Work continues on health centre improvement plan

Plans to reduce waiting times and improve the appointment booking system at the Lerwick Health Centre are to be revealed to the board of NHS Shetland in February.

Ways of improving the situation are being worked on, head of community care Simon Bokor-Ingram and primary healthcare service manager manager Lisa Watt indicated at a board meeting today.

The news follows the results of a survey of Lerwick Health Centre users carried out in the autumn by chairman of Shetland Public Partnership Forum Harold Massie with the help of a sub-group, which he presented to the board.

A total of 908 patients, about a tenth of the number registered at the practice, responded to his questionnaire. Deep feelings of frustration about long waiting times to see a specific GP and lengthy waits at the walk-in clinic, set up to enable people to be seen the same day, were revealed.

Of the 908 respondents, 53 per cent had waited two weeks of more for a booked appointment, 682 had used the walk-in clinic, with 80 per cent of that number waiting between one and three hours. A total of 73 per cent of people were unhappy with this, and 78 per cent were unhappy with the overall system.

Mr Massie said that when people made appointments they wanted to see a named doctor. “The concept of ‘my own GP’ came through very strongly,” he said.

Patients used the walk-in clinic because it took so long to get an appointment, but, he said: “One to three hours is a long time to sit. A number [of patients] left without being seen, the satisfaction was very low. People prefer to book rather than sit and wait.” Any more than one hour was “tedious”, he said, and pointed out that people with some medical conditions found it difficult to sit for any length of time.

In order to be seen early, people sometimes queue outside – 40 per cent of survey respondents who had used the clinic had done this.

Mr Massie said: “It has a third world feel about it.” And, he added: “On a morning like this [cold and windy with hail showers] it’s not funny.”

Mr Massie told board members: “There was great dissatisfaction with the appointment system, up to three weeks is not acceptable. People need quicker access to their GP, they also need continuity of care.” However this was problematical because many of the GPs are part-time and the service often employs locum doctors.

He described the walk-in clinic as a “difficult experience”, particularly if people are working, and questioned whether Saturday or evening access could be considered, together with “customer care”, with a doctor in overall charge of the service.

Mr Massie also pointed out that very few people had made use of the nurse practitioner, who is able to prescribe, and said there should be more publicity and understanding of this role, which worked well in islands where there was no doctor.

Chairman of the board Ian Kinniburgh said the issue of Lerwick Health Centre had bedevilled NHS Shetland for 10 years. Mr Bokor-Ingram said various strategies had been tried in this time, including a telephone triage system, which proved unpopular and was disbanded.

Council members of the board Malcolm Bell and Cecil Smith said that the issue of the health centre was the one which filled their in-boxes, but, said Mr Bell, to compare Lerwick to other health centres was to compare “night and day”.

NHS Shetland medical director Roger Diggle said Lerwick had around 1,500 patients per doctor, whereas the average was 1,200. Some rural practices had fewer patients per doctor. He said that Lerwick needs to “get the balance better with people booking appointments and being able to be seen on the day, and get the walk-in clinic to work.” The situation could be improved when a new consultant obstetrician is appointed, he said, taking that burden off Lerwick GPs.

Ms Watt said that boundaries of health centres are being looked at, as some country practices want to expand. Although some could potentially take patients from Lerwick, this could be offset by people moving into town because of the changes in schools and ferries.

Director of public health Sarah Taylor said patients are registered with the health centre, not a named doctor, but a relationship with a “small team” could be a possibility.

Board members thanked Mr Massie for the huge amount of work he had undertaken in the survey.