Shere Surgery & Dispensary 

By the time you read this the flu vaccination clinics will be in full swing. If you are not signed up for the SALV email cascade, please let us know so we can get you added. This (& twitter @ShereSurgery) is our quickest way to update you when things move swiftly.  Emails are only sent out when there is something new to report that needs to be swiftly received.

Covid boosters: We will hopefully be vaccinating against Covid on site for the first time, having requested on site access to covid vaccination from the outset...  if you have a flu vaccination appointment already booked then please keep it and we will book an extra appointment for the Covid vaccination. We are anticipating that from October we will be making combined vaccine appointments, and updates will be delivered via SALV cascade and twitter, together with a poster in the surgery window.

National Drug Shortages: We have ongoing problems with national stock shortages of different drugs. We have had to change doses for loads of our statin patients as drugs have not been available. This is consuming a huge amount of time for both dispensary and clinical teams as the problems are affecting hundreds of patients, so we apologise if it is taking a while to update you on your prescription. Sometimes we only find out that a medication has become unavailable when it doesn't arrive in the order, so this creates a delay.  For further info on the background to drug shortages read the May newsletter on the website.

Blood Test Forms: The increase in outpatient appointments being offered remotely is causing a knock-on problem for us if the specialist forgets to send out the paper blood test request form in the post after the appointment. We have hoped for some time that the hospital would put requests on the online system we all share as that would solve the problem, but this is still not happening. We have had to insist in the past 6 months that any specialist blood tests that are booked need to be accompanied by the blood test form. Patients are caught in the middle, and we have sympathy for this, hence the explanation. If a specialist requests tests it remains within their responsibility to order, review and act upon them. We can take the blood locally for convenience, but we don't have the time to help the hospital with their admin and we have found that this is reducing the time we have to spend time with our patients, which is the part of our job that gives us satisfaction.  We hope you understand. I would be more than happy to support anyone who would like to write to the hospital to question why their doctors aren't allowed access to the online blood test requesting system we have all shared for some years.

Missed Appointments: The audit into missed nurse appointments is ongoing.  As of 31st July, 89 hours of nurse appointments have been wasted so far this year. For clarity, this refers to appointments where the patient failed to turn up and does not include patients who had to cancel.  In 2019 we moved to AskmyGP for access to doctors. Whilst there is no system that suits everyone, it has been hugely successful in reducing the hours wasted by those who do not attend.

Personal Note: I'd like to thank Dr Douglas Wardrop for nominating me for Fellowship of the Royal College of GPs, which I have been awarded. I think this reflects us continuing to uphold the professional standards that Dr Tyrrell held dearly, and I see it as a positive reflection on the whole team. I'm confident that there will be more of these announcements in the coming years. For those of you who follow my silly kayaking exploits, I am just back from the World Canoe Marathon Championships in Denmark where I represented GB in the Masters category. My crewboat partner and I came 4th after a hard catch-up slog of a race having been involved in a collision near the start that sank a USA boat...!

Dr Emma W

Thank you to everyone who contributed to the National GP Survey. We were delighted to come 4th in Surrey (we are sort of claiming a 3rd as the practices in position 2 and 3 are one practice...!). We know that there have been many difficulties in the past few years, so the fact that we still seem to be able to help you despite this is hugely reassuring. 

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We are delighted to welcome Sadia Rashid to the team. Sadia is a Physician's Associate. This is a graduate role in general medical education, and they are trained to work under the supervision of a doctor. We have not had a Physician's Associate before, and we hope you will offer Sadia a warm welcome.

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Dr Douglas Wardrop is currently on sabbatical, taking a month out to spend some time travelling with his family. We are all a bit jealous (!) but wish him an amazing time. He will be back before you know it, and all of his patients have been handed over to ensure seamless care.

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Sadly, Annie Watts (our midwife) will be retiring at the end of September. Annie has been part of the team for years and we will miss her. Royal Surrey have made the decision not to replace her and so from the 1st October all of our pregnant patients will be seen at the Cranleigh Maternity Hub. We are hugely disappointed by this. All current pregnant patients will receive a separate letter.

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Back on the subject of drug shortages, the big problem this month is atorvastatin. This is a really well tolerated statin that we use a lot to reduce cholesterol. There is no national stock of 20mg, 40mg or 80mg and scant stock of 10mg. We have secured stock of 30mg and 60mg so will have to change doses for a little while until the problem resolves. Affected patients will get a text and a note in their prescription. We would like to talk to you all individually, but the magnitude of the drug shortage crisis means we simply don't have time to have a one-to-one interaction with everyone. We really hope you understand. Please share this message with anyone who isn't on the mailing list. I have put a message on twitter @ShereSurgery also.

Finally, I was pleased to have the opportunity to highlight some of the current problems facing rural GPs on both BBC Farming Today and BBC You & Yours on 2nd August. I hope those who heard it felt that I represented the practice, and rural GPs, adequately.

Dr Emma Watts

Staffing: I am delighted to be able to announce that our new Practice Manager has started with us. We like to think that Lorraine (Knapp) is returning home, as she worked at Shere many years ago as our fundholding manager. She has since been working as a Practice Manager at a busy surgery in Woking. Lorraine lives locally and has hit the ground running back at Shere. We are very excited to have her with us!

Flu Vaccines: Many of you will remember that last year our flu vaccine delivery was late.  This meant that many of you were worried and chose a pharmacy instead.  Unfortunately, this led to a lot of wasted vaccines, and cost associated. We wanted to reassure you that this year we put in our order over a year in advance (it is always tricky to get it right as decisions on entitlement/type of vaccine etc are sometimes sprung on us at short notice).  We have been assured delivery at the start of september, and we will advertise availability as soon as the delivery date is confirmed. If possible, we would like to encourage you to get your vaccination from us so that we don't have to throw any away. However, the priority is getting patients vaccinated, so please choose whichever method is most convenient.  (NB We are still failing to meet our childhood immunisation targets, so any suggestions on challenging anti-vaccination beliefs would be welcomed)

Medication Shortages: An ongoing problem involving a wide range of medications, from nasal sprays for hayfever, to the ongoing HRT supply problem, and more recently diabetes drugs.  We continue to evolve our plans for these patients, finding suitable alternatives, and explaining them.  This is hugely time consuming, and we continue to push for top-down changes that would help to ease the burden for all practices.

Rural Inequity in the NHS Recovery Plan: I am delighted to report that Jeremy Hunt has accepted my invitation to meet with the CEO of the Dispensing Doctors Association and myself to look at the rural inequity built into the recovery plan, which will provide you with poorer access to healthcare than your urban counterparts. I haven't heard back from our local MP on the subject. If anyone else who wrote received a reply, I wonder if you could let me know?

SALV Evening Meeting: We are currently preparing for the autumn meeting and are hoping to be talking about how to keep your heart healthy. We really would welcome a younger audience to this, and we are hoping to have a demonstration device of a new defibrillator for home use, which is relatively inexpensive.  Whilst we hope these devices will never be needed, there are some patients that may find them extremely reassuring.  My son Felix will also be presenting (for 3 minutes only!) his project on engaging with Brenda that was presented at the rural medicine conference last month.

Have a lovely summer and keep well as we head toward autumn.

Dr Emma Watts

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Thank you to everyone who responded to the SALV email cascade where I requested help writing to the local MP about the discrimination against rural populations that is embedded within the new 'GP Recovery Plan'.  This seeks to use pharmacists to plug the gap created by having far too few GPs.  We don't have enough pharmacists either and they are under significant strain, so we aren't sure that increasing the burden on them will be that helpful or effective. Nevertheless, we are a dispensing practice because our area is too small to make a pharmacy viable. There is £640 million allocated to this new scheme.  17% of the population live in rural areas with a dispensing doctor, and they will NOT have access to these new services. We are calling for a change in the policy wording to include dispensaries in the new scheme, so that rural patients have equity of access to services, rather than being a poor second to their urban counterparts. I am hoping that Jeremy Hunt, who published the inquiry into the future of general practice and is now in a position to influence how the £640 million is spent, will accept my invitation to meet with the CEO of the Dispensing Doctors Association and myself, to try to agree a solution.

In more positive news, last month my son Felix presented his study on Brenda at the National Conference for Remote and Rural Medicine. I am delighted to tell you he spoke really well and was awarded both the student (he was the only non-medical/ school student) prize and the audience choice prize!  The audience included the Surgeon General, Tim Hodgetts, and other incredible speakers, so it really was a baptism of fire on public speaking for Felix! He is hoping to present to you at the next SALV evening meeting.

Finally, don't forget sunscreen and hydration during this hot weather, and please continue to look out for our elderly and unwell, who may struggle more with the heat.

Emma

I promised this month to try to find some more lighthearted material to cover...!

The sun is shining, and I am happy to report that Dr Amy Baker has just started maternity leave, nervously awaiting the arrival of her first baby.  Dr Amy Baker (not to be confused with Dr Amy Bissell- who we have recently happily welcomed back from maternity leave!) has not been with us that long, but she has fitted in really well to our team. We wish her and her husband well over the coming weeks and months.

We were delighted to see a strong turnout at the recent SALV evening meeting where the lovely Dr Jonathan Slater presented on skin conditions. There were lots of really pertinent and thoughtful questions, demonstrating that you were all listening!  If you haven't been to a SALV evening meeting before, they are really worth attending and are a great chance to give us feedback, both good and bad!

Thank you to everyone who responded overwhelmingly positively to my call for Firearms Licence details back in April. Thanks to those who pointed out the differences with Shotgun Licensing which we had no idea about, and really just highlighted how the system (and GP involvement within it) needs to be tightened up.

Finally, this month we are representing the practice at a few conferences nationally. Dr Barnes will be speaking to GPs about best practice in Women's Health (a subject for which she has an excellent reputation), Charlotte Wells (Dispensary Technician) and I will be speaking about 'Embracing Innovation', helping other Dispensing Doctors find a way forward in challenging times. Finally, my 17-year-old son Felix (who has decided Medical School seems a good idea) submitted his project on Brenda, focused on understanding barriers to embracing technology in rural populations. This has been accepted for presentation at the National Conference on Remote and Rural Medicine.  This will be the first time either Charlotte or Felix have spoken publicly to large groups of doctors, so please wish them luck!  Felix has promised to present the project at the next SALV evening meeting if you'd like to hear about his findings, and thanks everyone who answered his questionnaire.

I hope this delivered the positivity I promised last month (!) and that the sun keeps shining so we can enjoy our beautiful surroundings.

Emma

I thought I would try this month to explain some of the reasons why we are having problems within Dispensary, and why pharmacies are closing at an alarming rate nationally. 

A few years ago (before the pandemic) we started having problems accessing some medications. We are a small purchaser with less buying power than some of the big chains, but nevertheless there seemed to be an increase in restricted lines.  We believed these pressures were down to Brexit and uncertainty within the market. Before this settled down the pandemic happened. China shut down ports and other countries that export base products for medications were obviously restricted. Some companies switched to producing more medication for pandemic specific purposes, and obviously production was affected by ill health in factory workers and base product availability. This led to severe shortages of some medications within the UK. At one point we were importing Paracetamol from India as it was cheaper/more accessible than buying in the UK.

Tensions rose at this point as some really important medications were not available/only available in small supply/only available in some brands, and our patients started getting worried about whether their medication would be available or not.  The long-term availability issue with HRT was a particularly troubling time for us as we use HRT a lot, and a lack of availability really had a significant impact on our patients.  We completely understood the worry (we shared it) but it was hard trying to explain the problem.  We have had to reassure patients who find their normal drug has a sticker label over the original box, as it has been imported from a different country, and the original label may been in Greek!  Aside from the combination of Brexit, and pandemic stock supplies, we have since seen a significant increase in sicker people in the community.  This is due to the backlog for operations and outpatient clinics at the hospital caused by Covid delays (where the hospital was consumed by treating Covid).  We are managing far more complex patients at home, and needing to prescribe more and more medications (from 8,000 to 11,000 items per month roughly), and find ways to source these.

Fast forward to summer last year and a new problem started hitting us... (this is the part where you need to bear with me as I try to explain this to the best of my ability ).  The Voluntary Scheme for Branded Medicines Pricing and Access (VPAS) is an agreement with the Dept of Health and Social Care to try to provide best value on drugs to get the most effective medicines into use more quickly.  It makes sense to try to keep medicines cost effective so that more people can benefit from them.  This is a voluntary scheme that manufacturers sign up to but my understanding is that, if they don't sign up, their drug is less likely to make it onto national drug formularies.  I would describe it like a tax on profit, and last summer the statutory scheme payment percentage started rising.  From 5% this had shifted to approaching 20% by the end of 2022.

Suddenly previously profitable lines were no longer cost effective, and manufacturers started buying and selling manufacturing rights for products/product lines or stopping production altogether. In December 2022 there were 170 drugs on the concessions list (usually about 60 in December) which is a reflector of drug availability issues.  This has led to problems with finding alternatives where a drug is no longer made, substantial swings in the price of drugs, different manufacturers signing sole provider deals with different wholesalers, and huge volatility in the market.  It has even affected the services we provide.  I was really upset to have to cancel minor surgery appointments in January 2023 as the local anaesthetic was not available.

