing, hopefully with funding from the Health Authority.
We have already contacted the other surgeries in the area to let them know about this, and we intend to contact the local schools as well. Initially patients will need to be referred by their GP in order to join the group, and we will then organise a meeting to discuss the group and their requirements; so if you know of anybody who is interested, but they’re not registered with us, get them to approach their GP in the first place and ask the GP to send us an email.
Michaela Clack from Carers First has started coming to the Crane Surgery on Tuesdays afternoons on a once-a-month basis for 3-hour sessions to offer support and advice to carers. She says ‘appointments can be used to speak about emotional and practical Carer needs and the support available from ourselves and other agencies’. A full assessment with her normally takes about 30 minutes.
If you would be interested in seeing her, please call the Carers Hub on 0300 303 1555 to book an appointment.
At our last Patient Participation Group meeting we had an update about how things now stand at Lloyds Pharmacy. As many readers will already know, the Pharmacy in Cranbrook has been struggling to keep up with processing prescriptions in recent months. Lloyds the parent group has been trying to save money, partly because the Government has reduced payments to all pharmacies for their dispensing work, while at the same time the workload itself, like almost all other workloads across health care, has kept growing. In February the Head Office informed the Cranbrook pharmacy that they were going to have to lose some staff hours. These cuts in staff coincided with or led to other members of staff going off sick or handing in their resignation, with the result that in March-April the pharmacy was about nine days behind processing prescriptions, even though some members of staff were coming in and working extra hours unpaid, including on Sundays, in an attempt to keep up. Eventually some member of the public complained to the General Pharmaceutical Council, who came and inspected the pharmacy, with the result that Lloyds Head Office were forced to acknowledge that there was a big problem and put some extra staff in there. For the past couple of months the Cranbrook Pharmacy has had the help of a temporary dispenser, who they describe as a ‘Ninja’, and who has basically got them back up to speed: however, he’s only with them until the end of August, and they’re worried that things may get difficult again after he leaves. They are currently trying to recruit a new dispenser, but qualified dispensers are very difficult to find.
It is important that patients do everything they can to help Lloyds by ordering their prescriptions at least four days in advance of when they are needed. Patients should also be aware that Lloyds Head Office have told all the local pharmacies they should now be charging for home deliveries, because the Government has stopped incentivising this service. At the moment Lloyds are continuing to deliver to all their existing home delivery customers free of charge, but new customers who need home delivery may have to pay (the suggested fee is £60 a year), and it may be that even existing customers will have to pay in the future.
Because of the difficulties at Lloyds, quite a lot of our patients have started either collecting their prescriptions from us and taking them to other pharmacies, or ordering their medicine from online providers such as Pharmacy 2 U. This is perfectly understandable, and the trend towards online providers is something that’s happening UK-wide, but the danger is that if enough business moves away from the Cranbrook Pharmacy, Lloyds Head Office may close it down. This would be a serious loss, because the staff there actually provide an extremely valuable personalised service that you wouldn’t be able to get from an online company.
The other piece of news about Lloyds is that Graham Morland, who was the Pharmacist there until recently and then started working part-time a couple of years ago, is now going to retire completely after 28 years in the business. We’ve always had a close working relationship with the Cranbrook pharmacy, and Graham has been one of the main reasons for this. He’s been a really good friend and colleague of ours, unfailingly friendly and helpful, and we wish him all the very best for his retirement.
Federation projects: holiday immunisation clinic and extended access
The West Kent Federation, which represents all the GPs and surgeries in this area, is currently working on a couple of new initiatives. One of these is to set up a holiday immunisation clinic, run by practice nurses, to look after all holiday vaccinations, instead of these having to be done by individual surgeries. At the moment holiday vaccinations tend to be quite difficult to organise, partly because people tend to want them done at very short notice, but also because vaccination requirements can get very complicated (for example if students are taking a ‘gap year’ and travelling all round the world), and some of them are available on the NHS, but others have to be done privately. If people need a lot of private vaccinations we normally send them to a private travel clinic, but the nearest one is based in Ashford (although they do come to Tenterden once a week). If holiday vaccinations were dealt with in a separate, centralised clinic, it would be easier to make appointments available, easier to make sure that a full stock of all the relevant vaccines was maintained, and easier to be sure that the nurses working there would have all the right information and expertise at their fingertips: it would also take quite a lot of pressure off our nursing appointments at certain times of the year. It could also pave the way for the centralisation of other nursing services (for example for dressings and removal of stitches) further down the line.
The second project the Federation is working on is the provision of Extended Access. The Government has set a target for every area to provide a certain number of Extended Access appointments, to allow patients to be seen outside of normal hours if they find it difficult to attend surgery in those hours for work or other reasons. ‘Core hours’ are Monday-Friday 8 a.m. to 6 p.m., so Extended Access appointments have to be made available at other times such as early mornings, evenings, Saturdays or Sundays. They don’t have to be doctors’ appointments, so the Travel Clinic, once it was set up, might count towards this provision. They do have to be available to patients from any surgery in the area, which is one point on which they differ from the old Extended Hours service, for which we used to offer early appointments on Wednesday mornings.
At first we were told that early morning appointments wouldn’t count towards Extended Access, which is why we stopped doing the early appointments on Wednesdays earlier this year. It now seems that they might count after all, however, so we might go back to offering these appointments a bit later on: the details of the new service are still being debated, however.
What this does mean is that once the service is up and running there should be appointments available on Saturday mornings, not at our surgery, but somewhere in the West Kent area. These Saturday clinics may be at different places on different weekends, on a rota basis. Exactly how this will work and how patients will be able to book into the appointments we don’t yet know, but we’ll publish information as soon as we have it available.
January 2018 Newsletter
Annual patient survey
The full results of our annual Patient Survey, which was completed in September last year, can be seen here: 2017 practice survey.pdf
Generally this was another very good set of results. 91% of patients were ‘Very satisfied’ with the overall care they received from the surgery, and 9% were ‘Fairly satisfied’, which means that none at all were dissatisfied or even undecided. One thing which has changed a bit since last year is that the percentage of patients who find it 'Very easy' to get through to us on the phone has gone down from 45% to 35%. This may reflect the fact that our list has been open and we have been taking on more patients for about two years now, which inevitably makes us busier. We have taken steps to make it easier for people to book appointments, reorder prescriptions and view their own records online, and we hope that this will take some strain off the telephone lines - more about this below.
