Llanfyllin Group Practice
Looking after our patients and our staff as we would want our families to be looked after
How we work
Over the last 16 years we have built a strong team where every member from cleaner to Doctor is recognised as integral to the working of the practice. While the Doctors take more responsibility for patient care and decisions -we recognise that nothing would function and care would be compromised without every member's skills and role. By focussing on what is needed for patients and prioritising the most unwell we have developed ways of working that ensure patients are seen in a timely and safe manner by the most appropriate member of the team and as Doctors we have retained what makes primary care such a rewarding career despite the many pressures we face.
The Doctors
We have 6 partners , 3 salaried GPs and two regular locums. We support each other both clinically and dealing with the stresses we face in working life and at home. Given our team approach, no-one is ever left dealing with work alone and any issues that crop up in the day we discuss together to try and work out solutions and a better way of working. Rural practice is a fantastic place to work- we are the only medical service and hence deal with anything from minor illness to major emergencies and everything in between. We work up patients before referral with in houseECG and extended holder monitoring, local Xray, US, CT and MRI access, and have a very good phone service for consultant advice. Under increasing pressure we looked at what made general practice both rewarding and workable and then worked to maintain that ideal by working in different ways and more as a team so the limited resource of GP time is used for what only a GP can deal with. We are very interested in supporting development of new services, following personal interests and have a good track record for obtaining funding for those pilots. More importantly perhaps? We like each other, we have a laugh, we are never unsupported or feel that we are alone- we go home together, we work things out together.
Senior partner, business lead- very good at parties . Struggles with names but knows an awful lot about everyone’s past history after 20 years -gets taken on major bike rides and is seriously bad at parking....
Dr Melanie Plant
Rather good at dermatology and a skilled well rounded GP, incredibly kind and Cluster lead for the practice. Known to like rum and rather keen on rather good holidays. Adamant he doesn't have gout and is definitely camping at this year's summer BBQ...
Dr Alun Lovell
Our only full time partner - a true workhorse, the go to physician in the practice- dedicated to patients and caring in the extreme. Also a renowned dancer as is his wife , Dhivya. 3 beautiful children complete the picture who are always lovely to host as a family of animal lovers as well as keen cricketers
Dr Ajith Kartha
Our highly active partner, responsible for the nursing team, amazing biker, outdoor girl- recently taken up surfing but not sure she shouldn't stick to biking.... Takes Mel and Suzanne on marvellous bike packing trips despite their protests
Dr Kate O'Dwyer
Our lovely Lale specialises in Mental Heath & Wellbeing, Women & Children, & Acute Medicine. Outside of work, Lale loves nothing more than spending time with her three children and going for countryside walks with her Cockapoo, Coco, and is also an avid skier and yogi!
Dr Lale Tuncer
Our newest partner , Dr Rao
*BIO PENDING*
Dr Raman Rao
Having been with us now since finishing his GP training David goes from strength to strength. Caring, thoughtful and knowledgeable David is a true team player - always an asset to any night out and great photos on the work group chat! A very high level biker, he needs to burn off energy but we hope not falling off at 40mph again!! He's the one in the middle!!!
Dr David Griffiths
Our beautiful Russian salaried GP Elena joined a few years ago at the start of COVID. A baptism of fire indeed! Caring, thorough and developing new ideas and her career while jaunting off to France to ski and walk in the hills much to the jealousy of us left behind.
Dr Elena France
Our longest serving salaried GP, Becs works harder at home and work than anyone I have known. Immensely thorough and deeply caring, loved by her patients - I did warn her that if she didn't give me a photo I would find one - Becs in full hazmat at the start of COVID was just too good to resist.
Dr Becs Edwards
The ANPs- the mainstay of the Duty Team
The ANPs
We have 5 prescribing ANPs who support the duty rota. Deb R, Deb L, Deb C ( I know hard to believe they are all Debs) Tasch and Suzanne.
Our Nurse team is led by Deb Lovell. A calm head in every storm Deb leads the team and organises the rest of us (mainly by bribing us with amazing cakes). She has a strong interest in adolescent mental health and nursing home care which is also supported by Suzanne. Deb Rigby is a highly experienced ANP with a side-line in Yoga teaching as well as being an excellent teacher which we hope to capitalise on if we realise our ambition to be a nurse training practice. Tasch and Deb C complete the team- we couldn't have safer hands.