It has not been a surprise to see the large chain pharmacies closing significant proportions of their outlets, but this has huge implications for communities nationally.

From the 1st April 2023 (sadly it wasn't an April Fool) the statutory scheme payment percentage has increased to 27.5%.  We are holding our breath to see which products are affected next.  

A couple of patients told me that my attempt at summarising a complicated few years for the pharmaceutical industry had been useful.  I decided to share it more widely because understanding the roots of a problem helps us work together.  Please remember this is my interpretation of what I have watched happen.  I (& the whole team) have spoken to scores of patients to try to explain why their medication needs to be changed.  At the start of the pandemic patients were less receptive, but I would really like to thank you all for working with us to try to find solutions, and accepting that we are no longer able to provide preferred brands as we have to accept what we are able to get hold of. 

I'll try for some lighter subject matter next month! 

Dr Emma Watts

FIREARM LICENSING:  

As you will be aware, there have been a few tragic incidents relating to licensed firearms over the past few years.  Nationally, general practice has had varying involvement in firearms licensing over the past decade and as such, we currently have no reliable way of knowing who is a holder of a firearms licence. 

Due to the sensitive nature of recent incidents, there is increasing scrutiny on those who are involved in the licensing process.  As GPs, we have a responsibility to our entire community and feel the current recording and information-sharing framework is inadequate.  We feel for our police service colleagues, as they are in a similar position, and a robust system would be helpful to them also. 

We are concerned that the current process does not allow for safe identification of those who hold a firearms licence, as there is no robust method of recording this within the electronic medical record.  A national solution to this (for general practice & police service) has not been forthcoming, hence we have decided as a partnership to lead the way by trying to create a more robust and safe system to identify those who hold a firearms licence. 

For some years, GPs were not involved in providing medical information as part of the application/renewal procedure, so there is a large cohort for whom we have no firearms licensing information. Currently, we are asked to provide factual information from the medical record for those who make either a new application or a renewal. We continue to be happy to do this, but we are not consistently informed of the outcome.  This creates a further cohort for whom we have no firearms licensing information. 

In a rural area where firearms licensing is an important way of life, we absolutely want to continue to support our patients. However, as we feel frustrated that no national solution has been forthcoming, we would like to try to create a local solution that we could pilot. If successful, this could then be adopted nationally.  We appreciate this may be an emotive area, but we really are looking for support to enable proper recording of firearms licensing status. 

We are asking, in the first instance, if those who currently hold firearms licences could let us know (ideally including renewal date).  We would then be able to code this in the medical notes, which would create a more robust system.  We would also appreciate community feedback on the above, because between us we might be able to find a safer solution for firearms licensing. 

Thank you for your ongoing support. Please contact me via the surgery email if you have any additional suggestions. 

 Dr Emma Watts

I'm so sorry I didn't have time to write last month. January was a challenging month with an upsurge in all viruses and the addition of Scarlet Fever increasing demand.  We continue to struggle with winter pressures.

In positive news we have managed to recruit 2 new Dispensary Technicians! This is so exciting for us as we have struggled to recruit for a very long time. Both have been working in Community Pharmacy so, although we are different, they are settling in quickly.  Hopefully, we will now have a little more time to focus on other aspects that will make us more efficient. One of these projects is increasing the sign up to @BrendaVendor and we will be working on this soon, contacting those who offered to help by being Brenda Ambassadors!  We also want to convert as many people who are on repeat prescriptions to an automated version, so they no longer need to remember to request them. This will help you as patients, and us as the workload will be more predictable with fewer last minute requests affecting efficiency. I am so excited that we have new team members and really hopeful that this will give us a little more space to be innovative.

Our most recently adopted innovation 'Golden Tote' (a simplified wholesaling solution) is working really well in Dispensary and Charlotte Wells (Dispensary Technician) and I will be featuring in the wholesaling magazine this month talking about the success of the project in reducing processing time for qualified staff.

Finally, our wonderful nursing team are really struggling with people not attending their appointments. Unlike the GP system, you can book Nursing appointments in advance for convenience, but the 'Did Not Attend' rate is increasing. This is hugely problematic as this appointment time is wasted, and it increases the waiting list time for a nurse appointment. Appointment durations are a little different dependent on what service has been booked, but the past 4 months data follows (please note this data does NOT include appointments where the patient called to cancel, only those who were no shows on the day):

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October : 64 missed appointments (13 hours of nurse time)

November : 81 missed appointments (19 hours of nurse time)

December : 95 missed appointments (21 hours of nurse time)

January : 56 missed appointments (11 hours of nurse time)

TOTAL: 296 appointments where patients did not attend, amounting to 64 hours of wasted nurse time over 4 months.

With services stretched as they are we cannot allow our precious nurse resource to be wasted. We will be considering options around this.  If you are unable to attend your appointment, please call to cancel, even if desperately late notice as at least it gives us a chance to repurpose that valuable time.

Finally, please don't forget the SALV Spring Meeting will be coming up in April, and we are hoping to bring in a really topical speaker that will appeal to those of all ages. If you haven't been before, please do consider attending. Everyone is welcome and it is the perfect opportunity to engage with us and tell us what you like/don't like and how we can serve the community better. We hope to see you there...

Dr Emma Watts

Happy New Year. Again, at the surgery we are hoping for a more staightforward year. The end of 2022 saw a fresh outbreak of Staph A infections which caused lots of worry in the community for the health of our children.  StaphA is not a new bug, it has been around for years and can lead to different infections, like Scarlet Fever.  It tends to cause waves of infection every few years, but in the context of the recent pandemic understandably everyone is worried, especially as lockdown may have led to reduced immunity to other community infections as people were prevented from sharing germs with each other for a while! Reassuringly, most children who have StaphA infections manage them really well, and only a small minority get very sick. Hopefully, the recent surge will be past into the New Year.

Thank you for everyone who has been patient with us recently as we have struggled with staff sickness (Covid) and recruitment problems, alongside the ongoing drug supply issues.

Demand for GP services continues to outstrip capacity across the UK and we continue to put our energy into trying to ensure we have a big enough team on site every day.  We will continue to update you as things evolve, but please know that we are absolutely committed to our community, and we will continue to provide the best service we are able to. Please try to bear with us if you feel this falls short of ideal. We hugely appreciate all the positive feedback and that people can recognise the challenges General Practice is currently facing.

Wishing you a Happy and Healthy New Year, from all the team at Shere.

Dr Emma Watts

As we approach the festive season we are aware that the cost of living crisis is affecting people across the country, including here in the villages.

- The Henry Smith Fund is an independent, local charity whose function is to provide financial help to people in need who are in the parish of Shere. 

 - This encompasses Gomshall, Holmbury St Mary, Peaslake, Shere, and a large part of Abinger Hammer.

- If you think they might be able to help, please contact Mrs Kim Keeble: clerk.hsfs@gmail.com

At the surgery, we are delighted to have recruited a new Dispensary Technician, who will be starting in January. We also now have some volunteer 'Brenda Ambassadors' who will be helping those who are uncertain to use @BrendaVendor outside. The use of Brenda frees up our dispensing team to focus on dispensing medication.  (If you have signed up as an ambassador I will be in contact soon).  We have been plagued this month with delivery delays on our drugs due to a lack of drivers, and are hoping this will soon be addressed.

As part of the Green NHS initiative, we are starting to make some changes. Single use plastic eye drop pipettes were historically used for preservative free eye drops that wouldn't last in a bigger bottle. However, we now have really good preservative free products available in bigger bottles, so we have started initiating the swaps.  We will also be looking at swapping asthma inhalers to more environmentally friendly versions.  We will consult you on this as it happens, and your health remains the priority, so please don't worry, but the CO2 emissions from some products are staggering.  One standard Ventolin inhaler creates emissions equivalent to 1420 miles per year in an average family car.   When there are other equivalent brands producing less than half this, we have a moral responsibility to change. 

Finally, a thank you to Hans Christmas Andersen Trees, who have donated us a tree for the waiting room.  We hope you all have a healthy and peaceful Christmas and New Year.  Dispensary will be open as usual on both Christmas Eve and New Year's Eve.

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Dr Emma Watts

As winter approaches we expect 'flu and Covid levels to increase. Please make sure you have had your flu vaccine, or book in ASAP.  We are hoping to have a Covid Vaccine van in the car park soon, but I have no further detail on this at present. We will update via the usual methods (SALV email chain, poster in window and Twitter) as soon as we have more information.

You may remember I spoke with excitement about the Family History Cancer Screening Project we had taken on in conjunction with St George's Hospital Genetics Department.  The project is not yet complete, and I am not allowed to give you any spoilers (sadly) but I'm really proud to say that our patients are doing really well with engagement. Thank you so much. In addition, so far, we have had patients detected who are at high risk, and they are being offered an enhanced screening programme. This is part of a trial to see if it has potential to save lives and if so, we can campaign for it to be rolled out across the country. If you are aged 38-45 and you have not yet responded to your invite, please do.  It is an incredible opportunity to assess individual risk, but might also go on to shape the future of screening. If your invite has time expired, then message me via AskmyGP and I will send you a fresh link. I will share the outcomes as soon as I can.

Finally, Dispensary... I just want to thank you for bearing with us recently as the repeat prescription process has been slower than ideal. We have an efficiency plan, but we are really struggling with recruitment, still needing both a full-time qualified and a full-time non-qualified Dispensary Technician.  The team is stretched and trying its best and we ask again if you can bear with us.  The Dispensary is vital to us as we are too small a population for a chemist to be viable, so if you haven't signed up for Brenda the Vendor yet, please do, as if we can get her working to her maximum it will free up the team to crack on with dispensing. It will also save you queuing. We are hoping to find a volunteer to be a Brenda Ambassador, who can demonstrate how to use her if anyone is feeling worried about it. I am happy to take any feedback, via the contact form on the website.

Over the last couple of years there have been lots of problems with stock availability of different medications.  I remember at the start of the pandemic this feeling really difficult as our patients didn't really understand why there were problems, and didn't want to swap their medications.  We have been working really hard with our wholesalers to reduce inconvenience when possible, but over recent months our patients have really positively accepted the need for medication changes when stock is a problem, or manufacturers stop producing non profitable lines.  I'd just like to thank you for this understanding, as it makes our job so much easier. 

Dr Emma Watts

This month we are writing as a whole partnership as we want to share some of our thoughts about the terribly sad loss of Dr Graham Tyrrell. Graham was our Senior Partner for many years and was valued and treasured by both our patients and our team. Please see the full piece on Graham in the 'news' section.

We are also really sad to have experienced the loss of Terry Edwards. Terry was the Treasurer of SALV ( Shere And Local Villages charitable trust), and devoted so much time and energy to supporting us at the Surgery.  Terry was also a prominent member of our community, and we were shocked to learn of his passing.  There will be further tributes to Terry, but we wanted to express our deepest condolences to his family & let them know how much we appreciated his support, energy and enthusiasm, & how much we will miss it.

This month has been a difficult one, but it is with great pride that we congratulate Sister Alison on 40 years of service to Nursing this month. The NHS is lucky to have incredible characters like Alison. She is a hugely valued member of our team, offering an extremely high standard of nursing care, but so much more besides. So many of our patients will be able to list the occasions where Sister Alison has gone above and beyond in order to do the right thing & resolve a multitude of problems. She is a shining example of the ethos that Graham wanted for the surgery, the person who sees a problem as a whole and finds a way to fix it.  We are extremely proud to have Sister Alison as a member of our team and know that she has inspired many through her years of service. Thank you so much Alison.

With much love to you all after this difficult month, 

Drs Charlotte Knight, Emma Watts, Douglas Wardrop, Marcus McEwen & Helen Barnes

A few things to update you on this month:

• SALV Autumn Meeting 26th Oct Evening Shere Village Hall- We would like to welcome anyone who hasn't been before as this is a brilliant opportunity for us to communicate with you and find out how we can improve our services.

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• FLU VACCINES- We are expecting delivery of our vaccine supply on the week commencing 19th Sept, so flu clinics will follow shortly after. We are hoping to offer an easy digital booking system this year, which will free up phone lines for those who prefer to phone in. Further information will follow on our website, posters, Twitter & via Salv email cascade (for latter please join SALV- link on website or info at the surgery

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• NHS 'Data Saves Lives' Data Strategy- the much-delayed switch on for digital access to medical record is apparently going live on 1st November 2022. You will have access to your medial record for all new entries from that date, but not previous information.  Clearly there are benefits to holding your own digital health information, such as becoming ill when away. There is no current provision in the system to apply to those who are vulnerable, so prior to November we will manually block sharing for these patients until suitable safeguards are in place.

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• Recruitment- we are recruiting to our team and are looking for a qualified Dispensary Technician, a non-qualified Dispensary Technician (training will be provided), a part-time Bookkeeper, Receptionists & a Care Co-ordinator.  Please contact via the website.

