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IVY GROVE NEWS

Some of this information may have been provided previously in the form of our regular newsletter Ivy Grove News which is available to download

Make the Most of your GP

Make the Most of Your GP part 1

Elements of this article have previously been published by the Patients Association

Think before you book

Please book an emergency same day appointment for genuine emergencies only. See a dentist for dental problems. GPs don't give antibiotics for common colds or viruses.

Telephone appointments

Consultations which do not require a face to face examination can be safely and easily dealt with by telephone. Sick note requests, medication advice and administrative issues are examples. Reception will always ask if your problem can be dealt with by telephone. See our website at bit.ly/11tPSRs for information.

Ask for advice

Not sure who to approach? You can always ask for advice first rather than book a surgery appointment. For instance, your problem may be better dealt with by a district nurse, or a health visitor. NHS 111 is also available for health advice round the clock. See our website at ivy.gs/medadv for more advice.

See the nurse

Our practice nurses are highly qualified and trained to deal with many medical conditions and manage the long term care of many patients themselves. See the list on our website for more information bit.ly/11GwHPY on what you can book to see the nurse with.

Make the Most of Your GP part 2

'Oh and doctor…'

It has been shown that presenting problems to the doctor as you leave distracts them and increases the risk that mistakes will be made and things will be missed. Unless the problem is a true emergency to be dealt with there and then, we would always encourage you to rebook a fresh appointment if you wish to discuss other concerns.

Book a double if needed

If you feel your problem is very complex, or you have multiple issues to discuss, please ask for a double appointment when you book. We find that when used responsibly, double appointments help everybody and reduce waiting times for other patients.

Cancel if you can't get

Every year, hundreds of appointments are wasted because people don't cancel their appointments when they cannot attend. This wastage is equivalent to the surgery being shut for a whole two weeks every year! Please bear this in mind when you find you can't book with us.

Don't miss out - get online!

There is a wealth of information on our website, including contact numbers, medical advice and self-help leaflets. You will have noticed that many of our newsletter articles include links to the full text online and to other website pages where you will find lots of useful information. We would therefore encourage all patients to go online and see if they can find the answer they need.

Make the Most of Your GP part 3

Getting dressed and undressed

Your appointment with the GP is only 10 minutes long. It will help your GP if you wear clothing appropriate to the part of your body that might need to be examined. If you find that you need to spend 3 minutes getting dressed and undressed during your consultation, then nearly a third of your precious time with the doctor will have been taken up.

Urine samples

If you attend with a problem relating to your waterworks, it is always sensible to provide a fresh specimen of urine on arrival at the surgery. Please ask reception for a urine bottle.

Drink plenty of fluids

It is apparent from blood test results that many patients do not drink enough fluids in the day. Normal daily fluid intake for healthy people should be between 2 and 2.5 litres (6 to 8 cups). Drinking too little not only makes you feel under the weather, but also affects your blood results which gives the impression that things are not as well as they seem and which may lead to unnecessary retesting.

Self-help for your condition

Many of the patients that we see have conditions that could have been managed safely at home, with advice and medication from pharmacists. If you are not sure where you need to go to get help, please see our poster at ivy.gs/go or read the Choose Well article on page 3.

Make the Most of Your GP part 4

Book appointments online

You can now help to reduce demand on the phones by booking your own appointment online. Please visit ivy.gs/online for more details.

Listen to our receptionists

When you call for an appointment with us, our receptionists are trained to pick up on verbal clues that might indicate a more serious problem, like heart attacks or strokes. In such situations, they have been authorised by the doctors to advise you to ring 999 or attend a major Accident and Emergency department. Please listen to our receptionists so that you do not unnecessarily delay the care that you need.

Join your Patient Group

Ivy Grove Surgery has its own patient group, which has been set up to help improve services for all patients. Please see the dedicated noticeboard in the waiting room or view the patient group pages on the surgery website at ivy.gs/pg.

Sick notes from hospital

Following your hospital stay or outpatient clinic appointment, your hospital doctor is legally obliged to issue you with a fit note (sick note) should you need it. Such a note should be for the full duration of time that they have advised you to be off work. We strongly urge all patients NOT to leave the hospital until they have received their sick note! More details at ivy.gs/med3.

Make the Most of Your GP part 5

Don't waste our time

A recent search showed that a staggering 677 patients did not attend their appointment with the doctor and an equally shocking 492 patients similarly did not attend their appointment with the nurse within the last 12 months. Each of these patients did not let us know that they could not come, meaning that their appointment could not be used by someone else, meaning that we lost six weeks of precious appointments! Such a scandalous waste makes it much more difficult for everyone else to book an appointment.

Tell us if you change your details

If you change your address or telephone number, please always take the time to let us know, just in case we may ever have to contact you.

