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HEALTH
AND PRIMARY CARE
Giving up-to-date
news on NHS Healthcare concerns throughout the Borough
 Croydon
Primary Care Proposals
Primary
Care Strategy
Pharmacy
Service
Staying
Healthy
Introducing
Croydon Primary Care Trust
New
Community Pharmacy Contract
Health
& Primary Care Survey
Frequently
Asked Questions - GPs and Dentists
Croydon
Primary
Care Proposals
Many of you are aware that
the NHS is trying to devolve certain hospital functions out “into the
community” so that patients will have “easier access to services”.
I use the italics carefully as I believe that the expressions used are
not necessarily to be interpreted literally. The extreme end of this
shift in strategy would transfer some hospital (or secondary care)
services into Primary Care Centres which far from making things easier
to access may achieve the reverse. What some planners envisage is that
many GP surgeries would merge under one roof as a form of healthcare
supermarket. These centres would also house a pharmacy, dentist,
chiropodist, optician etc in their grand design scheme. This might sound
attractive in principle until one realises that this would mean the
closure of all the satellite surgeries and pharmacies in what would be
quite a large area. In order to achieve the critical mass necessary to
make these centres viable, there would have to be 20,000 – 30,000
patients registered under the one roof. Thus a town the size of Croydon
would support up to 15 of these centres with the abolition of 50
pharmacies and virtually all the existing GP practices. Now it doesn’t
take a genius to realise that the vast majority of patients would end up
travelling much further to reach healthcare facilities than they do at
present. (Let us not even get into the carbon footprint debate on the
implications of this!) Many Croydon residents can walk to their nearest
pharmacy or GP at the present time and this means that access is good.
There are several pharmacies that stay open until 9pm in Croydon and 2
that stay open until 11pm. (Sainsburys Upper Norwood & Purley Way).
The
latest report into HealthCare provision in London written by Professor
Ari Darzi further muddies the water. He wants 50 “Poly Clinics”
which are essentially the same thing as Primary Care centres with some
minor hospital functions bolted on. If you recall some years ago, Tony
Blair had the concept of the Walk-In-Centre which everyone assumed would
be the answer to the pressure on Accident & Emergency centres. This
turned out to be a false hope. Walk in Centres are nurse led clinics and
although they do sterling work, the list of what they cannot do far
exceeds that which they can. I would have thought the best answer to
solve at least some of the short term access problems in the NHS,
especially in London, is to equip the current network of Walk-in-Centres
with more functionality. What about a doctor on the premises performing
minor surgery, a scanner or two, or some diagnostic capability? Let us
make far better use of what we have in primary care rather than invest
millions of more NHS money (that’s our taxes) in building new
concepts. By developing the capabilities and skills of those who could
work and do work in existing pharmacy & GP practice premises, the
NHS could have real expansive resources in the community without wasting
yet more millions on grand schemes and ambitious designs.
Andrew
McCoig
McCoig Pharmacy, 143 Wickham Road, Shirley
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Primary
Care Strategy
Croydon is in the process of
developing a Primary Care Strategy that proposes to provide appropriate
services in the community as well as in hospitals, for example cluster
centres which will cater for 20,000 people and will provide services
such as G.P.s, dentists, pharmacists, optometrists, community services
and services for long-term conditions. What is being proposed will bring
about great change in local health provision. MORA has studied copies of
the consultation and had discussions with relevant PCT representatives.
MORA has submitted a detailed response on behalf of the local community.
There has been an enormous public response to the consultation and early
indications are that the proposals will not find favour with local G. P’s
and Pharmacists. At this point MORA would like to reiterate that people
would lose the personal doctor patient relationship as we know it. It
addition to losing our local GP’s and Pharmacies, people, and
especially the elderly and disabled of our society, will be obliged to
travel greater distances for their health care.
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Pharmacy
Service
I want to cover two
aspects of pharmacy service in this month’s issue which I hope are of
interest to residents. The first involves the all important buzz word
within the NHS – access.
Many
customers want to know how they can access a prescription service or
emergency medicine supplies after hours and on bank holidays. The vast
majority of pharmacies close between 6 and 7pm on weekdays and it is
common to see many closed on Saturday afternoons. Pharmacies tend to
mirror shopping habits and GP surgery times with considerable overlap.
