Thursday, December 6, 2012

Drug Warning


There have been reports from the Dawlish locality of 3 drug users attending hospital for fitting in the last 4 weeks after having smoked a substance sold as ‘crack mephedrone’. Reports suggest that this is being sold as a crystallised form or mephedrone, however no samples have been obtained that confirms the actual pharmaceutical composition.

None of these individuals were ‘drug naive’ and all are known within the heroin/crack using communities.



In November 2012, 3 people in the Devon area have been admitted to hospital due to fitting after smoking a substance called ‘crack mephedrone’.
Reports indicate that this substance is being sold as a crystallised form of mephedrone.
The risks are: To short-term health: fitting and convulsions To long-term health: unknown
To reduce your risk of overdose (o/d): Make sure someone is around when you use (if you o/d alone nobody can help). Avoidmixing drugs. Usein smaller amounts, - please remember that very little is known about this substance and its risks (you can’t tell what’s in it by looking at it and your dealer probably won’t know what’s in it either).
Avoid products described as ‘crack mephedrone

Monday, November 12, 2012

Recent Charity Things...


My latest Charity endeavours:

I did my my skydive on Sunday 11th August.
For the second time I got stuck on the A30 getting to Dunkeswell so was late this time and had to hand around as it were til the end of the day.
Really worth it though to zoom up to 15000 feet then get out.
The whole getting out thing was quite odd.
Getting to that height the air gets a little thin so as they tighten the straps up for the jump it all gets a bit tight-chested. The hat is tight; the goggles are on...
You are strapped to your tandem partner who sits directly behind you on a long low bench running from the pilots chair to the back of the plane and the getting-out door.
So sat low on this bench you do a sort of coordinated shuffle to the back door.
When you get there you try to do as you were told in your training: to kneel at the edge of the door and lean your body back as you exit.
Strapped to the other chap I got to the door, and as I was thinking about how on earth to get my knees to the door so I could kneel on them we just sort of fell out the door; so I didn't have any time at all to worry about that bit!
Tumbling over and over on exit was lovely really. No sense of falling or turning.
Rather like that disoriented feeling diving in water when you suddenly aren't sure which way is up.....
The settle into a proper free-fall position and fall for a full minute. Just like Felix Baumgartner!
All the while looking around at what seems to be a view of the whole of Devon. I could see the North Coast easily, and the moor, and Start point, and up towards Portland....
then after a tap on the shoulder we swing to vertical as the chute is deployed. No jump or jerk as it happens. Smooth.
Then goggles off and gently float to earth. The chap with me let me steer and showed me how to slow down / speed up / turn left and then right and so on.
Fantastic.
I let him do the landing though....
Must have raised £2000 for Totnes Caring.



Then on Sunday October 21st I did the Raft Race with a team from the Surgery.
8.6 miles down the river Dart from Buckfast to Totnes.
The Raft went quite well despite some cynics' views on its construction!
Took about 4 hours and was absolutely exhausted by the finish.
Not sure of our total raised but must be a few hundred pounds, for Rotary who will divide the proceeds among several charities.
Next year with a bigger number of entrants I'm sure they'll do really well..



Then this Saturday 10th November I was happy to be involved once again in the fundraising Bingo night in the Civic Hall.
This to raise money for Totnes Caring.
A night of Bingo - masses of people and £1061 raised.

This week I shall be scoring the Darts in the Bull.
Again, a fundraising night for Totnes Caring happening in many local hostelries.

Monday, August 27, 2012

Totnes Show 2012


Well, we got up to the show again this year.

A small team of Dr Watkins, Dr Gelder, new Nurse Venetia Giles and Receptionist Deborah Trotman braved the early-morning mud.
I had meant to get onto the site the afternoon before to set things up but because of the heavy rain that afternoon the officials were keeping all vehicles off the field. 
I headed up for a 7am start on showday instead.
I slithered sideways across the field in my loaded up car to our pitch. I can't have done too badly as the tractor only had to drag me about 10yards at the end!
As I was first there I got the tent up ready for the others to arrive.
Having got the others there and got set up we then got on with the business of the day which was - well, what were we there for exactly? While we worked that out I made a cup of tea in the boot of the car.
It turns out we were there really just to be there. To remind people that we exist and to take a few blood pressures of people who don't otherwise come to the doctors often.
We had some information about the new eBike scheme being run jointly with totnes on  the move. This week we should receive an electric-assisted bicycle which is to be loaned to patients whose health may benefit from a spell cycling, and where the electric assist may help then get going. Not got the details worked out yet of how this is going to run but we are working it out.
We also discussed that we are partnering with Tresoc to have a solar panel array installed on our surgery roof. 
We had the chance to remind people about the benefits of vaccination as well as the business of the national summary care record.
I had a really good day meeting many people I haven't seen in ages and managed to talk myself hoarse after a while.... I hope that in some way we have done some good. It is rather difficult to say how but I believe that people do need to have confidence and trust in their doctors surgery and I think being at the show, in the  community we serve helps achieve that.

