Merging of four practices

The merging of four practices in June 2018

Thank you for your patience in this whole transition. We know that it has been a difficult time for patients and the practice alike, that the current situation is far from perfect and we are working hard to deal with it and to improve the services provided.

Following comments and feedback from our patients, we felt it would be helpful to explain why we made the decision to merge, the various problems encountered and where we are currently in terms of addressing the issues.

Why did the four practices make the decision to merge?

  • Put simply, to survive. Recruitment of GPs in Gloucester City is at an all time low. For example, 10 years ago a vacancy for a GP partnership typically attracted 50 or more applicants, but before we merged our adverts were going unanswered. This has resulted in greater pressure on remaining GPs and levels of stress/sickness have risen. As 4 smaller separate practices we simply could not recruit, and indeed London Medical Practice went from five to only one GP partner, and he was alone for almost a year prior to the merger. If one practice closes, it can start a domino-effect where the patients of that practice have to be reallocated to others. This places extra pressure on remaining (already struggling) practices, which in turn can cause them to fail as well. The reality is that had the 4 practices not merged, all 4 practices would have probably closed over the next 2 to 3 years.
  • For all the difficulties in coming together, as a larger entity, we have managed recruit new doctors and this in itself is a huge success.
  • We never lose sight of our most important goal- that of delivering good, safe and effective care. We understand that it is immensely frustrating to have to wait for significant improvement but our priority has to be to do everything properly rather than just quickly.

It will take time to settle

  • The partnership took the decision to adopt a new model of working and this new model is evolving and continues to evolve as we figure out what works and what does not. We are flexible and will always be adapting where we can.
  • We intend to grow our team of Allied Health Professionals (including Advanced Nurse Practitioners, Clinical Pharmacists, Pharmacy technicians, Community Matron etc) in order to support the practice in delivering services.
  • When you throw different groups in together to work in a completely different way, there will be inevitable problems initially but we felt this was essential to forge a new, more dynamic way to work.

Problems encountered

  • We recognise that for both patients and staff alike there were major problems with IT systems and phones in June 2018 which brought us to a near stand-still. There were many lessons learnt from this. It took several months to recover from this alone.
  • Staffing issues – due to unforeseen sickness and staff leaving (due to the merger as well as other issues), it meant that we were very short-staffed in both the Reception and Prescriptions team in the first few months following the merger. This has added to the frustration and upset for patients due to delay in the answering of phones and again, we apologise for that.
  • Cultural changes for both practice staff and patients – again it is inevitable that one cannot suddenly bring together 4 different groups of people and expect them to magically work as one unit overnight. Equally all patients have been used to the way that their previous practices operated. To many people change is often perceived as a threat.
  • Workload – Our merger coincided with a summer that was so busy across the whole NHS system. A&E set an all-time daily attendance record in early June just as we merged. Instead of being quieter than winter, it was busier! This meant that, rather than using a relatively quiet time of year in which to manage the changes, the practice was working extremely hard just to manage the increased workload.

Addressing Issues

  • The main telephone system issues have been resolved, and we have many more phone lines but recognise that there are still improvements that can be made to our response times. However, we are still managing to deal with over 300-400 additional urgent call-backs by doctors per day.
  • Our main IT system provided by the NHS is now stable and working well, meaning that we can begin to introduce new features to help staff and patients.
  • Our a new website allows more queries to be dealt with online and we encourage patients to make full use of it.
  • There is ongoing recruitment and training of clinical, prescriptions and admin teams to increase capacity and responsiveness, particularly with regards the telephones. We are pleased that we have taken on a number of new staff members although accept that it will take some time to fully train them to the skill levels we need.
  • Communication with our Patient Representative Group is a priority, and we would welcome new members of our PRG who feel can help us improve services.

 Achievements so far – what has gone well?

  • We have recruited seven new GPs (three GP partners and four salaried GPs) since June 2018 and thus justifying our merger for that reason alone.
  • In addition, we have also taken on three nurses, two clinical pharmacists, a community matron and a new Chief Operating Officer. Our team will continue to grow.
  • We successfully implemented the Improved Access system which increases the number of appointments available on weekday evenings between 18:30 and 20:00, and on Saturday mornings.
  • We have introduced an innovative and popular patient group sessions for people with and at risk of diabetes called ‘Eat Real Food’ which is helping people treat, prevent and reverse Type 2 Diabetes without the need for medicines.
  • We have strengthened our systems for safeguarding children and vulnerable adults, making sure the right information is available to the right people.
  • Palliative care for those approaching the end of their life has been prioritised and systems have been put in place to ensure continuity of care which is essential for these patients.
  • The care of older people with complex needs has been improved by the recruitment of a specialised Community Matron.
  • Whilst we acknowledge that we have had some complaints about our services, complaints from patients of a clinical nature are very low in number. This strengthens our feeling that the new way of working, with longer appointments for patients and more clinicians, is helping us further improve our ability to deliver safe and effective clinical care. However, when things don’t go as well as we want them to (or they go really well), because we have a bigger team we now have a more robust system to analyse and share the learning that comes from this.

Thank you for taking the time and trouble to read this. We hope this goes some way towards updating you on the situation.

We are one practice now and will continue to work hard to deliver services to our patients.