Another interesting finding is that the percentage of patients 'Very Satisfied' with our opening hours has gone up from 65% to 74% - our highest ever score. This is particularly noteworthy in view of the fact that the Department of Health are trying to encourage (or possibly oblige) all surgeries to open from eight in the morning until eight in the evening on weekdays, with additional availability at weekends. They believe that if surgeries were open longer, fewer people with trivial health problems would go to the A&E department at the hospital. The counter-arguments are that there's no research evidence to show this, and the majority of doctors would prefer not to work longer hours. Furthermore there is research evidence to show that surgeries with good continuity of care - usually smaller surgeries - are better at keeping their patients out of hospital, especially elderly patients with lots of health problems; but of course the smaller you are, the more difficult it is to extend your hours into evenings and weekends. At the Crane Surgery we have a half-day on Wednesday, and half-days are particularly unpopular with the Health Authority - but it does allow us to catch up on a lot of paperwork, have meetings, and generally fit in things which are very difficult to manage while the surgery is open, and it doesn't seem to interfere with our continuity of care.
The Wellbeing Project
Last year we ran a Wellbeing Project in our Waiting Room: videos related to wellbeing were displayed on our wall-mounted TV, information-sheets about wellbeing were available on the tables, and there was a Happiness Tree, to which people could add leaves with the things that made them happy written on them.
Part of our Patient Survey this year was about the information on display in our Waiting Room, and we were hoping that this would give us some good feedback about the Wellbeing Project, but unfortunately the results were rather inconclusive. The majority of patients were 'fairly happy' with the Waiting Room before the Wellbeing Project began, and more of them were still 'fairly happy' while it was running (the top scores went up from 41% to 69%), so on the whole we could call it a success. From questionnaire comments and verbal feedback while the project was running, however, it's clear that some patients found the Waiting Room videos intrusive, or in some cases even depressing. A lot of people say they prefer to have something playing in the Waiting Room rather than just silence, but they might prefer just music or a montage of photographs. The one thing that was a big hit was the Happiness Tree, which was so well-used that its branches started to fall off.
We can't really go back to playing music in the Waiting Room, because the license fees are too expensive, but we'd like to go back to having something playing, preferably with a wellbeing-related element.
Waiting Room redesign
On the subject of the Waiting Room, it won't have escaped the attention of our patients that we've had the floor repolished and redesigned the Waiting Room itself in the course of the last 12 months. The redesign has involved taking out some of the old church pews and replacing them with chairs. This makes the seating arrangements much more flexible, which means that it's now easier for us to use the Waiting Room for meetings and presentations outside of surgery hours. There were some Yoga for Bad Backs sessions running the the Waiting Room last year; we've been hosting regular educational group meetings for local GPs in the evenings for a few months; and the 3rd Cranbrook Video Festival will be held in the Waiting Room on Saturday 17th February.
GP Federation, extended hours, and half-day cover
As we've mentioned in several previous Newsletters, the Crane Surgery is part of a Federation of local GPs. The Department of Health is trying to get surgeries to extend their opening hours into evening and weekends, and as a lot of GPs don't want to work longer hours than they are doing already, one option for providing this extra cover is through the Federation: setting up a 'hub' which will be open at evenings and weekends, into which we and the other surgeries in the area will be able to book our patients if they can't attend or can't be fitted in during normal hours.
What would make make this different from the existing out-of-hours cover, we hope, would be that whichever GP was covering the extended hours sessions would be able to see the patient's GP notes - in other words they would have access to our computer system. They could see the patient's medical history, blood test results, allergies, repeat prescriptions, and so on; and they should be able to record consultations onto the patient's medical notes too.
There is a system called Vision Federated which allows GPs from different surgeries to see each other's medical notes in this way, and we are actually in the process of trying it out at the moment, in collaboration with the Orchard End surgery. We cover the Orchard End surgery for emergencies during their half-day closure on Thursdays, and they cover us during our half-day on Wednesdays. Up until now, the Doctor seeing a patient from the other surgery has had to work 'blind'; but we have just installed Vision Federated, and this should mean that from now on we will be able to see the notes of Orchard End patients, and they will be able to see the notes of our patients, which should be really helpful going forward. If the experiment is a success, it could also pave the way for the same technology to be used for an extended hours 'hub' in the future.
iPlato and myGP
Another bit of new technology which has already made quite a difference to the way we work is iPlato. Up until the end of last year we were using a system called MJog to send people text reminders about their appointments. In the Autumn, however, MJog was replaced by iPlato, which does much the same job, but a bit better - if you get a reminder about an appointment that you don't need any more, you can text back 'CANCEL', and the appointment will automatically be cancelled. The iPlato system also allows us to send people text invitations instead of letters for things like asthma checks and blood pressure checks, which saves us time and money.
Along with iPlato there is a further option for people with smartphones to download an app called myGP, which has got some additional functionality. The main thing it does is allow people to book appointments using their smartphones. At the moment they can only book Doctors' appointments, although we may extend this to the Nurses later on. Obviously, the more people use this method to book their appointments, the less phonecalls we have to take in Reception, which could save us a lot of work in the long run. Another advantage is that myGP encourages people to put in a reason for their appointment, which can be useful information for the Doctor.
The app also allows people to view their records and order repeat prescriptions online, but this is a little bit confusing - because in fact all it does is forward people to the Patient Access website, which is run by our clinical system, EMIS. What this means is that you can't really use myGP to view your records or order your repeat prescriptions unless you have already set yourself up to use Patient Access via EMIS. But registering for Patient Access is another thing that saves us quite a lot of time, because it means that people can order their prescriptions and look at their test results without having to go through us, so we would encourage everybody to take this up: just request a printout of registration details from us, set yourself up online, and away you go.
