PPG: Questions and Answers

Q1: What medical training has a receptionist had to enable them to know when a patient does not require a medical practitioner? Many patients are concerned eg prior format

Receptionists do not have medical training but all receptionists have care navigation training as encouraged by NHS England. This helps manage workflow in the practice to ensure people see the right person first time.

Q2: Non confidentiality at the receptionist desk when patients are talking to the receptionist . All in the waiting area can over hear the conversation. Are receptionists made aware to advise Patients there is a side room they can go into for privacy. This side room was especially made for that purpose.

There is a notice informing patients that the room is available for use should they require it, most patients if they need a confidential conversation they will call rather than attend in person.

Q3: Concerns from patients regarding disclosure to admin staff of private medical information given to GPs when using Doctrin. Can this be addressed?

All our staff are subject to same confidentiality agreements. Admin staff need to be able to access information to complete referrals, follow-ups. If you have an example of a problem that has arisen please let us know. All DOCTRIN cases are received into an administrative waiting room and allocated to the most appropriate person – this is no different to a call being handled by the reception team.

Q4: Patients have placed a concern about non urgent appointments not being given due to failure of first come first served system.

Our appointments are a mixture of pre-bookable and on the day

Q5: Again more concerns about the word abnormal test results then a comment saying no actions. Why is this ?

Many chronic health conditions will result in abnormal numerical values on blood tests. Tests demonstrate the impact of the disease on the affected organ, tissue or cell. Type 2 Diabetes Mellitus is a good example. We monitor disease progression, efficacy of medication using glycated haemoglobin, expressed as HbA1C. In all type 2 diabetics I expect their HbA1C to be above 48, abnormal (above normal reference range) but expected because of the patients condition, type 2 diabetes. Those with type 2 diabetes whom have managed illness with medications and or diet and lifestyle changes may have a HbA1C reading lower or in the normal range a condition called Type 2 Diabetes Mellitus in remission, this a clinician may file as normal. We would file as no action required if patient is on all correct medications, personal diabetic plan is up to date and that numerical is best result for patient. Another good example is renal function monitoring where a patient has a diagnosis of chronic kidney disease (CKD). If CKD is known, renal function numerical values are above normal reference range, again, this result would be filed as abnormal but expected. If a patient is on correct CKD medication, then there is little or no clinical input at this time, hence no further action for this abnormal but expected result. Acute conditions, infection, positive or abnormal but expected urine culture where a patient is on correct antibiotics already, will be filed as no further action as treatment is in place. Polymyalgia rheumatica where we track an inflammatory test, ESR, to monitor steroid efficacy and disease progression will be elevated, if on correct treatment then no further action is required.

Q6: Some patients NHS records show that they have been informed of results and diagnosis by the Practitioner when they have not. Please can this be explained and addressed ?

It would be really helpful to have a specific example that could be followed through to answer this fully.

Q7: Patients who turn up at the Surgery quite poorly are being sent to Corby Urgent Care despite Practitioners being available at the Surgery surely there is a duty of care by Oundle Surgery

The duty doctor may already at capacity and if it is urgent they may also need diagnostics so on a case by case basis this may be best for the patient.

Q8: A number of patients are being alerted to being Pre Diabetic when no blood tests have been given . Why is this happening?

Pre-diabetes is a condition where the medical coding vocabulary has been updated in recent months. NICE and NHS QoF guidance and targets have moved from the phrase of impaired glucose tolerance or impaired fasting hyperglycaemia to Pre-Diabetes. We have subsequently applied new codes to medical records with previously labelled condition or unlabelled on previous blood tests results, the HbA1C. All patients with condition of Pre-Diabetes are eligible for review, assessment then support through National Diabetes Prevention Programme (NDPP). We have actively shared NDPP invitations with those eligible recently. HbA1C blood test is often included during health checks, those with cardiovascular disease, renal disease, i Inflammatory conditions, certain medication annual monitoring when annual review is completed. Thus test is being completed in some without awareness of a diagnosis of Pre-Diabetes of Diabetes. Both conditions, Pre-Diabetes and Diabetes may present without symptoms, crucial to include this test for this reason.

Q9: Many patients are concerned they cannot communicate with their named GP who is responsible for the over sight of their care. Is there a reason for this.

