FORGIVE me for continuing to take an interest in this issue but, unless I’ve missed my guess, staff at the Halstead Surgery must be greatly demoralised at the continuing stream of criticism.

An organisation which has pretensions to efficiency and effectiveness cannot function in such a climate and the tide must be turned.

I remain convinced that a dispassionate examination of the organisation of the surgery is needed. With full patient involvement this would improve services and I have a number of suggestions regarding such a review.

Firstly, it must take as its starting point the fact that all staff at the surgery are motivated and have a keen sense of mission. Such a review cannot be an exercise in the assignment of blame.

The reviewer must examine the process from beginning to end, from a person feeling unwell to his or her recovery.

There also needs to be a detailed quantitative study of the current workload. For example, the number of people on the books, the number of phone calls and the number, types and duration of consultations.

The amount of prescriptions needs looking into as well. Is the pharmacy on the premises? This would save a lot of time for a start.

These are off the top of my head but there will be many more categories of data.

Detailed data will be crucial for quantifying the workload and coming up with improvements. There should be a study of staff turnover and a study of the adequacy of IT support.

Also, what is the surgery’s catchment area? Is it central enough?

There should be an epidemiological review of the area. Whether or not is it suitable served by public transport and opening hours should be reviewed.

There must be a desire on the part of the staff and patients for the review to be a success so there must be determination on all sides.

There should be selective pilot studies of aspects of the surgery’s operations, with the pilot being ‘tweaked’ as it goes along and everything must be on the table; there can be no sacred cow.

If the argument put forward is that the workload has been increasing over the years, why exactly is this? Is the health of the patient base declining? Are people seeking medical attention more than heretofore?

Has the catchment area increased?

Neither these questions nor their answers are obvious, rather they are fundamental to understanding the difficulties.

If the Halstead Surgery management team feels that an internal review would be appropriate, then fine. If the decision is for an external review, then cost rears its head.

The surgery will presumably invite tenders for a consultancy, unless it feels justified in issuing a single tender. Having regard to Halstead’s unique circumstances, it could very well do.

I am in the United Kingdom pe riodically and I happen to be rather good at reviews like this. I have fond memories of Halstead and would like to give something back.

Therefore, I would be happy to do this review pro bono.

Peter Halliday