Slough GP practice staff discuss challenges and the future of GP surgeries

It is a challenging world for GP surgeries and their patients; pay disputes and junior doctor strikes have been adding pressure, and face-to-face appointments are not as common as they used to be.

Though some are dismayed by this change, a practice in Slough is keen to highlight the positives – and its staff have called for ‘patience and compassion’ from both patients and medical professionals.

Dr Kesar Sadhra, Slough GP and managing partner at Manor Medical Centre, has been working as a GP for decades, and has seen the landscape shift.

Workloads for GPs and demand has ‘undoubtably increased’ post Covid for ‘a number of reasons’, he said, including ongoing and chronic ill health and mental health needs.

“A significant number of GPs have retired and reduced hours because of the pressure,” he said. “Having said that, there is clearly a drive to increase the number of clinicians.”

In addition, world events have fundamentally altered the way GPs do things. Covid-19 ‘changed the landscape permanently’, said Dr Sadhra.

Face-to-face appointments have increased since Covid, but are ‘nowhere near’ what they were pre-pandemic.

But this is largely because of changes in technology and culture – not, as people think, a reduction in available appointments, he said.

Video consultations and the ability to send encrypted photos of symptoms for the doctor to examine have changed how patients receive help and made it more efficient, said Dr Sadhra.

“Face to face consultations are a relatively small amount of the overall picture,” he said.

Indeed, the surgery has offered a staggering number of consultations, including digital and phone.

In one data snapshot, Manor Park offered 7,200 consultations in one month – 659 per 1000 patients.

“When you look at these figures, you can’t possibly say it’s not accessible to patients,” said Dr Sadhra.

Samreen Aslam Raja, primary care lead at Manor Park, seconds this. She is also programme lead for Central Slough Network Primary Care Network

She supports five surgeries within this – the biggest primary care network in Slough, with more than 52,000 registered patients.

“We do offer a huge number of appointments. There are more portals now than there have ever been,” Sam said.

“We’re now making [face to face] appointments for the people wo really need to be examined.

“Often, people are under the impression that they need a face-to-face appointment for their particular problems when it is not the case,” Sam continued.

“There’s no difference between a digital consultation and sitting in a consultation room.”

Sam said that while patients tend to prefer what they are used to, they have shown an openness to try things a different way, if they are ‘educated and empowered’ to do so.

As well as the ‘stress and pressure’ on doctors and staff at GP surgeries, there has been a ‘massive’ spike in mental health need among patients in the past two years – so ‘patience on both sides’ is required, she said.

“We need to understand people’s frustration. I think that compassion is very important,” she said.

Communication is a key issue in Slough, which has ‘unique challenges.’

“One of the biggest challenges is we have a significant migration and BAME cohort not able to speak English,” said Sam. “It’s an unseen, unspoken challenge.”

For example, in November 2022, the surgery received tens of thousands of calls – a large spike, partly due to Covid-related mental health needs and partly due to language barriers.

Callers were unable to understand the recorded list of options spoken in English and would simply press a random button trying to get through to someone, then when they were unsuccessful, would hang up and try again.

The surgery is working hard to reach more and more people for whom English is not their first language.

It has translated patient information into about 100 languages, hoping this will reduce the need for people to book a GP appointment for simple medical advice that will allow them to self-care.

There has also been an attempt to tackle general lack of knowledge about what basic healthcare exists – patients are sometimes unaware of tests like pap smears.

“We’re doing a lot of education. All these little pieces of work will have a major impact on people’s behaviour, understanding and self-care,” said Sam.

GP surgeries are also trying to reduce the pressure on A&E departments – which are facing ‘a great deal of pressure,’ said Dr Sadhra.

One way to reduce strain on both A&E and GPs is to make as much use as possible of the multi-disciplinary team based at the surgery.

This includes a physiotherapist, paramedic, pharmacist, social prescriber and nurse practitioner.

Diabetes checks and certain kinds of testing, including some lung tests and cardiology check-ups, can then be completed at GP surgery rather than hospital by clinical pharmacists and nurses, meaning this work does not fall to GPs.

This is helping ‘immensely’, said Dr Sadhra.

Also helping is the mental health help option introduced into the 111 service, which is ‘quite vital’.

NHS Frimley (which runs Manor Park and other local surgeries) is ‘improving its working relationship’ with 111.

Among other things, 111 books appointments in designated slots at GP surgeries for patients it has identified will need them.

• Residents of Slough with minor illnesses needing same day care such as chest infections, skin infections, or urinary tract infections can now be seen locally at the new Urgent Care Centre.
• Frimley Health and Care has launched a pilot service in Priors Close to increase access to same day urgent care.