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Frequently Asked Questions

  • Why an online 'front door'? Can't we go back to the 'normal way' of everyone booking their own appointments?
    To run our service efficiently, it is really important to know in advance what sort of help is needed. We can then tailor our response to offer the most appropriate assistance.

    We have lots of different people working in the surgery nowadays and a GP may not necessarily be the best person to help - for instance medication queries can be dealt with by the skilled Clinical Pharmacists, musculoskeletal problems by a First Contact Physiotherapist, contraception by a Nurse, diabetic reviews by a Nurse or Healthcare Assistant, social isolation by a Social Prescribing Linkworker, certificates can be sorted by Administrators etc - leaving GPs to concentrate on problems they are best placed to deal with.

    In the 'old days' people would book a GP appointment for everything, often having to wait for a couple of weeks, arrange to take time off work or someone to bring them, sit in the surgery and see the doctor just to ask for their certificate, a prescription or test results, asking for blood tests to be arranged or a simple referral - all things that could have been done with a quick online application. Surgeries still running this traditional model are often criticised for running out of appointments by 9am or having to wait three weeks for the first appointment: with our system, we respond to most people the same day!

    When an online query comes, we look at them all really quickly - within a few minutes if sent during office hours - and prioritise to respond first to urgent problems.

    Most problems are responded to on the same day, or at least within 24 hours.This rapid service improves safety and reduces worry for patients with significant problems. The first response is often a phone call but can be completing the requested action without further contact. We can also book a face to face or video consultation or request more information, maybe a photo of a rash to make a diagnosis and arrange treatment.

    By not filling up our appointments for a week or more ahead, we can arrange to see patients who need a face to face appointment pretty well any time - often on the same day within an hour or two - and at their convenience and also give time for longer appointments.

    It also allows us to rearrange our work rapidly, for instance when the demand increases during spikes in Covid or Flu, so makes our service more responsive. This is especially important now, as we - and general practice and the NHS as a whole - have serious recruitment problems and we have shortfalls in our staffing at times. It saves cancelling a booked clinic when someone is off sick.

    What about people uncomfortable with online access? We still have the phones and our receptionists will ask the same questions as the online system, so we have the same information from everyone to prioritise care. Of course, this takes time and can result in queues, so we do try and ask those people who can, to try the Patchs online system: it is very easy and you can do it in your own time and give us as much detail as you want.

    Many people use online services, whether for their banks, utility providers, Amazon, travel, or pizza deliver. A few years back these might have seemed difficult but now they are acceptable to most people and we think the first access to health services digitally will become the norm, especially in this era of reduced resources and increased demand.

    No everyone will find the new system acceptable. Certainly, no previous appointment system suited everyone - and GPs have tried many over the years! We hope to evolve to something that suits the majority and welcome any constructive comments in our endeavour to make our service as suitable and responsive as possible.
  • Why do we not accept patients from any area?

    Our contract with patients is to look after them 24hrs a day 7 days a week and if we undertake that responsibility it also involves the need to be able to visit at home if required. Obviously if the patient is far away it takes us out of the surgery when we could be seeing other patients and with modern traffic conditions means we really have to keep within a fairly tight geographical area.

    When arranging services for patients such as physiotherapy, district nursing, blood tests, mental health and counselling, pharmacy deliveries and so on, it becomes very complex when dealing with other areas. Services are often arranged very differently elsewhere and we can't access contact details or referral pathways. We already deal with patients living in 3 different boroughs and that's bad enough! We try and do the best we can for our patients, so this means doing it within the area we know with services we can access.

    We do have a slightly larger 'outer area' where we can keep existing patients who happen to move just a street or two away but further than that, we have to say a sad 'farewell'.

    It is always a great pity to lose our patients with whom we have often built up a long-term relationship. We will give you time to make suitable arrangements in your new area and can offer assistance if needed. We hope you will understand that if we make exceptions we'll have to do it for all and it will become impossible for us to manage.

