TROWBRIDGE HEALTH CENTRE UPDATE MEETING 19TH January 2017
LOCATION – TROWBRIDGE CIVIC HALL
DURATION APPROXIMATELY 19.00 – 20.15 HRS
ATTENDED BY DR’S – COOKSON
LOCKE
FOGGETT
SHEPPARD
BUNDY
MANAGEMENT SUPPORT – FROM THE THREE PRACTICES
PURPOSE OF MEETING – TO UPDATE OUR PATIENTS ABOUT THE CURRENT STATE OF PRIMARY CARE AND PROGRESS OF THE DEVELOPMENT .
Currently primary care is suffering from many pressures. Newer clinical graduates are not wanting a career in primary care – they prefer a portfolio career involving some general practice but lots of opportunities to do other types of work as well. By being bigger organisation we will be able to be more flexible as employers and hopefully attract the kind of candidate that we want to join our organisation.
There are stories of many near misses in primary care in the surrounding towns. One of the practices in a large town near us has seen its partner work force reduced by 50% over three years. This summer they struggled to keep their doors open but have managed to but not in sustainable fashion. They have started urgent merger talks with their neighbouring practices.
Being a larger practice will enable us to provide a more specialisation in our services – it will be in our interest to have doctors and nurses with more specialised skills particularly in chronic disease i.e. Diabetes and respiratory medicines. It will also enable us to run clinics on different days - currently Bradford roads respiratory clinic runs on a Tuesday but in the bigger organisation this can run on several days of the week. It will also give a nice spread of extended hours appointments both in the morning and the evening.
WHAT THIS ISN’T
The partners are very definite that this is not a “venture capitalist” takeover and it is not asset stripping of primary care in Trowbridge. It is the partners working together to secure the future of our patients in the 21st century and to provide them with a service that is fit for function and also to provide ourselves with an organisation that is fit for function.
All the doctors currently working in all three organisations will continue with their current commitment. There will be some obvious advantages as regard access primarily in that rather having to send three doctors (i.e. a representative from each practice) to locality meetings we only have to send one now.
The partners are the individuals who are funding this development and as such we are putting a lot of time and effort into the whole process and are not wanting to design an organisation that is going to fail.
TROWBRIDGE HEALTH CENTRE
Trowbridge Health Centre will be the new name for the merged practice of the Adcroft, Bradford Road and Widbrook surgeries. This will number approximately 30,000 patients and will operate from two sites – the current Adcroft surgery (being extended) and the current Widbrook surgery. It will have a unified telephone and IT system and we are very definite that this is going to be one organisation run over two sites and not two separate organisations loosely linked together under the banner of Trowbridge Health Centre.
Clinical staff; There will be seven GP partners, fourteen other GP’s, three GP’s in training (registrars), nine nurse practitioners and sixteen nurses and health care assistants.
The demographic of the workforce in the NHS in general is part time and predominately female and our workforce reflects that demographics.
Obviously behind this clinical team there will be a fully functioning, integrated administrative team.
Community team; The practice will have access to a visiting paramedic, two care co-ordinators and one elderly care facilitator (all organised through the Trowbridge locality). It will also have access to the Community Nursing Team (previously known as the District Nursing Team).
Activity Levels;
The table shows a typical week in December. Without going through the entire table you can see that Adcroft runs 61 GP surgeries, Bradford Road 48 and Widbrook 19.
Given the current climate of primary care we will be doing well to maintain GP surgeries at their current level. Again as outlined earlier hopefully by being a big organisation we can be a more flexible employer and attract the new doctors that we want. There a lot of practices locally that has seen their total number of GP surgeries drop over the last few years.
We can see definite benefits from increasing the capacity in the other three rows. Generally if phlebotomy fills up their work gets pushed into treatment room, the treatment work then gets pushed into the triage system, the triage system work then gets pushed into the doctor’s surgeries and then this creates the big pinch point for our complex patients who need to see a GP rather than any other practitioner. By increasing capacity across these other three areas we will hopefully be able to decompress some of the log jams as regards to GP appointments.
Staffing Levels at the two different ends:
Our aim is to provide comprehensive and advance services from both sides. We are very definite that we want this to be one organisation run from two sites rather than two sites operating as a loosely affiliated union. To achieve this there will be staff rotated across both sites with the aim to provide a balance between continuity of care for our patients and also offer a choice of care as well. If our patients are able to be flexible about which site they attend then they will benefit from having a fuller range of appointments.
How do you get to make an appointment; It is very important they we all move away from our current geographic and surgery boundaries. The Adcroft, Bradford Road and Widbrook surgeries will cease to exist on the 1st July 2017. All our patients will be registered as Trowbridge Health Centre patients. All our patients registered doctors will remain the same. The exception to this is patients who are previously registered with Dr Collins who will be allocated a new registered doctor once we are all together in Trowbridge Health Centre.
We would definitely ask that patients use either online booking or the telephone as a way of arranging appointments. The new organisation will have enhanced in house call handling service. This will have extra capacity and its own dedicated office. The staff manning that will be solely doing call handling unlike the current situation where most of the surgeries they are doing call handling some filing and various other jobs at the same time. We are trying to strike a balance between giving patients a choice of seeing clinicians at different sites and providing continuity of care for our patients. This is all on the background of making the two sites fully integrated.
