Current Concerns Last Updated: 24 February 2016

GP Services

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 here )

  • 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 here.

    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 an appointment.

    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.