Questions often asked by patients and answers from the Randolph Surgery

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1 Questions often asked by patients and answers from the Randolph Surgery 1. Why does the Randolph Surgery insist that everyone over 40 (or anyone who requires prescribed medication under 40) has a comprehensive health check when they register to be a patient with the practice? We believe this is the most efficient way of assessing your current state of heath, your risk of preventable conditions such as heart disease and diabetes, and recording your family history and own medical history. It means we have all this information from the first time we meet you and enables us to make sure you get seen by the appropriate health care worker (GP or Nurse) if there is an immediate health concern. It also means that we don t have to wait for your previous medical records to catch up with you (which can take many weeks). We offer early morning and late appointments to fit in with work and home life for these appointments, and our Nurse Jo conducts the appointments. When these appointments are booked weeks in advance, some people didn t bother to keep them and appointments are wasted. They are usually booked one or two weeks ahead. We regularly review our capacity to look after new patients safely. 2. What does telephone triage or Duty Doctor mean? The Randolph Surgery GPs take it turns to provide a daily telephone triage service from Monday to Friday. If patients call during our daily telephone triage sessions (8-9.15am, pm), the Duty Doctor for that session will call the patient back on a dedicated mobile phone line within 45 minutes. Patients are invited to use these times to request telephone advice, to review regular medication, to discuss test results, and to review specific issues that they may have already seen a GP about. Calls will be taken at the end of the day too, but the wait for a call back cannot be guaranteed at the end of the day the Duty Doctor will call you as soon as they can before closing time. If the GP feels a patient should be seen quickly, they will offer a face to face timed appointment for that day, or they may decide that a routine appointment is needed. The system allows us to prioritise each patient according to health needs, and makes sure the most appropriate type of appointment is booked if one is needed. We use the term triage because it means we can direct each person to the best place for their care and sometimes it means the patient might actually be directed to the local Minor Injuries Unit (St Charles Hospital, Exmoor Street, W2) or Walk-in Centre (Half Penny Steps Health Centre Harrow Road, W10 tel: ). 3. How can I order a repeat prescription and why are some items such as contraception or hormone replacement therapy not included in this system? Repeat prescription requests are accepted in writing (by post, handed in or faxed) but not taken over the telephone. Verbal messages results in errors being made too easily. We ask that patients give us 2 working days to process repeat requests, although the vast majority will be processed on the same day. If there are queries about the request this allows us a little more time to sort them out. The receptionist may have a message for you about what information is required. If your repeat prescription item carries a note saying Please see GP to order more it means you may be due to have blood tests and/or a blood pressure check before we can issue any more tablets safely. We take prescribing safety very seriously and do not over-ride this process. Sometimes we simply want to have the opportunity to review your medication and make sure it is still working or still needed. Hormone treatment always requires a 6 or 12 month blood pressure and weight review so these items are only issued after a review with a GP or Nurse has taken place.

2 4. How does the appointment system work? We offer three sorts of appointments: (1) emergency appointments; (2) same day appointments and (3) advance appointments. Emergency Appointments: these are for things that really can t wait, for example abdominal pain, a bad infection, a severe headache, a pregnancy problem, an unwell child etc. They are arranged by first speaking with the Duty Doctor during their telephone triage session (ideally between 8am and 9.15am, or between 2pm and 3.15pm). If the Duty Doctor agrees that you do need to be seen in an emergency slot, they will book you into one within a few hours (usually between 10am and 11.30am). Same Day Appointments: these are for things that people feel they would like to be seen quickly. To book one of these appointments we ask that you call (or come to the Reception desk) at, or any time after, 8am. The receptionist will ask you what you would like to see the GP about, and if it would be better to have you prioritised to the emergency system, the receptionist will arrange this for you. The same day appointments start from 9am and are spread throughout the working day. You may be lucky and manage to get hold of one by calling later in the day, but they tend to be booked up quite quickly, so our advice to you is that you call sooner rather than later. These appointments won t always be with the GP of your first choice, but we try and accommodate these requests as best we can. Advance appointments: these can be booked at any time and don t require an early morning call. If you know you need to see a GP within the next few weeks, then it s best to be organised and try and use one of these appointments. In addition, this is the best system to use if you want to guarantee seeing the GP of your first choice. The number of appointments we offer in any one week is not infinitely large, and we hold back a proportion of appointments every day for Same Day appointment slots; the remainder are left free to be booked up whenever requested. In general the next available advance appointment is 7-10 days ahead, and we have a good spread of appointments throughout the week. However, when a GP is away, their next available bookable appointment may be 2-3 weeks away. Please remember you can cancel any appointment by text: cancel, your name, date, time to Why can t I book an appointment on-line? The Randolph Surgery does not yet offer an electronic booking system that enables patients to book appointments from their own computers. Our intention to introduce such a system has had to be postponed until the roll-out of a whole new software computer system which will be happening across the whole of the Central London Clinical Commissioning Group is completed. This is likely to be by the end of 2014, and once we are confident the new system works, then we will be adopting an online appointments sytem. We have discussed this with our Patient Participation Group over the last 12 months and our recent patient survey suggests it s a service that our patients would welcome once we are all satisfied that it is safe and effective to roll out. 6. Why are some of my regular medications being changed? The Randolph Surgery is committed to prescribing the most cost-effective medications available for all our patients. From time to time, as pharmaceutical companies improve their tariffs or as medications come off patent, it makes sense to make changes. It doesn t happen very often, but when it does we will write to you explaining the need for the change and how we will monitor the new medication.