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• Doctors- we are pleased to welcome Dr Alex McEwen to the team! She is Marcus' wife and will be helping us out for a few months to provide maternity cover for Dr Bissell. We are already all getting mixed up with two Dr McEwens in the building!  We also have 4 new GP trainees: Dr Ellie Balme, Dr Natalie Odedra & Dr Tom Bird (all of whom have been with us before) and Dr Amy Crosthwaite, who is brand new to General Practice.  We are hoping to enthuse them to work in a rural location once they complete training.

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• Family History Cancer Project- this will hopefully be underway by the time you read this. We are so excited to be working in partnership with St George's Hospital to screen our 38–45-year-old population to assess their cancer risk. I will be sending a text to patients within this cohort inviting them to fill in a questionnaire. This will identify low risk patients, who will be sent a reassurance leaflet and their personal risk level. This group will attend normal screening as they reach screening age.#The rest will be offered a detailed family history assessment. This will identify moderate risk patients, who will be referred locally for enhanced screening (for example annual breast screening, instead of 3 yearly). The final group, deemed high risk, will be looked after going forward by the Genetics Dept at St George's, who will create an individual risk management plan for each patient.This is a fantastic opportunity for our patient group, which is why we were keen to engage. Equally, one of the aims is to assess rates of take-up of the offer and see if they are different for different populations. We are being compared against a GP practice in Streatham, where both the population, and the methods of communication with them are very different to ours.

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• We really hope our population embrace this project. Please encourage anyone in this age cohort to complete the questionnaire. If you are in this group, have opted out of receiving texts, but would like to be involved, please contact me via AskmyGP.  I hope to follow up on outcomes at the SALV Autumn Meeting and hope this encourages this age cohort to come along!

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It has been really nice to talk about other issues this month, but recruitment and retention remain difficult due to the strains we are working under. We really appreciate your ongoing support and patience.

Dr Emma Watts

As I write, we are again suffering with Covid absence in our team. The doctor team is working at 2/3 capacity & each team has absences. In addition our Dispensary wholesalers have had Covid absence meaning deliveries have been delayed. An increase in Covid in the community has meant we are asking patients to wear masks again and avoid coming to the surgery when they are positive.  Unfortunately, there are scenarios where Covid positive patients need to come to the building for treatment for other problems. We are trying to manage this as carefully as possible in order to fulfil our duty of care to our patients, whilst trying to protect staff and other patients. We again ask you to bear with us and hope to bring some more positive news soon.

We continue to struggle with staff shortages, both due to Covid absence and recruitment difficulties. We are aware we have been asking you to bear with us for some time now, and we continue to ask you to do this.  We are working on strategies to improve turnaround in Dispensary in light of the enforced systems changes. Once we have found a way to make it efficient, we have been asked to share our system with the Dispensing Doctors Association. It would appear everyone is struggling equally with the inherent delay that came from having to swap to digital prescribing. We are committed to finding a solution, and have engaged Megan Morgan, a local systems analyst, to try to help us with it. Updates will follow!  In the interim, if everyone possible can use @BrendaVendor that would help free up our dispensary team. 

Last month, we were asked to give some of our free time on days off to film a short film for our dispensary wholesaler, PSUK. You may have seen filming in the village. I was keen to engage with this as PSUK have really worked with us since Brexit and through the pandemic to help us secure medication during times of shortage, even helping us to import Paracetamol from India at one point.  If you saw us on BBC Countryfile, you will have seen that Dispensing Doctor colleagues in other parts of the UK are also struggling.  Many practices have closed over the past couple of years, and we feel a strong desire to use the strategies that we have learned to help other practices.  A core part of our strategy has been community engagement, and we have really felt supported when you understand our limitations. If you saw the filming then this was the purpose, aimed toward other GP practices. We thank everyone who gave their free time to contribute, and we hope that other practices will benefit. 

You may have seen on Twitter that we welcomed a new PCSO to the area. Her name is Chloe Chapman, and she will be increasing patrols in the area. Please go and say hello if you see her and make her feel welcome. She is helping us with some of the difficult behaviours we have been experiencing. The Police are also stepping up patrols to address drug dealing in the car park and we are sharing all number plates with them. 

In other news, we were named Finalists for the Boarding School's Wellbeing & Mental Health Initiative Award.  Having noticed an increase in diagnosis of ADHD and a lack of consistent approach to its management, we created a Neurodiversity Pathway to help the patient, parents, teachers and specialists to work with us to create a consistent approach and support network around the patient. We are delighted that this has been recognised and will hopefully now be replicated in other schools/surgeries.

Dr Emma Watts

The sun is shining and the Surrey Hills are looking beautiful. This brings a bit of joy and hope as we hope to move out of the pandemic, hopefully toward more positive times.

I have alluded to the problems on the horizon for General Practice & our absolute commitment to try to preserve GP as a local service, fit for purpose.  We are feeling increasing pressure against this as contracts and funding are set up to favour survival of large urban providers, accepting the loss of their rural counterparts. The reason I have been trying to share these developments is that we may need to look for community support for a local, rural GP model soon, and it feels only fair to prepare you for why this may be coming.  We are lucky to be supported by SALV, and I encourage any reader who isn't signed up to visit our website and sign up. We can communicate far quicker this way, by email cascade, and it enables us to be more information mobile as a community... which in the past couple of years has proven extremely important.

My submission to the Parliamentary Inquiry into the Future of General Practice was accepted for publication by the House of Commons and has become part of the supporting documentation. The link follows if you wish to read my thoughts further now they have reached the public domain: https://committees.parliament.uk/writtenevidence/42329/pdf/

You already know how upset I have been about the negative press around GP over the past year or so. The stories of doors closed etc are hard to accept when we only closed for one day in March 2020 for a deep clean after Covid exposure and have been open door ever since.  The impact of this negative press on our staff has been huge, as every member of our team is trying to make a difference. Seeing constant media anti GP rhetoric has been so hard for morale, affecting both recruitment and retention.

To this end, I decided to engage the enemy, helping to write an article for the Daily Mail, which was published on 14th June. Alarming figures show desperate shortage of GPs as rural areas are worst hit | Daily Mail Online

Clearly, I'm hoping you know by now I had a huge amount to say on the subject and was hoping to deliver my message to the readers that are currently only receiving anti GP rhetoric. This was a huge risk, as I was fearful of my words being misrepresented, but I feel the journalist represented what I said well, albeit heavily editing my extensive content!

Finally, last month I talked about the surgery's commitment to trying to help dispensing practices in other areas of the UK that may be struggling, by sharing our strategies and solutions. This was intended to become a short film for sharing (still in production) but we were surprised/bemused to find that written copy had made it into the monthly publication, with Shere on the cover.  This was unexpected, and a little embarrassing, but drawing on the positives I really hope you are able to see that, despite national limitations, we at Shere are absolutely committed to doing whatever is needed to keep NHS healthcare local.

I really hope that soon I can be writing about simpler matters, but in the meantime I hope you all can enjoy the summer and that those planning to go abroad are not hampered by flight difficulties.

Dr Emma Watts

By the time you read this the flu vaccination clinics will be in full swing. If you are not signed up for the SALV email cascade, please let us know so we can get you added. This (& twitter @ShereSurgery) is our quickest way to update you when things move swiftly.  Emails are only sent out when there is something new to report that needs to be swiftly received.

Covid boosters: We will hopefully be vaccinating against Covid on site for the first time, having requested on site access to covid vaccination from the outset...  if you have a flu vaccination appointment already booked then please keep it and we will book an extra appointment for the Covid vaccination. We are anticipating that from October we will be making combined vaccine appointments, and updates will be delivered via SALV cascade and twitter, together with a poster in the surgery window.

National Drug Shortages: We have ongoing problems with national stock shortages of different drugs. We have had to change doses for loads of our statin patients as drugs have not been available. This is consuming a huge amount of time for both dispensary and clinical teams as the problems are affecting hundreds of patients, so we apologise if it is taking a while to update you on your prescription. Sometimes we only find out that a medication has become unavailable when it doesn't arrive in the order, so this creates a delay.  For further info on the background to drug shortages read the May newsletter on the website.

Blood Test Forms: The increase in outpatient appointments being offered remotely is causing a knock-on problem for us if the specialist forgets to send out the paper blood test request form in the post after the appointment. We have hoped for some time that the hospital would put requests on the online system we all share as that would solve the problem, but this is still not happening. We have had to insist in the past 6 months that any specialist blood tests that are booked need to be accompanied by the blood test form. Patients are caught in the middle, and we have sympathy for this, hence the explanation. If a specialist requests tests it remains within their responsibility to order, review and act upon them. We can take the blood locally for convenience, but we don't have the time to help the hospital with their admin and we have found that this is reducing the time we have to spend time with our patients, which is the part of our job that gives us satisfaction.  We hope you understand. I would be more than happy to support anyone who would like to write to the hospital to question why their doctors aren't allowed access to the online blood test requesting system we have all shared for some years.

Missed Appointments: The audit into missed nurse appointments is ongoing.  As of 31st July, 89 hours of nurse appointments have been wasted so far this year. For clarity, this refers to appointments where the patient failed to turn up and does not include patients who had to cancel.  In 2019 we moved to AskmyGP for access to doctors. Whilst there is no system that suits everyone, it has been hugely successful in reducing the hours wasted by those who do not attend.

Personal Note: I'd like to thank Dr Douglas Wardrop for nominating me for Fellowship of the Royal College of GPs, which I have been awarded. I think this reflects us continuing to uphold the professional standards that Dr Tyrrell held dearly, and I see it as a positive reflection on the whole team. I'm confident that there will be more of these announcements in the coming years. For those of you who follow my silly kayaking exploits, I am just back from the World Canoe Marathon Championships in Denmark where I represented GB in the Masters category. My crewboat partner and I came 4th after a hard catch-up slog of a race having been involved in a collision near the start that sank a USA boat...!

Dr Emma W

This month we have struggled greatly with staff shortages. At one point 4 doctors unwell with covid, some for the second time, we are struggling to provide the service we would like. Unfortunately, we have been unable to cover the absence with locums as there simply are not enough doctors available to meet demand. We hope you can bear with our team who are all trying their hardest.

 

That's all for this month, sorry.

Dr Emma Watts

January brought with it a further wave of Covid cases in our community. Thankfully we have not seen severe cases like we did in the earlier months of the pandemic. Unfortunately we have struggled,  as have many other businesses, with staff sickness. This is inevitable when we work with sick patients, but has led to disruption with every team affected and feeling the strain covering for one another. We have had to prioritise urgent work during this time, so please bear with us if you have had a delay with letters etc.

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Found: Wedding Ring: in late December we found a wedding band at the surgery. We still haven't located the owner. If this might be yours please can you contact Kate via the surgery.

Prescription fees: We are anticipating Prescription fees will increase on 1st April, but as yet it is unclear how much these will rise by. If you pay for your prescriptions it may be worth purchasing a prepayment certificate. This involves a one off payment/ monthly direct debit and covers all prescription charges for a year. If you have 12 prescriptions a year or more it is more cost effective to buy a prepay certificate. These are subject to annual fee rises too, so if this is of interest it would be worth buying now, prior to the April fee increase. Please note, we have no financial interest in this either way, it leads to no benefit for us, but we do think prepay certificates are usually of benefit to our patients.

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https://services.nhsbsa.nhs.uk/buy-prescription-prepayment-certificate/start

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Finally, we hear lots of stories from vulnerable patients about the support they receive from the community. It is impossible to put a value on this but is something that makes our community very special. Please continue to look out for each other through the coldest part of winter as we wait for the hope of Spring that comes with the daffodils.

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Emma

Happy New Year from the Surgery.

2020 and 2021 didn't serve us well and staff at the surgery start 2022 exhausted and a bit trepidatious as to what 2022 and the Omicron variant will bring.

Writing this in December I don't know what to expect or report, but there are two messages I would like to be really clear on.

First, we will continue to try to communicate well with you about pandemic updates, within the limitations of what we can achieve whilst fulfilling the day job. Please remember we use the website, twitter (the last 3 messages appear on the home page of website for non-twitter users), email cascade via SALV (see website home page for info and to join) and posters outside.  Please try to look for information and share it with friends. We need to keep phone lines open for medical problems for those without internet rather than advice we can try to disseminate out to a group.  Our communication frequency will adapt according to how quickly things are changing. As ever, if you want contact with a doctor, please get in touch online via the "ASKMYGP" button on the web site - not only is it much quicker and easier for you and us, it also means we have the facility to send and receive documents and photos, as well as freeing up the phone lines for those without internet. The web site has a short video to show you just how easy it is to do.

Second, the media were unkind to GPs this year, when in fact nationally we can prove demand for our time has skyrocketed at a time GP and nurse numbers are decreasing.  This was hard on the profession's morale, especially as nationally patients felt empowered by negative media and began to become increasingly aggressive and unpleasant to our teams, including locally.  My message though is one of thanks.  By far the majority of our patients do recognise the pressure we have been under. I cannot tell you how much we value this.  One unpleasant interaction may ruin our day, but when we reflect at the end of each week, we know that we are appreciated and we are all so very grateful.

