What should I expect from my G.P Dr Mohammed Abedi

1. What should I expect from my G.P? Dr Mohammed Abedi

2. Who did I ask? My Patients Group(disabled, hearing/sight impaired, BME, NES) Annual Practice Patients Survey. Recent Enfield wide patients survey conducted by Enfield Primary Care Trust. Over 50’s Forum Chairman Enfield. Patient LINKS representative for Enfield. Myself Slide 1: It would have been much easier for me to tell you what GP’s think their patients should expect but I felt it was important that this talk be patient centred. That is why I asked the patients. What I wanted to concentrate on were patient expectations of a 21st century GP in a 21st century setting. LINKS Patients liaise with primary care organisations and are actively involved in decision making. Slide 1: It would have been much easier for me to tell you what GP’s think their patients should expect but I felt it was important that this talk be patient centred. That is why I asked the patients. What I wanted to concentrate on were patient expectations of a 21st century GP in a 21st century setting. LINKS Patients liaise with primary care organisations and are actively involved in decision making.

3. “To see a Doctor when I need to see one” Appointments No half day closing No lunchtime closing Extended hours for patients who work Named Doctor Slide 3: Appointments—Patients want to get to see their doctor within a reasonable time; not weeks, but rather a few days, or, in the case of a person who is unwell, a few hours if possible. Appointments need to be structured accordingly. And it doesn’t always have to be a Doctor. More often than not a Practice Nurse can deal with the problem, and patients need to be educated about this. The issue of a Named Doctor: This is ok For routine appointments i.e. Those that can be booked in advance. For emergency/on the day appointments, this may not always be possible.Slide 3: Appointments—Patients want to get to see their doctor within a reasonable time; not weeks, but rather a few days, or, in the case of a person who is unwell, a few hours if possible. Appointments need to be structured accordingly. And it doesn’t always have to be a Doctor. More often than not a Practice Nurse can deal with the problem, and patients need to be educated about this. The issue of a Named Doctor: This is ok For routine appointments i.e. Those that can be booked in advance. For emergency/on the day appointments, this may not always be possible.

4. “A Doctor who listens” Slide 4: There is nothing worse than walking into a consulting room and not getting any eye contact from the doctor. You knock on the door, to be greeted with “Come” and to find the doctor sitting looking at his computer screen. And he continues to do so throughout the consultation. I’ve been guilty of it. Sometimes, due to our pursuit of a multitude of targets we can obsess about the computer and what we are asked to put into it. This occurs at the expense of the patient. I remember as a GP registrars in my training year we were required to produce a video of our best consultations. One trick I learnt at the beginning was to try and listen to patients for a full 2 minutes without interrupting. It wasn’t easy controlling the urge to interrupt.Slide 4: There is nothing worse than walking into a consulting room and not getting any eye contact from the doctor. You knock on the door, to be greeted with “Come” and to find the doctor sitting looking at his computer screen. And he continues to do so throughout the consultation. I’ve been guilty of it. Sometimes, due to our pursuit of a multitude of targets we can obsess about the computer and what we are asked to put into it. This occurs at the expense of the patient. I remember as a GP registrars in my training year we were required to produce a video of our best consultations. One trick I learnt at the beginning was to try and listen to patients for a full 2 minutes without interrupting. It wasn’t easy controlling the urge to interrupt.

5. A Doctor who has time for me Slide 5: Stress: The 10 minute appt. was a government initiative. Imagine trying to deal with two or three major problems in ten minutes when you have the pressure of a heaving waiting room. Without a shadow of doubt, 10 minute consultations have made things almost impossible and I think that they compromise patient care.Slide 5: Stress: The 10 minute appt. was a government initiative. Imagine trying to deal with two or three major problems in ten minutes when you have the pressure of a heaving waiting room. Without a shadow of doubt, 10 minute consultations have made things almost impossible and I think that they compromise patient care.

6. To Get Treated Properly No discrimination (Age, gender, race, sexuality). Diagnosis Appropriate Referral Choice Confidentiality Partnership-Patients want to be people who Doctors do things with, not people that Doctors do things to Slide 6: Patients have to be involved in reaching their management decision. Partnership—Patients want to be people who doctors do things with, not people that doctors do things to. Patients want to be consulted about their condition, their treatment, and how things will progress from the consultation. Slide 6: Patients have to be involved in reaching their management decision. Partnership—Patients want to be people who doctors do things with, not people that doctors do things to. Patients want to be consulted about their condition, their treatment, and how things will progress from the consultation.

7. Staff and Premises Fit for Purpose Space. Friendly and approachable staff. Facilities for elderly, disabled, sight impaired, hard of hearing. Appropriately advertised, easy to access information. Slide 7: I work in a converted terraced house. You can imagine how cramped we are on a busy day. Add a hot summers day with no air conditioning and it really is stifling; not only for the patients but staff as well.Slide 7: I work in a converted terraced house. You can imagine how cramped we are on a busy day. Add a hot summers day with no air conditioning and it really is stifling; not only for the patients but staff as well.

8. Services Closer to home Slide 8: I believe that this is the future of Primary Care. Modernised premises with adequate space and a workforce with the right skill mix providing services within easy reach of patients.Slide 8: I believe that this is the future of Primary Care. Modernised premises with adequate space and a workforce with the right skill mix providing services within easy reach of patients.

