Litchdon Patient Participation Group, Barnstaple Devon

NHS & Litchdon Medical Centre Information

This page contains information from the NHS, Litchdon Medical Centre and topics suggested by you.

Better for You, Better for Devon: engaging on the NHS Long Term Plan

The feedback from our engagement activity will be fed into Devon's Long Term Plan, as well as the work that has commenced on a Peninsula Clinical Services Strategy.

If you'd like the opportunity to comment more specifically on the development of Devon's Long Term Plan, a further Devon-wide survey is currently underway, covering a wide range of topics.

This survey runs until 5 September and can be accessed at: External Link.

Further information
More information is in the briefing pdf document link (176kb). This information is also available on our website at External Link. If you have any questions or comments, please don't hesitate to contact the Trust on

Acute Services Review Survey

Services at North Devon District Hospital are still under threat. The Acute Services Review in Devon is ongoing. Despite earlier assurances, another public engagement is now under way.

Patients and the public have an opportunity to complete the survey about services in North Devon.
Use the opportunity – ensure your voice is heard.


In 2017, the first stage of the Acute Services Review produced recommendations that North Devon District Hospital should continue to provide: 24/7 urgent and emergency care services (including A&E), acute stroke services, consultant-led maternity services, neonatal & paediatric services. But these are ONLY recommendations!

The second stage of the review is testing whether the recommendations can actually be implemented in the face of financial and workforce challenges. Now the following services have been identified as vulnerable: care of the elderly, stroke, oncology, maternity, radiology, trauma & orthopaedics, acute medicine and paediatrics.

Have you had recent experience of any of these services? Were you able to access the services where and when you needed them? Or maybe you had to travel outside North Devon for treatment? Were there delays in receiving your treatment?

In North Devon, SOHS is continuing to fight to protect our hospital services in Barnstaple and ensure that patients are not forced to travel to Exeter and further afield for treatment. We need your support more than ever. Together, we can save our hospital services.

Sue Matthews. PPG Chair

Litchdon E Consult System

Litchdon has started a new e consult system that we as the PPG have looked at and hope you will find useful as another way to contact the surgery if you wish via on line email.

You can now receive help, advice and treatment for your health problems at a convenient time for you and your lifestyle.
Patients can access safe and efficient advice for lots of health conditions and symptoms on our eConsult website 24/7.

If you need further advice or think you may require treatment you can now consult with your GP online! All you need to do is fill out a simple form about your problem and a GP will get back to you within 3 working days. You access the form via External Link

You can also request further sick certificates (sick notes), discuss recent tests or get help for other administrative issues at a time that is convenient for you.
Your GP will email you back within 3 working days unless a different method of contact is more appropriate. Please ensure we have a verified email address saved on your record so your GP is able to get back to you.
Your completed form will be sent to your registered GP unless they are unavailable. If your registered GP is absent your form will be forwarded to an available GP who will get back to you within 3 working days.
You are unable to book appointments or order repeat medications via eConsult, however you are able to do this online by registering with Systm Online and using the buttons at the bottom of the Litchdon website page
Please note - eConsult is not suitable for emergency or severe health problems.

 A brief overview of how the NHS works and the development of Accountable Care.

This weblink audio-video/how-does-nhs-in- england-work External Website Link gives an overview of all the different strands of the NHS, what other organisations it works with, where and how the money comes from and where it is spent.  Take a look, but also,  take a somewhat guarded view of  ‘the future’. This animation seems to have a slightly gung-ho attitude to the future, telling us that we will still be able to see our GP and  go to hospital if we need to and that whatever happens, the NHS will continue to change.

This outline acknowledges a shortage of funds but it doesn’t spell out that the present government is pushing the NHS to breaking point through so called ‘efficiency savings’ which have resulted in ever increasing staff shortages, both in primary and secondary care (GP Practice and Hospital care); restraints on referrals;  removal of inpatient beds and a drive for care to take place in the patient’s home rather than in hospital: a great idea in theory but yet to be adequately proven as  a more beneficial system than hospital care after treatment.

