Willow Tree Family Doctors News Blog

'Prescribing wisely'

We are being asked to cut down our prescribing in NW London

The NHS in NW London CCGs: Brent, Ealing, Harrow, Hillingdon, Hounslow, Hammersmith & Fulham, Kensington & Chelsea, and Westminster spent over £13 million in 2016 on products that can be bought without a prescription at community pharmacies.

The NHS is under pressure. Our budgets are not large enough to pay for all the treatments the public would like us to provide. We would therefore like to spend less on medicines you can buy without a prescription so as to free up funds for other valuable NHS services.  

So practices across North West London are being asked to stop routinely prescribing medicines which are available to buy over the counter in pharmacies (and, in the case of some medicines, in supermarkets and other shops too). If a medicine you need can be bought without a prescription, your GP may ask if you are willing to buy it.  If you are not willing to buy it, it will be prescribed.

More details here

Here is a list of commonly prescribed medicines which are available without a prescription 

Additionally, we are recommending patients to order their repeat prescriptions from us (easiest to use the online service with an App: Patient Accesseasy to sign up to

The reason is we often find if the pharmacy orders on behalf of patients, they order all the medicines on the list, whether or not the patient needs them. And so many patients have ended up with large stocks of unwanted items, costing a huge waste of money to the NHS. So it is better to select for yourself just what you need - and it is so easy. 

We send the items directly to the pharmacy of your choice by EPS (Electronic Prescription Service) - that saves you coming to collect a paper prescription and reducing the chance for lost or delayed items.


New Clinical Pharmacist joins us

New Clinical Pharmacist Shaina Thakrar

"I qualified from the University of Nottingham in 2014 and completed training as an Independent Prescriber in 2018, with a keen interest in diabetes.

My role as a Clinical Pharmacist in the practice is a varied and expanding! I deal with prescription and medication queries, see patients for medication reviews and help with the management of long-term conditions.
When I am not at work, I enjoy going to the gym and spending time with my family and friends."

We welcome Shaina to this new role to help us develop our services to patients and high standard of clinical care. Pharmacists are extremely valuable at this time of increasing pharmaceutical complexity, with many new drugs being developed and patients taking more diverse mixtures of drugs as the treatments for long term conditions become ever more sophisticated. She will also be helping us with changes to medication following hospital discharges and other areas of risk and will help us develop new services.  Safety is paramount and having someone with Shaina's skills and knowledge is a real boon for us and our patients.

Some of you will be seeing Shaina for reviews of repeat medication and long term conditions - sometimes at home in the case of housebound people - and we're sure you will appreciate her care.

The post is part of an NHS initiative to introduce Clinical Pharmacists to primary care and we are sharing the project with our Harness Federation.

New Advanced Nurse Practitioner joining us

We welcome Rebecca Feeley, who starts in mid July

"I’m so happy to be joining the Willow Tree team and integrating my role as an Advanced Nurse Practitioner & Independent Nurse Prescriber. 

I have worked in accident and emergency departments for 15 years, beginning as a staff nurse graduating to an advanced emergency nurse practitioner after many years of training.  

During my many years in A&E I specialised in Injuries and minor illness and also have experience in critical care and paediatrics.

My role as an advanced clinical practitioner means that I complete full assessments of patients, including a full medical examination, diagnosis of illness and injuries,  treatment and discharge. I am also a nurse prescriber, which means I can prescribe any medication necessary during my consultation.  

I shall be taking part in the Rapid Access appointments 2.5 days a week, working alongside the Duty Doctor who shall offer support should my patients require their input at any point.  

I have a passion for medicine and also have a special interest in aesthetics and have experience as an aesthetics practitioner.   
I recently left my accident and emergency / urgent care centre job after welcoming my little daughter into the world. I'm really looking forward to working within a primary care setting and getting to know my patients."

We welcome Rebecca and are certain she'll make a big contribution to our service and help us to continue offering excellent and speedy medical care.  Advanced Nurse Practitioners (ANPs) are highly trained, as you see from Rebecca's introduction and can handle a wide range of minor illness and injuries completely autonomously and safely and they complement the skills of the existing team. They are carefully trained to identify problems outside their area of expertise and to call a doctor and we'll ensure Rebecca always has our full support. 