Book with Citizens Advice

You can book directly with the Citizens Advice Bureaux (CAB) who run a surgery on Friday mornings at Ivy Grove. CAB offer free, confidential, impartial and independent advice and helps people resolve their problems with debt, benefits, employment, housing, discrimination, and many more issues. It is available free to everyone.

Get help from our website

Don't know where to turn for help or who to ring if you have a problem? Visit the help page on our site at ivy.gs/help, or check the telephone numbers at ivy.gs/numbers.

Make the Most of Your GP part 6

10 minutes is not very long

Many patients do not realise that their allocated appointment time is only 10 minutes. 10 minutes is not a long time, when you consider that this will include time spent with history taking and examination, dealing with any pressing problems you might have, and time spent completing forms, prescriptions and making an entry on the computer.

Whilst we will always aim to give patients the time that they need, we do need to try and run on time in order not to unduly inconvenience other patients who will be waiting. If you have multiple problems that need dealing with, we would always ask that you book a double appointment as necessary.

Go to MIU for injuries

Changes in our contract mean that GPs are no longer paid to provide care for any patients with minor injuries. If you have an accident, injury, strain, sprain, or have any other conditions which can easily and safely be managed by the Minor Injuries Unit at Ripley Hospital, we would encourage you to attend there promptly. In order to help patients, we have developed a simple information poster which is available at ivy.gs/miu.

Request visits before 11am

Please see the rest of this newsletter for our new home visiting policy, but if you feel you qualify for a home visit, please always ring us early so that we can assess your request and plan our day effectively.

Make the Most of Your GP part 7

Learn to self-care

A large part of what we see in General Practice constitutes 'minor illness, such as sore throats, sickness and diarrhoea, coughs and colds, It is not always necessary to ring and book for a doctor's appointment as many of these conditions will get better with appropriate self-care and advice. For help, please see our symptom checker at ivy.gs/symptoms.

Request home visits appropriately

Just a reminder that we will only carry out home visits to those patients who are bedbound or terminally ill. Housebound patients do not automatically qualify for a home visit as transport can often be arranged with friends, family and other services. We have a duty to use our resources for the benefit of all our patients. Please read our policy at ivy.gs/visits.

Self-refer where possible

Patients with many different conditions can self-refer to the most appropriate service without needing to see a GP first. Examples are those with back, neck or joint pains (Physio Direct), incontinence (continence advisory service), mild to moderate anxiety or depression (counselling services), foot care advice and treatment (podiatry at Ripley Hospital), alcohol and drug misuse (various addiction services), social services help (social services). For more information, visit our symptom checker page at ivy.gs/symptoms.

Make the Most of Your GP part 8

Avoid just turning up

Unlike walk-in centres, we are not a walk-in or turn-up service. Also, General Practice is not geared up to be an emergency service like Accident and Emergency departments. We run a full appointment system for the benefit of all patients. We would therefore kindly ask that all patients ring us and book an appointment first before arriving at the surgery. This will mean you are less likely to be kept waiting. We have a doctor on duty daily and will always deal with urgent and serious problems the same day.

Use our Symptom Checker

A doctor's appointment is not always required nor is it always the best option for your condition. In order to help patients direct themselves to the most appropriate service, we have a Symptom Checker online at ivy.gs/symptoms. This is designed to encourage patients to access appropriate help in a timely manner. We have now added a new search facility to the page so it will be even easier to find your symptom or condition. Try it out!

Later appointments are for working people

We have a limited number of evening and late evening appointments available and would suggest that these appointments are booked by those who are working in the day or who are otherwise unable to attend our daytime appointments for other reasons. We provide such services to try and help as many different types of patients as possible.

Make the Most of Your GP part 9

Keep to the same doctor

We know it can sometimes be a struggle to get an appointment with any doctor, let alone the one that you want to see, but we would always encourage patients to try and stick to the same doctor for any ongoing problem, even if it may mean a short wait. By doing so, you will maintain continuity, one of the guiding principles of practising safe medicine. Seeing another doctor for an ongoing problem, whilst it may be convenient, may not provide you with the best care: the doctor must spend significant time evaluating your condition from the beginning again, they may not agree with previous treatments, they may come to a completely different conclusion or feel pressured into acting outside their normal practice. All of this may therefore not be in your best interests.

Try not to miss your slot

We offer text reminders of your appointment and will confirm your appointment time and date with you when you book. Despite this, we do still however have many patients who miss their slots. By doing so, such patients waste precious appointment time, and will deprive other needy patients from seeing the doctor. Please be considerate: if you cannot attend, do let us know as soon as you can so that we can offer your slot to another patient.

Check our website

We will collate all these articles into one page on our website for ease of reference. Watch this space!

