Wyndham House Surgery

                                               Don’t call us, we’ll text you
Wyndham House has again scored in the very top percentile in the annual government
General Practice patient survey. A random 5% of adult patients in every GP surgery in England
receive a questionnaire asking them to rate their GP practice in a multitude of areas. An
enormous thank you to those who completed the questionnaires this year for rating our team
and our service so highly.
We are one of the approximately 1000 GP practices that can dispense medication to their
patients. This privilege comes with a lot of work but also enables us to solve problems with
medication quickly. Getting the correct medication in the required timeframe is often the
weakest link in medical care outside of hospital. Recently we have had some changes in our
dispensary team but we are now back to full strength with Caroline and Polly joining us over
the summer. We have also started to use an automated system that will let patients know
when their medications have been dispensed and are ready for collection. At the same time
as your bag of medication is placed on the shelf for pick up a text will be sent to your mobile
phone. This means you will no longer have to pop in to see if medication is ready; just wait for
the text.
We have always asked patients to leave 3 – 5 working days between requesting and collecting
their repeat medication. This needs to remain the expected time frame as occasionally
common drugs can be difficult to source due to manufacturing hiccoughs. This is the most
common reason for longer waits as we try to source then from elsewhere. However, since we
both prescribe and dispense there is always the option of prescribing an alternative and this
is what we do when required. Please do not ring the surgery asking about medication until
after the 5-day window. We are predicting that almost everyone will receive a text well within,
and sometimes a lot earlier, than the expected time. We hope patients will welcome the new
system.
This is an example of increasing the use of mobile phone communication alongside
development of the NHS App that is central to Government planning for the NHS. You can now
use the NHS App to see your clinical records and test results. You can also use it to order your
repeat prescriptions and book appointments. In the Autumn we are planning to pilot a new
system for booking flu vaccinations on-line. All these changes mean the benefits of using a
mobile phone continue to increase. Joan Povey, our Digital Social Prescriber, continues to run
sessions from RoomForU as well as being available for one-to-one assistance if you need help
setting up a device or you are new to the digital world. If you would like to meet with Joan, let
the Wyndham reception team know and we will put you in touch.

Anthony O’Brien
Wyndham House Surgery

Walking on the sunny side of the street

We have had a lot of sun during May and hopefully this will continue for the next few months. We should not be scared of getting out and enjoying the sunshine as bright sunny weather is of great benefit to our health.

Good exposure to the sun during April to September builds up our stores of Vitamin D. Like hibernating creatures, we store the Vitamin D we accrue over the summer in our fat reserves to keep us going through the dark winter months. This is very important in keeping our bones strong, it also boosts our immune system and may have other effects although research is still being done to confirm this.

There is no doubt that sunlight has a ‘feel good’ factor and this is also backed up by research studies. The most commonly used antidepressants work by boosting the level of Serotonin in our bodies and exposure to sunlight has been shown to have identical effects. One study found that people had higher levels of serotonin in their blood on bright days compared to overcast or cloudy ones. They also found that the rate of serotonin production in the brain was directly related to the duration of bright sunlight, regardless of the season or outside temperature. On top of this, there is some research to suggest that direct sunlight can trigger your skin cells to produce endorphins. These are neurotransmitters related to pleasure also released by exercise, eating, massage, chocolate and sex.

Sunlight has also been found to directly lower blood pressure. Scientists from Edinburgh University did an experiment showing that if you expose your arm to just 20 minutes of sunlight, that is enough to boost production of nitric oxide in your skin – which in turn causes your blood vessels to expand, bringing your blood pressure down.

Little and often is the best approach to topping up on sunshine plus minimising long exposure times is also the best way to avoid burning. Using suncream does not reduce any of the benefits I have listed above and protects the skin from damaged.

Skin cancers are directly related to sun damage. They can be broadly divided into two groups: melanoma and non-melanoma cancers.

Melanomas are abnormal looking moles. If you are over 40 and develop any new pigmented lesions then please make an appointment for a GP to take a look. We are particularly concerned about new moles or a mole that changes and meets any of the following ABCD criteria:

· Asymmetry: One half of the mole does not match the other.

· Border Irregularity: The edges of the mole are uneven, notched, or blurred.

· Colour: The mole has multiple shades of brown, black or blue.

