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Hebden Bridge Group Practice

From Vivien Aspey

Thursday, 10 January 2019

Hi folks! Long time since I've posted on here. Although there is no evidence that anything changes as a result of what we say, sometimes just knowing that others are in the same boat makes the present situation more bearable.

I'm finding that booking an appointment is far more effective than attending the morning free for all, because you choose who you see. Of course depending on your problem that is not always possible and attending in the morning results in your seeing practioners from a variety of clinical backgrounds  other than medical.

I dont know whether anyone in the Practice is undertaking a clinical audit of appropriateness of clinical discipline or outcomes of consultations, but I am certainly gleaning information, not just from my own experience but from that of others.

It is extremely important that if you think the person you spoke with was not the best discipline to deal with your symptoms, and even more so if later events proved you right, that you write to the Clinical Commissioning Group.

Using the Practice complaints procedure is a purely internal mechanism, and the Practice should be evaluating their own performance anyway as they have access to all relevant information. But it is the Clinical Commissioning Group on behalf of the government who are paying for this professionally watered down service, however unavoidable, and it is only over time and based on feedback from many patients that the adequacy of primary care in Hebden Bridge, Mytholmroyd and Luddendenfoot can be judged.

Silence in this context gives consent and approval.

From Jim Brierley

Saturday, 12 January 2019

I have long suspected that there is a plan to redevelop the whole of Valley Road, since the market was relocated.  Perhaps this includes the HBGP building as well?

From Sally J Richards

Saturday, 19 January 2019

I'm upset about the advice I got from ANP recently when I attempted to get advice and treatment for vertigo and was offered a prescription for antihistamines...for god's sake! I questioned it and the ANP couldn't substantiate why he had offered the medication other than to say most people want a prescription. He also offered exercises and requested I return if the condition didn't improve. This was more like it. I question the control drug companies have?

From David Morby

Tuesday, 22 January 2019

Having just returned from being hospitalised in Bavaria with pneumonia where I received, prompt, efficient and appropriate caring services. I attempted to get a GP appointment as I needed to explain the situation and gain advice support and continued medication. This was a condition imposed by the German Dr who let me fly home. I also needed to interpret the Drs report which would take more than 5 mins. 

The receptionists response was pretty dismissive, polite, but dismissive and the only option was to go to mytholmroyd and join the queue from 08.30. Although this was the last thing I felt like doing, I did and was seen by nurse practitioner who was very nice, but on this occasion a Dr would have been preferable. 

This system of queueing and waiting to see a GP took me back to when I was a child in the 60s. It was terrible then and it’s appalling now. What has happened to our practice? It used he so good, now Poor at best. 

From Vivien Aspey

Friday, 15 February 2019

I would like to know where the 2019 posts are for the Hebden Bridge Group Practice.

Unfortunately, the challenges of 2018 for ordinary people accessing primary care in the Upper Calder Valley have not gone away- the practice continues to survive through the use of temporary doctors, and even though their clinical skills are not in question, continuity of care and the need felt by people with chronic health problems for medical advice from someone who knows their family and background, are completely overlooked.

There is no foreseeable likelihood of the practice's situation improving in 2019.  Meanwhile its patients need somewhere to communicate with each other about what it is like to be on the receiving end of heartless management policies communicated by staff who all share a duty of confidentiality but not necessarily an understanding of the impact on people with health problems.

The Hebden Bridge Group Practice has never distinguished itself by consulting its patients but without this forum , and despite the best efforts of the long suffering PPG, they appear to have stopped e ven listening.

From Carol Jackson

Tuesday, 19 March 2019

After being ill recently, and managing  with prescription tablets that I keep at home  for such relapses in my chronic illness, I have just looked online to book a routine appointment to follow things up and was shocked to see there is only one appointment in any area apart from blood tests (the appointment is  at Lud Foot) until after the 2/5/2019. This seems an awful long time to be cut loose and I am starting to really feel anxious about getting urgent help if I ever needed it,and the way things are going at Hebden Bridge practice.

When one does go in, the waiting room seems empty, what are they actually doing in there? The hearing aid clinic is finished, and now they will no longer syringe ears. It means waiting months for a hospital visit.