The Practice Nurse Team
The practice nurse team leads the chronic disease management as well as supporting every aspect of patient care from contraception and smears to injections, health promotion and supporting minor surgery and coil clinics. Tracey Hutton leads on diabetes , insulin initiation and GLP-1 initiation. Leanne apart from leading on COPD and asthma also looks after the HCAs and managed the BMD service and Zio service.
Enid our longest serving Nurse has worked in the NHS all her working life. What Enid doesn't know probably isn't that important and we are very proud to have our own 'NHS hero' in the practice.
Our newest additions to the nursing team are Nerys and Amelia. Nerys has joined us from the DN team bringing her expertise to our holistic service - currently called the frailty service but really a coordinated service focussing on supporting our patients as they become more dependent on others to live their lives as and where they wish, maintaining their independence for as long as possible and allowing them realistic choices as they reach the end of life. Amelia is a newly qualified nurse and is developing her skills whilst being supported by our incredibly experienced nursing team. Annie completes the team, retiring from District nursing for practice work.
Our HCA team of Helen and Glesni have recently been joined by Amy. Once settled in we fully encourage and mentor our HCAs to take their profession further- the sky is the limit! .
Tony Hewett,
our Pharmacist Partner
Is there anything he can't do?
Tony leads and provides governance and training to our very large dispensing operation and dispensers. Every discharge summary, clinic letter and medication query passes under his expert gaze before actioning and passing on as needed. He supports the Nursing Homes and the frailty service and provides essential support for the face to face clinicians. This year he has enjoyed having Pharmacy Interns and we hope this will continue. As if this wasn't enough he is also a vital part of the management team and moving projects forward.
The Dispensing Team
Truly Indispensable
Elise Parry, Dispensary Manager
An example of our commitment to the training and development of our team, Elise started life at the practice as a dispenser and has worked her way up to the position of Dispensary Manager, leading a team 20 dispensers across the 3 sites. Elise is a calm, and professional presence at all times, and contributes greatly to the effectiveness of the Management Team.
The Dispensers
The dispensers work on each site interpreting patient requests for medication, ensuring medication reviews are not due, getting the monthly meds ready as well as checking medication knowledge and compliance with patients. We encourage and support our dispensers to move ahead with NVQ training.
The Management and Admin team
The unsung heroes!
Juliet Sagar, our Managing Partner
Juliet makes everything seem easy and manageable. Despite the challenges of COVID with months of 10 staff off every day, she remained her serene self offering much needed individual support and keeping patients informed. Any new development is worked through, delegated and put in place with transparent explanations.
The Management Team
Led by Juliet Sagar (we are still getting used to the new surname) in her own inimitable style, our Management Team is vital to the effective operation of our Practice, and is made up of:
Tony Hewett, Pharmacist Partner
Corby bailey, Operations Lead
Sharon Williams, Finance Lead
Leanne Davies, Data/IT Lead
Chloe Morris, Management Support
Elise Parry, Dispensary Manager
Jan Davies & Sue Lewis, Admin Assistants
Sian Roberts, Dispensary Supervisor
Lyndsay Spencer, Four Crosses Supervsisor
Dawn Mayer, Llanrhaeadr Supervisor
The Reception Team
Each site has dispensers and receptionists but the main phone centre is in Llanfyllin. This team are expert in signposting / advising and somehow making patients feel safe and listened to while arranging the most appropriate next step . We have a strong training ethos and work together to solve the hiccups that occur. How they deal with everything from queries about dog treatment to whether the spar is open in between major issues is beyond me but glad they do !!!!
The Secretaries & Admin team
Vital - how do they know everything??
The Secretaries
Not just the letter writers (and indeed decipherers of vague instructions about the uh lady who lives up the hill in the White House) but the first port of call for patients chasing appointments, the secretaries navigate the NHS and cross border issues with consummate ease, walking up hills, coordinating cake Fests, known to have a gin or two...…..
The Coders and Administrators
Dealing with notes, reading the letters, coding and getting the letter to the right person keeps on top of this avalanche of incoming work and allows the Doctors and pharmacists breathing space to read the important letters well. Insurance reports, DWP and bribing the doctors with chocolate to complete the endless firearms reports..... a successful strategy
So how do we work ?