Make the Most of Your GP part 10

Drink more water

It is apparent that most people don't drink enough; we have busy lifestyles and we forget, we don't want to go to the toilet that often, or we may not have access to regular drinks. Drinking too little can cause headaches, makes us feel unwell and puts a strain on our kidneys.

No need to ring for results

Several years ago we changed our system so that we will actively inform patients if results are abnormal. Therefore if you don't hear from us, you can assume that your test result was either normal or requiring no action from the doctor. Doing so will make it easier for others to get through on the telephone.

We are not an emergency service

Unlike Police, Ambulance and Fire Services, General Practice is most definitely not an emergency service! We have fully booked surgeries and planned visiting sessions. If you have an acute emergency, for their own safety, we would kindly ask that patients try not to present to the front desk to be seen.

We would advise that patients with conditions such as suspected heart attack, suspected stroke, severe bleeding, should always ring 999 for an emergency ambulance. In cases where a visit may be required or has already been agreed with the doctor, again we would advise a 999 ambulance if the patient becomes seriously ill or deteriorates.

Make the Most of Your GP part 11

Get the Right Help

A doctor's appointment is not always the best option and may even lead to a delay in care. Please visit our new landing page for all help about your condition and to see if you can self-refer, self-care or seek help from other more appropriate health professionals. The address of the page is ivy.gs/help (link opens in a new window).

Coming for an injection?

Please help us to be as efficient as possible by being appropriately dressed in attire that will easily expose the area of your body that requires the injection. This will help to avoid undue delays. We also advise that following an injection, all patients sit in the waiting room for a short while, to ensure that they are well and ready to leave the surgery.

Plan your repeat requests

We advise all patients to ensure that they request their repeat prescriptions well in advance. Prescriptions take up to 48 hours to be turned around. Whilst this may seem like a long time, it is actually a rather tight time-frame, as time is required for the receptionist to check the thousands of items being issued in several hundred prescriptions every day; then each prescription must be checked and signed by a doctor. We find that urgent requests take time out of this process and delay the prescriptions of other patients. Please also note that that anything written on your repeat slip may delay your entire script whilst we investigate your request.

Make the Most of Your GP part 12

Away from home?

We cannot visit nor provide medical advice to any of our patients who are out of our practice area, other than to advise that, if you are away from home but still in the UK and need a GP, you can contact any local GP surgery nearby. You can receive emergency treatment from a GP surgery for up to 14 days whilst away from home.

If you need medical advice or treatment but you don't need to see a GP, you can call NHS 111, see a pharmacist who provides advice and treatment for minor conditions, attend a minor injuries unit (MIU) which provides treatment for less serious injuries, or go to a walk-in centre for other medical conditions. These services do not require you to make an appointment or register as a patient.

Double Appointments

We always encourage patients to book double appointments if they have several problems to discuss. However, we would like to remind all patients, with such appointments, to ensure that they arrive on time and that they have checked in.

Arriving late for an appointment may cause you to miss your time slot, with the result that you may be asked to rebook, or the doctor may be unable to deal with your other issues within the shorter time frame. Arriving on time helps to reduce frustration to other patients who have arrived for their own appointments well in time. Thank you.

Make the Most of Your GP part 13

We are not an emergency round-the-clock service!

General Practice is by definition not an emergency service. Emergency services for health include 999, out of hours services, Accident and Emergency, Minor Injuries Units and Walk-in Centres. For GPs, urgent is actually within 48 hours, but is usually later the same day.

GPs are contracted to provide services from 8.00am to 6.30pm weekdays. In this surgery we hold routine appointments till 6.00pm. We are not paid to provide any services outside of these times, nor are we paid to treat any patient with minor injuries. This is not our choice, but rather a decision made by those who pay for health services.

Please bear the above in mind when using our services.

Self-refer, Self-refer, Self-refer, Self-refer, Self-refer

We might not like the self-service tills at the checkout, and would much prefer a human being to scan our groceries for us, but the self-service tills are very much here to stay. With this in mind, we ask that patients familiarise themselves with all the different agencies that they can all self-refer to, all without having to see a GP first. For instance, counselling, drug and alcohol services, continence services, physio, STD clinic, social services, stop smoking, family planning clinic, citizens advice, podiatry, the list is endless.

See our page at ivy.gs/help.

Make the Most of Your GP part 14

Don’t poke cotton buds in your ear!

Yes, we know cotton buds are almost too perfectly shaped to be inserted into the ear, however, as they say, you should never put anything smaller than your elbow into your ear! The skin within the ear is very sensitive and fragile, and can be easily damaged by literally anything that it gets into contact with, including water, shampoo and cotton buds. We would always advise that you seek the help of a pharmacist in the first instance if you think you have problems with ear wax.

Make sure we have an up-to-date contact number

As mentioned later in this newsletter, we have a new text messaging service. If you want to take part in this service, please let us have your correct mobile number. In the future, we may be able to send messages to landline phones.