New housing in Cranbrook and Sissinghurst
Another subject that came up in our last Patient Participation Group meeting is the fact that there are going to be a lot of new houses built in our area. Patients will know that there's already a lot of building going on around Tenterden. Apparently Cranbrook and Sissinghurst are going to get about 600 new homes, which will mean a lot of new patients moving into the area, and it will be difficult to accommodate all those new patients within our existing premises and with the existing number of doctors. At the moment the Crane surgery is the only one in Cranbrook with an 'open list', which means that we are registering anybody who is new to the area. As a result our list size has gone up by about 400 in the last two years, from 1800 to 2200. We wouldn't be able to fit in all the patients from the new homes, however, so the Cranbrook surgeries are going to have to work together to cope with the influx. Just to complicate things, several of the Cranbrook doctors (including Dr Hindmarsh himself) are only 5-10 years away from retirement. New doctors are going to be needed, not just to cope with the extra patients but to ensure the stability of primary care in this area going forward; and new premises may be needed too. We will need to increase our cooperation with the other Cranbrook surgeries, and there may come a time when all three surgeries are working out of the same building - but this is a long way off, and if it does ever happen we are all anxious to make sure that we preserve our teams, our individuality and our continuity of care as much as possible.
March 2017 Newsletter
When the CQC originally visited us in June last year they gave us an overall rating of ‘Good’, but scored us as ‘Needs Improvement’ with regard to our infection control audit, our method of stock-checking our medications, and our staff records. A single representative from the CQC team came back to re-check those specific areas last month to see what we had done to improve things, and although she hasn’t yet sent us the official report she seemed happy that we could be upgraded to a ‘Good’ in all categories.
Annual Patient Survey
The full results of our annual Patient Survey, which was completed in September last year, can be seen here: 2016 practice survey results.pdf
Generally this was another very encouraging set of results. 90% of patients were ‘Very satisfied’ with the overall care they received from the surgery, and 10% were ‘Fairly satisfied’, which means that none at all were dissatisfied or even undecided. In a number of other categories we also got our best-ever results. However, both our staffing arrangements and our practice population have changed a bit since this survey was conducted, so it will be interesting to see what the results look like next time around.
Dr Van Sloun and Dr Shan
One thing which always emerges from the ‘Comments’ section at the end of our survey is that people would like us to have a female GP available. There were comments about this again in the most recent survey, and since Christmas we’ve actually done something about it, with a lady called Dr Shan now working for us, alongside Dr Hindmarsh, on most Thursday mornings.
Dr Hans Van Sloun has also been regularly covering our Fridays, allowing Dr Hindmarsh to have a long weekend. Dr Van Sloun has been working locally for many years, sometimes as a locum and sometimes as a permanent member of staff in one of the other Kent practices, and he’s also done a lot of out-of-hours work, so he’s very experienced and a safe pair of hands. We’ve known him personally for about twenty years.
Changes to the Waiting Room, and the Wellbeing project
As mentioned in the previous Newsletter, we are intending to show videos on the theme of Wellbeing in our Waiting Room. We had a video-show on that theme in February, and with the permission of the video-makers we’re going to incorporate some of the shorter, more upbeat and ‘arty’ pieces from this show into our Waiting Room display. We would also like to incorporate input from our patients, if anyone would like to send us a video on the subject of wellbeing, or some music or art they have made. As a starting-point in this direction, we have put up a ‘Wellbeing Tree’ in the Waiting Room, and invited people to write down the things that make them happy on leaves made out of card and hang them on the branches of the tree. We will photograph these leaves and turn them into a montage, to be incorporated into our video display. Hopefully this will encourage more contributions, which can then also be incorporated, so that the display will evolve over a period of time with input from our patients.
We are also intending to make some alterations to the layout of the Waiting Room to make it easier to hold meetings there. We will be taking out come of the pews and replacing them with new seats that can be rearranged easily as required. Dr Hindmarsh, who does some hypnotherapy in his spare time, may organise some group hypnotherapy sessions in the evenings and at weekends. Again, these will probably be aimed at promoting the wellbeing of participants.
Our Federation and our CCG
The Federation is a group of GP Practices from this area who have come together with a view to working more cooperatively, pooling their resources and offering certain services jointly (possibly, for example, weekend and evening opening).
Our own Federation, the Mid Kent GP Alliance, has just announced that it’s going to merge with the one next door, South West Kent Health, to create a bigger organisation called West Kent Health.
In the meantime the West Kent CCG – the Clinical Commissioning Group, which controls the finances and contracts for health in this area – is also talking about going into a merger with another local CCG to create an organisation similar to the old Strategic Health Authority.
The cynics among us tend to think that all this stuff just goes round and round in circles. Large organisations such as Strategic Health Authorities are broken up in order to create smaller groups which will be more flexible and responsive to local needs. Five minutes later the smaller groups all start merging with each other in order to be more cost-effective and give themselves more clout. Before you know it, we’re right back where we started but with different letterheads, nothing much seems to have improved, and a certain number of people who used to do really good jobs have been made redundant.
However, we here at the Crane Surgery do not take this simplistic and cynical view. We think everything is getting better all the time thanks to the numerous reorganisations that have taken place. Hurray!
October 2016 Newsletter
The report from our CQC Inspection in June 2016 is available to download here. Our overall rating was ‘Good’, but we scored ‘Requires Improvement’ in the safety category. This was because we hadn’t carried out an infection control audit, and there were some out-of-date drugs in our drugs cupboard. Both of these things have been rectified since the inspection took place. As far as we can work out, the CQC aren’t intending to re-visit us until their next routine inspection, which should be in about five years’ time.
On the whole the inspection was a much more positive experience than we had been led to expect, and the CQC team turned out to be perfectly friendly and not particularly nit-picking in their approach. It was an awful lot of work, but it did give us a chance to think about the services we provide and our values as an organisation, so it ended up being quite a good team-building exercise.
We would like to particularly thank Barbara Royle, who acted as our patient representative and was interviewed in that capacity by the CQC, and evidently told them a complete pack of lies about how nice and helpful we are.
Transforming Health and Social Care in Kent & Medway
A document of this title has recently been jointly circulated by Kent County Council, Medway Council and West Kent NHS. It indicates that there is going to be an attempt to get health care and social care services in the area working together more closely, in an attempt to improve care and generate some efficiency savings.
‘Across Kent and Medway, health and social care have £3.4billion in funding but overspent by £141million last year. Without change, we will be looking at a hole of £485million in our budgets by 2020/21.’
