Councillors probe local primary care: Three new salaried GPs set to be hired – 60 minute average wait on phones cut by half
Three new salaried GPs are set to be hired for Hillcrest, Borras and Forge Road surgeries to avoid use of locums and temporary staff, as part of a wide range of efforts from the health board to improve local services.
The details emerged during a long scrutiny session where councillors gathered evidence and probed a range of health board officials yesterday, in a meeting to discuss possible solutions to the problems being experienced when trying to access GPs across areas of Wrexham County Borough.
The area Director of BCUHB, Mr Rob Smith gave a written response to the information requested by the Committee at the meeting in June, with background to changes in services as well as answers to specific points – you can read that document here.
The report also gave a range of data and graphs, one of which detailed the numbers and percentage of GP appointments being cancelled at surgeries on a weekly basis and impact of it on referrals to the “A&E Department at the Maelor Hospital”.
The health board states in the report: “After a data dive it has been identified that on average the number of cancellations being made by these surgeries since the 1st June is approximately 13 per week on average. This equates to approximately 3 per day.
“Based on the data provided by the Emergency Department it appears these cancellations are not having a direct impact on the number of attendances at the Emergency department.”
The report adds: “There has been recent gradual reduction in the number of attendances at the Emergency Department coming from the residents of Wrexham Town. Part of this reduction is expected to be due to the stabilising of Hillcrest Medical centre and its GP access.”
During yesterday’s meeting Mr Smith and his team gave a presentation at the meeting to councillors, explaining: “We appreciate the concerns that were raised at the previous meeting, we welcome the opportunity to come here and describe the challenges that we’re facing in primary care and also our response to that and what we’re doing to make sure that we’re providing as high quality as possible service to the residents of Wrexham.”
Mr Smith split issues raised into two, specific to three Hilcrest practices and also primary care issues ‘that affect everyone in Wales’.
Councillors were told of how GP contacts have changed: “People who contact the GP surgery might expect to see somebody who’s a nurse practitioner or be referred to another member of the clinical team to be able to help them.
“We need to take the public along with us on that change. Because if you’re expecting a GP and you get referred to somebody else that could be an area for potential mismatched expectations.”
A second major change was noted: “There is a shift towards phone triage services, we are assessing people’s needs initially on the triage service on the phone, and then contacting people at home for a clinical assessment wherever possible.”
The meeting was told that with lockdowns coming to an end there is an expectation that services would return to an old normal, which would not be happening regardless of a pandemic, and thus there are ‘tensions in the community’ as surgeries “are finding people frustrated with the fact they’re contacting the GPs, the measures that were put in place for social distancing are still in place, our practices are reporting quite a lot of stress on the phone, from residents thinking that they’re expecting something else to be available.”
All of the above was given in the context of demand that has ‘shot up’ since unlocking of society, possibly due to ‘pent up demand’ for services.
Several times the councillors were told of ‘difficulties in bringing the public along’ and issues with communication of changes of how services are provided – like many councillors also, Wrexham.com has not been given any such information to pass onwards to the people of Wrexham.
The Health Board representatives referred to ‘some national media coming out shortly’, along with some leaflets.
Speaking of local issues around Hillcrest Medical Centre (if you visit the relevant Wales 111 page and try to visit the Hillcrest Medical centre page you get a 404 not found), Forge Road Surgery and Borras Park Surgery the meeting was told by the health board: “At the beginning of June, the Health Board took them on as what we call managed practices.
“So in the past, they were independent practices. So we took them on, and so the health board now has responsibility for the operations and services from those practices.
“When we took over Hillcrest, Borras and Forge Road, there were clearly a number of gaps in some of the key parts of the system. So for example, some of the triage, so seeing the right person with the right skills in a timely way – there was a real deficits there. We are recruiting what we call advanced nurse practitioners, the interviews are tomorrow.