Urgent Medication Issues

Like many other surgeries, repeat prescriptions need two working days for us to process. This gives us time to perform checks and maintain safety. We are getting increasing numbers of requests for repeat medication to be issued urgently due to a lack of simple forward planning from patients. Such requests delay other patients’ prescriptions and increase the risk of mistakes. We will now only issue urgent medications if they are on a list of medications that are considered essential to continue without a break.

Make the Most of Your GP part 15

Ringing for results

If you are waiting for results of any recent tests, please telephone the surgery after 2.00pm.

Please bear in mind that reception staff are not medically qualified and are not allowed to give out specific information regarding test results, and they will only be able to inform you whether the doctor has seen the result, if it has been filed as ‘normal’ or ‘no action’, or if the doctor wishes to see you further to discuss your condition.

For confidentiality reasons, staff are not allowed to give results to anyone other than the patient.

Carers Clinics

We run a Carers Clinic at Ivy Grove Surgery on the second Wednesday of each month.

This service is there to support carers with their physical, mental and emotional wellbeing as well as obtain practical advice and information that may assist with your caring role.

The service is available to all who care for anyone over the age of 18 years. No referral form is required; if you think you would benefit from support just contact one of our receptionists to make an appointment.

This service is provided in conjunction with the Derbyshire Carers Association. For further information, please visit derbyshirecarers.co.uk .

Make the Most of Your GP part 16

Your GP is not a substitute

Although we are generally more accessible by phone than your average hospital consultant, as your GPs, we are definitely not substitutes for when you need specialist advice or treatment from your regular hospital consultant. Some patients feel that they cannot ask their hospital doctors detailed questions about planned procedures or results, or request sick notes or prescriptions fearing that it is either not the hospital doctor’s job, or that it would be wasting their time, so they get in touch with us instead.

You may not know it, but the hospital is contractually obliged to deal with all your queries regarding your ongoing care at the hospital. Feel free to contact them via their secretaries.

Please respect hygiene

Your GP is not immune to coughs and colds and we kindly ask that patients do all they can to maintain hygiene and reduce the risk of spreading disease. This means keeping clean, washing hands regularly, using disposal tissues and also alcohol gel to clean hands and surfaces.

Accordingly, we also respectfully request that patients do not blow or cough in our faces when we are examining them, and at the very least, use a tissue and cover their mouths. The last thing patients or the practice needs is our medical staff going off sick after catching something from our patients. Many thanks.

Did you know..?

Did you know patients who do not attend...

or cancel their appointments cost the NHS over £700m in lost revenue annually? That is enough to run two hospitals! Recent data shows that the total number of missed appointments last year at Ivy Grove is equivalent to the loss of 6 weeks of GP and nurse time!

Did you know hospitals should not tell patients to bring their hospital outpatient prescriptions to their GP surgery?

GPs are not supposed to convert hospital prescriptions to GP prescriptions as this mean the NHS pays for this twice!

Did you know you can now book GP appointments on-line?

Ask at reception or go to ivy.gs/online.

Did you know the hospital should give you a fit note?

(if you need one) following your inpatient episode or outpatient appointment. See ivy.gs/med3 for more info.

Did you know you can self refer for physio treatment?

Just call Physio Direct on 01335 230079.

Did you know it can take up to 6 weeks for your GP to receive a letter from the consultant..

following your hospital appointment?

Did you know you are free to book a telephone appointment...

for conditions that do not require us to see you face to face? For example, sick note requests where we have seen you before, advice on minor illness, reviews of simple conditions, discussion of results. Simply ask reception when you ring to book.

Did you know when your no-win no-fee solicitor requests a copy of your records...

with your consent we are obliged to send over the entire copy of your medical record for their advisors to review? You should be aware that this may include sensitive information about your own medical history, which you may or may not wish to reveal to others. Please bear this in mind when you next make a claim.

Did you know you can now view certain aspects of your medical record online?

You can view your current medications and drug allergies if you have a Patient Access account. With this account you can also order your repeat prescriptions and book a limited number of appointments online. Ask reception for registration details if you wish to register for this useful service.

Did you know you can self-refer to the Stop Smoking Service without seeing a doctor?

If one of your resolutions was to stop smoking, then well done! You can ring 0800 0852299 or 01246 515153 and access the free service run by Derbyshire Community Health Services.

Did you know about a million people see their GP every single day?

And the NHS employs 1.3 million people making it one of the largest employers in the world.

Did you know you can now check your symptoms on our website?

Not sure where to go or who to turn to for advice and help for your condition or symptom? We have now launched our symptom checker online, where you can look up your symptom on our website. Please note this page is simply a guide to the most appropriate first port of call. Please visit ivy.gs/symptoms.

