Wyndham House Surgery

The surgery has been invited to take part in a Welcome research project running over the next three years examining the effect of waiting times on patients. This project is Humanities led rather than a more traditional scientific statistical approach. Our role will be to help with collecting the experiences of patients and staff operating in a rural practice with widely acknowledged excellent access. These will be compared with the experiences of patients in a practice in a deprived community in East London. There are many other strands of this project and you might come across these in and around Exeter over the next few years. For more information click here

“I would like a scan please?” is the opening gambit in many consultations.  It is a simple and direct request but often leads to some complex and difficult conversations.  This is because ordering any test does not come risk free.  The consequences of too many X-rays, ultrasounds, CT and MRI scans are enormous for both individual patients and the NHS as a whole. The problems are more than concerns about excess radiation but more to do with the complications of uncovering things that we were not looking for. These incidental findings almost always turn out to be nothing worrying but only after much time and money is spent on exploring them. MRI scans provide the most detailed imaging available and as a result have the highest ‘incidentaloma’ rate. The chance of a headache being a symptom of a brain tumour is very small (approximately 1 in 1000) however the chance of finding something abnormal on a brain scan can be as great as 1 in 10. This leads to further investigations that have costs for both patients and the NHS. Although medical science has a fantastic understanding of the anatomy, physiology and pathology of the human body we are still a long way from fully explaining everything abnormal we find. Watch, wait and see what happens is a highly valued diagnostic tool; it is the cheapest and most effective treatment strategy we have for almost all minor illnesses and GPs are very skilled at using it.  Most patients prefer this approach rather than taking medicines with their potential to cause side effects.  However, watching and waiting when there is something physical to see or an abnormal test result to consider is much more anxiety provoking. Symptoms are easy for patients to monitor, however abnormal scans and blood results are more difficult to manage. So if a doctor seems reticent about ordering a test that you request it is often much more complicated than it might at first seem.  This is not direct rationing, it is evidence based decision making that is considering the pros and cons of the test. We can now treat many carcinomas very successfully however ‘incidentalomas’ are starting to prove more difficult, more complicated and much more expensive for all.

Anthony O’Brien

Parish Magazine article 2019

Spring has arrived.  Daffodils, cherry blossom and lighter mornings all have a mood enhancing affect.  Suffering from the winter blues is a well recognized clinical phenomenon.  There are lots of theories as to why this cyclical mood pattern persists in a proportion of the population. One proposal is that there were evolutionary advantages of being more sedate and more withdrawn during periods when the weather was cold and the food supply was reduced.  Depressive symptoms can often be described as ‘withdrawing into a cave’ and I suspect this may have some real truth in it.  On reflection it is not surprising that behavioural patterns have survived through evolution.  So we should certainly grasp all the advantages of the new found energy and feel of invigoration that many of us experience at this time of year. 

Certainly at the surgery it is a time for new projects.  The most exciting and most visible of these is our new ‘Bertie’.  This is the car that delivers medication to housebound patients and for the last 12 years it has been the familiar light green Berlingo. However over this winter he started to suffer signs of old age.  In order to keep the service running the Friends of Wyndham House have bought a new blue ‘Bertie’ who many will have already seen motoring around the lanes.  We are indebted to the Friends for funding this amazing service that delivers so much more than medication. Our wonderful volunteer drivers make contact with our elderly more frail patients at least once a month and there are weekly deliveries for those on more complex medications.  This acts as a close liaison between the surgery and our most vulnerable.  The value of social contact, a quick ‘Hello, how are you doing’ has enormous power and positive effects.  It often is the stimulus that nudges those who find themselves in a ‘cave’ towards the entrance. Life is so much better when they can see what is passing by.  The Friends Befriending Service is also staffed by volunteers who are keen to support anyone who needs help to venture further. Trish Jones, the Friends Wellbeing Coordinator, runs this service and if you think you, a friend, or a relative might benefit please do contact Trish directly (0748 437 7289 silverwellbeing@gmail.com)

So Spring is a great time to try something new, develop new friendships, take up new hobbies, get out of our ‘caves’ (we all have one) whether deep or shallow. Jump up, get out and light a metaphorical fire somewhere that will warm yourself and everyone passing by.  All social interactions endue a sense of wellbeing and, as I have written many times before, we underestimate the health giving power of community and connection at our peril.  Cavemen knew a thing or two about surviving and making the most of what was around them.

