BENTHAM SURGERY

Bentham Medical Practice

Trainers: - Dr R Sullivan and Dr Nick Howlett

Practice: -
Dr C Storey, Dr R Sullivan, Dr J Burnett, Dr M McKirdy, Dr N Howlett, Dr A Astle
The Surgery,
Grasmere Drive,
High Bentham,
Lancaster, LA2 7JP
Tel 01524 261202
Fax: 01524 262905
Email: ralph.sullivan@gp-b82061.nhs.uk

The Practice

A medical practice has existed in Bentham for as long as anyone can remember. It has expanded into the surrounding countryside over the last hundred years to take in previously single-handed practices in Ingleton and Wray. Almost all of the doctors, nurses and staff live in the practice area, which helps give us a particularly close relationship with our local rural community.

Our aim is to provide the highest standard of friendly personal care to our patients. We try to achieve this by

• A continuous process of practice personal development, linked to staff appraisal and training and an in-house educational programme,
• Close teamwork with the Primary Health Care Team, and other agencies involved in patient care,
• Continuing development of the practice premises, services and information infrastructure,
• A commitment to education as a training and teaching practice.

We seek to maintain an above average practice profitability, but our commitment to patient care comes before an entrepreneurial approach to General Practice.

We have been a training practice since 1996. Our aim is to provide registrars with a supportive and challenging experience that develops your interest in, and enjoyment, of rural General Practice.

The Practice Team

The Doctors

Clive Story (joined the practice in 1967) He has a special interest in asthma and chronic obstructive pulmonary disease and is also chair of the Professional Executive Committee of our PCT: Craven, Harrogate and Rural District. Half time partner.

Ralph Sullivan (1984) is the GP trainer. He has special interests in therapeutics and health informatics. He is the past-chair of the EMIS National User Group and is involved of a number of NHS Information Authority projects including PRIMIS of which he is a Project Board member. He is an advisor to the PCT on IT. Full time partner.

Jane Burnett (2000, previously retainee and assistant with the practice) is responsible for the practice child clinic and practice staff. Part time partner.

Mairi McKirdy (2000) is responsible for medical student training in the practice, and patients at our one local nursing home. Part time partner.

Nick Howlett (2000) is the practice prescribing lead and is responsible for the diabetes clinic. He is also a clinical assistant in dermatology at Lancaster Infirmary. Full time partner & GP trainer.

Abby Astle (2004) has just joined the practice. She also has a special interest in dermatology. Full time partner.

The Practice Nurses

We have three practice nurses: Sue Lumb, Meg Disberry and Rachel Clay. They specialise in health education and preventive health care. They are the cornerstone of our management of diabetes, asthma, COPD, hypertension, ischaemic heart and cerebrovascular diseases and offer a variety of other service such as well person checks, cervical cytology, travel, family planning and smoking cessation.

The Management and Administration Staff

Our practice manager runs, Shirley Macdonald, a very friendly and efficient team. We have a very low turnover of staff including two secretaries, a chief dispenser and seven receptionists, most of whom have special interests such as phlebotomy, IT support or scanning.

The Community Nursing Team and Other Attached Therapists

There are seven district nurses, one nursing assistant, two midwives, and two health visitors in the local Craven, Harrogate and Rural District PCT Community Nursing Team attached to the practice. They also work with the Settle practice. Morecambe Bay Primary Care Trust provides districtnursing services to our Lancashire patients from Kirkby Lonsdale. We also have regular physiotherapy, chiropody, counselling, family planning and consultant psychiatry clinics at Bentham and Ingleton. The local community health teams are frequent visitors to the practice as well.

Education

As registrar with the practice, your first weeks will be spent with your trainer, and shadowing key members of the practice team but you will soon being to consult alone. You will have your own room. Starting at twenty minutes, your consultation times will come down to ten minutes as you gain experience. The range of educational topics to cover in the year is huge but as time passes you will be able to set your learning agenda to your own priorities. Most of your teaching will be provided by your trainer, but many members of the team will also be involved and everyone is willing to answer a question whenever you have one.

As well as training GP registrars, we are involved in teaching medical undergraduates from Leeds University. We receive between six and eight students each year for three-week attachments.

Most continuing professional education is carried out in the surgery. We hold a clinical meeting for the full Primary Health Care Team once a fortnight. We have recently instituted a regular in house training program for administrative staff, closing the surgery to all but emergencies for an hour at lunchtime each month. The meetings usually cover issues relating to the year’s practice development plan and the outcome of staff appraisals.

The Practice Environment

The Geography

The practice covers a large rural area of 300 or 400 square miles, depending on how many bare hillsides you include, in the south west corner of the Yorkshire Dales which includes Ingleborough, Whernside, and the Ribblehead viaduct. It is glorious limestone country with lots of famous potholes such as Gaping Gill and superb walking and cycling opportunities on the doorstep.

