APRIL 2004

It's some time since my last editorial in April 2003 and a lot has happened and more things are going to be happening in the near future.

Within the practice we have had a number of changes and events. Dr. Chou left us in the Spring of 2003 to extend his interest in the surgery of skin lesions which he now carries out working directly for Darlington PCT - he and Dr. Tim Cunliffe, formerly a partner at Denmark St. Surgery, have set up the Primary Care Skin Service, which is a pioneering Darlington initiative providing more rapid access for patients to receive care for those skin lesions that do not require the input of a consultant dermatologist or plastic surgeon, though in the event of it being necessary then referral to these consultants is readily available.

Dr. Elliot left us at the end of January for pastures new in Middlesbrough. Also, very soon after Dr. Elizabeth Carlton had her baby, called Patrick, and so is off for a while on maternity leave.

At present we don't have a replacement for Dr. Chou and Dr. Elliot although we do have Dr.Riccardo Benci joining us shortly. Dr. Benci is from Italy where he has had a lot of experience in the Italian medical system including some time as a GP in Italy. More recently he has been working directly for Sedgefield PCT, providing additional medical input in practices in the Sedgefield area and at the same time gaining experience in the British way of providing primary care, which is different in a number of ways from Italy. Dr. Benci has been working on behalf of the Department of Health as well, helping to recruit more doctors from Italy.

We have had a number of locums working within the practice and they have been providing cover for Dr. Carlton's maternity leave and also for the time that Dr. Harker spends in his capacity as chair of the Professional Executive Committee of the PCT. It is likely that for the foreseeable future there will be quite considerable use of locums.

Nationally the GP's have negotiated a new contract with the Government which represents quite a major change - see the Out of Hours Team's site for national information. Important aspects of this new contract are that quite a lot of GP's pay will be dependant on the quality, rather than quantity, of health care delivered, especially in relation to diseases such as ischaemic heart disease (heart attacks and angina) and diabetes. Also the new contract allows GP's to opt out of the responsibility for providing out of hours care, either personally, or as all Darlington practices did prior to the change, through the use of either a co-operative or a deputising service such as the one provided through Primecare in Darlington but for which the GP's still retained overall responsibility. In fact the Darlington practices are all contracted directly with Darlington PCT but the terms of this contract will be very similar to the national one and Darlington practices have decided to take advantage of the opt-out from out of hours care to pass this responsibility directly to the PCT from the first of April though the contract is still placed with Primecare. As far as you the Darlington patient is concerned the only differences that you should notice will be that the out of hours cover will start an hour earlier at 6pm each evening and continue until 8am instead of 7am on weekdays but perhaps much more noticeably it will carry on from 8am on Saturday morning through the whole weekend and we, along with other practices in the town, will no longer be opening our surgery at all on a Saturday morning. You may also notice that starting from April the first some out of hours consultations will be with a new type of health care professional, the Emergency Care Practitioner (or ECP) who will have either a paramedic background or a nurse practitioner background but will have received special training in the kind of diseases that commonly cause problems in the out of hours period . They will have back-up from a doctor who can advise them if necessary or even review the case themselves on rare occasions and of course they will have access to hospital admission if that were appropriate. We have had two Emergency Care Practitioners undertaking part of their training in our practice, both highly experienced senior paramedics, Bill who has graduated and will be amongst the 'first wave' and Mark who has recently started with us. We have been impressed with their professionalism and the high level of expertise that they possess which they are now developing into a new area. ECP's will also be doing some work 'in hours'.From 1st April the ECPs will be working within some of the practices (including Whinfield) on a rota basis and may be responding to some of the emergency requests for a doctor to visit between 10:00am and 6:00 pm.These can be very disruptive to the functioning of the afternoon surgery and are very stressful for us doctors because it inevitably involves balancing the needs of the patient home against those, sometimes quite ill, who've made the effort to come to the surgery to see us so that if the need to undertake even a proportion of these visits can be safely delegated to another practitioner then everyone should gain. However, this is a pilot study and we will have to see how it works in practice.

Computerisation expands at a rapid pace. We have just had new hardware delivered to us by the PCT and this is of the very latest specification and all set to run the enhanced services that will soon be available such as online booking of outpatient appointments and the Integrated Care Record. This (known as the ICR) will enable the instantaneous transmission of clinical information from the places where it is held (here at the surgery and at the hospitals where you are receiving care) to the point at which you are receiving care at that moment - even if it were, say, an accident and emergency department in Brighton. This may seem straightforward enough but it is a hugely ambitious project both in complexity and size and not made easier by the multiplicity of different computer systems in use across the NHS and the very different levels of computerisation of tasks within the Health Service. In fact General Practice leads the way in computerisation and many practices record their notes, results and correspondence electronically now in their entirety although some information, such as letters and discharge summaries are still transmitted on paper even if the storage is electronic. In time it is intended that all this transmission of information will take place in a secure environment across NHS' own computer network and indeed it is probable that electronic records will be held centrally rather than on local servers in the future. Of course GP's and all other doctors working in the NHS will only agree to this happening if the very highest standard of data security can be guaranteed because the record belongs to you, the patient, and we are the guardians of that record charged with both a legal and an ethical responsibility for its safe-keeping. However, there is great potential for the improvements in care that will flow from improvements in information flows because information is central to the effective delivery of health care; the information that you tell us about when you attend surgery, the information that we obtain from examining you and from carrying out tests and the information that we deduce from putting all of this together. If another health professional seeing you has only limited, delayed or inaccurate access to this information then your care will suffer and you may have to endure unnecessarily repeated tests or even in the worst case the wrong treatment and this is clearly something to be avoided if the information exists that could prevent this happening. And of course at the moment this can happen in reverse if you come to see us in the surgery and we don't have access to the latest information from the hospital be it a recent test or the most recent opinion of the specialist as to how you should be treated. The benefits are clearly obvious. Additionally to improve information flows internally all the doctors will soon be carrying palmtop computers with encrypted copies of patient's records for use in the home visit situation. This will ensure that we can access the latest test results and most recent consultations with other doctors and any clinical information we obtain or medication we prescribe can be recorded and then automatically transferred to the practice clinical system when the files are synchronised on our return to the surgery. At the moment we are reliant on paper records which in some cases have become very bulky and have to be printed out in their entirety each time the patient is seen and then any changes have to be entered by hand and the computer record shredded - I'm sure that you would agree that that is a very cumbersome system and tremendously wasteful of paper if nothing else.

More soon.....

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