Anthony O’Brien

Parish Magazine article April 2019

Good medicine needs good communication.  This is most important in the arena of Public Health.  Ensuring messages about how to access healthcare and how to interpret symptoms are key to influencing how patients use the services on offer.  Getting the patient to see the right person, in the right place, at the right time is a mantra the NHS has adopted over the last few years.  This is mainly a drive to increase NHS efficiency and it starts from the first symptom.  Should you book directly with a GP, seek advice from a pharmacist, book a physiotherapy appointment, or use an over-the-counter treatment? The majority of information flow used to come through television and radio with leaflets in waiting rooms and posters as part of billboard campaigns. However in the digital world this is changing fast.  Almost everyone less than 55 has a smartphone and uses the Internet several times every day.  They therefore have a small powerful computer in their pocket that they use to harness information about any question they choose to ask.  The drive to be able to do everything from the palm of your hand is immense and will become even greater.  Over the next 5 years the NHS will continue to embrace this technology:  all GP surgeries will be offering on-line appointments, e-mail consultations and turning their paper notes into digital files that patients can download.  For us at Wyndham House this will not change very much as we have already achieved most of the recently published digital targets.  We are the first practice in the South West to have all our notes reduced from a room full of paper to a 2cm x 2cm Memory stick.  We will continue to produce information via all routes but the emphasis will continue to change to electronic (our digital display in the waiting room being an example of this).

However we must all recognize that the use of smart phones decreases significantly with age.  It is estimated that about a third of adults > 75 years have never used the Internet.  It can be scary and it is a revolutionary change.  I still clearly remember starting medical school in 1986 when libraries and encyclopedias were the source of almost all information. Like a new language, digital communication is hard to learn the older you are.  So for those who wish to take up the challenge The Friends of Wyndham House in conjunction with Room4U are in early stages of planning some introductory ‘How to use the Internet’ teaching sessions.

Wyndham House will remain fully bilingual but encourages anyone hesitant about digital communication to pass on details of our website and our App to your younger relatives. They will be able to help you find information and order medication quicker via these routes.  Good communication needs to use all possible routes and this leads to even better medicine for everyone.

Anthony O’Brien

Parish Magazine article March 2019

It’s the small steps that count

As February arrives our New Year resolutions have often faded.  It is extremely hard to change habits or introduce new behaviours. So enormous congratulations if you have completed the now popular dry January, joined a gym and or stopped smoking. I tell patients who stop smoking that it is probably one of the hardest challenges they will ever face. Research shows that the two most important factors optimizing success is to have someone alongside you and to break the challenge down into stages.  You need someone to nudge, support, and egg you on.  This is why all stop smoking services are like the one we run from the surgery: a plan is made with regular markers, pit stops and pep talk sessions. 

We bought our 17 year old daughter a Fitbit for Christmas. This is a watch that will record your activity during the day.  It measures the number of steps you take and can convert these into calories burned.  It is itself a coach and an incentivisor.  It has shown her the enormous difference regular small amounts of activity can make.  Taking every opportunity during the day to walk slightly further or slightly quicker than you have previously done soon adds up.  She has set herself a daily target and is now asking me to park at the other end of the car park, is volunteering to walk to the shop to get the milk and is setting a slightly quicker pace when walking the dog.  All small and barely noticeable but recorded by the Fibit and incentivizing her to continue to do that little bit more.

Last year some patients with insulin dependent diabetes benefited from a massive technological step in their care. A small electronic disc sits on the skin and is changed every fortnight.  It continually measures glucose in the blood and so rather than having to prick their fingers several times per day patients can now see whether their glucose levels are going up or down as many times as they need to. Diabetes patients need to balance the sugar in the food they eat with the energy they expend. The constant feedback enables small adjustments to improve the control of the condition.  These electronic meters will be available to many more patients in the coming months.

So small changes with constant positive feedback and encouragement are the keys to keeping health related resolutions on track.  So look for those opportunities to take small steps towards the big goals of improved fitness and weight loss.  They will add up and are certainly a lot easier and a lot more effective than that commitment you might have made on New Year’s day to run a marathon this year….maybe.

Anthony O’Brien

Published in Parish magazines Feb 2019

NEW Devon CCG have developed an excellent website with information about local services, referral pathways and some patient decision aids.  It is certainly worth a look click here

Patients of Wyndham House are now able to make routine appointments with a GP at evenings and weekends (including Bank Holidays). To book an appointment outside of normal surgery hours use the contact number advertised.

Your appointment will not be at the Wyndham House site, you will be advised of the location at the time of booking.

Dr Catherine Burkill is on sabbatical leave for the next 12 months in New Zealand. While she is away we are delighted to welcome Dr Emma Stone. She has just returned from a sabbatical herself, spending the last year in Melbourne.

DevonLive published its Top Ten GP surgeries in Devon based on the 2018 GP Patient Survey (a national Government Audit)

We knew we had performed well but are very proud to be at the top of the charts at No.9.  We are alongside several other small, rural GP practices that all aspire to the same ethos and values as ourselves providing high quality, accessible, community based healthcare

Harriet is joining us to complete her final year of GP training. Following her first two years at the RD&E and with a practice in Exeter she had the opportunity to go abroad for 12 months. She spent this working in a refugee camp in Greece and also as the doctor to a team of cyclists who rode from Cairo to Cape Town.