December 2020 Patient Update

Dear all,

Many thanks for your ongoing understanding as we continue to adapt to this ‘new normal’ whilst Covid 19 and the efforts to limit its impact affect us all. We remain, as we have been throughout this pandemic, fully open with the only difference being that your first contact with us is over the phone to ensure only patients who need to be seen face to face come on site. This is to minimize the risk of Covid 19 transmission to patients and staff but we have in fact expanded our capacity to consult over the past 8 months and believe access has improved as a result.

We can only deliver the best care in partnership with you and we are reliant upon patient engagement to improve and maintain our standards. With this in mind I would be grateful if you could read and consider the following essential information concerning flu vaccination, cervical smears and repeat prescriptions. Further information about new staff and our Patient Participation Group follows.

Flu Vaccination

Every year the flu hospitalizes and kills thousands of patients in the UK and flu vaccination is the best way to protect yourselves and others who are most vulnerable. This year it is even more important to prevent hospitalization as the combination of flu and Covid 19 threatens to overwhelm the NHS, having a knock-on effect on care for everybody.

We have approximately 3000 patients at risk from flu complications and contacting all of you for this takes a significant amount of time and resources away from providing other care. We are doing our best to vaccinate as many of you as possible and everybody who is eligible and wants a vaccine will get one. If, for any reason, you are contacted but do not want the flu vaccine, please let us know as we are contacting some patients multiple times with no reply and this significant time and effort is much better placed providing care in other areas. You can let us know you wish to decline by text, by phone, or by letter and we are in the process of setting up an email address which will be dedicated to receiving information from patients when requested by clinicians.

Cervical Smears

It has been well documented that Covid 19 has resulted in a reduction in patients presenting with symptoms and signs of cancer and we are concerned that cancer will be diagnosed later as a result. The best way to treat cancer is to prevent it in the first place and fortunately we are able to prevent many cases of cervical cancer by screening for it through cervical smears.

Cervical screening rates have been declining and it is so important that you are all aware we are open for screening and encourage all patients in whom screening is due to attend. If you have been contacted or are asked to attend for a cervical smear please book an appointment with our practice nurse who will be only too pleased to discuss it and perform your smear. If, for whatever reason, you wish to opt out of cervical screening please let us know as again we are contacting some patients multiple times with no reply and this significant time and effort is much better placed providing care in other areas. You can let us know you wish to opt out by text, by phone, or by letter and we are in the process of setting up an email address which will be dedicated to receiving information from patients when requested by clinicians. You will need to sign an opt-out document to formalize this decision.

Repeat Prescriptions

This has been an area we have worked hard on over the past 6 months as we are aware many patients have been frustrated by apparent delays between requesting their prescription and it being available to collect in their pharmacy. We receive approximately 90 prescriptions each day, most containing multiple medications, and each one has to be checked to ensure the medication being requested is safe; appropriate; correctly dosed; and is not being prescribed before it is needed.

In addition to increasing the number of doctors able to prescribe each day and recruiting a clinical pharmacist to the surgery we have identified the following issues leading to delays in this process:

  1. Patients requesting medication too early
  2. Patients requesting medication which is not a repeat item
  3. Patients requesting medication for which monitoring blood tests have not been performed

Medication Requested Too Early

Requesting medication too early results in large volumes of medication being stored in patients’ houses which studies show contributes to medication waste as well as being a significant safety concern.

Medication requests will therefore only be processed if the items requested are due to run out within the next 7 days.

The exception to this is medication provided in a ‘dossette box’ which is normally ordered by pharmacies. We will process requests within 21 days for medication in a dossette box to give the pharmacy plenty of time to prepare the box.

Medication Which is Not a Repeat Item

When patients request a medication which is not a repeat item, clinicians need to work out why it has been requested. It is often not clear that prescription is safe; or appropriate; or that the dose is correct, even if it has been prescribed before.

For this reason, from January 2021, we will be rejecting all patient requests for medication that is not a repeat item. If you believe you need a medication on a repeat basis, it must be discussed with a clinician to determine it is safe, appropriate and correctly dosed.

Medication for Which Monitoring Blood Tests Have Not Been Performed

Many patients take medication which requires regular blood tests to ensure it remains safe to prescribe. Once a year, at your medication review with our pharmacist, you should go through the monitoring requirements for your medication. If you request medication and the monitoring blood tests have not been done, this will result in a delay in approving your prescription and may also lead to delays in approving other patients’ prescriptions as well.

Therefore if you are asked to have monitoring blood tests please do so to ensure your and others’ medication can be prescribed in a timely fashion.

Repeat Dispensing

A final step we are in the process of taking is to switch all our patients over to ‘repeat dispensing’ where it is safe and appropriate to do so. This is a significant undertaking for all our patients who currently receive repeat medication and whilst it has already been done for some patients, the majority will be switched throughout 2021.

