On the Ridge (Issue 37)

Surgery Matters: who does what at The Ridgeway

Dr Etherington writes:

The team at the Ridgeway and Alexandra Avenue, plus the staff we share with the practices in our Primary Care Network (PCN), offers 30% more appointments than it did five years ago, to roughly the same number of patients. Partly this is because more people have more medical illnesses such as lung disease, heart disease and diabetes but now these illnesses are managed in the community rather than by hospital doctors.

We do have lots of additions to the team, many of whom have extra, specialised training so they can offer more help to particular groups. As many of these roles are new, the patient group thought it might be useful to know more about all of them.

You don’t see some of the staff. We couldn’t run the surgery for example without our cleaners who work well into the evening keeping the building and rooms clean enough to be clinically safe. We have an incredibly low infection rate for our medical procedures.

You may not see our administration team although they may phone or text you. They deal with the hundreds of blood test results, hospital letters and queries from you and from multiple medical and other organisations across the health and care system. They also mastermind dealing with data in the practice. The practice has over a hundred targets to achieve to demonstrate that we are giving good medical care.

You do see and speak to our reception team. They mastermind dealing with all of the questions asked at the front desk, both answer and make multiple phone calls during the day, and have masses of knowledge about the different sources of help in the area. They are not trained to be medical staff but they do get extra training to recognise medical emergencies and deal with the unexpected. They also give extra help to people who have difficulty accessing the system for example people with dementia or with communication difficulties. All of the partners occasionally do a stint in reception - probably the most difficult role in the practice as it is always busy, and there is never enough slack in the system to be able to give everyone the appointment they want exactly when they want it and with the  person that they want.

Ridgeway managers support all of the staff, and always there is a senior manager or GP available on site to help with any problems.

Our healthcare assistants do far more than take your blood. They perform other tests for example ECGs ( heart tracings), give some injections such as vaccinations and vitamin replacement injections, do some simple dressings, and offer health screening appointments. They juggle our stocks of medical supplies making sure that all rooms have the equipment they need.

At our surgeries the practice nurses have done extra training to run our ‘ treatment room’ sessions and all have other extra qualifications. This means that they run our ‘long term conditions’ clinics for people with medical conditions such as diabetes or high blood pressure to have regular tests and reviews. They deal with many dressings for complicated ulcers and skin problems and teach people with less complicated problems to care for themselves. Our childhood and adult immunisation programmes are run by our practice nurses too. They give broad advice about travel alongside vaccinations and have training in contraception and other sexual health issues. Independent Prescriber training means they can prescribe medication. Some have done Masters level training to be Advanced Nurse Practitioners allowing them to deal with minor illnesses and management of complex patients with multiple long term conditions, including mental health problems. Often they come into contact with our carers (there are more than 6 million carers in the UK) ensuring that they also are offered regular checks and know what help is available.

Some nurses who have had extra training give support to those who are housebound or medically frail are called enhanced nurse practitioners.  Any of you on regular medication will probably meet our clinical pharmacists who are all trained at Masters level to see complex patients, to prescribe and to try to make your medication prescribing efficient, safe and , ideally, better for the planet (the NHS is responsible for about 5% of the UK carbon footprint. Prescribing wasted medication, or less carbon efficient versions of things like inhalers is responsible for a big chunk of this). They run our medication reviews, particularly for people on lots of medication, and help deal with many of the requests for medication.

We get lots of help from our local community pharmacists who work with us to try to get you the right medications when you need them.

Our physician associates are people with a science degree and then a masters degree in learning to examine, diagnose and treat patients. They are often part of our on call and home visiting team. Our paramedics also make up part of this team too. They have experience of very sick patients when they are on the London Ambulance Service, as well as the extra training they get when moving into general practice. This makes them real experts in helping decide whether or not to send a sick person into hospital or to bring in other teams to support and treat someone at home.

Qualified doctors in the surgery are a mix. This means that we have a regular team of GP partners running the practice as well as seeing patients, salaried GPs and some regular GP locums filling in for holiday and sickness cover. Our GP registrars are qualified doctors training to be GPs. We have a variety of learners in the practice as well as the G.P. registrars. As some of us teach medical students so we often have student versions of the clinicians in our teams, or sometimes people from wider clinical teams who are learning about general practice. You should always be asked if you would be happy to see a student, you should always know that they are being supervised, and we will always accept you saying no- without pushing you to change your mind.

Some new roles in the PCN were described in the last newsletter. They are part of the personalised care team - a mix of people who can give you one to one help. They include social prescribers who can help you find resources in the community including green activities and signposting to financial, care and other support. We have a health and wellbeing coach who can help you choose and find the motivation for wellbeing activities. The PCN care navigators will offer help to people who have to juggle lots of appointments. We can also refer to our First Contact Physiotherapist who does a one-off assessment to help decide the best route to treatment for musculoskeletal problems. We may also refer people to our PCN mental health practitioner who can help plan the best forms of mental health support.

You may have read scare stories in the newspapers about people who are not doctors making mistakes when they see patients. All clinicians working with us have an induction when they start at the practice, have proper training to make sure they know about the sorts of problems that are seen in people in the community, and know when to ask for help from a senior GP and always have that help accessible. They bring extra skills to the surgery from their previous roles and training adding to the range of care that we can offer to our patients.

Everyone you see should introduce themselves, tell you what they do at the Ridgeway and how they can help you. When they visit you at home they should have ID to show you. If you are worried about seeing someone that you have not seen before, please contact us at the surgery so that we confirm that they are a member of our team.

Meet our team