Sunday, August 19, 2012

Parachute Jump



Well, I did my Parachute Jump on Saturday the 11th.
In total I was able to hand in about £1200 to Totnes Caring, so thank-you to anyone who put some coins in my bucket at reception.

Friday, July 13, 2012

National Transplant Week


People on Facebook can now show their intention to become an organ donor in their Timeline.
The Timeline is a new addition to Facebook profiles, which allows people to record major life events.
A new 'Health and Wellbeing' menu forms part of the Timeline feature from which people can highlight their intention to become an organ donor and, if they wish, click through to NHSBT's Facebook page to officially register.

I personally think this could be one of the most significant changes and link-ups the transplant people could have made.
If the majority of facebookers registered and encouraged their friends too as well then the number of registered donors could rocket.

Traditionalists (at least those with internet) can register on the transplant website 

For the even more traditionalists there is a phone number: Organ Donor Line: 0300 123 23 23

I appreciate that organ donation is almost always associated with personal tragedy, but ask anyone in Totnes who has received a donated organ, and there are many, and you quickly appreciate the amazing change it can make to someone else's difficult life with organ failure.
 

Thursday, May 31, 2012

Doctors' Industrial Action 21st June 2012



At Leatside we will be participating in the BMA's day of industrial action on 21st June.
The Doctors will be available for urgent cases only on that day but we will not be offering any routine care or telephone consultations.
In practice this means we will have a duty doctor available for urgent cases from 8am until 6pm with a duty nurse available for urgent care also.
If you are ill ring in and you will be dealt with as usual.
If you aren't ill it might be better to leave it until another day.
 
In Devon this national day of action coincides with a county-wide training afternoon.
Ordinarily Devon Doctors On Call cover this session for emergency cases.
It is yet to become clear if this will still be the case.

 
So why are we taking part in the industrial action?
The changes to the NHS pension scheme
Doctors’ pension contributions increased in 2008 from 6% of their salary to up to 8.5% – a 42% rise.
The contribution taken from NHS employees pay for their pensions increased again in April 2012. 
Contributions will go up again in 2013 and 2014, with, under current proposals, the highest earners contributing 14.5 per cent of their pay by 2014.

also:
In 2015, there will be a switch to a new career average revalued earnings (CARE) scheme for all doctors.
For hospital doctors, this means the end of the final salary scheme, resulting in around a 30 per cent reduction in value on a like-for like basis. 
GPs already have a CARE scheme but they will also see their contributions rise very significantly. 
In 2015, the normal pension age will be linked to, and will increase in line with, the state pension age, with many NHS staff having to work to the age of 68 to be able to draw a full pension.
The state pension age may well rise beyond this in future.

Increase in Normal Pension Age
Under the proposals, NHS staff will be required to work until the state pension age (set to rise to 68, and probably further
in future) until they can draw a full pension, rather than 65 under the current scheme.
By contrast, members of the police and firefighter pension schemes are able to keep a normal pension age of 55.

Affordability and sustainability of current NHS pension scheme
The Government’s main argument for its radical changes to the NHS pension scheme is that it is unaffordable and unsustainable.
This does not stand up to scrutiny.
In 2008, NHS staff agreed to major changes to their pension scheme to make it sustainable in the long term. This involved a large hike in employee contributions, and the introduction of tiered contributions to protect lower paid workers. It also meant an increase in the pension age for new entrants (to 65), and employees – not taxpayers – taking on responsibility for future rises in the cost of the scheme (for example because of increasing longevity).
Clearly, the country is now in a very different financial situation. However, this has not affected the sustainability of the NHS scheme. It is currently providing a positive cashflow of £2 billion to the Treasury each year and a 2011 report from the Public Accounts Committee found that the 2008 reforms are bringing substantial savings to taxpayers, with the scheme set to be sustainable well into the future.

Pensions contributions for NHS staff compared with other public sector workers
Higher paid NHS staff already pay proportionately more for their pensions than most other public sector workers.
Contributions for NHS staff rose in 2008, again in April 2012, and are set to increase again in 2013 and 2014. By 2014, some doctors will see deductions of 14.5% from their pay for their pensions, compared to 7.35% for civil servants on similar salaries, to receive similar pensions. Doctors currently at the start of their careers would be hardest hit, having to pay hundreds of thousands of pounds extra – double what they would have paid – in lifetime pensions contributions.


We recognize that GPs are well paid for the work we do and on retirement will receive a healthy pension.
It seems to me unfair to be treating different areas of public service differently.
If all Civil Servants and Police / Fire etc were asked to pay the same proportionate increases in pension contribution as well as having to work on til 68 to get a full pension then I think we would accept we were being treated fairly.
Being treated fairly with respect to other areas of is the crux of this I think.
We know that longevity and an increasing elderly population is going to make even more of an impact as the years go by and that pension age would doubtless have to increase. It could I think be phased in more gently with a plan for it to increase slowly over many years.
So, we will withold our routine or non urgent work for a day to try to make this point.

Dr Dylan Watkins

Monday, April 16, 2012

Dr Watkins' Parachute Jump

I've taken the plunge and booked in to do a Charity Skydive.
In support of Totnes Caring I shall be jumping at Dunkeswell on 7th July.
I've no idea how much I shall raise but hope to get above £500
If you wish to support Totnes Caring via me jumping out of a plane at 15000 feet then you can sponsor me via the Surgery Reception desk or online at http://www.virginmoneygiving.com/drdylan

Sunday, March 18, 2012

C-R-Y Charity Heart Screening.




This weekend Leatside Surgery hosted a 7-person team from the charity Cardiac Risk in the Young.
They had been invited by Kevin and Linda Marsden who had been fundraising for such an event since their 21 year old son Oliver died 2 years ago.
He had been perfectly fit and healthy, right up to the moment he died.
There was no clue at all that he had a life-threatening condition until it killed him.
He was found to have ARVC or arrythmogenic right ventricular cardiomyopathy, which is one of many potentially fatal conditions of the heart affecting youngsters.
Cardiac screening is the only effective way to identify these cardiac condition when they are causing no symptoms.
On average there are 12-16 such sudden cardiac deaths each week in the UK.


The team below came and ran the screening event:


Tony Hill from CRY
Rebecca Howes from CRY
Dr Martina Muggenthaler, Cardiology Specialist Registrar and researcher from St George's Hospital in London
Rob Pring, Cardiac Physiologist at Treliske
Sam Bowen, Echocardiographer from University Hospital, Cardiff
Kate Miller, Freelance Cardiac Physiologist
Jon Senior, Warwick University Medical Student


Between the lot of them they managed to get 200 young people to fill in a cardiac and general health questionnaire; have a screening ECG, have an discussion about the findings with the doctor and have an echocardiogram if needed.
Where any findings warranted further investigations detailed letter has been sent to their doctor with recommendations.


It is odd but the greatest result from all the effort involved is to find nothing wrong with anyone.
Over the weekend we thankfully didn't pick up any really serious problems but there were a few cases where the heart will need a bit of a closer look-at.
This happened to be the same weekend that Fabrice Muamba had a cardiac arrest on the football field. Thankfully he survived and got to hospital, which the majority don't.


It was a fabulous weekend of effort and a pleasure to meet and assist this dedicated team of staff who have chosen to help the charity in their weekend.


L>R Tony, Kate, Rob, Kevin, Linda, Jon, Rebecca, Martina


Thursday, December 22, 2011

Cardiac Screening at Leatside


In March we are hosting a weekend Cardiac Screening event for local young people (14-35yrs).



Details are here.
You can book online for screening by going here.

This event has been organised in conjunction with CRY by the parents of the late Ollie Marsden who died at Rugby training on October 22nd 2008.
Ollie had an undiagnosed heart condition which he was completely unaware of.
It caused no symptoms at all until he died.
Despite me being at the scene (admittedly armed with only a hockey stick) and, soon after, my GP colleague and BASICS trained Doctor, Dr Morris with a full paramedic crew with the full gamut of resuscitation equipment, we could not save him.
If there had been some form of screening beforehand, his was the kind of heart condition that could have been picked up.
If it had been he is likely to have still been alive today.


Cardiac screening takes two forms.
An ECG is the simplest and easiest thing to do, and this is what will be being done at Leatside in March.
The screening equipment, and the program as a whole, is supported by Philips.
The benefit of screening in this way is that they are looking for the particular signs of these heart complaints that can cause sudden death.


As a GP I am used to looking at heart traces for signs of heart attacks or angina and so on.
The traces in the younger people may show more subtle signs, so the expertise is on hand to look for these signs.
If there are any worrying signs then an Ultrasound scan of the heart (Echocardiogram) may be undertaken there and then.
If the ECG is entirely normal then no scan is required.


The testmyheart website has a Q&A section that covers a lot of questions you may have.


I am pleased to allow CRY and Philips the free use of the whole of Leatside Surgery on March 17th to help them run this event.
I don't think it can ever be a regular event, but if we only pick up one case we may save a tragedy.
Better that we pick up none.

Thursday, October 6, 2011

Grasp-AF


Atrial Fibrillation (AF) is an irregularity of the pulse.
Having this irregular pulse puts the patient at an increased risk of having a stroke.

This risk can be reduced by taking aspirin or warfarin.
The risk of having a stroke increases with age so we tend to recommend warfarin for the older folk with AF.


So what is the risk?


If you are less than 65 with an otherwise healthy heart then the annual risk of stroke is about 1%
If you are between 65 and 75 that risk increases to 3% especially in those with diabetes or known vascular disease
Over 75 or anyone with a damaged heart valve or a previous stroke, the risk is nearer 6%



Imagine 1000 people at 1% risk of having a stroke each year.
Without treatment about 10 of them will have a stroke.
So 990 of them will not have a stroke. 




However, if those same 1000 people each take low dose aspirin, over a year:

• About 2 people will be ‘saved’ from having a stroke by taking aspirin
• About 8 people will still have a stroke, even though they take aspirin.




If we look at the 6% risk category in 1000 people it is likely that about 60 would have a stroke.



If those same 1000 people each take low dose aspirin, over a year: 


• About 12 people will be ‘saved’ from having a stroke by taking aspirin
• About 48 people will still have a stroke, even though they take aspirin. 


So aspirin seems more efficient the higher the risk.


Warfarin is better still and in this same higher risk group being on warfarin 36 people a year would not have a stroke because of being on warfarin; and only 24 would have a stroke even though they were on warfarin.


Statistically about 3 of those 1000 people in that year might have a serious haemorrhage because they were on warfarin. But it would save 21 more strokes than the aspirin, so in the end the benefits statistically outweigh the risks.


There is a document here called a "Patient Decision Aid"


This shows those same figures somewhat more graphically.
It is funny but when you look at the picture of 1000 people and who might have a stroke it seems to be to reduce the impact of the risk of a stroke.
BUT you just can't tell which patients are the ones that will be the ones to have a stroke.


We are moving now to attempting to identify more people with irregular pulses and will then try to decide individually with them whether to recommend taking aspirin or warfarin to reduce the risk of stroke.


We have something like 250-300 patients on our list with AF. I haven't sat down and risk assessed them individually but we must be looking at a potential half-dozen strokes a year without aspirin or warfarin, so that may translate into a couple of strokes a year avoided if we had the majority of patients on preventive treatment.

Wednesday, October 5, 2011

New carers' support service launched in Devon



Carers in Devon can now find out about support and information from one place for the first time, as part of a £1.3 million investment by Devon County Council and NHS Devon.

As part of the new Devon Carers Centre a new telephone helpline has been launched to give carers better access to support to help them stay healthy and live a normal life outside of caring.

Carers will be able to access the following services through the helpline:

• Support and information at the ‘first stop’ from the helpline advisor
• A network of local carers’ support workers who provide face to face support and activities for young carers to enjoy being young people
• Opportunities to meet other carers in their area for mutual support, friendship and time away from caring
• Short carers breaks

The new helpline (08456 434 435) is open from 8am to 6pm Monday to Friday and on Saturdays from 9am to 1pm.

The helpline is run by voluntary organisation Westbank, working closely with other carers’ voluntary groups, who will also provide support in their local area. A website has been launched at www.devoncarerscentre.org.uk/

Self referral for mood disorders



I had news this week that our patients are now able to self-refer for psychological treatment of anxiety and depression. The self-referral system for physiotherapy has been very helpful so extending into mental health areas should be too.
If you wanted just a quick reference on helping yourself they have a leaflet you can download here.


I've lifted a few bits from their leaflet to post here.
It doesn't really make it clear here that if you are already undergoing treatment with the mental health services then self-referral isn't appropriate.
They also would prefer that if you are low or anxious during pregnancy and seeking help that you go to your GP initially.
Common sense suggests that if you are significantly ill with mental health problems then this route of referral would not be appropriate initially either.

Veterans and those with a complex history of childhood abuse should really start with their GP also.




The Depression and Anxiety service is a primary care service delivering evidenced based psychological interventions in line with NICE guidance.
These include Cognitive Behavioural Therapy (CBT), Eye Movement, Desensitisation and Reprocessing (EMDR) and Applied Relaxation.
Psychological interventions take place both in a group setting and via individual sessions.




The service is for people in the South and West of Devon who are 18 years and over.