One of the biggest problems is that with an ageing population, people are often being admitted to hospital simply because they become unable to care for themselves properly in their own homes; and once they are in the hospital they often can’t be discharged quickly because there isn’t the social care available to look after them back in the community. It is in the interests of both the health service and social services to work together to stop this sort of thing happening – but the underlying difficulty, of course, is that both health and social services are struggling to keep pace with increasing demand, and their budgets are limited.
Efficiency savings and new ways of working are often touted as the solution to this situation, but although they can be good ideas in themselves, experience suggests that they probably won’t deliver the kind of savings that are required. In the long run, we’re simply going to have to spend a lot more money on health and social care, or the whole system is going to fall to pieces.
Leaving all that doom and gloom on one side, however, the NHS and County Councils are seeking feedback from members of the public about what kind of health and social care people want: and if anyone would like to fill out an online survey, or get more actively involved, they can find more information on the West Kent CCG website (http://www.westkentccg.nhs.uk/news/news-articles/?blogpost=9127).
Our Waiting Room and the Wellbeing project
We've discussed the Waiting Room several times in these newsletters. Licences to play music in the Waiting Room are prohibitively expensive, but we’re conscious that without music it’s sometimes difficult for people not to overhear what’s happening in Reception, and we thought that a solution to this might be to get music from local musicians, who would give permission for it to be played copyright-free.
We have also been trying to update the posters on display in the Waiting Room, so that the same ones don’t just stay on the walls for an indefinite period of time.
Recently, however, we came across a piece of research into Waiting Rooms in general, which mentioned that they are often very dreary places for patients to spend time, and even when the posters on the walls are regularly updated most of the information tends to be negative – warning people that they might have diabetes without realising it, or bowel cancer without realising it, or skin cancer without realising it, etc. etc.
Partly because of this we have decided to try to get some more positive information into the Waiting Room. There is a lot of research now to show that wellbeing is just as good for your health as the usual physiological things like low cholesterol, low blood pressure, keeping your weight down, not drinking too much alcohol and so forth. Yet most people are very much in the dark about what practical things they can do to promote their own mental and spiritual good health. But the information's out there: creative activity, learning new things, staying active, socialising, giving to others and mindfulness are all good for your wellbeing.
We are going to put up a display screen in the Waiting Room, and we are putting together a series of text-based information-videos about wellbeing to be shown on this screen. The idea is that they will be interspersed with music from local musicians, and with more creative videos about one aspect of wellbeing or another. We are also going to make information about wellbeing available in the form of a leaflet which will be available from Reception; and at the same time Dr Hindmarsh, who is a trained hypnotherapist, is going to put together a CD with a number of different hypnotherapy talks on it, dealing with subjects such as anxiety, sleeplessness, weight control, pain relief etc. This CD will also be available from Reception, for a small price.
Julian the Practice Manager is also organising a small video-festival on the subject of Wellbeing, which will be held in the Surgery Waiting Room on Saturday 18th February 2017. More information about this will be available once the programme has been finalised, towards the end of December. Some of the videos from this festival, if the artists agree, may be permanently incorporated into the waiting room display later on.
In order to research the effects of this project, we have incorporated an extra questionnaire about the waiting room into this year’s Patient Survey, and we will re-circulate the same questionnaire next spring after the changes have been made, to see whether people like them or not.
Our Patient Participation Group have also commented that they like it when we display art in the waiting room; and they would also like to have pictures on display of the other GPs who work for us from time to time, Dr Gabriel and Dr Van Sloun; so we’ll try to do both of those things.
March 2016 Newsletter
The results of our patient survey, which was completed in September 2015, were very encouraging. Overall satisfaction with our services remains very high at 98%. Satisfaction with our opening hours is 91%; 83% of responders reported that they could get an appointment within 2 days, and 86% said they they were able to see the doctor they preferred.
As in previous years, we do acknowledge comments from some patients to the effect that they would like a female GP to be available, or appointments in the evenings and/or at weekends. Clearly as a single-handed practice with one male GP it’s hard to see how we can meet these expectations ourselves, but as mentioned in the last newsletter there may be scope for some flexibility via federation with other local practices: see below.
A copy of the full survey can be downloaded from this website (click the link below), or a printed copy is available from Julian the Practice Manager on request.
As mentioned in the last Newsletter, all practices in Cranbrook, Hawkhurst and the surrounding areas are now part of a Federation. One purpose of this Federation is to make it possible for the local doctors as a group to bid for services – for example, if the local Health Commissioners wanted to organise diabetic care in the community, instead of people having to visit one of the hospitals to get their care, then the Federation could put in a bid to provide the service.
Another potential benefit of Federation is that surgeries could save themselves time and money by pooling their work – ordering of stationery, payment of wages, writing of policies, or possibly nursing service for things like holiday immunisations. As a further development surgeries might be able to cover each other’s nursing holidays, or even each other’s GP holidays, to save on locum expenses.
At the moment all of this is under discussion, and it’s likely that the approach will be to undertake one or two small projects to start with, and build up from there. Watch this space for further developments!
Our project for the coming year
Our initiative for the coming year is to try to improve confidentiality by making it more difficult to overhear what’s being said in the Reception area. We may look at improving the sound-proofing between Reception and the Waiting Room, although we couldn’t get involved in any rebuilding if it was too costly. The other avenue worth exploring would be to go back to playing music in the Waiting Room, which we stopped doing because the licensing fees were becoming so exorbitant (more than £400 per year). These fees would not apply if we were playing music by permission of the musicians themselves – so we’d be interested to hear from any musicians who would be happy for us to use their recordings. Any punk bands with names like Kill All the Patients in the Waiting Room, however, need not apply.
November 2015 Newsletter
Dr Hughes' departure
Dr Sean Hughes left us on 21st September, mainly because the trip from Folkestone to Cranbrook and back every day was too much of a strain, especially when Operation Stack came into effect. We don't have any immediate plans to take on a new partner, so for the time being Dr Hindmarsh has gone back to being single-handed, and he is the Named GP responsible for all patients on our list. Dr Gabriel is working with us for a few sessions a week as an assistant for the time being, but this arrangement is only temporary.
