Doctors promoting merger of three Chiswick GP surgeries say it will benefit patients

Images above: Grove Park Surgery; Computer Generated Image of the new health centre being built at Fisher’s Lane, where Chiswick Family Doctors Practice will be based

Doctors say the merger of Grove Park Surgery, Wellesley Rd practice and the Chiswick Family Doctors Practice will enable them to provide a better service

Doctors from the three practices in Chiswick which are planning to merge outlined their plans to a public meeting on Wednesday 4 October. The merged practices will become known as Chiswick Medical Practice.

GPs from Grove Park Surgery, Wellesley Rd practice and the Chiswick Family Doctors Practice, which collectively look after nearly half the population of Chiswick, told a well-attended meeting at the Methodist Church on Sutton Court Rd that they had no alternative if they were to address the problems that beset the NHS at a local level.

There is a shortage of GPs; they have found it “impossible” to attract new doctors, while at the same time there is an increase in demand for their services from an ageing population.

They hope that by merging their practices they will benefit from economies of scale and they will be able to be more efficient: they will have one patient list, one management system, one ordering system, one contract with the NHS and one website instead of three.

They are also planning to use a new interactive online system for booking appointments which they think will be fairer and free up doctors’ time to focus on the patients who really need their attention.

Currently there are about 10% to 15% of patients who do not show up for appointments and about 20% appointments which the GPs say could have been better handled by another healthcare professional.

Image above: Wellesley Road practice

Wellesley Rd practice threatened with closure if merger does not go ahead

The merger has been prompted by the retirement of Dr Nicola Burbidge from the Wellesley Rd practice. She held the contract with the NHS and none of the other doctors who work there want to take on that responsibility. They are not, however, planning to retire themselves, as has been rumoured, Dr Maria Caballero told the meeting.

Dr Richard Drewry from Grove Park Surgery said if Wellesley Rd did not merge with the other two practices it would be bought up by a private health company and “the standard of care would drop as a result.”

Improving access to healthcare

The merger was also prompted by the desire to improve patients’ access to healthcare – how quickly and how easily patients can get to see a doctor or other healthcare professional. At Grove Park Surgery the system currently in place is that patients wanting a quick appointment have to ring or turn up at 8am and hold on the line or wait in a queue in person for a considerable time.

Not everyone is able to do that, even if their need is urgent, and there is a 20% drop out rate. The current system is both stressful and unfair said Dr Drewry, and doctors are aware that there is an unseen need which they are not meeting, while at the same time they are wasting time seeing some patients who do not need to see a doctor.

They propose to move to an online booking using a system called Klinik, where patients answer a series of questions online, being triaged, or sorted into categories of need, by the software, which will be available to patients all day.

Doctors will look at all the incoming requests for appointments to check the right decisions are being made, but some patients will be referred directly to another healthcare professional, such as a physiotherapist or a pharmacist instead of a doctor. If the patient just needs a sick note for work they will be referred to an administrator.

That, they say, is more beneficial for the patient to get direct access to the type of help they need, and more beneficial to the doctors as it frees them up to see more patients who really need to see a doctor.

There is a financial incentive for GP surgeries to improve access. Their contracts with the NHS are overseen by the North West London ICS – ‘Integrated Community Care System’, who have made it a target this year for GPs to improve access to appointments, with a financial incentive attached.

Dr Drewry stressed they had made improved access their goal before the Integrated Community Care Board (ICB) introduced it as a specific target this year.

Image above: Graphic from video promoting the merger on Grove Park Surgery’s website

Consulting their patients

The three surgeries merged their partnership a year ago, but they retain separate contracts with the Integrated Community Care Board. The next step is to merge their clinical systems. They expected to be approved at a meeting on Monday 25 September, but it was delayed because patients from the Grove Park Surgery wanted “proper consultation.”

Chair of the Grove Park Surgery Patients Group James Armitage told The Chiswick Calendar:

“I don’t want to stand in their way. I am not qualified to say whether it’s a good or a bad thing. I just want to find out the pros and cons and let people know.”

READ ALSO: Merger of three of Chiswick’s GP practices delayed as patients seek “proper consultation”

Doctors from the three surgeries hastily arranged a succession of public meetings to share their plans with their patients and the ICB, which meets regularly every three months, is convening a special meeting to consider the merger once those meetings have been held.

The doctors at Wednesday’s meeting were Dr Richard Drewry and Dr Shantha Sethurajan from Grove Park Surgery; Dr Preethi Venkatesham from Chiswick Family Doctors Practice and Dr Maria Caballero from the Wellesley Road Practice.