The composition of the Primary Care Team is changing  to cope with the increased demand and the shortage of doctors and many surgeries are recruiting a wider range clinicians, including more nurses, Advanced Nurse Practiitoners,  Healthcare Assistants, Physicians' Assistants, Clinical Pharmacists (we have our own, Shaina Thakrar, who we'll introduce shortly). The landscape is changing and you can be sure Willow Tree Family Doctors will be near the front and we'll keep you up to date on further developments.

Welcome to a new doctor!

We're very happy to introduce to our clinic team, Dr Jeremy Parfitt, an experienced GP with many skills to complement those of existing colleagues at Willow Tree. He has been working as a partner in a good local practice and we're very lucky to have signed him up. We feel confident he'll be a great asset and sure he'll soon be developing a loyal following.

"I trained at St Marys Hospital and spent a few years in General Surgery. I completed my GP training at Northwick Park Hospital.
I have worked as a GP locally for a few years. I have an interest in many aspects of general practice including minor surgery.
Outside of General Practice I enjoy cycling and family walks with our dog."

Please give Dr Parfitt a warm welcome !
Comments (1)

Judd's Pharmacy opens at Willow Tree Family Doctors

Congratulations to Ramesh of Judd's Pharmacy, now open at Willow Tree Family Doctors! 

Ramesh has opened his state-of-the-art pharmacy, complete with all the high tech. to ensure accurate and timely dispensing of medication. He has an exciting new robot dispensing system from Germany, one of only a handful in UK pharmacies. We wish Ramesh every success in his venture and hope our continued close cooperation will help improve and extend services to patients.


FLU VACCINATIONS: Prepare for a bad outbreak this year

Flu predicted to be particularly bad this year!!
There is a large outbreak of flu in Australia at the moment ("the worst on record") and due to weather patterns , what happens over there tends to come this way later. So this year is predicted to be potentially bad, perhaps "the worst in history".
Flu jabs are running short, are free of charge and are recommended for all those over 65 years , all pregnant women (at whatever stage), those under 65 (including children over 6m) in certain high risk groups and you may also qualify if you are a carer for a vulnerable person or receive the carer's allowance or live in a long stay care facility. 

We have walk-in slots between 9am- 6pm  (there may occasionally be a short wait at peak times). 
If you prefer a booked time, we're making bookings NOW!

Health workers and others deemed to be at risk will be vaccinated under their Occupational Health service.

At risk groups include those with: 
  • Chronic respiratory disease (incl. serious asthma requiring regular preventative treatment, COPD, children admitted to hospital with respiratory problems), 
  • Chronic heart disease, 
  • Chronic liver disease (incl. cirrhosis), 
  • Chronic neurological disease (such as MS, stroke), 
  • Diabetes, 
  • Decreased immunity (such as steroids, chemotherapy, lack of spleen) and 
  • All pregnant women
  • Morbid obesity (BMI -Body Mass Index-  of 40 or more)
  • Those in long stay residential homes or care facilities
2-8 year old children will also be offered the nasal flu vaccine. Those aged 2 or 3 on 31.8.17 will be offered this nasal vaccine here. Children in reception class and school years 1,2,3 and 4 will be vacccinated at school. 

Click on this image for a leaflet on this year's programme with useful answers to common questions:


Fantastic results in patient survey

The annual practice patient surgery conducted for the NHS for 2017 showed great results.
We were well above average both nationally and locally for most parameters.

90% of respondents found their overall experience of the surgery as good, compared with a local average of 79%.

98% of respondents had trust and confidence in the GP they contacted, 99% in the nurse.88% would recommend us to a new neighbour, against a national average of 77% and a local average of 69%.

91% found receptionists helpful, 82% said they found the process of making an appointment good compared with a local average of 67% and nationally 73%.

Full survey results

Prescribing changes proposed for NW London

Consultation open until 30th June  -your chance to have your voice heard

In order to save money from the increasing prescribing (medicines) budget for North-West London, the eight CCG's (clinical commissioning groups) have set out three proposals.

Proposal One suggests that GPs should ask patients if they are willing to buy certain medicines or products that can be bought without a prescription.
Proposal Two asks that GPs would stop routinely prescribing certain products and medicines which can be bought without a prescription.
Proposal Three states that to reduce waste patients will be expected to order their own repeat prescriptions instead of asking the chemist or another agent to do it for them.