As previously discussed we are going to be running full and comprehensive services from both sites. There will be rotation of clinical staff around both sites. Not all doctors will work from both ends but there will be a significant majority that will. We feel that this will strike the right balance between doctor availability and clinicians being available at different sites. This system will be monitored and obviously changes can be put in place once we have more of an understanding for where the demand lies.
Same day service; The nurse triage/same day service/ hot general practice service will run from both sites. We will aim to see our patients at the site of their choice but this will definitely be dependent upon where the capacity lies. Again we are prepared to change these arrangements when we get more feel for where our patients want to be seen. It will definitely be best to phone to make these appointments so you can be directed to the right site.
Building; The building is progressing well. The roof is going on and the brickwork is going up. There has been one design issue around some beams running across the staircase which has bumped us back four to five weeks. The builders are bullish that this will not affect our completion date of July.
We have applied for the road to be called “Bevan Place” after Aneurin Bevan one the founding fathers of the NHS.
Car parking; Currently Adcroft has 22 slots and Bradford Road 18. The 22 slots at Adcroft surgery will remain in existence. The new site has approximately 40 allocated spaces so this will be a positive for people using this end. Also it is a double track road which I know that the Bradford Road patients will greatly appreciate allowing much easier access in and out of the site.
The car park is for our patients and to police this the number plate recognition system will operate from both of those car parks.
Time lines; On the 1st April 2017 Bradford Road and Widbrook surgeries will merge. Widbrook surgery will technically become a branch surgery of Bradford Road. This is primarily a back office merger. The two surgeries will continue to have their current phone numbers and we ask our patients to continue accessing their surgery services as they currently do. You may possibly be asked to attend a building that you are not normally asked to but generally things will carry on as they are.
1st July 2017 from a contract point of view the Trowbridge Health centre forms. We are anticipating that the front doors of the new Seymour road building will also open on that date and that both sites will be fully integrated from that date onwards.
New services; As previously mentioned we need to alter the skill mix of our current clinical teams because of a shortage of traditional clinicians.
Mental health practitioner; We are in the process of recruiting a Mental health practitioner. This will be a prescriber with a qualification who will be able to manage both acute and chronic mental health problems.
Leg ulcer service; The current provider of the leg ulcer service has withdrawn and the partners see this as a big opportunity for us to get this service and run it for our patients. We are well under way with bids and negotiations.
Expanded nursing team; As mentioned earlier in the talk we see definite advantage from increasing our capacity and we are looking at the options around that.
Two pathology collections a day; Having to have all our bloods taken by 12 o’clock puts a huge pressure on our patients (it is not always easy to get to the surgery in the morning) and our car park. We will begin negotiations with the CCG about extending this service to hopefully two collections five times a day. If we are not able to manage that then it may be that the practice arranges for Alpha taxis to run a second service on certain days of the week.
Muscular skeletal practitioner; We see a role for a physio working in an acute setting to diagnose and manage acute muscular skeletal problems.
Patient participation group; We are very keen that Trowbridge Health Centre has a real life (rather than virtual) group. We have been to PPG network events and would see the formation of such a group as a positive. Expressions of interest were taken after the talk and if there is anybody else wishing to be involved then please will you contact your surgery and we can arrange for your details to be fed into the group. We see the role as one of “a critical friend” – there to help shape our services and also help the surgery at busy times i.e. flu clinics.
It would very much be the patients group and the doctors would attend the relevant meetings.
Questions from the floor were taken:
Availability of online appointments - There were various questions about what percentage of appointments were available online and those bookable through other means. The online system has massive advantages but is not available to everyone (some people do not have internet access). We will continue to monitor and balance the split of appointments that are available through the various avenues of booking. We will need to explore about if online users will need new passwords when Trowbridge Health Centre is formed. We will look at sending text reminders 24 hours before appointments.
Substance misuse -The practice has no plans to start running a substance misuse service.
DNA’s - We discussed the frustration around these episodes. Most people genuinely forget. We are not able to fine these people.
There was a written question about bus routes - We will explore with the council what surgeries lie on which bus routes.
Cost of the project - The project is costing several million pounds and the risk is being taken by the GP partners.
Expansion of list size -The building is so designed that if we run out of our current rooms then extension of the building will not be too disruptive. Our clinical teams will need to increase in size if and when our list size increases.
Widbrook car parking being used by the school - This issue was discussed. I understand that there has been a long involved discussion with the school. Number plate recognition would not work as the car park is also used by the care homes. The situation will continue to be monitored.
News letter – We will aim to be publishing a three times a year newsletter for the new organisation keeping our patients abreast of the developments. We will aim to get the new Trowbridge Health Centre up and running within the next couple of months to keep our patients further abreast of developments.
Disabled access – Both buildings will be fully discrimination act (TDA) compliant. The Seymour road site will have a lift to negate the height difference between the current build and the new build. The Widbrook surgery will provide to Disabled parking slots and the Seymour road site will provide 6 spread across the two car park sites.
Widbrook CQC report – The Widbrook practice remains in special measures with a warning notice relating to a small number of administrative issues. This report has just been published. The Adcroft & Bradford Road Surgeries are providing both clinical & administrative support. CQC acknowledged that there had been a lot of improvement since the practices last inspection.