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.

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.

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 357260.
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.

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.

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.

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)

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.

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.

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."

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

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.

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 

The Creameries

We are now moved in. Start work there tomorrow morning.

No phones though. Somehow BT couldn't get their act together to plug in their end of our ISDN line at the exchange, so our phone computer is still at the Surgery. Hopefully get that sorted mid week though. It may of course make getting in touch a little tricky for a few days but we have a contingency plan of leaving some staff at Leatside manning some phones until it gets sorted. I am quietly pleased that the computer system works. You've probably little idea how much thought that took, and in some ways how much we rely on it nowadays.

I've been either amazed or amused by the number of people who seem to have no idea where the Creameries Social Club is. I've told them it is "down at Unigate" and I get a blank look back. I then say it is "just by the "Up" platform at the station" - but then someone came back with "where's the station?". Astonishing.

So, to help you along, here are a few pics. You can click on them to enlarge them.

The view from Totnes Railway Bridge
 - you can see our big yellow sign from here.

turn in by Redworth Traffic Lights

(Free) Car parking this side of the building and in front
Keep the commuters off it!!

The ramp up to the entrance

...and here's the entrance..

in the waiting room

...more waiting room.

this is the corridor between the portacabins (it drips)

my consulting room in the portacabin.

and here's a map.

So there we have it. All ready for use I hope. If you still don't know where it is put TQ9 5JP into your SatNav and it will get you there.

Moving Day

Moving to Dairy Crest in a week!!
We will be moving on Friday 26th. Open for business Monday 29th.
That day will of course be a bit chaotic at Leatside.
We have a skeleton service planned for that day as we have to get everything moved.
The worst bits to move I think are the techie bits.
Our Toshiba phone system for example. We have had a bit of trouble getting a decent ISDN30 line into the new place, which actually put back our move by a week.
Rather than get a secure NHS Net broadband connection installed there we are using a wireless link from Dairy Crest back to the Surgery and leaving our server and major hardware there. Ingenious.
The paper records will be kept secure at the surgery as well, so if anyone needs the paper in the middle of a consultation we will have to send a runner!
Bob the bus will change route to accommodate our move.
There is some parking on the temporary site, but not a whole lot. We are hoping that the train commuters won't use all our spaces. We are preparing some of those lovely, very sticky "polite notices" to slap on their windscreens if they do. For cars leaving the surgery we think it might be best if as a routine everyone tuned left at the top of the road to head back into town, to then come back round the roundabout if needs be. Remember how difficult it used to be for the milk factory traffic to get out onto the lights?
Once we are moved in then all we can do is hope for fine weather this winter/spring so that Midas can crack on with getting the changes at the surgery done as quickly as possible.

Moving to Dairy Crest

OK. Plans are in place. Things are moving.

We will be operating from the Dairy Crest Social Club building (pictured) on Monday 29th November.

Looks lovely doesn't it!

Boots shop will be there too, but may not be able to dispense medicines. We are pretty sure it is Morrisons who have appealed against the PCTs decision to allow the pharmacy to move there with us, so that is now held up in further red tape.
It seems one major point of the objection was the lack of disabled access.
I've just been there today (16th Nov) and walked up the disabled access ramp that had been specified to be there all along. I think their appeal is, as they say, "vexatious" and I feel the PCT should dismiss it.

How will we all squeeze in?

We'll just have to get used to losing our sense of personal space, and have a load of Portakabins too.

Not so sure the midwives will be there though.

It seems their management it looking at ways of reducing costs- proposals include having NO home visits for antenatal or postnatal checks. All these checks would be done at their clinic. The clinic wouldn't be at the Surgery either as it is currently. One option they are looking at has the patients on the Dartmouth and Totnes patch having a Newton Abbot Hospital based midwife for all their care. This would mean you having to go to one of their community clinics for even the 3rd day postnatal checkup. Just imagine, drained and exhausted, with a newborn child and a perineum bruised and torn, dragging yourself the clinic for a  check up. What impact this all might have on your ability to get a home birth I don't know. What it would mean is that if you had your baby in Torbay then you certainly wouldn't have the same midwife as had done your antenatal care.

Health care assistants would do much of the work currently done by trained midwives- including some of the postnatal checks etc. I can't believe that would be safe.

It does seem as though now they've built Newton hospital they are having to justify its existence- by dragging all and sundry there from all over the place for whatever reason. 

There is a posh delivery suite at Newton though- currently though only 3 or 4 births a month. You can park there though.

While I am ranting... has anyone seen any sign of any work starting at Rushbrook?

