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Eastern & Coastal Kent – slow pace of change

Here one of the largest practices in the country has raced ahead of the pack.

Here one of the largest practices in the country has raced ahead of the pack.

The Whitstable Medical Practice has 18 partners and 33,000 patients. Dr John Ribchester, one of two NHS Alliance PBC leads in the region, says: ‘We embraced PBC from the beginning. We have done quite well, partly as we have GPSIs who are enthusiastic and partly because we have the critical mass of patients.'

The practice has managed to set up 10 in-house clinics. These include an insulin initiation service and an echocardiography service that has radically reduced pressure on outpatients – waiting times have fallen from more than a year to just two weeks.

Dr Ribchester runs a sigmoidoscopy clinic, again cutting waits, and costing just 70% of the tariff price.

The practice now plans to open a third surgery building, linked to a centre run by private provider Circle. This will offer day surgery at tariff price, as well as diagnostics such as near-patient testing, X-ray, ultrasound and MRI. ‘It is not just co-location, it is integrated care and one-stop patient pathways,' says Dr Ribchester.

Yet despite such innovation, getting commissioning plans agreed is a ‘slow and tortuous process' – a proposal for in-house ultrasound has taken a year so far, and in-house physiotherapy took nine months.

And elsewhere in East Kent, GPs are frustrated with the slow pace of change, says Dr John Neden, PBC lead for East Cliff Practice in Ramsgate. ‘We sometimes feel we are driving a sports car and trying to change the wheel on a juggernaut.' However, he says there is ‘a real desire to see PBC working'. PBC leads meet PCT directors and programme leads every month and are ‘involved at decision-taking levels at the PCT with full voting rights'.

A few schemes are up and running.

A new hearing aid service has cut waiting lists dramatically, from two years to six weeks – even in some cases fitting aids straight away. ‘People go in deaf and come out hearing,' says Dr Neden. ‘It's one of our biggest success stories as a practice.'

Eastern and Coastal Kent PCT

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