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Jeffrey Krell – Regional Representative (England).

Having had over 30 years in running a family business I decided in 2004 to make a career change.

I have been in my present role for nearly 8 years as a practice manager in a 2 doctor practice in a deprived part
of Manchester.  With over 4000 patients the position is both challenging and rewarding. In this time I programme managed a change of computer system and helped steer the practice through the very many changes we have had
to adopt with the help of a small but loyal group of staff.

I have taken an active role in our local PCT being a Practice Manager representative on boards such as IM&T DES, Summary Care Records and the Quality Governance Board.

I am married to Bev and have one son who has just started at university, I am an active Lay Magistrate and also do some voluntary work.

My hobbies include gardening, reading.

Latest news



Practices throughout England have just been notified of a new DES covering extended hours opening.

In essence this is a reworking of a similar DES/LES from a about three years ago,

For every 1000 patients on the practice list at April 1st 2013 a practice will need to offer an additional 3O minutes of appointments outside of the core hours that are currently worked i.e. before 8:00am and after 6:30pm.

These appointments can be with a doctor or a nurse or using a combination of both. In return for taking part a practice will receive a payment of £1-90p per patient.

So for example a practice with 4000 patients would need to open an extra 2 hours per week for the year and in return will receive £7600.00 extra income.

Whether practices will take this offer up is debatable. as the extra costs of overheads with extra reception staffing and increased payment to salaried doctors and nurses will eat away at a good portion of the extra money received.

We did participate in the DES when it last ran and for some patients it was good and responsibly used but we still had many DNAs and some slots were not even filled. 

Up until April this year we took part in a LES that offered easier access to the doctors and it worked very well. We altered the variety of appointments on offer to include telephone consultations, and more emergency appointments. This worked well and we returned figures to the then PCT on the number in each category we saw which is some weeks were very high.

This LES ceased on March 31st (without any notification) and yet we carried on with what had been a popular scheme without any extra income.  I cannot see how we can run both these schemes as there is only so much work a GP and nurse can do.


We are about 6 weeks in to the new financial year under the new CCGs and it is probably a good time to have initial thoughts on the changeover.

Gauging the changes I have experienced, things have not been as bad as they could have been. I note from our local CCG (Manchester North) a real willingness to engage with the practice. A lot of email introductions by the new staff and offers of help and support if needed.  With the new weekly News Round up from the CCG we are being made to feel part of the new process. Hope this is the same nationally!!

Where I have noticed some problems are on the payments side. A delay in the end of month payment by a couple of days, which whilst not major for us, could have caused problems for other surgeries. I also noticed that a Local Enhanced Service had stopped without any notification.

I am keeping a close eye on all our payments to check that we actually receive the full monies for all the work we are doing. Not an easy job keeping tabs!

We have been receiving information on the various new Direct Enhanced Services we can sign up for in England for 2013/14

The details at the moment are a little bit sketchy. Obviously we will all need to look at how easy they will be to achieve and whether payments will be fair for the increased work. Expectations against achievability!!!

The DES across England are as follows:-

Alcohol Participation DES

Learning Disabilities DES

Remote Care Monitoring DES

  • Identify and agree the priority clinical area for remote care monitoring to be implemented 2014/15
  • Record appropriate patient preferences for receiving and monitoring the required test results.
  • Maintain up to date contact details for relevant patients.
  •  Plan a system for registering patients for remote care monitoring of the agreed local priority

Dementia Screening DES

  •  Identify patients at clinical risk of dementia
  • Offer assessment to detect for possible signs in those at risk
  • Offer referral for diagnosis where dementia is suspected
  • Support the health and wellbeing of carers for patients diagnosed with dementia

Improving On LINE Access

  • Enabling and utilising electronic communications for booking of appointments
  • Enabling and utilising communications for repeat prescriptions
  • Registering patients issuing passwords and user verification practices to enable patients to gain on line access

We also have the MMR catch up campaign and also the continuation of the Pertussis programme.  So it is going to be a very busy period ahead.

Practices in England I am sure are watching with interest the situation with the ongoing press and government claims that the Doctors are the cause of the serious problems at Accident & Emergencies.
I am sure that like us, many other surgeries have same day access, have emergency appointments, and also telephone consultations.

Asking around some of the local practices they like us say they have never been busier. So what is the answer?

Until it is recognised that the doctors roles have increased over the last few years, to cover more illnesses, and more social and personal problems,  the easy excuse will be to continue to blame General Practice for the current state of the NHS.

Recently looking through our out of hours and accident & emergency letters I could see they were treating such minor things, like a sore finger, a cold for 48 hours, a sore, and purely wanting a repeat prescription for medication that had not been ordered.

Until this type of abuse of the system is tackled and patients are told that they need to be more responsible for their own care I cannot see much improvement. You cannot really blame the hospitals or the OOH as they have to be careful that they do not turn away the one case that seems trivial, but turns out major.

The expansion of NHS111 in England has been disastrous. I am aware that in some areas where this has been trialled it works well, so why did the NHS not commission the extension of this rather than letting all areas do their own thing trying to reinvent the wheel.

In the Manchester area it started and lasted just a few hours, it was chaos and I am led to believe other areas had a similar experience.

I can see that since the responsibility for pension contributions for locums has now passed to the practice, there seems to be many more locums available. This again seems another way of clawing back money from surgeries and penalise the smaller practices that are more unlikely to use in house doctors to cover for holidays and sickness.

It is a fact that patients like the continuity of care given by smaller surgeries as some of the super practices have so many doctors that it is difficult to see the doctor of choice. There is an argument for both sides of this case but to penalise smaller surgeries does them and the patients a disservice.

All these arguments will go on I am sure and we individually will carry on giving the care we have always done and will continue to get critisicm from outside the NHS but that is life.

Library Update: 

Complaints Procedure - England (POD)

Agenda for Change pay scales from 1.4.2012