I thought the idea of the various cuts and changes were to make more time for so called routine care? Now we seem to have no access to care at all except perhaps by enduring the scrum of the walk in appointments between 8.30 and 10.30. One hopes that any illness occurs at the specified times in order to get treatment.

From Jan Scott

Wednesday, 20 March 2019

In my experience, it is worth logging in to the GP website regularly. I have been able to secure several 'same day' appointments that way.  e.g. I've just looked and there are currently two available for tomorrow.

From Brenda S

Wednesday, 20 March 2019

The Reception staff are now seriously interrogating you at the Walk-in-Clinic. Is it urgent? Do you have symptoms etc? It is no longer easy to be seen. I attended last week because there appeared to be no appointments at all. 

I was directed to a NP appointment an hour later. The health issue was not appropriately treated and there appeared to be little knowledge of what to do. I am now waiting a further 3 weeks for a Doctor's appointment. I too have started to check appointment availability 3 times a day for an illusive cancellation. 

From Vivien Aspey

Friday, 29 March 2019

I note one or two people concerned at potentially incorrect diagnosis. My strategy is that if I am not satisfied with a diagnosis, ie, if it fails to take account of all my symptoms and their duration, I shall access either the Tod Walkin service or A and E, and if my suspicions are borne out I shall complain. Depending on seriousness there may also be an option of legal redress.

So far I have not had to take such action as both a locum doctor and an ANP have responded efficiently.

It's important not to leave the consultation without saying you are dissatisfied and will seek a second opinion.

It's also important to ask the name and professional background of the professional to whom you are talking. Some don't have the courtesy to introduce themselves.

From Arla R

Thursday, 28 March 2019

This thing with pharmacists at the group practice seems to be getting out of hand now: a pharmacist I have never met has changed my prescription for Voltarol gel to an Ibuprofen gel which I know from experience won't work - and has written in that the reason is it's cheaper.

Thankfully I've spotted it before I need a repeat prescription as I've found out through hard won experience that there is no way to sort prescriptions over the phone now, and no way to get to see a GP about it quickly even if it's urgent.

I live in one of the villages and don't have a car, plus waiting rooms are too stressful,so the Mytholmroyd walk in thing is not an option for me, so I don't know what I will do when I do have an emergency, as previously I've always been able to see someone on the day at HB surgery.

From Vivien Aspey

Sunday, 28 April 2019

It would appear from various comments that the processes within Hebden Bridge Group Practice are becoming more and more opaque. Given the nature of general practice, over time a growing number of patients are likely to experience problems relevant to their general health, and when you come into contact with the Practice at a time of feeling below par, the result is not a happy one.

The Practice is contracted to provide general medical services, which they can choose to do via other health professionals. But communication and continuity of care are the first casualties of working with a patchwork of part time health care professionals of different disciplines.

Two other new thoughts.

First, this is a Hebden Bridge forum so most of its users will be registered with Hebden Bridge Group Practice. Therefore very few readers will have experience of life with other Upper Valley practices. Just in case anyone reading these posts is actually registered with a GP in Todmorden or Sowerby Bridge, are things at a comparable level of crisis, whether better or worse?

The second point is related. Recently I asked the Clinical Commissioning Group which alternative practices folk registered with Hebden Bridge Group Practice are entitled to register with. The answere were a practice in Sowerby Bridge run by Virgincare, and a practice in Todmorden run by Locala.

There are other practices in both places that are part of the local "hub" (a concept which merits separate discussion in its own right) but they have to be accessed through HBGP. And they can't do hospital referrals so the only solution to our underlying dissatisfaction with Hebden Bridge Group Practice is to register with a different practice. The point I am coming to is that there is no alternative practice for new registration that runs to the traditional primary care model of GPs running a business according to the current GP contract wihin the NHS. The two alternative practices run according to a commercial business or a cooperative.

Like many people posting here I have reached a point of feeling that my care is coming so close to being unsafe that I am inclined to leave Hebden Bridge Group Practice after over 30 years' attendance in favour of finding a practice in whom I can have confidence. Complaining is not going to solve immediate problems.

So back to the beginning - has anybody out there tried another practice?

From Michael Prior

Monday, 29 April 2019

Later in May I am hoping to organise a  project where on a given day at around the same time, people outside HBGP try to get a doctor's appointment and compare the results with the online service here.

