The majority of GP practices in Swindon (and the UK) are owned and run by GPs (something which has been allowed since 2005-6) with the vast majority working to NHS contracts, following NHS guidelines and seeing NHS patients.
A number of local GPs in Swindon chose to receive the support services of IMH and have said that this has allowed them to stabilise their GP practices & focus more on clinical decisions. A few practices have seen solid improvements since seeking support from IMH (they are not new to Swindon and the CCG).
Therefore the CCG, alongside GPs and IMH, have created this new system with the aim to deliver better patient outcomes, standardised GP appointments (which effectively means more available) and to lift the pressure off individual practices. In effect, it is a ‘we are stronger together’ approach.
Both Cllr Oliver Donachie and I made it clear that the implementation of this new system has been very poor, and as a result, residents have been put off due to the way its bad implementation has already lost peoples' trust. We made it clear that there would have to be immediate improvements to regain that trust.
Below I have outlined the points that the clinicians made, and below that, the points that we have agreed with them following all of the residents’ comments which we fed in:
Firstly, the points they made:
- They apologised again for the initial problems with the phones. They have recruited more call handlers as a result and they now have more people on the phones than the original number of people who were on the phones at the separate surgeries. For example, at peak times they have 14 people answering calls.
- They now cover 60,000 patients collectively. Therefore when you ring up, it is going to give you a bigger queue number than you had under the old system as there are more people contacting one site. However that doesn’t mean that you should be on the phone any longer than you were under the old system. So basically, don’t be put off by your queue number, instead it’s about the waiting time. They showed us the call centre as well as the main switchboard (which monitors and notes the entire phone system) where the average waiting time on the phones today was 4 minutes.
- From their data, they showed us that of the high volume of calls that they had already received today, the majority had been given same-day appointments across all of the surgeries, whilst the majority of the others had been given a pre-booked appointment (where the average waiting time has not changed).
- People can still see their doctor and attend their own surgery. The difference is that residents are now being offered an alternative appointment at another surgery if they want to be seen sooner. They do not have to do if they don’t want to, it might just mean that they have to wait a bit longer (depending on how busy their particular surgery is that week).
- Disabled people and elderly people will of course be prioritised for their own/nearest surgeries.
- The prescription lines continue to be run by the pharmacists. If people have a prescription that runs out at a certain point (after 3 months say) they have always been advised to factor in time to get an appointment to see the doctor as well as the time it takes to process the prescription – this has not changed.
- There are a significant number of residents who are not available for call backs – one clinician even commented that close to 50% of their particular call backs were not answered. Two common examples are; the call handlers are met with an answering machine message or the resident expects a call back on their mobile phone even when the resident called from a landline. It is important to stay next to the telephone you placed the call on if expecting a call back.
- One of the top priorities under the new system is to have standardised GP appointments from 9am till 6pm at every surgery under the umbrella. There have been issues whereby some GPs have not wanted to do certain times, or some haven’t wanted to have appointments after 2pm etc. which means there are less appointments on offer for residents. With standardised appointments, there will be more appointments available from 9-6, especially as IMH have covered the back-office operations. They expect these to be available from the 1st November.
- With a centralised model, they hope that everybody based at the hub will be better placed to direct patients much more quickly to the service that they require (physio, Asthma pharmacy clinic etc).
- In regards to the pharmacy clinic, an initial trial was held at the Taw Hill pharmacy which was run for one day a week. This has now been brought in house at the medical hub and there will still be a pharmacy clinic available under the new system.
Now the points that we also made, alongside the proposed solutions:
- The communication about the whole changes had been non-existent, which has made the whole experience worse for residents and got the new system off to a bad start. Myself as the MP nor Borough Councillors were informed of the changes either. We said that at the very least, information should be available in the surgeries themselves and have also asked for the CCG & IMH to issue clear advice and information.
- In response they apologised for this, commenting that they did not want to release information with a set date for the new system, in case there were issues and in the event that the new system wasn’t ready to go live. Whilst they wouldn’t be able to write individually to 60,000 residents, they would certainly look to issue out information and communication on the changes asap.
- Despite taking on additional staff, we suggested that even more were needed to make sure that waiting times on the phone were no longer than they had been when residents were calling individual surgeries. We really pressed the point that there were instances where people were still waiting too long on the phone. We also suggested that they change the messaging on the phone so that it doesn’t say the queue number (as this gives people a wrong impression on how long they will have to wait) but instead tells people how many minutes they can be expecting to wait.
- They are looking to recruit even more call handlers, in addition to the extra they have already taken on, and will look at their phone messaging. They will also make sure that people are clear what line they need to dial and are therefore not getting stuck on the wrong lines (blood test result line for example). Their aim/expectation is to reduce the length of waiting time on the phones so that they are less than the waiting times under the old system.
- Online booking. This was something that residents had quite rightly raised and we made the point that people were being told different things on different websites, and that we needed one (well-informed) coordinated way for booking online appointments especially to help relieve pressure on the phones.
- There has been an ongoing problem with the surgery websites whereby the new system has not been given all the access codes for each surgery website. They accepted the need to get this sorted immediately and the urgent need to provide proper information on each website regarding the new system. They accepted that there were currently inconsistencies with online bookings as each surgery differed in their approach. They have not yet been able to introduce a uniform online booking system as they are wanting to introduce the standardised GP appointments (as above) in order to make sure that everybody can have online access to appointments from 9am-6pm. As soon as this is expected to be introduced (from the 1st November) then an online facility will be made available. To access online bookings, you will have to register by going into the hub and taking a form of ID with you.
One concern that residents have flagged is that they feel there will have been increased pressures on A&E since the new system has come into place. I have spoken with the Great Western Hospital and asked if they have seen more people present themselves at the Emergency Department over the course of the last few weeks. Having liaised with the Trust, they have confirmed that they have not seen an impact on front door services (e.g. ED attendances or admissions) as a result of the recent changes. The medical hub have also confirmed that people are still able to get same-day appointments and/or routine appointments.
With the promise of more call handlers than the old system, some more improvements to the phone system, a coordinated online booking system and standardised GP appointments, both the CCG and IMH are confident that this service will deliver more available GP appointments with increased flexibility for local residents.
We will continue to press for the promised improvements.
If anybody has any further questions, please do email me on justin.tomlinson.mp@parliament.uk