Did you know you can download a range of patient information leaflets from our website?

We have a range of leaflets and also links to other sites, where you can download information for your condition. For more details, please visit ivy.gs/dl.

Did you know that you can carry resistant bacteria for up to one year after taking an antibiotic?

That means the bacteria will not be killed off if you are given the same antibiotics again. This is why it's best to use antibiotics only when you really need them, in case you get something really serious and need life-saving antibiotics to work for you.

Did you know that you can visit our mobile website simply by using your smartphone and going to our desktop website ivy.gs?

You will be redirected to our mobile site which has been optimised to display the same essential information as the main site, but in an easy to browse format. You can always leave the mobile site and visit our desktop site by clicking the link at the bottom of each page.

Did you know that if you are going on holiday and need more medications to cover it...

We can issue an extended supply before you go away? Simply indicate that you are going away on your next repeat prescription request. Please note that we are not permitted to issue more than three month's supply of any medication to take out of the country.

Did you know that we send text reminders 48 hours before your appointment?

To all patients for whom we have a mobile phone number on record.

Did you know that you can book appointments online 24/7?

This service is available round the clock every day at ivy.gs/online

Did you know that you can prebook appointments up to 6 weeks ahead?

But we do ask that you try and do your best not to forget your appointment (but we will text you as above)!

Did you know that we are open late on Wednesdays?

We offer appointments till 7.20pm for those who work or need a later appointment.

Did you know that we can carry out limited numbers of minor operations?

However the list of procedures we are allowed to perform has been drastically reduced by the Department of Health.

Did you know that blood tests are not carried out at the surgery any more?

All phlebotomy services are carried out at Ripley Hospital and are commissioned by Southern Derbyshire Clinical Commissioning Group (SDCCG).

Did you know there is a search function now on certain key pages of our website?

If you need to search for newsletter content (ivy.gs/ign), telephone numbers (ivy.gs/numbers), downloadable leaflets (ivy.gs/dl), symptoms (ivy.gs/symptoms) then please use the search boxes now provided on those pages.

Did you know Ripley Hospital no longer take children's blood tests?

For blood tests in children aged 5 to 12 years old, contact Royal Derby Hospital 01332 340131 or Ilkeston Hospital 0115 930 5522 extension 231 to book an appointment for a blood test.

Did you know domestic violence affects all people regardless of age, colour or sex?

It happens in all kinds of families and relationships. Persons of any class, culture, religion, sexual orientation, marital status, age, and sex can be victims or perpetrators of domestic violence. For help ring the Derbyshire Domestic Abuse Helpline available 24 hours a day, seven days a week, on 08000 198 668. In an emergency, contact 999. You will find posters that can be read in private in our patient toilets.

Did you know if you need any back-issues of our newsletter

You can visit ivy.gs/ign and download older issues, dating all the way back to 2009.

Did you know you can use shortcuts to get to our website

Don't worry if you forget our full Ivy Grove Surgery website address! You can always get to it easily by typing our ivy.gs shortcut directly into your web browser. Can't remember the shortcut? Here's how you can remember it:

IVY dot Grove Surgery

IVY.GS

Did you know we do answer our phones even though it may not feel like it!

In 2015 we had a total of 118,391 calls in and out of the surgery, of which 81,593 were incoming calls. This averages as around 323 calls every day. One day in March 2015 we received 441 calls, of which 290 were made before 1pm.

Did you know your choose and book passwords are in your paperwork!

We get many calls to our admin team from patients who cannot find the passwords to enable them to book their hospital appointments. Please note that the passwords are on the third or last page of your referral paperwork.

Day in the Life of... newsletter articles

... a GP ... a Practice Nurse ... a Practice Manager ... a Health Visitor ... an Admin Team Member

Day in the Life of a GP - part 1 of a series

Contrary to what you read in some tabloids, an everyday GP does not work 9 to 5 with a good dose of golf in the middle of the day! Here we start a new series having a brief look at the working lives of some of the practice staff. For this first episode, we look at a typical day for a GP at Ivy Grove.

Arrive at 8.00am. Deal with half a dozen urgent prescription queries and look at about a dozen hospital discharge letters requiring action. Start morning surgery at 8.30am with face to face appointments followed by ringing patients on a telephone list. Sign prescriptions and a short break at 10.30am. Continue seeing patients face to face till 12.00pm.

Meet with colleagues again at around 12.30pm and discuss clinical cases, significant events and chat about the morning. Perhaps eat a packed lunch if didn't forget to bring it! Discuss and share out the visiting workload.

Visit anything from 2 to 4 patients from about 1.00pm. Get back to surgery at around 2.00 to 2.30pm. Deal with 30 to 40 clinic letters, ensuring information is added correctly to the system, respond to about a dozen electronic notes for action, review about 30 to 40 blood results. Ring GP and hospital colleagues for advice on a few patients. Dictate letters. Catch up on reading of clinical journals and reply to emails.

