Meeting re Temple and St Augustine’s Merger
@ The Scout Hut Keynsham
25th October 2023
Meeting started 6:15 pm
97 attendees
Present:
Dr Gavin Jewell GP Partner – Temple House,
Dr Nick Woodward GP Partner – St Augustine’s
Dr Ed Fletcher GP Partner St Augustine’s
Mrs Becky Greatorex Practice Manager – Temple House
Mrs Kate Parkins Practice Manager – St Augustine’s
Summary of meeting
Becky, Practice Manager from Temple House thanked everyone for attending and made introductions.
Dr Gavin Jewell explained reasons for the need for change at Temple House. Two of their three partners are retiring next year. Advertisements for GP partners have not attracted any candidates. This may be because many younger GPs are reluctant to take on the financial responsibility for managing a practice.
It is not possible to run a practice with a single Partner. This meant that the practice had to consider giving notice on their contract to NHS commissioners. However, after lengthy discussions with GP surgeries in the area, St Augustine’s agreed they could support. They offered to bring Dr Jewell into the partnership and take on the Temple contract.
Dr Lockyear and Dr Branfoot although stepping down as partners would like to return as salaried GP’s. This will mean that there is no loss of GP clinical time.
Dr Nick Woodward (St Augustine’s) went on to explain the options that were available to Temple House and the reasons for St Augustine’s support.
If a practice hands back their contract the following may happen.
1.
List dispersal – NHS commissioners would ask patients to re-register at another practice (St Augustine’s or West View).
There is a risk here for the remaining local practices, as they may need to accept between four to eight thousand additional patients. This influx of patients can destabilise neighbouring practices. The two remaining practices would have no extra space to increase resources or staffing, to support a significant increase in patients.
2.
The NHS commissioners may tender the contract to any other interested party / practice.
This could be a Bristol practice or a private provider, who does not know Keynsham or the local area. This may also destabilise our current primary care network.
All three practices in Keynsham are used to working together as part of the Primary Care Network (PCN), and we currently share staff already e.g., pharmacist’s, first contact physios, home visiting team etc.
He went on to say that by coming together both practices could retain continuity, and this is not only rewarding for clinical staff such as GP’s but also better for patient care.
He reassured everyone that all the staff and the premises are needed going forward, there is no plan to close sites or reduce hours, so patients will still be able to see a doctor they know.
The meeting was then opened to questions from the floor:
Historical decisions re Temple Site
Concerns were raised over the original purpose of the health centre site / nursing home site (that never materialised) and the fact that St Augustine’s were not given space in the health centre some years ago.
The clinical space currently occupied by Temple House will remain in place as will the chocolate qtr., and Saltford branch surgery. Both Practices make use of all their clinical rooms each day. There is no plan to reduce or stop services at any site.
Also raised from the floor were concerns over new proposal for the tree tops site and number of parking spaces and whether this would make access to Temple House difficult.
Temple House rent their premises from NHS property services, as such they have little say or control over the land, premises, or parking. Like residents they have raised concerns over the parking with the new planning application.
Patient access, how will shortage of GP’s be resolved?
There is a national problem with the retention and recruitment of GP’s, Keynsham is not unique. The way we care for patients has changed, with many more consultants in secondary care the management of long-term conditions has shifted to primary care, however, the number of GP’s has not increased.
St Augustine’s is a training practice, this helps to not only develop the next generation of GP’s but often trainees want to stay on with the practice post qualification.
St Augustine’s is a research practice which means that patients may be able to participate in clinical trials for the benefit of future generations.
Both parties feel positive that coming together will help to improve resilience and retain staff.
Will you increase face to face appointments?
St Augustines offer patients a choice between face to face or telephone appointment for many appointments. Temple is working towards a similar template.
However, both practices will continue to use telephone triage for their emergency list as this offers the maximum numbers of appointments for patients. If the emergency list was face to face the number of appointments would be significantly reduced.
Will you fix problems getting through on the phone?
Both practices are in the process of upgrading to cloud-based telephony. The benefits will be.
•
unlimited number of calls into the practice (no engaged tone)
•
call queue system and messaging
•
call back function (which will hold your place in the queue)
•
check and cancel appointment function.
The practice managers are meeting with the phone company next week to find an interim solution for Temple and a future solution for both practices.
