The changing face of General Practice

The Changing face of General Practice and how it is effecting Audlem Medical Practice

The Partners at Audlem Medical Practice thought it would be useful to explain some of the recent NHS changes and how they might impact locally.

There is a continuing drive to deliver services in the community rather than hospital wherever possible; partly because patients prefer local services and partly because in general terms it is cheaper – so in these financially challenged times with rising health demand, this is a significant consideration.

Service reconfiguration is often a long, tortuous and sometimes ineffective process but the hope is that the new Clinical Commissioning Groups (CCG), led by GPs, will be able to move swiftly and decisively, aided by support from their patients.

Audlem has a Patient Participation Group (PPG) which can feed your ideas into the system and be consulted about future changes. Details of the members of this group can be found on a notice in the practice should you wish to contact them.

The Practice has become a member of 'Your Practice Plus', an independent organisation set up by local Practices to enable new services to be delivered through existing premises by an extended team of clinicians and other support staff.

Whilst we are small and somewhat challenged for room availability, there will be opportunities to provide outreach outpatient clinics, some investigations like ultrasound scans and expanded community nurse services for example, either in-house or in Nantwich

Local GP Practices felt the need to get together as we are struggling to meet the ever changing demands of the NHS with reducing resources. The number of patients we see per year has increased 300% since 2004 and any efficiency we had for absorbing this work have now been exhausted. Initially there were 2 GPs providing 18 sessions per week – now we provide 21 GP sessions per week plus 8 sessions from our nurse practitioner.

Our nurse hours have doubled plus the development of the health care assistant role, the funding for which has been reduced. The admin/reception team has also almost doubled to cope with the increased administration tasks and regulations, along with increased investment in more efficient computer and telephone systems. Yet the resources never seem to be enough and we are anxious that our current excellent standards for access and care will be negatively affected as the workload continues to rise.

We are only able to maintain our high standards because of a partnership approach, the dedication of our staff and our patients using the Practice reasonably and appropriately the majority of the time. In other areas where this is not the case we know that the service provided is not of the high standard you have come to expect from this practice.

As these various factors become more difficult to manage, we will be faced with choices which up until now we may have avoided:

• Referral processes may appear where you have to accept alternative pathways rather than being directly referred to a consultant out-patient clinic, irrespective of your personal preference.
• Certain conditions eg; hip or knee replacements, will be subject to qualifying thresholds before consultant referral is allowed
• Some medications cost more than others and you may be asked to swap over to a cheaper version even though you have been used to a particular variety for years. Up until now we have allowed this to remain patient choice – but that will have to change if we are to meet our targets. Prescribing savings do not become Practice profits; any monies saved are retained by the CCGs to be used for other patient services.
• Where funding has been withdrawn for certain services eg; ECG, lung function tests or even blood taking, we will have to review whether we can still provide those services in-house.
• Opening times are on the agenda again; evenings and weekends. It is unlikely additional funding will support this, so we may as a community have to debate whether the same quantity of clinical time can be delivered differently. We will be asking your opinions on this and other relevant issues soon in our annual patient survey

We suspect that General Practice is facing a significant change over the next few years and this will be challenging for us all. There will be a lot of information and news stories appearing – we would caution believing everything you hear, especially from politicians and the media.

As ever, life at the 'coal face' can be quite different and there is a definite gap between expectation and what will be practically deliverable. By being involved with our PPG you can find out what is really going on

Hopefully this is not too depressing – as we said, we are looking at all appropriate avenues to ensure a full and quality service continues to be provided to our patients in the future.

Drs Muirhead, Leftwick, Verso and Holden

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