Start evening surgery at 3.30pm by ringing more patients then face to face appointments after that. Finish surgery at 6.00pm if running right on time.

Dictate a couple of letters and finish off the day's work. If all goes well, leave surgery at 6.30pm. If a last minute emergency comes in, home time could well be 9.00pm.

The above does not include running late because of having to admit a poorly patient to hospital, emergencies cropping up throughout the day, abnormal blood results being rung through and needing action, fitting in required clinical meetings at lunchtime, preparing for an annual appraisal, keeping up to date and any of the other 1,001 things that a GP must do. As you can see, no time for golf at any point!

Day in the Life of a Practice Nurse - part 2 of a series

No two days are the same; but the variety of patient's conditions, ages and personalities make our job interesting. Some days can be more hectic than others, but we are never short of things to keep us busy.

A typical day starts when we arrive at around 8.15am to log onto the patient system, check the immunisation fridge temperatures, clean the ear irrigation machine and check equipment stock. Morning surgery starts at 8.30am with patients being able to see us for wound care/suture removal, ear irrigation, travel immunisations and advice, smear tests, blood pressure checks, health checks, family planning, warfarin management, vitamin and other injections. In between seeing patients we may be attending to requests from GPs for chaperones, taking a heart tracing or attending to wound care. From reception, we also have requests for queries and advice, urine samples to dip, travel forms to assess and results to deal with.

Lunch at 12noon (if morning surgery not overrun) will be spent with colleagues giving the opportunity to discuss any issues that have arisen during the morning. We also hold nurse/clinical meetings in our lunch break. In order to maintain our nursing registration, we have to provide evidence of our continuing professional development, which usually means keeping up to date with current policies and guidelines, reading relevant journals all of which is time consuming, so we use any spare time for this.

Afternoon surgery restarts at 1.00pm. As well as general nurse appointments as in the mornings, afternoons also tend to be when we have appointments for patients to be seen with chronic diseases such as diabetes and COPD/spirometry (we do of course accommodate for patients who cannot get to set clinic appointments due to work or other commitments). We will usually have finished seeing patients by 6.00pm, the last half an hour or so being used to tidy up our rooms, finish any paperwork and deal with any questions/queries before logging off the computer for the day….. all ready to start afresh the next day!!

Day in the Life of a Practice Manager - part 3 of a series

My day normally starts at 7.30am when I leave home for my one hour commute to work. On my way to work I stop to collect milk for the practice so everybody can have a cuppa at work.

8.15 – I arrive a little earlier today as the school children are off school on their summer holidays and the traffic is lighter – hooray! I check in on reception first to ensure that all is well and there are no immediate problems which need my attention.

I start off my morning by checking my emails, only 29 to deal with this morning – I work through them, respond to a couple of easy ones and flag those I need to action so that I don't lose them later in the raft of others than come in throughout the day. I also review the list of tasks I need to do today.

9.00 – I receive a telephone call from a locum agency to say that the doctor we had booked for next week is no longer available – they made a mistake with their annual leave dates. So it is back to the drawing board and I spend the next half an hour emailing around the various locums and calling the locum agencies to see if we can find a replacement at such short notice – it's not looking good!

9.30 – I make a cup of coffee and start going through my post and the 20 new emails which have arrived in my inbox since this morning.

10.00 – Reception call to say the patient booking in system is not working properly – I am on the phone to the clinical system providers for the next 40 minutes while they try everything they can think of to get it working again including getting me to sit in the waiting room and watch the screen for any signs of life – nothing happens and they decide they need to send an engineer out.

The receptionist on the front desk is overjoyed at having 8 GPs and 4 nurses buzzing her by telephone every couple of minutes to send down their next patient, whilst also trying to book appointments; print out repeat prescription request forms; take in, stamp and check repeat prescriptions and hospital discharge summaries and hand out prescriptions to the patients presenting at the desk. The receptionists in the back office are all busy on the telephones so I stay at the front desk to help out.

11.00 - the accountant calls to go over the queries he sent to me last week. We manage to resolve most of them but as the accountant has all the paperwork for last year's accounts at their office in Sheffield, I ask them to fax over some documents so I have a clearer picture on which to make a decision.

So far I have not managed to complete any of the tasks on my list.

12.00 – I email back responses to most of the accountant's queries but there are some Janette needs to look through when she gets a minute and I leave these to meet with the electrician who has come to give me a quote for the work we need to carry out in the admin office. The work will need to be scheduled on a weekend so staff and patients are not disrupted. I give him a date for the work to be done so I can tie it in with the work the heating engineers have to carry out. Hopefully this will mean I will only need to spend 1 weekend at the surgery rather than 2.

