Woolpit Health Centre near Bury St Edmunds has faced increased workload, new technology, stress and a balancing act
It was March 2020. January’s rumours of a deadly new virus in China had become a European reality, with Covid-19 cases sweeping the continent.
In a matter of days life as we knew it ground to a halt and almost overnight GP surgeries across the country stopped seeing the majority of cases face-to-face.
The situation at Woolpit Health Centre, near Bury St Edmunds, was no different, after the Government and chief medical officer pushed for appointments to move to ‘telephone first’ for safety reasons in an attempt to control the spread of the virus and prevent bringing patients into health centre waiting rooms, potentially spreading disease.
In addition to the swift and dramatic change to the operating model, Woolpit Health Centre senior partner Dr Richard West MBE said the start of the pandemic was also a very uncertain time from a workforce point of view, as nobody knew how many staff might be affected by the virus.
“As well as everything moving to telephone first for our patients, we were planning for staff to be off sick with the disease and working out how to manage the workload as a result,” he said.
As a result, the practice moved to one patient list and whoever was available worked through the list.
“We never stopped seeing people face to face, but we would telephone them first and if we didn’t need to see them, we didn’t,” he said.
Two years on, the practice has moved back to a mixture of face-to-face and telephone appointments, although clinicians handle more telephone appointments now than before the pandemic.
“We have a mixture of booked appointments and on the day,” said Dr West.
“We are still doing all our on-the-day work as telephone first, but that is to do with volume rather than anything else – we can’t get through the workload any other way.”
He said that week’s typical Monday ‘on-the-day’ list included 125 people who phoned up on the day wanting an appointment.
“We spoke to them all on Monday morning and converted 30 to face-to-face appointments.
“We have booked appointments on top of that,” said Dr West, who joined Woolpit Health Centre in 1997.
One of the new services introduced at Woolpit during the pandemic was e-consult, which allows the practice to offer online consultations, with patients submitting their symptoms or requests electronically.
Dr West said: “We are trying to offer a mixture of ways people can communicate with us, but they all take time – an e-consult can take as long as a phone call or face-to-face appointment.
“Some people find it really useful and helpful and it is easier for them to fit in. Some people find it frustrating and don’t want to use it.
“As things go forward we will have more routine face-to-face bookable appointments to get the balance right and to try to deal with the workload.
“However a quick query can be dealt with over the phone – looking at the numbers, we just wouldn’t be able to do it all face-to-face.”
More than 15,000 patients are currently registered at Woolpit Health Centre – nearly 2,000 more than 10 years ago – a number Dr West expects to increase further as a result of house building in Woolpit, Elmswell and surrounding villages.
With the centre’s GPs alone carrying out 73,656 consultations – not including 40,000 covid vaccination appointments – during 2021, Dr West is already thinking about how the surgery could cope with an increased workload in the future.
“We will carry on with digital and telephone and face-to-face appointments. We will carry on trying to utilise the system so it works for the most people in the most efficient way,” he said.
“Somehow we need to work out the most efficient way to work with the resource we have got to see the most people as quickly as possible.
“We will need to develop in order to deal with increased demand and some development of new staff will give some extra capacity. We will also have to look at remodelling the building again.
“All of that takes time and effort and resource and sometimes my time is spent dealing with these issues rather than dealing with face-to-face patients.”
In 2012, Woolpit’s GPs carried out 25,188 appointments.
Ten years on the workload is significantly higher – for a few reasons, according to Dr West.
“The pandemic hasn’t really helped workload in that people are waiting longer for things such as surgery and they need managing in that waiting period, where before they would have had it done.
“We have to accept that is what happened in the pandemic.
“Partly, the increased workload is due to the increasing amount of follow-up work for chronic disease.”
For example, the practice had 200 diabetic patients 20 years ago and now has 1,100, due to patients getting older and some conditions becoming easier to diagnose.
“We have got more patients with chronic conditions and they all need monitoring,” said Dr West.
“Meanwhile, the easy access of video and telephone consultations is a double-edged sword.
