Thank you to everyone took the time and trouble to respond to the survey and the suggestions section for issue 1. We are going to be trying a slightly different format for this issue. The full survey results are included in a later section. Opinion was slightly divided on the length and level of detail, with some patients observing that they struggled with some of the statistics and concepts, and others correcting the grammar, critiquing the Johari window diagrams and wanting to know what each of the colours for the different types of appointments represented. It was deliberately detailed to convey the day-to-day complexities we have to contend with for coordinating the entire lifetime healthcare journey of nearly 21,000 patients, however in this issue we will try for the middle ground. The newsletter is still long but there are lots of pictures and graphs for an easier read.
This issue we will keep a bit shorter, there is the news section, an overview of the clinical team, (we will introduce other teams in later issues), an update on innovations and supply and demand management, and the results of the survey from issue 1. There is a shorter survey on what you would like to hear about in future issues, with the suggestions section and field trip volunteers (see below).
News:
The solicitors are still beavering away finalising the arrangements for our new premises, this has been a few years in the making, but as soon as the ink is dry, we will officially update you with this exciting news. In the meantime, expanding on the access theme of the last newsletter, we are in the process of arranging a field trip for patients with enhanced access requirements to view the new building before the minor building works start. This building has to be CQC compliant but also usable. It is important that we make sure that our patients who use a wheelchair or walking equipment, or those with visual or hearing impairment, can access the building unaided and check in without needing additional help, and interact with the reception desk and access suitable washroom facilities. If not, we will insist on remedial works to comply with disability access requirements before we take possession of the building. The numbers for this visit will be strictly limited, but if you would like to help us with this preliminary access check, please can you leave your contact details in the comments section of the end of letter survey with details of enhanced access needs you have.
Courtesy of NHSE, sometimes the simplest solution is the best one
Lung health News:
Targeted Lung Screening:
Sussex are rolling out a targeted lung health check and screening programme for 55-74 year old smokers/ ex-smokers over the next 2 years. Please see the link below for an explanation video of the screening programme for early detection of lung diseases including lung cancers. The Sussex ICB are already reporting 100 new lung cancers have been identified at stage 1 and 2. The practice have no control over the timing of any individual offer of the screening programme appointments and will not be able to tell you when you are going to be contacted if you are eligible. We have had several enquiries already.
https://sussexlunghealthcheck.nhs.uk/#first
Please see the link below for help with smoking cessation:
or try the NHS Quit Smoking app
Flu Season:
We are starting to plan our flu clinics, please give your preferred flu clinic format for each site in the survey at the end of the letter.
General Practice news in the media:
The bad news, the not so bad news and the really rather good news
The bad news. General Practice has hit a tipping point. GP numbers are falling. General Practice real terms funding has fallen, year on year, at a time of spiralling demand and costs, and the proportion spent on General Practice in comparison to the rest of the NHS, has halved in the past 20 years. As you may have heard from coverage in the newspapers and on breakfast television, there has been a long running dispute between NHS England and the General Practitioner Committee (GPC) of the BMA around funding the General Practice, “General Medical Services” contract (GMS).
The BMA have launched their “Save General Practice” campaign, aimed at restoring the funding level from NHS budgets, to stop General Practice from imploding. General Practice will be taking Collective Action around the funding terms of the current contract. Unfortunately as with all news stories, the need for a sensational headline versus reality does not reflect the actual situation, which unusually is probably even more serious on this occasion.
GPs are not employed, they cannot take industrial action under employment law legislation, unlike our hospital colleagues. As independent contract holders, we have a contract to supply basic general medical services to the NHS for a registered list of patients. In many ways, it is not very different from a turnip supplier to Tesco’s, in that every year we get handed a new annual supply contract, which over the past few years has not been agreed by the GPC, as the representative for GPs as suppliers, and has been imposed by NHS England. Like Tesco’s and the turnip farmers, it has been a case of “accept the imposed terms or hand the contract back”.
The dispute is very simple, either:
Fund General Practice for what we are currently providing, without GPs having to personally subsidise the NHS, by paying for staff to make up for the increasing gaps in every other service in the NHS that is not resourced properly.
Or
General Practice will have to work to the actual terms of their contract and supply only what is being paid for.
In other words, we will be reduced to supplying the medical equivalent of turnips, and not the carrots, aubergines and kiwi fruit, which we currently supply, on the basis of good practice and in the interests of our patients, for the same allocated resources, that have been eroded dramatically in the past 20 years (our apologies for the fruit and veg analogies, but I am sure you get the point). You will be surprised to learn that these funded “turnip services” are so basic, they do not even include taking a blood test or blood pressure monitoring, health checks for diabetes, heart disease or asthma, HRT or the supply of medications that require monitoring. The action is incremental, and patient safety is paramount, so it is starting with things that affect NHS England rather than patient care, like their ability to access our systems, and extract non-patient care data.
