Riverside is the largest practice in East Lothian and one of the biggest in Scotland, but in recent years has been continuously criticised by patients, who report difficulties getting in contact by phone and booking an appointment.

In April, East Lothian Health and Social Care Partnership (ELHSCP) announced an independent review to assess patient concern.

After five months of research, observations, engagement, benchmarking and analysis, the final report was published last Friday, providing a detailed description of the steps taken by the review team, as well as 17 recommendations for RMP, ELHSCP and NHS Lothian.

Colin Beattie, Musselburgh MSP, said that he hoped the recommendations would be put into practice soon.

He said: “My constituents have long awaited the outcome of this report after years of complaints regarding issues accessing healthcare at RMP.

'Gone on for too long'

“I would urge Riverside, ELHSCP and NHS Lothian to take on board all 17 recommendations set out in the report and action them as quickly as possible.

“The issues regarding access to healthcare at Riverside have gone on for too long and it would be unfair to delay any improvements the patients have long-awaited for.

“I have subsequently set up a meeting with the review team and will meet again with the cabinet secretary for health and social care, Humza Yousaf, to ensure these recommendations are carried out in a timely manner.”

The review was designed to gather patient feedback and consider how the practice provided access, covering areas such as triaging and prioritising of patients’ needs and clinical capacity.

Dr Dorothy Armstrong, who led the review, said: “It was both humbling and poignant to hear the accounts from patients about their experiences both positive and negative.

“We are very encouraged by the progress RMP have already made in adopting some of our early suggestions and feedback.

“There is more work to be done and we trust this report offers helpful insights, suggestions and resources to enable change.”

'Welcome recommendations'

Fiona Wilson, chief officer for ELHSCP, added: “We welcome the review team’s recommendations and look forward to working with Riverside Medical Practice to collaboratively put together an action plan.

“Our priorities are to deliver the best possible outcome for the community; improve access to health services; and instil patient confidence in both the practice and wider health and social care services across East Lothian.”

The report makes several recommendations to improve care at Riverside, such as reviewing the telephone system to ensure it meets patient needs; reviewing the job title, role and working hours of staff; resuming pre-booked appointments; and reviewing its access arrangements for patients who find it difficult to access care over the telephone or online.

In response to the report, the practice said in a statement: “We’d like to thank all of the patients who shared their views with the review team, and the review team for their exploration of this complex issue. We hope the report represents a stepping stone on the way to patients in Musselburgh having their primary care needs better met.

“This report should be the catalyst for GPs and other healthcare professionals, patients, ELHSCP and other local stakeholders coming together to find a way forward.

“We thank the review team for their other recommendations and will now look to consider if, how and when we can put them in place – and where we need the support and involvement of ELHSCP and NHS Lothian to allow us to implement them fully.”

'A big sigh of relief'

Ward councillor Andrew Forrest was glad that members of the public were having their voices heard.

He said: “I welcome the support from this report, it has been a long time coming. There has been a lot of discussion with the council, previous councillors and the community council on the issue.

“I’m sure this will give people a big sigh of relief they are being listened to.

“We always knew that it was never the staff at Riverside who were the problem, it was the difficulty with booking appointments that was the issue.

“If the recommendations that have been made are implemented, then it will allow staff to do the job they set out to do.”

Fellow ward councillor Ruaridh Bennett added: “I hope that the report and recommendations bring a change to the practice and help Riverside provide the best care possible for the people of East Lothian.”

Irene Tait, chairwoman of Musselburgh and Inveresk Community Council, also highlighted that the staff at Riverside were not to blame for the issues.

She said: “I don’t believe it’s the fault of the staff at the practice but rather the the system, particularly the phone system, that is greatly flawed. We are hoping for an improvement, it’s been a challenging time over the last few months so any improvement would be greatly welcomed.”

The 17 recommendations in full

The 17 recommendations suggest that Riverside:

1. Urgently review the telephone system to ensure it meets patient needs. Areas to be considered include call-waiting, filtering of phone calls and content of messages to be more patient centred.
2. Carry out further work to maximise the utilisation of the data from the telephone system to improve the patients’ experience of accessing care.
3. Should carry out quality improvement work to identify the nature of the requests they get from patients in relation to pre-bookable, same day or urgent care.
4. Should continue to review the job title, role and working hours of the team to ensure that there is sufficient staff working with the appropriate skills at the right time i.e., 8am to 10am, to meet patient demand.
5. Continue along with ELHSCP to promote and signpost patients to the range of alternative services that are available in the locality. This information should be easily accessible for patients in a range of venues and formats, such as online and in the community.
6. Continue to support its call navigators’ learning and development and consider further training in areas such as care navigation, customer care and challenging conversations and complaints. The practice considers developing a care navigation protocol for the call navigators which could also be shared with patients.
7. Continue, along with ELHSCP, to review their triage and telephone consultation processes and consider providing more personalised call back or a booked telephone consultation time. RMP should review its list of issues which should be managed in a face-to-face appointment to prevent patients having to have both a telephone and face-to-face consultation.
8. In collaboration with ELHSCP, review the process for signposting to ELHSCP services to reduce double handling or duplication.
9. Consider introducing online appointments for more routine appointments with the practice nurse and other members of the team.
10. Review its access arrangements for patients who find it difficult to access care over the telephone or online.
11. Adopt the NHS Model Complaints Handling Procedure to ensure patients can make complaints in an accessible and person centred manner. a) Survey those patients who have complained to monitor the process and subsequent satisfaction. b) Measure and monitor the key performance indicators for complaints and report these on the RMP website. c) Review the policy and associated materials about unacceptable actions. d) Ensure staff continue to be supported about how best to respond, resolve and learn from complaints.
12. Resume pre-booked appointments, particularly for patients with more complex conditions or increased need.
13. Working with patient participation group and other stakeholders, produce a vision and values blueprint as a basis for building relationships.
14. Work with ELHSCP to renew the patient engagement strategy to include the principles in the National Standards for Community Engagement and the VOiCE tool.
15. Review prescribing processes alongside pharmacy team, informed by patient experience to improve quality and efficiency of access to acute and repeat medication.
16. ELHSCP should urgently review their contracting and working arrangements with RMP to develop a shared understanding of how the resources provided [in addition to GMS] such as the Care When It Counts (CWIC) service can be delivered and sustained.
17. NHS Lothian and ELHSCP should support the contractual and legislative requirements for the monitoring and reporting of complaints. Consideration should be given to further learning and training opportunities for staff.