Primary Care - Data
What you told us
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What the data tells us
GPs
There are 12 G.P. Practices in Midlothian operating from 10 premises. A number of these premises are good quality and modern, the latest being Loanhead Medical Centre.
Several have, or are likely to outgrow the capacity of their premises. One additional clinic has been opened in Newtongrange and plans are being developed to address the other main pressure points - in the Shawfair development, South Bonnyrigg and Newbyres. This will increase capacity by between 7,300 and 8,300 patients or between 9% and 11% of the existing total practice list number in Midlothian.
We are unable to describe the total amount of doctor time as only headcount figures are available. Demand for GP appointments is high. The average number of consultations is 6 per person per year (increased from 3.7) and 600 000 appointments are offered every year. National figures suggest that 1 in 10 people visit their GP practice on a weekly basis.
Between 84.6% to 98.9% people can access a GP within 48 hours or advance booking to an appropriate member of the GP team. NHS Lothian and Scotland rates are (93%).
The National Health and Care Experience Survey asks people’s experiences of their GP practice and out –of-hours services, and their outcomes from NHS treatments. 69% of people said they had a positive experience of the care provided by their GP practice. This is lower than the previous 2 years and is lower than Scotland (79%). There are no clear reasons for this. In general smaller practices seem to have fared better than larger ones. 48% of people said their GP practice allows them to make an appointment more than 3 days in advance. This is an increase from the previous result but lower than Scotland (64%). 87% of people said they had a positive experience when needing to see a GP urgently. This is lower than the previous result but similar to Scotland (86%)
The new GP Contract was agreed in May 2018, it will 'refocus' the GP role to help them become ‘expert medical generalists’. For local practice, this means that the primary care team will change to include a wider range of health professionals, such as Physiotherapists and Mental Health Nurses as well as exiting team members such as Practice Nurses taking on wider responsibilities. Having a broader range of skills and expertise will help patients see the most appropriate person who can help them. These plans are also designed to allow GPs the time and space for people with more complicated health conditions. 71% people are aware of alternative services to the GP which can be used when they are unwell. Most people said they knew about these because of word of mouth.
Nurses
The District Nursing Team comprises of 41 whole time equivalent workers. They work across the whole of Midlothian and provide 24 hour support.
Similar information for community nurses was only available at a Lothian level until 2015. This showed an increase in the total numbers of community nurses in the Lothians. (Information and Statistics Division of NHS Scotland.) While we cannot quantify the number of community nurses the increased focus on community responses has led to several new community nursing posts e.g. the Hospital at Home Team (7 nursing staff) and the Community Health Inequalities Team (2.6 nursing posts). Higher numbers of nursing staff are employed in the Midlothian Community Hospital. This is as a direct result of the remodelling of the hospital (2017) to create a rehabilitation and assessment ward for older people - previously hosted at Liberton Hospital. This ward has been staffed on a ratio of 60% registered nurse: 40% non-registered nurse, having 1.3 whole time equivalent nurses per bed.
We are facing a specific pressure point in District Nursing as a number of staff are nearing retirement age and young graduates are less likely to choose District Nursing as a career path than other areas of nursing.
Anecdotally we know that demand is high for nursing care but there is insufficient data to measure this. Demand is often masked by the fact that many teams cannot run a waiting list due to the nature of the work. There is also no data routinely collected on how long people have to wait to see a Practice Nurse but access to Practice Nurses has not been raised as an issue through the 2019 consultation in the way that access to a GP has.
Within the new GP contract which came into force on the 1st April 2018 there is an emphasis on enhanced nursing roles. These advanced nurse practitioners will have advanced assessment skills, clinical decision making and be qualified non-medical prescribers.
Allied Health Professionals
Allied Health Professionals (AHP) encompass a broad group of professionals working in a range of health and care settings including patients` homes, hospitals, community based teams and surgeries. They work alongside doctors, dentists and nurses. The partnership directly employs Occupational Therapists (in Council and NHS) as well as Physiotherapists in NHS with a total of 60 whole time equivalent employed across health and social care.