The net value of the General Practice contract has not changed in 20 years, so with inflation eroding the real terms value of the contract, increases in tax, regulatory and professional costs, it is not surprising that so many practices are not economically viable, and have simply closed their doors and handed their contracts back.
To make the point, here are some graphs with statistics from the royal College of GPs, the Nuffield trust and the BMA. It is important that everyone understands what is at stake. This problem has been a long time in the making.
Appleby BMJ 2023;380p564 Note GP numbers at the bottom of the graph are the same as in 1998 including trainees and locums.
This graph does not even distinguish between full time and part time head count, remember part time was not an option in 1949.
This graph above has simply divided the number of full time equivalent qualified GPs by the number of patients, it includes all types of GPs registered to practice.
Each year we are getting an influx of new GPs to training, but numbers are not keeping up with Qualified GPs leaving or retiring.
This BMA graph shows that there are now less than 16,000 full time equivalent GP Partners, a fall of 6,000 in 10 years.
Be under no illusion, it has been central NHS policy since the days of “Shipman” to put pressure on smaller practices. To deliver General Practice health care “at scale”, has been the direction for many years. Governments of all shades have promised to end the traditional General Practice partnership model. As GP partners are rarely replaced on retirement now, it is only a matter of time before the entire structure of General Practice needs to be completely rethought and restructured. On a lighter note, we are doing better than in France, where there are “GP deserts”, in many deprived and rural areas, everyone in the UK is at least registered with a GP.
On an “it could be worse” note, we are actually not too bad overall in this part of the world, according to one of the GP magazines who have looked at GP numbers for each primary care network (ours covers the whole of Hastings), but it looks “a bit grim up north”, in Kent.
However, for some better news, it is probably time to introduce you to the very experienced and diverse team professionals who are currently providing your care:
Meet the Multidisciplinary team
Again expanding on our last Newsletter’s access theme, when you do get to see one of our clinicians, you will have noticed that not all of your care is delivered by the traditional GP in a Tweed jacket (although there is at least 1 GP that looks very dapper in his Tweed jacket and jumper). We have a large team of clinicians and highly trained administrative support people, who are organising, assessing and delivering your General Practice based healthcare. What follows is a thumbnail sketch of the teams and the people within them. We are very lucky to have a large number of very qualified people who have chosen to allocate some of their professional time to working with us.
Everyone is fully trained in their generalist area of work, but most people have individual interests and areas of expertise. The individual listings are in alphabetical order, as we do not believe in excessive hierarchy at the Hill Surgery. Our practice mantra is: “We Google, not the Army” all opinions are valued. Unfortunately, everyone’s camera shy, and not very photo-genetic, but we have found a few “mug shots” of the partners that are on the website if you have not met them previously. We will introduce you to the other teams and how they are helping to manage your care in later issues.
GP partners:
“Who let the Doc’s out????”
Dr Anthony Dann is our training lead. He leads on registrar and newly qualified doctor training. He is leading on the de-prescribing of controlled and dependence forming medications, and the frequent attenders healthcare rationalisation programme. He is a practice safeguarding Doctor. He should really be known as “Dr Dr Dann” as he also has a PhD
The practice also trains medical students, nurses, pharmacists and allied health care professionals. Responsibilities for these groups fall to the leads for the respective teams.
Dr Naomi Konu has also been a GP registrar trainer, and is an extended role diabetes Doctor.
Dr Linda Parker is an extended role diabetes Doctor, The practice safeguarding Doctor and a Named Safeguarding GP for the Sussex ICB.
Dr Milan Radia is an extended role diabetes Doctor, and a PCN locality lead and GP Federation board representative for the practice and the provisional CQC registered manager.
Sessional and portfolio GPs:
Dr Chandni Radia works with us part-time, she has GP fellowship training for change management and IT in General Practice, she manages the proxy access for various IT applications, and test drives and selects some of the add on programmes that you can use such as the online consulting.
Dr Lisa Sansom works with us part-time, she has been working with public health, particularly on deprivation driven healthcare issues which she is continuing as part of the NHS leadership fellowship program, working on key screening and lifestyle issues.
We have a pool of trusted Drs who form our portfolio of locum GPs:
Dr Jason Barrow is an experienced GP partner from Bexhill, a GP appraiser, who likes to see how other practices organise their services, and likes to borrow our innovations.
Dr Jorg Bruuns has extensive experience as a GP partner in Eastbourne, worked with Dr Parker and Dr Radia as a CCG GP governing body board member. He has an expertise in acupuncture.
Dr Mridula Nayak has extensive experience as a GP partner in Eastbourne
Dr Emmanuel Obiabo has been a senior GP partner in Suffolk, his interest is complex medical need patient’s.
