Response to the questions from members of
St Andrew’s Surgery Patient Reference Group
1. What is the Practice’s policy on preventative services? What regular
assessments are offered to e.g. children, women of reproductive age,
seniors, etc? How are these services advertised / promoted to members
of the Practice?
There is at present no scope to offer 'across the board' screening type health
checks to these patient groups as they fall outside the scope of standard NHS
care provision. There have been various 'local enhanced service schemes'
promoted by government / DOH or PCT but these have been for specific
groups of population, only funded from 1 year to the next, and on our
assessment not funded adequately in terms of the Nurse & Dr time required to
provide them, when taking into account the health needs of patients who
already have chronic diseases, and the very low percentage of health needs
identified when screening a well population. Patients can self select and
attend a GP or nurse with preventative/screening health concerns and
regularly do (such as family history, blood pressure checks, prostate
screening pros & cons, osteoporosis testing, HRT pro's & con's, should I have
my cholesterol checked? etc etc). We spend a considerable time on such
consultations which tend to meet needs/answer questions more specifically
for the individual. Arguably a lot of these consultations are to a self selected
& more health motivated population in any case & might tend to not identify
those at greater risk who do not self select.
The surgery offers routine assessments for children at 6 weeks then the
formal immunisation programme with the nurses and routine developmental
assessments are done by the health visitors.
Private health providers offer more comprehensive but one size fits all
screening, at a price. Screening programmes such as Lifescan etc in our
anecdotal experience do not pick up very many real health concerns.
Nationally offered screening programmes such as Aortic aneurysm screening
for 60+ men, Breast screening mammography, Bowel cancer screening etc
are advertised at the surgery.
In truth far more difference could be made by the population/individual taking
up & acting on healthy living messages such as stopping smoking, eating
more healthily, optimizing weight, exercising more regularly, drinking less,
availing themselves of vaccination programmes, etc, than can be achieved by
seeing patients one by one & delivering these messages. If we then had fewer
pieces to pick up from the health damage of not heeding the above advice, we
would have more time to seek out & treat those conditions that arise in-spite
of the individual’s best effort to live a healthy lifestyle.
A media/government conspiracy to shy away from pointing the responsibility
for health at the individual, & instead 'blame' GP's (for example for the
'obesity' epidemic as was done in 2013) needs to be addressed in my
personal opinion. This does not of course take away from the efforts of those
that do take their health responsibly.
We are currently seeking the view of St Andrew’s patients regarding NHS
health checks and will be offering these to eligible patients from April 2014.
2. Within the three practices in Lewes, what GP specialist services are
offered and how do St Andrew’s patients have entry/access to these
(e.g. dermatology, gynaecology,)? Can the Lewes Community Hospital
be used to run these local specialist services from?
Across Lewes the practices offer:
Expertise in family planning aimed at teens & young adults: open
access School Hill
Dermatology: by referral to School Hill Surgery
Substance misuse: by referral St Andrews Surgery
Joint injections: all surgeries, practice specific
Minor surgery: at St Andrews - other surgeries probably offer also & to
registered pt's only.
Travel vaccination services: usually to individually registered patients
though St Andrew’s Surgery is a Yellow fever centre & can see any
patients in this regard.
Implanon contraceptive insertion / removal: individual surgeries.
St Andrews surgery operates an in-house cross referral policy whereby if a
GP feels there is another GP the patients might benefit from gaining a second
opinion from we can arrange a further appointment with them, eg
Gastroenterogy, Cardiology, minor skin lesions, Gynaecology, GU medicine,
Diabetes. These arrangements are in-house & do not require any formalized
referral.
Lewes Victoria Hospital at present runs consultant outpatient services in most
major specialties. The above mentioned GP services are offered at the
surgery concerned. Some minor operations are performed at the LVH minor
injuries centre, and this could be used more regularly if required. We are
keen to see the facilities at the LVH utilised as much as possible.
3. Many St Andrew’s patients are currently under the care of RSCH
teams and are reviewed at clinics at the Lewes Victoria Hospital. We see
a pressing need to continue to commission these services for St
Andrew’s patients. We view with dismay the need for new audiology
patients to now have to attend Eastbourne Hospital instead of the local
Lewes Victoria. This travel is wasteful and stressful for many older
people who predominate in the group troubled with hearing difficulties.
When services such as audiology are commissioned, a wider view has to be
taken of the economies of scale of providing such a service in more places to
fewer patients vs. fewer places to more patients, especially where expensive
or specialist equipment or facilities are required. There is inevitably a trade off
between the conveniences of locality vs. the sense of concentrating and
therefore benefiting from regionalised expertise. Audiology straddles these
issues - some of it can be provided quite cost effectively, as evidenced by
private high street providers tendering to provide services - this however runs
the risk of such providers 'cherry picking' cheaper to provide services, leaving
those with more complex needs having to travel to wherever the dwindling
more specialist provision is based.
There is an audiology service available in the School Hill Surgery building.
4. What is the current policy at St Andrew’s Surgery on home visits to
patients recently discharged from hospital and to the terminally ill?
Between the hours of 1pm and 3pm we do home visits when requested and
when the patient's clinical need or circumstances are judged by the Doctor to
require this. We ask that requests for home visits are made before 11.30am
where possible. This has always been our policy and we do not see it
changing in the foreseeable future,
We do not have the time or resources to routinely visit every patient recently
discharged from hospital. The care needs following discharge have been
anticipated prior to the discharge date and liaison will usually be between the
discharge team and district nurses or the surgery.
In general our patients use the option of requesting a home visit very
responsibly, though there are notable exceptions. e.g. lack of transport to be
able to get to the surgery to see a Doctor is not generally felt to justify a home
visit. Every request is judged on the clinical circumstances.
Terminal care is provided on a case by case basis, in conjunction with the
community palliative care team from St Peter's & St James Hospice. All of our
Doctors pride themselves on continuity of care when looking after terminally ill
patients and aim to support and meet the patient's hopes in terms of preferred
place of dying. Terminal care may often require patients to be visited on an
almost daily basis in the final stages of their illness. This will often occur in
conjunction with the palliative care nurses.