New ways to help GPs help you

Dr Felicity Guest
Dr Felicity Guest
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Summer is just around the corner.

Good for most of us - but for Blackpool Victoria Hospital’s A&E department it presents a unique set of challenges.

Summer is when the tourists flock to town. And that influx of visitors on top of the existing population means the summer months are the busiest time for the hospital.

A key part of easing the pressure on the A&E department – which treats around 95,000 people a year – is ensuring GP practices across the Fylde coast are stepping up to the mark to help ensure only patients with urgent medical needs visit the casualty department.

But surgeries are facing challenges of their own to cope with demand – and now they are looking at different ways of caring for people to ensure they get the treatment they need.

Video consultations, and a health app (mobile phone application) which goes through symptoms to advise people what kind of appointment to make, are two ways in which technology could be used.

Other innovations include assessing patients so those with the most complex needs are directed to specialist care and those with the least serious needs are encouraged to take up more appointments with practice nurses or even pharmacists.

This, it is hoped, will ease pressure on the middle section of patients who do need to see a doctor but are not in the most serious or more minor bracket of illness.

It all adds up to a different way of working.

Tony Naughton, 57, of Thornton Practice, Church Road, Thornton, has seen plenty of changes since he started work as a GP in the early 1990s.

In those days doctors provided their own out-of-hours cover but had less complex issues to deal with during their day-to-day surgeries.

Dr Naughton said: “When I first started in general practice, we did our own on call cover and we would be up four or five times in a night and then working in the day.

“That just wasn’t sustainable so we have had to adapt and change which is why we now have a separate night service.

“We get a fax from the out-of-hours service every morning and we’ll frequently have had 15 patients who have either chosen to go to the walk-in centre or been seen by out-of-hours services.

“It just wouldn’t be possible to deal with the complexity of the conditions people are coming to you with during the day if you were also up all night with so many patients.”

Another change has been in the way people perceive the seriousness of their illness - often based on information they have gleaned from TV.

Dr Naughton said: “There is a lot on TV about innocuous symptoms potentially having serious consequences and people see unusual and rare things on the internet which affects their perceptions.

“But the main change has been in the ability we have to look after people with long term conditions such as asthma, COPD, diabetes and heart disease.

“Now we look after people so well it is rare we have to go to their house and rescue them.

“But that means we need extra nurses and extra rooms.”

Thornton Practice started off in a front room just after the war before moving to purpose built premises with 15 rooms in about 1980.

The current medical centre was built in 2000 at a cost of more than £2m. There are 10,000 patients on the list, 20 members of staff including five full-time equivalent doctors, and a turnover of £4m.

Appointment times used to be five minutes, now they are 12 minutes and could move to 15 minutes.

Twenty five years ago people saw their GP on average four times a year, but that has now doubled to eight times due partly to an increasingly ageing population, but also because treatments are followed up on a more regular basis.

So better management of appointments is key to the smooth running of any practice.

Dr Naughton said: “If someone wants to see a doctor today, they will be seen - it can be done. But you have to have enough appointments available on the day, and that in turn makes it more difficult to book ahead.

“We are making more use of technology to help ease some of these issues.

“There are far more telephone consultations now than we used to have, electronic prescriptions, and the internet means people have researched their condition. ”

The Royal College of General Practitioners has set out a vision for where it sees GP services going between now and 2022.

Priorities include a good in and out-of-hours service, patients and carers “routinely sharing decisions”, investment in premises, more collaboration and co-ordination across health services and greater use of information and technology.

It’s a future which another Fylde coast GP, Felicity Guest, hopes to be very much a part of.

Dr Guest, 32, has worked as a GP at the Thornton Practice since she finished her medical training almost four years ago.

It has been a long haul reaching the role she holds now - six years in medical school, two years of foundation training and three years of GP training.

And in between all that she has also had a baby - now nearly a year old.

But Dr Guest has no doubt the hard work has been worth it, and she is building her career in health care at a time when general practice is changing like never before.

However, being there for patients in their hour of need remains at the heart of being a family doctor.

Dr Guest said: “I decided to go into general practice because I appreciated the continuity of care and the way you see people through their lives.

“The nicest thing about the traditional GP is you get to know people and their families over the years although there is an ongoing issue between continuity and access.

“We all want continuity and try to get that for our patients as much as we possibly can. It is a challenge.

“When a patient needs palliative care or there is a cancer diagnosis we try to make sure they can see the same doctor. We understand they would like to see their favourite doctor all the time in those circumstances.

“However when an ailment is a more routine cough or cold, it wouldn’t be terrible for them to see another doctor.”

Everyone has experienced the frustration of having to sit in the waiting room as appointment times slip, but Dr Guest explains the complexities of many medical conditions mean some people end up taking up more of their doctor’s time.

She said: “The usual appointment time of 12 minutes isn’t enough to deal with some of the complexities we are seeing, and there is so much more now that we can do for people so there is a lot of work to fit into a single consultation.

“People’s expectations have also changed.

“Sometimes they come to us with internet printouts, or with information they have gleaned from the TV. That can be helpful, but it can also take time so it is different to the way things were 30 years ago.”

Despite the challenges, Dr Guest says being a GP is hugely rewarding.

She added: “It is hard work and particularly with a young baby, you have to rely on your partner and the rest of your family.

“There are a lot of opportunities in general practice and there are going to be a lot of changes in the next 10 or 20 years.

“But I think it’s an exciting area to be involved in.

“The way things are going to be moving, we need to think about services that meet our needs as we have an ageing population and have to treat more complex conditions.

“Survival figures for most cancers have improved vastly but people will have other issues and we have to change the way we organise the service to plan for it.

“There is no option to do nothing but there has to be a lot of engagement and people have to be on board with what we are doing.”

In tomorrow’s paper our third and final instalment and The Gazette volunteers at blackpool Victoria hospital