Back in February / March we finally had the possibility of moving temporarily into Rushbrook finally removed.

"The project work and pre planning we have already undertaken with regard to Rushbrook together with our timings, mean it is likely we will need to commence work on the site before your centre will be ready for re-occupation"  was the message we had in March. At that point we could have got going and been well settled in with building work at Leatside well under way.... "could we back in for New Year???"

As it is we have had to use a less suitable site at much greater expense. Much more.

No going back now but it makes me very cross.

Does anyone know how Rushbrook came to be in Devon County Councils hands?- did they buy it off Dr Jellicoe? Does anyone walk round there and still hear a faint distant call of a peacock?

Red Tape

Thankfully, and perhaps surprisingly, as a GP I seldom get tangled in red tape.
Usually in my profession if something needs to be done I am in a position to just do it.
There is the overriding principle of doing whatever is best for the patient and in the end that really does trump all other concerns most of the time.
In business however life is different.

As you may be aware we are having to relocate the Surgery for a few months while some improvement work is done.
Relocating Boots Pharmacy is turning out to be tricky.
We've had Midas build a space at Unigate for the pharmacy to move in to. That is the easy bit.
Getting the PCT authorities to agree that it is alright for them to move there temporarily is another matter.
It turns out that pharmacy rules are complex.
For a temporary move the pharmacy is not allowed to move more than 500m from its original position. Or perhaps 800m in exceptional circumstances.
A temporary move apparently has to be for 12 months at least (?), but we hope to move for 6 months at the most.
Various committees have to look at the proposed move and invite feedback.
The committee met and after looking at the objections (yes, there were objections, we think from Morrisons) passed it to the Devon PCT to agree.
When they met they deferred a decision til December, because they were apparently busy working out how to manage their own demise. (PCTs are devolving their authority to consortia of GPs)
All this time we are accumulating costs having had to engage Midas to start the project as well as paying interset on the loan we've taken out to do the work, and not getting any work done.
It looks now as though we are just going to have to move anyway and hope that Boots can sort themselves out.
I hope that someone from the PCT can then come down and see if a pharmacy can function in the middle of a building site with all the noise and dust, power going on and off and all the other difficulties of access.
Common sense may then prevail.
It would be better if they could make that, what seems to be, common-sense decision now, but the suits are so tied up in due process that the right decision may never be made it seems.
Quite why our Primary Care trust has no apparent interest in Primary Care is beyond me.
We are taking a risk borrowing a LOT of money to provide the people of Totnes with a good quality Health Centre / Surgery that should last a good few years now. You'd have thought they might show some interest or support.
As it stands we are now looking at starting work from the Unigate / Dairy Crest / Daw's Dairy site on Monday 15th Nov. We'll let everyone know when it is for definite.

Another blog one day might be on why it was we couldn't use Rushbrook temporarily.
As and when I find out why that is I'll let you know here.

Flu Vaccine 2010

Quote from the guidelines on vaccination:

Influenza vaccines are prepared using virus strains in line with the WHO recommendations. Current seasonal influenza vaccines are trivalent, containing two subtypes of influenza A and one type B virus. In recent years these have closely matched viruses circulating subsequently, although the seasonal influenza vaccine produced in 2009/10 was poorly matched to the influenza A (H1N1)v strain that was subsequently predominant. Should a new influenza A subtype emerge with epidemic or pandemic potential, a monovalent vaccine against that strain is developed and implemented as in 2009 when the influenza A (H1N1)v strain emerged. The influenza A (H1N1)v strain is expected to be the predominant influenza strain once again during the 2010/11 influenza season. For this reason, WHO has recommended that this strain be included in the trivalent seasonal influenza vaccine for the 2010/11 influenza season.

You can read the full guidance here.

Influenza has a local link- some say it was John Huxham who first introduced the term to medical use in England.

John Huxham 1733, born in Harberton in 1672, lived later in Staverton.

10K follow up

I am please to report here that we all completed the 10k.
I was happy to get round in 1h15m, the others were quicker.......
Through the sponsor forms at the surgery we raised something over £300, which is fantastic... so I thank you all who gave money.
This you will remember was to support Totnes Caring. Through the race organisers Teign Trotters, Totnes Caring have already had a cheque for £750 from the entry fees and so on as well.
The only downside (apart from my not being able to negotiate any stairs for a couple of days) was that some of the sponsorship money collected went missing from the surgery.
We have asked the Police to look into it, so they have been and looked at our CCTV and spoken to a few people, but unfortunately with no result.
We shall therefore offer up a cheque to Totnes Caring based on what we guess the amount missing was on top of the figures we know for certain. As it stands that will be around £350 I think.
It is really gutting to see that money offered in good faith has been taken.
Next time we do any fundraising we shall be certain to make sure stringent measures are in place to protect any donations.