Please can you clarify what patients need to communicate? If it is a general query then it can be handled by available members of the team./p>

Q10: Patients particularly from villages east of Oundle have traditionally been referred to Peterborough Hospital and other venues in the city. If these patients have to go to Kettering and Wellingborough this would involve a trip of around 47 miles. It would be difficult for carers and family visiting and supporting patients. Does the Practice have the same relationship and communication with Healthcare in Peterborough as in Northamptonshire. If so will this continue in the foreseeable future.

Since NHS England moved Oundle to the Northamptonshire Integrated Care system, some pathways have changed. We do still have communication with the Peterborough system but not all pathways are through Peterborough now. Specific examples should be taken up with the Integrated Care Board. Generally patients still have a choice of where they wish to be referred for secondary care.

Q11: Blood tests : How do patients access blood tests at the Surgery . All venues on line involve a trip of between 20 and 40 miles further for those villages to the east of Oundle. Will funding and staffing be available for adequate staff to do blood tests at the Oundle Surgery and if not , why?

We now have 2 new Healthcare Assistants who have received the necessary phlebotomy training and are now able to take blood. If a patient tells us they are not able to travel to the KGH sites then they will be offered an appointment at the surgery. The ICB commission KGH to provide a phlebotomy service for patients registered with a Northamptonshire GP surgery

Q12: Why are carers requested to register. Is there a reason for this, what are the benefits and what does the Practice do with the information

If we know that someone is a carer then we can help support them in their caring role, this may include offering them a Flu or Covid vaccination, help in referring to the various Carers support groups or just being able to discuss medical issues on behalf of the person they are a carer for. Carers don’t have to register and any patients that have a carer don’t have to tell us that they have one, but without knowing that someone is a carer we cant offer them the additional support.

Q1: Please could the front desk be manned during opening hours as patients have noticed some of the time it is empty . It has made a big difference to patients having a greet and meet.

The reception team will man the desk at certain times of the day, usually the busy periods. Our priority is to answer the phones and ensure we are dealing with the calls in a timely manner. Putting someone on the front desk at all times would delay us in answering these calls. We are looking at having a phone at the front desk once we have recruited to an administration role but this also brings issues of confidentiality as there is no sound protection or screen. Patients can ring the bell for attention.

Q2: Patients have expressed that some of the time data on the records are not accurate . Example. Communication has not been received from the practice to the patient but it is listed patients have been informed why is this ? Who is responsible for putting this information on System on Line

This would need to be investigated on a one to one basis with the patient as there are many people who add to the clinical record. We would ask anyone who feels something on their record is inaccurate to contact us and arrange a meeting to discuss this further.

Q3: Why does the Practice close on Bank Holidays . Many patients expressed concern that this could increase overload on working days. Is there a reason for the closure

National Bank Holidays are set by the Government and all GP Practices are not contracted to open on these days. As practices we prepare in advance for opening after a bank holiday by ensuring appointments are restricted to on the day urgents in order for us to manage the increased workload.

Q4: Patients have expressed their waiting times to see a doctor has been beyond 40 mins , a suggestion has been given by these patients perhaps a text could be sent out to them if a long delay is occurring before they arrive.

Clinicians can run late sometimes due to some complex patients needing more that their 10 minute appointment. Patients are asked to make double appointments if they find they have more than one problem to discuss. However there are times when the duty doctor may be need to deal with another urgent issue, such as a call from the ambulance service. The clinicians at the surgery always try to run to time, however patient care is absolute priority and if needed they will have to deal with them for a longer period of time. However we do need patients to attend at their normal booked appointment time.

Q5: Is there a qualified Doctor at the surgery during opening hours ?

There is normally a doctor on site during opening hours. There may be times when the doctors are out on urgent home visits but we are always able to contact a doctor and there are a number of other clinicians on site.

Q6: Patients are being offered postnatal telephone consultations when they would prefer a face to face appointment is there a reason for this ?

Patients are offered choice of telephone or face to face appointments – if an individuals feels this wasn’t offered, please can they contact us.

Q7: Patients are concerned unqualified staff are directing their care . Can they be reassured all receptionists have the necessary training and this is not happening

Our reception team have all the relevant training needed to ensure we are signposting patients for help when needed. Nationally this is encouraged as there may be other staff other than the doctor can help the patient and get advice more quickly.

Q8: Patients have been advised to chase their own results from Consultants could this be explained.

