Louise King

Good evening. Thank you for joining our webinar on our private GP service, my name is Louise I'm your host this evening. Our expert presenter is GP, Dr Fiona Warner. This presentation will be followed by Q and A session and you're welcome to ask questions during the webinar by the Q and A icon on the bottom of the screen or at the end of the session, you can do this with or without providing your name.

Please note that this session is also being recorded if you do provide your name.

If you would like to book a GP appointment with Dr Warner or one of my other GPs, there will be a link at the end of the session and now I will hand over to Dr Fiona Warner.

Dr Fiona Warner

Thank you very much for the introduction and yes, I am one of the GP’s working here. There are several of us that all provide the service, but I am just going to talk very briefly through what we can offer you today and thank you for tuning in and listening. I have not done one of these before, but I hope that you will find it very useful.

Just a little bit to start with about me and my background, I was brought up in in Kent actually and I went and studied medicine in London at King's College and I qualified in 2001 and did my house training or my junior doctor jobs in various different hospitals in London and then I qualified as a GP and worked as a GP for a few years in London before returning back to Kent when I started a family I have a I really enjoy general practice it's a job that I've always found extremely fulfilling. I work currently as a GP partner in Rye, in a practice in Rye where I work part-time and then I do a session a week here at Benenden and I joined here in 2019 I have a wide range of interests in general practice but I have a particular interest in women's health and sexual health.

So, what do we offer at Benenden and why might you want to choose to book an appointment at Benenden Hospital? One of the main reasons that people like to book an appointment at Benenden is because you get a 25 minute appointment, for a lot of patients they find that they might want a little bit longer to discuss a particular problem and having a 25-minute consultation will allow that process to take place they might also want to discuss a couple of different problems as well and it can enable us to give a slightly more holistic approach if we have a bit of a longer time to to address all the issues. We offer face-to-face appointments and that enables us to be able to perform examinations and do procedures if we want to as well. You are able to book online for the appointments and often there can sometimes be appointments available on the day or certainly within the week. So, you can usually access quickly and there is a variety of different times that you would be able to book these appointments we also have an on-site Pharmacy. So, if you need to make an appointment and you are issued a prescription you can also get it at the same time

So, in this session I was just going to talk a little bit about the most common presentations that we would see here in general practice general practice essentially covers everything we see a variety of different conditions and as most of you probably would have experience of general practice you know sort of things that we cover but I'm just going to speak to you about the most common presentations that we tend to see.

So, we will cover General health concerns, digestive health, ear nose and throat issues, aches and pains, urinary problems, skin conditions, mental health, women's health and we will go from there. So, these few sections are the most common things that I spoke about, I suggested these because these are the most common presentations that I tend to see here at Benenden. So, mental health, joint pains, digestion, menopause and any ear nose and throat problems.

So common digestive conditions that the patients might come to talk to us about include abdominal pain, changes in your bowel, acid reflux or heartburn, rectal bleeding, dysphagia which is a difficulty in swallowing, nausea and irritable bowel syndrome.

If you presented with any of these problems, we may be able to offer you medication that could benefit you. Sometimes it's just a case of discussing lifestyle changes, we might assess you, do an examination and then feel that a gastroenterological referral would be appropriate and we might suggest referring over to a colleague for a further opinion. We might suggest that it would be sensible to perform some diagnostic tests, we can arrange blood tests which can be done directly on the day, scans possibly at a later date but we can also refer for other investigations such as endoscopy and gastroscopy etc.

Ear nose and throat common conditions that people might present with again. So, hearing loss, sensation of a blocked ear or wax in the ear, infections or tinnitus. So, obviously we can perform an examination, take a history, examine the ear and then if we're able to give treatment we can offer that. We might also suggest referral elsewhere. Common conditions with the nose; blocked sinuses, infection, headaches, hay fever and the throat people sometimes present with difficulty with sleeping and sleep apnoea or persistent sore throat and these can all be things that we can advise on possibly give medication for and refer. There are also options to be able to refer for flexible nasal endoscopy here at Benenden.

General aches and pains this is an extremely common presentation again that we see and we can give advice on various different aspects of managing joint pains the most common joints obviously shoulder, hip and knee, foot, hand, elbow and neck and back pain.

There are many different causes for possible joint pains it can be related to injury or it can be a longer lasting problem. Osteoarthritis is essentially a term we use to describe sort of the wear and tear type arthritis, there can sometimes be other conditions such as rheumatoid arthritis which is a condition that can present slightly differently to osteoarthritis and affect joints slightly differently. Sprain or strain if there's been an injury but also other conditions such as gout or a possible infection in the joint, although that's not quite as common.

We can give information about how to manage pain with medication. We can give advice on lifestyle. We can give advice as to whether physiotherapy would be beneficial for you here at Benenden. We're able to offer referrals for a scan or for treatment if it's simply for something like an x-ray, often that can even be arranged the same day, if it needs a more in-depth scan such as an MRI or a CT we can refer for that from the GP service and but you would need a later appointment for that. There's also options of joint replacement surgery or joint injections, again which we can refer for.

