Letter to Patients

The surgery has implemented major changes in appointment booking and provision over the past few months. We would like to thank our patients for their understanding and support during this time.

We have moved away from a ‘total triage’ model where every patient contact with the surgery was assessed by a clinician. This model came about due to the COVID crisis, and the need to provide care remotely in all surgeries. Total triage gave online and telephone answers rapidly, but at the expense of your being able to book a telephone call or face to face appointment with your regular GP. Patients and doctors perceive the medical importance of problems very differently and this process led to frustration for all parties.

In December 2022 the surgery moved back to a traditional model of primary care provision. This means that you can book appointments in advance, for any issue that concerns you, to see a GP in person or speak to them by telephone. We will only decline your appointment if it is clearly inappropriate for our service, or if it has been booked with an inappropriate staff member.

We continue to strive to provide the best possible care for the patient in front of us, whilst also supporting the several thousand patients at the surgery with long term conditions that need regular monitoring of their conditions and medications. A lot of this happens behind the scenes but makes up a very important part of the care we provide. This preventative work helps keep patients as well as possible and involves the whole practice team.

The surgery provides an urgent ‘duty’ GP service each day. This is not an unlimited service and operates with a duty clinician (a GP or advanced nurse practitioner) between the hours of 0830-1830 with a second clinician assisting them during peak periods. We provide about 40% of our appointments ‘on the day’ to provide urgent care. We trust patients to identify if their issue is genuinely medically urgent. When this service is full patients are directed to other urgent care services as provisioned by NHS Gloucestershire ICB

We recommend patients book routine appointments via the online booking system, to avoid long queues on the phone. Our small team of patient care advisors has been consistently short of staff due to a national difficulty in recruiting and retaining sufficient staff into NHS organisations. We have recently appointed new team members and we are confident that this will ease some pressures.

We appreciate that long phone queues are frustrating.  To help us speak to everyone who needs our help, please try to refrain from holding lengthy discussions on the phone about other issues with our patient care advisors. Our team is unable to resolve hospital issues or appointment availability. Such behaviour blocks other patients from getting through.

We do recognise that some patients cannot access online services and do need to call reception to book an appointment. Our team do not have access to any GP appointments than cannot be seen online, so please only call to book if you genuinely cannot use online services for routine GP appointments. Phoning for other types of appointments remains necessary.

It is important that we are honest with you about the situation regarding appointment numbers, both urgent and routine. While patients have welcomed aspects of the new booking system, such as regaining control over booking consultations with your chosen clinician, this has exposed the widening gap between the capacity of the General Practice workforce and rising patient demand for appointments. This situation is not unique to Leckhampton Surgery, it is a national issue. Removing the triage system- and giving our patients back control of appointment booking- has unmasked the problem we have recognised for many years before the COVID crisis – that there are not enough GPs, nurses or support staff and the supply of appointments they provide does not meet demand.

NHS Digital figures show that demand for appointments has increased by 20% since the beginning of the pandemic. In 2020, our government pledged to recruit an additional 6000 GPs to cope with rising demand; instead, there is now the equivalent of 2000 fewer full time GPs working in England.

We are pleased to have more full-time GPs than the national average, but still, we cannot meet demand. Government funding does not provide sufficient resources to get close to meeting patient requirements and this is deeply frustrating for patients and staff.

We share your frustration of not having enough appointments, of having to redirect calls to the 111 service when the urgent GP list is full, of feeling we cannot give the best possible care due to funding restrictions whilst also finding ourselves being held responsible for the failing of other NHS and statutory organisations. All these factors, and more, are causing a loss of staff and morale – this then further impacts on our patients.

The possible solutions: a radical funding change in the GP contract, nationalisation of primary care into trusts (like hospitals) or privatisation of primary care (like dentists) are all major changes with positives and negatives, and are subject to political will and beyond our control as a local GP surgery.

What can you do to help?

Firstly, reading this document will help you understand the situation. Here are some practical actions to take to help you access care and use resources wisely:

Be kind to the team in reception, if they tell you there is no appointment available then unfortunately there really is no appointment available. Try online tomorrow, or alternatively any time from midnight when appointments are released.

  • Book online where possible and provide a good level of detail regarding what you want to get out of the appointment.
  • Book the appointment with the right person. We have a guidance chart on how to book, and who to book with, on our website booking section.
  • Please do not book a phone appointment for a condition where you know you need to be seen in person. Photos are a poor substitute for face-to-face assessment of skin lesions for example.
  • Don’t ask us to do the hospital’s work for them. Your hospital needs to arrange their own blood tests, give you your hospital test results, give starting prescriptions for the drugs they recommend and arrange your follow up. These are their contractual responsibilities. Every time you consult with us to ask us to take on hospital work is an appointment blocked for a primary care problem, and an awkward conversation about the hospital’s responsibilities to you. If you haven’t heard from your consultant about a planned appointment or procedure, please contact the hospital secretary directly. We don’t have any influence over hospital waiting times.

Lobby your MP to make things better. For nearly all our patients, this will be Mr Alex Chalk and we would encourage our patients to voice your concerns for our NHS to him. Leckhampton is lucky to have a better than average GP staff supply but this will not last forever. Business costs are rising and staff need to be paid fairly in this climate of rising prices.  Patient access to NHS services is being restricted as practices are not able to afford to recruit or replace leaving staff. Radical change is needed from government if NHS General Practice is to survive, and if GP partnerships are to continue to provide primary care in the future.