It is the hospital’s job to provide results for patients. Practices are not contracted, nor do they have the resources to be able to chase individual hospital results for patient. The Clinician who orders tests for patients are responsible for the results and how they manage these or how they are communicated to their patients.

Q9: An Oundle patient was contacted from Peterborough Hospital about an urgent hospital appointment which they knew nothing about. Totally confused they contacted the hospital who confirmed it was an urgent referral from a Doctor from Oundle Surgery. On investigation it was found two patients with the same name. The Doctor had forgotten to put in their date of birth causing confusion . The patient who was contacted by the hospital was concerned that the correct patient did attend the urgent referral . Also a worry about confidentiality about a patient is at risk. Hopefully this has been addressed to the appropriate staff and training given if necessary.

Unfortunately we cannot comment on individual patient concerns. However can reassure you that all concerns are taken seriously, reported appropriately and investigated with learning outcomes shared with the team and improvements made to ensure doesn’t happen again. Please can you encourage the individual to contact us so we can look into their concern properly.

Q1: What number does the Patient or relative call for a First Responder ?

The number the patient rings for the first responder is 999. The First Responders are dispatched by the East Midlands Ambulance Service Emergency Operations Centre and patients are not able to contact them direct to book or request an ambulance..

Q2: Has the practice got all records for all patients dating back to their childhood, for example a record of infectious diseases and vaccination record ?

The practice will not necessarily have this information for all patients for all records. This will depend on how old the patient is and whether these records actually existed in the first place. We will have this information if it has been shared with us from a previous practice or if we have recorded this information.

Q3: Please could a “befriender” system be set up to help patients navigate Doctrin or any form of communication with their practitioner.

The reception team are more than happy to help any patient where they can. Are there particular areas of Doctrin or particular areas of communication patients are struggling with as a set of instructions could be put together and shared with patients if the practice knows which specific areas patients require help with. If this is general help across all areas, then the reception team help and navigate where they can to the best of their knowledge and ability.

Q4: Please could the PPG, How to contact and join us, be added to your phone messages ?

Patient feedback is that our telephone messages are too long as they are currently but it is very easy to add a recorded message about the PPG whilst the patient is on hold if patients are happy to hear this message repeated over and over.

Q5: Please can the practitioner contact a patient on receipt of an abnormal blood result.

The reception team are asked to contact patients on the instruction of the clinician. The clinician will contact the patient as and when they deem necessary, otherwise this is tasked to the receptionist – this is due to the capacity and workload of the clinicians.

Q6: Is a red flag system used to contact patients for on going monitoring and management ? EG Hypertension, Diabetes etc.. Does the practice contact patients to remind them for blood tests and check ups?

The system that is in place to contact patients for on-going monitoring is called our recall system and yes it is in place. Patients are contacted when the necessary tests and check ups are due and are required.

Q1 - Staff Training: Follow up by Gill regarding CB monitoring patient phone calls. Has any customer service training been undertaken for reception staff? E.g. how to respond to anxious or upset patients with empathy and concern. Is the new HR person doing this?

Unfortunately, there has been no capacity for me to monitor phone calls recently due to my workload. A meeting has been arranged with the reception team to address recent concerns raised about “customer service”. The new talent Business Manager is based in Corby not at site.

Q2 - Phone Systems: Are still a major cause for concern. Why are appointment calls only allowed at 8 and 12? Due to high volume, would it be better to allow calls throughout the day? Also as the system relies on the internet, are there contingency plans should the internet fail?

Patients can telephone for an appointment or contact the surgery at any time of the day between 8am – 6.30pm. Our appointments are released at 8am and 12pm. We have contingency plans in the event of a telephone system outage.

Q3 - Advance Appointments: Is it possible to have a F2F consultation with a GP of choice by booking in advance and if so what is the procedure? Bearing in mind that some patients will want to see a female GP and vice versa?

Contrary to recent statements by members of the government and the unhelpful coverage in some sections of the national media, GP practices are not contractually obliged to offer a F2F appointments ‘on demand’. As has been the case since before the pandemic, face to face appointments are offered to patients where it is deemed clinically appropriate. The measures implemented to keep patients and staff safe during the pandemic have increased awareness of this model. Due to the limited number of GPs and clinicians working each day due to their contracted hours, patient choice is limited but we will accommodate a request for a female or male GP as best we can with the clinicians available on any given day. This is the case for the vast majority of GP practices across the country.