So, urology is the area of medicine that deals with diseases of the are male and female urinary tract and the reproductive organs for men. The most common presentation often will be prostate enlargement, but we also see a lot of what we describe as overactive bladder. So, that's often when people have just an increased frequency and urination, often getting up in the night to go to the toilet, urinary incontinence, we also can advise on sometimes people have a history of bladder stones or colic renal colic or recurrent urinary tract infections.

One of my GP colleagues that I work with, Dr Kondigari, is a particular specialist has an interest in skin conditions and actually does run his own dermatology clinics. He is very good at skin, obviously all of us are qualified to be able to also give advice in this area and common conditions again that we might see are cysts, acne, dermatitis, eczema, shingles, fungal infections, mole changes and rosacea and we can advise on oral treatments or medicated creams that might help with these conditions. We can also offer screening for moles if there anybody has any concerns about these types of conditions and we can also refer on to dermatology if we feel that a more specialist opinion would be required.

Mental health conditions are quite common to present with here at Benenden and I think a reason that may be is because we're able to offer a slightly longer appointment to be able to really talk about symptoms that you might be having. The most common presentations are usually depression or anxiety, there are obviously lots of different types of mental health conditions that also have very similar symptom presentations. So, we can also talk about panic attacks also obsessive-compulsive disorder as well and we can give advice again possibly medication advice or lifestyle advice or give advice regarding counselling and other ways to manage these symptoms.

Women's Health which is a particular area of interest that I have, again this is something that we very commonly see here, or I certainly see a lot at Benenden hospital, we can give advice about periods and menstrual bleeding, premenstrual syndrome, we can talk about contraception and birth control and pregnancy or pre-pregnancy advice or concern or issues that have occurred as a result of pregnancy. Menopause is quite a large area that I cover, discussing HRT and other ways to manage menopause or symptoms. We can also discuss sexual health issues, cervical smears we offer that as a private service, there are some patients who like to attend for more frequent smears than is available on the general screening program which often will only offer a three-year screening endometriosis. Osteoporosis is where your bones started to reduce in strength as you get older and breast health.

So, just sort of talking more specifically about menopause I would be able to offer advice about menopausal symptoms that you may be experiencing and I can discuss options for hormone replacement therapy if this was something you might be interested in, we would discuss this in depth and discuss the issues and concerns that one may have about starting HRT and discuss the risks associated with that and whether it's an appropriate option for you. We don't have to go down that route, you can also just take lifestyle advice and how to manage symptoms but we also talk a lot about bone health and breast care.

I am also qualified to fit into uterine devices and implants for contraception. So, this is also a service that we offer through the GP service.

Just a little bit of information for you about the online booking system that's available. You're now able to book appointments online, you can see what availability there is, you can select which doctor you would like to see and there's some information there about each GP and the experience that they have or the interests that they have and hopefully that makes it easier for everybody to use.

So, I have flown through my presentation and I very much welcome any questions anyone might have about the service today.

Louise King

Thank you very much, that was very interesting.

Okay, we do have a variety of questions. The first they say you mentioned there is an on-site Pharmacy, they are wondering if they are able to get a prescription completed and you know take it away whilst they wait at the hospital?

Dr Fiona Warner

Yes, absolutely.

So, it is just like any other Pharmacy. So, we would give you a prescription to take with you to the Pharmacy and as long as they have the medication in stock, they do seem to stock a comprehensive range of medication, then we are able to give you that medicine there and then.

Louise King

Thank you. Regarding mental health issues, do we provide therapy at the hospital for that? I obviously know we do not, but you want to give some advice on where to best place to go?

Dr Fiona Warner

So, we will often give advice and we work also by writing. So, if you had an appointment to come in to see us we would often recommend that we write to possibly to your doctor as well to involve your NHS doctor who would also be able to offer you a range of information and local services to you but we can also give advice about how you can access counselling possibly privately if that was route you wanted to go down but yes we can certainly supply plenty of information about other resources where you'd be able to access counselling.

Louise King

Thank you. I have had a few people raised your hands if you do have questions can you please type them through the Q and A? Thank you.

Someone has been considering getting the coil and would like to see someone for more information, they ask with their long appointments with the GP at the hospital would there be enough time to go through the risks and benefits just within one appointment?

Dr Fiona Warner

Yes. So, so we have 25 minutes in our consultation and I believe that's plenty of time to go through all the issues all the questions that you might have. It sometimes is quite helpful if you have been able to do your own research, there is quite extensive information online if you if you look at. Although, I know sometimes that can be a bit scary because sometimes you can get caught up with ‘Dr Google’ and it can be a bit confusing. We have plenty of time to go through anything and you're always welcome to make a further appointment if you wanted to, or if you find you have any further questions and that you'd forgotten, when you leave the consultation room you can always speak to the secretaries who work for the GPs and if there's any questions that really need to be answered we will always be very happy to do that.

