At present we are advertising for a senior practice nurse, an experienced paramedic capable of seeing unbooked appointments, and a GP on a salaried or partnership bases. We have advertised for someone up to full time, so as to cast our net as wide as possible. We define full time as being 4 full days, 8 or 9am to 6.30pm. We split each day into two, each half being longer than a standard session. A booked surgery is currently for 14 or 15 slots. To apply, please visit the NHS jobs website here(broken-link awaiting-revision).
We serve a very wide demography, from hostel to penthouse. Butetown is the old dock area, Tiger Bay, with a long-standing, mixed race stable population. In the early 1990s, a large number of Somali people, fleeing the civil war in Somalia, joined the established sea-faring Somali men. This population now forms about half of the population within old Butetown. Also in the 1990s, the redevelopment of the Docks area began, and has gathered momentum since. This development has consisted mainly of water-front blocks of flats, many bought as buy-to-let properties. There is also a large development containing a wide variety of restaurants. There are many offices, the Welsh Government buildings including the Senedd, and, best of all, the Wales Millennium Centre, home of, amongst other artistic organisations, Welsh National Opera and the BBC National Orchestra of Wales. Several of the hostels for the homeless are situated near the railway station and we have strong links with them.
We therefore have a wide variety of people to serve with a wide variety of expectations. As well as booked surgeries morning and afternoon, we run an open surgery every morning, seeing all who turn up between opening up and 11am. This is invaluable for those who find it hard to plan ahead, as well as for those who appreciate being able just to turn up if they are unwell. It can be a long surgery, with long waits, but there is no phone competition in the mornings. Patients can make a booked appointment on another day if they prefer, and accept that the appointment length has to be shorter if many people are waiting.
On entering the new building, @Loudoun, you enter a spacious atrium. Our reception counter is slightly to the right, ahead of you. There is a large waiting area. Our consulting and treatment rooms are along a corridor to the right. We have more space on the second floor (non patient areas) with an admin office, the practice manager’s office, a meeting room, library, record store and store rooms. There is also the building’s common room, kitchen, locker room and showers. The health visitors, district nurses, multi-cultural resource centre and sickle cell service offices are on the second floor.
Coming back to the ground floor, Cardiff Council has an advice centre in the atrium. There is also an entrance into the Co-op pharmacy. Three of the rooms at the end of our corridor are used for community services, such as diabetic retinopathy screening, complex wound clinic, antenatal clinic, family planning clinic, sickle cell service consultations. Other community services take place on the first floor, including podiatry. There is also a dental practice. Cardiff Community Housing Association are the landlords of the whole building, and they run the community space on the first floor.
Since 3/7/14, the hepatitis nurses have been running a drop in clinic for blood bourne virus screening and supervising treatment for hepatitis.
Dr Kay Saunders moved to Cardiff in 1994. In February 1995 she joined a practice in Grangetown, who in April 1995 took on a branch surgery in Butetown, and this is when she met Christine Read. During 1995 and 1996, she worked more and more closely with Mary Cooksley, the first nurse appointed to work in the hostels for the homeless. This is when her interest began in the complex physical, psychiatric and substance dependency issues faced by many of those unlucky enough to find themselves in the very difficult situation of being single and homeless.
In April 1997, after several months of planning and with encouragement from the then Bro Taf Health Authority, she and Christine opened as a single handed GP practice. This started by using a share of a community consulting room in the South side of the old Butetown Health Centre. In 2001, to keep her able to continue working in Butetown, the Butetown Pilot was set up by the then Cardiff Local Health Group. The alterations entailed fashioning a nurse’s room from the old kitchen, a waiting room from the Health Centre common room, and a new partition to make a bigger admin office. More extensive alterations were not done as the old Health Centre was shortly to be re-developed as part of the St David’s Hospital PFI initiative. However, this did not happen. We were also provided with IT, being the first practice in Wales with a remote server. Up till then, capping the list size as 1100, we had used a database on a lap top computer. We also received funding for a practice nurse. With these developments, we were able remain working and to expand to 1500 patients.
Following the disappointment of the St David’s PFI not extending to Butetown, we expended huge energies over several years trying to get new/extra premises. The patient participation group (PPG) was formed in early 2007, and was instrumental in getting people together and helping us to make our case. We also extend very great thanks to Lorraine Barrett, who was our Assembly Member at the time. She did some very important advocacy for us and the area. We eventually got action, with the Local Health Board making some alterations and movement of services within Butetown Health Centre. This resulted in us having the whole of the South side, with 3 consulting rooms, a nurses treatment room and a practice manager’s office.
Through this time there was extreme pressure on all practices in Butetown and Grangetown due to the huge population expansion, mainly in Cardiff Bay. For patient safety and our own sanity, we capped the list size at 1500. For much of the time through 2005 to 2008 we only accepted homeless people as patients. In mid 2008 we formally closed the list (though remaining open to homeless people). The list had got to 1700 and this was too many given the demographics.
In April 2008, Dr Jane Fenton-May joined the practice and the Partnership was formed with the 2 GPs, and Christine Read as business partner/practice manager. Dr Saunders had been a single handed GP for 11 years.
Serious discussions about a new building really got going in mid 2008, driven at the LHB end by Bruce Whitear. He doggedly pursued all the twists and turns of the negotiations between all the parties involved in the Loudoun Square development. By autumn 2008, we could see that the new building was really going to happen. We employed Dr Manish Garg and opened the list. We expected a surge followed by slower growth, but the growth has continued steadily, masking a very high turnover as the Cardiff Bay population is highly transient. As of July 2014, the list size was just over 6,000.
In early 2011, we were at a stage when we needed another GP. Dr Garg also decided it was the right time to explore other opportunities, so we recruited 4 more GPs, Drs Jill Davies, Maria Johnson and Mair Strinati working 5 half days, and Dr Kamila Hawthorne 2 half days. Dr Strinati left in August 2012. Dr Jane Fenton-May wished to retire in 2013, but we have finally allowed her to do so on 3o/6/14.
The relentless growth in list continued, such that we needed a period (March to July 2013) when we did not accept new patients and unfortunately, from February 2018, are temporarily suspending new registrations again. The pressure of growth coupled with high turnover of patients has forced us to focus on our duties to existing patient. We continue to work with the LHB to control growth, and focus on clinically significant aspect of out work. It is a help that the Welsh Government added the resources from the spare QOF points to Global Sum, but this does not compensate for the fact that we only have an MPIG for 1500 of our over 8,000 patients. As the list growth is always paid for in arrears, the extra work of new registrations is not adequately compensated. Our work, especially with the homeless people, is rewarding, if exhausting.
We are pleased that we have recently recruited several GPs who are keen to join in with our practice ethos and help us to strive for a sustainable future, and now have three partners and one salaried doctor (currently on maternity leave). We continue to be involved in the training of medical students, and are pioneering the use of allied health professionals (paramedics and nurses) in managing the increasing workload despite national shortages of GPs. In 2014/15 we engaged with the QOF cluster work and continue to be high performing in all QOF areas, despite the relaxation of targets over the past two years.