I will finish by repeating something I wrote on 20th March 2020. I never imagined then it would be just as important nearly 2 years later:

'Despite this time of unprecedented stress, please remember to be KIND to one another, set a good EXAMPLE by our behaviour, retain INTEGRITY, & remain LOYAL to the community in which we live and work.  If we achieve these VALUES we will come out at the end of this pandemic with a sense of TOGETHERNESS that will help us rebuild again.'

I very much hope we all have a happier and healthier 2022.

Dr Emma Watts

As the year draws to a close, we reflect on 2021 and think with hope that 2022 is a happier and healthier year for our community.

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Covid-19 has been a major feature of this year again, with both the vaccination programme and sadly the ongoing pandemic.  These pressures have caused delays to hospital care and more of you are waiting for operations and treatments than ever before. The responsibility for managing the increased need in these patients has become ours in General Practice, together with an increase in mental health issues, Covid itself and obviously our normal workload. This has caused strain in the system which has been picked up in the media.  We have offered face to face appointments where needed throughout the pandemic but have had to try to streamline our approach where we can.  The increased workload is shared by the same team and there is no increased funding to recruit more staff, even if there were trained staff out there.  This has led to patient frustration, and our need to republish our zero-tolerance policy as frustration led to increasing levels of abuse to our staff.  It is hard writing about this as most of our patients are reasonable and understand the current strains on the system.

Dispensary have suffered another intense year with increased levels of prescribing to manage the above issues.  In addition, delivery driver problems have led to items previously supplied by councils (ie sharpsbins) suddenly becoming our responsibility- increasing workload further. We have responded to this by introducing more systems using bar code scanners in order to reduce the number of trained staff required in the dispensing process. This has recently led to a reduction in the turnaround for repeat medication, which had become stretched when digital prescribing added a day to the process. We continue to try to innovate in this area and have recently been lucky enough to recruit two lovely new team members after many months of searching.  You can help Dispensary by signing up to use the Pharmaself machine, thereby allowing dispensers away from the window to dispense medication.

I was lucky enough to take my sabbatical (postponed due to pandemic) in September 2020 and as travel was largely off the menu, I bought a panel van and converted it into a camper with my daughter, Sienna.  We then travelled the North Coast 500 route around Scotland, diverting off to the Outer Hebrides.  After such a hectic 18 months it was a good time to recharge ready for the coming year, and spend some family time, which has suffered. Instagram fans can see our journey @avancalledken and I'm grateful to my colleagues for holding the fort whilst I was away. 

I'll close by wishing everyone a peaceful festive season, and hope that our community can enjoy a happier and healthier 2022.

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Dr Emma Watts

 Now autumn is in full swing and winter is fast approaching there has once again been focus on the health of the nation; with Covid -19 boosters and flu vaccines hot topics of conversation. There have been numerous media stories regarding General Practice with a particular focus on face-to-face appointments. We can assure you that everyone at Shere Surgery are working extremely hard to offer the best possible care to our patients and we will continue to see patients in person, as we have throughout the pandemic.

The Covid boosters have now started at Artington Park & Ride, south of Guildford. The ProCare team are working through the priority grouping 1-9, but can only offer a booster when 6 months have elapsed from the second dose. They have the lists of all of our patients requiring a booster and will contact you when they are ready to offer an appointment, usually by mobile phone or failing that your home phone.

The wait for the delivery of the flu vaccine has been very frustrating and due to a delay by the supplier we have not been able to offer these yet. At the time of writing we are expecting a delivery towards the middle of October and as soon as they have arrived we will be booking in those eligible as soon as possible. We hope by the time of reading this that the clinics will be up and running and urge you all to book in for your dose!

I’m afraid to report that that our reception staff have been subjected to increasing volumes of verbal abuse. Whilst the majority of patients are fantastic; polite, courteous, and understanding of current pressures, the behaviour of the minority has been unacceptable. Please always remember that we our doing our best in these extremely challenging times and to be kind to yourself and others.

We are very mindful that repeat prescriptions have been significantly delayed in recent weeks. This has been due to unforeseen staff shortages, but we have recently managed to increase our workforce and the dispensary team have been working tirelessly over the weekends to clear the backlog. We look forward to resuming our normal waiting time very soon.

We’re very excited to reveal that with the help of the SALV trust, we have just launched a new service to help diagnose heart palpitations. This involves the loan of a device that connects to a smart phone, which allows an ECG recording of the heart to be taken by simply putting 2 fingers on the sensor. This recording can then be shared with the medical team to enable a diagnosis to be made. This is just another example of how with the tremendous help of SALV, we can offer care above and beyond what is normally possible in general practice.

This month we were sad to say goodbye to Dr Brigid McGaw who has moved back to Scotland with her family. We wish her all the best for the future and hope that she and her young family have all settled in as swiftly as possible.

Dr Watts will take up the reins again from next month to keep you updated about everything to do with Shere Surgery, and we look forward to seeing as many of you as possible at the SALV Autumn Evening presentation on Monday 8th November.

Dr Marcus McEwen

As I write this, the last few days of Summer are soon to pass and a new season of mists and mellow fruitfulness awaits us. 

Work at the surgery remains busy and demand remains very high. Our new measure of taking all requests (routine and urgent) before 12pm midday and only urgent requests after 12pm has proven helpful and has so far allowed us to continue to offer a same-day service. As ever, the best way to get to get in touch with us is online, via our web site, but the phone lines are available for those without internet access.

You may have noticed some new faces at the surgery – we have been very fortunate to have been

joined by some excellent new trainees: Dr Karen Kwok, Dr Adell Mintah-Sem, and Dr Alex Argent will

be with us for the next few months and have already settled in very well. They bring lots of hospital

experience and we love their fresh enthusiasm and admirable work ethic when helping patients with

their medical problems. They have already said what a pleasure it has been so far to be furthering

their training at the surgery, so thank you for making them feel so welcome.

We are trying to normalise things at the surgery as much as we can whilst observing national advice

as it unfolds. Our waiting room is now open for use and we no longer need to use the side door and

check temperatures on entry. We do ask that you continue to wear a mask, as will we, and that you

stay away from the surgery and request a PCR test if you have any of the three cardinal features of

COVID-19: high fever, new, continuous cough, or a loss of the sense of smell or taste. For more information, please see  https://www.gov.uk/get-coronavirus-test or call 111 for more information about testing and please remember, we will be available for further medical advice if you need it.

There have been many calls about the flu jab and the Coronavirus boosters. Unfortunately, there is a

national delay affecting deliveries of the flu jab due to supply problems, but we will continue to keep

the web site updated as soon as we know more so you will be kept as closely informed as possible.

In the meantime, please do not call the surgery for more information, as we don’t know any more

than is on our web site and we need to keep the lines free for people without internet access to get

in touch for help with their medical problems.

Normally a fan of the excellent Spectator magazine, I was dismayed to see an article last week

entitled “It’s time for GPs to stop hiding behind their phones!” Not only do we need to keep everyone safe and reduce the risk of transmission, it is important to note that many problems can be dealt with more quickly, and more easily, by online or telephone interactions. There can never be a substitute for face-to-face consultations though and they will continued to be offered based on clinical appropriateness. In order for us to help as many patients as best we can, we need to maintain use of every modality available to us for the benefit of all.

The NHS GP survey brought more gratifying news - we have been ranked 164th out of a

total of 6,659 surgeries in England – of course, this is no time for complacency. On the contrary, the

news gave us a nice boost as a surgery and spurs us on to continue to develop and improve all the

time. Please take a look at the web site for more information at https://gp-patient.co.uk/

Dr Watts will be back as usual next month once she has returned from her well-earned sabbatical

but, on behalf of the surgery, I would like to extend my gratitude to our patients for their patience, good humour, and support during these difficult times. 

We all feel very fortunate to serve a population who share our philosophy of compassion, support, and excellence and we will continue to do all we can to look after your health to the best of our ability.

Dr Douglas Wardrop

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We have good news to share this month.  We were proud to receive an award (shared with SALV) from the Lord Lieutenant of Surrey for our contribution to the community through the pandemic thus far. The award was presented by Deputy Lord Lieutenant, Jane Macaulay, and you can read more about this in the news section of our website. Different stages of the pandemic have brought different challenges for the team, and we continue to struggle currently with the level of demand, so to be given this award was brilliant for morale. 

Our second piece of good news is to share that we have been shortlisted for the Health Equity Award in the Royal Society for Public Health Awards 2021.  This is for our Homelessness Project, which has been running now for a few years and aims to allow equity of access to healthcare for those who don’t have a fixed address. These people often have more complex health needs, but as they can’t prove a residence within our boundary we were not previously able to provide them GP services.  We are one of three projects to be shortlisted and the awards evening is 21st October.  We will have a webpage created on the RSPH website, which will give more info. It hasn’t yet been created fully, but I think the address will be https://www.rsph.org.uk/shere-surgery-dispensary.html 

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Please take a look at this page because as well as providing more information about the project, there will be a link to where you can join the award ceremony live online in October.  We are hoping that after a year of minimal social activity, some of you will join us online and keep your fingers crossed for us! 

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I mentioned above that we are currently struggling with level of demand for GP services.  This is a national issue caused by multiple factors. Unfortunately, this is being compounded by issues with recruitment and retention of staff due to the stressful work environment.  We continue to advertise for a Business Manager, Care Coordinator, Reception, Dispensary Technician and two Dispensary Apprentices and these posts have been vacant for some time. It creates conflict if we employ patients so we try to avoid this, but if anyone knows anybody outside our immediate area who might be interested please do send them our way. 

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Finally, my sabbatical (which was cancelled during the pandemic first wave) has been rescheduled, and whilst I can’t travel as I had hoped, I will be taking September off to spend some time travelling round the north coast of Scotland with my daughter.  I shall be asking one of my colleagues to write for you next month.

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With the relaxation of Covid rules on 19th July we are expecting to see an increasing Covid case rate by the time this is published. Rates are already going up locally, although hospital admission rates are low.  With the relaxation in mask wearing rules Nationally, we are still very keen for patients to wear a mask when on our premises.  This is to protect other vulnerable patients who are in the building, and also to protect our staff.  We have been lucky thus far to have only had a few staff self-isolating at any one time, but neighbouring Milford & Witley Surgery struggled significantly when a huge proportion of their workforce were forced to self-isolate at the same time.  We will continue to update on evolving issues via Twitter (@ShereSurgery), which can also be viewed at the bottom of our website home page, and on posters outside the surgery.  Things have been calmer for news in recent weeks, and it has been nice not to need to use twitter updates so frequently.

Hearing Champions

A short note from Betty Adams, who is retiring from her role with Hearing Champions...

     "Hello, you lovely patients!  It's been quite a ride over this Covid period and I'm really sorry that the Clinic

       could not function during this time.  Upon reflection, I have also decided that it's time for me to retire too.

       I thank you all for your support over the last 4 years (including one of Covid!) and if there is anyone out

       there in our lovely community who feels that they would like to take up the reins, then please do call me on

       01483.229135.  Thank you all for your friendship and support over the years.           Betty Adams"

Thank you so much to Betty for her dedication to this voluntary role over past years, we really have appreciated her. She has kindly said she would be happy to discuss with the role with any new volunteer keen to take it on.

We hope you all manage to have a lovely summer, despite all the disruption and uncertainty, and can have a little bit of time out to enjoy the beautiful countryside we live and work in.

Dr Emma Watts

As I write this, our practice has had no confirmed cases of Covid for well over a week, the population uptake of vaccine is good, and Covid restrictions are lifting.

In General Practice things aren't as rosy. We have tried to keep you away from the politics of our profession as we prefer to focus on patient care, but it is impossible to avoid the huge upsurgence in anti GP rhetoric within the mainstream media.  The idea that we have been 'closed' through the pandemic is at odds with the demonstrated 40% increase in demand & provision. Although this dropped in March 2020, it swiftly returned to normal and has been rising ever since to a volume we have never seen. We are increasingly unable to manage this demand, which has led to an increase in complaints, patients quoting the Daily Mail & Daily Telegraph, plus the individual cutting out and sending in these articles, unkindly annotated in the margins. Alongside this has been work with Covid, the Covid Vaccination Programme, and trying to both keep you informed, and develop services so they remain fit for purpose as the world changes around us.

For this reason, as demand outstrips the available clinicians, and to try to prevent GP Burnout 14 months into the pandemic, we are having to urgently review our service.  I don't currently know what this will look like, but I know it is a necessity. Our surrounding practices are facing the same pressures and are responding similarly.  We know this will create anxiety. Our core beliefs about patient care and our commitment to our community remain unchanged.  

Please know that we do feel supported by our community, but currently there is more demand than hours in the day, and that is no longer viable.  By the time you read this, hopefully we will have found a way to take this forward. You have my commitment to try to explain our rationale along the way. 