To see more and comment look at this link. Many of the medicines and products listed are those that are commonly used by many of us and so it may well affect you..

Saving money is essential but is this the best way to do it? Is it fair to expect your GP to ask if you would prefer to buy certain items rather than have a prescription? Might it not be better to simply exclude certain items from NHS prescribing altogether and if this is the case, should it be done nationally rather than at a local level?  Postcode lottery seems to be coming back into fashion in the NHS. To discuss things with some patients only could introduce inequity and unfairness. Returning responsibility for ordering  repeat prescriptions may well be unpopular with many people who are used now to having their repeat items automatically supplied by the chemist.  However, as GPs, we see many wasted items which are not required by the patient but are simply ordered each month automatically.  Stopping that would certainly help.

There is wide variance in prescribing behaviour across practices. We have excellent prescribing data detailing our own personal and practice patterns and can compare ourselves with local practices and those across London and the country. Very few of the wide differences can be justified easily.  GPs have been brought up in different eras and have different degrees of experience,knowledge and skills and perhaps prescribing could be rationalised with better training. Some will also be unduly influenced by the pharmaceutical industry and that is a whole other area for discussion.

Please answer the questionnaire so let's get a wide is as wide a range of answers as possible. Maybe they really are consulting and maybe there is no pre-determined plan?  At least that's what we prefer to believe! But if this goes through it may only be the beginning of more changes along these lines.

Wasted medication - a serious concern

When we visit patients at home we often find piles of old unused medicines, inhalers and other items. Not only does this present a hazard but it is a huge drain on the increasingly scarce NHS resources.
It is estimated that every year around £300m is wasted in unused medicines. 
This would for instance pay for 11,778 MORE community nurses or 80,906 MORE hip replacements or 19,799 MORE drug treatment courses for breast cancer or 300,000 MORE drug treatment courses for Alzheimer's or 312,175 MORE cataract operations, so it is a major problem.
How does it happen? Often with repeat prescriptions the whole lot is ordered each time, meaning over-stocking occurs, or when new medicines are started sometimes the old ones continue to be ordered. Sometimes  patients don't like to take the prescribed medicines or have side effects and stop them but are afraid to tell the doctor. Other times duplicate supplies are given in hospital without the GP knowing.
What you can do:
Only order what you need. Take back unused medicines to the pharmacy for disposal.Tell your doctor if you need to stop taking something. 

For more information, look at this campaign: Medicine Waste


Willow Tree granted Training Practice status!

It has been a long journey but we’ve finally made it: Willow Tree Family Doctors was approved as a Training Practice earlier today by Health Education England - North West London. This means that later this year we will hopefully be able to welcome Foundation 2 (F2) doctors to our wonderful team.

The Foundation Programme is a  two-year training programme which forms the bridge between medical school and specialist/general practice training. Drs Dodhia and Mehrali, who have overseen the process, were also approved as trainers.

F2 doctors remain under clinical supervision (as do all doctors in training) but take on increasing responsibility for patient care. In particular they begin to make management decisions as part of their progress towards independent practice.

We believe that achieving and maintaining training practice status enhances the quality of the medical care that we provide at the practice. It also enables patients to see a wider range of clinicians whilst allowing the surgery to benefit from the fresh ideas and approaches brought by young enthusiastic doctors. You can of course still elect to see your chosen regular doctor.

The doctors will be in post for 4 months, becoming an integral part of the practice team and an invaluable resource for patients.  

The NWL Sustainability and Transformation Plan (STP)

Sustainability and transformation plans (STPs) have just been submitted by NHS organisations in different parts of the country outlining the future of health and care services in their area. Ours involves the whole of North West London and involves the NHS services and the Local Authorities planning ways in which they hope to come together to deliver health and care in a more intelligent and integrated way, bridging the gap between social care and health services. 

One of the principle themes now is cooperation rather than competition, which has  driven the way we work over the last 4 years (in, some would say, a very destructive and dysfunctional way). The other themes are, of course, diminishing resources - both money and people - and rising and changing patterns of demand and how to provide good quality care under these circumstances. 

There will be a lot of re-balancing budgets and reshaping the types of services offered. There is simply no possibility of carrying on in the current way.

