Elmham Surgery and Swanton Morley Nurse-Led Surgery
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Opting out of NHS Central Databases
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You will be hearing more about this from coming meetings of the patient participation group. You can contact Ted Sansom (01362 668734) or Alan MacKim (01362 668831).
Chairman Alan MacKim writes:
NEW BLOOD AT ELMHAM SURGERY New faces are to be seen at Elmham Surgery. They belong to three new assistant doctors who were appointed to fill gaps left by the departure of doctors who had been on short-term appointments. Two of the new arrivals are women: Dr Jenny Lees, who has been practising in Wisbech, and Dr Amreetha De Var. She, like the other new arrival, Dr Marc Epstein, is recently qualified. The Patient Participation group was told at its latest meeting that the aim was to increase the staffing at each surgery session and thus enable them to further reduce the waiting time to see a doctor. On the longer term, the practice is still one short of a partner. There is still the intention to make up the number to four again but the search for candidates is apparently unlikely to begin before the end of the year. Meanwhile, the Elmham practice continues to establish itself as a front-runner for local health-care in Norfolk. One innovation that has attracted a lot of attention has become known as ‘integrated care’ . This procedure brings a social services case-worker into the surgery to join in the supervision of patients going into hospital and, importantly, their return home. The Elmham scheme is now one of the primary care trust’s standard models of care, to be extended throughout Norfolk. Don’t forget, if there’s anything you want to raise about the Surgery, you should contact Ted Sansom (01362 668734) or Alan MacKim (01362 668831). Alan MacKim
THE CHANGING FACES OF ELMHAM SURGERY So it’s farewell to Dr Strickland... well, at least as far as Elmham Surgery is concerned. It is, however, a truth universally acknowledged that a man is as old as he feels and Dr Strickland feels he is not quite old enough to hang up his stethoscope and go for fully-fledged retirement. Instead, he is taking up a part-time teaching post at the University of East Anglia medical school. His departure marks the end of a 22-year chapter. Dr Strickland joined the Elmham practice in 1987, shortly after it had moved to its present site from the White House next door. At the time, the practice was headed by Dr Pearson. (The next new arrival, the following year, was a young Dr Hibberd.) Dr Strickland became the senior partner in 1997. He has seen three reorganisations of the local health authority and the addition of new wings at either end of Elmham surgery, to house treatment and nursing rooms. The practice has also acquired a reputation throughout the county for innovative thinking. This included the opening of the nurse-led surgery in Swanton Morley. Other examples have been the introduction of the delivery service around the villages for repeat prescriptions, the computerisation of patient records and appointments systems, the ground-breaking steps that have been taken to support patients coming home from hospital and the formation of patient participation groups for the two surgeries. Dr Strickland was also noted, in Elmham at least, for appearances on his cycle. This was not a matter of occasional exercise: along with sailing, cycling was quite a serious matter. He was a frequent entrant in the annual ‘Norfolk Hundred’ event – that’s cycling a hundred miles. It usually takes him about five hours. His going sees the arrival of a new partner. He is Dr Murali Sri-Ganeshan. Just call me Dr Sri, he says. (That’s pronounced ‘Shree’.) He graduated from both Oxford and Cambridge and has been practising as a GP in London. Being a doctor, in his case, is a family matter. Both his mother a father are GPs. So, welcome Dr Sri. Alan MacKim
YOUR CHANCE TO MAKE YOUR POINT
Yes, we know you’ve heard it before. You’ve heard it so many times, from the most unlikely people: how what you have to say is important. This time, though, it is important.
At issue is the facility of dispensaries such as those at the Elmham and Swanton Morley surgeries. The question that is being asked by the government in a national consultation is whether dispensaries operated by, and earning money for, doctors is the best way of meeting patients’ needs. In this case, it will not be enough to register the view of the Elmham patient participation group: it will require the individual views of as many people as possible.
One suggestion on offer in the consultation is that dispensaries might be better placed by the primary care trust which oversees all the health services in each county. Again, there could be a general shift to providing prescriptions by commercial pharmacies. There is talk of patients’ being given the choice of going directly to a chemist’s shop instead of their doctor.
The doctors at the Elmham practice argue for ‘no change’. They point to a dispensary service geared to patients scattered over 39 villages and hamlets; to the abolition of queues at the dispensary itself; to the introduction of ‘on-line’ ordering of repeat prescriptions and the delivery service of medication for patients who have difficulty getting about.
You can get the details from the surgery and you have until November 20th to have your say, no matter how short. You can do it by visiting the website
http//:www.dh.gov.uk/en/Consultations/LiveConsultations/DH 087324 or by writing to: Gillian Farnfield, MPI Community Pharmacy Policy, 4th floor, Skipton House, 80 London Road, London. SE1 8LH
Remember: doing, or saying, nothing could mean that you finish up with something you do not want. Alan MacKim
THE NEW FUTURE OF CARE
Some ground-breaking ideas are taking shape at Elmham Surgery, directed towards improving the care of patients returning from hospital and providing care that could avoid the need to go to hospital in the first place.
