GP Hub Update - 21 November

As promised I said that I would update residents once I had received a further report including some answers to some of the comments put forward by residents.

As you may/may not be aware; I have been demanding improvements since this poorly-implemented new system was first introduced.

Thanks to emails & message from local residents who shared their experiences with me, and to local councillors who have also been raising concerns on behalf of their residents, I have continued to highlight and push for much-needed improvements and we have managed to get IMH to:

Invest thousands of extra pounds to increase the number of call handlers. They had completely underestimated the number they would need to handle the calls of 60,000 residents. Now, they have more people answering the calls than there were before. I have to say that I am receiving far more positive reports of the phones now than negative
Increase the number of clinical staff, including GPs. I have put the details of this below as I know many residents wanted to know the number of clinical staff so I asked them to give me the numbers.

I know that there is still more to do and it certainly has felt like an uphill battle. I am having further conversations and meetings over the course of the next week to look at where we are, what more needs to be done and what actions should be taken.

Please can residents continue to email me – justin.tomlinson.mp@parliament.uk with their experiences. Please note: I am not always able to monitor Facebook regularly throughout the day & for GDPR purposes it is better to email. In the meantime, I have copied below the responses which I received to the queries raised by residents:-

Clarity over Online Booking

The on-line appointments go on to the system, as a first come first served basis. We only have a limited number of appointments that we are able to offer at each site on-line and once they have been taken no more can be added. It is important to note that only a small number of patients use on line booking. Increasing the number of online appointments risks inequity of access for patients not using this service.

Can patients book in person at the surgeries?

Yes patients can go to their GP surgery to book an appointment, but we encourage them to book via the hub to access the full range of services offered by the wider team and believe this to be the more direct route to the right treatment. Historically all sites only released the GP appointment on the day to cover the same day demand. We are now able to pre-book appointments at all sites and offer a greater range of services rather than the traditional face to face appointment with a GP. This is all part of the continued offer to improve patient care and attempts to safely manage peaks of demand.

Surgery opening times

All surgeries have standardised core opening time of 08.30 – 18.00 when patients can attend access surgery sites. Moredon and Abbey Meads are open daily from 07.30 to provide early morning clinics. Phone lines are open from 08.00 to 18.30 Monday to Friday.

Will practices including Abbey Meads & Moredon retain the same opening hours

The practices offer appointments during standard contracted hours, the difference you identify is due to extended hours offered as part of an NHS scheme to better serve patients who find it difficult to attend in working hours. This service is offered at Moredon and Abbey Meads surgeries

The practise websites are still all different

It is recognised that the individual practice web sites are not yet aligned and therefore display different opening times. When the practices are registered by the CQC as the Better Health Partnership, all 5 practice websites will be merged into one website where we will be able to have central control and update this frequently. This is scheduled to occur before Christmas.

What time are the phone lines open? And what happens if somebody phones just before they close?

Phone lines are open from 08.00 to 18.30 Monday to Friday. The phones switch off automatically at 18.30, however any patient still in the queue at 18.30 is dealt with before staff leave, we would not cut someone off mid call

Clarity over the Children’s Clinic and GP appointments

The Children and Young People’s clinic provided by Swindon CCG at Moredon Health Centre. This facility is open for any child in Swindon that requires medical advice. Parents have the option of either booking directly with their surgery or calling the Children and Young People’s clinic the choice is down to the parents. Parents calling the Hub line are given the option to call the Children’s clinic. Parents who choose to access an appointment with their own GP surgery can do so via the Hub phone line.

Please can you clarify the number of clinical staff working across the surgeries, and whether this has gone up or down

Since the 10 Sept we have recruited three new GPs to the surgery sites, two Advanced Nurse Practitioners (ANPs), two Emergency Care Practitioner (ECPs), two nurses, two physiotherapist and two pharmacists.

At sites the following:

Eldene
Additional GP added – total three

Moredon
Additional GP - total four

Taw Hill
1 GP has returned from maternity leave they now have a total of four GPs

Abbey Meads
Additional GP – total 3

A GP at Penhill and a GP at Crossroads

In addition, the Hub has
Two full time GP – currently Long Term Locums are in post pending recruitment of substantive staff
Two Pharmacists supporting all sites
Two Physiotherapists based at Moredon and Abbey Meads to support all sites.
ANP, 2x ECP (Providing support to all sites, home visit and safeguarding expertise)
Nurses
Diabetes and Asthma specialist nurse working across all sites
Practice Nurse – working from Taw Hill and Eldene

We have therefore increased the work force by 15 Clinical staff.

The phones no longer tell you where you are in the queue

There should be no difference from any number that patients call. If there is we would like to understand these more so that we can investigate. We have looked at all options regarding average wait time and number in queue, since turning off both we have had a huge reduction in abuse to the call handlers. In advice from the phone company, they have also advised not to put on the average queue time. We will of course continue to monitor this.

Finally, and this is probably more of a question for Kate/Nicki (CCG) - there have been a number of residents who have asked about key performance indicators and how the accountable organisation is monitoring the situation in order to ensure decent patients outcomes. This is a very important question and whilst I appreciate there are National Institute for Health and Care Excellence guidelines, and the Care Quality Commission, but would you be able to assure residents that you will be monitoring the situation closely in order to be assured of the quality of service?

Response from the CCG: As is standard practice where we identify concerns within services provided for our population, members of our quality team visit providers and carry out an inspection. A member of our quality team who has been into the hub to see for herself how IMH are managing and reacting to the issues and concerns raised. She noticed improvement in the phone handling but also identified that IMH were ensuring good back office administration function in relation to clinical records etc.

Gill May our Director of Nursing and Transformation met with Martyn and David Jones (IMH Medical Director) this morning as part of our ongoing communication and oversight with them to understand actions being taken and impact. Gill was particularly concerned to pick up issues that had been raised following HOSC (SBC’s health scrutiny committee) in respect of potential patient harm. In the meeting this morning IMH were able to demonstrate they had responded proactively to the impact of the clinical hub and more generally in the work they want to do to improve services and seek direct patient feedback.

Gill agreed with Martyn and David this morning that IMH will be a test bed for how we review clinical governance oversight, looking at how we support them to use a quality improvement cycle which enables providers to test changes as they are implemented, review, change and test again, this is more dynamic that the traditional audit used within primary care.

Whilst we continue to see concerns in respect of the service we will continue to remain in daily contact with IMH Executive Team.

I have also copied below the links to my previous updates:

Posted in Articles on Nov 21, 2018