9. A 20 Minute Bus Ride  Slide 9: That was the easy part. For those of you who don’t know the area, if we go about half a mile down that way we come to Chase Farm Hospital. From there, a W8 bus will take you over the A10 to Edmonton and the eastern side of Enfield. And in this area patient expectations change and where some difficult challenges lie. Slide 9: That was the easy part. For those of you who don’t know the area, if we go about half a mile down that way we come to Chase Farm Hospital. From there, a W8 bus will take you over the A10 to Edmonton and the eastern side of Enfield. And in this area patient expectations change and where some difficult challenges lie.

10. Eastern Enfield-A different challenge Life expectancy in the eastern and south eastern parts of the borough is much lower than the west (9yrs for males and 5 years for females). This reflects the wider determinants of health. Wards in Edmonton and East Enfield have the highest proportions of their populations belonging to Black or Minority Ethnic groups with large numbers of asylum seekers and non-English speaking patients. In Enfield, the majority of the areas with the highest deprivation scores are found in the southeast and eastern parts of the borough. Slide 10: We know that a person’s ethnic and cultural background may have a profound effect on their health and well-being. People from different ethnic backgrounds have different health needs. Research shows that minority populations generally suffer poorer health than that of the majority population. For example, there are higher rates of Diabetes among populations of South Asian descent. Understanding of disease and good health varies across different ethnic and cultural groups. It is vital that services are delivered in a culturally appropriate manner. Some ethnic and cultural groups also access healthcare in different ways. For example they are more likely to go to A+E/hospital than a GP and this is why there are a large number of unregistered patients in this part of the borough. The level of deprivation in which someone lives will impact on his or her long and short-term mental and physical health. For young people, deprivation can affect their performance at school, which may lead into a cycle of low paid employment, low self-esteem and poor health. Slide 10: We know that a person’s ethnic and cultural background may have a profound effect on their health and well-being. People from different ethnic backgrounds have different health needs. Research shows that minority populations generally suffer poorer health than that of the majority population. For example, there are higher rates of Diabetes among populations of South Asian descent. Understanding of disease and good health varies across different ethnic and cultural groups. It is vital that services are delivered in a culturally appropriate manner. Some ethnic and cultural groups also access healthcare in different ways. For example they are more likely to go to A+E/hospital than a GP and this is why there are a large number of unregistered patients in this part of the borough. The level of deprivation in which someone lives will impact on his or her long and short-term mental and physical health. For young people, deprivation can affect their performance at school, which may lead into a cycle of low paid employment, low self-esteem and poor health.

11. Eastern Enfield-A different challenge Higher rates of morbidity and mortality(cardiovascular, cerebrovascular, cancer). Higher rates of Alcohol, tobacco and drug abuse. Higher rates of teenage pregnancy. Slide 11: Those with lower incomes, living in deprived areas, are much more likely to suffer from LTCs than their wealthier neighbours. Again, those in deprived areas are less likely to access care. Slide 11: Those with lower incomes, living in deprived areas, are much more likely to suffer from LTCs than their wealthier neighbours. Again, those in deprived areas are less likely to access care.

12. Raise Expectations Remove Barriers to registration and access. Form partnerships with schools, local, religious, cultural and ethnic organisations. Tailored services for non-English speaking patients. Training of interpreters and provision of health promotion literature in different languages Promoting a culture change. Slide 12: Without stereotyping too much. These are instant populations. Who see visit their GP’s for simple things. Main issues are non health related e.g. Food, sick notes, housing or benefits. They have a poor understanding of the significance of disease and therefore they don’t present till late in the course of their illness. Mention Diabetes Awareness day at Practice.Slide 12: Without stereotyping too much. These are instant populations. Who see visit their GP’s for simple things. Main issues are non health related e.g. Food, sick notes, housing or benefits. They have a poor understanding of the significance of disease and therefore they don’t present till late in the course of their illness. Mention Diabetes Awareness day at Practice.

13. An Example Enfield Diabetes Ramadan Project: Improving links with the Muslim population of Enfield during the Holy month of Ramadan Aim: The aim of this project was to raise awareness of fasting related issues for people with diabetes during Ramadan. We also needed to improve our links with “hard to reach” groups living in the locality, especially the Bangladeshi community.

14. Partnership working Meetings were held with key figures in the Enfield Muslim community and three awareness events were planned, one was held in Jalalia Jamme Masjeed Mosque Ponders End, one at the Edmonton Islamic Centre Mosque, the other at the Bangladeshi Welfare Association Ponders End. The Ponders End Mosque also transmitted their awareness event over their own radio station . Culturally sensitive information was purchased and given to patients. Information about Ramadan published on the EPCT diabetes web pages. All General Practices received information about the start of Ramadan.

15. Success! The events at both Mosques were regarded as successful. Raised awareness/expectations in the particular group. Relationships that have been forged during the project this year will act as building blocks for action in subsequent years. We are considering our options for similar events in the future. Project has been accepted for presentation at Diabetes UK in March 2009.   Slide 15: If I can do it anyone can.Slide 15: If I can do it anyone can.

16. What should I expect from my GP? To sum up then, what patients should expect: “doctors who are clever enough to practise the science and wise enough to practise the art of healing.” (Dr. Bernard Lown 1952)     Slide 16: Slide 16: