Update to PPGs from Elmham Group of Practices 

Our last update to you all was in mid-August, from Judith Wood. As she informed you then, Judith was planning to retire at the end of September, and we hope we gave her a good send off! I know she very much appreciated the visit on her last day from Roger Thorneley and Liz Waddy, on behalf of the PPGs, to present her with a gift. The Senior Management Team have been running the practice since then, but we have our new Practice Manager, Lian Tan, joining us from 8th November. Lian has a background in management as well as experience in the health sector. She has moved with her whole family to Norfolk, and we are very excited about her joining us. We have been having discussions about when to restart our Patient Participation Group meetings. It seems sensible for all the reasons that Roger and Liz have shared with us that we delay meeting till the middle of January. Bawdeswell village hall seems to be the most convenient and best placed venue and I would imagine that this will be a significant meeting that Lian and all the partners will want to attend. We are aware that various Parish Councils are also wanting regular updates from us during the pandemic and hope that this briefing provides that for now.

Operational issues

Telephone system: We continue to hear from patients about the difficulties in getting through on the telephone. We are sorry that this remains the case and are genuinely grateful for the feedback that we receive from patients alerting us to specific issues. The background to this was covered in Judith’s last update. At its simplest we have a ‘pre-pandemic’ phone system in a ‘post-pandemic’ world: it is just not up to the job that we are now needing it to do. The good news is that our new phone system goes live on 3rd December. This will not be the single solution to the problem, but the increased functionality will remove some of the annoying failings and shortcomings that the current system has; please bear with us as we learn how to make best use of the system in the first few weeks. Our advice to patients is still to avoid phoning in at 8.30am unless there is an urgent or pressing need to contact the surgery at that time.

The partners regularly change the outgoing message on the phone to reflect the operational circumstances of the day. Same day telephone triage appointments are offered for both urgent and routine problems all day from Monday to Thursday and until midday on Friday. On Friday afternoons the clinicians can’t accept non-urgent cases and expect to complete them before the start of the weekend.

Appointments: Patients are asked to phone up and tell the Receptionists what their problem is so they can be directed to the most appropriate clinician or team. After a consultation, if the doctor or Nurse Practitioner thinks that a face-to-face appointment is needed, or if the patient feels that their problem cannot be dealt with over the telephone or on a video consultation, then an appointment is given for later that same day or on another agreed day.   

The demands on Primary Care throughout the pandemic, due to both increased workload as well as reduced numbers of clinicians, means this is the most efficient way of meeting the health needs of our communities. It is not how General Practice used to be organised, but a lot of patients find this new way of working more convenient and for those who really do need to ‘see the doctor’ then this can be discussed over the phone. Patients are often surprised however at how much can be achieved remotely and it means that many more patients can be dealt with, without the long waiting times for appointments that would be the inevitable consequence of an open-access system.

We regularly discuss the timetable for a return to ‘business as normal’ which may include a combination of both pre-bookable appointments (as in the past) and remote consultations. We are limited by the uncertainties of the pandemic and need to ensure the surgery buildings remain a place of safety, adhering to Health and Safety and Infection Prevention and Control guidance, to minimise the risk to all our patients, but especially our most vulnerable. We will naturally keep you all informed about these plans as they evolve.

Dispensary: We have made some changes over recent months to improve the service in the dispensary. Staff numbers have been increased to deal with the almost 20% increase in items which the staff are processing every month; the current monthly average is now at a level previously only seen at times of peak demand, typically at Easter and Christmas. There is now also a second delivery driver to work alongside the one we have always had, in order to cope with the number of home deliveries to our elderly house-bound patients. The outside second hatch at Elmham surgery also allows more patients to be served. We still aim to maintain the turnaround time of three working days for routine prescriptions, as well as dealing with the urgent same day prescriptions generated by clinicians and pharmacists.

Staffing: We are fully recruited in our Reception and Dispensary departments. Staff still need their holidays and of course need time off when they or their children get Covid or have to self-isolate. We are very proud of how the staff have worked in these patient-facing roles throughout the pandemic whilst they too have been dealing with the stresses of what we are going through. Our secretarial team is also responding to new ways of working and are taking on much more responsibility in communicating with patients and dealing with problems that previously might have been managed by clinicians.

Toftwood Medical Centre: Elmham Group of Practices continues to hold the APMS contract to deliver care to patients in Toftwood. This is an important part of the ethos and business model of the organisation and it supports the Dereham practices and whole patient population. We are looking to move the surgery in to temporary accommodation in the Spring due to the inadequacies of the current building, and this will also be a hub for some of the clinical and support staff employed by the Primary Care Network. The work done in Toftwood complements the work at Elmham and Swanton Morley surgeries and does not detract from the delivery of care at these other sites.

Army: The role that Elmham Group of Practices has had in managing the Medical Centre at Robertson Army Barracks comes to an end on 30th November. We have provided clinical cover for the Light Dragoons and more recently the Queens Dragoon Guards for over 15 years; it has been a privilege to have been involved with them, particularly so during the times of conflict when they were deployed abroad.

Vaccination programmes at Swanton Morley Surgery

Judith reported last time that we had delivered first and second covid vaccinations to the patients in mid Norfolk on behalf of the Primary Care Network of local GP surgeries. Over the summer the team has continued to deliver this to younger adults and are now engaged in rolling out the booster programme. In total 39,283 jabs have been given, and from October over 1,600 further booster jabs to the Clinically Extremely Vulnerable and frontline health care workers have been given, both at Swanton Morley surgery and in care homes. 

From the outset, back in late 2020, the partners felt there was a clinical imperative to set this up as we were probably the only organisation locally that could roll it out so rapidly and deliver it so efficiently. The project team and volunteers have worked incredibly hard - often at weekends and anti-social hours - to do this within the very strict guidelines that the Department of Health has imposed.

The mass vaccination site at Dereham Hospital is now up-and-running and we will be considering whether there is still a need to offer Covid booster jabs to the community in the coming months. The roll out of flu vaccination has now started for our own patients, also out of Swanton Morley surgery, but as in previous years is reliant on supplies coming in from NHS England. We have restarted offering appointment for blood tests and ECGs at Swanton Morley surgery on non-vaccination days and are pleased that the NNUH ultrasound team have returned to the building to start doing scans again.

Long Term Conditions

We are aware that many patients with Long Term Conditions who need regular blood tests and follow up have been concerned over the last 18 months about their care. At the peak of the pandemic, we were advised to put all of this on hold but were then able to provide a limited service with nurses contacting patients and doing virtual reviews. Over the last few months nurses have been operating as normal a service as possible and are now making significant progress in catching up with all patients needing a review.

Pandemic issues

We continue to remain concerned about this coming winter and how the NHS will cope with the ongoing threat of Covid and the very real risk of an Influenza outbreak. We have regular updates from the Norfolk and Norwich and Queen Elizabeth, Kings Lynn, Hospitals and are aware of the tremendous pressures they are under and how hard their staff are working. There is an obvious impact on our patients whose planned and unscheduled care is affected. We are doing our best to expedite the follow up of those patients whose clinical condition needs prioritising.

The Department of Health regularly provides GP surgeries with advice on maintaining a safe environment. For the time being we still ask patients to attend with a face-covering unless exempt. Staff will still be wearing PPE during the consultations.

We are very grateful for the support and words of encouragement that we continue to receive from our patients. These are very much appreciated and mean a lot in these difficult times.

Dr Simon Carroll 

4th November 2021

Published: Nov 5, 2021