The plan is for 5 years and covers 9 priorities: 

  1. Support people who are mainly healthy to stay mentally and physically well, enabling and empowering them to make healthy choices and look after themselves 
  2. Improve children’s mental and physical health and wellbeing
  3. Reduce health inequalities and unequal outcomes for the top three killers: cancer, heart diseases and respiratory illness 
  4. Reduce social isolation 
  5. Reduce unfair variation in the management of long-term conditions – diabetes, cardio vascular disease and respiratory disease
  6.  Ensure people access the right care in the right place at the right time 
  7. Improve the quality of care for people in their last phase of life, enabling them to die in their place of choice
  8. Reduce the gap in life expectancy between adults with serious and long-term mental health needs and the rest of the population 
  9. Ensure services and experiences are of a high quality every day of the week 
And 5 delivery areas:
  1. Improving your health and wellbeing
  2. Better care for people with longterm conditions
  3.  Better care for older people
  4. Improving mental health services 
  5. Safe, high quality sustainable services 
Probably not many would disagree with these but how is the plan going to be achieved?  A 9 page summary can be viewed here  and for the brave, the complete plan can be viewed  here .

Help! We need another doctor.

If you've been wondering why appointments choice has recently not been as good as usual,  it's because we're short of one doctor. Since Dr Rapsey has moved away we've been hard at work trying to recruit but there really is NOBODY around. Fortunately Dr Rapsey has kindly been driving into town to help us out for a couple of surgeries a week but with holidays booked, we're going to be very short at times and all the doctors are doing extra sessions to fill in.

In the past we would have 20-40 applicants for each GP vacancy but now, despite extensive advertising, none at all. Not even long term locums. We have recently met a couple of doctors who will soon be able to offer a few sessions on a short term basis but we really need another long term, hopefully permanent, member of the team, in order to give good continuity.

So where have all the doctors gone? Many are taking short term appointments of very limited commitment, or constructing 'portfolio' careers - mixtures such as working in A&E, sexual health clinics, diet clinics, online services or research and many are travelling abroad to work. A GP can earn far more as a locum and have total flexibility about when and where to work - practices all around the country are desperate for them - and of course no long term responsibilities for running buildings, employing staff, dealing with inspections and a mass of growing regulation and legislation. 

A recent survey in London revealed 31% of practices have at least one GP vacancy. And in some parts of the country, GPs are walking away from their practices with nobody to share the work. And again in the London survey, vacancies are remaining unfilled for an average of 8 months.

General Practice had, until recently, been a very popular option, with the thought that you can settle down in one place, really get to know your patients and build something of lasting value. Unfortunately the stress of being a GP has increased exponentially over the past few years. There has been a rise in the complexity of what we deal with: social conditions have changed greatly with more instability and fragmentation in the local population. That exacerbates ill health and with an ageing population and advances in medicine, combinations of complex serious conditions have become survivable making management more challenging. 

This medical progress has given rise to greater and frequently unreasonable expectations, fuelled by the media. Politicians and the media, again, have at the same time, been very critical of doctors and particularly GPs. Eventually a bombardment of negativity has demoralised many. At the same time the government has constantly meddled with the health service, introducing many damaging changes whilst creating a stranglehold by micromanagement, in the process deprofessionalising doctors. All rather similar to the changing conditions teachers have faced. 

Perhaps the biggest harm was the creation of a pseudo-market in the NHS- providers, the hospitals and other bodies selling their services to the commissioners - GPs and public health now spending much of their professional lives trying to organise a viable services to meet the needs of the rising local population on a falling budget. The hospitals, driven by contracts, have become ever more restricted and rigid in the way they provide their services - and it must be said, inefficient, as administrative budgets have been cut - and leave more and more to the GP to sort out. 

It's all become a bit too much and no wonder around 60% say they are considering retiring early. 

It's a shame as it's still a fabulous job and there is much good work to be done. We hope to find someone soon, before we become exhausted and before you become frustrated by the reduced choice of appointments . In the meantime, thank you for your understanding.


Announcing a new Partner

We're delighted to announce Dr Lauren Newman, until now an Associate GP at the practice, becomes a partner from July 1st.  Congratulations!

Dr Lauren Newman 
I've been working at Willow Tree for over a year, having completed my GP training at Millway Medical Practice in Mill Hill. My professional interests include Women's Health, Teaching and Health Promotion. Out of work I enjoy cooking, coffee, attending exercise classes and growing vegetables. 


