The future of primary care in the Lambourn Valley and new arrangements at Lambourn Surgery: 4 August 2023 update

Primary care in the Lambourn Valley

In the summer of 2023, a number of changes were introduced to primary care in the Lambourn Valley, including to some of the arrangements at Lambourn Surgery. A summary of this was prepared (in three parts) by the Patient Participation Group with the full co-operation of the Surgery leadership team and is reproduced below (green headings). Additional news or statements will be added at the top of the post (red headings).

Update 4 August 2023

There have recently been some changes introduced at Lambourn Surgery (see part three below) which culminated on 13 July with the introduction of a new system of triaging as part of the appointment-making process. This included an e-consult form which is, as the Surgery has confirmed on its Facebook page, “much more detailed than the previous one.” This has been causing some concern among patients, as new systems so often do.

It’s important to stress that the new-e-consult system is an alternative method of contacting the surgery, whereby you can begin your consultation online. Those who prefer to book an appointment using the phone, can do so (see details here). You should be prepared to answer some questions from the care navigation team (formally receptionists) in order to be booked in with the most appropriate team member in the shortest possible timeframe. The further good news is that a new phone system has recently been installed which is more sophisticated and flexible than the previous one and has a call-back facility.

The e-consult form is no longer or more complex than it needs to be in order to be clinically safe. The form itself is used by many surgeries across the country and provides your local medical team with comprehensive and consistently presented information which will assist with diagnosis. This replaces the previous free-text version which, though quicker to use, was less informative. As mentioned above, using e-consult is not mandatory and the upgraded phone system is there if you prefer.

There is also important information regarding repeat prescriptions. “We have also added some help pages under the repeat prescription options to help with how to log on to the Airmid app if that is your preferred option,” a spokesperson for the Surgery explained on the FB page. “We do realise all these apps can be confusing. The majority of our patients already have an NHS log-in. If once you have downloaded the Airmid app you choose the option to log in with your NHS Log in, you will not need any further sign-in details. It will all be linked automatically. We are producing a guide to help with the process but please bear with us – it is a new system and we are all learning.”

If you need help with this, please contact the surgery.

Part one: May 2023

This is the first in a series of articles to help patients understand the challenges facing Lambourn Surgery, their approach to facing them and the plans for the future. It has been prepared by the PPG with the full co-operation of the Surgery leadership team. The other two are published below this one.

Background

The NHS England five-year vision and plan for the future of the service was originally spelt out in 2014 with the Five-year Forward View and updated in 2019: then came the pandemic. The goals were not significantly changed but the environment did.

The main objectives of this vision for primary care (GP services) are:

  • Boost GP numbers (or maximise use of GPs time to clinical tasks).
  • More convenient access to GP services for patients.
  • Expand multidisciplinary primary care services.

All of this against a background of an aging population and greater demand on the service. The growth in demand can be measured in many ways but the following examples here, at Lambourn Surgery, help to illustrate this.

Since 2018

  • A 30% increase in repeat prescriptions.
  • A 30% increase in blood tests.
  • A 25% increase in medication issued.
  • A significant increase in requests for new GP appointments (not including follow ups or nurse appointments), currently averaging 50 per day.

All of this is with a static patient population and the same number of GPs, who valiantly coped throughout the staff restrictions caused by the pandemic.

Progress

In line with NHS guidance, Lambourn formed an alliance with Hungerford and Kintbury/Wooton Hill surgeries to form the West Berkshire Rural Patient Care Network (PCN). PCNs are a key way in which practices can obtain increased funding for additional roles without impacting the base budget.

As a result, there are already 9 staff members that have been employed under this regime, freeing up GP time. These include a clinician pharmacist, a musculo-skeletal practitioner and a mental-health specialist.

Plans to provide a range of ways to access GP services were accelerated by the pandemic and the introduction of triage (preliminary assessment) forms on the surgery website were necessarily introduced hurriedly, together with telephone and on-line consultations. These received a mixed reaction at first but have now been widely accepted and often preferred by those who are comfortable using online services, with others using telephone access to use the same process via reception.