Kind Regards,

Dr Emma Watts

GP Partner

Shere Surgery & Dispensary

This month I don't have much to update you on! We continue to push through the Covid Vaccination Programme as fast as possible, within the restrictions created by supply of vaccine.  Hopefully, by the time you read this we will be making good headway with second dosing. At the time of writing there is much controversy about the AstraZeneca vaccine, and the news has suggested everyone under the age of 30 should discuss this with their GP. I am hoping this advice is reversed swiftly as we a) have no more information than is publicly available b) information is changing rapidly c) we simply do not have capacity to offer a consultation to all over our under 30's in addition to our current workload.  It may be that, to cope with demand, we issue a standard statement detailing all the up-to-date information.  If this is the case, we hope you understand. We will continue to keep our website up to date with the latest information.  

With regard vaccination generally, you will continue to be contacted and do not need to contact us. If we reach a point where we feel we have covered different groups but have people missing, we will put out an appeal for them to contact us via the SALV regular updates, or by Twitter @ShereSurgery.

I am pleased to update that the drainage work to the road outside the surgery, and the levelling of the bumpy pavement has now been completed after nearly 2 years of effort from both us and Shere Parish Council.  Thank you very much for Parish Council support.

That's it for this month. If you want to keep up to date more frequently, please do contact Adrian O'Loughlin, SALV Chairman, via the SALV tab on the website homepage. Adrian can add you to the regular mailing list.

Thanks for your ongoing support.

Emma Watts

As Easter approaches we are thankful to have put the second wave of Covid-19 behind us and continue to make our way through the Covid Vaccination Programme. This is fast moving and changing so please refer to the SALV updates (sign up to emails via the SALV link on our website homepage) or Twitter for the latest on this. At the time of writing we understand you will be contacted for second vaccination around 12 weeks. You can book a first vaccination following the link below: 

https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/book-coronavirus-vaccination/

Demand for our services has dramatically increased. One of the reasons for this is that outpatient appointments are happening on the phone and consultants are telling patients that their investigations and prescriptions will be fulfilled by the GP. In addition, patients are receiving clinic letters they don't understand and are consulting us to discuss this. Whilst we understand and want to help, the sheer volume of these requests is becoming unmanageable, so we are in discussion with our secondary care colleagues to try to find a resolution. 

You may have seen our SALV update where we discussed our tentative plans to build an extension to help manage the increased demand. To try to offset the cost of the loan, we are looking at applying for an NHS Dental contract, in order to combine services on site. Clearly there will be many questions around this and we will be addressing these at our SALV Open Evening on 26th April. 

By the time you read this I am hopeful that works to create drainage from Gomshall Lane outside the surgery will be complete, and that there is no longer a permapuddle by the bus stop and ambulance/disabled bay. In addition, the pavement works to address the tripping hazard created by tree roots should also be complete. This is the result of a lot of hard work over the past 18 months. I would like to express gratitude to Shere Parish Council for their support, both in helping increase the profile of the problem, and financial support at latter stages to ensure project completion. We are truly grateful, & I know our patients will be too.

As lockdown hopefully continues to ease, we look forward to starting to see groups of people out enjoying our beautiful surroundings again, hopefully in glorious sunshine!

Happy Easter.

Dr Emma Watts

“In the aftermath of the first wave we had time to take stock. It was not as bad in the end as we had feared, and all our patients who required admission to hospital had a bed. Morale began to rise as the number of Covid-19 affected patients reduced, and we found a way to open our doors safely to increased numbers of patients, focusing on managing our patients’ general health as well as the increasingly high number of mental health problems that emerged in the wake of the first wave.

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“Patient demand grew overall, which is what we wanted. We were concerned patients had been holding on to their medical complaints for too long, thinking that their problems weren’t important enough to merit an appointment or so fearful of the pandemic they stayed away. We were generally able to cope with increased demand at the surgery, but hospital appointments proved more difficult – there was a big backlog because hospitals had closed down all their outpatient services during the first wave, and patients became restive.

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“The weather last summer was a wonderful spirit lifter, and with amazing community support we renovated our outdoor area so that we could enjoy occasional ‘air breaks’ outside; continuing through winter thanks to the kind donation of an outdoor heater. The one downside of the heat was that our PPE became less comfortable, particularly when it hit 36 degrees. Our nursing team were worst affected as most of their patients need face-to-face appointments, unlike many doctors’ appointments which can now be conducted online or over the phone. The cleaning of rooms between patients became an essential and sometimes much-anticipated break from the oppressive heat of gloves, mask, visor and plastic apron!

“We were delighted to reach the finals of the National GP awards for Public Health and Prevention, which recognise a team who have demonstrated excellence in improving local healthcare. One of the Covid-related improvements is our new Pharmaself dispensing system donated by the Shere and Local Villages Charitable Trust (SALV) supported by our incredibly generous patients and for which we are immensely grateful.

“In autumn we saw the second wave approaching, but this time we felt ‘battle ready’ and with high team morale and continued extraordinary community support we felt well equipped to protect our patients, our staff and the building. However this second wave proved very different from the first, with many more patients affected. With the new variant, clinical presentation has become more varied, and patients are now presenting with Long Covid. In the first three weeks of January, 1% of our patient population tested positive and this rose to 5% by the end of January. Patients were frequently needing admission and as a team we were shocked and saddened by the impact.

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“During the first wave, we assessed Covid-19 patients in a tent or ‘Hot Pod’ in our garden area, keeping the surgery building safe for staff and patients alike. As the weather declined and the symptoms of the new strain became more diverse we had to reassess. We constructed a ‘Hot Bay’ at the far corner of our car park where patients with Covid-related problems could come in their car for a basic assessment and oxygen saturation measurement. This proved challenging in the wind and rain of winter as our equipment stops functioning when too cold, so swaddling both ourselves and our equipment became the key to success. We do see some Covid-19 patients in the building now, because presentations have become so varied and many patients need a general examination within a fully equipped consultation room. We’ve assigned a room by the back door for this, which is deep cleaned after use, but it has challenged our desire for a ‘Covid-free’ building.

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“Thankfully locally numbers are now declining, and fewer are being admitted to hospital. Life at the hospital is slowly going back to normal. In the surgery we’ve recently introduced lateral flow testing (a rapid test that returns results within 30 minutes) for staff which is now done twice weekly, an immense comfort for patients, staff and their families, to know that we are not vectors of the virus.

“The vaccination programme is well underway. After such a long time waiting it’s been a real high point for our team to deliver the vaccine to our housebound patients. Our calls delivering news of vaccination appointments have been met with great excitement and to see our housebound patients face-to-face again has been a heart-warming experience.  The vaccination programme has allowed us to raise awareness of the constraints of rural general practice. We’d hoped to deliver the service at the surgery but due to problems of cold storing the Pfizer vaccine and the requirement to give 975 doses in three days, our patients have had to travel. We’ve lobbied MP’s to allow us to deliver the more manageable Oxford/AstraZeneca vaccine, and are hopeful these representations will change the contract available to rural GP’s Nationally.

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“We are beginning to feel optimistic that there’s light at the end of the tunnel, and we’ll soon be able to spend some quality time with our families and friends. The surgery team are continually encouraged and very grateful for the generosity and thoughtfulness of our patients during this challenging time. It is the strength of community that has helped deliver us through this second wave.”

Spring has finally arrived, and with it hopefully promise of some healthier months ahead. The Covid Vaccination Programme has been going really well, and 180 of you are now on the SALV email distribution list, receiving my updates when things change.  At the time of writing, we have had excellent uptake from the Over 80's, the Over 70's, the Clinically Extremely Vulnerable, the Housebound & those with Learning Disabilities.  We are continuing to work on our Homeless population and by the time you read this I hope we will be actively booking in anyone Over 60.  I've spoken with a lot of pride about our hardworking team over the past year, but Reception and Admin deserve much recognition for the extra hours they have put in on the phones.  Thank you for the positive feedback you gave from our virtual Twitter tour of the Surrey Hills on our Housebound Vaccination Day.  We covered 140km of narrow roads in the Surrey Hills that day, against the deadline of vaccine expiry at 6pm. It was quite exciting, tiring, but lovely to see faces of those we haven't seen for so many months.  We had a bit of fun stopping to take photos on the way and were pleased that this brought a bit of community cheer at a rather bleak time.  We were followed online by 28,000 people at one point, from South West England to Scotland, including NHS England, which is staggering considering it was just supposed to be a bit of fun for our patients!

Second Covid Vaccinations: Keep your eye on the news as this has evolved over time, but once we are authorised to start giving second vaccinations, you will be contacted by the site that gave you your first. We are not expecting any involvement in this, and we won't be able to switch you to a different site.  This is potentially subject to change, so keep an eye on Twitter, SALV updates, or posters at the Surgery. However, do not worry that you need to organise second vaccination, you will be contacted.  Currently this is expected to be 12 weeks after the first.

Royal Surrey coped with the peak of the Second Wave really well, and we are so grateful to them, and to the Ambulance service, for helping to support our patients. Our thoughts are very much with the family members of our patients who sadly passed away during this time, but we are so grateful that the majority of our patients have recovered well.

SALV (Shere and Local Villages) Charity has been so supportive to us over the years, and over recent months I have been really grateful for the help with communication to the community. In the background, SALV have offered to buy us new seating for the surgery, which hopefully will be arriving soon. Our current seating is not coping with the degree of cleaning required now and is starting to fatigue, which could be a problem for infection control.  We are gradually redecorating the building inside to make it feel more warm and welcoming for our patients, and for our staff. Local photographer Michael Hutchinson is letting us use some of his images to create some high impact artwork for our reception area. We have a new surgery sign on its way to replace the faded green one, and a team of local volunteers are going to help clean the algae from the building.  The pavement repairs and drainage issues in the road and disabled/ambulance bay will be addressed at the start of April thanks to a significant funding contribution from Shere Parish Council, to subsidise Surrey County Council shortfall.

SALV have booked their Spring Open Evening for Monday 26th April. The format for this will depend on social distancing at that point, but I would encourage anyone who hasn't attended before to come along.  SALV have supported the surgery for many years, but it really feels that the past year has been different in so many ways. It would be nice to expand their reach to enable us to evolve our services going forward to meet the requirements of our community more effectively.  

Emma Watts

Writing for the parish magazine this past year has been challenging as things at the surgery sometimes now change hour by hour. Therefore, submitting 2 weeks in advance is fraught with potential communication fails. In the early stages of the pandemic I felt we were managing to communicate fairly well, with boards outside, the Parish Magazine &Twitter.  However, in December I began to feel unable to truly convey to our community what was happening at the Surgery regarding the Covid Vaccination Programme.  We began to be so preoccupied with communicating above us to try to secure a contract we were able to deliver as a small rural practice, that communication with you took a back foot, as we had no updates. I know our silence led to worry, as I was watching the news which talked of the vaccination progress being made, and I know you weren’t feeling it here locally.  Adrian O’Loughlin, SALV Chairman, kindly contacted me for a chat and, aside from updating him; we discussed the issues we were facing.  Kindly, Adrian agreed to consolidate our chat into an email to go out to the SALV distribution list. This was brilliant as it meant we were able to communicate faster, disseminating news to our community better.  The content hopefully reassured everyone that we were doing everything in our power to get vaccination underway (even if it couldn’t be at the surgery). 

As a consequence of this, yet realising many are not on the SALV distribution list, I wondered if I could clarify how we intend to communicate with our community en masse.  When we have an update we will: 

1) Use Twitter- this is really quick. If you are able to join Twitter and follow us this will simplify things, but if not, the last 5 messages are available to view on the home page of our website at any one time, so you could choose to look at this regularly instead. (As I write, I am conscious that my children would eye roll to read me advocating social media!  I completely accept social media is less than perfect. We will try to engage many methods, but it is the quickest.)  

2) Email updates by SALV distribution list- Adrian has a cascade system to disseminate updates by email. These emails can go out daily if required.   If you would like to join the SALV supporters, we have simplified our website and there is a simple SALV box to click on our home page. 

3) Boards at the Surgery- we will update these as quickly as we can, but they reach the community far slower, and sometimes less accurately, leading to multiple phone calls. 

We have decided to stop updating the website separately from the Twitter updates on the home page. This is because the home page had become so busy that it was hard to see the pertinent communications. 

At the time of writing all of our over 80’s should have a planned vaccination. The next group will be the over 75’s. I cannot stress enough that we will call you, and keep calling you until we get you! Please don’t call in and block our lines for vaccine queries unless you are in a completed group and are unvaccinated.  We will continue this way until the process is complete.   

Please keep a pen and paper by your phone to write down your appointment details. It delays us if you need to call to check. We don’t have the ability to cancel appointments made, so please bear this in mind. 