· Diameter: The mole is larger than 6 millimeters (about 1/4 inch) in diameter

Non-melanoma skin cancers present as non-healing or persistent irritated areas or skin, often dry and red; once identified they can normally be treated by ourselves with a topical chemotherapy.

So, profit from the sunny weather, use suncream to protect your skin and if you have a growth on your skin that’s getting bigger, has changed colour or texture or an area of skin that hurts, itches, bleeds, crusts or scabs for more than 4 weeks please make an appointment.

Anthony O’Brien

Wyndham House Surgery

Team working

We were one of the first GP practices in Devon to set up a website in the early years of the internet. At that time the surgery team put together a statement to summarise our values and aims. It is at the top of the website’s Home page:

“Wyndham House Surgery is committed to high quality, accessible, community-based healthcare. We are a friendly, healthy, hardworking, innovative team who share core values of empathy, trust and honesty, in a harmonious, supportive environment.”

The key operational word is ’team’. Without a highly functioning team we would have no chance of providing the service we do, in the way that we do it.

Our team is currently going through some significant alterations due to a set of retirements coinciding with some unforeseen changes. As a result, the surgery will be stretched over the next 4 – 6 weeks as we cope with the transition. Within the surgery we sub-divide ourselves into smaller groups: clinical, dispensary, reception, administration. However, we are small and to ensure we can adapt whenever needed everyone can multi-task and cross cover. This is best demonstrated by your experience of seeing one of our clinicians. Each of us will endeavour to do everything required within one appointment, for example, GPs take blood tests when needed rather than asking patients to make another appointment with another member of the team. This is unusual in GP practices but produces a much faster, more efficient service. I could describe similar examples of how our systems operate smoothly behind the reception desk. As the team changes, we will need to train our new members whilst at the same time cope with covering the staff leave that is already booked. Therefore, as well as seeing some new faces, you might also come across some old ones in different places.

We would be very grateful if patients could bear with us especially during May when it might be difficult to hit our targets of turning prescription requests around within three days. Having five days’ notice for repeat prescriptions would be extremely helpful. We our delaying our Covid booster vaccine clinics until the end of the month. This Spring, the booster is being offered to all patients over 75 years old and patients who are immunosuppressed. These are

The national guidelines for Asthma care have changed. They are now directing us to stop prescribing blue inhalers and replace them with a combination inhaler. Introducing this change will save lives; there are still a very large number of preventable asthma deaths across the UK.

The evidence shows that using a single inhaler (the surgery will use the pink Fostair inhaler) for almost all asthma patients greatly reduces the number of exacerbations patients experience, reduces hospital admissions and is a much better for the environment. Inhalers comprise 4% of the NHS Carbon footprint. Halving the number we use, plus using powder inhalers where possible, is on the same environmental scale as closing an international airport!

The combination inhaler contains a long acting ‘reliever’ (equivalent to the blue inhaler) and a small dose of steroid (equivalent to the previous brown inhalers). Inhaling both components at the same time is of great benefit for both short and long term control of asthma symptoms. The benefits are greatest for patients who previously only used a blue inhaler. You use the pink inhaler in the same way as the blue; it acts just as quickly, and the effect lasts a lot longer.

This is a very significant change for asthma patients; the security and reliability of their blue inhaler is deeply engrained over many years. Starting the brown inhaler alongside it if symptoms worsen is a firmly embedded learnt response. This is being replaced with simply increasing the number of pink inhalations. The new Single Inhaler regime does not change the thinking, it just removes the need for two inhalers and heightens the speed of response to the treatment.

Managing behind the scenes

Five years ago at 8.30pm on Monday 23^rd March the Prime Minister made a television address to the nation. He announced a stay-at-home order effective immediately. Mr Johnson told people they “must” stay at home and said that “we will immediately” close some businesses. Everybody’s lives were upended overnight and the subsequent two years were difficult and dramatic.

