Appointment times

Up until now the Strachur Practice has had open surgeries. That is, the surgery times were 9 till 10.30 and 5 till 6, and anyone turning up between these hours could wait be seen in the order that they arrived.

Open surgeries are the traditional form of General Practice, and have the advantages of simplicity and ease of access. Basically, you turn up and you'll get seen...eventually. That's the disadvantage - you may need to wait a long time to be seen. Waits of over two (or even three) hours is not uncommon on busy days.

But, after eight years working in small remote practices, I'm acutely aware that the great fear of patients is that an appointment system will mean having to wait days or even weeks to see the doctor - a great problem for larger surgeries in cities and towns*.

Thankfully, there is another way to run small surgery appointment systems which combines the best of both worlds. I've set up four such systems in the past for Highland Health Board in remote practices similar to Strachur and they all worked very well.

The idea is that you phone the practice first to be told our best guess as to when you will be seen. This avoids the long waits and uncertainty, lets people plan their day better, and is great for people who have to get friends or family to bring them to the surgery.

Photo: The kind of queue we want to avoid

Of course, the appointment times are only estimates - medicine is complex, and sometimes we need to spend longer than average with patients, or there may be an emergency that can't wait, but the important thing is that you won't be turned away. If you need to be seen that day, then you will.

So, from now on call us before you leave to come down and we'll tell you what time to come down. If you want to arrange a time for later on (up to several weeks in advance) then let us know and we will give you one of several 'available in advance' appointment slots. If you prefer, come to the surgery as before, and we can tell you roughly when you will be seen, so you can go and do your shopping, or whatever else takes your fancy, in the meantime.

Of course, if you prefer the old system, you can still turn up and wait in the waiting room and catch up on the local gossip.

*In fact the larger city and town practices are getting much better at seeing patients sooner (not least because they now get paid a bonus for doing so in the new contract).

New Centrifuge arrives

Our new centrifuge arrived this week.

We had to pay for it ourselves (the Health Board does not fund them) and it cost us around £800, but it means that for the first time the practice will be able to do kidney function blood tests.

Kidney function blood tests (U+Es) are essential. They let you check on the salts in the blood that can be affected by medications such as water tablets (diuretics such as furosemide or bendrofluazide), blood pressure tablets (such as lisinopril). In extreme cases, if not monitored properly over months or years, changes to the potassium salt in the blood from some medications can lead to heart problems. This can include, rarely, sudden death.

Without a centrifuge to prepare the blood sample before it is sent to the lab, the sample spoils and the result is useless.

Now with the new centrifuge, we can get accurate blood test results no matter when the sample is taken. This will avoid the risks of salt imbalances in patients taking such medications.

If you are on blood pressure tablets and would like to check if you need a U+E blood test, please call the surgery to discuss your medication.

I take it all back

The manager from the Health Board Estates department came up to see us and could not have been more helpful this time.

The Health Board have authorised us to get in John Brown of Strone to do most of the work, and the Health Board will organise the rest.

So over the next few weeks we will be getting:

  • the treatment room door (rotten) replaced

  • dispensary shelving to store drugs

  • new shelving for our notes (which were scattered all over the place)

  • broken door locks replaced

  • the sinks that didn't work fixed

  • the toilet fixed

  • the rusty railings repainted

  • the rusty/damaged gates repaired and repainted

  • the gate posts repainted

  • the grounds repaired

  • the parking spaces repainted, including adding a second disabled/parent and baby space at the front

  • the rooms repainted

Of course, this will mean some disruption as we get around 16 years worth of maintenance work done in the space of a few weeks, but it will be well worth it in the end.

Health Board estates department not meeting its responsibilities?

One of the things that struck me most when I looked at the Strachur Practice before coming here was the poor state of repair of the health center building and grounds. The Health Center, Doctor's House, and grounds are all owned by the Health Board and the practice rents the building from them.

As has been mentioned in a previous post, the layout and design of the practice is poor. But much more worrying was the fact that there was no running water in the treatment room, and that the treatment room's external door was rotten the whole way through. Not only can you see daylight through the holes, with water pooling on the treatment room floor whenever it rains, but clearly it is not possible to maintain a clean clinical environment. It turns out that this was an internal door which was fitted externally, and that this problem had been ongoing for at least two years.

This breaks so many laws it's hard to know where to start - Health and Safety, Infection Control, and of course the legal responsibility on landlords to provide an watertight building.

Anyway, when we did our walk-round with the Health Board on the 14th of April, I pointed these out to the Estates Manager, Steve Bernard, who is responsible for the Health Center. I was assured that these issues would be dealt with by the 23rd of April. However, the Health Board's contractors failed to turn up on the 23rd as promised. Nor did they turn up on the 26th as was then promised. Phone calls to these contractors produced a series of 'no-one at home' type calls and unanswered messages. So, we have told the Health Board that we are engaging our own contractors to put these serious issues right, and that we will then bill the Health Board for the work.

Of course, these are just the most serious problems. We also have:
  • outside 'security' lighting that doesn't work - I nearly fell and broke my neck leaving the practice after dark one night
  • walls that are pockmarked and dirty - for a new tenant, the Health Board really should have repainted the premises, and I think that the current state of the practice is depressing and unprofessional
  • gates, fences, walls and grounds that are unkempt, rusty and dilapidated - not only is this ugly, depressing and unprofessional, there are rusty sharp pieces of wire sticking out which could cause injury.

So, we are insisting that the Health Board tackle these issues rapidly too and will be giving them a deadline of two weeks after which we will commission our own contractors.

Argyll and Clyde Health Board had a very poor reputation, and in my experience and opinion (and, it would seem, that of the Scottish Executive), management incompetence was rife in the Health Board. Thankfully, Highland Health Board has now taken over responsibility for the area. Highland Health Board, as with any public body, has its problems, but is in my opinion one of the more competent Health Boards in Scotland. Certainly, the standard of the Health Center buildings in Highland area is very high.

So, hopefully, as Highland Health Board reforms the health services in the Argyll area, the standard of our buildings should improve to a more acceptable level.