The development of Accountable Care Systems, or ACSs, mentioned in this video, across the country is something we should be particularly aware of. The animation acknowledges that these are rooted in an American system of care, with a set budget. It also acknowledges that their introduction is in part to save money, while at the same time telling us there is an intention to work much more closely with organisations ‘outside the NHS’ like social care and public health and in theory at least, embrace issues affecting health arising from policy and practice in housing and education.  On the face of things this all makes sense, but we need to dig a little deeper and be asking questions about commissioning of services: by whom? and from whom? and then on the structuring of the system and who is ultimately responsible for it. Will it be central government? which should ensure that the  ACSs are overseen by a fully accountable and equal system across the country, or will it be an Accountable Care Organisation or ACO - set up to administer the ACS and likely to be a private business, such as Virgin?  The recently collapsed Carillion would also be the kind of company that could have taken over the running of such an organization. Since an ACO will be a single corporate entity it will not be subject to democratic scrutiny and accountability.

On 25 January 2018 the Government announced that there would be a 12 week consultation period on the introduction of ACOs. We should all be very aware of the issues involved. To date we have been told there is no intention to introduce ACOs into Devon, but that could very well change and we should be prepared. We should be reading up on all aspects of ACSs and ACOs, from NEW Devon CCG’s own statements and that of the Kings Fund

Accountable Care Explained External Website Link
to  Professor Alyson Pollock’s

Why we should be concerned about accountable care organisations in England’s NHS External Website Link
This is just a short quote from her statement:
“the contracting associated with an ACO model is likely to lead to further fragmentation and loss of public control and public accountability. In the absence of the government’s duty to provide throughout England, we believe this will leave wide open the possibility of groups of people and services being excluded from NHS services, as providers seek to find ways to reduce their financial risks and maximise their gains. As well as loss of universal coverage, we expect that everyone will be required to produce proof of entitlement.”

Rosie Haworth-Booth 12 February 2018

Things you may not know about your GP Surgery External Website Link

Re-cycling medical equipment

Over the last two meetings  (2017) the PPG has raised the issue of medical/independent living equipment waste. Members had been shocked to see stockpiles, at council rubbish-  and re-cycling centres, of equipment apparently destined for destruction or sales overseas and read press reports of huge disparities across the country in recycling procedure or lack of it. The following weblinks give some information about the position that Devon CCG and County Council take on this issue. In June 2017 a private company, Millbrook, was contracted by DCC to provide and dispose of equipment for the Devon Independent Living Integrated Service (DILIS). This company appear to work in collaboration both with the CCG and DCC  in the provision and disposal of equipment, as the  pdf link below was supplied to members of the the Public Stakeholder Network group, who are representatives of local PPGs meeting on regularly throughout the year with the North Devon CCG representatives at their office in South Molton.  Two of the links, provided by one of our PPG members, relate to how the Scottish Borders have been dealing with equipment re-cycling and make interesting and useful reading.

PDF document pdf document link (pdf 25KB)
Appeal goes out for return of mobility aids in the Borders External Website Link
Revamped Borders care home and relocated equipment service now open External Website Link
Community Equipment Returns - Waste and Recycling External Website Link

Litchdon PPG, in collaboration where possible with other local PPGs, will continue to work to persuade both DCC and the CCG that  more has to be done to reduce the carbon footprint and take other direct or indirect environmental degredations seriously. Waste had serious long term impacts on everyone’s health and wellbeing.

If you have any further information on issues around equipment disposal/recycling do let me know. I’m sure other patients would like to hear about it.

Rosie Haworth-Booth, Secretary.

Cheaper Prescriptions

Get a prescription prepayment certificate. You can buy prescription prepayment certificates (PPCs) from the NHS which may make your prescriptions cheaper. You can only get a PPC if you live in England. A 3 or 12 month PPC covers all your prescriptions for that period, no matter how many you need. A prescription costs £8.40 per item, but a PPC costs: £29.10 for 3 months £104 for 12 months. This means if you're going to buy 4 or more prescriptions in 3 months, or 14 or more prescriptions in 12 months, it may be cheaper to buy a PPC. You can pay in 10 monthly installments if you buy a 12 month PPC. How to buy You can buy PPCs online External Website Link or call the order line and pay by debit or credit card. PPC order line Telephone: 0300 330 1341.