12.30 – I receive a telephone call from our Flu vaccine supplier to say that our vaccine delivery will be delayed due to a manufacturing problem. At the moment they think it will only be a one week delay – now due to arrive at the beginning of October. Luckily we have not planned our first flu clinic until 19th October but it does mean that our home visit plans will need to be changed. I review the nurses working schedules to see when this can be pulled in.

12.45 – I start to deal with some of my emails – one is from NHS England requesting data on the enhanced services they commission from us. I run a search on the clinical system to gather the data on what procedures we have completed in the last month, log in on line to the new reporting system and enter our details. Because of the changes to the local organisations since April, we now have to do this for three separate organisations every month instead of the previous one.

The doctors come up to the staff room to have a coffee at the end of morning surgery and sign the 200+ prescriptions produced that morning by the prescription clerk. I take the opportunity to ask them to sign a few documents and chat with them about any last minute items they might have for the business meeting planned for the following Wednesday evening.

13.30 – I make another cup of coffee, grab my sandwich and head into the Safeguarding Families/Clinical Meeting. There is a lot on the agenda today. The Health Visitors give an update of the families on their safeguarding register; one of the practice nurses gives an update on the recent changes within Family Planning and a presents the latest guidance on Infection Control. Two of the GPs present significant events, and the group agrees on the changes we need to make in practice to ensure non recurrence of these events. Changes to the way the practices confirms consent from patients for release of information to third parties is also agreed and I add the production of the form to my new tasks list.

15.00 – We leave the meeting and the GPs head off to see the patients requesting home visits, the nurses return to start their afternoon clinics and I go back to my office and the 11 new emails which have come in since lunchtime. I start to work through the emails I flagged this morning as needing action and prioritise those which need to be actioned today.

I start reading through the agenda and papers for the Amber Valley & South Dales Practice Managers Meeting planned for tomorrow, which Ivy Grove Surgery hosts each month, and the agenda and papers for the Primary Care Development Meeting I am due to attend the day after that.

15.15 – A receptionist calls to say the light in one of the patient toilets is not working. I go down stairs to check. I get the stepladder and a new bulb from the store room and change the bulb. This does not resolve the problem, so the receptionist logs a call to the estates department, gets a job number and puts an "out of order" sign on the door.

15.30 - I start on my list of tasks. The premises insurance is due for renewal within the next few weeks so I email the companies I contacted last year and request updated quotes.

Reception inform me that the Duty Doctor has just been called out on an urgent visit and will not be back in time to start her afternoon surgery at 4pm. The receptionist at the front desk informs her patients as they arrive and give them the option of waiting for her to return or rebooking for another day.

16.00 – one of the nurses comes to see me about the training course she is due to attend in a few weeks time. She has just completed the degree module in Family Planning and we have asked her to undertake training to insert coils and implants so we can offer an advanced Family Planning service to our female patients. All of the nurses have recently undertaken specialist training in a variety of chronic disease areas, including Asthma, COPD and Diabetes.

16.30 – I have a staff appraisal scheduled for tomorrow morning so I go over the pre-appraisal questionnaire the staff member has completed and make a few more notes of the things I want to discuss with her. I review the online training she has completed so far this year and consider the areas for development she has highlighted for the coming year.

17.00 – I go back to the emails I highlighted for 'action' this morning and work through a few more. I have already received responses from some to the insurance companies and I have a quick look through the quotes. I set up a new task for myself to produce a spreadsheet so I can clearly compare the quotes as I receive them.

17.30 - My computer alarm goes off reminding me to put the boiler on for the Patient Group meeting taking place in an hour. I set up the boiler and the drinks station for the meeting and go back to my office to finish off my emails and any tasks I can manage before the meeting starts. Unfortunately, to complete some to the tasks I need speak to a number of people by telephone but it is too late to catch them now. I will try again tomorrow.

18.30 – I go downstairs to join the patient group meeting in the health promotion room. Dr Wong has not finished surgery yet – he still has 1 patient left to see so he will be late joining the meeting.

The meeting goes really well. The group has found a dynamic trio to lead them. They seem committed to developing the patient group into a useful tool for the patients to have input into the development of services within the practice. I am looking forward to working with them.

The meeting finishes at 19.30 and I set off for home – but first I amend the date of the next patient group meeting on the patient messaging and the patient booking in system. If I leave it until tomorrow I will undoubtedly forget to do it!

Day in the Life of a Health Visitor - part 4 of a series

Health Visitors are all qualified nurses with additional training in public health and child development. Many Health Visitors have also previously worked as midwives or in other areas of the NHS and have a wide variety of skills and experience.