A new model for Urgent Care for NW London?

If you want urgent (unplanned) medical help where do you turn to – your GP, A&E, a Walk In Centre , an Urgent Care Centre,  Minor Injuries Unit, or Out of Hours GP service, ring 999 or 111 ? In hours and Out of Hours the choices are rather different. This multiplicity of choices and the different options in each area makes for a very confusing picture and it is no wonder people often go to less appropriate places.

There is a lot of duplication and very poor communication so that you have to repeat your story and there no access to your complete medical record held at your GP practice and the information about your urgent care contact may not filter back to the GP or other people involved in your ongoing care. You may be seen by a doctor or a nurse or another type of professional. And the cost is high; attendance at A&E is rising inexorably and you’ll have seen the headlines showing that the system is breaking and unsustainable in its present form.

We need a system that is much clearer and less confusing, quicker and more responsive, able to share information when needed and joined up with all other bits of the health and social care systems, breaking down the artificial organisational barriers that inhibit good quality, efficient care.

But how to do this and within a shrinking budget? The service providers do not know all the answers and look to users of the system to help set the agenda and shape the future. 19 separate events have taken place across NW London to gain insights into what the public would like to see.

Some small scale but important changes have already happened. But some bigger changes are planned, for instance the proposed creation of a Clinical Advice and Treatment Service (CATS)  set up within or alongside 111 to give better triage and quicker advice and treatment options from a wider variety of professionals including doctors, pharmacists, nurses  and social workers (111 is currently mainly a call handling service with limited clinical support from nurses and paramedics relying on computer decision making tools).

All this is hugely complex and will require great cooperation and ‘ownership’ across  all the different agencies, much better technology and systems and a wider skill mix involved in providing the service and of course it will cost a lot to set up before it makes any savings, if indeed it ever does.

To see what’s going on and get involved if you want to, please look at some of the documentation from a recent event held in Brent on 14th June, available here 

We've done it!

We have finally opened the new surgery - only around 5 months later than originally planned but we think well worth waiting for. It was touch and go right until the end and there are still some finishing details needed here and there but we hope you like it.

Here are our first patients through the door this morning (May 3rd) and their strictly medicinal champagne and therapeutic chocolates. 

Now to get it all working perfectly in time for the likely CQC inspection - it's certainly all go!

Sharing information to improve care

Information Processing
We in Brent CCG are part of the North West London Collaboration of Clinical Commissioning Groups which is engaged on a huge project to integrate health and social care across the 8 boroughs of North West London (Whole Systems Integration Pilot). 
A fundamental part of this is to link the information systems so if you are seen in A&E, General Practice, Hospital Outpatients, Community clinic, wherever, that appropriate levels of information flow across to enable safe, efficient care. Some of this information also needs to tell Social Services what you need to have in place when you are discharged from hospital, the Ambulance crew to understand your essential medical history in an emergency, the Palliative Care team to help give the most appropriate care and all the Community teams to coordinate their care properly. Surprisingly, most of the IT systems do not speak to each other and so there is duplication of information, big gaps and things done by fax and phone. You may have been aware of this when having to repeat your medical history many times over when accessing services.
To make this information flow happen we need good secure data sharing agreements and protocols to protect your personal information. 
We have added a Fair Processing Notice to our website to inform patients of the data we hold and how we might use it to help improve care. A printable copy is available here.
There are also a set of FAQs available 
A useful video is available here 

How to deal with your sick child

It's that time of the year when all children get ill with coughs, colds and other viral infections often accompanied by fevers, vomiting and rashes and they can feel really miserable and distressed.  As adults we've all been through these infections and as a result our immune systems now give us resistance, so even if we get ill we usually don't feel so bad. And we can understand and know we'll feel better in a few days but a young child doesn't know this.
When we see a sick child with a high fever it can be extremely worrying for a parent to know if it is part of a more serious illness and what should be done to make your child better.

The NHS 111 service has produced a very useful booklet to help:  
                                            When should I worry?