Reopening our list to new patients
For several years we have been 'closed but full', which means that we haven't officially been closed to new registrations, but we haven't been taking on new patients because we weren't sure we could cope with the extra workload. However, new arrivals in the Cranbrook area were always able to find themselves a new GP because the Charlesworths, who run the Orchard End Surgery in Dorothy Avenue, were taking people on. During the summer the Charlesworths decided that they had reached their limit and couldn't take on any more, which meant that lots of people immediately started turning up at our Reception desk complaining that they had just moved to the area and couldn't find anywhere to register. Largely because of this, and also because our own list-size was getting quite low, we decided to reopen our list.
Our workload concerns haven't entirely gone away. New patients involve a lot of extra work, especially summarising their notes. For the time being, however, we seem to be coping all right. Our current list size is about 1900, and our plan is to increase the list to about 2100 (which will probably take at least a year, and possibly a couple of years), and then review the situation.
We had some teething problems with the electronic prescribing system - which is the system whereby prescriptions are sent to the Pharmacy electronically rather than on paper. However, it now seems to be working fine as long as the prescriptions are being sent to Lloyds Pharmacy in Cranbrook - anything further afield tends to get a bit complicated. Lloyds also report that having electronic precriptions coming to them in a steady trickle - rather than having a big bundle of paper ones arriving all at once - is a big help from their point of view.
We have to get consent from people before their prescriptions can be sent electronically, and we removed the consent-form from the top of our Repeat Prescriptions during the period of teething troubles, but this will now be restored so that we can get as many people onto the electronic prescribing system as possible.
One of the ladies from Lloyds Pharmacy came on a visit to the Crane Surgery to see how the prescribing process worked from our end, and this was a big success. We now intend to organise a return visit, where one of our members of staff goes to Lloyds for a morning to see what they do with the prescriptions down there.
Minor Ailments scheme
Lloyds Pharmacy are now taking part in a Minor Ailments scheme, also known as Pharmacy First, which is designed to encourage patients to visit the Pharmacy rather than the Surgery if they have a minor problem such as a sore throat, an ear ache or hay fever. This can be a useful alternative, especially if all our routine appointments have been booked up but patients need help with a minor ailment on a same-day basis, which often happens. The Pharmacy staff will always pass people back to us if the problem turns out to be more serious, and seems to need looking at by a doctor. Lloyds will let us have some more information about this scheme so that we can display it in the surgery.
West Kent CCG & the Federation
All GPs in West Kent are part of the West Kent CCG, which is the Clinical Commissioning Group, responsible for looking after health care expenditure in this area, including things like prescribing budgets and the cost of hospital treatments.
Up until now the West Kent CCG has been working under the supervision and control of NHS England, but in the summer they voted to apply for Co-Commissioning status, which will basically mean that they have more complete control over health arrangements in West Kent, and won't be responsible to NHS England any more.
There are some concerns about CCGs taking full control of health organisation in this way, because there are potential conflicts of interest. One of the things Commissioning Groups try to do, in order to keep costs down, is redirect work away from the hospitals, which often means sending patients to GP specialists instead. For example, patients with urgent eye problems in our area are often seen by Dr Stuart Williams in Staplehurst, who is an eye specialist; and patients with skin problems are often seen either by Dr Clive Dewing or Dr Clare Kendall, who specialise in minor surgery and dermatology. These arrangements usually mean that patients get seen more quickly and more locally, with less cost to the NHS, than if they were sent to the hospitals - but, bearing in mind that the CCG is run by GPs, when they start redirecting work towards their fellow-GPs in this way, the process has to be monitored very carefully to make sure that they're not doing it just to make some extra money for themselves or their friends.
One way of trying to keep the commissioning process separate from the provision of services is to organise GPs into a Federation. The idea is that GPs in the CCG - the Commissioning Group - will offer contracts for services, and GPs in the Federation can bid for those contracts.
The Crane Surgery, along with all the other local surgeries, is now part of a Federation, and it's possible that in the future, as the Federation develops, we may be able to group together with other surgeries to offer things like extended opening hours at weekends and in the evenings. It's unlikely to happen very quickly, though.
The posters and leaflets in the Waiting Room
Our initiative for this year, as discussed with the Patient Participation Group, was to try to get the posters and leaflets in the Waiting Room updated and changed more regularly. Kristina Avery has now taken on this responsibility, and although she's only partly finished, the Patient Participation Group wanted to thank her for making things look much nicer, more interesting and less out of date already.
June 2015 Newsletter
Patient Participation Groups are no longer an Enhanced Service - they are now a contractual obligation. This means that the surgery will no longer be given any funding to help run a Patient Participation Group, but is still expected to keep one going, and to consult it about surgery developments.
Some other contractual obligations have been brought in this year:
- Last year a rule was brought in that all patients over the age of 75 must have a 'named accountable GP', and must be informed in writing of who it was. This year the rule has been extended to all patients of any age, although those under 75 don't have to be informed in writing. The "Named GP" rule was mainly introduced for the benefit of patients in big group practices, where you can see lots of GPs in quick succession and it can be helpful to have one person in particular who is taking responsibility for your care. In a small practice like The Crane Surgery, having a Named GP doesn't really make any practical difference. However, we will allocate a Named GP to every patient, in accordance with the rules, and the information will be available on our website, in our Practice Leaflet, on posters in the Waiting Room, or from Reception if patients ask. We may also print it onto Repeat Prescription lists.
- Online Access to Patient Records: It's a contractual obligation to make this available by the end of the year, but we've actually been doing it for some time. Patients who sign up to order their Repeat Prescriptions online can see their patient records online by default, and other patients who want the same service can be set up on request. We will re-publicise this to try and increase uptake of the service.
- Online Appointment Booking: As with the last service, we have already had online appointment booking available for some time, but it has only been used once or twice.
- Publication of mean GP net earnings: This information is supposed to appear on our website (and be made available in printed form on request) by the end of the current financial year. According to the BMA website, 'NHS England will publish guidance for GPs and their accountants on how mean net earnings should be calculated', so we will await further guidance before we do anything.
