Both Dr Raeburn and myself acknowledge that it is becoming increasingly difficult to obtain an appointment with ourselves due to us having to do the majority of on-call days. We’re sorry that we are unable to meet your expectations and would like to apologise for any distress which arose from your recent contact with the practice. We would however, like to reassure you that although we might not be able to provide a face to face appointment with us when you would like one, there is always a GP who is available to speak to on the telephone when this is deemed necessary and a decision will be made regarding further assessment.

The practice advertised for a GP to replace Dr Lyle several months prior to his retirement but unfortunately we have received very little response. You might be aware that in recent years the role of the GP has become less attractive to the newly qualified doctor which has resulted in conspicuous recruitment difficulties. This combined with the changing nature of disease and health care delivery has provided an opportunity to restructure health care roles to meet current and future needs. The practice recognised and acknowledged this issue as early as 2008 when we employed our first advanced nurse practitioner Diane Yates and following her success we later engaged her as a partner.

In general practice, it is accepted that nurse practitioners are competent to deal with acute illness and common conditions while delivering a good quality of care since they have received approved training in physical examination, diagnostic skills and prescribing and we are delighted to have three Nurse Practitioners – Debbie Dobbing, Julie Kirkbride and Shona Gonzalez. In addition, pharmacists remain one of the most underutilised professional resources in the system we took a decision to bring their considerable skills in to play more fully – thus we have also recently employed a Clinical Pharmacist, Richard Thompson, who commences work next month. As an interim measure we are also engaging locum GPs and nurse practitioners to assist in our ability to assess patients properly and in a timely manner. Wherever it is possible we endeavour to utilise the same group of practitioners and in the last few weeks we are pleased to have employed a GP Dr Mark Pritchard for one regular afternoon a week. In the spirit of medical training we will also be intermittently hosting a doctor who is at an earlier stage in their career and who will be holding surgeries and seeking advice from GPs in the same manner as our nurse practitioners.

We are committed to providing the very best service to our patients and will continue to develop the primary care team to optimise efficiency and to cope with the demand to provide our patients with appointments. Sharing our ability to deliver care with other professionals enables GPs to focus on co-ordinating care for people with more complex conditions. Therefore, at times, the first point of clinical contact within the surgery will not necessarily be a GP – but in the same way that a GP would recognise that a referral to a hospital specialist is required to manage a patient’s condition, a similar escalation of referral can be made within the practice. The prioritisation of the referral will vary according to the urgency of the clinical condition e.g. the nurse practitioner might request the GP to see the patient during her consultation, advice might be sought contemporaneously over the telephone or in writing using the practice computer system within the personal medical records or alternatively, a recommendation might be made for the patient to be assessed by a GP as a telephone consultation or face to face. In the future we might also explore the possibility of using Skype to consult, as this has already been utilised in UK primary care.

We appreciate that for our patients (and to some extent our administrative staff) this is a significant departure from the historically well-established and noble tradition of a GP undertaking all care from ‘cradle to grave’ and for this I am truly sorry. I would have personally loved to have endured in this role for it has been a privilege to serve my patients at The Coatham Surgery and to have provided such a personal high level continuity of care. However, the changing face of General Practice has thrown down the gauntlet to primary care and The Coatham Surgery is determined to meet the challenge in order to ensure that we are able to maintain high standards of care in the delivery of a quality service.

Dr E J Summers