Signs of potentially more serious illness:
Your child is drowsy or irritable. (Although children with a temperature are often more sleepy, irritable and lacking interest than usual, they usually improve after treatment with paracetamol and / or Ibuprofen. If they do not improve, or if they are very drowsy indeed, they should see a doctor urgently).
Your child has problems breathing - including rapid breathing and being short of breath or ’working hard’ to breath. (It sometimes looks as though the tissues between the ribs and below the ribs get sucked in each time they breath). Any child who has a lot of difficulty breathing needs to see a doctor urgently.
Cold or discoloured hands or feet with a warm body
Severe arm and/or leg pains (for no obvious reason and more than the usual aches and pains in the limbs that accompany many viral infections
Unusual skin colour (pale, blue or dusky around lips, especially if mottled)
High temperature (40 C or higher) (not necessarily a sign of serious infection, but if the temperature does not come down with treatment or your child has other features on this list then you should seek help).

An infant who is not feeding or any child that is showing signs of dehydration
Signs which can be related to meningitis:
- Unusually severe headache
- A stiff neck (difficulty putting chin to chest)
- Dislike of bright lights
- A rash that does not fade with pressure 

In summary:
Most common infections do not get better quicker with antibiotics.
Most children with a cold, cough, sore throat or earache, who see their GP, will still be ill 4 days later. This does not mean that they need treatment or need to be seen again.
One third of children who have seen their GP with a cough will still be coughing 2 weeks later. This does not mean that they need treatment.
Only children with signs of more serious illness as indicated above generally need to be seen by a doctor or nurse. 

For advice on where to turn for help Out of Hours, see our previous blog on the subject. 

Feeling ill and your GP practice is closed?

There is a multiplicity of services in this increasingly fragmented NHS. Where do you go when you're ill? 
With A&E waiting times typically of several hours and likely to get worse this winter, it seems many choose that option. But is it the best? If you you haven't had an accident and it's not an emergency (chest pain, collapse, loss of consciousness etc) then probably not.  Many people visiting A&E are making the wrong choice and are delaying the care of more urgent cases. Should they instead have chosen a walk-in centre, urgent care centre, GP out of hours service, visited a pharmacist or checked what to do on-line?
So, how to choose, if you're not sure? 
A good starting point is to ring NHS 111 which has a directory of all local services. If it's not urgent and they are busy, you may have to wait a while until someone calls you back. You will be asked about your problem and a computer will help the adviser to decide on the level of urgency and give you advice or direct you where to go or call a doctor to visit or an ambulance to take you to hospital. The computer usually plays ultra-safe so you may be unexpectedly advised to go to A&E anyway! 
Another great place to check is NHS Choices which has more and more information about health problems and how to manage them. 
If you're not sure what might be wrong, try the excellent NHS Choices Symptom Checker 
If you want a more detailed overview of the options for help available and which it is most appropriate to use, try RightCare4U 

Here is some information about local services usefully provided by our Patient Participation Group:

116 CHAPLIN ROAD WEMBLEY MIDDX HA0 4UZ  Tel 0208 900 6020
This is open to anyone, who lives in Brent. 
Open 8am to 8pm 7days a week no appointment needed, GPs and Nurse Practitioners work at this site and provide the sort of service you'd expect to find at a GP surgery. 
There is now NO minor injuries unit at this site.
More information here. 

Tel 0208 732 6459
Open 7am to 9pm 7 days a week
Treats minor injuries and illnesses such as for cuts that require stitches, grazes, strains and sprains, insect bites, minor burns and minor illnesses such as tonsillitis, urinary tract infections and emergency contraception.  Children can be seen but there is no paediatrician on site so you may then have to go to Barnet hosp or Northwick Park. Any fractures again have to go on to A&E dept though there are Xray facilities during the day.
More information here

ACTON LANE  NW107NS   Tel 0208 965 5733
Open 24hrs 7 days/ week. Run by GPs and extended nurse practitioners.
It is for minor injuries and illnesses not life threatening conditions. E.g sprains, minor burns, cuts (including those needing stitches ), minor infections and X-rays. If a fracture is discovered you have to go on to an A&E dept. Children can be seen but there is no paediatrician on site and you may have to be referred on to A&E services at Northwick Park.
More information here. 

When you arrive you will be triaged at desk and sent to:
        Urgent Care Centre – for minor injuries or illnesses, including fractures, ( that is where the long wait is  and why sometimes, if appropriate, it is better to go to CMH or Edgware)
        A&E for major problems
        Paediatrics A&E

More details here