Last year we decided that we would try out Electronic Prescribing, which sends prescriptions electronically to a nominated Pharmacy (usually, for us, Lloyds Pharmacy in Cranbrook High Street) instead of them having to be printed out and delivered by hand. The first step was to get consent from our patients, and we did this by putting a short sign-up form at the top of the Repeat Prescription List, to which lots of people responded. When we actually tried the Electronic Prescribing system, however, it emerged that there were various problems with it:
- When we printed out people's prescriptions we also printed out their Repeat Prescription Lists, so that they could re-order their medications next time. Once we started transmitting the prescriptions electronically, without printing anything, the Repeat Prescription Lists were printed by Lloyds instead - but instead of coming out in alphabetical order, they were coming out mixed up, which was likely to cause errors when we tried to process them next time around.
- When the Doctor sees a patient in evening surgery and wants to give the patient an urgent prescription - eg. for antibiotics - the patient wants to be able to take this prescription straight down to the Chemist and get the tablets. The Electronic Prescribing System sends off the prescription electronically, which can mean that it takes up to a couple of hours to reach the Chemist, because it has to be processed through the national Spine (which is a bit like a big national telephone exchange, only slower).
- Some patients didn't want their prescriptions to be sent to Lloyds - they wanted them sent elsewhere, eg. Boots in Tunbridge Wells. The Electronic Prescribing System was supposed to make this sort of thing very easy, but in fact every time we attempted it, it seemed to go wrong, the prescriptions would get lost, and we'd end up having to print them out.
As a result of these problems we suspended our use of the Electronic Prescribing System - but the first issue (Repeat Prescription Lists printing out in the wrong order) now seems to have been solved, so we're going to think about giving it another try. We do think that Electronic Prescribing is a good idea in principle,
As a result of having a meeting about Electronic Prescribing and its problems, we're also going to organise a job-swap between ourselves and Lloyds, where a member of staff from Lloyds comes up to our surgery to see what we do with repeat prescriptions, and a member of staff from the surgery goes down to Lloyds to see what happens at their end.
The Crane Surgery, along with the other surgeries in the Weald area (ie. the other surgeries in Cranbrook, Hawkhurst, Staplehurst, Goudhurst and Lamberhurst) have signed up for membership of the Mid Kent Federation.
Federation is a grouping-together of surgeries for the purposes of things like group purchasing, group tendering for contracts, or sharing of resources. In the short term it may help us to organise cheaper contracts for services such as electricity, telephony, surgery insurance or medical supplies. In the longer term we might be able to organise things like shared flu clinics, a shared rota for weekend cover, or even shared holiday cover to save the expense of hiring locums. In the here-and-now, on the other hand, what has actually happened so far is that we've paid nine hundred quid and we're not really sure what we're going to get for it.
Chronic Disease Recalls
One of the improvements we decided to implement last year was an improvement to our Chronic Disease Recalls system, so that people who were on more than one Chronic Disease Register would get called for all their check-ups at the same time, instead of being asked to attend for one set of blood tests one month, and another set the month after, and perhaps another one the month after that.
As a result of this idea we have set up a Multi-Morbidity Register, which includes anybody who has got Diabetes, Coronary Heart Disease and Chronic Kidney Disease; and these patients are now being asked to come to have all their checkups done at once. The system is still in its early stages, and may be extended to other Chronic Disease Registers later, but it seems to be working reasonably well at the moment.
The Posters in the Waiting Room
Our initiative for the coming year is that we're going to try to be more organised about the posters in the Waiting Room. At the moment the same posters are sitting on the wall for months or even years on end, which means that nobody ever looks at them any more. We need to try to vary or rotate the display, and the display of patient leaflets probably needs to be reviewed on a regular basis as well. Julian hasn't got time to do this himself, so he'll try to get a member of staff to take it on.
December 2014 Newsletter
Results of Patient Satisfaction Survey
This year's survey was almost identical in design to last year's: basically it had all the same questions, with one additional question asking people whether they thought we should try to co-ordinate chronic disease recalls better (the answer was yes), and a short extra section asking about age and gender. The survey was also distributed in the same way as last year - ie. we gave out 100 copies to patients in Reception, mostly in the mornings. This meant that our survey-analysis man, Mr Niel Caddick, was able to compare this year's results with last year's results very accurately: and the addition of the age and gender questions meant that he was also able tell whether the people who answered the survey were representative of our practice population as a whole (broadly they were, but skewed towards the 65-84 age range).
On the whole the results were very good again. The percentage of patients who said they were "very satisfied" with the surgery's overall care was exactly the same as last year (86%) and so was the percentage who said they were "fairly satisfied" (10%). In some of the more detailed questions the answers were slightly less favourable than previously, but the overwhelming majority of reponses were still positive ones.
In the text comments a number of people asked if it would be possible for us to change/extend our opening hours or to have a female GP - unfortunately we're not in a position to do anything about either of these suggestions at the moment, because of the limits on our finances, but we acknowledge that they do crop up regularly. There is a possibility that all of the surgeries in this area may be grouping together into a "federation" at some point, in order to pool their resources and offer new services on a shared basis, and extended opening hours and the availability of a female GP might both be on offer if this were to happen.
Friends and Family test
The Friends and Family test is a very short questionnaire which has been used in hospitals for some time now. It asks patients whether they would recommend a particular service to their friends and family, and gives them a chance to make additional comments if they feel inclined. From December 2014 the Friends and Family test is being rolled out from hospitals to GP surgeries. It has already been on our practice website for some time, and we now have paper questionnaire forms in Reception if anybody would like to fill them out. We will be sending monthly returns to NHS England to let them know how many people have responded and what the responses were like.
We have applied for Electronic Prescribing, and the system is due to go live next April. What this means is that we have to ask patients to nominate a pharmacy to which their prescriptions should be sent - the majority of our patients will probably want theirs sent to Lloyds in Cranbrook High Street - and once this information has been recorded on our computer, the prescriptions can be transmitted electronically rather than printed out and delivered by hand. This will obviously save a lot of paper, but it should save time as well, especially when combined with people requesting their prescriptions online.
Online access to patient notes
Our computer system is now set up so that patients can view their own notes online, and if you register to order your Repeat Prescriptions online you will get access to your notes by default. What this means is that you will be able to see everything on your notes except your consultations with the Doctor: your lab test results, x-ray results, letters from Consultants, medical summary, allergies etc. will all be viewable.