As a GP practice we had to change how we looked after our patients very quickly. Mark Flinton, our Practice Manager, helped us rapidly reorganise how we operated.  We needed to make changes to our building; put screens in place, alter entrance and exit pathways, identify and equip ‘hot’ clinical rooms to see possible Covid patients. Although we swapped overnight to a telephone triage and appointment system, we acknowledged that our role was to ensure we kept open. We needed to see sick patients, we needed our dispensary to provide and distribute medication. Mark put procedures in place to reduce the risk of Covid spreading between staff and causing us to shut. When the vaccines arrived, we delivered them with speed and safety. There were strict rules we had to abide by and it took a lot of work to enable us to have these clinics in Silverton. Mark together with the Friends of Wyndham House designed how our vaccine clinics worked. A lot of the innovation from this time continues today in our regular large Flu clinics. Amazingly we kept open and dispensing throughout the whole 2 years. This was all down to incredibly hard work and professionalism from everyone within the team but Mark was the one who spotted problems and solved them, often before they occurred. He kept us emotionally balanced; nothing was ever too bad or too good, everything stayed on an even keel, exactly where we and our patients needed to be.

Mark retired at the end of March after 11 years at Wyndham House. He has been a fantastic member of our team. The GP Practice Manager is very much a behind the scenes job; patients only meet them if they are making a complaint. However, many of you will have met Mark as he often greeted patients for vaccine clinics and for many years it was his voice, with recognisable Mancunian accent, on our answerphone message. The Practice Manager’s role is wide ranging: staff timetables, rotas, training, maintenance of the building, CQC compliance, instigation of new NHS requirements (this happens a lot and change regularly). The critical nature of the skill set required was brought into focus very quickly in March 2020. As I have described Mark rose to this challenge with resilience and determination enabling Wyndham House to manage so well during the subsequent 2 years.

Mark will be missed by us all. His replacement (Mark Dodds) comes with an enormous amount of experience. He has previously managed two GP Practices similar to ourselves: dispensing, rural, high-performance markers with national recognition. However, I am hoping that hardly any patients will meet him and that he will not have to deal with any national emergencies over the next few years.

Anthony O’Brien

Wyndham House Surgery

FAST means don’t wait

Medicine is full of abbreviations and acronyms. Some of them come from Latin terminology, some relate to capital letters from words of commonly used phrases. There are many of these and they are not always obvious. It took me a long time to work out what to do on my first day on the wards when the senior nurse asked me to go and fetch the patient’s TTAs. To Take Aways – medications on leaving hospital. However, the most important are the mnemonics used to help clinicians remember important facts or actions. For example; ABC – airway, breathing, circulation that can be applied to the assessment of all critically ill patients – is the airway open, are they breathing, do they have a pulse? It is uncommon for these memory aids to be shared with the public but there is one that has entered our general lexicon and this is because it is so important. FAST is an easy way of remembering the symptoms of a stroke and the actions required.

A stroke or CVA (Cerebrovascular Accident) happens when the blood supply to part of the brain is cut off, killing brain cells. The effects of a stroke depend on where it takes place in the brain, and how big the damaged area is.

Ischaemic stroke is the most common type (85%) and occurs when there is a blockage to an artery either from a narrowing, from a clot, or a combination of both. The other 15% of strokes are due to bleeding in or around the brain. Both types will cause the same symptoms however they are treated differently and this is the reason for the need for speed.

The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify the three most common signs of stroke.

• Face weakness: Can the person smile? Has their mouth or eye drooped?
• Arm weakness: Can the person raise both arms fully and keep them there?
• Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred? Are they speaking in clear sentences? Are they having difficulty finding words?
• Time to call 999: if you see any one of these signs.

There are other symptoms of stroke; any sudden loss of sight, power in any limb, balance or memory should be taken seriously – call 999.

If patients get to the hospital within 3 hours of the first symptoms of an ischemic stroke, they may get a type of medicine called a thrombolytic (a “clot-busting” drug) to break up blood clots. Quickly removing the cause of the stroke massively increases the chances of a full recovery. Paramedic crews prioritise patients who might have had an ischaemic stroke as there is a critical timeframe to give a life changing treatment.

We now see far fewer patients suffering strokes than when I qualified. This is mainly due to a significant reduction in the threshold for starting blood pressure treatment and that fewer patients are smoking. While most people who have a stroke are older, younger people can have strokes too. One in four strokes in the UK happens to people of working age.  So, if you are with someone who suddenly develops any of the symptoms that I have described, act FAST, don’t wait, dial 999.

Anthony O’Brien, Wyndham House Surgery

(Parish Magazine article March 2025)

The Government are looking for innovative ways of tackling problems with health and social care. They are proposing more scanning, more appointments, more Apps. However, the evidence suggests that for an ageing population, loneliness and isolation are the major problems that need to be addressed and simpler interventions would be more helpful to more people.

