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Tuesday 27 September 2016
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A patient manager’s perspective

Feature: Practice profile

Shrewsbury Practice Manager Tony Marriott's experience of living with a long-term condition has not only given him an understanding of patients' needs but has also inspired frontline service change...

I became the practice manager of Radbrook Green Surgery three years ago, after I was medically discharged from the Army, having been diagnosed with chronic fatigue syndrome (CFS). I was seeking an appropriately stimulating job in the local community, and luckily this position became available at the right time.

What I enjoy most about the role is the variety – practice management is not a job you get bored with! I am blessed with a fantastic team of supportive partners and staff.

The partners here at Radbrook are keen to be innovative and they have given me a clear direction and the authority to invest in new ways and means to improve the patient experience. And, as it turns out, living with a long-term condition (LTC) myself has helped to inform our plans for the surgery. I have even attended an Expert Patients Programme alongside our patients.

Since I first arrived I have made it my practice to talk to patients and observe what's going on. Getting out there to get patient feedback is useful – although you do have to expect a few grumbles, as some people do not care for change even when it benefits them!

Café culture
We are delighted to have transformed our waiting area in July this year, when we opened a community space, complete with self-service café in partnership with Esquires Coffee Houses. We wanted something brighter, lighter and more welcoming, where patients could feel relaxed and are free to chat and have a coffee. We were keen to get away from the gloomy silence and stuffy atmosphere that can sometimes persist in waiting rooms.

Now, patients walking into our practice are greeted with something more akin to a modern high-street coffee house than a waiting room! The space serves as waiting area, social space and a health space for group clinics and patient
education programmes.

One of my biggest challenges recently has been managing to keep the practice open and functioning in the midst of this major refurbishment, which included the introduction of a pharmacy.

Some patients have voiced concern over the funding of the refurbishment, despite us promoting messages that the costs have not involved any public funds – the pharmacist paid the upfront costs in return for a significant rebate on his lease. The quid pro quo is that the practice benefits from a 0% loan. I am very keen to engage with patients and provide a service that patients want, but it's worth remembering the old adage about not being able to please all of the people all of the time.

Patient participation
Despite this innovation and looking at new ways to support patients, we are a very traditional practice of family-oriented GPs. The type of patients we see are indicative of the demographic in Shrewsbury – an ageing population of what might be called the 'affluent greys'. We have 9,500 patients on our list, served by five partners and three employed doctors. We have around 600 diabetic patients, including around 180 with chronic obstructive pulmonary disease (COPD).

We have developed a range of services over and above our regular GP services. We now support patients with diabetes by hosting group clinics facilitated by an expert health educator. We intend to use this successful model as a basis for similar patient groups, such as for COPD.

We have expanded our minor-surgery skills and invested in a dermatoscope so our clinicians can decide whether a suspicious mark requires referral to an oncologist or can be dealt with in the practice. We are very proud of the fact that our patient participation group (PPG) helped to secure the £1,000 funding to buy the equipment and have had a real say in the direction of the practice.

In the new cafe, the menu cards explain that profits are reinvested in the practice: 5p from every cuppa goes to the Patient Participation Fund and the balance is used to improve services. At the moment we are funding extra reception time to provide more cover at peak times to improve patient experience. We do try to put the emphasis on treating people as customers and maintaining an ethos of customer service.

Living with an LTC myself gives me a personal motivation for ensuring that our patients' voices are heard. I became ill in 1998 before eventually being diagnosed with chronic fatigue syndrome. It's had a huge impact on my life and my family: it has caused depression and cost me my military career, but it does mean I have an understanding of what it's like to be on the other side of the desk.

At the beginning of 2011, I was invited to attend an Expert Patients self-management programme by my own GP, but I wanted to attend with the patients here at the Radbrook practice, so I contacted the Expert Patients Programme Community Interest Company (EPP CIC) and they arranged a course here. It was very useful to see it both as a patient and a practice manager. I also really liked the fact that the tutors are themselves patients – that empathy is very helpful.

Since the course, I've been trying to exercise more and balance that with my other commitments. I've also been using the communication skills the course teaches: 60% of conditions are not obvious to the observer, so people simply don't understand what you're going through. It helps to be able to explain why you can't deal with something. I've also learnt about the relationship between fatigue, stress and headaches – I'd not seen that presented in that format before, and this helped me.

Support and service development
As a patient, I really appreciated the course. As a practice manager, I came away really committed to bringing these techniques into frontline service delivery. Since doing the course, one of our patients has been motivated to set up a self-help group and I am very happy to support her with that; the practice introduced disease-specific events and we got the PPG involved. We're running a second self-management course now in our new community space to support a further group of LTC patients.

One of the things we instigated off the back of the EPP CIC course was a 'Diabetes Day', where we invited all our diabetic patients to a whole day of learning and support. We were grateful to have enthusiastic support from the Shropshire Community Council who set this up and invited a range of experts in podiatry, nutrition and so on. The event was so well attended that we had to organise another one. 

Now we have developed our group clinics for diabetic patients who can self-manage within a support group and do not always need to see a doctor. This model has been so successful we are expanding that into other areas. Our diabetic specialist personally telephones and triages all our diabetics and identifies those who need to see a GP individually and those who would benefit from the group clinic. The doctor addresses the group along with other guest speakers, such as a nutritionist, and throughout the session the nurse collects patients individually to do their checks.

Obviously this cuts down on GP time – the doctor can see 20 patients in the time it would take to see just one – as well as providing a valuable support network for the patients. It's easy to see how self-management can reduce costs and improve clinical efficiency.

Customer focus
Reading all the policy directives coming out of the NHS shake-up, it's clear that patient participation will be a central element in the restructured health service. We welcome that: the more you can include patients, help them to manage themselves and provide awareness and education, the better. It's part of a cultural change in the way we work with patients, rather than 'do unto' them. The Expert Patients Programme has been an important tool in that process.

It's a matter of constantly communicating with patients and trying to respond as quickly as possible to genuine issues. The practice has signed up to a new local enhanced service, the Patient Reference Group, to improve the opportunity to collect feedback. This is all part of our commitment to patient participation and keeping customer service at the heart of Radbrook Green Surgery. It's a challenge, but one that I continue to enjoy.