Our team is able to help you with the following:
• Panic attacks
• Depression
• Anxiety
• Excessive worry
• Social anxiety/shyness
• Phobias
• Post traumatic stress disorder
• Agoraphobia




Your GP can refer you or you can refer yourself and we will let your GP know.
You can refer yourself by phoning 01626 203500.
Outside of office hours there is an answerphone. Please leave your name and contact details and we will phone you back.
You can email on:  tr.southandwestdevondas@nhs.net


We will talk to you about your difficulties and agree with you the best way forward.
We can refer you on to other services and give you telephone numbers of alternative treatment options.


We aim to see everyone within four weeks of referral and the initial appointment will take approximately 30 - 40 minutes.






We will look at treatment options with you which are based on Cognitive Behavioural Therapy (CBT).
This looks at the way that thoughts, feelings and behaviours interact, sometimes in a helpful, and sometimes in an unhelpful way.


We provide a choice of help that includes:
• Working with you to identify the difficulty you are having
•  Help you in deciding where to start
•  Recommending reading that would be helpful for you
•  Providing information about other local resources that might be helpful for you
•  Identifying thoughts and actions which may be unhelpful for you
•  Identifying strengths and support to draw on
•  Guidance in setting realistic goals and support in achieving them
•  Providing support through self management programmes that have proven to be effective
•  Group work and/or individual therapy.


We also offer Eye Movement Desensitisation and Reprocessing (EMDR).
This is a specific treatment for people who have experienced a trauma.



Wednesday, September 7, 2011

Flu Vaccination 2011



This year our usual Flu vaccination "campaign" coincides with our move back to Leatside.
For various reasons we are now going to have to try to do the bulk of the vaccinations from where we are now at the Creameries site by the Station.
I had hoped we could do it the week after we moved back but technicalities to do with guaranteeing the cold-storage chain mean we can't really.
SO - we will be getting the vaccines delivered on 6th Oct we hope, then will have a day set aside on Friday 14th Oct to do most of the jabs.
We don't want everyone to pile in at once so I will put an ad in the Totnes Times at the end of this month to explain how we hope to space people out.


As usual it would be daft to have the jabs in the fridge and not be giving them out, so the week of the 10th to the 14th Oct, if you are in seeing the nurse or a doctor and qualify for a jab, then you will probably get one there and then. I'll be keeping a few available during each surgery that week, and I'm sure everyone else there will be doing the same.


This year as usual we would expect to be giving the jab to anyone over the age of 65 and anyone with a long-lasting condition that would mean if they got flu they would be more at risk of serious illness or death. This usually means heart and lung conditions, kidney or liver disease, diabetes or stroke/TIA, people with MS or cerebral palsy and those with Parkinsons. Others where they may have a lowered immunity such as those on long-term steroids, have no spleen or are having immunosuppresive therapy.


This year the Dept of Health has put a greater emphasis on jabbing healthcare workers. Only a third of hospital nurses had a flu jab last year. GPs weren't much better with only 38% having a jab. I had mine as always.
The other emphasis is on pregnant mums. This is because during previous flu outbreaks it has become clear that pregnant women were much more prone to complications from flu than others. This was particularly evident during the swine flu outbreak, and there is still a concern that this strain might come back.


I see people with Influenza every year and I still don't think most people appreciate just how bad it can be, particularly in the younger population. I have  my jab every year because I really don't want to catch it.

Sunday, September 4, 2011

Registrars

I don't think anywhere that I had introduced the fact that we have two new registrars at the surgery.
From August 2011 until the end of July 2012 we are lucky to have two registrars with us - Lorraine Hutchinson-Gale and Rizwan Irshad.


Lorraine's training is being supervised by Dr Frankland and Rizwan by Dr Watkins.



Lorraine worked for many years as a nurse in Torbay and Exeter. 
She did her training at the Peninsula Medical School.
She has a family of four children ranging between 14 and 23 years of age and when not busy with them enjoys walking her two golden retrievers in the Devon countryside.

Rizwan was born and raised in Newton Abbot and went to school and sixth form locally.
He studied medicine in St George's Hospital Medical School in London.
Outside of work he enjoys keeping fit and going to the gym.
He has competed locally in powerlifting for the BDFPA and regularly goes the gym. He also enjoys other sports (both playing and watching) and spending time with his family.

Wednesday, August 31, 2011

Twitter & Facebook




I have decided now to go even more "modern" and start a Leatside Facebook page and twitter feed.
That just might be gobbledegook to you, but for many this means a quick way of getting any information we might want to disseminate.
This Blog is useful for me to have a rant, or go on about something in more detail; but these other social networking sites are good for a quick, snappy bit of information about any small thing we might be doing.
I suspect a different audience may see these than you here reading this blog. We'll see.
I'll be putting the buttons up on the website in the next day or two.
http://www.facebook.com/pages/Leatside-Surgery (I think....)