Chronic disease recalls
Our Patient Satisfaction Survey confirmed that most of our patients think it would be a good idea to simplify our chronic disease recalls, so that patients who are on more than one register don't get lots of different invitations one after the other. We're still thinking about exactly how to implement this, but one suggestion made by our Patient Participation Group was that we could think about contacting people by email rather than sending them letters.
We don't have very many email addresses on record at the moment, but when we ask people for their preferred pharmacy in order to set up the Electronic Prescribing service, we could also ask for their email addresses (assuming that they've got one). Almost everyone who is on a Chronic Disease register is also on a Repeat Prescription of some kind, so if we got email addresses in this way it could make a big difference to our recall systems - but it has to be remembered that a lot of our patients won't have email addresses, and we will need to carry on sending invitations to those people by post.
May 2014 Newsletter
Changes to Personnel
We mentioned in our last Newsletter that one of our Practice Nurses, Julia Haynes, who was also working as a Health Visitor in Tenterden, had started a campaign called Born to Move, designed to encourage new parents to make sure that their babies are getting plenty of activity. Shortly after the Newsletter was published Julia was offered a full-time job coordinating and promoting this campaign, and as a result she is no longer working at the Crane Surgery. We're sorry to lose her, but it's a very positive move for her, and a great opportunity to take the Born to Move campaign to the next level, so we wish her all the very best.
Online Access to your Patient Records
This year the Government have introduced a new requirement for surgeries to make arrangements so that patients will be able to access their own medical records online by the end of the year. We already have arrangements in place for patients to be able to order their Repeat Prescriptions online, and this service has been a great success, with more than 10% of our practice population registering to use it. We are also able to set people up so that they can book and cancel a limited range of doctors' appointments online (Tuesday p.m. and Thursday p.m. only at the moment). From now on, we will also be able to set people up so that they can view their own medical records - the Patient Summary, blood test results, letters from consultants, smear test results, x-ray results, etc. If you are interested in this service please contact Julian Le Saux, the Practice Manager.
Patient Participation - Virtual Group
In order to increase our engagement with our patient population, we would like to start a Virtual Group which will be open to anyone who would like to give us their email address. The idea of this group is to act as a sounding-board for any new ideas we may have about developing or improving our servicesr. If we have a number of different ideas, the virtual group may also be able to help us decide which one(s) to go ahead with first. If you would like to volunteer your own email address and join the virtual group, you can download a joiners' form by clicking below:
Chronic Disease recalls - our project for this year
The main improvement we want to try and make this year is to reorganise the way we do our Chronic Disease recalls. At the moment we have a lot of different Chronic Disease registers, such as
Coronary Heart Disease
Chronic Obstructive Pulmonary Disease
Chronic Kidney Disease
- and each of these registers has its own recall schedule. This means that if you happen to be on more than one register (as many of our patients are) you may find yourself called to the surgery for several different kinds of check one after another, in quick succession. Many of our patients have commented over the years that it would be better if they could have all their tests done at the same time, instead of some one month and some the next.
There probably isn't a perfect solution to this question, because some of the checks are done by the Doctor and others by the Practice Nurse; most of them are done once a year, but some are done once every six months or three months; and doing all the checks at once, for someone who is on more than one register, could sometimes involve very long and complicated appointments. However, we will see what can be done to simplify and coordinate our recall systems.
Our answerphone message
Another improvement we intend to make - a much simpler one - is to re-record our answerphone message. At the moment, if you call our telephone number when we are closed, you get quite a long message telling you what to do in the event of an emergency, and only right at the end of the message do you find out that our answerphone doesn't take messages. A lot of people therefore listen right the way through to the end, expecting to be able to leave a message, only to discover that it can't be done, which is rather frustrating for them. We're going to redesign the message so that the bit about our answerphone not taking messages will be at the front from now on.
The Cranbrook Community Hub
One last thing to come up at the most recent Patient Participation Group meeting was that the Cranbrook Community Hub has had to go back to the drawing board. One of our Patient Participation Group members is also a member of the Parish Council, and he has been telling us for the past couple of years about plans to build a Community Hub in the field behind the Postal Sorting Office.
The Hub was going to provide a modern and flexible space in which both a range of community services and a variety of group activities, exhibitions and other social events could all be housed.
However, Tunbridge Wells Borough Council believe the plans are too elaborate and expensive, and the Parish Council need to come up with something simpler.
As a result the Parish is asking for anyone who would like to use the space, for anything whatever, to get in touch so the centre can offer as many opportunities as possible for the provision of service coordination and community development.
At the Crane Surgery we were very supportive of the Community Hub project, and we plan to write to the Tunbridge Wells Borough Council to tell them so.
December 2013 Newsletter
Results of Patient Satisfaction Survey
This year's Practice Survey was conducted by handing out 100 questionnaires in Reception from July to August. The results were very positive, with 99% of respondents reporting that they were either "very satisfied" or "fairly satisfied" with the care they receive from the Surgery. However, it should be borne in mind that regular patients are probably over-represented in these results because of the way the questionnaire was given out, and also that the Surgery has been substantially reorganised since August, with Dr Sean Hughes joining us and Dr Hindmarsh going part-time. The results of next year's survey will therefore be particularly interesting.
You can access the full survey results by clicking on the link above, or a printed version is available on request.
Donna Clarke, Health and Social Care Co-Ordinator
Donna came to our last Patient Participation Group meeting, to introduce herself and explain her role in the area. Essentially her job is to help people access a range of services - things like respite care, home helps, meals on wheels, aids for getting around the house, etc. We've been referring patients to her for a few months now, with very positive results.
A lot of patients who are struggling to cope at home - or struggling to care for someone else - may not be aware of all the help that's available from different agencies. Donna can put together a "basket of care" for people, depending what their requirements are, and she can also look after the form-filling and phonecalling side of things, which can be really helpful as the process of applying for assistance can often be deterringly bureaucratic.
Her post is jointly funded by the Kent County Council and the local CCG (the Clinical Commissioning Group - which basically means all the doctors in the area), and it's still a pilot scheme at the moment, so the more referrals she gets the better chance there is that the arrangement will become permanent. Patients can't refer themselves to her directly, but if you think you might be interested please contact either Julian Le Saux (the Practice Manager) or one of the doctors, and we can organise the referral for you.
