Parkbury House Newsletter

FeNO machine update

We are very grateful to Kathryn for her efforts in raising funds for the Feno machine, she walked the equivalent of 7 marathons in January of this year, that’s about 184 miles! The team is currently undergoing training and trialling its use, and we look forward to sharing further updates next month as implementation progresses.

In addition, the additional funds have enabled us to purchase an upgraded audio radio system for the waiting area, improving sound quality and offering a wider selection of music for patients and visitors.

A Day In The Life

In a recent conversation with a patient in the waiting room they casually asked, ‘What do doctors do all day?’ On reflection I thought it might be a good idea to ask one of our doctors, Dr. Freedman what his day looked like, this is his response.

When Paul asked me to pen an article for the PPG newsletter on the ‘day in the life’ of a GP, I thought long and hard about how I might proceed and decided to focus on a day managing e-consults. As you are all aware, this is now the front door for contacting the surgery on almost all matters and is also very much in line with expectations from the Department of Health. It has certainly been a significant adjustment for the partnership and our reception staff and not least for patients!

In the patient/doctor journey, e-consult is a valuable tool that helps us quickly evaluate, triage and signpost patients to the best possible treatment options. Rather than gatekeeping to restrict access the aim of this tool is to make the whole process more efficient ensuring patients get the best possible care quickly and efficiently in whatever form that takes.

Seeing as I spend many hours responding e-consults. I thought it would be helpful to share some observations from my perspective. I hope these will be informative and helpful.

On a typical ‘e-consult day’ I login at 8.00 am and we have a ‘huddle’ with senior admin staff and the duty doctor team. This allows us to review capacity and make adjustments as needed for staff sickness etc. The e-consults start to arrive on the system shortly after 8.00. On a Monday we often receive over 200 during the morning alone and 300-350 overall. Nevertheless, I believe this system represents a significant improvement compared with the historic 8.00 am rush of calls which was one of the chief government motivations for pushing this approach. Despite receiving this number of e-consults we have kept our appointment numbers the same, so we do need to risk assess carefully requests or signpost to the most appropriate solution.

I try and look at any urgent queries first and ensure that patients receive a prompt phone call for advice and/or an appointment as required. Urgent queries are determined by the information the patient includes and specifically by responses to question prompts which generate amber or red flags. Patients can choose between administrative and clinical queries and there are several subcategories. Like all systems, it's far from perfect, particularly when there isn’t an obvious choice to begin with. I find it incredibly helpful when patients can succinctly explain their concerns and expectations, usually at the beginning of the e-consult. This gives me a very clear picture as to how I can best help and whether I can sort something out quickly or whether a more detailed assessment is required, either on the phone or in person.

I'm very aware that the e-consult completion process is quite long-winded and there's a fair amount of repetition which can be frustrating. However, if the concerns are clearly expressed and there's enough information provided, we are happy for patients to use whichever category they feel is the best match and to put ‘not applicable’ in subsequent boxes. Our receptionists are always willing to support patients if they can’t manage to complete an e-consult but most report satisfaction with the process and are able to work through it without a need for extensive knowledge or skills in IT! My experience is that e-consults completed

directly by patients are the most helpful in terms of understanding concerns and providing the most appropriate and efficient support.

We receive very many e-consults regarding mental health concerns. It's very helpful to have sufficient detail here about how patients are feeling and particularly including the sensitive subject of whether there are any concerns about self-harm. We know from experience that it's sometimes easier to indicate these using a remote form ahead of any more detailed conversation. We have access to an excellent mental health nurse and support workers so you also may be booked in with them depending on the concerns raised.

Once the urgent calls are addressed (and usually together with a colleague) I work through the other calls in order of receipt, try and make sure that everyone gets an individual response that addresses their concerns. In many cases, we're able to make a diagnosis based on photographs or at least exclude a serious concern. It's very helpful, therefore, to include a good quality photograph if feasible. Quite often with skin lesions we will still arrange an appointment in person, but the photograph will be a good guide as to the urgency.