Louise King

We've had a question around the GPs at the hospital having specialisms and would it be best to book with those when available or can I see any of the GPs? I think the answer for that is that we do have a profile for each of the GPs on the website with their specialisms with the information that they're experts in and it's quite a good idea to read through that and get on an idea of who if you need to see someone's a specialist and see when they're available or if you want to see the next person that is available.

Dr Fiona Warner

Yes, because we are all GPs who have all been doing general practice for quite a long time. So, we are all we have all got a similar level of experience and we should all be able to cover each other anyway. So, there wouldn't be a problem that you would come in with that we wouldn't be able to deal with it's just that some of us may have a bit more of a knowledge or a bit more of an interest in a particular area and if you have a specific problem that you want to discuss in that particular area then yes you might want to book with that specific doctor.

Louise King

Can a GP advise on HRT for someone who has had breast cancer?

Dr Fiona Warner

The answer is yes, they can advise. Whether or not they decide that they're able to prescribe that is very much down to the interval individual doctor and also with very careful discussion of the patient it's a very individual discussion that has to be made but yes it certainly can be discussed with the GP in in this context great.

Louise King

Thank you. and have a bit of a longer question here. As a woman in her 60s, this lady has experienced a level of discomfort when sitting at a desk or table for over a year now. It's a low level of pain and discomfort, after viewing the NHS Choices website they've bought a good quality specialist cushion which eases the pressure and they thought this is all part of the aging process. So, they thought it is all part of the ageing process or is it kind of a minor issue concern and is it a common concern and it is just a correct thing for them to be doing.

Dr Fiona Warner

So, a discomfort when sitting or a low level of pain when sitting at a desk or table,  the first thing I would suggest is looking very carefully at you’re the sort of ergonomics of your desk or your chair and how you're sitting and because sometimes it's just if you're sitting for a prolonged period of time in a set position. Sometimes it's because often chairs are not very well designed to support you in the right way but if it's something that's happening all the time and causing a level of discomfort I would seek advice on that. It could be a range of different problems which do need to be looked into. So, it could be related to a problem with your back or your hips and it is worth seeing a doctor to discuss it in a little bit more detail and have an examination so that they can discuss with you what options might help improve the situation and to ensure there is not anything that needs further investigation.

Louise King

Do we have heart specialists at Benenden hospital?

Dr Fiona Warner

We do, yes.

Louise King

This person has not seen a private GP before they are wondering if they needed a referral would they see a consultant in the hospital? Would you mind explaining the pathway afterwards if treatment was needed after seeing a private GP?

Dr Fiona Warner

So, if you came to see us, you don't need a referral to come and see a GP here at Benenden, anybody can come in and be seen. You can just phone up and book the appointment or book online, if you then wanted to see a specialist in a particular area or if you discussed an issue and felt that it would be appropriate we felt that it would be appropriate for you to then see a specialist we can then do the referral for you directly to the specialist here at Benenden.

Louise King

Okay, and just a couple more questions.

If after seeing the GP and if they need medication, could you write an NHS prescription or would you need to have to have a private prescription?

Dr Fiona Warner

No, if they were seen here, they would have to have a private prescription, but we do always write to your GP, to your NHS GP. So, if we started a medication for you we will write to your GP and if they're willing to continue to prescribe it you may then continue to receive the prescription as an NHS prescription from your own GP but from us here at Benenden, because it is a private hospital and it's a private consultation, you would have a private prescription.

Louise King

Okay, and our last question.

So, Benenden Health referred this person to physiotherapy where they had six successful sessions as recommended regarding hip pain. They recommended they have an MRI scan and that went through Benenden Health, they agreed that this would be the right way forward and they said can you suggest where I go from here to find what is going wrong with my hip?

So, so they have been through Physiotherapy, and they have had an MRI and they were told that there was not anything further that the physiotherapists would be able to offer I am thinking they mean Benenden Health offers. MRI did not happen, sorry.

Dr Fiona Warner

Okay, yes. So, then it may well be a case of having a referral through to the orthopaedic team to discuss whether there would be any benefit in any other treatment options.

Louise King

Thank you. and we do have a few more questions but if you've provided your name we will answer these after the event and if you'd like to book a GP appointment you can do so via the link on the page in front of you or via their phone number. You can do that online if you do by our website link and their phone number is open 8am to 6pm Monday to Friday.

At the end of this webinar you'll receive a short survey and it would be great to get your feedback if you could spare a few minutes just to find out how we can improve for future webinars and to give feedback to Dr Warner.

Our next webinar is on the 5th of December, it's on Urology treatments for men.

So, on behalf of Dr Warner myself and my colleagues at the hospital, I would like to say thank you very much for joining us today. We hope to see you soon and hope you stay safe in this blustery evening. Thank you.

Dr Fiona Warner

Thank you, bye.