FAIR TREATMENT?

Page 1 | 2 | 3
 

Sai Medical Centre on Sale Street, which only serves asylum seekers, may be shut because there are only 400 registered. This is despite capacity being cut twice, first to 900 then to 600, to allow for longer appointments required because of language barriers. Central Derby Primary Care Trust (PCT), which runs the practice, is looking at two options for its future. The first would see the surgery closed and the team which runs it, GP Dr Richard Crowson and nurse practitioner Karen Gilliver, providing support to the city's 37 GP surgeries on a mobile basis at an annual cost of £110,000.

The second option was to open the surgery to patients with special needs, such as the homeless or people with drug or alcohol problems, to boost numbers. Trust spokeswoman Debbie Jackson said, "The reason we're looking at this new model is because there are not people coming into Derby in the numbers we originally anticipated." Dr Prasanta Chakraborti, vice-chairman of Derbyshire Local Medical Committee, which represents GPs, said, "This is a shining example of how taxpayers' money is wasted by the bureaucratic misadventure of the NHS administration.

The trust has been going against public opinion on this from day one. Apart from the PCT, nobody agreed to use the Sale Street surgery for the purposes for which it has been used." Mrs Jackson said the building was only big enough to house a single-handed GP surgery, which were difficult to recruit to, and that it was not part of the trust's future plans. The primary care trust may decide that Sale Street is now unsuitable as a general surgery once again. Locals will not accept the argument that it is too difficult to recruit a GP to run it, when there was no such problem when the patients were asylum seekers.

Dr Prasanta Chakraborti, vice-chairman of Derbyshire Local Medical Committee, which represents GPs, has branded the surgery a "total flop". He said, "Nobody apart from the Primary Care Trusts wanted to use the Sale Street surgery for the purposes for which it was used. I am very dubious about the new service because I saw what happened with the Sale Street practice." But Greater and Central Derby Primary Care Trusts, which run GP services in the city, blamed the surgery's closure on the Government's decision to halt dispersal of asylum seekers to Derby in 2003. "If the number of people coming into Derby had been what we had originally anticipated, it would have worked," a spokeswoman for the trusts insisted.

Dr Chakraborti and his wife Alaka have run the Family Medical Centre on London Road since 1978 but are now retiring. All of their 5,000 patients and eight staff are to transfer to the Ascot Medical Centre on Osmaston Road. A spokesperson from Derby Central Primary Care Trust said, "There is a national shortage of GPs and this shortage is being addressed through the NHS Plan, but it will take some time for more GPs to be trained and recruited. Practices in Central and Greater Derby PCTs' locality have experienced difficulties in recruiting GPs to fill some vacancies. This is because many GPs do not want to work in the more demanding inner city environment."

A specialist service for violent patients offered by a Derby GP surgery has been hailed a success after its launch a year ago. Wilson Street Surgery caters for violent patients from across southern Derbyshire. All but one of the area's five primary care trusts, which manage GP services, pay the surgery to provide the service. Amber Valley's trust provides its own services at Ripley Hospital. Although people are entitled to free healthcare within the NHS, GPs have the right to refuse to treat a patient. If a surgery refuses to treat a violent patient, they are referred to Wilson Street via the police. That includes patients who may live as far away from Derby as Ashbourne or Ilkeston.

Wilson Street Surgery built an extension in 1998, which included a secure unit to allow it to treat aggressive patients without them disrupting the smooth running of the surgery. The unit, which has its own waiting room, is equipped with CCTV cameras and it allows a GP to consult a violent patient while a security guard looks on from outside. The service is run by two of the surgery's GPs, Dr Steve Little and Dr Jim Daniels, both of whom have a special interest in violent patients. A third GP, Dr Andy Fyall, helps when needed. In April 2003, six violent patients aged 25 to 45, were referred to Wilson Street. There have been no more referrals. A year on, five of them are now ready to return to "normal" GP care, although no formal decision has yet been taken.

Dr Little said, "Usually the patient has had some issue which has led to a fracas at the previous practice. That needs to be sorted out and normally takes a few visits. Once they're on the straight and narrow, they usually visit only as often as the average patient. Working with violent patients has its moments, but it can be very satisfying. To most people, they would seem to have a psychiatric illness but, when you examine them, they're not depressed or psychotic. To correct their behaviour, repetition is necessary. They almost always feel like they've been treated unjustly."

Wilson Street aims to provide the same type of care to its violent patients as for the rest of its 15,000 patients, he said. At first, a patient may have a series of appointments to establish the ground rules. The aim of the service is not just to protect GPs, their staff and patients but to "cure" the patient of a violent streak. Pat Marjoram, former chairman of Southern Derbyshire Community Health Council, which was disbanded in 2003, said, "This very small group of people can be a severe problem to a particular GP. This scheme seems to have worked very well." Violent patients are defined as those who are verbally or physically aggressive with GPs, surgery staff or other patients to an extent which is deemed unacceptable.

Medical staff say the behaviour can range from persistent swearing to hurling chairs about waiting rooms. In the past, violent or abusive patients that no GP wanted to deal with were passed from surgery to surgery, with little chance of continuous treatment. There was little help for them and the root cause of their problems was rarely tackled, experts have argued. It has been claimed that the cause of some of the violent behaviour can often be down to drug or alcohol dependency, or a borderline personality disorder. Doctors say the people are not mentally ill but have difficulty interacting with other people. A violent patient has to sign a contract when he joins the surgery, setting out what is deemed to be acceptable behaviour.

<<< Prev