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GP Dr Philip Lusty witnesses a miracle in Portadown

Dr Philip Lusty writes:

“I’ve just witnessed a miracle and it happened in Portadown…

Portadown, a large town in Northern Ireland has had significant negative publicity lately with the threatened closure of a neighbour general practice  leaving this month 5000 patients without a GP and potential list dispersal.   The stress and strain this has put in all those involved in trying to provide solutions and the neighbouring GPs who fear a list dispersal and worry about domino effect is very palpable within the area.  The patient population are in fighting spirit as they demand a solution from local government that protected their much loved GP practice and maintained service where they were familiar.

A few metres away at a neighbouring practice where I work, Riverside Portadown, with just under 14,000 patients, the Health and Social Care Board kindly supported our involvement to participate with askmyGP pilot.  They had already kindly granted us a list closure following a shock resignation of a partner last June that left us struggling to survive with list size 2,500 per FTE.  With further resignations entering into 2017 we faced the real possibility of adding to the problems of Portadown by handing our contract back if unable to rescue our practice, as we had failed to recruit sufficient GP cover to make us feel safe and secure. All the negative vibes have been successful at encouraging young GPs to avoid the area making it even more difficult to recruit.

Preparing to launch askmyGP and overnight change our system felt like our last stand at trying to survive as a practice, bit like the 11th round in a Rocky Movie.  Entering into the 11th round we have had some serious knocks this year and been on the floor several times. We have entered into the last round exhausted and beaten and like some of the best Rocky movies, it looks like askmyGP has paid off giving us the tools to get back on our feet again and are punching back with force!!

Everything Harry said would happen has taken place.  We had never any need to worry about the change.  But what Harry doesn’t fully understand is that in Northern Ireland we never truly believe what we hear and often we expect the worst as part of our personality and when things go right we often wait for everything to go wrong.  I know I’d have colleagues reading this now skeptical saying “too good to be true..what’s the catch…” We can be a pessimistic bunch!  Plus we seem to have our fair share of skeptics in Northern Ireland “Oh it would never work here our patients are too old..too young…too rural…too many foreigners… etc etc.”  I have heard every reason from the skeptics!


Now 5 days into askmyGP I definitely have witnessed a miracle and that is from day 1.  There is joy back in my working life again, I have a spring in my step and everyone around me share in the same happiness and success of this new change.  A miracle has surely occurred on Monday 11th January and all we did was launch askmyGP overnight!!  It did take almost one year of discussion, convincing and then over one month planning the change but it was worth it as all the skeptics (which there are many) have been silenced, and everyone  and I mean everyone is very happy…yet some are still waiting for that tsunami.

I am so glad that I and my partners had faith in Dr Sara Cowell’s experience and knowledge as he coached us over our fears of change helping us to take the initial steps this week. All the planning and discussion has paid off in spades and to see everyone more relaxed, and doctors saying they have got their joy back of practicing medicine is highly rewarding for me. The reception staff no longer have to face the daily “sorry there are no appointments left for 3 weeks” and all the emergency appointment are gone at 8.40 am and yes sometimes our patients have been known to get verbally aggressive upsetting my staff. No one seems to have been that annoyed by anyone else this week!! The pressure had come off and stress levels are at their lowest.

The “On-call” doctor no longer has to face the 50 plus contacts per day to triage on their own and decide where and when to see them as there is nowhere left and all your colleagues are too busy to help buried in their own same 15 patient surgery that runs same time every day. Now the demand is faced together as a team who collectively take responsibility of the entire days’s work load and everyone feels equally valued.  There is time for lunch and on Tuesday I noticed at our pre lunch team meeting with doctors that this went on for about 45 minutes as we just enjoyed the new experience of calm and started to converse sharing other ideas of how to drive the practice forward. No one was in a rush.  I now have time to empty my bladder as much as I want, time for coffee break and also time for lunch, plus I am getting home earlier and far less stressed.  The change is immense.