When the practice come together there will be a single contact number.
Will more appointments be available online?
Both practices do offer appointments online and will continue to review and increase choice. Practices acknowledge that this is not what all patients want. Therefore, it would be unfair if all appointments were online, as often booked quickly it would leave no appointments for those who use the telephone.
Online booking is tricky for even simple appointments like nurses or HCAs as what they do in each appointment and the equipment they need can vary. Where online appointments are available, practices often find the wrong type of appointment has been made. This leads to cancellation and wastes patient / clinical time.
For routine long term condition review, blood tests, cervical smears, and vaccinations St Augustine’s use self-book. This allows patients to choose an appointment via text link. For those who do not provide a mobile, this frees up phone lines for other patients or enables the practice to call the patients who do not wish to use digital platforms.
A new website and online consultation are also currently in development. The website pilot is co-produced with patients to make it user friendly. Both practices will move to a single website in April 2024.
Will services change e.g., reduction of health checks etc?
All GP practices run similar services as part of their core contract, this includes long term condition review and health checks. There are currently a reduced number of HCA/ nurse appointments at Temple House, but this is due to planned leave and should improve.
How many patients are at each practice and what are the staffing levels / locums?
St Augustine’s have 11.5k patients / Temple have 8k patients.
The Practices are made up of the following staff.
Many of our staff including GPs are part time. GPs often have other clinical interests in addition to working in general practice e.g., mentoring, research etc.
4 GP Partners
8 Salaried GP’s
Practice Manager
Deputy PM / Business Manager
Deputy PM – Operational Rota / IT lead –
Admin Lead
Finance Lead
3 Medical Secretaries
24 Admin staff
Research admin
Advanced Nurse practitioners
Practice Nurses
Health Care Assistants
Primary Care Network funded.
3 care coordinators
Home Visiting Service
Paramedic
First Contact Physio
Pharmacists
Pharmacy Techs
Nursing Associates
3 GP partners
2 Salaried GP’s
Practice Manager
Medical Secretary
Senior admin
8 Admin Staff
Advanced Nurse practitioners
Practice Nurses
Health Care Assistants
Phlebotomist
Primary Care Network funded.
2 care coordinators
Home Visiting Service
Paramedic
First Contact Physio
Pharmacists
Pharmacy Techs
Nursing Associates
Visiting Staff
Physiotherapist
Community Dermatology
Dorothy House
Talking Therapies
Diabetic Eye Screening
DHI worker
Visiting Staff
Physiotherapist
Diabetic Eye Screening
DHI worker
Both practices use locums when needed to fill gaps such as maternity leave or sickness. Practices use regular locums to ensure continuity.
Will the level of service be maintained?
Concerns were raised over level of service as patients feel they have a very good service at Temple.
Without this change Dr Jewell cannot maintain the existing service at Temple on his own. If the practice was to close and patients may be asked to register elsewhere this would result in a reduction in service for all patients. By coming together, the aim is to maintain the current good standard of service for patients. Patients will be able to continue to see a doctor who knows you.
There was a concern that with two partners leaving Dr Jewell would be away from his clinical work.
This will not be the case as all the Partners will come together to share the workload such as administration, running of the practices, business planning, meetings etc.
Will patients be asked to travel between sites?
Question raised about whether patients will need to travel between sites and whether each site would access the medical record.
The answer is yes. There will be choice in most circumstances. However, if there is a medical emergency and a doctor is available at a different site, you may need to attend a different location. Other routine appointments, and nurse appointments will be available as usual at each site.
The clinical system will come together at the end of April 2024, if you see a GP at another site, they will have full access to your electronic record. Some of our Primary Care Network services already work in this way across Keynsham.
Will there be a future Keynsham Super practice perhaps with admin in a different location?
This is the direction of travel nationally. It is difficult financially for smaller practices to survive. There are no plans currently to bring all three Keynsham practices together or to re locate any admin teams. All our existing premises will remain in place to deliver services.
Will there be a change of name?
It is our intention to retain the three existing names – St Augustine’s, Saltford, Temple under one umbrella. We have asked staff to suggest new names, we are happy to except any suggestions from patients.
The meeting drawn to a close at 7pm, attendees thanked for their time.