My own pharmacy is open for 52 hours each week but I have to acknowledge
that this does not meet emergency needs at all times of the night and
early morning.
An
on-call duty pharmacy service is available after 8pm and until 8am 365
days a year for all Croydon residents. To access this service, you need
to call NHS Direct (0845 46 47) and they will contact the duty
pharmacist on his or her mobile for you to have a direct contact. It is
normal to screen calls in order to cascade and triage patients’
requirements in the right direction and to the appropriate healthcare
professional. So far, the workload has not been onerous for the
pharmacists involved but it is a valuable safety net for those in need
of emergency medication. The on call duty doctor based at Croydoc within
Mayday hospital also has access to the duty pharmacy service should the
need arise.
Residents
should also be reminded that there is a pharmacy within Sainsbury’s
store on the Purley Way (opposite PC World) that remains open until 11pm
weekdays and until 4pm on Sundays. This store must keep to these strict
opening hours in order to keep the pharmacy contract under their terms
of service with the NHS so if any customer turns up to find that the
pharmacy is temporarily closed for some reason, then it would be helpful
to let us know about that closure.
My second
topic is one that has been in the public eye for some while – obesity.
We recently started a weight management service at the pharmacy in
response to customer demand. We are currently providing just more than
medicines, advice and prescriptions but most additional services are
something that remains outside of the NHS at this present time.
Hopefully in the future, we will be commissioned by the local Primary
Care Trust to provide many more services free of charge but at the
moment, the patient picks up the small costs involved. Most people are
aware of the dangers of smoking and becoming overweight. As a general
rule, a Body Mass Index calculation of more than 30 is classified as
obese. This figure is a measured relationship between height and weight
but is not applicable to body builders and some athletes who depend on
muscle development e.g. rugby players. As an example, a man who is not a
competitive sportsman and weighs 100kilos at a height of 5 foot 9 inches
will have a BMI of 31. This person will need to do something about his
weight if he wishes to lead a long healthy life into old age. This man
will risk the onset of diabetes, elevated blood pressure and other
complications such a joint pain as he grows older. Losing weight confers
so many advantages to the individual that they are too numerous to list
here. One of the common themes that customers continually report to me
when they are losing weight is the amount of extra energy they acquire.
The lethargy vanishes; they can cycle to West Wickham without feeling
any breathlessness and can usually last until 9pm before starting to
feeling tired.
We don’t
try to push people into being slimmer of the year because, like Jamie
Oliver, we believe diets are fattening. We like to see slow but steady
weight loss and a gradual change in the person’s lifestyle and eating
habits. We simply provide some useful menu guides and ideas for meals
but these do not constitute “slimming meals” or any form of prepared
food. We measure weight, BMI and blood pressure at every session and
talk through the experiences of the past week. We advocate more “activity”
not exercise; a moderate pace of walking through Shirley Hills should be
a pleasure not a task and should leave anyone feeling better than when
they started out. In our opinion, the view from the top of the hill in
Shirley by the Chinese restaurant on a clear day is worth more than any
TV programme. All our weight losers are handled on a one-to-one session
and we never engage in group activity – we believe this should be
personal and confidential.
This kind
of health promotion and public health emphasis is an intrinsic part of
the new culture within pharmacy – we need to keep people out of
hospital and away from the surgeon’s knife. So much can be prevented
and however nicely designed or private accommodation any hospital can
provide, the comfort is not a patch on one’s own home. The message
should always be – stay away!
Andrew McCoig
McCoig Pharmacy, 143 Wickham Road, Shirley, CR0 8TE.
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Staying
Healthy
People find it
difficult to admit to themselves that they are getting on in years, have
become frail and are losing physical strength and, as a consequence, are
more vulnerable to falls and minor accidents. People are certainly
living longer and some seem to have endless strength and energy but the
ageing process cannot be stemmed forever. It is only when the statistics
are examined that a mature person might become concerned about their
well-being and the potential dangers that are easy to ignore. Following
an injury and period of recuperation life is seldom quite the same.