Initial talks don't suggest that things are very different elsewhere but we will see.

Anyone willing to take part, it will only take a few minutes and a short email, can email me directly.

From J Moore

Monday, 29 April 2019

 In the last 6 months the inhouse pharmacist, someone I have never met or had a conversation with, has cancelled a prescription from my G.P., cancelled the pain relief which I have found effective and changed  Voltarol gel for one which does not have the active ingredient diclofenic.  

I was curious as to why a pharmacist would not know an item did not have the key ingredient.  I looked on the practise website, no mention of an inhouse pharmacist.  I went into the Hebden Bridge practise to ask to speak to the practise manager, Tony Martin, he wasn't in.  I asked to speak to his assistant Christine Banford, at 8.10am on a Monday she was in a meeting and unable to see me.  

The receptionist gave me a form to complete to complain about the situation with my medicine and I will be doing that, however I have now discovered that there isn't just one inhouse pharmacist, there are several, a group of them who work in this group practise in the afternoon and work somewhere else in the mornings.  

Who is employing these nameless individuals?  Is it the NHS? sAre they infact not pharmacists but bureaucrats?  Are they going down lists looking for cheaper medications to replace the ones specified by GP's?  They apparently have the authority to over rule doctors, doctors who have a duty of care to their patient, someone they have promised to do no harm to.  But this is doing harm.  Cancelling prescriptions, altering medications for ones that do not work causes harm.

From J Moore

Wednesday, 1 May 2019

I have just left the chemist situated in Luddenden Foot Surgery.  The locum pharmacist working there today has explained to me that doctors now have to closely follow guidelines when prescribing medicine.  If a medicine can be bought over the counter, patients are now expected to buy it, such items are no longer available on prescription.  I asked if a G.P. prescribes something that cannot be bought over the counter, can I expect that I will be allowed it on prescription. She replied not necessarily.  I am over 60 years and therefore allowed prescriptions free of charge. I'm guessing that I am part of the group being targeted for savings by the NHS.

The situation wasn't helped by the fact that while I was talking to the chemist, a person came in, signed the back of their prescription so they were eligible for free medicine and left with their daily dose of methodone. That is affordable by the NHS but pain relief for the elderly is not.   

From Jade I

Wednesday, 1 May 2019

Methadone is a very cheap medication and is used to support people trying to stop their heroin use. If the person is on benefits then they will receive it free. I for one am very pleased if this prevents people using drugs, usually people who can't cope or who have experienced adverse life events. Are your painkillers opiate based, because if they are then you too in theory could get addicted, like some people I know.

From Vivien Aspey

Thursday, 2 May 2019

Replying to J Moore, pharmacists would be employed by the practice or, if this is part of a project by the Clinical commissioning Group, possibly by the CCG. Either way the practice is responsible for prescribing to its patients and if you are not being prescribed medications with resulting damage to your health I would suggest you complain in writing to the Practice Manager with a copy to the Clinical Commissioning Group.

Update: Update on my last post- having googled the general question of what NHS England is doing about primary care, I learned that pharmacists are being placed in practices to assist with all matters pharmaceutical most of all prescribing. It has long been the case that pharmacist know a great deal more about drugs and their interactions than doctors.

Admittedly there is a money saving angle to this, but a cheaper drug is not necessarily an inferior one. So- GPs themselves have no choice about this, and a better informed prescribing decision has to be in the long term interest of patients.

It also sheds an interesting light on primary care where GPs are not necessarily masters of their own destiny. Thank God.

From J. Moore

Tuesday, 7 May 2019

I have just received a letter from the Practice Manager, Tony Martin with information for anyone who does not have to pay for prescriptions.  

Any item which a doctor would like a patient to use, if that item can be bought over the counter it is no longer possible for it to be prescribed, a patient has to buy it for themselves.  This would include Voltarol gel, the item the 'inhouse pharmcists' first started substituting with an anti-inflammitory gel.

The letter says, "Although I understand that some patients may not find it easy to pay for over the counter medicines that they have previously had on prescription, this presents a significant overall cost to the NHS.
In view of this, Calderdale Clinical Commissioning Group, in common with many others across the country have established this policy."

