Concerns expressed on Facebook 

 

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To All of our Patients and our Community, 

Many of you may have seen the concerns expressed over the last few days about Gillingham Medical  Practice on the Gillingham, Dorset Facebook page. We wanted to respond with care and in full, so have  drafted this open letter rather than responding in the comments. 

 

Last 18 months 

Everyone at the Practice works tirelessly to provide the best possible service and care to our patients and  our community. We work here because we are passionate about what we do, and because we want to make a positive difference to those around us. 

Over the last 18 months, our team has completely changed how we work, multiple times, in response to  challenges that no one could have predicted. We have done this whilst maintaining essential services and our standard of care. Team members have had COVID, we have had to isolate due to COVID, we have juggled childcare and family commitments with a vastly increased workload, and we have consistently aimed to learn and improve. This is not unusual in primary care, but we know that the media have often chosen to represent us differently. 

To put it into context, we currently have 12,762 patients on our list. In the last 30 days we have received 10,246 calls, and Monday 12th July was our busiest day, with 724 calls made to the Practice. This is on top of the eConsults and other requests that we receive online and physically. 

We have also been delivering the COVID vaccination programme with the Blackmore Vale Partnership. Together, we have given 34,687 vaccinations since January 2021. This represents significant clinical time, but also a huge administrative effort from our teams, which we have delivered alongside the “normal” day-to-day, plus our COVID response, plus catching up on the COVID backlog. This backlog is both internal and external, with the hospital backlogs creating significant additional work here. 

We were instructed, by NHS England, to pause various activities during the pandemic. We continued services where we could, but did have to follow directions. We have been putting on additional clinics to catch up with smears, and additional clinical and administrative time to ensure that we catch up with vital immunisations and reviews. 

 

What we have done 

We introduced our new telephone system in February. This was in direct response to feedback from our patients and staff that the current system was not working. Calls were dropped or cut off without answer, and there was no facility to queue calls or to respond effectively to new challenges, such as moving buildings or staff working from home. The new system has been brilliant, but one of the consequences is that all calls get through to the queuing system. This is far safer, but it means that some people are experiencing long waits. The Queue Buster system (which gives you the option to hang up and be called back when you are at the front of the queue) helps, but we are aware, and sorry, that peak waiting times can be excessive. 

To help manage this, we have asked patients to use eConsult or the NHS App to request medication and treatment or advice. We continue to support patients who cannot use digital access, but we also need patients who can go online to do so, to free up enough capacity for those who cannot. To be clear, every practice in the country is struggling with unprecedented demand, and every practice is asking patients to use a range of access methods to help with this. 

Total Triage was introduced in April, to try to address the imbalance between capacity and demand. We very much want to provide exemplary care to everyone, but the previous model meant that those who managed to get through on the telephone at 08.30 or 2pm would get an appointment, rather than those who most needed it. The new system ensures that everyone receives the appropriate care at the appropriate time, although we acknowledge that this may not always be through the route that an individual might ideally prefer. 

 

Concerns raised 

We do appreciate that there are elements of eConsult which are not perfect. This is an external provider, commissioned by NHS Dorset CCG, so we have a very limited ability to change how it works. The questions can be repetitive, and sometimes the safety netting asks you to ring 111 or 999 or the Practice. This is all for safety purposes, but it can be frustrating. When you submit an eConsult, you are normally asked if you would like to provide feedback. This is a good opportunity to raise concerns. We are currently not able to change our provider, so we will continue to work with them, and internally, to make the process as smooth as possible. 

In terms of waiting times and delays, the vast majority of patients requiring input from a doctor are receiving a response and resolution within three working days. Pre-COVID, we would normally have a waiting time of up to two or three weeks for a routine appointment with a GP. 

We must all also remember that Gillingham Medical Practice is not an emergency service. Emergencies must be directed to 999, and urgent requirements relating to minor injuries or out of hours should call 111, who can direct them to Minor Injuries in Shaftesbury, or the most appropriate place. 

 

What are we doing to address the issues? 

  • We continue to review and learn from feedback from all sources. We have recently made some changes to how we process requests, and have improved our communication with patients so that we aim to acknowledge every eConsult received. 
  • We continue to improve our communication, and have purchased another system for sending SMS messages, to help us communicate effectively with our patients. These messages are used to reduce waiting times, so please try to receive these in the spirit in which they were sent. 
  • We continue to recruit, with advertisements currently open for Patient Services team members, Maternity Cover for one of our Practice Nurses, two Advanced Nurse Practitioners, an Advanced Paramedic, a Care Coordinator, and a Social Prescriber. The purpose of every one of these roles is to improve our services for our patients. 
  • We continue to work with our Patient Participation Group Steering Group, and with our Health Champions, to ensure that we maintain excellent links with the community. 
  • We continue to try to increase the number of patients on electronic repeat dispensing, which means that their prescriptions go automatically to the pharmacy every month, without requiring the patient to request their medication. We are working very closely with the insurers and contractors for the Barn Surgery, aiming to reopen there as soon as possible. The timing of the works has been out of our control, but please be assured that we have always tried to minimise disruption as far as possible. 
 

What can Gillingham do to help?

  • We really value feedback and constructive criticism. It would be really helpful if this could be given direct to us, rather than on social media. As some commenters said, it is very demoralising and difficult for our team to see such critical and accusatory messages on Facebook. It also runs the risk of putting patients off from trying to contact us, which clearly no one wants. 
  • We would be very grateful for your continued patience and perseverance with our new systems. The telephones are great, but please do make use of the Queue Buster when offered. And please do try to use other contact methods, such as eConsult and the NHS App, if you can. This helps those members of our community who do not have the ability to go online. 
  • Please make sure that we have your correct contact details, particularly mobile phone numbers. This allows us to arrange medication reviews and update you about your requests. 
  • Please, as ever, make sure that you request your prescriptions in plenty of time. This is to allow the requests to be processed here and passed to the pharmacies for processing, but also allows any issues about medication reviews or drug shortages to be resolved before you run out. If you would like to try electronic repeat dispensing, which makes things quicker and easier, please get in touch via eConsult and we can set it up as appropriate. 
  • All requests via eConsult and the telephones are triaged by clinicians. Urgent requests will receive a response that day, and non-urgent requests will normally receive a response within three working days. Please be patient with us, and avoid submitting multiple editions of the same request, or calling up to chase. This puts even more pressure on the system, thereby extending response times for all requests. If you have not received a response within three working days, please do let us know and we can look into it for you. 
  • As we continue to work through the pandemic, please be respectful of our team and of the policies and procedures that we put in place to keep everyone safe. 
 

Summary 

We all feel very lucky to work in Gillingham. Things are not perfect, but please do believe that we work every day to improve them and to provide the best possible care for all of our 12,762 patients. This is generally reflected in our positive interactions and feedback, including on this year’s GP Patient Survey. 

We sincerely apologise for those people who have had negative experiences, and would welcome a conversation to try to resolve any outstanding issues. Please email us via our secure online form and we will direct your query to the appropriate person. Please note that we cannot respond to any clinical queries via email. 

Yours faithfully, 
Dr Geoff Lewis, Dr Claire Chambers, Dr Kathryn Mounde, Dr Will Fenton, Dr Clare Boulind, Dr Chris 
Pearce, and Katie Pearce (Practice Manager)

Published: Jul 13, 2021