Following the continued work to push for much-need improvements to the new GP system, on Thursday 24th January I met with the Chief Executive of IMH after I requested an urgent meeting.
I made it clear that despite earlier signs of improvements after the introduction of more call handlers and more clinical staff after I first raised complaints; the system is still not where it should be. He accepted this and said that they would deliver improvements.
From what I gathered at our meeting, there have been a number of issues within the actual surgeries which have also caused admin issues and problems which have been affecting patients. In particular, there have been issues with referral letters not being sent to the hospitals in time (due to the GPs not being able to actively refer patients with the hit of a button, but instead putting referrals onto a long, manual admin pile which require admin staff to type up and hit send). This has also been the issue where prescriptions have not been sent in time (or in some cases at all) to the pharmacy, again because of the same problem.
I know these are two particular issues which have been raised with me and which I was keen to address. Whilst IMH have entered into a partnership with the GP surgeries, there is still an expectation that each individual surgery will have a clinical lead and that these leads will still be able to control and ensure that referrals are sent and prescriptions are processed.
IMH have said that they are hoping to make this easier for the GPs by ensuring that they are able to process referrals there and then as they are having the appointment with the patient. This will then decrease any chances of a referral or prescription being slowed down or getting lost on an admin pile. They will also make sure that Locum GPs have the same ability, as there were some issues where Locums were seeing patients, but not processing the referrals or prescriptions, and instead leaving them on a pile to be sorted later by admin staff.
IMH have said to me that there have been a number of issues arising out of each surgery which need addressing. These are issues which perhaps they didn’t realise before entering into a partnership, but have learnt since trying to improve the entire system. This includes issues such as the above which they are working with the individual surgeries to improve. There was also an under appreciation of the fact that each surgery worked and used different systems, many of them inefficient systems (for example some weren’t doing electronic prescriptions), which are now being improved. As a result of this, they are undertaking a full surgical review to ensure that all of the practices are organised and running efficiently, so that patients don’t have any further issues relating to referrals or prescriptions.
With regards to prescriptions, I am in contact with the CCG (IMH do not run the Prescription Ordering Service) as to whether they are able to increase capacity, and do more to ensure that prescriptions are dealt with swiftly and processed efficiently.
On the telephone system, obviously this was something I wanted to push and make it clear that we expected immediate and long-lasting improvements. IMH explained that they had had issues with a vomiting bug affecting their call handlers, with many absences, however they also accepted that this wasn’t an excuse and that things had to change.
I set out with them what should be acceptable and reasonable targets for phone waiting times, and I will be pushing them to make sure they meet these targets. On a Monday morning between 8-11am they said that waiting times should be no longer than 20-25 minutes (as was the average before the change). On a Tuesday morning the waiting time should be no longer than 10 minutes, and for the rest of the day/week, we should be seeing waits of no more than 5 mins.
With demand very high, they are taking further steps to ensure that the phone system will be able to direct people correctly, in order to reduce waiting times. For example, they have changed the line so that those people who wish to cancel an appointment, will be able to press a separate number and not have to wait in the main queue – this was after I raised the point that many residents had spent ages trying to get through only to cancel an appointment, which would then free up more capacity!
Similarly, they are going to reintroduce the message that the old surgeries used, which advised non-urgent callers to call after 11am. Currently, there is a significant number of people trying to get through first thing in the morning with a non-urgent query. This means that those people who need an urgent appointment are then waiting longer on the call. So those with non-urgent enquiries who want to book a routine appointment are going to be advised to call after 11am, so that they will also experience a shorter waiting time.
Having raised a few examples of some residents being given incorrect or confusing advice on the phones, there is also going to be another round of training sessions for the hub members of staff and call handlers.
The surgeries are also making the decision to make ALL Monday morning appointments as book on the day. Currently, there are routine appointments booked in for Monday mornings, so at a time when the vast majority of urgent appointments are requested by patients, often this demand can’t be met as there are less urgent appointments booked in. By reserving a section of Monday (the busiest day by far) for the urgent appointments, hopefully we will see more capacity for those who urgently need to see a GP after the weekend. There are many surgeries across the country which simply have ALL of their appointments as book on the day, however, the will locally is to still provide advanced, routine appointment bookings, with the exception of Monday morning.
We also discussed the need to recruit more GPs locally. I am going to discuss with Health Officials what more we can do to encourage newly qualified GPs to work in a practice, rather than choose to become locum GPs. The current problem is that GPs (not unreasonably) are choosing to become locums so that they can charge a higher fee and don’t have to trouble themselves with any of the day to day running of a practice. IMH are also aware that they need to attract GPs to the 5 practices locally. They are currently advertising new roles and have interviewed newly qualified GPs. They are looking to make it more attractive for new GPs to join one of the practices, rather than become locums. We discussed a number of ways in which we could help with this and there is a proactive approach on all sides to do what we can.
Finally, I have reiterated that one of the big issues for patients has been the lack of communication from IMH. I have requested that the Chief Executive of IMH does an interview with BBC Points West to explain the work that they are doing behind the scenes to make improvements across the system locally. He is a GP with years of experience in the NHS and also the former Director for Public Safety in the NHS. I have made it clear that they need to be accountable and tell the patients exactly what they are doing to improve patient outcomes.
As they have repeatedly acknowledged to me, this was a new system which was introduced without any warning, without any trialling and without proper assessment of all the work involved to ensure that each surgery performs as well as it can do. Thankfully, the original project manager at IMH has left, but obviously they still need to do all they can to rectify the issues which have occurred as a result of the system going live before it was properly ready.
Thank you as ever to all of those residents who have shared their experiences with me. I will continue to do all in my power to push forward improvements.