(Update- I can't seem to get the "buttons" to go quite where I want them to on our website yet- still playing - 4.9.11)

Sunday, July 3, 2011

South Hams Health Profile 2011

This web site shows some of the latest health stats for our area...
The two that jump out are our high incidence of melanoma and a high rate of higher risk drinking.

Tuesday, May 10, 2011

Dr Loverock's retirement

As Dr Loverock has now retired his regular patients are now jockeying for position to see which GP they will end up seeing regularly instead.
Dr Thake is with us now finishing his GP Training before he joins the Doctors full time in August. He is the "official" replacement for Dr Loverock.
 He has worked as a Doctor for many years here and overseas but only in the last few years decided to do the official UK General Practice training, which he is now concluding.


The practice has also just changed one other technicality to do with registering patients.
Patients used to be registered with one or other partner, regardless of which Doctor they ended up seeing regularly.
We have now changed things so that all patients are registered with the practice rather than an individual Doctor.
Our computer system also allows patients to be allocated a "usual Doctor" and this is how we will now be dividing you up. This is the Doctor named at the bottom of your repeat prescriptions and the one who signs them.
If you feel you have been allocated the wrong "Usual Doctor", let us know and we'll change it.

Wednesday, May 4, 2011

More Measles

A letter recieved from Health Protection at NHS Devon a couple of weeks ago.
As far as I am aware we have not seen any cases of measles recently.
The majority of cases were in the under 30 age group.
The European vaccination website euvac suggests that 18% of measles cases in France were hospitalised. There has so far though been only one death which seems an unusually low number for such an outbreak.


"MMR and measles outbreaks


This is to you alert you that France is currently experiencing a large outbreak of measles with over 3,700
cases confirmed so far this year. Outbreaks have also been reported in countries bordering France and in
other parts of Europe. http://www.euvac.net/graphics/euvac/pdf/2011_jan_feb.pdf


There has been a much smaller increase in confirmed cases of measles in the United Kingdom during the
past month and the vast majority of cases have occurred in people who have not been immunised with most
relating to older children attending secondary school, university students and in adults. Many of these cases
have links to those in France.


In light of this information, we are asking practices to consider the following:


1. Immunise those children who present to your practice and have not received two doses of the MMR
vaccine


2. If a patient presents with a history consistent with the signs and symptoms of measles and you are
aware that they have recently been travelling, please take salivary samples for analysis to confirm
whether or not they have measles


Measles, mumps, rubella (MMR) vaccine


Immunisation with MMR vaccine is the safest way that parents can protect their children against measles,
mumps and rubella which are diseases that can have serious consequences for babies, young children and
their families. Not all people respond adequately to a single dose of vaccine, so to ensure greater protection,
people need to receive two doses of MMR. Two doses of measles, mumps, rubella (MMR) vaccine offer full
protection against the three illnesses, provided the first dose is given from 12 months of age."

Thursday, April 14, 2011

Feedback and Patient Input Group



I think as a practice we could do with more feedback from our users (patients).
We don't have, and have never had, a suggestions box.

We did have a patient participation group, which is currently inactive.
We get complaints, as all practices do. This is a form of feedback.
We get some plaudits, but being modest tend to shrug them off as nothing.
We can get feedback via the comments section on this blog.
We can see comments submitted via the NHS Choices practice page.
Another website people use is patient opinion.


We do look at any feedback we get and see if it needs any changes to be made.
Of course we aren't always in a position to make changes, and if changes do seem appropriate what amount of discontent would we need to see before changing anything? ie I don't think we should always change something on the back of one bit of feedback; but we might do.
It is a difficult time at the Surgery to get good feedback. Clearly the current accommodation isn't what we would like. We have few available appointments due to a combination of leave and Easter (and the Royal Wedding). We have a locum until Dr Thake can start properly in August. etc.


I thought that we might initially invite comment or feedback in the main area that taxes us most of the time - the management of urgent cases. 
This might cover the process of phoning in- to access your own GP or the duty doctor to call you back. How your case is then dealt with- eg with advice or a prescription or an appointment to see you. Maybe a house call. Is that appointment suitable for you? 


and so on..


We shall be looking at reconvening a patient participation group. If this sort of thing fires you up perhaps you might want to get involved. We could do with a few people who are patients who have some sort of background in management or business who are used to systems and change? on the other hand any people who have a clear idea about how they would like things to be would be welcome. 
Perhaps if we just get that sort of input we'll get a "predictable result"- if you are a bit of a wildcard perhaps you might be able to have a useful if alternative input.