The stark
facts are these; more accidents occur in the home than anywhere else,
falls account for 43% of accidental injuries; one third of people over
54 will fall at least once a year. In Croydon approximately 43,000
people are aged over 65 and about 2,400 of these attended Accident and
Emergency (A&E) at Mayday Hospital in 2004 as a result of a fall.
One in nine were admitted to hospital with a broken hip. Where do most
of the falls occur? 60% take place on stairs, 15% from a chair or bed,
and 15% tripping over something such as a rug or mat. (Figures supplied
by Primary Care Trust)
How can a
person avoid slips, trips, broken hips and wrists? There are a few
preliminary steps that can be taken to reduce the risks. Vision changes
with the passing of the years so have your eyes tested regularly.
Especially important if you still drive a car. Inform your Doctor if
your medication is making you feel dizzy. Keep muscles strong and
improve balance by taking some form of regular exercise. Croydon Healthy
Living Centres Network offers much to older people and you can contact
Jo Guest, Network Co-ordinator on 020 8683 5906 for information on
courses and swimming sessions set aside specifically for older people.
It is
also sensible to tackle the danger areas and improve safety in the home
environment. Increase illumination by putting 100-watt lights bulbs in
the kitchen and stair landings so they are brightly lit. Use non-slip
mats under rugs in the kitchen, stair landings and inside and next to
the bath. Fit handrails by the toilet and bath, also on the stairs.
Repair or remove frayed edges from carpets to make them safer to walk
on. Finally, remove the casters from furniture that you hold or lean on.
Age Concern Croydon have an excellent range of services available e.g.
Nail Clipping; Domicillary Care; Small Repairs; Home Security and
Accident Prevention and can be contacted on 020 8680 5450.
Advice is
also available from Help the Aged on 0845 605 2535 on further steps that
should be taken in order to avoid injuries to yourself and others.
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Introducing
Croydon Primary Care Trust
The NHS seems to be
forever changing. As soon as patients and the public get used to
one set of health organisations, another revamp follows and there are
new Trusts and Authorities to get to know and understand. The
staff find it just as bewildering!
Everyone
knows Mayday Hospital, of course, and Mayday Healthcare NHS Trust - but
perhaps not Croydon Primary Care Trust (PCT). The PCT was formed
in 2002 after the merger of Croydon Health Authority and the local
Community Health Trust and has four main roles:
-
Overseeing and developing local primary
care services – these are the services provided by GPs, dentists,
opticians and pharmacists.
-
Providing community health services –
such as district nursing, health visiting, school nursing, therapies
and rehabilitation, child health, family planning, etc.
-
Commissioning (or “buying”) hospital
services and other specialist healthcare from other parts of the NHS
– such as Mayday, South London and Maudsley Trust (mental health)
and Surrey and Borders Partnership Trust (learning disability).
-
Preventing disease and improving health
– especially in the areas of accidents, cancer, coronary heart
disease and strokem diabetes, mental health and sexual health.
The PCT works
closely with the other NHS Trusts, GPs, Croydon Council, voluntary
organisations and groups representing patients and the public.
Often,
because of the way the NHS is organised, people are unsure who to ask
when they want advice or information or where to turn when they have a
problem. The answer: the
Patient Advice and Liaison Service, known as PALS.
PALS is the PCT’s customer services department – it aims to
solve problems and give information quickly, and to pass on comments and
suggestions from patients and carers for improving services.
It also gives advice and support and details of local health
services, such as how to find a GP or dentist, plus info on health
conditions, helplines and support groups.
If you need help
from PALS, please call 020 8274 6333 or email pals@croydonpct.nhs.uk
Mayday Hospital also
has a PALS on 020 8401 3210 or email pals@mayday.nhs.uk. Among its
community health services, the PCT runs:
-
Croydon NHS Walk-in Centre – open every day of the year for
treatment for minor injuries and illnesses, no appointment needed.
It is at 45 High Street, Croydon, and open Monday-Friday
7.00am-10.00pm, and Saturday, Sunday and bank holidays
9.00am-10.00pm.
-
Expert Patients Programme
– a free self-management course run by the NHS for people with a
long term health condition, such as diabetes, arthritis, asthma, heart disease or multiple sclerosis.