Covid Precautions: We continue to experience really high demand for appointments despite the pandemic. From the outset we have continued to see patients face to face when clinically indicated and this has not changed. We need you to be aware that, if visiting the building, your appointment will be as swift as we can make it as additional face to face time (even with masks) increases risk for you, and for our team who spend a lot of the day in face contact.  Anything that can be dealt with on the phone/remotely will be.  We want you to contact us if you have clinical need. If it is something minor that can wait, please could you do so.  However, we DO NOT want you to hold back if you are worried about something more significant. 

Seasonal Flu Vaccination: This is a funny one… we had an incredible flu clinic series run by our epic nursing team, who adapted to circumstances and delivered outdoors. When we ran out of vaccine (as more people wanted it this year and we put our orders in many months in advance) I worked hard to secure additional supply to ensure everyone in the standard cohort (& in the new 50-64 cohort) could have access to a vaccine. We achieved a significant delivery but have been a bit disappointed that appetite for seasonal flu vaccine seems to have dwindled? The importance this year was because if you were to have both seasonal flu and Covid combined (or one followed by another) mortality rates were far higher. We have excess flu vaccine in our fridges, and I would be devastated if it were wasted…  

Covid Assessment Bay: We are now assessing potential Covid patients in their car in the car park, as this reduces transmission risk. If you are attending the bay, please can you try to keep warm on your drive to us and maybe keep engine on and heaters on while you wait? We particularly need your fingers to be warm so if driving please wear gloves, and maybe passengers could wear gloves but keep hands squished between thighs for warmth on the journey? We are experiencing difficulty with our kit working in cold temperatures and are looking at ways to manage this.  

By the time you read this, I hope we are well and truly into the vaccination programme and that you feel that you are being involved with the issues along the way. If you have any suggestions for how we can involve you more, in a swift and efficient way, PLEASE do let us know, as currently this feels like a priority. 

Dr Emma Watts 

In the early part of 2020 we began to realise we were going to need to prepare the practice for something which had the potential to become one of the biggest challenges in the history of the NHS. Early projections of potential Covid deaths led us to believe we could lose 80,000 people nationally, and we started to prepare our local response. Having never been through anything like this before in our many years working for the NHS, it felt like we were preparing for War. The partnership felt a huge and emotional sense of loyalty and responsibility toward our staff.  People were afraid about coming to work, unprotected by absent PPE, fearful of taking disease home to vulnerable loved ones.  We felt the same feelings about our patients, and started to reflect on the numbers of vulnerable patients we have, feeling anxious about how the community could possibly cope with potential losses of so many vibrant personalities.

This took us swiftly into active pandemic planning. The early signs of mixed political messages (news on the TV that didn't reflect experience on the ground) came right from the start. There was a delay in guidelines being cascaded down, and the GP community responded by creating our own guidelines & policies, sharing them widely on social media with other practices. We formed closer bonds with colleagues from neighbouring practices.

 From the sense of inadequate leadership from above, came a sense of unity within our profession, and an increased speed of sharing consensus on good practice.

Very early on we were closed due to proven Covid-19 within the building, and from the point of the closure and deep clean we started to experience admission of sick patients, friends, and colleagues.  Then, for me, the first death of an old colleague, and one of my best friends, his ITU consultant, blaming herself for failing to save him. Meanwhile, my nephew Thomas, aged 14, became the first person to upload specifications for a working 3D printable ventilator solution for mass production in hospitals. It blew me away with pride that he would use his time, age 14, to try to make a positive impact in the world. https://www.ventilatorcrowd.org/post/five-days-that-built-an-mvp

Instinctively we began to counter emotions with action.  Staff worry about safety at work was met with an increased resolve to keep the building safe for staff and healthy patients, leading to the set up of the HotPod outside, to keep Covid patients separately managed.  Upset about the barrage of mixed communications from the media and our governing bodies, was met with the introduction of a daily SitRep (situation report) meeting for the entire team at 1pm daily, to update on new policies agreed by the partnership, help iron out any worries & provide camaraderie with an increased sense of cohesion.

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Not having time to queue to buy groceries led to supermarkets offering an NHS hour.  Our team experienced a horrible feeling of judgement when they were allowed in as others queued for mainstream opening, with negative emotion expressed at them.  We countered this by giving them NHS lanyards to make their NHS ID cards look more obvious to the public, and car stickers to try to achieve the same. There are too many examples to list here, but we learned that the best way to counter difficult emotion was to meet it with a corrective action, as best possible within the uncertainties of a global pandemic. 

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Lockdown one brought a new influx of emotion, mainly guilt.  Our entire team was working hard, working long hours, feeling emotionally drained, but lockdown brought a new problem with the obvious differences the population were experiencing.  Our children became sad that their friends were home with their parents, experiencing a time like never before, showing pictures on social media of family walks, board games, gardening, cooking and an unforgettable family bonding experience. Our children were experiencing the stigma of being ‘keyworker kids’ and school communications repeatedly referred to needing to remain open to cater for them. This was just clumsy wording in school communications, when the teachers were also under strain, but enough to lead me to allow my children (who were luckily old enough) to stay home alone.  Looking forward to Bank Holidays and Easter, to try to compensate for these lost family times, led to disappointment as General Practice was ordered to remain open, but our staff rose to the challenge of this, and we met the feeling of disappointment with a drive to spend any spare moments tidying up our outside space to make our environment a bit more homely.

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The evolving emotions within the surgery throughout the First Wave were also countered by actions outside of the surgery… from our community. Too many wonderful actions to list here, we discussed them at our SALV zoom meeting and we have them documented so that history never forgets them, but they range from small children washing cars to raise money to buy us PPE when we had none, patients donating us anything they had to protect us, cakes (in some cases regular cake making!), a garden table for our staff, land rover on loan for home visiting, all the way through to the SALV community fundraise for the incredible dispensing machine.  The community spirit that was evoked by the First Wave was really humbling, and no amount of Thank You messages will truly convey how much this meant to us when things were hard.

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We prepared for First Wave as if preparing for War.  We tried to cover all aspects we might need and prepared for the worst, expecting the NHS to be overwhelmed very swiftly.  The reality was that, at the peak, the NHS coped and the danger abated for a while. The First Wave battle had passed, but the war continued…

Dr Emma Watts

Happy New Year from all of us at the Surgery!

This time last year none of us really knew what was ahead of us, and I sincerely hope that 2021 brings us a widespread vaccination programme and that life can gradually return to some form of normal.

At the time of writing, Pfizer vaccine is being given from Royal Surrey County Hospital and other sites that can accommodate the cold chain demands of the vaccine. We are hoping that other vaccines will be licensed shortly as these are the type that will be deliverable from the surgery similarly to our seasonal flu vaccine programme. We have doubled our refrigeration capacity in anticipation.

Please watch our website, Twitter (@ShereSurgery) and posters at the surgery for updates.

Regarding seasonal flu vaccination, you will remember we ran out of vaccine and applied for more to cover the new cohort of 50–64-year old's. We were lucky to be sent a top up delivery. Surprisingly uptake of the vaccine was poor, with only 16% of the eligible population taking up the offer of the vaccination. We have spare vaccine, so please do contact us if you wish to be vaccinated and we will try to fit you in if possible. We had hoped to do these vaccines in our saturday clinics so as not to block our weekday nurse appointments, but we were unable to even half fill the final saturday clinic. 

Please can everyone be careful on the pavement outside the surgery. This has become quite bumpy due to tree root disruption. Shere Parish Council have offered to contribute to works undertaken by the council, but there has been a significant delay. In December, despite us keeping the path free of leaves twice weekly, we had two patients with significant head injury from falling. I have been reassured by Surrey County Council, after members of Shere Parish Council helped highlight the issue, that the work will be prioritised. Please tread carefully in the interim, especially as we head into the season of ice and snow.

At the time of writing, we are running at full capacity at the surgery, with a significant increase in demand compared to the same time in 2019. This increase in demand is reflected nationally, but leads us to have some concern with the busier months ahead. Please bear with us if you feel we are responding slower than usual. 

Finally, the Dispensary machine has been really active, and we have had lots of positive feedback from patients. Please do remember if it is your first time using it, there is a video on our twitter feed running through how it works. Our dispensary staff are happy to pop out and help anyone who is not sure also.  Thanks again to SALV for fundraising for the project, I really do think it will be a godsend through the winter months.  Now the install is complete, we are slowly working to improve the planting outside the surgery for everyone to enjoy.

We look forward to 2021 being another really strong year for our community, and very much hope it leads somehow to us all being able to celebrate the positives that came from facing a pandemic together.

Wishing you a happy and healthy New Year,

Dr Emma Watts

At the time of writing we are approaching Christmas with uncertainty about what will happen after lockdown. Things are busy at the surgery with appointment demand at mid-winter levels. We may be told we have to be open on the Bank Holidays over Christmas and New Year (as with Easter and other Bank Holidays earlier in the year) but we are hoping our staff can have some well-earned time with their families. We currently plan to be closed on Sat 26th Dec. Due to increased demands at Christmas we request you put in your repeat prescription requests as early as possible. 

As we progress through the second wave, with patient demand already at high levels, we are seeking advice on how to manage when we reach capacity for safe practice. We will update you when possible, but this may involve a traffic light system or a scaling back to urgent services. We await advice.  

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Covid vaccination has featured heavily in the media. Although it is an exciting development, we have no certainty yet. We were asked to provide an 8am-8pm 7 day a week service, on top of our normal roles, with no additional staff available as our staff are working at full capacity. The service required to achieve this would dwarf our busy flu clinics. We are 100% committed to ensuring safe delivery of an effective vaccine and are working hard at trying to design a service which can be responsive as soon as a safe and effective vaccine is available. 

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The DVLA are struggling with backlog and have started writing to patients suggesting that their GP can verify their fitness to drive. This puts us in a difficult position with our patients, whose expectations have then been raised, as we are not trained or indemnified to do this. An error in deciding fitness to drive could have catastrophic consequences, which is why there are doctors specifically trained in this area. Unfortunately this has led to patient upset recently. If you have been diagnosed with a condition that legally requires you not to drive, we cannot override this, even though we have a huge amount of sympathy for the consequences, especially in our rural area. 

Finally, some happy news… The dispensing machine (nicknamed Brenda the Vendor) was finally installed in November and we are currently learning how to use her! We have had a lot of fun loading up, and watching patients do a collection. Initial feedback is great. (Please bear in mind you only have 60 seconds to push the flap open and retrieve your medication once it has been dropped into the tray).  We are already seeing benefits, for example at 7pm Friday, when we were closed, I needed to give an urgent prescription out, so I loaded it into the machine, and the patient’s relative came to collect. I hadn’t foreseen this additional benefit.  

2020 has been an extremely demanding year for the surgery. The one enduring positive throughout has been the feeling of community, and the support we have had. Thank you to SALV and all donors to the innovative Pharmaself project, and thank you to all of you who have been supportive and understanding, as we try to do our best for you in challenging circumstances. We wish you all a Merry Christmas and a Happier 2021.  

Dr Emma Watts 

At the time of writing, we are heading into the second wave of Covid-19, but so far local services are coping.  We will continue to keep you updated via our website, and via Twitter (@ShereSurgery).  You may have seen nationally there are issues this year with regard supply of flu vaccines, together with the expected increase in uptake this year. We started talking about the importance of this year's campaign back in the August issue, but I am disappointed to report that, at the time of writing, all of our promised stock has been allocated to patients who are on the vulnerable list.   We do have vulnerable patients who have NOT been vaccinated, and I can assure you we are working tirelessly to access further supply to cover this population. We will post updates on our website, on Twitter, and on noticeboards at the surgery. You may have seen the Government announce some time ago that a new cohort (healthy 50-64 year olds) would also be offered a flu vaccine this year. If we are allowed further supply, and if we have vaccinated our vulnerable population, we will put on further clinics to vaccinate this group. Again, please look out for further updates. 

We have also struggled recently with a national supply problem of blood test reagent. We believe this has been to do with the company prioritising Covid testing kits, but the impact has been a national one, with reduction in ability to perform routine blood tests at our local laboratories.  There will be more news nationally on this, but please be aware that we may need to cancel/not order blood tests.

This year the flu clinic had to take on a different, outdoor format. We worked hard to ensure these have run smoothly, avoiding queueing by running as seamlessly as possible.  I feel extremely proud of our team for delivering over 1500 vaccines safely.  I also feel proud of our patients, for understanding the difficulties, and embracing the change in system with good humour!

If you are passing the surgery, you will see we now have builders fencing surrounding the Pharmaself installation site. We have had numerous hiccoughs along the way, but work is now in progress. I really hope that by the time this is published we will be almost ready for the machine to produce it's first prescription!  The strength of community spirit allowed this project to come this far, and we really hope it will allow easier access to medicine, especially over the winter months, and substantially reduce the need for queuing.

