NHS urgent care facility at Martock Surgery set to close

The GP Urgent Assessment Service (GPUAS) at Martock Surgery opened in January for patients from four medical centres: Buttercross Health Centre & Ilchester Surgery, Crewkerne Health Centre & West One Surgery, Hamdon Medical Centre, and Martock Surgery & South Petherton Medical Centre.

Patients who contact their surgery by phone or online are assessed for urgency (“triage”), and many of those who might have gone to A&E are instead offered an appointment with GPUAS.

Set up by GP Dr Tim Quinlan and senior nurse Sue Fearn with a £400,000 grant from NHS Somerset, GPUAS will close on Friday May 31, to the dismay of many patients and staff.

Symphony Healthcare Services (SHS), which provides services commissioned by the NHS Somerset Integrated Care Board (ICB), including GPUAS, is committed to ensuring it continues in some form.

Among the unusual and innovative elements that have made GPUAS so popular are three “point of care” testing kits. Common in hospitals but rarely used in primary care, one of these, the Abbott ID Now system, can test on-site for flu A and B, Covid and strep A.

This bacterium can cause a range of infections, often sore throats, which are treatable by antibiotics. By using the test kit, the team at GPUAS have been able to reassure patients who do not have strep A that they will not be helped by antibiotics, reducing the many harmful effects of unnecessary use of these drugs.

The GPUAS team have been involved in service evaluation of the ID Now system, assessing whether it can reassure patients and staff about how to use antibiotics safely and effectively.

The technology also proved invaluable during a recent scarlet fever outbreak at Martock Church of England Primary School.

Dr Maddie Smith, one of three GPs who work within GPUAS explains: “It is thought that the Abbott testing helped the school contain the outbreak more effectively, and I certainly feel it avoided a lot of unnecessary antibiotic prescriptions as we could withhold treatment with confidence, with all the benefits this incurs to patients and the planet.”

Two other devices in use at GPUAS can investigate potentially life-threatening risks such as blood clotting or bleed, sepsis, and blood gases in those with lung disease.

If patients need X-rays they can be sent to nearby South Petherton Community Hospital, but if referred off-site they always come back to GPUAS for results and any treatment plan.

Alongside Drs Quinlan and Smith, GPUAS is currently staffed by a third GP, ensuring there is always a doctor on site, three senior nurses and two healthcare assistants.

These staff are enthusiastic about the service, so rare, at a time when the NHS is struggling to recruit and retain staff.

Dr Smith said: “Staff morale is through the roof; I’ve never felt as happy about coming to work.”

She describes the service as “combining really modern technology with the very best of old-fashioned medicine, having more time to be with patients and really understand what they need”.

Kate Dunston, a former district nurse, now a practice nurse at GPUAS, explains: “This is a fantastic team to work in and really supports the upskilling of staff. I can take a patient history, complete a work up plan and run it past the GP on duty.

“It is a safe and supportive environment and you really see the impact of what you do. Patients can have all the tests they need here, they leave with a plan, rather than booking in at their own surgery for these tests and another wait.

“It is what the patients want, it saves a lot of clinical time and we get to feel part of their journey and see the impact of what we do.”

This theme of upskilling staff runs through the team. Tom Bannan, a former A&E nurse, is looking to train as a prescriber, and Dr Quinlan says that such high workforce satisfaction, with shared learning, training and development are helping staff view primary care and how to run it in new ways.

If patients need to be transferred to hospital, as happens about once or twice a week, they can be stabilised before they are transferred and relevant tests done, so that on arrival at hospital they can go straight to the correct department, reducing pressure on A&E further still.

And the service has just introduced another technological advance, Anima, which uses artificial intelligence to triage. The decisions it makes are then “finessed” by clinicians.

Dr Smith explains: “In the early days we tended to be sent patients who were too well for us, they probably could have waited to see their own GP, but it’s very challenging to make these decisions and we think Anima may really help ensure we get to see those patients who really need our help, and who would otherwise go to hospital.”

GPUAS ticks many boxes of an NHS 2022 report by Dr Claire Fuller which looked at how primary care can work more effectively, and included a requirement for “streamlined and flexible access for people who require same-day urgent access”.

Kerry White, managing director of Symphony Healthcare Services, says that GPUAS was always a “test and learn pilot” which is why it will now close while further work is done to see how it can be brought back, which she says will happen before the end of this year.

She said: “The trial of the GPUAS model in some of our practices, has provided a really useful opportunity to test a new way of delivering an enhanced level of care for patients who need to be seen urgently, but don’t necessarily need to go to hospital.

“We’re grateful for the support of our healthcare partners, Dr Quinlan and all the staff who have been involved in the design and delivery of the new model.

“During the trial we’ve found that initial feedback from patients and staff has been very positive, but we’ve also found that the model needs further refinement to ensure that we’re providing the right level of care in the right place for our patients, and that we are able to develop a model that is both efficient and financially sustainable for the future.

“Over the coming months, we will continue to collect feedback as part of the test and learn initiative, so that we can further refine and develop the model.”

Sophie Olszowski, journalist and writer, is former NHS Director of Patient Involvement at Oxford University Hospitals NHS Foundation Trust and author of  ‘Doctor What’s Wrong? Making the NHS human again’ (Routledge).