  • Why do we only supply 2 months' worth of repeat prescriptions?
    Most practice supply a 2 month quantity of repeat medication but some offer only one month, others three months. Our standard repeat medication cycle is 56 days ( 8 weeks), unless for more risky medicines and is considered good practice. A three month supply might seem less work for us and more convenient for patients, so why not more?

    It is a balance between convenience for the patient and allowing us to monitor usage, safety, keeping wastage to a minimum (doses and preparations change as people’s conditions evolve) and avoiding depleting supplies (there are many medicine shortages at present).

    We keep our policies under review and may change in the future if the evidence shifts. 

    Making use of one of the Apps for ordering your medicines (eg NHS app or Patient app) makes it just a simple tick box selection process 6 times a year, so not terribly inconvenient. It also allows you to see when monitoring reviews might be coming up and when we send invitations for blood tests or questionnaires, we hope you will respond and if the monitoring requirements are successful, we can refresh your supply for a further year.
  • What is my GP doing when not seeing patients?
    When your GP is not seeing patients, they are doing other important work. Don't forget though, even if they are not doing a surgery session, they may still be seeing patients, either on a home visit or maybe doing some minor surgery or carrying out a medical examination.

    The GPs always have tons of administrative work - it sometimes feels like an uncontrollable avalanche!

    Each surgery generates a lot of additional work: there are always referral letters and other correspondence to write - writing letters to hospitals and other health and social care agencies has become an increasing part of the job.

    We also have a pile of new admin. tasks awaiting us each day - many NHS 'First Notes' and private certificates, reports to write for insurance companies, employers, DWP, DVLA etc as well as requests or queries from other team members from within or outside of the surgery.

    Each day we have prescription requests from 100 or more patients, a lot marked 'urgent'. Many of these are for multiple medicines - sometimes up to 14 separate items and each needs careful checking to ensure essential monitoring has been carried out, the doses remain the same, the hospital has not changed anything and that there are no interactions or contraindications. Most are sent electronically and others go to third party suppliers. It takes around 2-3hrs for the doctor doing that day's prescriptions to sort all this out safely (and a staff member another 3hrs to organise them all, ready for the doctor).

    Each day every doctor receives electronic test results from 10 - 30 patients , again often multiple items for each patient - and it takes around an hour to look at these, check against the records and informing the patient (often phoning or writing to the patient), adjusting the medication, referring to hospital, requesting more tests or whatever action is required.

    Every day we each have a number of telephone calls to patients resulting from hospital letters received requiring action or calls from patients asking for advice. We encourage patients to use the online consultation system or call for simple enquiries , rather than make an unnecessary face to face consultation. The Duty Dr may deal with 20 or more such calls each day but each doctor has their own to deal with as well. We also have other telephone calls to and from other agencies such as the hospital, care homes, urgent care services, 111, social services, community nurses, hospice nurses, various clinics , schools, employers and so on. We also book a number of follow up phone calls to check on progress of patients.

    Each day over 120 letters about patients are received including discharge summaries, outpatient letters, contacts from social care, from private doctors, from patients, from DWP, DVLA, insurance companies, employers, schools etc. Most are delivered electronically but many still have to be scanned. We have an administrative team assessing these and sending them on to the relevant doctors each day for further actions, such as contacting the patient, booking some tests or maybe referring elsewhere. This can take a couple of hours to sort out.

    Two GPs are Postgraduate Trainers looking after the Trainee GPs in the practice, dealing with their queries during every surgery session but also checking and holding de-briefing sessions to review each each patient interaction, assess their progress and help them prepare for their qualifications. A similar process of induction and training happens with new clinical staff joining the practice team and the doctors are also involved in some of the training or Reception and Administrative staff.