Some advice on Antibiotics

Winter is here which means many of us will be asking the doctor for something to at least soothe the symptoms if not cure common coughs and colds as well as some other ailments. But antibiotics aren't always the answer, in fact, truth to tell, they are increasingly less the answer as bacterial resistance to them is on an irrepressible rise.

Litchdon PPG thinks it might be helpful to give patients some information on antibiotics and explain why our GPs might not always be willing to prescribe them. Not just for coughs and colds but for some other conditions as well.

You can check out all the information given here on various websites, including the NICE guidelines: here is a link: External Website Link but we hope the summary below will be helpful.

Our knowledge of bacteria goes back many centuries but the watershed moment in our treatment of the infections caused by them came in the 1920s when Alexander Fleming discovered penicillin. Since then medical history has been transformed and the use of antibiotics has brought the cure of many hitherto lethal infections.

Nevertheless, there is a downside to the use of antibiotics and that is that resistance to them by the bacteria they are set to kill can develop, rendering them useless. This resistance can develop pretty fast or much more slowly, depending on how freely they are used. The medical research profession has been aware of this for many decades and for many years new strains of antibiotics could be developed but over the last ten years or so, as antibiotic use has become ever more intense and widespread, we have had increasingly worried reports that antibiotics are becoming less and less viable and our world is under threat of major bacterial infections that could cause huge pandemics.

The good news is that there is a way of slowing down this resistance and thereby buying time to develop new strains, but this can only be done if we are very careful in our use of the strains we currently have. Many patients will turn up at the surgery thinking that a cough or cold or possibly some other complaint they have, can be cured more or less straight away by a course of antibiotics. This is not only a fallacy, it has also contributed fairly extensively to the situation of an antibiotics shortage in which we now find ourselves. Many respiratory tract infections, aka coughs and colds, are not caused by bacteria at all: they are viral infections and antibiotics are useless in the face of viruses, although taking them can add to the overall lowering of their effectiveness.

This is why GPs have been cutting back on prescribing antibiotics. It is for our good, not because they are trying to save money, although that is another aspect of this strategy. Other courses of treatment, such as steaming menthol crystals or saline sprays for nasal infections, or warm water, lemon and honey for a sore throat can in most cases be more effective. However, if your doctor does prescribe antibiotics be sure to take the course exactly as instructed - complete the course, don't stop taking them simply because you feel better and observe all the other guidelines. By all means ask your GP for antibiotics if that is what you think you need, but don't be surprised or upset if they don't think it's a good idea.

Devon CCG (clinical commisioning group)

Devon CCG like most other CCGs country wide are in Debt. This means they are having to tighten the belt on various areas of work. As GPs we have to be mindful of this and try to reduce inappropriate admissions or referrals to secondary care.

This is currently being carried out with admission avoidance work within the practice and also across the country. This involves a detailed review of our most vulnerable patients who are most likely to be admitted. We aim to work out specific management plans to help hit illnesses or conditions that are likely to cause admission early and hopefully avoid admission. In addition we review our referrals regularly and try to see if a more appropriate non hospital based treatment or management plan could have been initiated. The education as a result of this helps to give the patient better care and reduce secondary care referrals, the latter which tends to lead to a number of additional investigations which often are not required but cause additional cost.

In terms of care, the CCG are having to look at prioritising work and appropriately reducing co morbidities (obesity, smoking, high blood pressure etc) for patients prior to surgical procedures, therefore reducing risk of inoperative and post operative complications. For example wound healing, DVT, chest infections, wound infection these both extend hospital stay and cause re admissions and therefore extra costs for the CCG.

We hope this is helpful, we do not believe any of this work will compromise patient care and GPs will continue to refer with regard to risk in the same manner.


How can flu affect you?

Flu occurs every year, usually in winter, which is why it's sometimes called seasonal flu. It's highly infectious, with symptoms that come on very quickly. A bad bout of flu is much worse than a heavy cold.