Totnes 10k

On August the 1st, just before 11am, an intrepid team of runners will emerge from the doors of Leatside and make their way to Borough Park.

These highly trained athletes, and Dr Watkins, will then engage with local running clubs in running the Totnes 10k.

This will take them from the park, out along the river to the drive then alongside the river round the back of Dartington to Staverton- back then up through North Wood and in through the Old Postern and the Cider Press, back into the Park.

In undertaking this we hope to raise a bit of money for Totnes Caring.

The team will comprise Dr Andrew Frankland, Dr Dylan Watkins, Dr Sarah Oxtoby, Dr Richard Hawker, Sally Smeaton and Sandra Day from the reception team, and Jane Peters from the District Nurses.

I am writing this just as I embark on a 10day holiday in France. 

Hopefully in between croissants and Souicissons and oodles of local Vino I might manage the odd jog to bring my fitness up to that of the others! 

Dr Morris will hopefully be standing by on the day with Oxygen and defibrillator.

Support Totnes Caring by supporting the 10k and the Leatside Runners.

Totnes Caring do a great job supporting the elderly in their own homes. Have a look at their website to see more of what they do.

If you want to give online then hopefully early next week Totnes Caring will have set up a just giving page.

Search for Totnes Caring at www.justgiving.com
OR you can give some sponsorship money at the surgery.

New developments at the Surgery

Why are we considering an extension?

Amazingly, it is now 20 years since we first considered moving from our old surgery in Fore Street; 15 years since the first plans were drawn up; and over 10 years since we moved into Leatside. Much has changed in this time. Some examples of this change are:

·      Over 2000 more people have registered with us as patients.

·      We open longer hours.

·      We spend a lot more time helping people with chronic diseases such as diabetes and asthma, monitoring their health and adjusting therapies.

·      We do a lot more to investigate cardiac and blood pressure problems; causes of allergies; types of skin lesions; types and severity of respiratory disease; and diagnostic work generally.

·      An increase in the number of contacts our doctors and nurses have with patients: from around 60,000 per year to 90,000 per year.

·      An increase in the number of doctors from 6 to 10; and an increase in the number of nurses and healthcare assistants from 3 to 9.

When we worked on the design of Leatside, 15 years ago, we knew much of this change was coming and so made sure we had room to expand. Mostly we were successful with this, but we have now almost reached the capacity of the building and so need to consider how we will continue to provide services over the next 15 to 20 years. In doing this we think we need to plan for:

·      A further increase in the number of people registered with us of 3000 or more.

·      A further increase in the amount and type of care we give to people because of NHS plans to transfer care from hospital and specialist centres to GP Practices.

What changes to the building are we planning?

By extending the building at ground floor level and creating a first floor we will increase the overall size of the building from 1022m² to 1602m². This will provide us with:

·      An additional 7 rooms for use by doctors and nurses immediately with the possibility of a further 6 rooms in future through changing the use of other accommodation.

·      A doubling in the size of Boots Chemists who, like the GP Practice are struggling to cope with increases in the number of people using their service.

·      An increase in the number of car parking spaces for use by patients from 36 to 41 and better facilities for parking bicycles.

·      The opportunity to make other improvements like installing a lift to provide better access to the first floor and improving the sound proofing of consulting and treatment rooms.

·      Accommodation for other individuals and organisations to provide services including:

o     An opticians

o     An osteopathic practice

o     The private practice of some local consultants

·      An opportunity to start up services to provide more specialist care currently provided in places like Torbay Hospital.

How are we going to get this done?

Not easily! The work we are planning will affect almost every part of the existing surgery. Added to this the shape of our site our surgery sits on, with only one entrance, means that it would be both very difficult and very unpleasant to carry on working here whilst the building work is underway. For this reason we have been exploring possibilities for using temporary accommodation for the six months it will take to complete the building work. To this end we have been discussing with Dairy Crest the possibility of using a building and car parks close to the railway station and have applied to South Hams District Council for planning permission. Although we have some way to go to finalise all of these plans we are hopeful that we will be able to start our project by the autumn. Through our website www.leatside.co.uk and through information sheets in the surgery we will endeavour to keep you updated on our plans.

Your thoughts..

We are interested to know what you think and particularly if there are ideas or services not mentioned in this outline that you would like us to consider. Over the next month or so we will be publishing more details on our plans so please have a look and let us know.