“We need to know what patients want before we work out a way of fitting our limited resources with the patients’ need.”

At the Nairn Patients Group inaugural public meeting on Wednesday night the GPs Surgery practice manager Barbara Graham took the hot seat for approximately half an hour and fielded questions from members of the group and other citizens who were present in the crowded conference room in the Community and Arts centre. 

It is refreshing, both that the practice and the Patients Group are now engaging in public debate and that there are so many people in Nairn that care about local health care issues enough to turn out in numbers to seek information and clarification. Top of the agenda of course was the controversial new appointments system. Barbara gave a no-holes bared look under the hood at the mechanics of the present (now hybrid) system, gave thorough explanations about recent events and went into depth into what the practice hope to do in the coming months to further improve the system. The Gurn has prepared a report that amounts to a brief summary of the main points of the Q&A session that we hope does justice to the evening’s events. Click read more to continue.

Barbara gave a brief introduction detailing things as they presently stand. She indicated that patients would be asked to complete data surveys and the information assessed for future improvements. She said:  “We need to know what patients want before we work out a way of fitting our limited resources with the patients’ need.” 

The first question then followed: “If a patient phones in are you still saying the doctor will phone you back?”

Barabara replied: “It depends on circumstances, we have a range of different appointments and once all these advance appointments are gone then there is an element of triage yes.”

A home carer then stated that patients could wait hours and her clients can start to panic and that home carers didn’t have the time to wait.

The response from Barbara was: “The reality is if 30 people phone up and all need a phone call back and there’s only one duty doctor on to do that clearly they are not going to be able to ring every single patient back within the time frame that the patient expects. And that’s the reality of what we are dealing with here and I know that is difficult for people when there are situations when they have pain. Equally there are likely to be lots of other people in the same situation. So what the duty doctor does with that case is to try to asses with the description that you give the receptionist which one has the highest priority and that’s something we do pretty much constantly throughout the day.

Simon Noble then asked for information concerning peaks and troughs of demand.

“We have two doctors throughout the day that deal with urgent calls and the A&E department. One might be on house visits for example, some days we can have very few house visits and some days we can have 20 house visits. Bear in mind that it can take up to 2 hours to do a house visit.”

There then followed a comment about the phone system when someone said that sometimes you could get an “all our operators are busy” response. The person raising this point then asked how many operators there were.

“We try to have 6 at peak times,” said Barbara.

Barbara went on to outline how the practice hopes to discourage patients phoning the surgery during peak times for non-urgent issues and she outlined some possibilities here: “Test results only being available between 11.00 and 4.30. Encouraging patients that when they ring in in the first 2 hours which are obviously the busiest hours of the day that it is just to make an appointment or for urgent issues.”

For the practice manager the essential question was: “How do we manage the appointment system in a way that satisfies as many patients as we can that allows us to use the resources what we have effectively and is safe for those patients that need it most.” She went on to say: “We’re not going to be able to provide the service that everybody wants. It’s just not realistic, it’s not possible.”

The practice were looking at the “horrendous level” of DNAs (do not attend) who fail to turn up for appointments. Barbara told the meeting that one practice nurse had 7 DNAs in one day. One doctor had 5 in one morning – two of which had been booked that morning. “Patients ringing up saying they needed urgent attention on the day and they didn’t turn up.

The debate returned to the phone system and one woman told of situations where she kept getting cut off.

“The phone system that we use is managed by NHS Highland, we don’t manage the phone system ourselves which puts an extra layer of complication in the way. We’ve had a couple of occasions in the last 3 to 4 weeks where it has cut out all together and one day where we had absolutely nothing at all on a Monday morning.” It emerged that the practice has a complaint in progress with BT about this. Barbara told the meeting that it would be helpful if all problems were reported to the receptionist once the callers got through.

Then there was more explanation of the appointments system: “There are a limited number of appointments every day for the GPs to book into based on clinical need, the receptionist can’t make that decision, and obviously the patient can’t make that decision. If there’s only say 30 appointments for the GP to book into and 40 people are asking for them then the doctor needs to decide which 30 of the 40 need appointments.

A woman present then stated: “When I said within the next week it will be fine. No, no, the doctor’s got to ring you back.”

“That’s because we have already go to the stage when we haven’t got any pre-bookable appointments in the next week […]Yes, the doctor is making an assessment and not everybody will be invited in for an appointment. Some people will get advice on the phone.

A gentleman present then asked: “If there are no appointments left how will the GP be able to give you and appointment?”

“The GP will have a range of bookable…”

“So he has his own appointments?”

”Yes, but it has to be a GP who decides who needs those appointments most urgently,” concluded Barbara.

There then followed a telling comment that which really sums up the reality of the situation facing the community and the practice. Barbara said: “It’s a very simple issue of we have a demand and we don’t have enough cover to meet that demand. So we have to be able to manage it in the best way that we can.  

Liz Bow then said: “It’s really positive that you are going to readdress the appointments system because I think there are huge issues with it: issues from an access point of view, from vulnerable groups, etc.”

Liz went on to say that she thought there was still a grey area around the system and people were confused and there had been no actual change in anything that was being said. She then asked: “Did it help the continuity of care by having appointments on the day?” 

Barbara said that they had been unable to measure this as there had been too many changes.

Liz said that there hadn’t been changes for 3 months but Barbara replied that the survey would have come in after 5 months. 

There was a request for more information to be published about the appointments system but Barbara replied that a statement had been published in the Nairnshire and added: “This is very much a system that is in a state of flux, so if we publish it now it could be that once we do a piece of work we might change it again so we don’t want to put too much into print while we are in the middle of making so many changes.”