Melton GP surgery reveals tough challenges staff are facing

These are some of the angry comments which patients of Melton’s Latham House Medical Practice regularly post on social media.

Of course, the pressure on the town’s only GP surgery has never been so intense, with the need for doctors and nurses to keep people safe during a pandemic while coping with their general patient workload.

And the task is further complicated with news we reported last week that the Sage Cross Street practice would have significantly fewer doctors available over the summer months, due to unfilled vacancies and staff absences.

As the Government relaxes most coronavirus restrictions this week and cases continue to rise in the borough and nationwide, we’ve been talking to Latham House this week about the latest situation there and what level of services patients can expect going forward.

GP partner, Dr Paul Atkinson, answered our questions and here is a flavour of what he told us:

Nick Rennie: What are the major demands on resources at Latham House since staff stepped back from giving covid vaccinations?

Dr Paul Atkinson: Prior to the pandemic general practice had already significantly declined due to decades of under-investment by consecutive governments. This meant that when the pandemic started there was less resilience than there should have been. During the pandemic we rapidly changed how we delivered services to keep patients, their family and carers, and our staff safe, whilst continuing to provide a service without ever pausing.

When hospitals had to close whole departments, general practices were left to support those patients with complex chronic conditions. The huge backlog means that general practice will remain busy for the foreseeable future. As hospital departments restart their outpatient clinics these are often done remotely, and they frequently expect general practice to support their work –for example arranging blood tests and scans, prescribing medication, arranging follow up, issuing sick notes – in addition to our own workload.

During the past year we, like many GP practices, have seen a significant increase in workload.

In Leicester, Leicestershire and Rutland the number of GP appointments since before the pandemic had increased by 54,000 (10 per cent) appointments per month.

This is all at a time when there has been an on-going significant decrease in the number of GPs in England.

NR: What are the current protocols for patients at the practice and will the social distancing and other Covid-19 safety measures remain in place now most national restrictions have been lifted?

Dr PA: At this stage we understand that there will be limited or no change to the guidance for primary care settings. The CCG state that patients must wear masks whilst in healthcare premises and infection prevention and control measures remain unchanged to ensure we continue to provide a safe environment for everyone. This means our clinical teams will still work in full PPE and we respectfully request that patients visiting the practice continue to wear masks and adhere to social distancing. GP practices are classed as amber sites and as the covid hot hubs move into general practice we will be seeing more suspected cases.

As this information is updated we will continue to inform our community and we thank everyone for their understanding.

NR: Are there plans to resume face-to-face consultations with patients and, if so, when is this likely to be?

Dr PA: Face-to-face consultations were significantly reduced during the pandemic in line with the NHS England guidance to reduce the spread of the virus, but they have never stopped. We have worked extremely hard to see patients in person where there has been a clinical need to do so.

NHS England has issued new guidance to GP practices across the country on facilitating more face-to-face appointments for patients including following IPC and social distancing guidance.

We agree with the principles set out by NHS England and believe that it is right that patients should get face-to-face appointments when they need them and we are doing everything in our power to respect people’s clinical needs. We have introduced more face-to-face appointments for all of our GPs and these are available at the request of the GP or the patient. Online and telephone consultations remain a key part of our services and as the pandemic continues to cause concern, care will be clinically prioritised for those most in need of support, including those with urgent healthcare needs.

NR: Which things worked well during the lockdown restrictions at the practice, for example online consultations, and will any of these be retained when the practice returns to normal and all restrictions are lifted?

Dr PA: Many patients found that the introduction of online services offered them greater convenience with both contacting the practice but also with proactively managing their own care. NHS online services are available to patients 24/7 enabling the patient to contact the practice when it is convenient to them.

Although we recognise the importance of a face-to-face consultation, in some instances a telephone consultation has also proved beneficial to patients, saving them a trip to the practice during working and school hours.

Ultimately, we are supportive of a system that puts shared decision making, personalisation and a mix of channels at its heart.

NR: What kind of toll has the past 15 months taken on staff at Latham House, physically, mentally and emotionally?

Dr PA: It is widely reported that the ever-increasing workload, negative press, and under-investment is having a significant effect on our colleagues with 20 per cent more GPs presenting to mental health services during the pandemic compared with the year before.

We send our sincere sympathies to everyone who has been affected by the pandemic. GPs and our staff have also been affected. Too many of our colleagues, family members, friends and patients who we have known for many years, have died or otherwise suffered. We are committed to supporting our community’s health care needs and are always grateful when our patients show us kindness and understanding.

The support we are shown really makes a difference.

NR: Could you explain the importance of training days and why the surgery needs to be closed at these times?

Dr PA: Practice training days are a contractual requirement of any GP practice and ensure that clinical staff have protected time to invest in their continued professional development to make sure they can deliver safe care to our patients. The training dates, typically an afternoon with 10 dates annually, are implemented by our CCG across all practices to ensure that alternative care provision is offered to patients during a practice training closure.

NR: You have recently told us that you have less GPs than you need at the practice over the summer. How has this happened?

Dr PA: As a practice, we are actively recruiting more clinical staff to our team and we have recruited some locum GPs to cover patient lists for existing GP vacancies. We have also recruited more GPs for our longer term plan and our new GPs will be joining our team up to September.

The current situation is as a result of unplanned and necessary leave required to support a number of our existing GP team. The reasons for the requested time off work include sick leave and compassionate leave. Our GP team are highly skilled, passionate and dedicated to providing quality care for our patients and supporting them with their own personal wellbeing is our key priority as their employer.

We continue to recruit to fulfil existing GP vacancies and we are also working to recruit more locum GPs to support our healthcare provision over this period.

Despite our best and continued efforts we recognise that there will be an impact to our GP services and we wanted to be open and honest about this situation with our community.

All other services such as nurse and pharmacist appointments are unaffected and we would like to assure our patients that we are open and available to support their health care needs.