After detailing further recruitment and staffing issues that are hopefully being resolved via ‘structural reform’ they added: “Doctors have been a problem in all three surgeries.
“When we took it over we did quite a bit of really focused work on trying to source salaried GPs, to try to mitigate that dependence on locums and temporary staff.
“I’m really pleased that at the end of last week we managed to source three salaried GPs, we’re just going through the processes now at the moment of getting them on board.”
20% more face to face appointments are being made available, and telephone issues are being resolved, with 60 minute waits previously being the average – although the now 30 minute average wait was described as ‘not by any means perfect’.
Councillors began their scrutiny with Cllr I David Bithell probing if, or why, declining staff and operational service had been ‘missed’ at local surgeries, a point denied by the health board who said ‘it isn’t an interventional relationship’, adding: “As soon as we were aware that they were problems with the practices, we’ve we’ve we’ve made attempts to support them as much as we possibly could.”
Cllr Nigel Williams spoke of how his ‘phone was almost off the hook’ with complaints over his local surgery at one point, with people explaining to him how a two hour wait on the phone to a surgery was the ‘norm’, and later detailing how a receptionist told him they “couldn’t believe in this day and age, people don’t have access to the internet, or somebody else that does”.
Cllr Williams also detailed how people from his ward were “having to pay £20 for a round trip to Hillcrest for routine appointments such as blood tests”. He asked what was in place to avoid the situation arising again in the future if and when contracts are re-awarded.
The health board defended their historic actions, stating: “The contract was awarded in good faith and, and appropriately, and it was right and proper to support the contract holders to deliver their model”.
Looking to the future the answer was vague, adding: “We will be retaining the practice in health board status until we’re satisfied that both the situation is stable, and that there is a viable alternative to health board practice.
“If that’s the case, then we will have a conversation and I would expect that to include yourselves, in terms of whether we should seek to put the practice back out to GMS. If it’s not the case, then we’ll continue to run the practice.”
Cllr Williams was unhappy, saying the reply “does slightly set alarm bells going off” pointing back to one earlier answer where the health board “said that you’re delighted that somebody actually took the contract on” who were “the only people who actually applied for it”.
The health board clarified: “My delight was that we had an applicant who passed the due diligence, but the fact that it hasn’t worked is as we’ve already discussed.”
Cllr Williams queried if Forge Road would become a standalone surgery once again rather than a ‘satellite surgery’, and was told: “We can be quite clear that we’ve heard and understand the feelings on Forge Road and can quite readily commit to providing whatever viable services can be delivered in Forge Road, in Forge Road.
“By that I mean normal delivery of general practice surgeries can be delivered in Forge Road, and should be as personal to Forge Road as possible.”
Cllr Andy Williams queried the locating of a new urgent primary care service at the Maelor Hospital, saying: “I think by putting your primary care service within the A&E departments I think reaffirms to people in the community that actually A&E is ‘anything and everything’.
“You use the same waiting rooms, which clogs up the waiting rooms. It should be a building maybe on the site somewhere, but not a direct link with A&E.
“This GP service has had a negative impact on the NHS and ambulances, I can say that personally from being a volunteer first responder for the ambulance service.
“I volunteer five nights a week with the ambulance service and I go to patients that say ‘I can’t get an appointment with my GP so my neighbours told me the quickest way to do it is to call an ambulance’.
“I’ve had one lady that tied up myself, a rapid response vehicle, and an ambulance, which then leads me to go into another call and maybe waiting three or four hours for an ambulance to come.”
“I think the ambulance service are being used as a bit of a scapegoat to get patients in that don’t really need an ambulance. Then these ambulances are getting tied up outside A&E, which means these ambulances aren’t available for other people to use.”
The meeting was told by the health board: “The urgent primary care centre isn’t located in A&E, it’s a very new service and we only secured funding recently, it’s located in the outpatients department.
“Now there’s a reason why it’s located close to ED (A&E). One is that it gives us access to all the the X ray diagnostics, and a much bigger group of clinicians.”