If you do think you have something to add in this way then why not email in on leatside.surgery@nhs.net for the attention of Andrew Moore. As the practice manager he will be the convener of the group.


If you would like to comment on the area of urgent or same-day appointments then please email in on the same address with the content line "Feedback".


The third option is of course to use the comments section below the blog. Each comment is emailed to mine and Andrew Moore's inbox before it is published....



Leatside Statement of Intent 2010-2015

I found this document the other day. It had been written by my practice manager in response to a revisit from the investors in people as well as the outline plans for our redevelopment coming to fruition, so a statement of intent was firming up the rationale for redeveloping.

Leatside Surgery Statement Of Intent 2010-2015

What we are here for:

  • To provide healthcare to people who register with the Practice for their immediate and long term problems. In doing this, to build and maintain the relationships with individuals and families that allow them to visit our surgery with confidence and trust.
  • To deliver our services in a way that helps our society make the long term improvements in the general health of the public that it wishes to.

What we value most highly:

  • Our ability to maintain the highest standards of healthcare and customer service
  • Our ability to make patients feel understood, cared for and safe
  • Our ability to make sure people working for the Practice feel happy and rewarded in their work
  • Our ability to ensure the safety of patients and people who work in the surgery
  • Our ability to deliver services that meet the requirements of the NHS
  • Our ability to respond to change in the NHS and society generally and use this change for the benefit of the Practice and its patients

The most important things we want to develop over the next three years:

  • To develop the Practice business: 
    • by expanding our capacity to provide services to an increasing population, having regard to government plans to remove restrictions on patients registering with GP Practices such as ‘Practice areas’
    • in the context of the new NHS ‘market’ approach to healthcare provision by seeking out new ways of providing services locally
    • identifying areas of the Practice business where costs can be reduced or resources redeployed should the financial problems of the UK economy and the NHS lead to further restrictions or curtailment of the Practices NHS income.
  • To continue the organisational development of the Practice in respect of:
    • the numbers of doctors, nurses and administrative staff employed by the Practice and the distribution of workload and skills between these groups
    • the use of IT and communications technology to improve and streamline Practice operations
  • To continue to implement systems that assure the quality of care patients receive particularly through mechanisms for clinical governance, learning, appraisal and accreditation

What are we going to do about this over the period 2010 to 2015:

  • We will continue to work toward meeting achieving the highest targets under QoF.
  • We will develop new services through PBC funding following our successful implementation of schemes for COPD and continence.
  • We will consider further developments in our IT and records system, particularly a move to a web based medical record keeping system and greater use of voice recognition software
  • We will increase building capacity to reflect the continuing expansion of Practice services
  • We will continue to increase our involvement in graduate and post graduate training of doctors
  • We will implement changes that improve the way we deal with requests for same day access to doctors and nurses and find a better balance between ‘quick access’ and ‘booked’ appointments
  • We will improve the way we market the Practice to ensure we are able to take advantage of changes in government policy or increases in the local population yo increase our list size

Monday, April 4, 2011

Patient Survey 2010

I have just seen that the latest patient survey results are available online here.
The full reports can be found here.
The highlights in comparison with the PCT are noted on one of the pages, and, despite the limitations of the small sample size used, it seems that we are easy to get hold of on the phone compared to other practices.
Having a modern telephone system allows flexibility in how people can phone in. It does also mean that by providing times when you can ring in to speak to your Doctor we set you up for disappointment if you can't get through because others are on the line.
My patients often tell me that they waited but couldn't get to speak to me. The trouble is that there is only so much time available in the day and I have to do Surgeries and house calls as well as find time for a bite to eat.
We could all spend longer on phone calls but it would likely be at the expense of some other area.
Some of my patients have my direct email address and for them that is now becoming an easier way to get hold of me. Some of the other doctors don't use email to communicate with patients at all. It is debatable whether that is really an effective way of keeping in touch but I am trying it out with a select few- by invitation if you like....
Perhaps in the comments here you could let me know what you think.

Wednesday, February 23, 2011

More on Midwifery

I wrote on a blog here back in October that there was the beginnings of a threat to local midwifery services.
Since then things have moved on but I have to say that at this exact point in time I'm really not clear whether our midwifery service is going to be badly affected or just affected.
I had let Richard Davies at the Totnes Times, and Steve Peacock at the Herald know that something was afoot.
They did a dutiful bit of investigative digging but couldn't get any definitive word from Torbay on what the changes were going to be.
Their getting in touch with Torbay must have put the wind up someone though, because within days we had had calls from the Consultant in charge of the changes and one of the midwifery managers literally popped in to the surgery to attempt to reassure the doctors that the changes were going to have no impact on our service at all.
At that point I let the newspapers know of the reassurance, and Richard has since put in a piece to say all is well.
Now it begins to look again much more like that might not be the case after all.