The Surgery’s patient participation group was told at its latest meeting of efforts that had been going on to restore a recent project which centred on the appointment of a Social Services case-worker operating in the practice. This appointment enabled care programmes to be worked out for patients returning home from hospital, bringing together Social Services, domiciliary and nursing care in single ‘packages’.
The project came to a premature end when the case-worker fell ill and Social Services was unable to provide a replacement. This provoked some pointed questions, though, at a recent high-profile meeting in Norwich which had been called by three of Norfolk’s MPs to find out what could be done to overcome unnecessary delays in discharging patients from Norfolk’s hospitals. The chairman, the Liberal-Democrat Norman Lamb, pressed Harold Bodmer, the director of Adult Social Services, for a pledge to get the Elmham scheme going again. The response has aroused hopes things will start to happen again
In addition, attention has turned to another aspect of the picture. This turns on the key difficulty that confronts anyone looking for help in coping with care in the home in predominantly rural areas: the almost-complete absence of people who will undertake the job. The Elmham practice is putting together a business plan to provide domiciliary care-workers or to arrange their availability through agencies.
The scheme would be another ‘first’ in Norfolk and is being closely watched by the health authority and by Social Services.
The patient group’s next meeting is on June 12th. If you have anything you would like to raise, you can contact Ted Sansom (01362 668734).
Alan MacKim
December 2007
An experiment has been going on quietly, directed at Elmham Surgery patients who like to make an early start – and it’s proving increasingly popular.
The new facility offers patients the opportunity to see a doctor early on Monday and Tuesday mornings at the Swanton Morley surgery. People who want to make an early start are being offered appointments there from 7.30am until 10am on the two mornings of every week.
The innovation was put into operation primarily to meet the needs of people working a long way from Elmham and who were thus finding it difficult to see a doctor without taking either a morning or afternoon off work. The facility is also proving attractive, though, to older people who just want to have more of the day to themselves.
To those who ask why this facility is centred on Swanton Morley, the answer is that the surgery there is small and thus easy to ensure that access is restricted to the doctor’s interviewing-room. This would not be possible in the much larger, and more open, Elmham surgery.
Alongside such new ways of working, work goes on to tackle the problems that emerge. There are, for instance, the problems which have afflicted the new arrangements for handling telephone calls. Trouble has been generated in no small measure by the new facilities that the practice has introduced but the fact is that telephone traffic has increased on a scale the would have been unimaginable just two years ago.
Alan MacKim
October 2007SHEDDING LIGHT ON OUT OF-HOURS CALLS ...The new shape of the ‘out-of-hours’ service – the service that answers our calls for a doctor through the night or over weekends – was the sole topic of the latest meeting of Elmham Surgery’s patient participation group. The meeting got off to an unpromising start when the whole of Elmham was plunged into darkness by another of the power company’s supply-failures. The guest speaker, Dr Nick Morton, soldiered on in the half-light of an emergency system, shedding some of his own light on how the new service would operate. Dr Morton is assistant medical director of the East of England ambulance service which Is answering out-of-hours calls in Norfolk under a new contract negotiated by the county primary care trust. He was questioned about the reported savings that are being made. The answer was: yes, costs are being cut; the local centre in Dereham hospital had gone. The emphasis was on a mobile service that would be quickly responsive to urgent cases. Patients and people seeking help would be answered, in the first instance, by staff at a centre in Norwich. Callers would be asked for such things as name, address and telephone number and a brief description of the trouble. They would then receive – within a strict time-limit - a call from a clinician who would decide on what action should be taken, whether there should be a home visit or whether it could be settled by advice over the ‘phone. In essence, the system is geared to identifying the urgent, possibly life-threatening, cases (the out-of-hours operators are in the same room as those of the ambulance service). What has to be seen is how effective the system is in dealing with callers who are alone, in the dark and feel threatened. Alan MacKim
September 2007PATIENTS, HAVE YOUR SAY…This time, the Elmham Surgery’s patient participation group wants your help. It wants the answer to two questions: have you tried to contact a doctor at night or over a weekend? What happened? The reason we’re asking these questions is that new arrangements for the ‘out-of-hours’ service came into operation in August. This was the outcome of a contract which was one of the first to be placed by the recently-formed Norfolk primary care trust. The change has caused a lot of anxiety, not least because of delay in finding out the terms of the new contract. It was awarded to the East of England ambulance trust, which was itself emerging as a new organisation, covering six counties. Elmham patients seeking help ‘out-of-hours’ will be tapping into a new service for the whole of Norfolk except Yarmouth. It will be served, apparently, by fewer doctors than were available over the three years of the first contract (with the old East Anglian ambulance trust). It’s acknowledged that the new contract will offer savings, a crucial consideration for the primary care trust that opened for business with a debt of over £45 million. The patient group is due to meet the ambulance trust’s assistant director in charge of the service in October and you’ll be hearing, of course, what he will have had to say. What would be really useful would be to feed into that meeting the experiences of patients who had used the service. Alan MacKim |