    It's not just trainees who need supervising: many staff are not able to work autonomously like a doctor can and need constant supervision to ensure their work is safe and appropriate. This is especially true of many of the new roles and all staff will have random checks on the alit off their work carried out by the partners and this takes time.

    The NHS is constantly coming up with new 'asks' of general practice: carry out this or that new activity for groups of patients, to a specification that requires regular monitoring and reporting. All off this takes additional time over and above the core consulting and looking after patients on a day to day basis.

    We have a lot of practice administration requiring detailed searches of our computer database to report on progress towards various targets we are set by NHS England and the ICS and CQC requirements. We then have to set strategies and design new ways of working for improving the care of various groups of our patients - more meetings.

    We have regular meetings within the practice teams and with the multidisciplinary teams sharing care with our patients (nurses, health visitors, palliative care team etc) and meetings with external bodies such as the Primary Care Network, Harness, the new NWL ICB structures (replacing the previous CCG) as well as other internal team meetings each week to attend to management of the practice, building, staffing, finances and so on.

    We have mandatory training requirements each year to maintain our fitness to practice - such as Infection Control, Resuscitation, Safeguarding etc. We also have an official annual Appraisal which requires us to attend education sessions and personal study and hold an annual meting with our Appraiser.

    The two Postgraduate Trainers also have to attend many regular meetings.

    Some of the GPs have commitments outside the practice such as part of the NW London Whole Systems Integration and the Complex Patient Management Group, one is IT lead for the CCG and sits on the panel of the National User Group for the GP software system we use and teaches at the local medical school. More meetings!

    Sometimes we even have time for lunch and 'comfort breaks'!

    Lastly, most GPs are no longer full-time. It has become an increasingly stressful job and some of the GPs at this practice have been working for over 30 years and feel increasingly fatigued and under pressure, with long hours, often late into the evening and weekends and increased fire-fighting, trying to patch together a fragmenting NHS and social care system. And with more and more stress put on practice budgets and more and more complexity and lack of support from the NHS. All around the country GPs have been retiring early or cutting back and some of the GPs at this practice have reduced their hours in order to practice safely, remain fresh and enthused and see their families occasionally.

    No wonder it is so hard to recruit new GPs and a large proportion of new graduates choose to be locums.

    So, whilst we may not always each be available for consultations, please don't think we are out on the golf course, as sometimes depicted in certain newspapers (in fact, we all hate golf)!
  • Why do we only issue a month's worth of repeat prescriptions once you reach 75yrs old?
    As part of the national drive to reduce the huge cost caused by the wastage of medicines, we reduce the quantity of medicines prescribed to those over 75 years of age from 8 weeks to 4 weeks (28 days).

    This is also a North West London-wide policy and is happening around the country. In fact many GPs routinely issue only 28 days' worth of repeat medicines for all patients.

    Around £100m a year is wasted in unused medicines.

    Why are we targeting the older age group?
    Research has shown that, particularly in the older age groups, large quantities of medicines remain unused.
    People over 75 years of age are, sadly, more prone to illness. Each time a condition changes, particularly with hospital admissions or clinic attendances, the medicines are often changed resulting in wastage of the existing supplies.

    Also, older people are often taking many medicines together for multiple conditions and confusion may occur when requesting them. Sometimes people stop taking medicines due to side effects but don’t tell us. We often see the result and sometimes huge quantities are returned to the pharmacist for disposal and we often find large quantities of old medicines lying about when we carry out home visits.

    Communication between hospital and surgery is often delayed, resulting in duplication or missed changes.

    Often other people are requesting the medicines on behalf of the patient and further mis-ordering can arise.
    It is almost certain we’ll have to carry out the same change in policy for the other age groups and we have to begin somewhere. It is most efficient to start with older people as this is where around half the drugs budget is spent.

    We review patients' medication regularly and synchronise the items to try and reduce ordering to once a month for everything.