South Hams had in 2009 a Home Birth rate of 11.3%- just below Glastonbury area I think, but the second highest in the country nonetheless. The England average is 2.7%. Some areas have only accidental home births.
This page shows a map on National Home Birth rates- demonstrating how high the south west is in general compared with other areas of England.
Our midwives in Totnes have been working for years at supporting home births, and if the statistics are anything to go by must be national experts by now. In a national survey only 22% of mums had met the midwife delivering them beforehand. In our area that is 43%. That is one of the major findings of effective team working in midwifery, and it is valued. If the proposed changes go ahead then this might suffer.
As doctors our main concern is that if midwifery services are reduced then midwifery led care will suffer. If that suffers then mums to be will end up more likely to deliver in hospital (possibly).
We know from the stats that Torbay has a Caesarean rate of around 25% of all deliveries.
It sort of flies in the face of progress doesn't it?
And why?
To attempt to save money.
As I understand it one of the major costs in providing midwifery services is the massive insurance required.
Having babies is still a dangerous business. 4.7/1000 births result in a dead baby statistically. (Not as dangerous here as in parts of Africa-184/1000 in Angola is the highest I could find)
Health trusts have to insure their professional staff against mishap. I don't have the costs but I have been told that relative to cutting staffing levels, the insurance costs outweigh the staff-cutting cost benefits vastly. The insurance costs won't change for cutting staffing numbers.

Torbay have written: "following extensive consultative work, the service is being reconfigured to safeguard the current high standard of maternity care that is nationally recognised as an exemplar, whilst acknowledging and facilitating the needs of an increasing number of pregnant women who have additional health and social risk factors, and are vulnerable".
They are doing this by "reducing the number of midwifery teams, but each team will have more midwives". So what was the previous ratio of midwives per birth, and what will it be after the changes? Expectant mums may now meet any of a large number of midwives, so the chance of continuity of care into their labour and afterwards is reduced.
Because each larger team covers a larger area, the worry is that the on call midwife in the team will be pulled all over the place geographically- which must make responsiveness to needs less. Some changes have been made to respond to the European working time directive, but this will include travelling times within the larger areas, and to and from the base for each midwife team. Getting in and out of Brixham (which is where the base is proposed to be for our midwives) can be a nightmare in the summer.
Why haven't they consulted AT ALL with the public or the GPs in this.

There are many more technical points and questions but that might make this all too long and boring.

All of my GP colleagues at Leatside have signed a letter drafted by Dr Morris to the Chief Executive of South Devon Healthcare Trust asking her to stop the process of change and review what is going on here.
This letter is copied below:


Paula Vasco-Knight
Chief Executive
South Devon Healthcare Trust

Dear Ms Knight

I am writing on behalf of Leatside Surgery with regards to our high level of concern over the upcoming changes that we have been informed second hand are going to take place within the midwifery service.  We have been told that our current provision of midwives will be dropping to 2 covering the Totnes area and that the base will be in Brixham.  We have real concerns over these changes.  Ten years ago our midwifery team was a nationally recognised team of 13 midwives just serving the Totnes area.  We also had the highest  home birth rate in the UK and national recognition in the media.    Over the years this team of 13 midwives has been reduced down to 6 and the home birth rate has dropped down from being the highest in the UK down to average. 

We have been in correspondence with the midwifery directorate and had reassurance that services to our patients will not be affected but we fail to see how dropping from 6 to 2 midwives will be of benefit to our patients.  We are also concerned that there has been no sign of any negotiation or consultation with any of the usual parties.  Certainly when this was brought up at the LMC last night there was general concern and surprise and I gather they will also be writing to you.  I also believe very little has been negotiated or discussed with the PCT.  Certainly for future commissioning the proposed set up is not one we would recommend as we foresee poor prenatal care and a substantial decrease in service to our local population. 

The whole change has caused a great deal of distress in the midwifery team who are concerned about the fragmentation of the team and increased journey times to their place of work.  There are also simple practical problems with the team being based in Brixham with the increased travelling times in the summer months due to increased traffic.  A simple journey which might normally take 30 minutes might very easily run into 2 hours or more. 

Andrew Lansley,  throughout the white paper consultations,  has stated that frontline services are to be protected and there has also been a push for an increase in home births and we fail to see how these changes would achieve either of these goals. 

We would welcome due process to be initiated on this project and it’s initiation date to be postponed until this occurs. 

Partners at Leatside