From High Bentham, the largest village with almost 2,000 residents, the practice area stretches 14 miles north to the watershed with Wensleydale, 14 miles west into Littledale which is just four miles from the M6 and Lancaster, and eight miles east to Eldroth and Wharfe. Thankfully half of the population live in the three local villages of Bentham, Burton-in-Lonsdale and Ingleton.

Our neighbouring practices are based in Kirkby Lonsdale (10 miles northwest) and Settle (13 miles east), and the Queen Square practice in Lancaster have a branch surgery in Caton.

The nearest hospitals are the Royal Lancaster Infirmary (15 miles from Bentham), Westmorland General Hospital (21 miles) and Airedale General Hospital (33 miles east).

Being based in Yorkshire we are part of Craven, Harrogate and Rural District Primary Care Trust and work with the Yorkshire-based social and education services. 90% of our referrals to secondary care are directed to Royal Lancaster Infirmary because it is much more convenient for our patients but we use some Airedale Acute Trust services that have close ties with the community (particularly psychiatry and medicine for the elderly).

The Patients

The practice population is pretty constant at around 7,500, of which around 1,300 (20%) live in Lancashire. Like most rural practices, our patient turnover is fairly low (7% per annum). 36% patients are registered as dispensing patients.

Compared to national averages, we have fewer than average between 15 and 35. 50% of young people leave the area after school to go to college or find work reducing the demand for maternity and family planning services. Those that stay may struggle to afford the cost of local housing or find limited rented accommodation.

On the other hand, there is an influx of people in their early thirties and post-retirement so we have a high population of over 70’s (1,054), roughly 25% above the national average. The area attracts a lot of tourists so we see a quite a few temporary resident in the summer.

Local Employment

The single biggest employer in the area is Angus Fire Armour in High Bentham. They employ about 100 local people. The ARC quarry at Ingleton also generates a lot of work, although mainly for self–employed lorry drivers. Many other people are employed or self-employed in the tourist industry, small businesses such as building, and of course in farming. A lot of people, particularly in the west of the practice commute to Lancaster or Kendal.

There is little severe deprivation in the area but the financial pressures on agriculture in recent years has taken a severe toll on the farming community, particularly in terms of mental health. This is a group of patients who are poor users of the health services but are increasingly in need of our help. Unemployment is also a problem for young people with many holding poorly paid unskilled jobs.

The Practice Infrastructure

Premises

The main practice surgery has occupied the same position on Grasmere Drive in Bentham since 1974. We carried out a £400,000 renovation and extension project in 1993 and we are about to start alterations to create two more consulting rooms and improve the facilities in the reception office (Feb 2004). We also have a major a branch surgery in Ingleton. As registrar you would work mainly at Bentham, but will do one surgery a week at Ingleton. We have a landline that permanently links the branch computers to the Bentham network.

Bentham surgery also serves as a Primary Care Centre for out-of-hours work though the future of this service is still uncertain with the arrival of the new GMS contract.

We hold short drop-in surgeries in key outlying villages to the west in Wray and east in Austwick.

Records and Computers

We were the second practice to install an EMIS system in 1989. RS is a past chair of the EMIS National User Group and is involved in several local and national health informatics projects. We have been as “paperless” as the technology has allowed since 1991, and have worked closely with EMIS on several projects over the years. Being at the (b)leading edge of technology has its pros and cons but is never less than interesting. We now use EMIS LV v5.2 in just about every aspect of clinical care and administration.

Patient Access

Surgeries and clinics all run with an appointment system, apart from the Wray and Austwick surgeries. Urgent appointments are always available on the day they are requested, though patients may have to wait some days to see their preferred doctor about a non-urgent problem. Patients may choose to see a doctor or a practice nurse. We have not formally adopted advanced access but we regularly carry out a thorough review of our access arrangements to continue to achieve the Department of Health targets without degrading continuity or quality of care.

We run a series of jointly-held doctor and nurse clinics to manage key chronic diseases: ischaemic heart disease, hypertension, heart failure, cerebrovascular disease and diabetes mellitus. We also run asthma, COPD, and child health clinics. We anticipate scoring highly in the Quality and Outcomes Framework and expect to offer an extensive list of Enhanced Services.

The practice nurses take the lead in the management of asthma and chronic obstructive pulmonary disease and deal with most of the minor injuries that are presented to us rather than make the long trek, and endure the long wait at the local Accident and Emergency Departments.

Transport from outlying villages is a perennial problem. Public transport is scarce and not usually at convenient times. We have overcome some of the difficulties by setting up a transport scheme with Bentham Community Transport that enables patients to get to the surgery with the help of a team of volunteer drivers. It is subsidised largely by a charity that the practice set up to provide services and equipment to our patients not available from the NHS or social services. We receive several thousand pounds a year.

Phlebotomy services are provided by receptionists specially trained to take blood and deal with urine samples, and by a community team nursing assistant.

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