Being sociable – even in small ways – has big benefits for your health. It lifts your mood, and lowers your stress levels. It is good for your heart, your sleep, and can influence how well you recover from illness. In a Swedish study, which followed 1,200 older people, it was found that those living alone or without close social ties, were at greater risk of developing dementia. Even occasional visits with friends kept the risk of the disease down.

Scientists who deliberately infected healthy volunteers with a cold virus found that those with a rich diversity of social ties were four times less likely to develop a cold than those who were less outgoing. And if they did get a cold, it wasn’t as bad. This turns on its head the excuse of not going out or mixing with others because “you do not want to pick something up”.

It’s not just about having close relationships. You also benefit if you have a wide range of social contacts, including neighbours and others in the wider community. The 2025 SCENE (Senior Citizens of the Exe Valley News & Events) magazine was published in January and is available at the surgery. It contains a multitude of different groups that meet regularly in Silverton and surrounding villages. The other very easily accessible and extremely welcoming weekly event is the Memory Café on Thursday afternoons.  This is the pinnacle of community activity to tackle the on-going pressures of caring for patients with dementia but also for others to come and socialise. This is a role that is both giving and taking; those who need the support appreciate it, those providing it will be benefiting from the social activity in all the ways described above.

However, when age affects your ability to get out, seeing people in person becomes harder, then meeting virtually can really help. This is one of the reasons we encourage all our patients who are not currently on-line to make that step with the help of Joan Povey our Digital Social prescriber. Joan runs classes at Room4U and is also happy to visit patients at home to set up new devices so they can discover how easy it is to contact and communicate with friends and family from your armchair. When a grandparent FaceTimes their grandchildren it gives a feel-good factor for both young and old. Joan can be contacted via the surgery reception or ring her directly on 07958 190554.

If the scans and appointments result in increased life expectancy it will not be worth it if the social structures, social care and necessary living environments are not in place to support the ageing population. Health, social care and community are all connected and we are fortunate that in our area there are plenty of opportunities to make this happen.

Dr Anthony O’Brien

Wyndham House Surgery

Wishing you a Pink Christmas

The comforts and traditions associated with Christmas are enjoyable. The predictability gives us feelings of security. However, we have all experienced changes to our Christmas routines at various points in our lifetimes. Initially the change feels strange but then the new festive habits bed in and become the comfortable normal, until circumstances alter them again.

There is a similarity here with how we treat some medical conditions.  We encourage patients to become comfortable with routines and patterns of symptoms.  They learn how their bodies respond to medication and this provides them the security of knowing they have control over these symptoms. Asthma is the best example of this method of care.

The national guidelines for Asthma care are changing. They are now directing us to stop prescribing blue inhalers and replace them with a combination inhaler. Introducing this change will save lives; there are still a very large number of preventable asthma deaths across the UK.

The evidence shows that using a single inhaler (the surgery will use the pink Fostair inhaler) for almost all asthma patients greatly reduces the number of exacerbations patients experience, reduces hospital admissions and is a much better for the environment.  Inhalers comprise 4% of the NHS Carbon footprint. Halving the number we use, plus using powder inhalers where possible, is on the same environmental scale as closing an international airport!

The combination inhaler contains a long acting ‘reliever’ (equivalent to the blue inhaler) and a small dose of steroid (equivalent to the previous brown inhalers).  Inhaling both components at the same time is of great benefit for both short and long term control of asthma symptoms. The benefits are greatest for patients who previously only used a blue inhaler. You use the pink inhaler in the same way as the blue; it acts just as quickly, and the effect lasts a lot longer.

This is a very significant change for asthma patients; the security and reliability of their blue inhaler is deeply engrained over many years. Starting the brown inhaler alongside it if symptoms worsen is a firmly embedded learnt response. This is being replaced with simply increasing the number of pink inhalations. The new Single Inhaler regime does not change the thinking, it just removes the need for two inhalers and heightens the speed of response to the treatment.

We will start sending letters explaining the change to our asthma patients in December and so some might receive their first pink inhaler for Christmas.  However, for the majority this will be in the New Year; a more traditional time to make changes and experience their benefits.

Happy Christmas and all our best wishes for 2025 from the team at Wyndham House

Anthony O’Brien

Getting rid of the mouse

I remember writing my first cheque in the middle of the 1980s, however, I cannot remember when I wrote the last one.  Cheques were replaced with cards and now my children only use their phones to carry out almost all their financial transactions. They do not know what a cheque is.