What is Repeat Dispensing?

Repeat dispensing means when we prescribe a medication for a patient, for example a 2 month supply of drug X, we can authorize the pharmacist to give the patient 3 prescriptions in a row. This means the patient will collect the first prescription which will last 2 months from the pharmacy; and when this is running out, they will go straight back to the pharmacy to collect the second prescription for the next 2 months; and when this is running out, they will go straight back to the pharmacy to collect the third prescription for the next 2 months. Only at the end of the third prescription will the patient need to request further prescription from the GP.

This means you will only need to ask for repeat medication twice a year instead of six times a year, reducing the volume of prescriptions we need to process each day and reducing the risk of a prescription delay.

Which Medication Is Suitable for Repeat Dispensing?

Only oral medication in tablet or capsule form which can be prescribed for a clearly defined period of time and has been deemed safe, appropriate and correctly dosed for repeat prescription will be placed on repeat dispensing. This means some of your medication might be placed on repeat dispensing whilst others might not.

How Will I Know Which Medication is on Repeat Dispensing?

All medication placed on repeat dispensing will have this written and attached to the medication box.

An essential part of the repeat dispensing process is that you request all your repeat dispensing medication at the same time even if you have some repeat dispensing items left over.

How Will I Know When I Need to Request Repeat Dispensing Medication From the Surgery Again?

Your pharmacist will be able to tell you when the last prescription they are authorized to dispense has been given to you.

New Staff

We have been delighted to welcome a number of new members of staff to The Rowans Surgery over the past few months, all of whom will strengthen our administrative capabilities and provide patients with much-needed clinical consistency and continuity of care.

Practice Management

We are delighted that Adama Ceesay and Claire Danskin have agreed to convert their interim management roles into substantive roles as our practice manager and deputy practice manager respectively. They both bring a wealth of management, administrative and locality experience and will ensure The Rowans Surgery continues to improve the quality of care we provide for our patients.

Practice Administration

We extend a warm welcome to Anika Agoreyo who joined our administration team over the summer and has had an immediate impact improving our capacity to receive, document and respond to practice correspondence. Anika is learning a number of new skills having had previous experience in a reception based role in primary care and is helping to ensure our workflow processes remain safe, efficient and underpin and support the work of our clinicians.

Clinical Team

Dr Ruqiya Noor, Dr Janet Liong, Dr Farzeen Khan and Dr Anitha Sanjeevappa have all joined the surgery this summer as salaried GPs providing much needed continuity of care. It has been a pleasure welcoming them to The Rowans and they join myself and Dr Jay Patel to make up a nucleus of 6 GPs providing a regular high quality service to all our patients with a broad range of interests, skills and experience between us.

Dr Imran Ali continues in his role as our integrated care lead, visiting patients who are housebound when required, and will be joining us in a substantive role in the near future.

We are also looking forward to the arrival of Kayantha Sivalingam, a clinical pharmacist working for the East Merton Primary Care Network, who will be joining us full time from January.

Further information and biographies on our staff can be found in the staff section of our website.

Staff Leavers

We have benefitted tremendously from the knowledge and skills of Krishna Punj who has worked as a locum clinical pharmacist for us 2 days per week since May 2020. Krishna will be leaving us in February next year and we are hugely grateful for the work she has done particularly around keeping accurate records, reviewing repeat medication and monitoring long term conditions. We wish her all the best in her future pharmacy career.

Many of you will be sad to learn that Trudy Seale, who has worked at The Rowans Surgery for the past 3 years providing nursing care, will be leaving us in the New Year. Trudy has made a significant contribution to the surgery and built relationships with many patients, particularly in her care of those with diabetes and related wound complications where she has been a source of information and advice. She has also taken a lead role in infection control and immunization, with an interest in public health and disease prevention, and we will all miss her energy and enthusiasm. We wish Trudy all the best for her future and thank her for all the work she has done.

Patient Participation Group

It is essential we work in partnership with you to enable us to provide you with the best care. One way in which we receive your feedback and input into the running of the surgery is through our Patient Participation Group (PPG) which was paused when Covid 19 began. We are keen to reactivate this group as it is a vital mechanism by which we can ensure we remain relevant and committed to the care that you need. On 21st December at 6:30pm we will be holding an informal virtual PPG meeting to set out a vision for the way in which we can best work together moving forwards.

If you would like to join our meeting on 21st December and/or are interested in joining our Patient Participation Group, please email our practice manager Adama Ceesay: adama.ceesay@nhs.net

I hope you find the above information useful and would be grateful if you could take note of the importance of responding to our flu vaccination and cervical smear invitations in particular.

Moving forwards we intend to communicate increasingly via our website but also through Rowans Surgery Newsletters which we will circulate on a 6 monthly basis.

With best wishes for a happy and healthy Christmas and New Year,

Dr Paul Riley

GP Clinical Lead

The Rowans Surgery