“It is a good thing, but often it means people will ring us rather than do something else. I have had people ring from airports and from abroad. Before, they would have gone to a local pharmacy or decided to wait until they came home. Now, because it is easier, people’s threshold for ringing the surgery has fallen.”
Dr West said some people found telephone appointments more convenient, therefore a ‘barrier’ to making a face-to-face appointment at the surgery had been removed.
“However, the temptation is to ring for things you might not have done in the past,” he said.
“Some things, people could sort out themselves or talk to a pharmacist. Some of it would have disappeared if you had waited two or three days.
“In the old days, when making and appointment, you might have had to wait a little while for it and some things would have disappeared as we all get aches and pains and colds and a lot of them do go.”
But Dr West stressed the importance of striking a balance.
“We want to to see the serious conditions early but it would be nice if some of the less serious stuff people could self-manage.
“We carried out 73,000 GP appointments last year. We have got 15,000 patients. That’s one appointment every eight/nine weeks for each of them. And that’s on top of nursing appointments and everything else we do here.
“The question is: How do we appropriately allow people to manage things they could manage and what needs intervention?
“The question is: Are we expecting things to happen more quickly (with healthcare) just as things in other parts of life are quicker in these modern times – but the reality is biology hasn’t changed?”
In addition to increased patient and appointment numbers, Dr West said the amount of paperwork within the system was also increasing.
“My day isn’t just about seeing patients but it is about dealing with requests from hospital etc. That all happens in the background without people seeing,” he said.
Just before the pandemic started Woolpit Health Centre started to develop primary care networks. There was ‘a bit of a hiatus’ during the pandemic, but the centre is now working with Botesdale and Stanton surgeries to employ other staff including paramedics, pharmacists, physiotherapists and mental health nurses.
“We now have a variety of other individuals as well as traditional GPs and nurses.
“The idea is that if I have a patient with a musculoskeletal problem they can go directly to the physio and it could speed up their treatment. They then get a faster service and it increases capacity,” said Dr West.
“There is quite a trend towards that way of working.
“A lot of the older generation think they have to see the doctor before seeing anyone else, but actually they don’t. These other staff know a lot about their particular areas.”
Meanwhile, Dr West said the pandemic had taken a toll on practice staff, with many left feeling ‘tired’.
“We have come out of the pandemic, which was very stressful. We then get to a period where society and the politicians decided the pandemic had stopped, although there is still quite a lot of infectious disease around and still covid around.
“At the same time we have got a system that has now that has said ‘now it’s stopped we need to sort out all the work that didn’t take place during it’.
“There is a thought we can now just ramp up and deal with the work that was postponed. Therefore we haven’t had that period of being able to take a breath and regroup before starting all over again.
“I’m not sure the system understands that the workforce hasn’t had a break and they weren’t waiting for more work, so that has been quite difficult,” said Dr West.
He said the primary care network changes which were introduced just before the pandemic started were still being implemented
“We have had lots of change at a time our people are tired and have had quite a lot of prolonged stress. It is difficult for them,” said Dr West.
“Most of our staff have been working through the period and have actually worked harder than they did before, so their experience of the pandemic is very different to other people’s.”
Dr West described patients’ as a ‘mixed group’ regarding their reaction to pandemic-related changes and new technology.
“The vast majority have managed the change very well and been helpful and supportive.There’s been a group that has been confused by it all who have struggled with technology, with even using the telephone difficult for some people.
“Part of that’s is due to hearing or sight problems, while change can also be very difficult or challenging,” said Dr West.
“Some people can get quite cross because they don’t understand. They take time to explain to and find a way that works for them and us.
“Sometimes tempers get a little bit frayed due to misunderstandings and sometimes the reception staff take a bit of flack. We do our best to try to manage everyone fairly and equitably as we want to get maximum benefit for maximum people as we don’t have a limitless resource.
“Our care navigators (receptionists) are trying to be helpful. They are not being nosy but trying to get enough information to get patients seen appropriately.”
However, as a training practice, Woolpit had a commitment to training future generations, which also placed a demand on resource, time and effort.
“But it is really important for the future of the system that we continue to do so and it is important for the county that we train doctors here in Suffolk, as people who train here tend to stay here,” he added.