The patients are amazed at how easy they get access and are equally delighted that they do not need to attend the practice unnecessarily when something can often get managed easily on the phone.  Harry did say we would manage 60% of our contacts on the phone on our first day and when we made our calculation we managed exactly 60%, not 1% more or less on day one. In three days this improved further and last look we had managed 70% of our phone contacts.  Our patients are so happy they have offered to write in to congratulate us on our achievements.  The praise from our patients this week has been such an encouragement to us as they too value the service they receive from their GP and are only too aware of the stress many of us have been under.

I am 100% wholly converted to no pre booked appointments, manage all your demand in one day.  In the current climate of dissatisfaction within the profession, GPs threatening to hand contracts back to HSCB, it is nice for once to have a good news story where other than the money to fund the expertise of Dr Sara Cowell and his team there has been no cost to the practice thanks to the funding from HSCB.  The first person who introduced me to the concept of askmyGP was Bride Harkin, one of the assistant directors of commissioning in Northern Ireland, when she sent me an e-mail during my time as GP on her local commissioning group.  Bride wanted to take all the credit if this week had been a success!! There is a revolution taking place and I urge all politicians and policy makers to take note and wake up and see some of the positive contributions to health care that can happen and I urge you all to listen and follow Dr Sara Cowell in his quest to change how we can operate.

I have witnessed a miracle and a rebirth in our passion for delivering a high quality service again for our patients.  Time is our most precious resource for caring and now I feel more in control to give that time appropriately to those who most need it and show Care with big C that one of my old partners used to talk about in a previous role.

Like Rocky Balboa I think we’re now well off the ropes, bit battered by experiences, but you know what I think we’ve lost some of that pessimism and we might just attract that new doctor we need now to the practice. If that happens not sure where can stop us.

Harry thank you so much for your patience with us as we took our time to consider our options.  Bride I know you’ll read this and what can I say but you are one of the many excellent examples of good leaders I have witnessed within my time at  Health and Social care Board and I think you deserve some of the credit!!  Can’t forget Margaret, Sloan or Keith either!!

Things can only get better!!


Updated 20th January from the local Portadown Times:

Way in to Riverside practice in Portadown Health Centre:

7 responses to “GP Dr Philip Lusty witnesses a miracle in Portadown”

  1. Simon Dodds says:

    Fantastic case study … this is the emotional impact of high quality health care systems engineering evaporating a queue and the associated chaos. And it raises the question “How come we did not know how to diagnose and treat this sick process ourselves?”

  2. Well done, Harry, Bride and all in Portadown. NI patients really are willing to try new and better ways to communicate with healthcare providers - even if it takes a while to get new systems up and running, it truly is win/win.

  3. Fed up GP says:

    I”m not sure if we want to go all the way but we definitely need to increase our same day access and I have always been interested in this model.

    I physically can’t work any harder than I am doing now. I temporarily increased my sessions to 7 from 6- I believe this has a bearing on me getting pneumonia. The result of this is I have had to go off sick- 60 patients cancelled and me feeling guilty for being ill.

    We can bearing cover 8-1830 in a leafy desirable area of Hampshire- if you make me work 8-2000 I’m out.

    If the government supports me to do the job I trained to do in the hours I agreed to do I’ll keep going for my 27 years until retirement age- if not I’m off- it’s not worth it I can’t help patients if I’m put in a situation where I’ll burn out.

  4. Raymond curran says:

    Nice one Philip; well articulated.

  5. Tony Kelpie says:

    This sounds great
    I think that you will soon be able to modify the ‘no prebooked appointments’ to ‘prebooked appointments only where clinically necessary for follow-up’ -if you haven’t already.
    Best wishes

  6. Esther Trouton says:

    Had experience of the new system on Friday and it was a breeze. An highly recommended this system to anyone thinking of making the change! A very happy patient. Great article Dr lustily.

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