The challenge

As we come out of the pandemic, now is the time to review the way forward, based upon patient reaction, their concerns, and the reality of providing a service that meets patient needs whilst being affordable.

The Lambourn Practice leadership team have been reviewing alternatives, consulting with staff and with patients through the PPG and are developing a plan for the foreseeable future.

Some patients often ask, “when will it return to how it used to be?”, the reality is that it won’t. Demand and cost escalation means that the service has to adapt but at the same time achieving the highest possible level of service. This will mean change and the PPG, together with the surgery team, are committed to ensuring that these changes are fully explained to patients and that support is available where necessary.

At Lambourn Surgery, 97% of patients currently rate their experience as very good (84%) or good (13%). This is a creditable performance, but the team is not complacent. Patient feedback identifies appointment timekeeping and patient communication as the top two areas requiring improvement. These will feature highly in the plan for the future and, through these newsletters and other activities, the PPG will play its part.

The surgery would like to gain a greater understanding of patient awareness of these changes and have developed an online questionnaire to help in this process. It may be found here.

Next month (see below)

We will introduce you to the directions of this plan and how the PPG plan to support patients through this change.

Part two: June 2023

No sooner had we published the first in this series of articles than NHS England published its “recovery plan” for Primary Care. This is a statement on the plans to deliver the Primary Care aspects of the “Five-year Forward Review” referred to last month.

The central ambitions are:

  1. Reduce the number of people struggling to contact their practice.
  2. For patients to know on the day they contact their practice how their request will be managed as follows
  3. If their need is clinically urgent it should be assessed on the same day by a telephone or face-to-face appointment. Afternoon requests may be assessed on the next day, where clinically appropriate. If their need is not urgent, but it requires an appointment, this should be scheduled within two weeks. Where appropriate, patients will be signposted to self-care or other local services (e.g., community pharmacy.)

The implications of this plan are being studied by the Lambourn Practice team to ensure that they are in a position to best achieve these goals.

You may have read in the press that this initiative has placed particular emphasis on the role of pharmacies and pharmacists (Pharmacy First). This article focuses on that area.

Pharmacy First

Pharmacists are highly qualified healthcare professionals who are experts in medicines. Typically, they work within a General Practice (Clinical Pharmacist) or in a Community Pharmacy such as Lambourn Pharmacy or Boots.  They are qualified to advise on many minor health concerns and their treatment, such as such as coughs, colds, sore throats, tummy trouble and aches and pains (the full list can be seen here) Some are also able to prescribe medicines.

The dispensary at Lambourn Surgery is not a pharmacy but has the responsibility to ensure the safe and accurate management and distribution of medicines prescribed by a qualified prescriber.

Lambourn Surgery has a Clinical Pharmacist, who is a key member of the clinical team. They support GPs with expert medicine knowledge and treats patients with long-term conditions such as asthma or those taking multiple medicines, often prescribing and monitoring the effect of these.

Lambourn Pharmacy (Graham Jones and Harvinder Sandhu) is our local Community Pharmacist and, like most others, has a private consultation room where you can discuss issues with a qualified pharmacist without being overheard. This may be as a result of a discussion with NHS 111 or by self-referral.

As qualified healthcare professionals, they can offer clinical advice and over-the-counter medicines for a range of minor illnesses and, in the future, certain prescribed medicines (yet to be defined).

If symptoms suggest it’s something more serious, pharmacists have the right training to make sure you get the help you need. For instance, they will tell you if you need to see a GP, nurse or other healthcare professional. Many pharmacies are open until late and at weekends. You do not normally need an appointment.

The future

Later this summer, Lambourn Surgery and Lambourn Pharmacy will be introducing an arrangement whereby, following assessment of an appointment request, the GP may refer patients directly for a same day appointment with the pharmacist at Lambourn Pharmacy. This scheme is part of a national scheme called the Community Pharmacy Consultation Service (CPCS).

