Foundry Patient Event - Partner Q&A

On Saturday 26th July we held a Foundry Patient Event in partnership with Ringmer Village Hall. 78 Patients visited the event and were invited to ask members of our Foundry team questions. Here is a summary of their questions and along with our answers.

Wendy Older, one of Foundry’s Nurse Specialists, answered this question.

She started off by acknowledging how difficult losing weight can be for some people and talked about the range of support services we are lucky to have in the Lewes and Ringmer area. These include One You East Sussex who provide on-line, group programmes and one-to-one sessions as well as the more specialist services which require a referral from the Practice. In addition to specific weight management support there are a range of organisations who collaborate with Foundry to promote healthy lifestyles including Pell’s Pool, Wave leisure etc.

The role of the Practice is more to identify those patients at risk and refer on to support rather than look to provide services ourselves. Unfortunately, providing a weight loss group in one of the surgeries would just not be feasible, however, One You and other programmes do offer local appointments plus online/digital versions, for those who prefer this as an option.

Geraldine Hoban, Managing Director answered this question.

She started by recognising how this change in practice will have affected patients and apologised for the difficulty and inconvenience it will have no doubt caused. The context around the decision includes the fact that the Practice is not contracted to carry out hospital bloods, and many Practices across Sussex do not undertake this function.

Foundry has chosen to do this in the past because we recognise how far away the referring hospital can be for patients. Foundry receives a very small amount of money to perform these tests (approx. £1.50 per test). This does not cover the cost of delivering them.

The financial challenge was not the reason this decision was taken however. An increase in demand has meant the wait for blood tests can regularly exceed 4 weeks, and this is a significant source of complaints to the Practice. As we attempt to be more proactive in our management of patients with long-term conditions such as diabetes, high blood pressure and more regularly provide testing for patients on long-term medication such as HRT, we are increasingly short of the capacity and need to keep on top of demand.

Currently we perform approximately 21,000 blood tests a year, of which approximately. 10% are generated by the hospital as part of their treatment regimes. Where it is possible for patients to receive their blood tests at the referring hospital (where the wait is often less than 4 weeks and hospitals receive funding for them), then we encourage patients to do so.

There are a number of exceptions to this approach, for example, patients with dementia or significant frailty, those receiving care for diabetes, chemotherapy, or under formal shared care arrangements with a specialist hospital (as in the case of the first question above). If a patient has concerns, then please talk to a receptionist, and they will discuss whether we can make an exception with the appropriate clinical lead.

Jonathan Harris, Digital Transformation Lead answered this question.

He spoke about the number of different digital sources of patient level information currently the NHS App, Patient Knows Best, Anima, SystmOnline and acknowledged how frustrating this can be for patients. There are plans, however, to rationalise these Apps and access points over time. For example, in the next few months, people should be able to use the NHS App as a way of accessing Anima requests.

Jonathan spoke about another digital tool that the Practice had invested in called Welby. Welby searches patient records to ensure we as a Practice are doing all we can to proactively manage patients and perform regular and timely health checks, medicine reviews, blood tests, long term condition (such as diabetes) monitoring etc. This is the source of the increased number of invitations to patients to attend the Practice and the questionnaires which are now being sent out to patients in advance. Currently longer texts are being split into multiple messages, but there are plans with NHS Sussex to fix this shortly.

Jonathan responded to a point made by a member of the audience that we shouldn’t assume that everyone has a smartphone and confirmed that Welby has different ways of filtering these patients, ensuring that they are contacted in other ways, such as via a phone call.

Geraldine Hoban had met with the Local Authority and NHS Sussex earlier in the week and shared their ongoing support and commitment to the Health Hub being at the heart of the promised Phoenix development.

Whilst this development is taking so much longer to materialise than the Practice would have hoped, having started on this journey a decade ago, we have been heartened by the Council’s positive response around timescales now, and the imminent decision from Homes England about funding to begin the first stage of the land clearance and flood defences.

The Foundry is meeting again with the Council and Sussex ICB in September, by which time the outcome of the Homes England bid should be clear. If the answer is not positive, then the Practice will have no option but to start looking at a contingency plan.

With regards to the planned population increases in the Ringmer area, Geraldine confirmed that an expression of interest for Minor Improvement Grant (MIG) Funding has been submitted to Sussex ICB for increased clinical rooms and more capacity at Anchor Field in recognition of these population increases. A full bid is being worked up currently, and we would hope to begin building either this year or early next.

Dr Dan Elliot, Partner GP & Clinical Director, answered this question.

He explained the new Anima triage function and how it has provided more equitable access for patients. Rather than the old system where people rang at 8.30am in the hope of getting an appointment, and receptionists booked people in on a first come, first-served basis.

Now everyone fills in a request, with key clinical information, which is then reviewed by a GP. GPs then direct patients to the most appropriate response; it could be a GP appointment later that day if it is clinically urgent, or it could mean waiting a few weeks if the GP thinks it's not so urgent. Equally, it could mean an exchange over text with the GP to resolve the issue or a referral to one of the many members of our extended team (all based in the surgery), including paramedics, clinical pharmacists, mental health workers, care coordinators, social prescribers, physiotherapists etc.

The data requested on Anima needs to be quite detailed so that the GP can make the most informed decision about the right next step.

Dr James Annis, Partner GP, answered this question.

He spoke about the extended multi-disciplinary team we have at Foundry, including paramedics, clinical pharmacists, mental health workers, care coordinators, social prescribers, physiotherapists etc.

Anima allows all requests for appointments to be reviewed by a GP so that the most appropriate team member in the Practice can respond, or alternately a referral can made out of the Practice to our Community Pharmacist via a route knows as Pharmacy First if the request can be easily met within a community pharmacy setting.

We are lucky to have three excellent Paramedics in the Practice, each of them are highly trained clinicians, competent in dealing appropriately with a wide range of conditions, including urgent care and frailty. Not only are paramedics very able to deal with the urgent requests triaged to them by a GP, they also ensure that GP appointments are preserved for the more complex patient requests, where only a GP can respond.

A member of the audience queried GPs' contractual obligation around this, and said this wasn’t her or others’ experience when attending in person at the surgery.

Geraldine confirmed that it was the case, that the Practice was obliged to support patients who attended in person to complete an Anima form at the front desk. There are reasons why this might not be optimal for patients in relation to confidentiality, for example, given the range and depth of the questions that need to be included. Where possible the option for patients going online or ringing in is discussed but where patients prefer to stay and complete the Anima, with support, they are entitled to do so and should be supported in this request.

Geraldine confirmed that she would reiterate the policy with our reception staff, as there seems to have been a lack of clarity in relation to this.