“The longer term plan is to put it in its own building, we’re just at the moment going through where that might be. So you’re right, it doesn’t need to be in ED, but it does need to be located on the same campus and that is the longer term the long term plan”.
Cllr Williams gave his first hand knowledge of the site and system, saying: “The outpatients department is the A&E outpatients department, you go through the same door into the hospital, you sit in the same waiting room, which leads them to nurses having to stand on the door of A&E to stop you going in, which leads the queues outside the hospital.
“I totally agree with you, it needs to be in that campus somewhere, but I wouldn’t want you to let people think that yes, you’re in that building, but you use a different service, you’re actually going through the same door and sitting on the same seats, which compounds a problem in in the A&E departments and the ambulance is going through.
Cllr Gwenfair Jones expressed her disappointed that the opening date of the much promised medical school in Bangor was not known, and queried GP pay in Wales against England (‘GPs in England, on average earn a little bit more than GPs in Wales’) and cost of calls to GPs (local rate).
Cllr Beverly Parry-Jones suggested renaming ‘Accident and Emergency’ A&E to ‘Emergency Department’ to highlight what it is there for, but was told ‘ED’ was the name and has been for over a decade.
Again, the health board pointed to improving communications – despite ‘A&E’ being used on comms, and various other parts of public health websites, and the health board’s own report before the meeting itself.
Cllr Parry-Jones was also promised further details on specific staffing levels compared to 2018, as a self confessed ‘cynic’ she said, “I cannot help but feel it is almost a case, in marketing terms, of over promising and under delivering for the people of Wrexham.
“To be honest, I feel Wrexham people do deserve a little bit better.”
Cllr Bill Baldwin had a blunt question, saying: “We’ve got all these plans and training you’re doing, I’m just wondering, when are things gonna get better for the people Wrexham? When are all these plans coming to fruition? When can we say that people won’t be queuing for services or waiting on the phone for hours? Any ideas? 12 or 18 months?”
Cllr Baldwin, and the meeting, was told: “There has already been quite a bit of progress progress made. In terms of recruitments, the three GPs that normally has within about a three month lead time, depending on where they’re recruited from. With the GPs it’ll be a lot quicker than that, because they’re currently locum GPs, so there’s no notice periods.”
The health board added that fixing telephone issues “shouldn’t be that long”, with October mentioned as a point where improvements should be seen.
Cllr Paul Rogers praised the ‘informative meeting’ before moving to his question: “One issue which I want to raise as the ward member for Brymbo is the fact that our branch surgery has not been open for 18 months. It’s not acceptable.”
“Even traveling to Forge Road was an issue before and now we’ve been expected to travel to Hillcrest and it’s just not good enough.”
Cllr Rogers also contrasted the flak and blame councillors were getting in their public elected roles for the issues, whereas ‘people don’t see anyone in the health board as accountable’.
The health board replied about ‘brimbo’: “We’ve seen a lot of activity in patients registering with another neighbouring in practice in Bryn Darland, so much so that the current list for Forge Road is about 40% of what it was.
“The practice at Bryn Darland have applied to open a branch surgery in Brymbo, which will, in effect, allow the remainder of the patients to then move into that, so that will be a branch of Bryn Darland.
“I know a number of councillors and committee members have been engaged as part of that engagement process, and we have a meeting tomorrow morning where we’re looking at that application.”
The topic of telephone waiting was raised again, with a 30 minute average time mentioned earlier in the meeting revisited and a 10-15 minute time mentioned by a councillor as a possible goal. That was rejected by the health board calling that as ‘no where near acceptable’ pointing towards ‘a couple of minutes’ as being the desire, although cautioning that would not be achieved overnight.
Cllr Williams said a few minutes goal would be ‘music’s people’s ears’.
The committee noted a recommendation to thank the health board for their attendance, and looked forward to similar such engagements in the future.
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