3 7. Why aren t all GP Surgeries organised in the same way? NHS General Practices are run as small businesses and are contracted by the government to offer medical services to their registered patients. As long as we fulfil the terms of our contract, each surgery is left to organise itself in which ever way best serves its patients, whilst still supporting the organisation. There are no rules and we believe our current structure is an innovative way forward and better enables us to meet all the NHS changes ahead of us, whilst ensuring that we maintain stability and probity in an increasingly uncertain world. 8. Why doesn t the Randolph Surgery have a practice manager? Several years ago we underwent a comprehensive staff re-structuring. NHS General Practice is becoming ever more complex, and for the size of practice we are we felt that the one size fits all approach no longer applied to us. We now have a Practice Administrator, a Financial Administrator, and a Clinical Co-ordinator, as well as a Head of Reception. The two Partners manage all the employees directly. This has significantly improved the way our organisation functions and this whole team approach feels safer and more confident. 9. How can we let you know if we re unhappy about things or have suggestions for improvement? We have a suggestion book at the front desk which we invite you to use. If you d like a personal response, please leave a contact telephone number. We invite patients who wish to complain when they feel things go wrong for them to write to the Partners, because we feel that if and when things go wrong, the Partners can take action quickly and make appropriate changes. Our relationship with patients depends hugely on you letting us know if you are unhappy about anything. Anonymous negative messages posted up on public websites are probably the least helpful way to communicate and leave us feeling depressed. 10. What does GP Commissioning mean, and how does it affect me? The current government believes that GPs are in the best place to know what services their patients need and therefore best placed to commission such services. GP Practices are now required to work in geographical clusters and for these clusters to take on the responsibility for holding contracts with local hospital and community services and for holding large budgets which pay for all aspects of hospital care. The government has already dismantled the Primary Care Trusts which were previously the overseers of service commissioning, whilst the new structures are still evolving. The Randolph Surgery is a member of Central London Clinical Commissioning Group (CLCCG) and we are in the North Locality. Patients can involve themselves both at the cluster level ( or at practice level by joining the Randolph Surgery Patient Participation Group. It remains to be seen whether the government s imposed changes reap benefits for patients. 11. How can I make sure my views about services at the Randolph Surgery are heard and how can I make sure no decisions are made for me, without me? It s simple come along to a Randolph Surgery Participation Group meeting and make your voice heard. We meet every 2 months on a Monday evening for one hour 7-8pm. For details of the next meeting please ask Maxine Carter, Head of Reception, at the Randolph Surgery. 12. Why are GP appointments only 10 minutes long? Government guidance is that NHS GP appointments are 10 minutes long. In reality as many of you appreciate its is sometimes impossible to keep to 10 minutes and at these times the GP will either give a little longer to ensure that something that s very important to patient or the GP is