    We’re sorry if patients are inconvenienced by this. However, by ordering on-line and using the Electronic Prescription Service it is easier than ever to get your medicines. Most pharmacies will arrange delivery if this is difficult for you and will often organise the regular supply of medicines without you needing to remember; please ask your pharmacist.

    If you wish to discuss this, please phone or come and see your usual doctor.
    Thank you for your understanding.

    The Doctors
  • Why do we not offer e-mail consultations with patients?
    We communicate with patients using secure, safe systems and Patchs is now our main communication portal for online consultations. You will need to register and this gives a safe route using the well-guarded NHS network through which to share your personal sensitive information without fear of hacking or data leakage.

    Using a normal email service for patient consultation is problematic. We do use it through our website for non-sensitive general queries, so why haven't we offered for all personal patient contacts - it would be so easy for everyone, after all?

    Email is not confidential. Email can easily leak out or be hacked. The NHS Mail system is a secure service, as are some official government and local authority systems but if we were to send messages outside, say to a Hotmail, Gmail or Yahoo account, we'd need to encrypt it if it included personal identifiable information. This is clunky for patients to use.

    Using a standard email service introduces another system for us to monitor and manage messages. We are already overburdened with information sources: face-to-face contacts, telephone messages, letters, SMS, online consultations, electronic test and radiology results, electronic hospital discharge summaries and scanned daily post and official professional email. If we miss one message a life could be at risk. We think the extra source could not be supported by our limited resources.

    One email often spawns a whole saga over many replies and so we would need strict rules of engagement.

    By answering an email enquiry, we are giving a professional opinion and subject to the full legal responsibilities. This is an area of some concern to the profession. Disclaimers and protocols may get round this objection but cannot be easily policed.

    We are using Patchs extensively and this is an excellent, secure portal for sensitive information exchange. And we use two way SMS and secure messaging through the Patchs platform (we also use another system, AccuRx for sending and receiving messages safely).

    As mentioned above, we do have an email contact form on this website but need to keep it to general feedback, suggestion and enquiries.

    We'd like to be as accessible as possible and welcome suggestions - but we do have a duty to keep safety uppermost and maintain control of it all!
  • What is the NHS Structure and how is it changing?
    The NHS is changing.

    Want to try and understand how the NHS will now be set up? You can have a go at it here (though we warn you it's not easy!). However, This excellent animation from the Kings' Fund is a great start to clarify some of the complexity of the new structure.

    From April 2022 the local landscape changed with 8 Clinical Commissioning Groups representing each borough joining into one NW London Integrated Care System. The ICS is run by the ICB (integrated Care Board) allocating the budgets and the ICP (Integrated Care Partnership bringing together primary and secondary care (hospitals), community services, public health, mental health services and working with the voluntary sector.

    Brent is now a 'Place' in the ICS. Practices have been forced to join together into Primary Care Networks in order to share resources and some of the work. We are in Harness North PCN, one of two parts of the Harness GP Federation.
  • What is 'Clinical Commissioning' and how is it changing?
    Commissioning is the process of assessing needs, planning and prioritising, purchasing and monitoring health services, to get the best health outcomes for the local population. Clinical Commissioning has now changed (2022). Many view the previous Clinical Commissioning structure put in place in 2012 Health & Social Care Act as bloated, wasteful, adversarial, slow and often obstructive - a very frustrating way to run a responsive, modern health service, so are pleased to see it go.

    Clinical Commissioning is now the responsibility of the Integrated Care Boards, for our patients, the NW London ICB running the NW London Integrated Care System. The ICBs bring together Primary Care, Secondary Care (hospital trusts), Mental Health, Community Trusts, Local authorities and others to plan across health and social care sectors.

    Until 2022, commissioning was the responsibility of Clinical Commissioning Groups - CCGs. In the 1990s a quasi-market structure was set up so that healthcare was 'provided' by hospitals and other organisations and their services had to be 'commissioned' – the needs of the population would be determined and services planned - within the budgets devolved to them -  to meet these demands. It used to be the job of Primary Care Trusts to plan services for its population and commission healthcare from hospitals, community care providers (district nurses, podiatrists, physiotherapists, dieticians and so on) and others.

