We are concerned that local GP services are becoming overstretched and fear that this will be exacerbated by the effects of an expanding population.
The demands on our local surgery have grown considerably in recent years due to a number of factors and there is not space to build additional rooms on the current restricted site. Until another surgery is built in the area, these pressures will remain.
Our patient to GP ratio is already above average and we are concerned that there is nothing about GP provision in the new local plan.
We will continue to press for all the necessary infrastructure to be put in place alongside any future housing development.
More detail as follows :-
- How the NHS is organised
- The role of the Local Council
- The view from our local surgery
- How you can help as a Patient
How the NHS is organised
NHS Primary care was re-structured in the Health and Social Care Act 2012.
A quick summary of how it works now is as follows (and you can find much more detail on wikipedia
- NHS England: oversee the working of the NHS as a whole.
- Clinical Commissioning Groups: PCTs were to be abolished by 2013 with new GP-led commissioning consortia, "Clinical Commissioning Groups", taking on their responsibilities.
Our local CCG is -
NHS Coastal West Sussex
- NHS Property Services: Facilities owned by PCTs were transfered to NHS Property Services.
- Doctors’ surgeries are run as independent businesses, as they have been from the beginning of the NHS
- Local Councils : The public health aspects of PCT business became the responsibility of local councils.
The Role of the local council
West Sussex County Council have a Health & Adult Social Care Select Committee - HASC for short.
GP provision was on the agenda for the HASC meeting in March and questions - including ours - were robustly put to NHS England reps.
The webcast of that meeting has expired, but note that Council Webcasts in general can be found
The view from our local surgery
Tiffany Boulton, the Practice Manager and Business Manager, Lesley Kent, from Lavant Road Surgery
attended a discussion at our
Committee meeting in May and provided the following :-
The practice has 12,000 patients and the equivalent of
6 full time GPs (3 full time and 5 part time) - an increase
from 5 ¼ in the last few years - resulting in an average
of 2000 patients per doctor. The Surgery is becoming
busier due to an increase in the local population and an
increased frequency of patients’ visits — up from an
average of 3 per patient in 2007 to 8 per patient now.
2000 patients per doctor is above the national average
but the figure has been increasing nationally. There is no
upper limit on patient numbers; there are only four
doctors’ surgeries in Chichester and residents can
register at any of them. The next surgery northwards is
Midhurst so Lavant Road covers a large area taking
patients from the outlying villages such as Singleton and
Charlton. The number of University students has also put
extra strain on the surgery .
Doctors’ surgeries are run as independent businesses
which fund their surgery premises and manage their own
operational costs from the grant provided for each
patient from central government. The surgery has taken
patient requests for registration from people moving into
the area but has received no new funding for expanding
the premises from central government for 3 years. A
doctor could close his/her list but would risk losing
funding in other areas. The practice acknowledged that
there were pressures on the service and there would
inevitably be delays seeing some patients until further
supply was delivered in terms of additional premises
within the city. Although there has been a rapid increase
in the local population no new surgery was currently
proposed in the local area. The new surgery discussed in
connection with the Graylingwell development had not
materialised. Doctors’ practices are required to fund
new premises themselves. Temporary buildings had
been considered at Lavant Road Surgery but would not
meet the strict health rules on premises used for
consultation. The practice had written to NHS England to
register an expression of interest in any new premises
funding, but had received no further news, due to the
fact that they have still not yet finalised premises
policies. They were asked whether there was the
possibility of getting information to planners to say there
was unacceptable pressure on surgeries due to increased
population, and whether practices could inform planners
that there was no further capacity at surgeries for more
patients. Perhaps the new Community Infrastructure
Levy (CIL) may help to direct funding to local needs.
However the practice is confident that the available
resources are being micro-managed efficiently and they
are genuinely trying to provide the best service to the
community under considerable pressure. There are 9
consulting rooms for doctors and nurses, used on a rota
basis. Accommodation is also required for mental health
nurse and midwife sessions. There is little opportunity for
expansion on the current site, with the possible
exception of a store room which they are considering
converting for use. Core hours are 8 am to 6.30 pm.
Extended hours are offered on Tuesday and Wednesday
mornings from 7.30 am and all the doctors are available
on Mondays evenings with the surgery open until 8 pm.
Each doctor manages their own work load, which
includes surgeries, home visits, telephone consultations,
and some patient administration. One target which is
generally achieved is for patients over 75 to be able to
see a named doctor; it is not always possible when
doctors are away but the work load is spread so these
patients are seen promptly.
The appointment system works as follows; a patient
arriving at the surgery is given the next available routine
appointment which, in some cases, could be 4 weeks
hence. However, if the need is more urgent,
receptionists are able to give a ‘soon’ appointment -
usually available within one week. If the patient’s need
is really urgent, they will always be given an appointment
that day. The average wait for non-urgent appointments
is 2-3 weeks, but can be over 4 weeks during holiday
periods. More urgent cases can book 5 days ahead.
Doctors will phone patients to determine their need for
Other staff are available to see patients, such as
Practice Nurses and Nurse Practitioners; the latter can
treat minor ailments and write prescriptions. To try and
prevent missed appointments, reminder texts are sent
automatically to patients who have provided the surgery
with a mobile telephone number; 271 appointments
were missed in December alone!
How can you help as Patients?
- Register your mobile phone number with the Practice so that you can be sent appointment
reminder text messages.
- Be aware that you are asked questions about your appointment by the receptionist to determine best use of resources - doctor, nurse practitioner or nurse.