4 covered safely (with the results that the GP runs late) or the GP will ask a patient to choose just one or two things they want to raise now, and to rebook another appointment. We are contracted to provide a specific number of appointments per week for a specific population size, worked out with a national formula, so we cannot book double appointments without it impacting unfairly on appointment access for the whole of our registered patient population. 13. Why can t I always see the same GP if I want to? The short answer is you can, as long as you are prepared to wait for the next available appointment with them. Remember that not all GPs work every day at the Surgery so the waiting times vary. Emergency appointments are dealt with on a strict rota shared out by the GPs so patients have to be prepared to see which ever GP is on-call for the emergency appointments on any particular day. 14. Why does it appear that the Randolph Surgery is inflexible in terms of times to call, or times by which patients have to have called for various things? The Randolph Surgery offers a telephone triage system (see question 2) and we can only provide this by making a GP freely available to take and make telephone calls. These dedicated sessions are offered over and above routine appointment times and are being offered over and above our contractual requirements. We think (and know from our patient surveys) that it s a much valued service so in order to keep providing it, we ask that patients call at specific times during the working day so the Duty Doctor can make the calls, still see emergency patients and still go out on house calls and complete all paperwork. It also means that we can arrange for staff cover to be greatest at the times when the phone lines are busiest. Without such a system, the Surgery would be in chaos and there would be no way to prioritise the needs of patients safely. When phoning for test results we ask that patients do not call first thing in the morning because that is the time that most people call for emergency medical advice and emergency appointments. In addition, the pathology results are sent electronically by the hospital midmorning. If the GP is to be able to read the results and decide what message should be left we ask you to call to discuss test results in the triage session that runs from pm 15. How do I access the Practice Counsellor? Patients can ask to be referred the Counsellor by consulting one of the GPs, or the GP may suggest a referral might be helpful. If you want to access one of the two cognitive behavioural therapists (CBT), patients can either self-refer or be refereed by a GP. The difference between the two different services can be discussed with a GP too. 16. Can I go to the hospital of my choice? If a GP refers you to a specialist, then in theory you can choose which hospital you attend. However, if your medical problem is one for which you have been under a specialist before, or is related to something you ve seen a specialist about before then for the sake of continuity of care we urge you to choose the same hospital as previously attended unless you have a specific reason not to. Your hospital records stay within the hospital and cannot be sent from one hospital to another. Specialists are not enthusiastic about seeing patients who ve had previous investigations elsewhere and will discharge you suggesting you get referred back to the original hospital - wasting your time, their time and other precious resources. 17. Why does the Randolph Surgery use an 0844 number? We changed to an 0844 telephone number when we expanded our telephone triage service and required a telephone queuing system. This replaced the engaged/ not engaged service we had before which would not allow us to deal with the volume of calls we receive. Our 0844 number is

5 not a premium line number, and the cost of any call to us is the same as the cost of a landline call made from a standard BT line. We know that some people have individualised phone packages which make calls to 0844 numbers more expensive, so we urge you to call us from a landline if at all possible. The Randolph Surgery calls you back whether on a landline or a mobile line. Gone are the days when patients have to hang on to speak to us numbers have been reviewed and approved by the government. To call from abroad: Do you have enough appointments for your patients? The answer is yes. The number of appointments required is worked out using a simple national formula and we keep this under review as our list size changes over time. 19. Are you adequately staffed for your population? Yes. Part of our budget is set against staff costs and is monitored. We do what we can to manage our staffing budget. For example, replacing a single expensive Practice Manager with two administrators who between them do more than one person could do, is one way we ve found to optimise expenditure. The number of staff hours has increased with our patient population. 20. How do I access a private specialist? If your GP refers you to see a specialist you can choose to stay in the NHS or you can use insurance or pay to see someone privately. Insurance companies ask us to explain why the referral is needed and all referrals to specialists require a referral letter to be prepared by the GP. We do not offer private GP appointments we are purely an NHS practice 21. How can I get hold of a doctor when the surgery is closed? The best option is to call the surgery and if we are closed (overnight or at weekends) your call will be connected to the local out of hours GP service. They will give you appropriate advice or they may ask you to come in to one of their local clinics. Alternatively you can access care through the local walk-in centre Halfpenny Steps ( Harrow Road). We would suggest you avoid Accident and Emergency departments unless you have injured yourself or a doctor advises you to attend. If you call 111 when we are closed, you ll be advised which service to access in the case of a need for urgent care or advice. If you want a private urgent care service there is one available at St John and St Elizabeth Hospital in St Johns Wood. Please remember that none of these options have access to your medical records so waiting to get advice from us is possibly the best option if you can wait until the next working day. 22. Why don t you use with patients? communication is largely avoided within the NHS because it is not a secure nor a confidential method to use. Even between hospital and general practice we only use if we have access to the NHS system (a system not accessed by patients). If we were to anyone without an NHS address on a non secure N3 line about a clinical matter (however small) we would be contravening national Clinical Governance and Information Governance policy and could be penalised very heavily. The Randolph Surgery October 2013