    From April 1st 2013, the Heath and Social Care Act has abolished PCTs and handed this responsibilities to CCGs. All GP practices had to be members of a CCG and many GPs were active within the CCG in different roles in addition to their day jobs and now a smaller number have roles in The ICB with representation from each Borough. Groups of practices were brought together into Primary Care Networks - we are in Harness North. (see our blog on the new NHS structures for more details).

    The nuts and bolts of commissioning involve a cycle of - Strategic Planning, Procuring Services and Monitoring and Evaluation

    In more detail, this entails:
    ·       The needs of the local population must be assessed (historical usage, statistical projections taking account of demographic shift and new developments and patterns of illness),
    ·       assessing the effectiveness and value for money of existing provision,
    ·       deciding priorities,
    ·       designing new services (lots of consultation!),
    ·       planning capacity and shaping the structure,
    ·       supporting patient choice
    ·       fitting national and local strategies
    ·       agreeing contracts with Key Performance Indicators (KPIs) and Service Level Agreements (SLAs),
    ·       Contract Performance Monitoring and management of the contracts,
    ·       renegotiation or commissioning replacement services before the terms of the contracts need renewing.

    Certainly complex, intensely time consuming and hugely responsible. How will it all shape up under the new ICBs? Nobody knows- this is a new structure being rapidly built … well…we’ll see.

    For more detail on how commissioning is changing look here
  • How can I become a doctor?
    Well, firstly we've got to ask, "are you stark raving bonkers?"
    However, we do need more doctors and if you are keen, try this link . It covers basic training through to specialisation.
  • How can grapefruit juice be dangerous?
    Whilst under normal circumstances grapefruit juice can be a delicious and healthy addition to your diet, it can sometimes be dangerous, even possibly lethal.

    Grapefruit juice is now known to interact with more than 85 different drugs, many of them commonly prescribed. There are two different mechanisms:

    First, grapefruit juice can inhibit an enzyme called CYP3A4 in the small intestine which breaks down many drugs, eliminating them from the body. By inhibiting this process, the concentration of the drug can build up in the body to sometimes more than seven times normal and the effect can last for up to three days after drinking the juice. The effect can be seen from eating a whole grapefruit, fresh juice, or concentrate in a serving from as little as 200ml. Regular consumption seems to increase the interaction.

    Common drugs affected include statins (anticholesterol drugs) such as simvastatin and atorvastatin, calcium channel blockers (for blood pressure) such as felodipine, amlodipine, nifedipine, lercanodipine and verapamil, some anti-arrhythmia drugs such as amiodarone (the effect can be seen for weeks or months after stopping the drug), some drugs acting on the central nervous system such as carbamazepine, buspirone and quetiapine and the anti-gout drug colchicine. Also affected are the antidepressant sertraline and drugs used in erectile dysfunction such as sildenafil, tadalafil and vardenafil. There are others but they are more rarely used.

    The results from this can be clinically unimportant but in some case can be dangerous, even rarely lethal.

    The second mechanism is not dangerous but may cause a decrease in the effectiveness of some drugs. As the effect of this is only up to four hours, it can be overcome by leaving a minimum four hour gap after drinking the juice before taking the medicine.  Commonly used drugs which may be affected include the antihistamine fexofenadine (eg Telfast) and the antibiotic ciprofloxacin.

    The consequences of both of these mechanisms are unpredictable and depend a lot on genetics as well as the type and quality of juice or fruit.

    Similar effects can sometimes be seen in other fruits and juices such as oranges, pomelos and maybe even cranberries and apples can affect drug metabolism but to a lesser degree. More research is needed.

    It is always important to read the directions included with the drug packaging and ask your GP if unsure.
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