When I started as a GP, I would record consultations by writing on small pieces of card, stored in a patient envelope, kept behind the reception desk.  Currently I type my notes and they are stored electronically. Early next year we will start the next step in the evolution of medical record keeping by trialling a new computer programme that will produce a transcription of the consultation as our patients leave the room.

As GPs we are at the start of a patient’s journey.  For the vast majority of patients this is a one stop shop; we see and we successfully treat. However, for patients who need further investigation our role is to transfer the information we have gathered to the hospital team.  This takes us a lot of time.  Three hours of a GP consulting with patients will typically generate one hour of administrative work, the bulk of which is writing letters.

At medical school doctors learn the language of medicine. The way in which we record a patient’s story follows a set pattern. A lot of this medical shorthand is now familiar to everyone from the medical dramas that are ever present on television. The new computer programme takes advantage of this predictability; it recognises patterns that regularly occur in GP consultations and links them together. A transcription of a consultation can be analysed in seconds by the algorithm and no matter how complicated and circuitous the conversation, no matter how many possible diagnoses may have been alluded to, it is able to produce an outline written recording in a ‘doctor-speak’ format. This is a draft summary for the record that can be checked and edited, however it is remarkably accurate. The programme then allows the GP to package the information extremely quickly for onward communication, such as a referral letter.

As far as practising medicine nothing will change; knowing your patients, asking the right questions, performing the examination are not something the computer can do.  However, no typing, no dictation, just editing will give GPs more time to spend with patients.

In 1992 Wyndham House was the first practice in Devon to stop using paper notes in consultations, in 2016 we were the first practice in Devon to convert all medical records into a digital format and in 2025 we are going to be one of the first practices to start the process of removing the computer keyboard from the consulting room.

Anthony O’Brien

Wyndham House

Running on empty

Last week Kier Starmer told us that “The NHS is broken but not beaten……it requires major surgery not sticking plasters…….there can be no investment without reform……this is a 10 year project”.  What does this mean for us in Silverton and surrounding villages? We recognise the long wait for hospital appointments but we have an excellent surgery; Wyndham House recently ranked 13^th out of the 6,311 GP practices in England in the 2024 GP Patient survey.

It is true we do provide an excellent service. This is down to an enormous amount of hard work from our team at the surgery and also the fact that patients use the services we provide in a responsible way. However, we are not immune from the effects of what has been happening in the last 20 years within the NHS. Sadly, this is a story of hospital versus community healthcare. Since 2008 the proportion of NHS budget that has come to Primary Care services has dropped from 11% to 7%, the money being redirected to Secondary Care.  The number of hospital doctors has increased by 30% whilst the number of GPs working in the UK has dropped by 10%. There has been an enormous exodus of recently trained GPs to work in Canada and Australia. 1,300 GP practices have closed due to the lack of resource they were given stacked against increasing demand and inflationary costs. Whilst the junior doctors have been awarded a 22% pay increase, investment in General Practice is 5% less than in 2018.

Last year the British Social Attitudes Survey showed a 29% decrease in patient satisfaction with the NHS over the previous 4 yrs. However, 85% of our population want a free at the point of delivery service and are happy to pay more tax to achieve this. Such a service needs a gatekeeper to ensure it is not overrun.  This is one of our GP roles but it only works if we are able to provide continuity of care cradle to grave. Wyndham House is top of the rankings because we strive to provide such care but many GPs in the UK have not experienced the satisfaction and enormous health benefits it brings for both GP and patients. The evidence is clear; you live longer and go to hospital less if you know your GP.

I am writing about this because we are having to make some changes that will affect patients to ensure we protect what we have. We take blood tests on behalf of the hospital however the funding for this work has never properly been transferred to us.  We can no longer do this and so patients will be directed by the hospital to attend Whipton or Tiverton. We have had an open access ear syringing service however we will now only offer a limited number per week and create a waiting list. We will also need to limit appointments for travel advice.  We have recently seen an increase in patients cancelling appointments at the last minute, this wastes valuable clinical time that other patients could have used. From now on when this occurs we will be more direct about our disappointment and record it.

The truth for UK General Practice is that it is near to breaking; it requires major investment to re-establish its core infrastructure and there is not much time for the Government to do this.

Anthony O’Brien

Wyndham House Surgery