The most common symptoms of flu are fever, chills, headache, aches and pains in the joints and muscles, and extreme tiredness. The symptoms are usually quite mild, but can be very serious. Healthy people usually recover in two to seven days, but the disease can lead to hospitalisation, disability or even death. As well as making you more vulnerable to flu, your existing condition can be made worse if you do get flu.

What causes flu?

Flu is caused by viruses that infect the windpipe and lungs. And because it's caused by viruses and not bacteria, antibiotics won't treat it.

How do you catch flu? Can you avoid it?

When an infected person coughs or sneezes, they spread the virus in tiny droplets. These can then be breathed in by other people or picked up by touching surfaces. You can prevent the spread of the virus by covering your mouth and nose when you cough or sneeze, and you can wash your hands frequently to reduce the risk of picking up the virus.

But the best way to avoid catching and spreading flu is by having the vaccination before the flu season starts.

Who should have a flu vaccination?

Free vaccination is available to everyone over the age of 65 and to people of any age who have certain existing medical conditions, because they are particularly vulnerable to flu. More specifically, you should come for vaccination if you have:

- a heart problem
- a chest complaint or breathing difficulties, including severe asthma, chronic bronchitis or emphysema
- kidney or liver disease
- lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
- had a stroke or a transient ischaemic attack (TIA)
- diabetes
- a neurological condition, such as multiple sclerosis (MS), cerebral palsy or Parkinson's
- a problem with your spleen, such as sickle cell disease, or you have had your spleen removed
- a learning disability

If you are unsure whether you should have the vaccination because of your medical condition, please ask.

What about children and young people?

If you have children who are are over six months of age and have any of the conditions set out above, please bring them to the surgery for vaccination. The vaccine can be given at the same time as all routine childhood vaccines.

Is there anyone who shouldn't have the vaccination?

Almost everybody can have the vaccine, but you should not be vaccinated if you have had a serious allergy to the vaccine, or any of its ingredients, in the past. If you are allergic to hen's eggs or have a condition that weakens your immune system, you may not be able to have certain types of flu vaccine - check with us first. If you have a fever, the vaccination may be delayed until you are better.

How does the vaccine work and will I get any side-effects?

The vaccine works by stimulating your immune system, so it can recognise and fight off the flu virus if you come into contact with it later. When the vaccine is well-matched to virus strains, around three-quarters of those vaccinated are likely to be protected. The rest may have some protection that reduces the severity of symptoms.

There are some fairly common but mild side-effects. Your arm may feel a bit sore where you were injected, and some people get a slight temperature and aching muscles for a couple of days afterwards. The vaccine doesn't give you even a mild dose of flu, as it doesn't contain the active virus. Any other reactions are very rare.

You should have it even if you have already had flu or had the vaccination last year, as there are different types of the virus.

NHS Choices

NHS Choices is the online 'front door' to the NHS. It is the country's biggest health website and gives all the information you need to make choices about your health.

More about NHS Choices External Website Link is the UK’s leading independent health site, established for over 15 years. With more than 11 million visits a month, it is a trusted source of information for both patients and health professionals nationwide.

The site contains over 4000 health information leaflets, a wellbeing centre, a free health check, and thousands of discussion forums. It is accredited by The Information Standard, NHS England’s quality mark and was listed as ‘The top health website you can’t live without’ by The Times newspaper (Jan 2013).

NHS alliance

NHS Alliance uniquely brings together clinicians of every kind, and managers and patients. It also brings together providers in primary care – whether they be general practice, NHS Trust, social enterprise or independent – all with a mission to improve and do their very best for each and every patient. Its strong values over the past fifteen years have given it the ear of government, while its tireless work in patient and public involvement has provided a voice for patients.

This ethic extends from the NHS Alliance National Executive, who all give their time for free to the frontline clinician or manager, whose ambition is to improve the service they offer. Everyone in Alliance has a day job – that is its strength as the voice of the working frontline – the people doing it!

Healthwatch Devon

Healthwatch Devon External Website Link is your consumer champion in health and care. We have significant statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services.

Healthwatch Devon Logo

Information poster on waste in the NHS