'This is the hardest I've ever worked' - says Banbury GP who is taking on patients' complaints which resulted in a petition calling for improved health centre services

Dr Rogers spoke to the Banbury Guardian after inviting a group of the dissatisfied patients to the surgery to discuss their complaints in person.

The patients had complained of being unable to get a personal appointment with a doctor, the lack of effectiveness of the merger of town surgeries, call centre staff deciding on appointments, a preference for telephone consultations and a reduction in clinics.

Dr Rogers said: "Our call centre team members are specially trained by clinical and non clinical staff, because we recognised receptionists didn't have all the answers and couldn't keep track of all the protocols. The team managers attend practice meetings and they talk to me regularly during the day; they can ask about specific issues at any time. We have an 'open door' policy so if we're not with a patient, any member of staff can come to see us.

"The questions they ask need to be asked so the GP is actually working on cases that must be seen by a doctor. We are ensuring we see people who need to be seen. There is a shortage of clinical staff so we have to triage people to get as many managed in the best possible way. Some patients may have issues that may not need an instant appointment - for example they might be people wanting to discuss vaccination of children, or other issues that are not clinically urgent.

"People can go onto the website and re-order their prescription. We're not allowed to take requests over the phone but we can prescribe in a phone consultation.

"We far prefer seeing people face to face; I don't know of any GPs who are not gregarious people. We love doing face to face work but it's hard to see how we could do all consultations that way because of the numbers - we have 15 - 20 GPs working any single day plus nurse practitioners and it soon becomes not do-able because of the closeness. If social distancing is officially stopped, it may affect our threshold (which includes psychological reasons for seeing a patient). Phone and e-consult consultations are brilliant."

Dr Rogers explained the e-consult page on the practice's website where cases are relayed to the most appropriate person or team. This could be a GP, the pharmacy or an administrator.

"This isn't a good option if you don't tell the absolute truth or if you have very serious symptoms. For red flag symptoms it asks the patient to phone the surgery - and the system has lower thresholds for older more frail people," she said.

"We have never stopped seeing people face to face - we have been doing dressings, immunisations and other treatments as we've always done. There may be a telephone consultation to start with so we don't accidentally bring someone in who has Covid.

"Demand is unpredictable and there's never going to be enough supply to meet that demand. For example during the week the the school immunisation service asked parents for children's NHS numbers we had a flood of calls. It unintentionally put a lot of extra work in our direction.

"If someone can't get through on the phone they can send an e-consult and tell us they're having trouble and there's our email address to write to. We've never not seen someone who needs to be seen urgently. Other practices have a practice of saying they will cut off and not accept calls after a certain time. We've never done that. However people's views of what is urgent may not be the same as a doctor's. Out of Hours starts at 6.30pm and ends at 8am," said Dr Rogers.

"The health centre has a finite number of GP appointments and it is never enough. During the pandemic, secondary (hospital) care, especially the John Radcliffe Hospital, did not take any referrals and we had to hold the risk for referrals we were unable to make. We're still holding those referrals which relate to all sorts of conditions, from eating disorders to child psychiatry."

Dr Rogers said GP services are trying to manage difficult expectations. The 111 service will insist a GP will call back within an hour but it is not always possible, she said. The surgery aims for continuity so one or two GPs get to know a patient and his or her needs so they don't have to describe their case repeatedly.

She said some patients might feel aggrieved if they are not seen for a condition for which everything possible is already being done. These include some patients with long Covid. She said the surgery's social prescribing team can sometimes help patients to get through difficult times.

Dr Rogers said it had not been possible for staff to respond to bad reviews or complaints on the NHS website link on the health centre's page because it is administrated separately by central NHS staff. She said moderator algorithms decide whether contributions should be posted up and whenever possible, she would respond. The web page for the former West Bar Surgery (which was merged into Banbury Health Centre) still appears but it does not have an active administrator and Banbury Health Centre staff are unable to manage it.

She said a huge amount of work had gone into accepting the 15,000 failed Horsefair Surgery patients and trying to catch up with four years of unmet need.

"We've been liaising closely with the Care Quality Commission and we have had extremely frank discussions with them; they've been totally involved from the beginning; they are being kept informed and they are supporting us," she said.

"This is the hardest I've ever worked in my career - it's relentless - which is why I am picking up on the social media comments which are having a bad effect on some staff. I know we are giving a good service; I know all of my staff share our principles and so when they feel people feel the reverse it gets to a point where I feel it's enough."

Dr Rogers' social media response to the patients petition can be seen in this Banbury Guardian report.