As always with initiatives directed by the government and NHS England, these changes will be subject to available resources. Although we currently have sufficient clinical resources in the Valley, the current national shortages of both GPs and pharmacists offer no contingency to us in the event of illness or absence.

This article has been prepared by the PPG to help patients understand the challenges facing Lambourn Surgery and its approach to achieving the ambitions”, with the full co-operation of the Surgery leadership team and Lambourn Pharmacy. More next month.

Please help keep everyone informed

We know there are patients who do not have access to the internet or email. Please be so kind as to help them feel involved in the community by printing a copy of this newsletter and/or its links and passing it on to them. Thank you.

You can contact the PPG via email at ppgchairpersonlambourn@gmail.com or in writing via the surgery office (Bockhampton Road, Lambourn, RG17 8PS) addressed to the Chair of the PPG.

Part three: July 2023

Things are moving at a pace now and some significant changes will be happening with effect from Thursday 13 July in order to meet the ambitions for Primary Care previously described.

From that date new procedures and website for Lambourn Surgery will be launched (it will still be www.lambournsurgery.co.uk) that will provide the gateway for most services. It is designed to be user friendly and aid access to all Primary Care Services. It is hoped that this will free up clinician time to offer more appointments. Telephone access will still be available.

These changes will fall broadly into three categories.

1 Care navigation

We have become familiar with care navigation over the past couple of years through the online forms process of triage, this will continue as below now using a guided system called eConsult. From 13 of July, the reception team, now care navigators, will choose the right clinician in the appropriate time frame to help with your problem based on the information you supply. They have undergone extensive training to enable them to provide the best solution for patients. If in doubt they will always refer to a clinician.

These are the appointment options that you may be offered by the care navigation team.

  • Doctor
  • Advanced Nurse Practitioner
  • Mental Health Nurse
  • Social Prescriber
  • Care Co-Ordinator
  • Practice Nurse
  • Musculo-Skeletal practitioner
  • GP Assistant
  • Community Pharmacy Service

2 Making an appointment

The aim is always to help patients to access the right person to support their care in the right timeframe for their condition or concern.

Option 1 – start your consultation online.

  • Visit the Lambourn Surgery website
  • Complete the eConsult form (available Monday to Friday 7.00am to 5.30pm) and submit to the surgery, you may be advised to contact the surgery if urgent symptoms are identified.
  • You will be contacted by the end of the next working day with a link to book an appointment or further advice to help your problem.

Option 2 – phone

  • Phone the surgery on the appointments line which is open 8.30am to 5.30pm on 01488 72299
  • Speak to our reception team (care navigators) They will need some explanation about the concern you have. They will then be able to offer you options on who can help with your concern and when they are available. They will be able to book an appointment for you directly with the appropriate member of the clinical team.

Note: please see the 5 August 2023 update at the top of this post for some clarifications about this system.

3 Requesting medication

With the changes to the website, you can request medication in one of four ways:

  1. Using the Airmid App – a smart phone app that works in the same way as Systm Online. (The existing system already used by 50% of patients). It also offers access to your test results and medical and vaccination records.
  2. Using Systm Online via the website with same facilities as Airmid.
  3. Using the NHS App – with same facilities as Airmid except it currently can only handle repeat prescriptions but not special requests.
  4. A written request handed into the chemist or dispensary.

Just a reminder – requests for medication cannot be accepted over the telephone as it is not safe.

Help is available

In the patient survey performed by the PPG in 2021, a significant percentage of patients who had not used online services before said they were prepared to give it a try if help was available. PPG members are available to help patients and/or community groups to get used to these new systems and processes, especially online access and phone apps. You can contact the PPG as below to request help/training.

Please help keep everyone informed

Please be so kind as to share this newsletter with those who would not normally have access.

Thank you.

You can contact the PPG via email on ppgchairpersonlambourn@gmail.com or in writing via the surgery office, addressed to the Chair of the PPG.

 

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