Proposed Catchment Area Changes

These changes will not affect any current registered patients (or their families registered at the same address).

Where are we at?

We have become victims of our own success with the largest growth of any practice in North Central London and we are now the biggest single practice in the North Central London NHS region. We are currently at over 22600 patients whereas around 6 years ago (2016) we were around 11000 patients.

Why has this happened?

Some of the list size increase has arisen due to recent local developments. The largest developments locally, however, are yet to occur. The developments completed to date locally would only amount to 10% of the increase in list size. This is supported by the modest increase in list size demonstrated by neighbouring practices. The majority of the increase in list size is due to other factors- a result of retention of existing patients and word of mouth prompting new patients to join. 

What examples can you give of areas of good care?

Although we have grown tremendously, we have done our utmost not to compromise the very best level of care that we can offer via the NHS. This has been demonstrated in a many quality areas:

• Regionally we have some of the lowest A&E attendance rates
• Low 111 utilisation
• Low rates of hospital admissions
• Nationally low prescribing costs and we excel in prescribing areas such as antibiotic stewardship. 
• We have some of the highest levels of face-to-face appointments and GP appointments
• High levels of staff retention
• Highest smears rates locally
• Highest  utilisation of teledermatology and  consultant advice and guidance to support prompt and optimum patient management 
• 24 hour provision of eConsult 

Are there any other factors?

As you may be aware, there is a severe and chronic lack of staff particularly for General Practitioners and Practice Nurses. We are keen to support the NHS train up the next generation of General Practice team members.

We therefore currently have 3 fulltime GP trainers (with another 2 due to be approved imminently). GP registrars typically have longer appointments during training. This longer appointment duration is very popular with patients however it does obviously reduce the number of appointments possible per session. This obviously makes it more difficult to provide adequate appointment numbers with the number of rooms available.

Until recently we provided training for Medical Students- very reluctantly we had to stop this due to the intense pressure on rooms. We would be exceedingly reluctant to further extend this to the placements we are still currently providing (GP trainees and a nurse trainee). We firmly believe that training the next generation of clinicians is crucial for the long term feasibility of the NHS.

What have we done to help make the best use of the space we have? 

In order to maintain the quality of service provided to date, we have had to take on new clinicians. This has obviously increased the number of clinical rooms required. We have maximised our current premises over the last few years, converting a number of admin and storage areas (and in one case even a toilet) into new clinical rooms. The practice building is leased from NHS Property Services and therefore, despite not owning the building, as a Practice we have been obliged to spend core / central funding (that could otherwise be spent on clinical sessions / appointments) getting these rooms converted.

There are no further realistic opportunities for additional clinical rooms- any space that could have been converted into a clinical rooms, has been done. We have tried, so far without success, to find an additional or alternative venue. Even if we found such a venue we would be reliant on approval being given for the extra funding required to rent the additional / bigger building. We are open most weeks 6 days a week. We are allowing our clinicians to respond remotely to eConsults. We are exceeding our extended access requirements by about 25%, having some clinics starting as early as 7.30am and finishing at 8pm on 4 out of 5 weekdays.

We have considered working from home for clinicians (several admin staff already do this) however this has not been popular with team members. It also relies on adequate provision of laptops/ wifi and clinicians having an ergonomically appropriate / confidential place to work from at home. Those that have tried working from home have asked to come back into the practice to be able to do face to face sessions as neither the patients nor clinicians found dedicated telephone consultation clinics (with no option of conversion to face-to-face if required) universally appropriate.

A recent Estates review confirmed that we have a significant number of clinical rooms fewer than we need and that this deficit is only going to get worse as the list size increases. The recommendation of the estates review was that we should convert an existing space into a number of sound-proofed “telephone consultation pods” however consulting in this way would preclude patients from being examined, prevent patients booked into those clinics from being seen face-to-face if required. We strongly believe that for the majority of consultations the best modality is a traditional face-to-face appointment. Nationally there has been understandable concern about patients being unable to see their GP face-to-face and it therefore seems particularly unsatisfactory that a transition away from face-to-face appointments is being put forward as a solution to the lack of clinical rooms.

We feel that ultimately we have done everything possible to maintain the high current level of service with the existing premises however we are rapidly approaching a point at which we will no longer be able to accommodate such a drastic lack of rooms. 

What else can be done?

In the current absence of short to medium additional suitable estates solution we have 2 main current ways forward:

1. We could drastically change the way we do things. We firmly believe that allowing patient’s choice in how they access services is not only preferable for patients but is safer and reduces inequalities of access. We could, like many practices, introduce a triage system whereby all access undergoes an initial assessment (typically via online forms). This enables sign-posting into dedicated face-to-face clinics and telephone clinics. In doing so however it dramatically reduces patient choice. It also relies on the triage system being successful and efficient and not booking patients in for telephone consultations when they actually require a face-to-face appointment. 
2. We can look at ways of trying to slow down our growth. It is for this reason we are proposing to reduce our catchment area.

How will this affect me?

Just to clarify, these changes will not affect any current patients (or their families registered at the same address).

The changes would, if anything, have a positive impact on the care provided to existing patients, enabling us to avoid a transition to the sub-optimal system detailed above and enabling us to maintain the level of service and care provided to date. The changes would mean that some prospective patients on the peripheries of the current catchment area, currently able to register would not be able to.

In some cases, however, this would actually result in their care being better. Many of the community providers (mental health, district nursing, community heart failure clinic etc) are organised not according to location of GP practice but according to the borough the patient resides in. While we meet and work closely with our colleagues in Camden as part of integrated teams, we do not have the same systems in other boroughs.

Increasingly General Practices are seen as part of a bigger, multi-disciplinary integrated team. These teams, however, do not cross the Borough boundaries and therefore patients  wanting to find a GP practice living in other Boroughs will increasingly find that they are generally better served by a GP practice based in that borough, with better access to domiciliary and complex mental health services in addition to complex multidisciplinary teams such as Heart Failure nurses and other local specialised teams.  

In effect the changes proposed are to help us maintain our current high standard of service provision and prevent, through necessity, the introduction of processes that reduce patient choice and reduce the safest modality of consulting  ie face to face. 
Just to clarify, these changes will not affect any current patients (or their families registered at the same address). 

There will only be a small minority of prospective new patients affected, primarily those who are mainly housebound or those requiring more complex local care services as such as domiciliary care provided by the district nurses. Obviously, the secondary effects of these changes may disincentive new patients to register and in doing so slow the growth.

How can I feedback any concerns I may have regarding the proposed changes directly to the practice management?

We welcome any feedback and you can do this completing the following survey (paper copies in the reception) or if you prefer you can do this via our online form, or via post, or you can drop a physical letter to reception.

Thank you for your continued support and understanding.

The Partners, West Hampstead Medical Centre

Published: May 4, 2023