Mr Martin further advices that if anyone does not like this choice that has been made, they should write to:-

The Parliamentary and Health Services Ombudsman
Millbank Tower,
Millbank,
London
SW1P 4AQ
or telephone 0345 0154033
or email phso.enquiries@ombudsman.org.uk

If this situation does not affect you, please would you consider writing or telephoning anyway, on behalf of so many people who do not have money to pay for their medicine. Thank you.

From Arla R

Tuesday, 7 May 2019

Regarding having to pay fortreatments availableover the counter, it's worth reading this.

And especially the bit that says "Are there any exceptions?"

Quote:

Exceptions may be made where a clinician believes it is clinically appropriate to prescribe an over-the-counter treatment.

Specific examples of exceptions to this guidance include:

  • Patients prescribed an over the counter treatment for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease).
  • For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines).
  • For those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms for example indigestion with very bad pain.)
  • Treatment for patients with complex needs(e.g. immunosuppressed patients).
  • Patients on prescription-only treatments.

Patients prescribed over-the-counter products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.

Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an over-the-counter product.
Individual patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care.

End Quote

So it would seem that most people on long term free prescriptions for chronic or complex conditions should be OK?

I guess I'll see - I order my next prescription on 20th May. 

From Vivien Aspey

Tuesday, 7 May 2019

J Moore - oh dear. I'm not surprised that this change whereby Over the Counter Medecines can't be prescribed has been introduced.Obviously its purpose is to save money and next to staffing costs, prescribing costs are the biggest cost element in general practice. The only thing I would advise you to watch out for is that over the counter medications are not always available in the same strengths or quantities as on prescription. Pain relieving gels for example come in different percentage strengths of the pain relieving ingredient, and tablets like paracetemol are not available over the counter in large quantities.

But when all that is said, some of those who do not pay for prescriptions are exempt because they are in receipt of certain benefits. So it would be very unfair if the practice is discriminating against those least able to pay. My understanding would be that the new policy applies to everybody including those who pay for their prescriptions, because actually in many instances current prescription charges go nowhere near meeting the actual cost of medication and its being dispensed. That of course is not the responsibility of patients who have never been consulted as members of the public on different ways of funding healthcare.  But it's a fact.

I would add that a niggardly approach to prescribing is not confined to primary care. Have you noticed how nowadays when you go into hospital you are requested to bring with you any medication you are taking? Naturally this makes sense from a patient welfare point of view by ensuring continuity between home and hospital. But a major reason behind it is to reduce the prescribing cost in hospitals.

Then there is the quantity of hospital prescribed medication you are sent home with- that is the subject of specific agreement between general practice and hospital doctors.

It would be possible to petition parliament to ensure that all medication recommended by GPs is prescribed regardless of whether it is available to buy over the counter, if enough people supported the idea. But factually the NHS is cash limited- what is spent on drugs isn't available for anything else, unless practices or trusts plan to overspend which NHS England won't accept. It's especially tough when choices are not explained to patients and when today's sharp practice becomes tomorrow's policy. I sometimes think it would all be less controversial if trusts and practtces were democratically accountable as are Council services. Democratic accountability might not increase resource availability but it might improve transparency.

From Jenny Shepherd

Wednesday, 8 May 2019

Please consider signing open letter asking GPs not to sign the new Primary Care Network contract. 

Calderdale and Kirklees 999 Call for the NHS are sending GP practices an urgent letter asking them not to enter the new Primary Care Network contract. 

If you agree with this, please sign the letter by midnight today, Weds 8th May, by clicking on this link, reading the letter and adding your name and postcode in the comment box at the bottom of the webpage.

A lot of the problems with Hebden Bridge GP Practice that people are reporting on this thread are caused by the Government’s NHS policies and programmes. These are carried out by the quango NHS England and its local minion, Calderdale Clinical Commissioning Group, which now works in “partnership” with Calderdale Council through the new Calderdale Integrated Commissioning Executive.

These players’ latest wheeze is the redisorganisation of the NHS in Calderdale into 5 large scale Primary Care  Networks in order to cut costs by "managing demand" for NHS services. (Although the official spin aims to hide the cost-cutting agenda by announcing "an end to the dependency model of care", "empowering patients to self care", "wrapping NHS and social care services round the patient" and "improving population health".)