The next two courses are on the six Wednesday mornings from 21st
September to 26th October 2005 in Purley and on the Tuesday mornings
from 1st November to 6th December 2005 in Thornton Heath. To
find out more, please phone 020 8274 6274 or email steve.hunt@croydonpct.nhs.uk
-
Stop Smoking Service – has more than 80 trained advisers
giving free advice and support to people who want to quit smoking,
individually or in groups. Four
weeks’ discounted supply of nicotine replacement therapy products,
such as patches and gum, is available from participating pharmacies.
Call 020 8666 0370.
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New
Community Pharmacy Contract
The new contract will
enable community pharmacies to contribute to NHS service provision for
patients in four major areas:
- Self-care
- Management
of long-term conditions
- Public
health
- Improving
access to services
Pharmacies will be
required to maintain a record of all medicines dispensed, and also keep
records of any interventions made which they judge to be significant.
Pharmacies will also
have to provide compliance support to patients who need help with taking
their medicines and are classed as disabled under the definitions of the
Disability Discrimination Act 1995.
Pharmacies will
dispense repeat prescriptions and store the documentation if required by
the patient. They will ensure that each repeat supply is required and
seek to ascertain that there is no reason why the patient should be
referred back to their General Practitioner.
Pharmacies will be
obliged to accept back unwanted medicines from patients. The pharmacy
will sort them into solid, liquid and aerosol forms, and PCTs will make
arrangements to collect the medicines from pharmacies at regular
intervals.
PCTs will provide
pharmacies with lists of sources of care and support in the area.
Pharmacies will be expected to help people who ask for assistance by
directing them to the most appropriate source of help.
Pharmacies will help
manage minor ailments and common conditions, by the provision of advice
and where appropriate, the sale of medicines, including dealing with
referrals from NHS Direct. Records will be kept where the pharmacist
considers it relevant to the care of the patient.
Patients will have
the opportunity to feed back on their level of satisfaction with their
local pharmacy service by completing a patient satisfaction survey.
Central guidance
will determine what patients will assess. This is likely to include:
- Promptness of supply
- Quality of service
- Quality of facilities
A pharmacy will review the
survey results and consider changes to improve service provision for the
benefit of patients.
The minimum weekly 'Hours
of Service' for which pharmacies need to provide a service to patients
will be increased from 30 hours to 40 hours. Pharmacies will need to
notify PCTs of the actual hours during which pharmaceutical services are
available from their premises. PCTs will then be able to make suitable
arrangements to cover any shortfall in service delivery.
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Health and
Primary Care Survey
Mayday Healthcare Trust in Croydon began a programme to learn from the
patient experience in 2000, and employs a variety of methods to analyse
what patients think of its services. These include: quarterly surveys of
150 recently discharged patients; analysis of complaints; direct
patient/carer feedback at monthly ward sisters’ development days;
analysis of contact with the patient advice and liaison service team;
and setting up patient user and focus groups in paediatric oncology,
continence, cardiology and others.
The
themes emerging from these sources of feedback have been remarkably
consistent. These are:
- Confusing
messages and a lack of information from doctors and nurses about
admission into the accident and emergency department;
- Being
talked about as if you are not there;
- Professionals
failing to recognise patients’ and carers’ knowledge;
- Cleanliness
and the ward environment;
- Brusque
attitudes from doctors, nurses and lack of privacy;
- Discharges
being delayed because of waits for drugs and lack of written
information.
Several
changes have been introduced as a result of patient feedback. These
include:
- The
introduction of an afternoon rest period on all wards, when visiting
is discouraged;
- 'The
Friends of Mayday' have provided a sponge bag with soap, flannels,
toothpaste and combs for emergency admissions (this year they have
spent over £4,000 on these packs, and are just one of many items
they have been able to provide the hospital);
- A
full-time patient information officer to produce written information
for patients;
- Preventing
drug and doctors’ rounds during mealtimes to give staff more time
to help patients;
- Revision
of the general information booklet.
A number
of improvements have been made as a direct result of the feedback
received at development days.
For example, the handover between A&E and the medical wards has been
improved so that patients are welcomed to the ward by a member of staff.
Other examples include changes to hospital nightdresses so that they are
not open at the back, and freshen-up towels with meals so that patients
can clean their hands before or after eating.