In Ripley, the Health Visitors work in teams covering a defined area and are supported by a Community Nursery Nurse and an administrator. The Health Visitors work closely with the doctor's surgery and all other professionals that support families.

Every child is allocated a Health Visitor from birth until they start full time education when the School Nurse takes over. This is often referred to as the 'Universal Health Visiting Service'.

Universal Health Visiting Service offered to all families

  • Antenatal visit (will eventually be offered to all mothers to be)
  • New baby visit (at around10-14 days)
  • A visit when baby is aged between six and eight weeks old
  • A visit when baby is aged between three to four months old
  • A development review before the age of twelve months
  • A development review before the age of two years and five months

The Health Visiting team also offers additional support to families, for example, advice about minor ailments, immunisations, healthy eating, sleep, behaviour, routines, toileting, child development, breastfeeding and postnatal depression. The Health Visiting team are also able to signpost or refer families to specific services as identified, for example, the local Children Centre, Welfare Rights, support groups, smoking cessation and housing etc.

A Health Visitors day is extremely varied and no two days are alike. Most Health Visitors arrive early for work in order to plan their day, check emails, to catch up on telephone calls and paper work and to complete their electronic records.

Once a week the whole team meet up to allocate the teams work, review caseloads and to undertake team reflection regarding current research, training and workload planning.

The day is then taken up by a variety of home visits, meetings with both families and professionals, Child Health Clinics, development reviews, liaison with GPs, midwives, Children Centres, social workers, hospitals, nurseries etc alongside supporting students, attending training and drop in sessions. Health Visitors are actively involved in policy and service development and may represent the organisation at a variety of meetings across a wide area. When we do finally return to the office there are usually calls from families to return, record keeping and paperwork to complete. Despite this busy pace Health Visitors are committed to improving services and outcomes for children and families. It is now widely recognised that providing support in the antenatal period and into the early years of a child's life can have a significant impact on the long term health and wellbeing of that individual.

If you would like to discuss any aspect of your child's health or development or have any further questions in relation to this article please do not hesitate to contact one of the Ripley Health Visiting team on:

Church Farm Primary Care Centre
01773 514129 / 01773 514148
Gill Jablonski, Caz Mattocks, Elaine Offler, Angela Litchfield,
Emma Waterhouse, Stephanie Watson-Clay

Ripley Hospital
01773 571425
Jan Rayner & Amanda Donnelly

Day in the Life of the Admin Department - part 5 of a series

We are the secretaries and administrative staff for the surgery and are based in a busy department hidden away at the top of the building, in an office just down the corridor from the management team. Our day starts at around 8.30am, the first job of the day in the summer is to throw all of the windows open as we have the warmest room in the building. The surgery receives correspondence which comes in a variety of mediums from traditional paper to high tech electronic versions of letters from consultants which are received via an electronic link with the Derby Hospitals. This all has to be sorted and processed and directed to the relevant GP or Nurse.

When patients see the GP at the surgery the GP might refer patients to specialist departments at the hospital or write to consultants to seek advice as to how to manage or treat a patient's condition. This involves the Doctor dictating a letter which the secretaries in the team type up and either create the paperwork needed to arrange a hospital appointment via the Choose and Book system or send letters direct to the consultants. The consultants then provide advice back to the surgery or write to patients to offer appointments.

The GPs receive numerous requests for information from individual patient's medical records which can be anything from filling out a holiday cancellation medical certificate, to producing a report based on the patient's entire record usually requested by insurance companies. All of this information can only be shared with the patient's consent. The admin department deals with the chasing of consent, agreement of fees and typing up the completed reports.

Throughout the day we also deal with internal messages from anyone who works in the practice asking us to chase queries. These queries can sometimes be answered by one simple telephone call or can become quite time consuming and very often we have to use your detective skills as we usually have very little information to go on. The majority of these are medication or prescribing queries which are raised from hospital discharge paperwork or letters received from the hospital. Other queries involve chasing up clinic letters or outpatient appointments. We do not have any hotline to the hospital or special method to do this and we have often found that patients will have as much success in calling the hospital themselves.

When a patient registers with the practice we receive a copy of their records via the Health Authority, this comes in a paper wallet. After the notes have been checked and all of the relevant information about past or current conditions extracted, this information is added to the patient's computer record by the admin staff. We call this coding or adding a problem title. We do a lot of coding! When the GP's have read all of the many hundreds of letters they receive every week, we attach a problem code to the letter which we will have already scanned into the computer records. This highlights in the records all the information relating to specific problems, so that searches can be carried out on the computer system to invite patients who may require certain annual blood tests, flu vaccinations or condition monitoring. We deal with all of these vital invitations.

We also have many, many other tasks which take place in our office but the ones mentioned are the ones which keep us busy for most of our time. Our day should end at around 4.30pm when one of us has to go round and close all of the windows again ready for tomorrow!