Q4 - Face to Face Appointments: This is still a major concern for patients who feel they should be seen by a doctor leaving many patients feeling extremely frustrated. What is the practice doing to increase the number of face to face consultations for those who prefer or request a face to face appointment?’ Is it possible to do this and if so what is the procedure? What can we as a PPG tell the Oundle patients?

The workload faced across the NHS since the relaxation of COVID restrictions earlier this year has increased hugely. Even before this, demand outstripped capacity in general practice across the country. Like every other practice in the country, Oundle is subject to the pressures this creates and has no additional resources or funding to meet these challenges. We therefore focus on care models that enable us to effectively create as much capacity as we possibly can with the available resources. If the practice increases the number of F2F appointments this will decrease the total number of appointments available each day as the vast majority of face-to-face appointments last significantly longer than other types of appointments. Moving to a ‘face to face first’ model would mean the vast majority of patients would have to wait even longer for an appointment. In line with the guidance provided by our Local Medical Committee, we will continue to ensure patients are being seen F2F if the clinician feels it is clinically necessary. We do offer patients the option to book into our Saturday clinics in advance. Doctrin can be used to access the surgery and as patients using Doctrin provide the majority of the information required by the clinician via the system. This means face to face appointments required for patients who have accessed the practice via Doctrin are usually shorter because the clinician already has much of the information they would otherwise have to gather as part of the face to face consultation. A higher take up of consultations such as Doctrin or providing more details during the initial call is likely to lead to shorter consultation times which will increase our ability to offer more appointments.

Q5: Will the COVID induced practice of sending photos of conditions, for analysis by practitioners be stopped or continue going forward?

Sending photos into the surgery is not a COVID induced practice. This existed prior to the pandemic but was used less than is now the case. Patients have, in the past, been requested to send in photos when clinicians have requested them. This process will continue in line with NHS guidance on the use of digital consultations.

Q6 - Doctrin: There seems to be a fair amount of confusion on how to access/use this system. Can you please explain how it works? There seems to be many positive comments on it on Oundle NextDoor so far from those who have successfully managed to log in

Doctrin is an online digital consultation and is available to anyone who has access to the internet. It is accessed via our website and patients need to sign up to the NHS app in order to use it. It asks a series of questions and the questions are reviewed appropriately. Our contract with NHS England obliges us (and all GP practices) to offer 25% of our access digitally. Doctrin is not intended for the non-tech savvy – it is merely an additional route through which patients can contact us - but it will potentially free up our telephone lines and appointments for those who are not able to access the surgery in this way.

Q7 - Flu Jabs: How many patients will be given the flu vaccine this year at the surgery?

Over 65 approx 1,500 Under 65 approx 1,000 As with all GP practices, we have to order our vaccines 11 months in advance of the flu vaccination season. As such when we order we do not know which patient groups will be eligible and we are unable to amend or return orders. We expect a national pool of additional vaccines to be made available in late November so may be able to order additional supplies if sufficient numbers of our registered patients remain unvaccinated.

Q8: Is it possible for the PPG to have a tour of the Practice to gain a better understanding of how it operates. E.g. See how the phone systems work etc. We feel this will benefit us greatly.

Yes of course I am happy to arrange a tour for any member of the PPG This will need to be at times / dates that are convenient to the practice.

Q9 - Patient Question: Following the decision to move Lakeside Healthcare GP practice at Oundle into North Northamptonshire Integrated Care System next spring, does this mean that referrals for specialist care and clinics will be to Kettering General Hospital or Northampton General Hospital or will Oundle patients still be able to be referred to/elect to see specialists and attend clinics at Peterborough City Hospital and Addenbrookes, Cambridge?

The system is still being “tweaked” so we can address this hopefully with our telephone provider. We are also awaiting Dr Newell to record the opening messages.

Q10 - Q and A Sessions: Can Treeview please ensure they put the Q and A meeting dates / Q and A records on the website and keep a copy of each session as per the PPG Minutes.

I will ask TreeView to ensure they add the Q and A information to the website and keep a copy of each session.

Q11: Are GPs working from home?

All our GPs are working from the surgery as they always have done and are not working from home. This has been the case throughout the whole of the pandemic, unless they were self-isolating. This only applied to 2 of our GPs at the beginning of Covid.

Q1: Are GP’s informed of patients discharged from hospital and a visit/ follow up programme of care implemented? Please explain the GP’s process of care after discharge from hospital if there is one. To enable feedback to patients.