Working in a rural area means we are the one stop shop for our patients from the minor trivial to the chest pain, fallen off a ladder type problem. We cover what on paper seems a very large area but actually does not appear so when you are here. It is sometimes rather a relief to be out visiting as the journeys are beautiful. We work from 3 purpose-built sites all with their own idiosyncrasies- as GPs mainly from Llanfyllin and Four Crosses but we fight over who goes to Llanrhaeadr as it is so beautiful and quiet. We have very supportive patients who appreciate what we do and that sometimes we don’t and indeed can’t live up to our own high standards. When mistakes happen ( and of course they do) we are open and honest about what happened and learn from our mistakes while making sure no one feels alone to deal with that awful feeling . Equally we do not tolerate abuse of any kind to any one of our staff - we are all doing the best we can every day and are human too. We are very lucky to have our district nurse team on site and they are very much part of the team . We have excellent social services, voluntary sector and community team links which makes life so much easier
Day to day life- how a patient accesses care
The receptionist is , of course, the Lynch pin. The patient rings in and the receptionist sympathetically and sensitively finds out what is happening and what is needed. Referring to the secretaries, pharmacy and dispensing team and signposting to external services such as voluntary sector, powys assist, podiatry etc sifts out some queries immediately. Patients requiring blood tests , a chronic disease appointment or to change an existing appointment are sorted out. Then we are on to the trickier part.
We have tried many different ways of working and at the moment feel that non clinical staff trying to work out if a problem is urgent, can wait a little or wait a long time is not fair or realistic. Equally a routine GP appointment is a scarce and valuable piece of time and should be utilised fully. Thus the receptionist will. book a routine slot for any follow up, or for the menopause, or any skin issue - the latter being booked into dedicated skin clinics.
Anything else is placed with an indication of the site the patient accesses and the issue onto a triage list. Each day there is a lead GP with one or two other GPs and 2 or 3 ANPs . The lead Gp rapidly triages the patients into ANP slots- phone call or face to face, into GP slots from 11 am , into routine slots when this is clear or for blood tests then a GP slot. The less clear are telephoned by the GPs or ANPs if free and within their expertise and a plan agreed. Requests for home visits are always called to find out what is happening and a visit is arranged as needed.
For this to be effective the routine GP day has 15minute routine slots, 6 x5min phone slots only for results, a blocked off time for home visits both planned and unplanned and some appointments held back to be used that week by the Lead GPs. So far we are seeing this working quite well. The lead receptionist is actioning the GP triage instructions and there is a reduction in patients actually needing routine slots and generally clinicians can focus effectively on one job.
As ever we discuss how this and other areas are going in our weekly meetings.
Extra Services
In house we take all bloods for ourselves and secondary care.
We undertake ECGs , 14 day zio monitors which are reviewed by Dr Kartha before passing back to the requesting clinician.
We can arrange US, Xrays( which we can view immediately when synapse works) , MRIs and CAT scans locally or in Shrewsbury, our DGH.
We provide a minor injury service on our main site.
We provide minor surgery, IUD fitting and implants, diabetic specialist service with insulin initiation led by our diabetic lead nurse and GP. We provide all chronic disease management, immunisations, child health surveillance, smears, we have good relations with the primary care mental health team for counselling and good links to the community mental health team.
We are now very fortunate to have highly skilled physiotherapists on site 4 mornings a week. Receptionists can book directly into both of these clinicians following guidelines.
And the things that keep us laughing
Organised by Helen -everyone contributes amazing cakes , candles, soaps , sausage rolls, quiches - average weight gain 3lb …..
Cake making for macmillan fundraising
A huge laugh on local Lake Vyrnwy
Practice boating expedition at Lake Vyrnwy
Juliet learnt you have to train to walk up hills and a bottle of gin in your back pack sounds a good idea when you set off `but a year later they finished a 10km run in style - we have to work off the effects of the cake fest!
Sporty stuff!
And the Parties....
Ju's hen do- see the blog for the rest of the photos!!
Going out
They thought they sounded FABULOUS
Karaoke
Many and varied- sadly missed during COVID as were the summer BBQs - but back on track for this year
Xmas Parties
Kept us sane- so glad Deb took up being a yoga teacher as a sideline to being an ANP-