Health and Welfare
Actions arising from Village Plan Survey results and comments regarding health and welfare in Keyworth.
The Village Plan Survey generated nearly 200 comments about the Keyworth Medical Practice, many very complimentary. Issues were raised and these have been investigated with the help of the Medical Practice Patient Participation Group (PPG). This report presents the issues, the findings of the PPG investigations, and their conclusions.
Appointments
There were 74 survey comments on the difficulty of obtaining appointments. These give the impression that it often takes more than a week to get a routine appointment with a particular doctor.
Investigation
The key word in this issue is particular. If a patient wishes to have an appointment with a particular General Practitionor (GP) who works part time, the patient has much less chance of seeing that GP when they wish, as the GP has only a limited number of sessions in the surgery. Other factors which may reduce the opportunities to see a particular GP are:
- Maternity leave.
- On holiday.
- Sickness.
- There may be a flu or tummy bug epidemic, which may mean there is an abnormal increase in the number of patients wanting to see the doctor.
- They may be on courses to keep up to date with current medical practice.
- If it is a doctor with a particular expertise, more patients may wish to see them.
It is important to be aware that although each GP appointment is around 10 minutes, the GP also has to deal with issues around that consultation at the end of surgery. For example:
- Seeing urgent or unforeseen patients (could be up to 60 per day).
- Telephoning consultants, nurses and other personnel regarding patients.
- Arranging hospital appointments or admissions to hospital.
- Writing letters.
- Making appointments.
- Writing up notes.
- Arranging investigations.
- Reading clinical letters from consultants and other staff regarding patients.
- Speaking to other personnel who telephone to discuss patients.
- Checking and signing results of investigations.
- Reading and signing repeat prescriptions (around 400 per day).
The practice has a population of around 11,000 people. There are 3 full time GPs: 1 GP working 3/4 time and 4 GPs working 1/2 time (8 GPs). There are 5 Nurses and 3 Health Care Assistants (HCAs).
One of the other issues which will influence the ability to get an appointment with the GP of choice is the number of people who fail to attend booked appointments.
Missed appointments at Keyworth Medical Practice (i.e. where patients did not attend the appointment they had made with a GP, nurse or health care assistant):
- In 2009 the number of missed appointments was 1,673.
- In 2010 the number of missed appointments was nearly 2000.
A proportion of these patients will need to make another appointment.
Conclusions
This is a complex problem with no easy solution. A significant improvement in the situation would be made by reducing the number of missed appointments. Everyone can help and the PPG is actively working with the medical practice to reduce these figures.
Opening Times
There were 22 survey comments on opening at lunch time, evenings and weekends.
Investigation
On checking other practices in the Principia consortium of medical practices in Rushcliffe that are comparable with the Keyworth medical practice, it was found that most have a period of an hour at lunchtime when the surgery is closed.
- This period of closing often means that practice staff can meet together as a team for meetings, which are essential for updating staff.
- Keyworth Medical Practice is available by telephone during the lunchtime period.
- Some practices in Principia have a half day each week when the practice is closed from lunchtime until the following day.
- Currently, no practices within Rushcliffe open on Saturdays.
Opening times for the surgery can be accessed through the Practice website www.keyworthmedicalpractice.co.uk outside the surgery and in the patient information packs in the waiting room.
Conclusions
Since the survey was conducted, the practice has offered early morning appointments between 7.00am and 7.40am. The opening times are consistent with other practices in the area. No further action on this issue is planned.
Medical Complaints
A number of villagers raised complaints about the way medical problems had been addressed.
Investigation
The Medical Practice has a complaints procedure for such problems.
Conclusions
These are not issues for the Village Plan. No further action is planned.
'Out of Hours' Service
Villagers asked whether it is possible to have a local 'out of hours' service.
Investigation
Out of hours services are the responsibility of the Primary Care Trust (PCT). The last government negotiated a new GP contract which gave PCTs responsibility for patient care out of hours. No local practices provide out of hours services.
Conclusion
No further action is planned.
Other Services
The survey generated suggestions for additional medical facilities such as mobile breast screening unit, preventative medicine and mental health support.
Investigation
No one service received particular support. Anyone with suggestions for additional services or improvements to current services can submit them through the existing complaints and suggestions procedure.
Conclusions
No further action is planned.
Elderly
The survey generated comments that more could be done by the Health Centre to check on and help the elderly.
Investigation
Keyworth Medical Practice offers health checks to the over 75s.Patients over 75 are advised to have a health check on a yearly basis. Home visits can be done if the patient is unable to attend the surgery; however, the full scope of the check cannot be achieved in the home as physical examinations may be compromised in the home setting.
Care for older people can fall into 2 categories: social care and health care. Different organisations have responsibilities for these 2 areas. Older people requiring help with shopping, cleaning and other social needs is not the responsibility of the National Health Service (NHS). There have been increasing demands on the NHS over the last 20 years. NHS staff no longer 'pop in' to see older people as there are too many demands on their time. In the past, health visitors would have been involved in monitoring older people; however, safe guarding children has taken priority over older people.
The practice is required by the Department of Health to monitor patients with certain conditions. These conditions are:
- Asthma.
- Diabetes.
- Atrial fibrillation.
- Dementia.
- Cancer.
- Epilepsy.
- Chronic kidney disease.
- Obesity.
- Hypertension.
- Depression.
- Mental health.
- Heart failure.
- Palliative care.
- Hypothyroidism.
- Learning disabilities.
- Chronic obstructive airways disease (COPD).
- Stroke and transient ischaemic attacks (TIA).
- Coronary heart disease.
- Cardiovascular disease prevention.
- Smoking.
The achievement of these targets leaves no time for nurses to 'check' on older people. Many of these conditions may affect the over 75s so many will be monitored through the checks that they are offered and will be seen regularly by a health practitioner. Perhaps the key thing with older people is to encourage the 'community' to help keep an eye out for older neighbours and seek help for them if problems arise. The number of older people is rising; therefore it is going to be increasingly difficult to supervise the elderly population. It is also important to note that many older people are fit and able and would resent being checked up on!
Better access to information on services available for assisting older people would be beneficial. Nottinghamshire PCT has developed a service to provide information on services. It is currently being launched. It is a guide to health and local services, for people with long-term health needs and social care needs. For more information, visit www.nottsinfoscript.co.uk or email email nottsinfoscript@nottspct.nhs.uk.
Care for older people may be a topic that the PPG will discuss in the future.
Conclusions
No doubt more could be done for the elderly by the community but the Community Concern Trust and PPG are not in a position to offer additional services.
Keyworth Health Centre
As well as accommodating the medical practice, Keyworth Health Centre houses other health service providers. The survey generated suggestions for additional health centre services such as a physiotherapist, chiropractor and osteopath. There were also comments on the suitability and use of the new building.
Investigation
The medical practice position is that questions about other services in the Keyworth Health Centre should be directed to the Primary Care Trust. The PPG, with limited resources, is not able to cover all services and concentrates on medical practice issues.
Conclusions
The abolition of Primary Care Trusts will lead to major changes in the organisation of health service provision and the PPG will no doubt have to review its role when more is known.