To All our patients:
We, the Partners, are writing this letter as we wish to explain some of the external factors that we have little or no control over which impact on the service we are able to provide for you by increasing the amount that has to be done in a working day. In order to assist us in providing you with a good service, we are therefore also making a plea to you, our patients, to use the services we provide in a carefully considered way.
General practice is facing a challenging time at the moment. We believe that our GPs and all our staff do a sterling job caring for you, our patients. Part of this is trying to minimise some of the uncertainty that has arisen through major NHS changes over the years, and most recently in April 2013. We often ‘pick up the pieces’ in Primary Care when things aren’t going well in Secondary Care, and you our patients turn to us for help. This is an increasing challenge.
GPs in the UK are roughly half as numerous per head of the population as in many developed countries, despite generally managing to offer a wider range of services. Given this UK-wide challenge, some patient dissatisfaction with the availability and length of appointments is inevitable, but this is certainly not through GPs working at anything less than full tilt. The rise in GP consultation rates nationally over the last few years has been inexorable, at substantially over the rate of population increase. Much work has also been removed from Secondary Care, and is now being done in Primary Care. Despite this, funding of Primary Care has fallen in real terms as a proportion of NHS expenditure. General practice is also given ever changing hoops to jump through, which means that annually there is always more work just to stand still. 90% of NHS work (i.e. face-to-face contacts) is now being done in Primary Care for only 9% of the budget. In this context both the Royal College of General Practitioners and the British Medical Association have recently launched a campaign to make sure policy-makers and the general public are aware of these issues and to press for more funding to be made available for this service. There is some publicity about this in our surgeries.
Given all the above information and threats, much of which sits at a national level, are there anything you our patients can do to help at local level? Actually, there are many things you can help your fellow patients and our staff with; here are some of them:
Please only request an appointment or a phone contact when it is really needed. If it is not an emergency, please consider contacting the Pharmacist (or NHS 111) first, and consider waiting for your illness to improve by natural means, e.g. if you have a virus it is unlikely your GP will be able to alter the course of your illness. Some have booked an appointment for a sore throat within hours of its onset for example. Please consider that if one patient takes an appointment in such circumstances it will make it more difficult for another patient to get an appointment. However the second patient may well be sicker than the first. Please do not claim you have an emergency in order to try to force the receptionist to give you an appointment.
2. Please always try and book with the same doctor/Physician Associate or nurse you saw last time. This ‘continuity of care’ aids the clinician, and it also aids you as you don’t need to re-tell your story over again. As many of our colleagues work with us part-time (often due to other medical commitments elsewhere) this will mean that you may need to wait a bit longer to be seen. However unless your problem is really urgent we would highly recommend this, as better continuity of care results in better care overall.
3. Please be patient. This may mean waiting longer for a routine appointment than you would like. We work hard to make our appointments system work as well as it can for our patients, however the bottom line is the finite resource we have. Our staff are already working extremely hard; the demand for appointments increases substantially in winter and spring; however the resource does not increase to match this. In addition our administrative workload mushrooms year on year. All this means that the number of appointments we can offer cannot be substantially increased in the winter. Please be assured we will always work to achieve the best outcomes for you, our patients, within the resource that we have. We changed our appointment system in summer 2013 to try and make it work better for you. Most of the feedback has been positive, however whatever system is used, there can be unintended consequences. We continue to keep the new system under review.
4. If you make an appointment, please keep it. If you are unable to make it, please cancel it with as much notice as possible. We have a dedicated cancellation line to make this possible. You can leave a ‘cancellation message’ on the same line whether the surgery is open or closed. If all the missed appointments in a month are added up, they are roughly equivalent in number to the employment of a full time doctor.
5. Ten minutes is usually long enough to deal with one problem only. The Department of Health has confirmed historically that it will not fund General practice to fund appointments that are longer than 10 minutes. In practice, our average appointment takes longer than 10 minutes as we endeavour to cover multiple issues in one consultation. However if you have more than one issue to be dealt with, please do not be offended if the doctor asks you to book a further appointment to deal more thoroughly with other issues you have raised.
6. Please have realistic expectations of how quickly we can complete administrative tasks on your behalf. Seeing sick patients will always be our first priority; secondly, all the factors impacting general practice described above reduce the time available for administrative tasks. The NHS is a service funded by taxation which by definition has to have some limits.
7. Please let us know if there are issues that you feel that we could improve upon; however please be reasonable; vexatious criticism is demoralising and can soak up an enormous amount of time to respond to, and it does take a doctor away from patient care in the process. Please be assured that we are keen to receive constructive criticism as this helps to improve the service we offer. Please do not hesitate to give such feedback to us, however please be reasonable.
We know that there are also many things we as a staff team will need to change and adapt
to. If we all work together we are more likely to be able to meet the challenges.
Dr Geraint Thomas MB Bch DFOM FPCert
Dr Ian Anderson MB BS MRCGP DRCOG DTM&H
Dr Hicham Nakouzi MRCGP DFFP