APRIL 2003
It is a long time since the last editorial and I apologise for that especially since there have been rapid changes both within the practice and in the provision of healthcare in Darlington.
In the practice we have two new permant doctors - Dr.Elizabeth Carlton and Dr. Helen Mcleish (Dr. Mcleish has been with us before, however, as a GP in training and if some of you only knew her before she was married then she might be more familiar as Dr. Helen Perryman). We also have a new nurse Margaret Garland. In addition to these permanent additions to our staff we have regular help from locum doctors - currently Dr. Peter Whitney. This is because Dr. Harker is chair of the Professional Executive Committee of the Primary Care Trust (see below), which is quite an onerous responsibility and takes up a good deal of his time. Additionally he regularly works for the General Medical Council helping to assess doctors who are having problems.
The structure of the NHS locally has significantly changed. Previously we were overseen by the Primary Care Group which was a subcommittee of the County Durham and Darlington Health Authority. This meant that although it had a great deal of influence it was not actually in charge of the provision of primary care in Darlington. Now we have a Primary Care Trust (PCT) which has a lot more power - it is the source of remuneration for doctors, dentists, opticians etc - and the Health Authority has merged with Tees Health and this now forms a Strategic Health Authority which is much less concerned with the day to day running of health care but is what it says a source of strategic planning. The PCT has a board which is responsible for supervising its functions and this board meets in public and has a preponderance of lay representation including the officers such as the Chief Executive (Colin Morris) and non-executives such including the lay chair Sandra Pollard. Dr. Harker chairs the Professional Executive Committee which represents the professionals working in the PCT area and which has a number of GP's on it as well as other health care staff. What this is supposed to ensure is that the PCT both remains relevant to the population that it serves and is getting the best advice from the local professionals that are charged with delivering the care.
Patients may recently have noticed a significant difference in the way that our appointments system works. We have made a commitment to "Advanced Access". Previously I am sure you would have been aware that although emergencies were always seen on the same day it was very difficult to accomodate patients who, whilst they didn't want a same day appointment, nevertheless would like to be seen within a day or so. This was not a problem unique to ourselves and it was something that the government was aware of and very keen to address. So from last Autumn we gradually started to implement a programme that was proposed to us by the PCT on behalf of the NHS as a whole. Dr. Mcleish was the "Guinea Pig" here and she operated this system from the moment that she started with us. Other doctors came "on stream" over the following weeks so that everyone was operating the system by the end of the year - and this has subsequently been extended to the nurses in a modified form. Essentially what has happened is that we have drastically reduced forward booking because we found that this resulted in our appointments becoming clogged up well in advance of the day. We now have 10 minute slots on our computer appointments system which are allocated to either the following day or the current day plus a number of five minute emergency slots which are shared out amongst all the doctors every day (instead of one doctor seeing all the emergencies on a given day as before). We do allow booking beyond two working days in specific circumstances - e.g. when a doctor requests it to perhaps follow up the progress of an acute illness or if the patient is really unable to make an appointment within the two day time frame. However, all other appointments should be requested either for the same day, or if that isn't possible, the following day. We would be very interested in your comments on how this is progressing because we do recognise that this is quite a radical change - email us at: Feedback.
Personally, I have been in the US quite a lot recently and last year completed a sabbatical in March and April. During that trip I took the opportunity to look at the provision of Healthcare in a very different system. See Comparing Health Care in the UK and the US which I wrote in conclusion. I think we are often very critical of health care in this country, and sometimes rightly so, but others have problems too though they may be different ones. What all systems share, I think is that modern medical research continues apace and is able to provide solutions to a lot of medical problems that were previously insoluble and some things that we may not previously even have recognised as a problem within the medical sphere - e.g. impotence, infertility,cosmetic problems and social embarrassment which are all controversial subjects and which have major cost implications for either the individual patient or for the healthcare system. Even without these new areas of treatment the costs of healthcare in all systems are spiralling. Also there is an ever increasing need for skilled workers to provide care. The resources going into health care inevitably have to increase if we are to keep pace with all this and that requires us to make choices since overall resources, both public and private are not unlimited. However, we have also come to recognise that duties that were assumed to be the exclusive province of doctors can, in fact, be carried out very effectively by other staff - especially nurses and paramedics and sometimes those duties that were once the exclusive preserve of nurses can be done equally well by Health Care Assistants. Some of you will already be aware of the excellent work done by our Health Care Assistant, Beverley Purdie, who takes blood and carries out ECG and hearing tests, thus enabling the nurses to have more time to spend with patients doing those things which only they can do. At the hospital some of you may already be aware that nurses are now carrying out proceedures which even most doctors are not qualified to carry out such as endosopic assessment of the gastrointestinal tract and review of patients in the ophthalmic clinic. One development that is getting serious consideration at present is the possible use of paramedic and nursing staff to provide the bulk of medical care that is provided in the patient's own home out of hours.
Other developments in progress include the requirement for doctors (and the allied professions) to be much more systematic about their continuing postgraduate education and also to be annually appraised - something that all the doctors in this practice have been going through in recent weeks. Shortly all GP's (and other doctors too) will be required to submit to a regular process of re-accreditation every few years. Long gone are the days when once a doctor had completed his or her training then s/he was left entirely to their own devices to ensure that standards were kept up. Although most of us were very diligent and seeking out educational opportunities we perhaps didn't always recognise where our weaknesses were that needed addressing. Additionally too we are increasingly having to reach targets for care quality and some of our pay will be conditional on that. We think that in this practice we have put a lot of stress on the quality of care but there is always room for improvement and the increasing sophistication of information technology means that it is a lot easier for us to monitor in real time how we are doing. One criterion for care quality will be patient satisfaction and that is very important. If there are times when we are not able to provide you with something that you feel you need then it may be because we are unable to access that service or it may be that in our professional opinion the problem should be addressed in a different way. Whichever is the case we recognise that it is our duty to you the patient to make sure that you are fully informed and to involve you in the decision making process.
Hopefully it won't be so long before I produce another editorial. If you have any comments or suggestions then please send them to FEEDBACK@whinfield.co.uk