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

The Devon & Cornwall Care Record is an innovative approach to connecting up those who provide health care to you and your families.

Click HERE for more information

Friends of Wyndham House, together with Wyndham House PPG and Room4U have initiated a bereavement drop in group commencing on 12th September 2024. Details are attached HERE

Over the last few years we have been extremely pro-active to ensure that our Diabetes patients have been prescribed continuous glucose monitoring devices as early as possible.  This has meant we have been ahead of the NHS curve in supplying these to patients.

The value of Friends – published in local Parish Magazines June 2024

The Friends of Wyndham House Surgery (FOWHS) group was formed in 1991 by Frank Varley (his wife Audrey is still one of our patients). The group’s aim was to help the surgery develop and innovate ahead of the NHS curve. Frank would never have believed how successful this has been. Currently the Chair of FOWHS is Mike Shipton who many of you will have met as one of our ‘Bertie’ medicine delivery volunteers. He works with the group of Trustees to ensure the FOWHS funds are put to good use. The Friends run the Bertie service that currently delivers regularly to patients who have difficulty getting to the surgery to pick up their prescriptions. The cost of ‘Bertie’ herself (now in her second version), all the maintenance and petrol are supported by FOWHS. We owe our volunteer drivers an enormous thank you for their time doing the deliveries. FOWHS are very generous in their funding of medical equipment that is beyond what is expected for NHS GPs. Over the last few years they have bought the surgery a MESI-M machine, ambulatory blood pressure monitors and INR devices; each of these have freed up a very large number of nurse appointments. They have also provided GPs with additional dermatoscopes, to optimise our assessment of pigmented skin lesions, and we are currently looking at a new improved remote heart rhythm monitoring device that will help us identify patients who have palpitations that need further investigation. FOWHS also support the large variety of groups that operate within our villages: the Memory Café, the Film Club, Qi Gong, Keep Fit classes, Balance Classes, Seated Yoga, Carers group, Menopause group, New Parents support group, SCENE magazine plus facilitate Jean Povey’s Digital Social Prescribing work and Jan Hebditch’s Palliative Care liaison support role.

Alongside the FOWHS we have also recently revived our Patient Participation Group (PPG) under the Chairmanship of Martin Holt. This group fulfils the honest appraisal, critical friend role. The group could be considered a ‘patient partner’ to the surgery advising the practice and upwards to NHS Devon on the patient perspective. All registered patients are welcome to join: contact Martin via reception or email wyndhamhousepatientsgroup@gmail.com

Supporting friends is normal but this is different to providing care for them. The two are not mutually exclusive however it is important that those who are doing caring work, especially if friend or family, are identified and helped in what is a very difficult and tiring role.  FOWHS run a monthly lunch club for carers and the surgery is currently updating our list of patients who are carers.  If you are a carer, please contact us to check we have your details.  We use this to ensure all carers are provided with as much information as possible from local agencies who can support you.

As a surgery we are enormously grateful to the FOWHS and those stepping forward to help Martin with the PPG.  If you would like to get involved with any of the above groups please get in touch via reception or email via our website and we will forward your details on.

Anthony O’Brien

Wyndham House Surgery