Our reception staff work literally alongside me to arrange appointments and call patients back to organise other actions including blood tests and referrals. We also work closely with our medical secretaries in this regard and our clinical pharmacy team who work through medication queries and concerns, including medication reviews. This is truly a team effort with all the staff pulling together to provide the best possible care to our patients.

Getting back to my day, the clinicians often have a short break over a cup of tea or coffee mid -morning. This is invaluable for team building, and we can also discuss any urgent concerns and share learning. We then work through the remaining e-consults and continue to prioritise our workload according to demand and our capacity to arrange telephone calls or appointments as required. We work very closely with the doctors and nurse practitioners at the St Albans Integrated Care Hub (the former Minor Injuries Unit) and will arrange appointments for patients there where appropriate, usually within 24 hours. We also have close links with our community pharmacy colleagues and refer patients to them using the Pharmacy First scheme, which covers a range of conditions and allows pharmacists to assess and treat patients. This can also be accessed directly by patients without a referral from us. Finally, we have a team of first-contact physiotherapists who are excellent at assessing and treating musculoskeletal conditions, another frequent reason for patients to make contact.

I try and have a few short breaks during the day to combat the inevitable decision fatigue. Where possible we split shifts so individual clinicians are not rostered to review e-consults the entire day.

On a good day I get to go home between 6.30 pm and 7.00 but often much later as I also need to spend time on admin tasks, including reviewing test results, clinic correspondence and ensuring along with the other partners that patient and staff concerns are addressed and the practice is running as smoothly as possible. In this regard, we are very lucky to have the support of an excellent senior management team led by Natacha Morar, our Operations’ Manager.

Our goal is the keep the e-consult system open from 8.00 am to 6.30 pm, Monday to Friday. We exercise the option to switch off temporarily the ability to send clinical concerns for a short time if the number of outstanding urgent e-consults is at such a high level that we are unable to provide a safe service. We realise that this can be inconvenient and we will only do this as a last resort e.g. due to staff sickness or unexpected emergencies. During these

periods our reception team is available to provide advice and support and can also speak to the duty doctor team if required.

Occasionally, e-consult does not allow patients to proceed and will either signpost to immediate care e.g. 999 or to call us. This includes children under 6 months of age with acute health concerns. Our reception team are always on hand to provide support and advice in these circumstances and will check with the duty doctor as needed and we will nearly always add babies directly onto the duty doctor call list.

You will see from this article that it’s a complex and multifaceted process from submission of an e-consult through to our response and the resolution of the concerns raised. We are making modifications all the time in response to feedback and our aim is to ensure this is as user friendly as possible for staff and patients alike. We know the system is not yet perfect and there are always things to learn and improve. But rest assured the care and wellbeing of our patients are the key drivers in everything we do.

If you’ve got this far, many thanks for reading

Dr. Jonathan Freedman

Social Prescribing

Many things that affect our health cannot be treated by doctors or medicine alone, like loneliness, isolation or stress due to problems with debt or housing. Social prescribing connects people to non-medical support to address these issues and other unmet needs. This could involve making an appointment to see one of the volunteers at Parkbury House.

We can help someone who is isolated to join a befriending group, an art class or a community gardening project, based on what matters to them. Connecting someone struggling with financial stress to a service that helps with managing debt or claiming benefits. Working with someone with high blood pressure to take up a form of exercise that they’re comfortable with. 

Social prescribing involves understanding the complexities of people’s lives and the inequalities they may face. It can help change the circumstances that make people unwell, and empower people to manage existing health problems. It can help people to connect and to grow in confidence. Recently some patients mentioned an interest in reading, reading groups, book clubs but could not always afford to buy the books. I discovered that Marshalswick library have a book club and they offer the books for free! I popped into the library and spoke the manager, Ian Dignum and I asked him what other services they offer, his response is below and it’s all free.

Our volunteer social prescribers work every Wednesday morning in the surgery.Appointments can be booked at Parkbury House through reception. Appointments (45 minutes long) are every Wednesday from 09.30am to 12.30pm.

Published: Jul 1, 2026