Dr Khalid Sachak is a Cambridge based GP who helps out with abnormal laboratory and radiology findings
Dr Sachi Sivananthan a GP from London, is also an aesthetics practitioner who organises and moderates international anatomy and plastic surgery conferences across the globe.
Dr Ratheesh Vimalendran is a London based GP who has worked with the PCN and the surgery on the online and remote access consultations, he has now found time for some occasional surgery based sessions and has an extended role in occupational health medicine.
The nursing team:
We have a large nurse practitioner team who complement the general practitioner resource,
Mrs Sabur is our women’s health lead, and fits coils and other contraceptive appliances, she also is the lead practitioner for our high dependency, profound medical and learning disability care home.
Mrs Venner and Mrs Fermor are very experienced nurse practitioners in all general medical issues across the age ranges, and long-term conditions.
Mrs Coshell has extensive emergency condition experience and is the lead clinician for 3 of our care homes for adults with a learning disability, mental health diagnosis or complex substance abuse issues.
Ms Hatami is our specialist neonatal and children’s nurse, and is the first port of call for children up to the age of 16 for all medical and developmental issues.
Mr Castro is a Diabetes Nurse consultant, who will be with us 2 days a week from September, and manages complex treatment regimes for all types of diabetes.
The practice nursing team have their own areas of expertise:
Mr Encea (Gigi) is a practice nurse with extensive experience in the high dependency nursing home sector. He is lead clinician for 12 of our 15 residential homes and 2 high input supported living complexes, for the elderly or those living with a learning disability. He visits weekly for care review rounds and has been working with homes on their care processes.
Mrs Magasin who has experience in all areas of General Practice nursing and is our lead nurse for women’s screening and immunisation.
Mrs Pullinger has just joined the Hill Surgery team. We are very pleased that she has decided to take a step back from her high-pressure previous post, to provide extensive practice nursing experience and expertise and mentorship for developing our nursing team.
Ms Ryan is a specialist respiratory nurse and is leading on infection control and compliance.
Mrs Hurlui has extensive experience in elderly complex need issues.
Our healthcare assistants Ms Mason and Ms Looby will be seeing you for routine screening procedures such as ECGs, blood tests and your diabetic foot checks.
Mrs Elrick is an experienced HCA who specialises in physical health checks for patients with serious mental illness.
Mrs Coglan is our phlebotomist.
Shane Morrison-Mcabe, has been working with our nursing team, and you may come across her in nursing quality compliance checks. Shane is our CQC consultant, she is a highly trained nurse and health visitor by training, but retired last year as the Chief Operating Officer for East Grinstead Hospital and has been helping out with our preparation for our new entity CQC inspection and the ICB weekly CQC liaison.
Other clinical members of the team you will be familiar with are:
Mrs Yeoell, our paramedic practitioner, who visits complex and palliative care patients.
Mrs Radia is our Lead clinical Pharmacist for the Medication Management team and an extended role clinician for the Sussex dementia service. She leads pharmacist training and anticoagulant assessment.
Ms Jose, Mr Thampi and Mr Kondor are our PCN Physiotherapy team.
Innovations:
Unfortunately, “Lab-bot” is back in the “dog house” after another software update.
Apologies to the patients who were told they needed to start statins after an over enthusiastic lab-bot recognised their normal cholesterol was not 40% lower than last time, when they were already taking statins that helped give them normal cholesterol.
We are going through the data reports to analyse for any other algorithm glitches before it gets let out again.
Supply and Demand management:
We have started our active management of non-attenders in August, the DNA reports compiled in July were not very good, 400 appointments were simply not attended. These are largely nurse appointments and can be 30 minutes or more for each appointment that are not available for other patients who need them. August has improved.
We have started the High Frequency Attenders Management Programme. We have held multidisciplinary meetings, briefed and allocated the key contact clinicians and prepared care contracts, sent notifications and reminders, and are well into the signing up stage. We will be scheduling the first structured reviews shortly, with a view to improving overall care needs and rationalising surgery contact for our highest frequency service users, who do NOT have a cancer or palliative care diagnosis.
Survey results Issue 1:
The feedback section had a variety of responses but interestingly the most frequent comment was about the Little Ridge Surgery which had to close 4 years ago due to structural engineering safety concerns when the internal walls buckled. Everyone agreed the disability access was better and the car park was very useful – hopefully we will have an agreed solution to this by the next Newsletter issue.
The most striking thing about the responses to the survey was the number of people with a disability and enhanced access needs who had not told the surgery there was an issue. Please can you contact the surgery and let us know you have access issues and what you need to overcome these and we will try to work around this.
65% above have not informed the surgery there may be an access issue due to disability – please contact us.
Please use this link or scan the QR code to access the survey for this issue of the Patient Participation Forum: https://www.surveymonkey.com/r/7J686P2
