A meeting was held this week between the MP’s office, the CCG, IMH, Healthwatch & some of the GP Practice Partners. The aim was to:
- Facilitate ongoing discussions between the GPs, IMH, CCG & patient representatives.
- To demonstrate that patients are being listened to and actions are being taken to address concerns.
- To provide an update on performance and how the service is being monitored.
- To agree further communication and next steps.
Overall it was acknowledged that there were significant improvements and that the issues with the phones had been addressed. However, the main issue remains that a lot of patients still lack trust in the new system, and that there would need to be extra communication to patients, including many to address the unsubstantiated rumours which are causing more concern.
I’ve included a number of the issues that were discussed and provided the information below:
Reasons for the change
Ever since GPs were allowed to own and run their own surgeries, managing admin and HR has been recognised as one of the biggest pressures on GPs. The IMH Hub was created to address this and relieve this pressure - so that GPs could spend more time treating patients.
According to GPs and IMH, doctors were burning themselves out with back-office issues including building & property issues.
They have been assisting the GPs at Abbey Meads & Eldene for the past 2 years ago, and the GP partners have stated that the stress and financial pressure which they have relieved as a result of their involvement has been incredible.
IMH background
IMH was formed by two GPs whose sole purpose was to work in partnership with GP surgeries as a clinically-led support organisation to help GPs within their practices. The new Chief Executive, Martyn Diaper, was in charge of patient safety within the NHS.
Complaints relating to the hub vs. general complaints with GP surgeries
A number of the most recent complaints currently being levelled at the new Hub are historic complaints, rather than issues which have resulted from the changeover. This is particularly relevant to complaints regarding the availability of appointments (due to very high demand) and complaints that there have been cancelled appointments (due to doctor or nurse absence). These issues pre-date the new system, and are issues that the Hub are looking to address.
Appointments
The number of appointments currently released is the same number that has always been released. There has always been a very high demand for appointments and these have always been snapped up very quickly.
Abbey Meads - only ever used to take on-the day appointments. You could not book advanced, routine appointments until they became a part of the Hub. This came from the GP practice manager at Abbey Meads.
December appointments – have always presented a challenge as December is always the busiest time of year for the NHS. As has always happened, many appointments in December have had to be reserved and have not been released for routine appointments. This is due to the fact that they have to be prepared to deal with more emergency appointments throughout December.
Appointments throughout the week – On a Monday appointments will be on-the day (due to the nature of the calls and being after the weekend). Tuesday through till Friday, half will be reserved for on-the day emergency appointments whilst the other half are routine appointments.
Benefits as a result of the Hub
The GPs who run the practices were very adamant that they had been able to deliver more health benefits as a result of joining the hub. Particular examples included:
- Proactively contacting elderly and vulnerable patients who are at risk of isolation, even if it is just a social call to check in.
- There is now a dedicated team responsible for on-the-day emergency appointments and home visits.
- Proactively contacting those at risk of diabetes to get them to come in for a check-up.
- Proactively contacting those who have not responded or turned up for a smear test.
- Proactively contacting those who are potentially eligible for certain types of screening including bowel cancer screenings.
- Proactively contacting the parents of youngsters who may be eligible for the nasal spray.
The GPs made it clear that these are benefits which are only now possible due to the hub taking on all of the admin burdens of the surgeries.
Responses to some claims
Concerns were raised that as a result of the initial problems with the system, people had lost trust. Therefore it was important that trust was rebuilt and that the GPs, CCG & IMH counter the claims of ongoing rumours which are often unsubstantiated, but are causing people to be deterred from using the system (even though improvements have been delivered). Some of the claims and counter-claims are outlined below:
Claim – "There are less GPs & Nurses across the surgeries"
There are now 15 more clinical staff as a result of the changes including GPs & nurses. The hub is also advertising for more GPs & nurses.
That’s not to say that we wouldn’t like to see more GPs recruited in Swindon. Nationally, the NHS is aiming to train and deliver 5,000 more doctors & 5,000 other clinical staff working within General Practise by 2020, compared with 2015. It takes 7 years to train as a doctor so it has taken a while to get new GPs through the system. Currently the NHS is embarking on its biggest recruitment drive in its history – including from across the world. So this is a big priority and the aim is to increase the number of GPs working in Swindon.
Claim – "The surgeries have become privatised"
IMH have not taken over the surgeries. They are working in partnership with the GPs who still own and run the surgeries. The surgeries still get the same amount of money each year as they did before – which is spent on patient care. The GPs made it very clear that nothing had changed in that the surgeries were always privately owned by the GPs – therefore this move has not privatised the surgeries.
Claim – "There are far less call handlers than there were before"
IMH has invested heavily into increasing the number of call handlers. This is after they hugely underestimated the number of calls they would receive and did not expect to see the terrible performance of the phone system in the first few weeks.
Now, the phones are being answered quickly and there are more call handlers, with even more at peak times.
Claim – "All of the reception staff were made redundant"
IMH and the GP partners asserted that all of the call handlers in the new hub were all receptionists at the surgeries beforehand.
Going forward
- Every single registered patient will now receive a letter regarding the changes.
- The Hub will look to create a PPG (patient participation group)
- The CCG will host a learning event for members of the public so that they can attend and learn how the improvements will benefit them as patients.
It is clear that the new system has been very much welcomed by the local GPs who were struggling to run the individual surgeries and having to deal with all of the admin and running of the actual building. This was distracting them and taking them away from treating patients.
The GPs believe that this new Hub will provide better patient outcomes and has already allowed them to take proactive steps in reaching out to patients, particularly vulnerable ones.
IMH have recognised the poor start and have apologised. They have invested thousands of pounds to address the problems and the vast majority of feedback has reported a huge improvement with the phone system. They have also outlined their major priority to hire more clinical staff, including GPs, and ensure that more appointments can be made available than there were under the old system.
It is clear that there have been improvements and I want to say a big thank you to all of the residents who have helped us to push for these. Without you sharing your experiences, we wouldn’t have been able to paint the picture and demonstrate that improvements were desperately needed.
Of course there will still be issues, as there is with every system anywhere. When brought to my attention I will be the first to raise these when needed. But hopefully we can moved forward constructively and continue to ensure that this new system continues to be held accountable, continues to make improvements where needed and continues to deliver better patient outcomes.