Some of the key messages fed back to staff have been:
- See the
patient journey as a ‘whole’ experience. Think about what has
gone before the patient gets to you, such as hours lying on a floor
at home, arrival at accident and emergency, and so on.
- Try not to
stereotype. Listen to what the patient and/or carer is saying.
- See
yourself as part of a whole healthcare team.
- Actions/procedures
that are familiar to you are not to the patient - measure the
appropriateness of your actions through the patient’s eyes.
- Recognise
your power to impact on a patient experience positively or
negatively - the effect could last for years.
- Recognise
the positive impact and health gain of showing you care, inspiring
trust knowing small things make a difference, and regularly sharing
and giving information.
- Personalise
and measure the appropriateness of your actions and delivery of
services by asking yourself whether you would want this for a
relative or friend.
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The NHS in
Croydon
Frequently
Asked Questions
How do I find a family
doctor (GP)?
A list of Croydon GPs can be
found on the NHS in Croydon website, www.croydon.nhs.uk,
under Local Services. There is also a search facility to help you find
the GPs nearest to where you live and those offering particular clinics
and languages spoken other than English. Alternatively, call Croydon
Health Authority for assistance on 020 8401 3900.
How do
I register with a family doctor (GP)?
Choose a GP from the list
found under Local Services on the NHS in Croydon website, www.croydon.nhs.uk
or call the Health Authority for assistance. Contact the surgery
directly and explain that you wish to register at the practice. You will
normally be asked for an initial appointment with a practice nurse or GP
for an overall check up. When you register you should be given a copy of
the practice leaflet. This will tell you when the surgery is open, how
to make an appointment and the arrangements for getting advice over the
phone and for home visits. It will also tell you how to order a repeat
prescription. Extensive information on GP practices is also available on
the NHS in Croydon website.
Can I change my family
doctor (GP)?
You can change your GP at
any time - you do not have to have a special reason. You need to fill in
the front of your NHS Medical Card and give it to your new GP. If the GP
is willing to accept you they will send the card to the Health Authority
and a new card will then be issued to you.
What happens if my family
doctor (GP) strikes me off his/her list?
You can either find a new GP
using the list of doctors on the NHS in Croydon website, www.croydon.nhs.uk,
or ask the Health Authority for assistance. In some cases the Health
Authority can allocate patients to a GP.
How do I register with an
NHS Dentist?
A list of dental practices
in Croydon can be found on the NHS in Croydon website, under Local
Services. There is also a search facility to help you find the ones
nearest to where you live and those offering particular services and
language spoken other than English. Alternatively call Croydon Health
Authority for assistance.
Most practices accepting NHS
patients also provide private dentistry. You should therefore ensure
that you are being accepted as an NHS patient when you arrange your
appointment. A dentist is not obliged to accept any individual as an NHS
patient. Once you are registered as an NHS patient the arrangement will
last for 15 months following the month in which you register and it may
be renewed during or at the end of this period provided both you and the
dentist agree.
How do I change my
dentist?
You may end an arrangement
and change your dentist at any time you wish. A dentist may end an NHS
arrangement by giving you three months written notice or, in certain
circumstances, less than three months, with the Health Authority's
agreement.
How do
I arrange an emergency dentist appointment?
If you are registered with a
dentist as an NHS patient, the dentist is required to make reasonable
arrangements for you to receive emergency treatment. Dentists would
generally be expected to ensure that you receive emergency treatment
within 24 hours of the initial request.
Emergency treatment is
defined as where, in the opinion of the dentist, your oral health is
likely to deteriorate significantly without such treatment, or you are
in severe pain by reason of the oral condition.
Many dentists in Croydon take part in a rota service at an emergency
dental clinic (Croydent) which is designed for both registered and
unregistered patients. The clinic provides a service daily, including
weekends and bank/public holidays, but is not a walk-in service and
appointments must be made by telephone on 020 8401 3443 between 6.30pm
and 9.30pm (different times may apply on bank/public holidays).
I take a lot of
medicines, am I entitled to any help?
If you take a lot of
medicines during the year but think you are not entitled to free
prescriptions, Croydon Health Authority can send you an application form
for a prepayment certificate which may save you money.
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