ProNurse

By Lyndsay Moss

It takes a dedicated and well-drilled team to look after the needs of 250 patients per day, writes Lyndsay Moss

Inside West Esk Medical Practice, a complex machine is working away, looking after patients. But this machine is not the latest gadget designed to deliver hi-tech treatments, or a new computer system to measure government targets.

The machine which looks after the patients at this Musselburgh surgery is its staff. And it is not only the practice’s ten doctors. Nurses, health visitors, healthcare technicians, counsellors and clerical staff all combine so patients get the care they need, when they need it.

A typical working day starts at 8am, when the staff prepare for their early surgeries and the phone starts ringing.

About 40 people work at the practice. General manager Lorna Johnston says staff turnover is low and puts this down to the way the practice has invested in training, so everyone – from doctors to admin staff – continually develops skills. The practice has recently been awarded a gold standard Investors in People award – the first general practice in Scotland to receive the award, for business and staff development.

Lorna’s husband, Dr Ian Johnston, is one of the practice’s GP partners and says having well-trained staff is vital to the care of patients and to meeting the demands of the Scottish Government.

“Practices are incredibly complex to run now because of all the targets we are set, because of all the audits we have to complete and the stuff we have to send in to the board under the direction if the Scottish Government,” he says. “It is pretty complex trying to keep on top of all of that.”

Lorna adds: “It is very complicated. It is like a mini cottage hospital now because there are so many different departments in general practice.”

GPs at the practice split their day between seeing patients in their surgeries and making house visits, as well as all the admin work which goes with it. But the doctors also take it in turns to do triage on the phone – speaking to patients who could be helped without the need to come into the practice. They offer advice and where necessary make an appointment or leave a prescription for them to collect. On an average day, Dr Johnston says, they could help 50 to 60 patients in this way. “We think it is a good use of doctor time,” he explains.

While doctors are busy seeing patients, elsewhere in the practice all manner of other services are being run.

Upstairs, Di Kettles, a health visitor based at the practice, says there are huge benefits of having health visitors alongside GPs, meaning they can chat to doctors and pass information between them. Her work involves going out and seeing families in their homes. “I like to focus on the first two or three months of babies’ lives and I do a lot of home visits,” she says.

Next door, the district nursing team is discussing the day’s work ahead. The five staff based at the practice spend their days and nights going out to patients’ homes, providing care such as looking after wounds, helping with medication and looking after those approaching the end of their lives. District nurse Niki Morrison says: “We try to encourage a lot more palliative care at home, so patients have a better choice of where to die. A lot of our time is spent doing that, whereas they used to go to the hospice to die. Now they tend to go there for pain management and come back home, which is much nicer for the families.”

The district nurses have a caseload of around 100 patients, with the team making around 20 home visits a day. Not all staff have to leave the building to provide a service to patients. Along the corridor, Julie McGill, medical secretary, is completing referrals to hospital appointments using a special computer system. “It is excellent, especially for urgent stuff. We know they can get it right away whereas before when we used to use the internal post it used to take a couple of days,” she says.

In the same room, Yvonne Robertson, operational manager at the practice, is completing an audit of what happens to patients who come to the practice, seeing how many are dealt with in general practice or end up in secondary care. Dr Johnston says: “This is something the health board ask us to do. They want a better idea of what our disposal techniques are. They also want to know if GPs are just firing everyone off to casualty, which is their perception.”

But the audit so far suggests that the vast majority of patients have their problem dealt with in primary care, without setting foot in a hospital. With around 250 patients contacting the surgery a day, either in person or by phone, this is no easy achievement.

Most patients at the practice are seen in the surgeries downstairs. But counsellor Joy McKaigue has an office upstairs where patients are helped with problems such as bereavement and other emotional issues. She sees around five people a day in hour-long appointments, helping the practice’s own patients and others from the area.

Back downstairs, the reception area is abuzz with patients and clerical staff arranging appointments and updating records. Kirsti Barnett is busy putting old hospital letters for new patients into the records so that doctors can access them on the computer.

Meanwhile, Wendy McCallum is helping to keep track of new patients coming to practice and those leaving. The practice receives around ten to 15 new patients a week and currently has around 8,600 on its books. Despite its large caseload, West Esk has never had to close its list to new patients.

Along from reception, a series of offices are home to the GPs, medical technician, who carry out tasks such as blood tests, and practice nursing staff. Near the GP offices, specialist nurses Jill Waugh and Andrea Lawrence run clinics for patients with conditions such as diabetes and asthma. Lawrence says: “We see about 95 per cent of our patients from start to finish without involving a doctor. We see 25 patients each a day.”

Back upstairs, some of the practice doctors are having a lunch break before seeing more patients. Dr Fiona O’Connell was an oncologist before becoming a GP. She says the change was “the best thing I’ve ever done”.

Dr Johnston believes one of the most beneficial changes in general practice has been the introduction of the Quality and Outcomes Framework (QOF). The system rewards practices for work done to improve the care of patients, such as carrying out regular checks on diabetics. “It actually produces results,” he says. “We have evidence now showing that secondary care admissions with diabetic complications are starting to edge down, because of the QOF, and the same for cardiac stuff.”

Another big change in general practice has been out-of-hours care, with most GPs passing responsibility for this service to the health board. Despite this, some of the doctors at West Esk still work evening and weekend shifts as part of the area’s local cover.

Dr Murray Fisken works out-of-hours as well as doing a day a week in the local community hospital, doing musculo-skeletal work. He says around a quarter of GPs now do out-of-hours, while many have chosen to concentrate on their daily work and allow others to take the strain which had been a burden for a long time. “Increasingly, there are doctors employed by the out-of-hours service,” Dr Fisken adds.

“They are not doing day shifts but just doing evenings and weekends and that is their career for that time. That did not really exist as a speciality before.”

But even without the evening and weekend duties, many GPs also have other roles outside of general practice, whether that’s research, hospital work or in Dr Johnston’s case being clinical director of East Lothian Community Health Partnership.

The patients of West Esk Medical Practice are probably not aware of all the work going on in the background when they turn up for their appointment. Without it, their journey through the NHS might be a little bumpier.

© 2010 Scotsman, The. Provided by ProQuest LLC. All rights Reserved.

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