Let’s face it, most of us don’t want to talk about medical matters on the phone. Nevertheless, since April, when you call to book a GP appointment in Shaftesbury, you have to explain why you want to see a doctor. Depending on your symptoms, this could prove rather uncomfortable.
So why do the staff want to know and why is there said to be a longer wait for non-urgent, routine appointments? ThisIsAlfred spoke with Richard Broad, the Blackmore Vale Partnership’s Clinical Services Manager.
Earlier this year Abbey View Medical Centre adopted an ‘urgent care team’ triage approach to appointments. Richard said that before the change, the receptionist would decide whether a patient should be seen that day. “They would be guided by what the patient said. If the patient felt it was urgent they would be put into a slot. We’ve tipped that on its head now,” said Richard. “We have an urgent care team service. There are clinicians who just do that for the day.”
Now, when a patient rings in and requests an urgent appointment, medical staff will assess whether they do need to see somebody as soon as possible. Richard went through some of the questions that clinicians will ask a caller. “We ask things such as, ‘Have you been to the chemist?’, ‘How long have your symptoms been there?’ or ‘Have you seen anybody else?’ We will put the patient on a list and staff will phone them back and ‘triage’ them, to see if it is urgent. If it is, we will try and deal with them over the phone, if we can. If we can’t, the patient can come in and we will see them.”
So is there a checklist, similar to when a patient rings NHS Direct? “There are standard template-like things, such as chest pain, shortness of breath, weakness or stroke-type symptoms,” said Richard. “But when you get a bit further with the patient and you are taking in their medical history, it becomes more multifaceted. It deviates from the standard. We don’t go down a long list of questions because we are all clinicians in our own right and we are able to give a consultation.”
Richard says the urgent care system has been introduced successfully by practices around the country. It’s been adopted because of the UK’s ageing population. “The older the individual, the more frail they can be and the more time they need. It is an attempt to free up the pre-bookable appointments so that those who need them can have more time with the most senior doctors. Those patients’ medicines and treatments can be multi-dimensional and a little more difficult. It means that they are also with the same GP.”
The new urgent care system approach explains why, if you ring the surgery and say you need to see a GP for a non-urgent issue, your appointment may be a few weeks later. A few years ago, it may have been possible to get an appointment later that day or week. “It could take a couple of weeks to see someone, depending on how our appointments are at that moment in time. Obviously, it fluctuates. There are busy and less busy times. If it’s a routine thing, it can take a few weeks to see somebody,” Richard said.
But Richard reiterated that patients who say they need a same-day appointment should be contacted by medically trained staff quickly. “If somebody phones in and they request an urgent appointment, then one of the clinicians will phone them back within two hours. If the patient phones and they have chest pains or they are acutely unwell then they will be advised to ring 999.”
Richard says a similar system is in place if patients arrive in person at the health centre. “Those who walk in and request an urgent appointment will be put on a list and phoned back. If the clinician phoning them needs to see them, they can be brought back in right away or they can arrange to come in after work. The flexibility is there. If anybody comes in with chest pains or stroke-like symptoms, they will be seen straight away.”
Shaftesbury businessman David Perry is full of praise for the new urgent care system. In August he walked into the Abbey View Medical Centre after his vision was seriously impaired in one eye. “I woke up one morning, got out of the shower and I went blind,” David explained. “I rubbed my eye with a towel expecting it to come back. I got dressed and rather than come to work I went straight to the health centre and explained what had happened to the receptionist. She told me the doctor would see me straight away.”
David says he had to wait five minutes before he saw somebody. The doctor told him to go to the eye clinic at Salisbury Hospital. “I got a lift there and I was seen immediately,” says David. “The only bit that really upset me was that I was transferred to ‘elderly care’!” he joked.
Richard stresses that the surgery is not an accident and emergency unit, but David didn’t consider his eye problem serious enough for a hospital visit before he went to the doctor. “I thought I had just rubbed my eyes funnily and I had gone blind from it. The doctor thought I’d had a stroke and I was treated at the hospital for that.” David says his experience of the urgent care system was good. “It was fantastic and quicker than driving myself to Salisbury Hospital.”
There are 24,000 patients registered with the Blackmore Vale Partnership in the Shaftesbury, Fontmell Magna, Sturminster Newton and Marnhull areas. Staff have assessed the urgent case numbers to ensure that enough clinicians are on duty. “In July, on a Monday, there were 159 triaged calls. 69 patients were brought in to be seen. The numbers go down during the week. On the Tuesday it was 97 calls and 48 people came in. On Wednesday it was 98 and 51. It was 93 and 41 on Thursday and it dropped down even more on the Friday to 65 triaged calls and 40 patients brought in to be seen,” Richard revealed.
Richard says the practice is now working towards extended opening hours to provide flexibility. “Shaftesbury already has GPs on a Saturday morning doing routine clinics. You can access urgent care until 6.30pm. Soon, there will be staff here earlier and we will be open until a bit later.”
Every health practice is required to host a patient participation group to gather locals’ feedback on the GP services. Richard says they have received positive reports following the introduction of the urgent care initiative. “We’ve had good feedback from them and they’ve had good feedback from the local community,” he said.
Richard says the newly adopted urgent care team approach is here to stay. “It is successful for the moment. We are happy with the way it’s going. Obviously, there are little tweaks that we are making based on feedback from patients and from the people working within it. We’re always looking at how many clinicians we need to meet the need on a particular day of the week, bearing in mind it will probably change during the winter months compared to the summer. As far as we’re concerned, it’s going to stay for the moment – absolutely,” Richard said.