Now NHS England and the BMA are cementing this redisorganisation by rushing out a new Primary Care Network contract, with a deadline for GP practices to sign up by 15th May. Without any chance for GPs to vote on this, via their membership of the BMA.

A Primary Care Network is a huge agglomeration of GP practices, mental health, community health, acute, social care, voluntary sector and outpatients’ services, each serving 30k-70K patients. Primary Care Networks are supposed to provide out-of-hospital services that make up for our hospitals’ cuts, downgrades and centralisation of services. 

But there’s no real evidence that they are an effective alternative and a lot of evidence that they will restrict patients' access to healthcare, because treatment decisions will become dependent on financial considerations, not clinical need. Regardless, the Primary Care Networks have been snuck in with NO public consultation. 

I will be leafletting about this at Hebden Bridge market this Thursday and delivering the letter with all signatures to Hebden Bridge Group Practice on Friday at around 3pm. If anyone would like to join me at either or both events, you are welcome!

If you’d like to keep up to date with Calderdale and Kirklees 999 Call for the NHS campaign actions, you can follow the Calderdale and Kirklees 999 Call for the NHS blog and receive emails when it is updated with new info.

From Vivien Aspey

Friday, 10 May 2019

Jenny Shepherd- you didn't give us much time to sign so I guess there won't be so many Hebden Bridge signatures.
Any plan to get practices to work more closely together has my vote. They have lived in their own glass bubbles for far too long in my book, with carte blanche to do almost as they please privided they meet the terms and conditions of service in the GP Contract. We were getting to the stage where provided they met their terms of service they could just about hold a cattle auction in the middle of Grange Dene and nobody would turn a hair.

No way do I agree that all our local Practice's problems emanate from Government policy on the NHS though I am no fan of this Government and have no illusions about their plans to drive the NHS into the ground. For example, the Hebden Bridge Group Practice does not consult patients on any decision affecting patient care, other than by ticking the PPG box and blaming them for policies people don't like, eg car parking policy at Grange Dene. OK that was ages ago but their accountability to patients has not improved since. 

Blaming the Government is a GP enshrined ploy of many years standing. It is well illustrated in the current display on the screens in front of patient waiting areas about the GP "state of emergency". This is propaganda promulgated by the BMA which is actually a doctors' trade union and is dominated by GPs. The same display is on show in other practices.

Of course there is a GP recruitment problem, but the figures quoted for how much practices get per patient are a gross oversimplification. They state only an average rate of remuneration per registered patient, which itself is oversimplified because they get more for some patients than others depending on age and health issues, but they say nothing about the fact that they get reimbursed additionally for rent and rates paid on premises, a high percentage of the salaries of practice based employees ...and so on.

Finally, because I could go on much longer about Practice exploitation of patients' naivety, there is the completely unmentioned fact that failure to recruit GPs is down in part to an understandable reluctance by young doctors to tie themselves into a legally binding partnership with a bunch of people who have been in the game for a lot longer than new doctors have been. The partnership model is an outmoded throwback to generations of tradition whereby GPs were once drawn from the ranks of those who had enough money to invest in property to house the practice. There have been radical shifts in social attitudes and personal finance resulting in a crumbling of the old social class sytem, and General Practice has not kept pace. 

So, apart from eroding this kind of foundation, national policy on primary care has my support if it empowers health care professionals other than doctors, and equips people to take more responsibility for their own health care. By equipping people, I mean educating and informing, while giving access to relevant and appropriate professional advice. It does of course mean dwindling patient naivety that is based on not being given a full picture but that would be all to the good. Time will tell.

From Arla R

Thursday, 16 May 2019

I saw my doctor yesterday and asked her about continuing to get the Voltarol gel on free prescription, and she said she's fine with that. It seems you need to tell your GP if you're on benefits or low waged, and at their discretion they can still prescribe things for you that you can get over the counter at the pharmacy, if you have a medical need for them.

See also

HebWeb News: NHS campaign group urges GPs to refuse contract that cuts patients' access 8 May 2019

HebWeb Forum: Hebden Bridge Group Practice - messages from August to December 2018

HebWeb News: Hebden Bridge Group Practice changes appointments system (25 Aug)