Also at the meeting were patients group representatives James Armitage from Grove Park Surgery, Henry Gewanter from Chiswick Family Doctors Practice and Pamela Majorcas from the Wellesley Road Practice, as well as Amanda Meehan from Health Integration Partners, a consultancy firm supporting the merger, and Ellie Tobin, Head of Primary Care (Hounslow) at NHS North West London.

The next two public meetings will be an online event via Microsoft Teams at 1pm on Wednesday 11 October, and an in-person event on Monday 16 October from 8 – 9am so people who are working can have a chance to get to the meeting before the start their day’s work.

To join the Microsoft Teams Online meeting on Wednesday use this link: LINKMeeting ID: 331 535 438 23 / Passcode: rtPwxY.

The in-person event next Monday will be at Chiswick Methodist Church Sutton Ct Rd, Chiswick, London W4 3QD.

Image above: Graphic from video promoting the merger on Grove Park Surgery’s website

Advantages and disadvantages

Outlining the benefits of the merger, Dr Drewry said each of the practices had doctors with areas of specialist knowledge which patients at the other practices were not currently able to take advantage of, but after the merger they would have access to them.

For example, all the GPs at the Wellesley Rd practice are women. Dr Drewry and Dr Sethurajan are taking the lead on male health problems and if patients particularly wanted to see a male GP, with a larger pool of doctors available to them, they would be able to.

On the other hand, patients may not be able to see a doctor at the nearest surgery for an on the day appointment. The three surgeries are not merging premises; each will retain its own, and every effort will be made, they said, that patients could continue to attend their current surgery, but if a patient needs an urgent appointment they may have to see a doctor at one of the other buildings.

“Everyone wants continuity” said Dr Drewry. Doctors want to get to know their patients and to be able to provide continuity of care. Patients do not want to see a different doctor every time but want to go back to someone who knows their history.

“We will bend over backwards to make that work, but if it’s urgent it may be that you have to go and see someone at another site.”

Image above: Graphic from video promoting the merger on Grove Park Surgery’s website

Klinik – the new online system for booking appointments

Pamela Majorcas, the Chair of the Wellesley Road Surgery Patients Group, asked about older people who did not have smart phones or computers. How would they be able to access care?

The doctors said people who are unable to use the online system could still ring up or come into the surgeries in person and someone would help them fill in the answers online it in on their behalf. The phone lines are open from 8am – 6.30pm.

“We anticipate there will be a very small number who can’t fill out the form” Amanda Meehan told The Chiswick Calendar. “But I want to stress we are still open for business, we are still able to help.”

The online form uses a mix of binary questions with Yes / No answers; it will require some descriptive text from patients and it also uses graphics so patients can highlight the part of the body which hurts. It can also ask for pictures, for example of a rash.

Klinik is already in use in some other GP surgeries around the UK, (about 300 Amanda thinks). Set up in 2013, the company’s software has also been used by GPs in Finland, Portugal and the Netherlands, so it is not new.

“It is a nationally recognised system” Amanda told us, “which has been scrutinised by the NHS.”

What is less clear is whether there has been any independent analysis of how it is working.

Image above: Graphic promoting online triage software Klinik

Majority of patients are in favour, older people are less in favour than those of working age

The feedback the practices have received has been more positive from those of working age than it has from older people. Each surgery has a feedback form on its website. So far 44% Grove Park Surgery’s patients have responded; 42% Wellesley Rd’s patients have given their feedback, while only 13% patients at Chiswick Family Practice have responded.

So far the majority have said they are in favour:

“56.9% people who have answered are happy for the merger to go ahead” Amanda told us. “43.1 are not, and they are all over the age of 60 with mobility and accessibility issues.”

They are receiving disproportionately more feedback from people in the older group, and people who came to their first public meeting on Wednesday 4 October were also largely older: 53% of those who have filled out the feedback forms are over the age of 60, while 44% are aged 20 – 60, yet the majority of patients on their lists are of working age.

The new system should benefit people of working age particularly. Instead of the “stampede” at 8am, as Dr Drewry described it, they could go to work, take their children to school and log on at any point during the day to make an appointment for a new problem or one which was getting worse.

This sort of system designed to provide better access to healthcare at primary level is being rolled out across the country under the banner of ‘Modern General Practice’.

“It’s what every practice in the country is doing,” said Amanda.

What the NHS is worried about is people falling through the cracks, who maybe have early signs of cancer that should be checked, who are not being seen because access to a doctor is too difficult.

James Armitage told us he had been convinced at the first public meeting that the merger was on balance a positive thing:

“They convinced me they believed it would be an improvement. I hope it does work.”

Frequently Asked Questions

The three surgeries have published a list of Frequently Asked Questions about the merger which you can see here: FAQs.

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