Finally, a goodbye.... Sarah Ingram retired as Dispensary Manager at Easter 2020. However, we were mid pandemic and as the incredible team player we know her to be, she swiftly shifted her retirement in order to try to help us get through those difficult first few months.  Finally, we said Good bye at the end of August 2020...although she has been back covering a few shifts here and there!!! Sarah worked at Dispensary for 25 years. She has been a highly valued member of our team, and remains a highly valued member of our local community.  For me, I think the fact that Sarah struggled to leave us at a difficult time, and the fact the we struggled to let her go says everything about what she has meant to us in the building. Sarah has helped new Dispensary Manager, Sharyn Mackay, to settle in to her new role, with a really supportive handover in order to ensure the service runs smoothly through the second wave of Covid-19. We will miss Sarah greatly, but wish her the very best in retirement. 

Please continue to keep an eye on our website/Twitter/noticeboard for updates on the evolving pandemic.

Dr Emma Watts

As I write this we are feeling disappointment with the media portrayal of GP work during the pandemic. The suggestion that we are not seeing patients is frustrating for our staff, as we are currently running at winter appointment levels, near full capacity. Whilst I believe some practices did close their doors, we have continued to see patients face to face throughout the pandemic, where appropriate. In order to protect both patients and staff we have reduced face to face contact to only when needed, using other methods where possible. We purposely chose to set up our HotPod in the garden because we wanted to assess you ourselves, as we feel we know you best, rather than sending you to a HotHub elsewhere to be seen by a Doctor you don't know. As soon as we were able to reopen after our deep clean, we brought nonCovid patients into the building to be seen where appropriate. We have had lots of positive feedback from the community, and some frustrations expressed about the imposed new ways of working, which we completely understand.

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As we move toward winter, we will have to slightly rethink the HotPod, as the weather becomes colder. We will update you next month.  We now have amended planning permission for the Pharmaself machine, and the access ramp is under fabrication. This will need to be in place prior to installation, as the machine itself is heavy to be moved into the building.

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We were delighted to see so many of your faces on Zoom at the recent SALV Autumn Meeting. Whilst it was not the same as meeting in person, we loved seeing you all, and having the chance to update you on many (not all) of the things that have happened at the surgery over the past 6 months. Thank you for attending, and for your continued support.

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Currently, Covid-19 infection is increasing in our area, and we expect this to continue. Please keep an eye on our website for updates. Dr Wardrop has kindly created an infographic to advise parents on how to manage unwell children as winter approaches. This is aimed at answering some of our current frequently asked questions, so that hopefully we can reduce phone calls around this.

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Finally, we look forward to seeing you at Flu Clinic. We are trying to make it as jolly as possible, despite being outdoors and potentially cold. There will be hot drinks available to purchase. Many of our patients have said they are looking forward to seeing friends in the queue, and we find this really lovely, but PLEASE remember we need to keep socially distanced in the queue. We will be on hand to remind people, but it will reflect badly on us as a community if we don't achieve safety at the Flu Clinic. I'm looking forward to seeing you in person too, and will be interested to see how the new style of clinic works out!

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Please continue to watch out for each other as autumn approaches and the weather becomes less favourable.

Dr Emma Watts

When you read this then, pandemic dependent, schools will be hopefully be returning, and we will be heading toward winter.  Summer at the surgery has been a hot and busy one, with high demand, and more complex turnaround with distancing measures. Our staff have coped admirably with wearing plastic visors,  scrub hats, plastic aprons, gloves, and of course, masks, in the heatwave.

A few updates:

Leaving our practice boundary
We often get asked by patients who are leaving the area if they can stay on as patients at Shere. This is a source of great encouragement for us and shows we are doing a good job as a practice. Indeed, in the past, the practice was able to keep patients on despite them moving outside the practice boundary.
However in the current climate, particularly as a rural practice, this is not practical, and sometimes might even be unsafe as we only have enough resources to look after the patients in our designated practice boundary which already covers 45 sq. miles,  [as set by the Clinical Commissioning Group (CCG)].
Furthermore, there is no NHS funding available to extend the building and accommodate more patients and staff – we are already at capacity at present. In addition, in common with most other practices, we already have difficulty recruiting staff for our existing area.
Sometimes a move may not seem geographically very far out of our boundary but causes safety and logistical concerns due to being served by different community services to the ones commissioned by our CCG with whom we normally correspond, have regular meetings, and streamline referral pathways.
It would not be fair to patients who live in our area to experience difficulty receiving medical attention because we are overstretched by caring for patients who live outside our practice boundary.
Please do not be offended when we have to decline such requests but it really is the only fair, and safe, way of operating.
It is important to note that existing registered patients who are outside our boundary, based on historical agreement of a previous partnership, will not be affected. 

Flu Clinics

There was an expectation of a centralised response to coordinate the flu vaccination programme this year, but thus far we have heard nothing, so are moving forward with our own plans. We have little time, so I am sharing our provisional plans, but please be aware these are subject to change.

Our nursing team have our staff and patients well trained to deliver a swift turnaround on vaccination. This year we will be limited by social distancing. We plan to deliver the vaccine in the Covid HotPod, set up in the carpark as a two lane walk through service. We are trying to create a more jolly atmosphere by demarcating the socially distanced queue using bunting, made from spare shirts from our early shirt campaign. (We had hoped for 50 shirts, were donated about 400, and subsequently were donated washable handmade gowns). We wanted the shirts to be a reminder of the kindness of our patients, donating the shirts from their backs, and we hope that you feel happy the spares are being repurposed as a further part of the pandemic effort.

There will be separate clinics for the Over 65's and Under 65's, as the vaccine is different, as are delivery dates. We will make separate arrangements for those too frail to queue in a wheelchair. The new cohort of all Over 50's, added by the Government recently, will NOT be part of the above plan YET as we ordered our stock according to our eligible population. We have not been allocated any additional vaccine stock for the additional cohort, and will prioritise the MOST vulnerable. If/when the Government guarantee us further stock, we will simply elongate our campaign until we have everyone vaccinated. Clearly we are expecting a huge increase in uptake this year.

Provisional dates: provided our stock arrives on time we will have 500 vaccines for Over 65's on 3rd October, and 200 vaccines for Under 65's on 10th October. There will be more dates announced as and when we have more information. We are not yet booking, but keep an eye on Twitter, our website & posters outside the practice for updates.

If a centralised vaccination plan emerges the above may change, but our plan is to celebrate the best of our community spirit by trying to keep our clinics as close to normal as possible, and make the best of the difficulties.

Pharmaself Dispensing Machine

I have been lucky enough to see a sneak preview of the machine facia, in British Racing Green....it looks fantastic! We are currently awaiting an amendment to planning permission for the access path, which needs to be of stronger build to cope with the installation weight of the machine. All contractors are poised for action once this is approved. 

Don't forget to sign up to use the Pharmaself machine, using the form available on the website or from Dispensary.

Finally, we were delighted in August to receive a donation of £111 from Sophia & Sebastian Ackroyd and Arabella & Oliver Hill. They had washed cars, and painted pebbles to raise money to buy us 250 masks, as we were struggling to get PPE. There have been many humbling moments through the pandemic so far, and this was certainly one of them. The fact that four young children were prepared to use their time and energy to help to protect our staff brought tears to our eyes. Thank you, you are clearly going to grow up to be wonderfully selfless individuals of whom we can all be proud.

I apologise for the length of this article.... I am longing for a quiet month in General Practice! In the interim, please continue to look out for each other.  Our strength is community.

Dr Emma Watts

As lockdown continues to ease, we would encourage everyone to remain mindful of social distancing, and the reasons for it.  We are gradually returning to normal service at the surgery, but are still aiming to only see patients face to face when absolutely necessary. This is for our safety, as well as yours, as the healthcare profession have been more unwell with Covid-19 due to higher viral load exposure from sick patients.  We need to protect our workforce as best possible. You will notice our turnaround is slower between patients due to enhanced cleaning processes, and changing PPE.  We are being supplied 50 masks per week as our NHS allocation, which is inadequate, but are currently still able to purchase what we need.  

We are delighted to inform you that our planning application was approved for the Pharmaself machine. It has been ordered, and we are hoping it will be installed in the next 4-6 weeks.  This will hopefully dramatically reduce the queue for Dispensary, which will be lovely as queuing without seating in hot/cold/rainy weather is less than ideal. 

We are starting our advance planning for the 'flu vaccination clinics. We have been told to expect far higher demand this year for obvious reasons, and our usual format of 300 appointments each saturday morning at the practice will not be possible, due to social distancing and PPE restrictions.  We have a few ideas for how we might run the service efficiently, in order to safely deliver the vaccine, but I am raising this now so that you can ensure you keep your eyes out for notices about the new plans, which are likely to be dramatically different to previous years.

Finally, a huge Thank You to those who supported my daughter Sienna and I with our Virtual version of the cancelled 125 mile Devizes to Westminster International Canoe Race 2020. We raised £5648.75 for the Royal Marsden Cancer Charity, and we are featuring in their August magazine as their most successful lockdown fundraisers! In addition, we have been nominated for The Pfeiffer Cup, which aims to reward fundraising as a motivator for completing the race.  Thank you all for your support.

Dr Emma Watts

Again, it is hard writing this as I’m not sure what Covid-19 will be bringing us by the time of publication.  We are following guidelines with the idea of getting the building up and running efficiently as quickly as possible, but we have continued to manage numbers of appointments as before Covid-19.  We have achieved this by consulting remotely, reducing face to face contact to essential only.  We have missed seeing you, but have loved having video consultations, where we can see smiles again. It has felt amazing to have a video consult with someone who stops in the middle of their run with their dog in the woods to chat on video, and use the camera to help demonstrate the problem.  Innovation appears to have evolved from this difficult time.

I have been asked to talk about numbers of cases in our villages, but I am unable to as we are only just getting the results of testing sent from the test providers into our computer system.  The likelihood is that actual case numbers will exceed the test positive numbers for a multitude of reasons. However, I can completely understand why this is information that is pertinent. Obviously we are aware of the patients that we have lost, and our thoughts go to their families. Equally, we have had some patients who have been extremely sick who have made incredible recoveries, and this has been brilliant as a morale boost, so amazing to see.  General population estimates for our area will probably take many months to generate. Anecdotally though, I feel we have been relatively spared compared to other areas of the UK.  Certainly Royal Surrey seem to have coped well, and Intensive Care & high intensity care has been able to match demand. Overwhelming the NHS with a surge was one of the main worries as we planned services, but so far locally we have coped, hence we hope that going forward case numbers remain low and predictable.

The update on the SALV Dispensary Machine project is that we have so far had one comment to the council, which was one of strong support, Thank You!  The council have indicated that they are hoping to complete the planning process quicker than the normal projected time, and we are grateful for this.  We have been organising the building aspects in anticipation, with the hope that we can progress as soon as we get a green light.  Initially, when we proposed this idea, it was as a response to the immediate problem facing us, but as time has passed it has become more apparent that there will be a new normal going forward. None of us like seeing the 2m distanced queue along our pavement, and the thought of this continuing into winter is unimaginable, so I truly hope that SALV’s expedient response to the pandemic will deliver a long term resolution for all.

If you follow us on Twitter you will have seen the picture I posted showing the volume of wasted medication.  Strangely, we are finding currently that people are requesting medication, but after 2 months haven’t actually collected it? This is tricky because we are still struggling with medication issues around Brexit. Whilst we understand issues around shielding etc, we have an incredible community support network, so nobody should feel unable to receive medication. Please contact us if you are struggling and we will find a solution.

Finally, a sad goodbye.... Cathryn Bovingdon has been our Business Manager for 16 years, but has progressed upward through the practice since she arrived as a young dispenser!  Throughout, she has been utterly dedicated to issues surrounding rural dispensing, progressing to being an absolute advocate for retaining the integrity of General Practice as an independent arm of the NHS.  Politics, and the fear of erosion of the continuity of care that is pivotal to what makes General Practice valuable, are beyond the scope of this article, but it is important to note that Cathryn has been a stalwart, encouraging neighbouring practices to adopt a Shere model. Cathryn’s children have now flown the nest and she is moving to a business development role nearer to home.  We will miss her desperately, but are delighted to announce that Tamsin Barnard will be moving from Deputy, to Practice Manager.

Finally, please continue to be considerate to each other. We have been humbled by the community spirit we have witnessed, which has helped us deliver person centred care at a tricky time. We will definitely need a time to reflect on all the wonderful positives once this is all over, but in the interim, please continue to look out for each other.

Thank you, Dr Emma Watts

In late April SALV started on the ambitious task of raising over £40,000 to supply Shere Surgery with an external wall dispensing machine so that patients could collect their prescriptions 24/7 and avoid unnecessary queueing in the Surgery with the potential risks that entails. I had expected this to be a long-term project, but thanks to the amazing generosity of our community we have already received, or had promised, our initial target – a truly amazing local effort of large and small donations. Sincere thanks to everyone. The next step will be to await planning permission for the installation, and thereafter we hope the project can move forward quickly. A typical dispensing machine is pictured left.

