GP SURGERY TRAINING MANAGER

Coronavirus – What Do You Need to Know

General Advice

The latest Government advice is to be found on this web site –

https://www.nhs.uk/conditions/coronavirus-covid-19/

Worldwide Status

Information about the status of the virus worldwide can be found on this web site –

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

United Kingdom Status

Information on the current spread in the United Kingdom, which is updated daily can be found on this web site –

https://www.gov.uk/government/publications/coronavirus-covid-19-number-of-cases-in-england/coronavirus-covid-19-number-of-cases-in-england

https://www.arcgis.com/apps/opsdashboard/index.html#/ae5dda8f86814ae99dde905d2a9070ae

Hand washing Video

This is one of many videos available on the internet and uTube –

https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/

Posters from Public Health England

https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources

Robert Campbell 11 March 2020

(23)

Is your Practice still viable? Are you getting approaches from other Practice to join forces? Are you experiencing problems engaging new doctors and replacing retirees? You may have a whole series of problems.

Here is a scoring system that may help you decide your next step. Are you going to survive. What do you need to put right? This scoring system based on a real experience may put you on the right track!

(21)

Coronavirus – Preventative Steps

The most obvious and prominent advice being given from all quarters currently is to constantly and thoroughly wash your hands and encourage mask wearing for all face to face contacts as well as keeping your distance.

There may be some preventative measures that you have not considered. Take a look at this list.

a) Is there a dedicated Isolation Room in your surgery, which can be constantly cleaned rather than just placing people in the only empty room available?

b) Is there a generous supply of hand gel dispensers scattered about your surgery?

c) Are regular arrangements made for the cleaning of handrails, door handles, and for checking and cleaning toilets.

d) Do you have separate toilets for staff to use? 

e) Is there a regime of disinfecting telephone handsets?

f) Are there sufficient mobile telephones available if contact away from the surgery is necessary? 

g) Can the clinical system be used off site? If not, why not? It does seem that some Practices are more savvy on IT issues than others.

h) Can you instantly lock down surgery entrances to prevent access? 

i) Does the reception counter have a glass safety screen?

k) Can you immediately isolate patients with symptoms?

j) Are you encouraging patients to use online services for repeat prescriptions but not for appointments?

k) Do you provide either an online messaging service or email address for patients to use? 

l) Have you spaced reception seating at a social distance? 

J) Do you have an intercom system installed at your main surgery entrance?

K) Can Patients post a repeat prescription request using an external letterbox?

I am sure there are more ideas for preventative measures.

Revised 10 March 2020

(18)

Yes, patients do and Practices like anyone do not like complaints. GP Practices these days are expected to handle and process their own complaints. Practices should have clearly defined procedures to deal with complaints and it should not be too difficult for them to find out how to complain by look at either the Practice Leaflet or Practice web site.

The Trouble is……

Patients these days are quite savvy and they know how to cause problems. They can look at the NHS Web site and add a few choice words anonymously to comment on their experiences at the Practice. They also have access to the Care Quality Commission and can report a Practice with or without grounds.

It’s best not to ignore complaints!

Having said that in over 50 years working in the NHS both as a Complaints officer with an FPC and in general practice. To be honest the number of complaints received each year compared with the number of patient contacts is infinitesimal. In fact, I recall struggling to gather and report annually on complaints dealt with by my surgery let alone find any learning points.

Sorry is not the easiest word to say

Saying sorry is such a way that there is no admission of fault is not easy. Showing empathy band understanding is a start. Giving a clearly worded explanation is the next stage and showing how the Practice might take on board or improve as a result of the complaints might provide some resolution.

Keeping a Register

Keeping a register of complaints for the Practice generally and for each individual GP is a wise move. Complaints might also be split into clinical and non-clinical. The register should show the name of the complainant and or patient. It should show the names of persons complained about. It should then detail the stages of processing the case. It might include acknowledging the complaint, responding formally and receiving further comments. It record the dates of meetings or telephone conversation. There should be a summary of the complaint along with the response or resolution. It might need to record any appeal internally or externally. It might also need to record details of any other bodies or persons involved not associated with the Practice.

A Professional Response

The long and short of it is that it is all time consuming. It needs to be dealt with professionally and in my opinion not just left to a GP to answer his or her own complaints. It is also important to consider whether a complaint is valid. The issues raised may relate to the GP contract and the terms of service contained therein to do with the treatment and care provided for a patient. Was the treatment and care provided within the realms of what might be expected from a GP or was the skill and knowledge that would be required be more appropriate to a fully trained and experienced consultant. Is the GP actually responsible for the treatment and care provided or is someone else. These days the responsibility is not 24 hours.

Another area to check is whether the complaint is timely – when did the event that gave rise to the complaint occur or when did the complainant become aware of its relevance – there are and need to be time limits. In addition if the complainant is not the patient does that person have written consent to complain on behalf of the patient. Clearly anyone can complain when a patient has died although it would normally be a relative.

Practices should have a Practice Complaints Procedure which is available in written form. It is not sufficient to simply say contact our Practice Manager. The procedure should set out all the conditions attached to making a complaint and give a timetable for processing the complaint. Going quiet and not replying is not an option. I fail to understand why some Practices fail to respond to complaints made on the NHS Choices web site. No response does not look good and will be picked up by CQC Inspection.

(19)

Nine Years On

It’s now nine years since I formally retired as a full time Practice Manager although even this year I have been drawn back to work in a Practice ‘helping out’. Nowadays I am more of a user of NHS services and start to question even more and more the quality and standards of the services I am offered added to that the expense!

Hospital Referrals

I was referred earlier in the year for a second operation on the same site in two years. The referral and process to a first hospital appointment were prompt only to be let down by ridiculous waiting lists that caused undue distress and major expense. The referral for an ultrasound was efficient and prompt with a 15 mile trip to a remote village surgery where the equipment had been transported in from Blackpool. The results were clear an operation was needed and an E-referral was made on the NHS but to a private hospital. This involved a train journey and long walk to the hospital and an examination which can only be described as cruel and extremely painful. I took an instant dislike to the consultant.

Pre-Operative Assessment weeks before operation

I was invited for a preoperative assessment the following week in late April which I attended (50 mile round trip) after which I received an operation date in June. Considering the pain I was already suffering I was astounded. I could not quite understand the decision to carry out a preoperative assessment over six weeks before the operation. As a layman I did not consider this good practice.

Private Hospital versus NHS Hospital

I contacted another private hospital in the same group was was offered a consultation with a consultant the next day and an operation the following Saturday – 11 May. It made a big £4,000 hole in my pocket (and pension) but to me the pain was a deciding factor. The operation was carried out and at the end of the year I am more comfortable and in far less pain but suspect that I will never be in perfect health.

Now Waiting Lists to see or speak to a GP

In general practice again I find myself lucky if I speak to a GP on the morning of the request. It’s rarely the same GP and I feel there is much repetition and little continuity. A member of my family was offered a telephone consultation in a weeks time. I find too that there is a drive to change medication and alter repeat medications not always to the benefit of a patients health. I have also witnessed a case of a drug being refused in writing only to find a text message from the pharmacy to collect said refused prescription. Has general practice actually lost the thread. So wrapped up in meeting targets can it no longer see the light at the end of the tunnel.

March 2020

(12)