At the beginning of the Autumn we were informed by the Department of Health that data was going to be extracted from our computerised patient records automatically by a system called Care.Data, as part of an exercise designed to gather information about "care pathways" and how patients access and use health services. Originally the data extractions were supposed to start in November, but they have now been put back to next year.
"The data to be extracted from GP systems for care.data includes information such as family history, vaccinations, diagnoses, referrals, biological values (such as blood pressure, BMI and cholesterol with QOF exceptions codes) and all NHS prescriptions. Identifiers (date of birth, postcode, NHS number and gender) are required to link the GP data with data from other care settings, in order to analyse patient care across pathways."
All the identifiers are meant to be removed once patient information from different sources has been successfully linked, so the information should end up as anonymised. All the same, some patients may prefer not to have data about themselves passed on to agencies outside the surgery in this way. If you would like to opt out of the care.data exercise please let us know: we will give you an opt-out form to sign, and put a code on your notes to stop your personal data from being uploaded.
"Dr Hindmarsh retiring - rumours quashed"
Ever since Dr Sean Hughes joined us in September, we have had patients asking us on a more-or-less daily basis whether Dr Hindmarsh is retiring, so we'd like to take this opportunity of reassuring everyone that he isn't. He is now usually seeing patients on Mondays and Tuesdays and doing his paperwork on Wednesdays, while Dr Hughes is seeing patients on Wednesdays, Thursdays and Fridays. However, they will be covering each other for holidays, so there will be lots of occasions when they take each other's sessions.
It might also be worth mentioning that they do talk to each other about patient care, especially the more complex cases; and of course they both have access to the computerised notes; so it shouldn't normally be a problem which doctor you see, even if it's not the one you've been dealing with about a particular problem.
Nurse Julia Haynes and the "Born to Move" pilot
As well as being one of our Practice Nurses, Julia Haynes is also a Health Visitor in the Tenterden area, and a couple of years ago, on her own initiative, she started a campaign called Born to Move, which is designed to encourage new parents to make sure their babies get plenty of physical activity. Research has shown that encouraging crawling, awake tummy-time, manipulating objects, active play and parent/baby interaction as soon as possible in the baby's life encourages brain development, helps babies to achieve their developmental potential, and relates to educational achievement once the child goes to school.
Julia's campaign spread from Tenterden to Ashford and is now being rolled out across Kent, and it looks set to go nationwide. It has been praised by the Department of Health as one of the top 20 key health visitor-led projects in the UK, and Julia has now done presentations about it all over the county, an international conference on public health in Ireland and even attended a meeting in the House of Commons!
Well done Julia: we're very proud of you - but it still doesn't mean you get a pay rise.
Our patient Ann Smith has given us the following poem to include in the Newsletter:
What is Life?...What has happened to the human race, That we all have to move at such a pace? What's wrong with driving slowly to admire the view, Those behind? It might be fun if you did too!! Blood pressure levels would be much less, Doctors would not have to treat so many for stress! Learn to relax, laugh, sit and chat, Without mobiles, ipods and all that! Perhaps discuss the meaning of life, With friends? Neighbours? Husband? Wife? Smile at people, take your time, You'll get up re-charged and feeling fine! THEN! - IF YOU MUST! Drive fast, rush about and do, All the jobs that have piled up for you!! But if blood pressure soars, think what you've read, Ponder well on what I've said! Only please remember our busy GP, He may appreciate seeing less of you and me!
Thank you very much, Mrs Smith! If anyone else has something they'd like to see included in the Newsletter - preferably something relevant to the surgery or the theme of medicine - please send or bring it to Julian Le Saux, the practice manager.
July 2013 Newsletter
Changes to Personnel
From 1st September 2013 Dr Sean Hughes will be joining us as a Partner in the practice. Dr Hughes trained with us as a Registrar, qualifying a couple of years ago, and has done the odd locum for us since then, so a lot of patients will remember him from before. The idea is that Dr Hindmarsh will work all day Monday, all day Tuesday and Wednesday morning, and Dr Hughes will work Wednesday morning, all day Thursday and all day Friday. This pattern will change quite frequently, however, as they will be covering each other's holidays.
The other change, which we are sorry to announce, is that Marian Michelle has retired as a District Nurse. She's been working in our area for more than twenty years, and she's been unfailingly kind, patient and helpful throughout that whole period. She'll be missed by lots of people, but luckily the other District Nurses are all very nice too, so we'll still have a good team.
From the time Dr Hughes starts working with us, we will be making a limited number of appointments available for booking online, on an experimental basis. Initially these appointments will be on Tuesday and Thursday afternoons.
The reason we're doing this is partly because there is a Government target decreeing that patients ought to be able to access more services online. We do realise that not everybody has access to the Internet, and we've got no intention of stopping people from booking appointments by telephone - but it's also true that our phones can be very busy at times, and for those who do use the Internet an online booking system could be quite handy. Also, we have been offering a service for people to reorder their Repeat Prescriptions online for some months now, and on the whole it's been a great success.
The flu season is coming up again, and patients are reminded that flu jabs are recommended for everyone over 65, plus all pregnant women and anyone who is diabetic, asthmatic, a coronary heart disease patient or immuno-compromised.
The flu vaccines arrive towards the end of September, and we will be taking appointments for our flu clinics from early August onwards.
The government is planning to introduce flu vaccinations for children this year (for "a limited group of pre-school-age children"), but we don't have full details yet. Hopefully we will know more by the beginning of August.
The Department of Health have also announced that a Shingles vaccine will be introduced this Autumn, initially for patients aged 70 or 79. Again we don't have full details, but hope to get them soon.
Poem or joke
We thought it might be nice to finish off these newsletters (which we hope to publish about once a quarter) with a poem or joke: so here's something which serves both purposes, by Harry Graham -
My son Augustus, in the street, one day,
Was feeling quite exceptionally merry.
A stranger asked him: "Can you show me, pray,
The quickest way to Brompton Cemetery?"
"The quickest way? You bet I can!" said Gus,
And pushed the fellow underneath a bus.
Whatever people say about my son,
He does enjoy his little bit of fun.
If you've got any poems or jokes that you think might be appropriate for the next edition - or any comments or suggestions about this newsletter or the surgery - please send them to Julian Le Saux, the Practice Manager (firstname.lastname@example.org if you want to send them by email).