Our next initiative, which will be a longer process, is to try to secure superfast broadband for the Surgery through B4SH, Broadband For the Surrey Hills. It would be good to identify a small group of Shere residents to act as ambassadors and to keep up the momentum. Everyone wants superfast broadband and our hope is that by maximising local support we can move the project forward and get the Surgery high on the waiting list. If you are interested in becoming involved or finding out more, please contact me at adrian@gooserye.com

Adrian O’Loughlin, Chairman

Writing this article for the past few months has been extremely difficult, as everything seems to be changing so fast. I would continue to point you towards our website, www.shere.surgery@nhs.net">www.shere.surgery@nhs.net, and www.nhs.uk for up to date advice on Covid-19. We have had lots of patients who have recovered from Covid-19, some of whom required hospital admission and some of whom remained at home throughout, and it has been lovely to see these positive outcomes. We have sadly had some losses too, and our thoughts are with the families of those who have lost a loved one.

In the HotPod, our outdoor tented consulting room set up in the Surgery garden (which we told you about last month), we have been able to use one of our scanners to scan lungs if appropriate, and have used the facility to decide if we can manage people at home or if we need to admit them to hospital. But we are still being advised to see patients face to face only when absolutely necessary.

We have been using phone and email to consult, but in May we have been excited to introduce secure video consultations. These are great as we can see you, and you can see us, which is nice at a time when things can feel a little lonely. We have been stunned to see how much we can “examine” on video with the help of patient and family, and we feel this has been a great development.

The Dispensary is still closing at 4.30pm to allow them time to catch up with the increased demand. This was a national directive, allowing all pharmacies to reduce opening hours and give them time to get the medications ready. Please continue to be patient with them – they are working as fast as they can – with many staff doing additional hours.

This crisis has highlighted the incredible strength of our community spirit. As a response to the demand on Dispensary, we have come up with a solution that will take us forward, and SALV has managed to raise funds to pay for this in an extraordinarily short time (see SALV report above). This machine will really put us at the forefront of General Practice. We were also stunned to have been given a substantial donation by Hilly’s Tea Room, who raised funds by selling cakes (and delivering many to us – yum!). We have used the money to buy our own PPE in order to protect our staff, and we are truly grateful to all donors to both of the above projects. In early May I also took delivery of 500 masks imported for us especially, and donated by Shere Village Cinema. The generosity we have received has been truly overwhelming. Thank you all so much.

Finally, you may remember that my daughter Sienna and I had planned to complete the Devizes to Westminster 125-mile international canoe race over Easter. This was cancelled, but we didn’t want to let down the Royal Marsden Cancer Charity and our sponsors, so we set up a pair of kayak machines in our back garden and completed the 125-mile race “virtually” in 20 hours, 45 minutes! The Canoe Show on YouTube picked this up and you can view it on https://www.youtube.com/watch?v=Oed6pyfIhLI ; the picture shows Sienna and me after finishing the race!

Please continue to look after yourselves and each other, and I truly hope it won’t be long before we can get together as a community and reflect on all the incredible ways everyone has pulled together during this unprecedented time for the NHS.

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Dr Emma Watts

Life in General Practice has changed dramatically. Our technology partners have stepped up, and we have been able to offer video consultations for the first time. We have made other dramatic steps forward for the NHS, such as sending sick notes as an attachment to a text message, with a digital signature!  When we do need to see patients face to face, they are being seen in our HotPod, which is an outdoor tented consulting room.  This allows good ventilation, is easier to mop down, and allows us to try to keep the building virus free for those vulnerable patients we do have to bring down. We are also using our ultrasound skills to scan patients lungs. This is usually done in hospital, and we are hoping that we can use our skills to try to pick out which patients might be at higher risk, and need priority hospital admission.  

We have been preparing for a massive increase in home visit demand, which will be challenging with our staff numbers and huge catchment area. There are significant worries about this with inadequate PPE. Many of you will be aware our appeal for men's shirts to use as gowns on visits had a tremendous response, with over 400 shirts in 36 hours (we were hoping for 50!).  Our community literally has given us the shirts from their backs, and you have no idea how wonderful it feels to be at the receiving end of this kindness. Worries about infecting our own cars, which have to carry our children, with high levels of virus were met with 5 offers of easily cleanable cars on loan, 2 of which we have kindly accepted. Again, it is difficult to articulate how valued this makes us feel. We will be using our bikes too, where possible.

We are truly blessed that SALV have been actively fundraising for our next project, as have Hilly's Tea Shop, and we will provide updates on this as soon as we can.

We are trying to think laterally and innovatively at the moment, at is hard to predict quite how the pandemic is going to hit us in our villages. Community spirit is high, and we aim to respond to the different demand by changing our service delivery as appropriate, but whilst keeping the main treasure of General Practice, which is continuity of care by clinicians who know you well.

The strength of community spirit we are witnessing is humbling, and we plan to share fully with your our experience of your support once this is all over.

Please continue to look after one another and keep an eye on our website and Twitter feed for the latest updates.

Take care and stay safe, Dr Emma Watts

At the time of writing we are experiencing a dramatic increase in COVID-19 cases. Services are currently reduced with no face to face contact. By the time this is published the hospital may be struggling and we may be managing more cases at home in the community.

In order to get the most up to date information please consult our website (www.sheresurgery.nhs.uk), our Twitter feed (@ShereSurgery) or Public Health England (www.gov.uk/government/organisations/public-health-england).

I would like to thank our community for all its support so far, for both the surgery, and for our vulnerable patients. Particularly through Shere Parish Council and by the initiative set up by Christian Staunskjaer.

We will continue to provide as full a service as we can. This may focus mainly on essential services, and the way we work may change over time as different needs evolve.

Despite this time of unprecedented stress, please remember to be kind to one another, set a good example by our own behaviour, retain integrity, & remain loyal and committed to the community in which we live and work. If we can achieve these values we will come out at the end of this pandemic with a sense of togetherness that will help us rebuild again.

At the time of writing, novel Coronavirus (COVID-19) has not yet reached pandemic status, but it may well do. Currently it is believed the virus remains viable for 9 days on door handles etc, so we need to be extremely careful in the surgery to prevent temporary closure. 

Our AskMyGP service is suited to managing this, as we have an opportunity to speak to patients before they come to the surgery, so hopefully we can prevent risk cases coming in to the building. The current advice is to phone 111 who will go through the risk template, sending risky cases to the special pod at Royal Surrey. 

For up to date information, please visit www.nhs.uk/conditions/coronavirus-covid-19

Dispensary have noticed that, for prescription queries, AskMyGP is providing a quicker response. If you do have a medication question and have internet access, please could you try to use this route for a faster response? Please also try to remember that repeat prescriptions require 3 working days to prepare. Phone lines remain open for those who don't have access to the internet.

Finally, my daughter (Sienna) & I are competing in the Devizes to Westminster (125 mile) International Canoe Race on 10th April 2020. We are attempting to achieve the fastest Women's Junior&Veteran time in the history of the race. The race starts in sleepy Devizes, onto the Thames tideway, finishing at Big Ben. We will be travelling in a wobbly boat, measuring 6.5m long by just 40cm wide. With 77 portages (jumping out and carrying boat around locks) we will run the distance of a half marathon with the boat on our shoulders during the race.

We are doing this in support of The Royal Marsden Cancer Charity in the name of Henry (one of my patients, and one of Sienna's friends), but also for all of my patients who I have cared about deeply, who have received exceptional care from The Marsden. 

If you felt able to support our charity endeavour it would be hugely appreciated. You can find out more at www.justgiving.com/fundraising/emma-watts24

January is always the busiest time of year at the surgery, and this January was no different.  We were nervous about how this would be, entering the busy season with the new AskMyGP system in place, especially as both staff and our patients are still learning how to make it work for our population here in the Surrey Hills.

So far it feels that we are coping. We have been receiving up to 180 requests per day.  The vast majority of requests have been responded to and a plan made within 90 minutes.  We anticipate this will improve as we all understand the system better.  Around 85% of patients are being dealt with by the Doctor they requested, and 93% say the new system is better than the old one (data captured up until 31/12/19).

On a personal level, I am finding I have to be mentally very nimble keeping up, but I am also feeling that it is improving my relationship with my patients.  Instead of feeling quite so fraught through the day, the service feels more personal, and more responsive, so that people haven’t been worrying for weeks before they are seen.  So many have thanked me for seeing them so swiftly, to allay their concerns or manage a problem, that it feels personally more rewarding than the slowness of the old system.

If I could offer any advice it would be that, if you are able, you access the system via the website. This allows us to respond to you more quickly and leaves the phone lines open for those who can’t use the online version.  I am enjoying being able to send a summary of a discussion via email after the consultation, sometimes with a link to a patient information leaflet, so that patients can read it again later or share it with family.  This feels like dramatic progress, but I can only do this for patients who access online.

We continue to listen to your feedback, and are working to create themes of things that aren’t going so well, so we can address these.  As well as being able to leave feedback online, we will be discussing the service at the next SALV evening meeting, and can respond to some questions there.

Finally, you may have been reading about National issues with a new GP contract attempting to force us to work more at scale with neighbouring practices. In our area this presents significant issues.  You can be absolutely reassured that we are actively engaged with the process and will not allow the local service, that is so dear to us, to be eroded.  I will update on this as soon as I am able.

Dr Emma Watts

All at the surgery wish you a Happy & Healthy New Year!

By the time you read this we will be 6 weeks in to our new computer system, AskMyGP.  I wrote about the reasons we had to make this change in the December magazine, but now for an update on the bedding in process. There has been a lot of worry about access, about how appointments can be organised, and whether patients will be able to be seen. The actual system seems to be working really well, with patients giving positive feedback about the speed of response and not needing to wait a few weeks.  As a doctor, it has felt lovely to be able to respond swiftly, having heard so many complaints about waiting times in the preceding months. In addition, the new ability to have email consultations, and longer telephone consultations has led to some really lovely doctor:patient interactions, which is really positive for doctor and patient alike. I believe we are now able to offer improved access to our working population, and those with mental health problems or other issues that make coming to the surgery more difficult. 

The feedback remains predominantly positive, but the main concern seems to be around access and understanding the system.  Ultimately, with 75% of access requests coming in through the website, it will free up our phone lines for people who don't use the internet to phone in to request an appointment.  Currently this is not working because for every phone call our receptionists have to explain the new system, which is time consuming, and keeps the phone lines busy. Once our patients have tried the system, we hope that they will have more faith in it, and as it becomes more familiar, the phone lines should become much more free. 

We are collecting feedback along the way and will be reflecting on this and addressing concerns.  We will be providing updates via Twitter @ShereSurgery, via this magazine, and via the SALV meetings. We would like to try to reassure you that our aim is to maintain a high quality service for a rapidly expanding population, whilst also being able to provide speed of access. 

In other news, I am delighted to report another award for Dr Helen Barnes. You will remember the surgery won at the National GP Awards 2018 for the Women's Health Initiative.  Dr Barnes also lectures nationally on Women's Health with the aim of improving the knowledge of other GPs so they can provide a superior service to their patients.  Dr Helen Barnes & Dr Lucy Cox (also from the Women's Health Initiative) have been producing webinars with company Red Whale, and have just won the ON24 Webinar of the Year 2019 for their Menopause webinar, beating multinational companies such as Siemens.  (ON24 is an American Tech firm that provides webinar platforms).  This is a huge achievement, their excellence being recognised despite stiff competition from very large companies.  The highlight for me, was Dr Barnes with her apron on in 'the kitchen' comparing prescribing HRT to making a Victoria sponge cake!  We are super proud of you Helen!

Finally, we look forward to helping you with New Year's Resolutions, but also remember that January can be a bleak month.  So please be kind to yourselves and make some nurturing resolutions alongside the common ones about stopping bad habits.

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Happy New Year,

Dr Emma Watts

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The big news from the surgery is the new computer system Ask My GP. The move to providing our services differently was not taken lightly, but as a response to increasing demand for access. We are all living longer, with more complex problems, whilst getting used to instant access to services. 

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I spoke about this on Radio 4's Farming Today on 19th November as it is as significant problem affecting General Practice nationally, with GP numbers falling at the same time as demand is increasing.

The old 10 minute appointment system had become unfit for purpose, & increasingly unsafe.

Change is always difficult, & it will take both Doctors & patients time to get used to the new way of working. We hope it will mean that people who want instant access, email & telephone consultation, will be helped swiftly online, keeping the phone lines less busy for those who don't use the internet.  Complex patients will be managed better, and unnecessary trips to visit us can be avoided. The service aims to manage everyone the same day, thereby avoiding the wait to be seen.

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Ask My GP told us not to announce the full detail of the change until the actual day (although we did talk about it at the SALV meeting) because we were already struggling to meet demand, and simply had no capacity to manage people panic booking appointments. 

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There will be teething issues as we work to adapt this service to suit our patients. Your feedback is important, both good and bad, so we can reflect on it and adapt. We are proud to provide services to all of our local villages. Please trust that this change was a very considered decision, with the aim of maintaining high standards, alongside continuity of care from us, a group of Doctors that you know well, rather than partnering with a faceless external provider.

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I will update you on our progress, and I will continue to represent our local needs at the General Practice Committee, UK.

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Have a Merry Christmas, & Healthy New Year!

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Dr Emma Watts