Podiatrists, Speech and Language Therapists, Arts Therapists, Radiographers and Dietitians are Lothian-wide NHS services which provide patient care to Midlothian residents. Arts Therapy and Dietetics are hosted in Midlothian so respective heads of Service form part of the Midlothian Management Team and the associated budget is held in Midlothian. The service employs 100 whole time equivalent Dietetic staff and 7 Arts Therapy staff who work across NHS Lothian.
The new GP contract came into force in April 2018. Under the plans physiotherapists will work as part of multi-disciplinary primary care teams providing a first point of contact service within the practice setting. Health and Social Care Partnerships are also required to embed Musculoskeletal services in practice teams within which Advanced Practitioner Physiotherapist will hold a caseload without the need for a GP referral. Three practices (Pathhead, Newbattle, Strathesk) were identified in 2017 to test this new model. The service has been operational since May 2018 and was rolled out to 50% of practices by the end of 2018.
Occupational Therapists work across the Adults Social Care Team. Both Occupational Therapists and Physiotherapists work within MERRIT, Reablement, Midlothian Community Physical Rehabilitation Team (MCPRT) in Midlothian Community Hospital with older adult patients, the Community Learning Disability Team , Dementia Team, Joint Mental Health Team and Spring (Support to women who are at risk of offending) and Substance Misuse Service.
Prescribed medication
£18m of the £131 million IJB budget is spent on drugs prescribed.
Efforts to reduce this cost safely whilst encouraging patient self-management of symptoms where appropriate include encouraging healthy lifestyles, the Wellbeing Service, “healthy reading” and exercise referral schemes.
£195 is the average GP prescribing cost per patient (2017/18), lower than a Scotland average of £198. In 2015 spending was higher than the Scottish average by £2 and was growing faster than the rest of Lothian and Scotland. Work has been done reducing items (polypharmacy) and the push of ‘realistic care realistic medicine’.
The most frequently prescribed medicines quarter one of 2017/18 were:
- Omeprazole
- Co-codamol
- Salbutamol inhaler
- Paracetamol
The most expensive items which for the same quarter were:
- Apixaban,
- Fostair inhaler,
- Freestyle Libre sensor kit
- Relva Ellipta Inhaler.
Regardless of savings made the overall cost is expected to continue to increase (albeit at a lower rate). This is as a result of an ageing population and the fact that people are living longer with co morbidity.
In NHS Scotland, medication is by far the most common form of medical intervention.
Four out of five people aged over 75 years take a prescription medicine and 36 per cent are taking four or more.
The Scottish review of polypharmacy prescribing data (10+ BNF paragraphs plus a high risk medicine) by deprivation demonstrates that multi-morbidity, and its associated problems, presents 10 to 15 years earlier in more deprived communities.
It is suggested that up to 50 per cent of drugs are not taken as prescribed, many drugs in common use can cause problems and adverse reactions to medicines are implicated in 5 - 17 per cent of hospital admissions. Furthermore it is estimated nationally that 50% of hospital admissions for adverse drug events for those aged 65 and over and on 5 or more medications are preventable.
Community Pharmacy
There are 19 pharmacies, most of which open until 6pm, with one opening until 10pm; and on a Sunday.
Pharmacies are located in the areas of greater population density, the more dense the population the higher number of pharmacies there are.
The community pharmacy contract aims to use the skills and knowledge of pharmacists better, ensuring that all patients have access to support in the management of their medicines as well as providing a minor ailments service for advice on such conditions as hay fever, athletes foot and cold sores. All pharmacies in Midlothian also now operate a pharmacy first service for women aged between 16 and 65 for the treatment of UTIs and impetigo.
The Midlothian Primary Care Implementation Plan (2018) sets out how the pharmacotherapy part of the new GP contract which came into force in April 2018 will be implemented. This will see the introduction of pharmacy and prescribing support in every GP practice providing all core elements by 2021.