Wyndham House Surgery

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.

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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

D for Don’t really know yet

It has been a long wet and dreary winter with little sun. There is no doubt this affects our mood and our vitamin D levels however whether these two are connected or just have the same causal link is currently a matter of scientific debate.

Our skin makes Vitamin D when exposed to the sun. We do not need much sun exposure to produce the amount of Vitamin D required to fulfil its main metabolic function of ensuring our bones have enough calcium.  In the summer this is easy but in the winter our Vitamin D levels will fall.  As we get older our skin is less efficient at making Vitamin D and this means that probably half of the older adult population has a low Vitamin D level in the winter.  As a result Public Health England advise older adults to take a Vitamin D supplement during the winter months.  These are 10mcg / 400 international unit tablets that can be bought cheaply over the counter in a pharmacy, they are not prescribed by GPs. Oily fish and eggs are the alternative main dietary source of Vitamin D. Optimising our bone strength is dependent on both having enough vitamin D and also doing sufficient daily exercise; walking in the sun ensures both needs are covered. Patients who have osteoporosis (weak bones), normally discovered following a low impact fracture, are treated with Vitamin D and calcium supplements plus a once weekly medication that ensures the calcium is deposited in the bones.

Whilst we have a good understanding of Vitamin D’s role in bone health the search continues for other roles that it might play within our bodies. There are Vitamin D receptors in some parts of our brain and there are also some trials that show it has a role in optimising our immune system. Taking a Vitamin D supplement in the winter is linked with fewer days of illness from viral infections. There is currently a trial being run by Exeter University testing whether taking very high daily doses of Vitamin D will decrease risks of dementia and other studies are trying to establish links to depression. No data is available yet. It is perhaps because so little is known, apart from the fact that levels are variable, that Vitamin D has been linked to so many pathological pathways. It was hailed as a panacea for Covid and as a protector against cardiovascular disease however neither of these claims stood up to scientific analysis.

One thing that is very clear from the research is that there is no benefit in measuring Vitamin D levels unless there is a clear medical indication for doing so.  This is because the levels are predictable; if you have reduced sun exposure your levels will be lower than they could be.  Nothing is gained from analysing the actual level as we are a long way from establishing what the most beneficial level is.  So, this summer get out, get exercising, use suncream (it does not affect Vitamin D production) and next winter consider taking a tablet during the darker months.

Anthony O’Brien, Wyndham House Surgery

Healthy digging

The arrival of Spring and the welcome return of longer days is always a signal in our house that the garden needs sorting out. The first cut of the lawn, weeding then mulching of flower beds, spreading compost on the vegetable patch often all coincide with the Easter holiday period. I have written before of the physical and mental health benefits of spending time in the garden. However, research over the last few years has also shown further benefits that gardeners accrue from the greater diversity of microbial life found in their intestines.

The best way to explain this is to use a horticultural analogy and thinking of our intestines as a garden. There are an enormous number of different microbes that live there in our guts, the same way that our gardens have a large variety of flowers, shrubs, herbs.  All of these have a multitude of species that spread and thrive according to the season and the composition of the soil. They all require basic nutrients to survive and some, like roses, require specific feeding with special fertilisers. For the garden to flourish and produce colourful flowers and large vegetables the gardener has to optimise the environment.  The intestines are similar; we know that microbes will produce vitamins and hormones that as well as aiding digestion are also absorbed to produce important benefits elsewhere in the body. If we create an environment in our bowels that promotes beneficial microbial growth our body will reap the rewards. We therefore need a gut flora that is optimally balanced and the food we eat is analogous to the soil in our gardens.

Bacteria were present on Earth long before humans.  We share DNA with them as we evolved from them over millions and millions of years.  Amazingly there are as many microbes living in our bodies as there are cells; we are a 50/50 split. Each of us consists of approximately 30 trillion human cells and 30 trillion microbial entities (bacteria, viruses, fungi) but because they are so small they only make up a very small percentage of our weight.  99% of these bugs live in harmony with us with only about 1% identified as being pathogenic ie causing illness.  We are all familiar with how our intestines adapt to our specific environment; bacteria in the water in some countries will be pathogenic to those who are travelling there, hence ‘travellers’ diarrhoea’.  Antibiotics taken for whatever reason will kill some of our intestinal bacterial, upsetting the balance and producing the common side effect of loose stools.

The research shows that for optimal health we need a healthy gut flora that is fed, via the food we eat, to produce the best microbial balance for our bodies. Fresh fruit and vegetables of varied colours (a rainbow diet), fibre rich food and regular meals with a chance for your bowels to rest overnight are all key. Having a diverse number of different organisms is also essential and recent studies have shown that gardeners have a healthier mix.  This could be because they eat their home-grown fruit and veg but more likely it is simply that getting grubby in the garden exposes you to a richer variety of microbes that infiltrate your gut.

So this Easter, get digging and get dirty to get healthy.

Dr Anthony O’Brien

Wyndham House Surgery

There are lots of questions about sleep that we do not know the answers to. However, we all know how important sleep is because the effects of not sleeping are very difficult to cope with. The good news is that we are developing a better understanding of what helps us sleep when the pattern goes awry.  Some of these are not what you expect.

We are animals used to routine and cycles of daily life that follow patterns dictated by sunlight. We have a great ability to train our bodies to respond to certain stimuli in a programmed way. When I was at medical school I took part in research projects that firmly established neural connections within the brain that promoted and engrained reward related behaviours. Sleep is one of these behaviours and the rituals of going to bed train the brain to switch to this ‘downtime’ operational mode. If sleep becomes difficult, sticking to these routines, or re-establishing them, is the first and most important step. Evening exercise helps, especially if followed by a hot bath before bedtime. This has recently been shown to increase the speed of ‘dropping off’ by 36%.  This is due to increase blood flow to the arms and legs causing the body’s core temperature to drop; a very old evolutionary trigger for sleep. Getting up at the same time each morning, whether you have slept or not, is also of vital importance.  It is the brain’s exposure to morning sunlight that turns off the production of melatonin (our sleep neurotransmitter) but at the same time it resets the clock for it to switch on again 12 hours later ie when you need it again.  Distraction techniques to help you drift off are not as good as concentrating on your breathing.  Emptying your mind by thinking about your respiratory rate, following a pattern of counting to 4 while breathing in, holding for a count of 2, and then another 1 to 4 whilst breathing out is a very effective technique. Lastly to help sleep at night, a quick nap in the afternoon has enormous benefits, especially as you get older.

Troublesome sleep is aften a sign of low mood or anxiety and we would advise you to make an appointment with a GP if it is associated with other symptoms such as loss of motivation, tearfulness or weight loss.  However, more often our patterns are disrupted temporarily and a reset will work. Wyndham House patients can access an on-line self-referral support service for free www.sleepstation.org.uk  which has a 75+% rate for helping patients improve their sleep.

So, if you are experiencing sleep difficulties short or long term it is worth trying some of the above. Diligently follow the same night time routine. Do some exercise to relax your muscles. Have a hot bath to help your body ‘cool’ down. Don’t lie in but get up early. Concentrate on your breathing to help you drift off. Most importantly do not allow your brain to associate lying quietly in bed as anything other than a direction to turn off.  If you cannot get to sleep then get up, leave the bedroom, read, watch TV, do a puzzle and then start again.

Anthony O’Brien

Wyndham House Surgery

Sleepstation NHS