Hospitals send a discharge letter to the GP. These are not always in a timely manner unfortunately. The actions are taken and the correspondence is filed on the patient’s record. Not all discharges require a visit/follow up. This discharge letter will detail any actions for the GP/pharmacist.

Q2: Does Oundle Lakeside have a Private service? If not why is there a comprehensive list of services and prices on the website. Please clarify.

Some services are classed as non NHS contracted core work & are therefore chargeable. We do not offer a private GP consultation service.

Q3: Is there always a General Practitioner on site at Oundle medical centre during opening hours?

Yes there is always a clinician on site.

Q4: Why are the working hours of the Practice GP’s not extended to reduce waiting times for patients to see a GP?

The GPs working hours are contractual.

Q5: Can the practice issue GP/nurse Practitioner availability weekly on website and four weeks in advance so that patients can book appointments in advance to see their personal/preferred GP?

GP usual working days are visible on the website. We are looking to reinstate online booking in the near future to help with access.

Q6: Discuss the NN Journal Article about GP access in Northants. We are aware it is a recurring theme nationally. Can CB tell us how long each virtual appointment takes compared with a F2F? Why do some surgeries appear to see patients and have done so for most of the pandemic? Is it that a lot of surgeries now have part-time medics i.e. 3½ days a week? Read the NN Journal article

We have continued to see patients F2F for the whole of the pandemic where clinically necessary and appropriate.

Q7: Who monitors patient’s records and ensures continuity of care? Please explain level of access from staff?

All members of staff have access to medical records.

Q8a: Open letter to patients on Practice website. Are there any plans to change to make it more receptive to patients?

This has been updated with the suggestions given at the previous meeting.

Q8b: Practice Plan timeline for reopening reception?

The reception desk is open. Patients are still required to wear a face mask and socially distance

Q8c: Latest information on new telephone system implementation/staff training?

New telephone system has been implemented. There have been some teething problems which are system not site related which are still being addressed. Staff training is complete

Q8d: Test results – In event of abnormal test results does a nurse/GP contact patients directly? Website states ‘it is your responsibility to check them and make any necessary follow up appointment with the doctor”

All results are viewed by a clinician. It is usual practice to mark normal results as normal – no further action. These are then filed within the patient’s medical record. Patients will not be contacted to advise of a normal result. Receptionists are usually asked to contact the patient, by the clinician, if any results require a follow up conversation.

Q8e: What percentage of patients have been seen face to face by the GP’s?

As an example - There were a total of 81 patients seen face to face on the 11th May - 21 were seen by the GP/ANP team - 60 were seen by a nurse or HCA

Q9: Feedback new telephone system. When you call the Surgery there is a silence on the line of about 7seconds. Is it possible for the voice recording to come in earlier as it is disconcerting for such a long silence?

The system is still being “tweaked” so we can address this hopefully with our telephone provider. We are also awaiting Dr Newell to record the opening messages.

Q10: We understand that Corby surgery have 5 Social Prescribers. Are there any plans to increase the number at Oundle?

These are PCN funded roles and our allocation is based on patient list size. Corby are 5 times bigger than us. No plans to increase the number at present

Q11: Are patients being recalled for annual check-ups? E.g. Blood pressure, cholesterol, blood sugar levels? Does the computer system have an automatic flagging system? Please explain the Practice’s Preventative care programme

Our recall system captures these patients via regular searches. We also use a risk stratification tool to ensure the most at risk patients are monitored appropriately.

Q1: Open letter to patients on Practice website. Are there any plans to change to make it more receptive to patients?

I am happy to update the wording with your suggestions – I am really sorry I haven’t had chance to do that yet but I will make sure that I do.

Q2: Practice Plan timeline for reopening reception?

The new flooring should be finished by tomorrow (fingers crossed) and I am hoping we can reopen the reception desk on Monday – but I can’t confirm this until I know the flooring is completed to the required standard. I will let you know as soon as I can about a definite date.

Q3: Latest information on new telephone system implementation/staff training?

The new telephone system went live yesterday! There have been a couple of teething problems but it all seems to working well so far and the staff who are not on leave or on a day off have received training.

Q4: Test results – Is it possible for a nurse/GP to contact patients directly?

I have asked the GPs to give more detail when they send a task to the reception team about sharing tests results with patients – I am happy to discuss this in more detail when we next meet.