Thank you for your patience during this difficult time for healthcare services. As you may know, over the last few months General Practice nationally has faced unprecedented demand despite offering more appointments than we ever have. Not only has there been a catch up from the lockdown period but the effects of COVID-19 on both our patient’s physical and mental health and the bottlenecks at hospital have impacted us greatly, as we try and care for you whilst you are waiting for specialist input. Together with the challenges of staff being unwell or isolating, this has resulted in further strain on an already stretched system which has not seen significant additional resource to meet this extra demand. Nonetheless, we have been listening to your feedback through various channels and wanted to address some of the concerns raised and also some misinformation.
Myth: Medicus is taking over practices and are an ‘American style’ organisation privatising the NHS.
In fact, we are the complete opposite. We are a partnership of 35 GPs who brought their practices together voluntarily in 2018 to pool our resources and expertise to deliver higher quality care and better access. We recognised that without the economies of scale we would not be able provide the innovative care that all patients deserve in line with our vision for primary care. We have made some great progress with significant improvement in patient clinical outcomes, very successful care home and extended access services and an innovative estates strategy to improve patient experience. Our COVID vaccine delivery programme has also been one of the most well regarded in North Central London. An example of our Estates strategy has been the recent merger of several of our sites into the brand-new Alma Healthcare Centre in Ponders End to provide state of the art facilities for patients, and this has been a giant undertaking and will need some time for the new processes at the site to adapt to the needs of our patients. We have achieved all of this without access to any more funding than any other practice in the country and our core business remains a public sector rather than a private organisation.
To reiterate, Medicus is clinically led and most of the GP partners are either Enfield residents or very local so have a vested interest in ensuring the best service possible. We honestly believe that if we had not come together many things would be worse and possibly a few of our practice sites would not be around now. However, we fully understand we are not where we and you want us to be. Some of that is within our control and this is where we are going to focus our resources in the next 6 months. We know that the front-end experience with long call wait times and stressed administrators is an issue. Although we have invested in a state-of-the-art VOIP telephony system that gives us useful data and some efficiency, we recognise that we will need to expand and improve our call handling services.
We can’t access PATCHS a lot of the time so defeats the purpose of having an online consultation system.
As you may recall, Medicus was one of the vanguard of practices that embraced online consultation during the beginning of the pandemic in line with NHS England’s digital strategy. We became an online first model but quickly realised that this did not suit the majority of our patients especially the more vulnerable who could not access this modality. Therefore, we changed direction by commissioning PATCHs – the first practice in the region to do so – which we felt better met the needs of our patients and would also allow us to spread our resources between online and telephone in a more defined manner, with a certain number of PATCHS appointments available per day. As we have a finite staffing pool, access is zero-sum so if we were to increase our PATCHS appointments, we would have to decrease our telephone access and vice versa. So hopefully you understand that this is a tricky area to get right but fundamentally speaks to the fact that demand is much greater than supply at the moment across most of our sites. The general feedback from us moving to PATCHs has been very positive and we are grateful to you for driving this change.
Why can’t we book a face-to-face appointment when we want?
During the pandemic, practices have been instructed by NHS England to follow the standard operating protocol for primary care which promotes a triage first system due to the infection control risks to staff and patients. This continues to be the case in their latest update letter in July 2021. Currently, by ringing the practice for an appointment or through the online portal, you will be triaged by a clinician first and then a face-to-face appointment booked if required. This is based on clinically assessed need as the infection control processes of donning protective equipment and cleaning before and after consultations makes this more time consuming than speaking to a patient on the phone. If we went entirely face to face, we would be able to offer significantly less appointments. In addition, a triage first models gives us a lot of efficiency in that we can deal with simple queries relatively quickly rather than the old system where a receptionist booked in an appointment regardless of the nature of the problem. Without this, we fear that again access problems would get worse and your wait would increase. So again, you may understand that this is a complex area, and we are trying to find the right balance. We are planning to release pre-bookable face to face appointments slowly over time as the restrictions on us ease.
Why are my letters addressed to a different GP and sent to the Medicus Forest road site?
As we are technically one practice, NHS England require us to have one site registered to their spine which is the mechanism by which any hospital or healthcare provider recognises where a patient is registered when you visit their setting. Therefore, letters for all Medicus patients are either sent to our Forest Road Branch by post or electronically. However, on receipt these are processed within 48 hours to the relevant branch site and sooner if urgent. We have heard feedback that patients or other providers think this is causing a delay in the branches receiving the relevant information. Our investigations have indicated that this is not the case and most of the time it is the delay in hospitals or other providers sending the information appropriately in the first place is perhaps a bigger issue. The unfamiliar doctor’s name on the letters may be confusing but this is how NHS Digital have set up the spine and we are trying to work with them to amend this.
Why can’t I speak to the doctor I want to?
Over the last few years, we have greatly expanded our workforce to meet the ever-increasing demand in primary care and due to the workload pressure, it is uncommon for a GP to be available every day. This has meant that you may often not be able to speak to the same clinician but be reassured that all the relevant information is captured on the patient record, and we work in teams with practice sites having clinical meetings that discuss any complex issues that may arise. We are looking at ways we can improve continuity in the future so watch this space.
Finally, we would like to remind you that as it stands, we are offering more appointments overall, reviewing more results and letters, answering more phone calls, reviewing your online requests, holding practice clinical meetings, taking on additional services for you and a host of other activities. Medicus is very much open and working as hard as we possibly can for your wellbeing and has been throughout the pandemic. With your help and understanding we will try and get to a place where we better meet your needs and appreciate your patience and feedback during this process.
Best Wishes,
Your Local Enfield GPs – Medicus Health Partners
