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Practice Updates

Please read the following Practice Updates which are published monthly in the East Bergholt Parish Magazine. These monthly updates enable the Practice to let our patients know what has been going on across our two sites. 

Pete Keeble

Practice Manager

Constable Country Medical Practice – Practice Update August 2016

Repeat Prescription Requests

The practice processes hundreds of prescriptions every week. To ensure patients are safely prescribed the medication they need, every item needs to be checked by a doctor before it is authorised. Please allow up to 72 working hours (3 working days) for prescriptions to be processed by the surgery before collection. Your chosen pharmacy may then take 24 hours or more to dispense the items, depending on availability. You can drop repeat slips into the practice or to your nominated pharmacy if it is close to the practice, though pharmacies in Essex are unable to accept repeat slips. You can also request repeat medication via SystmOnline Web access or phone app if you have registered for an account. However, requests cannot be accepted over the phone.


Medication Following Hospital Discharge

When a Hospital discharges a patient they should be given a minimum of 14 days medication if any is required. The consultant will send the practice a letter requesting our doctors prescribe any further medication. However, the patient will need to contact the practice if they need a prescription to be issued. Patients’ circumstances can change and this system ensures that medication is not dispensed unnecessarily.


Electronic Prescription Service (EPS)

In November the practice will be implementing the Electronic Prescription Service (EPS). This is a national system which is now being rolled-out across Suffolk. The aim of the EPS is to reduce reliance on printed prescriptions. With the exception of prescriptions for some special types medication, the majority of prescriptions will be signed and sent electronically to a pharmacy of the patient’s choice. This will speed up the process and provide a clear audit trail of where the prescription is at any point in time.

In order for the system to work, patients should nominate a pharmacy for their prescription to be sent to. You can inform either the pharmacy of your choice or the practice. You can change your nominated pharmacy at any time and if you need to pick up a paper prescription you can still do so. However, patients who are on repeat medication will benefit the most as potential delays will be minimised. Note that you will still have to submit your repeat slip, which will be issued by the pharmacy, with the items you require ticked and the practice will still require up to 72 hours to process your request.

There are many other benefits to EPS including nominating a pharmacy elsewhere in the UK when you are on holiday, or a pharmacy near where you work. Prescriptions are sent as soon as the doctor has authorised them, minimising delay for urgent medication needs.


Breast Feeding Facilities

If mothers would like somewhere private to feed their baby, please ask a receptionist who will be happy to find a suitable room.

Annual Flu Clinics

We are starting to prepare for our annual flu clinics and I’m happy to confirm the dates as follow:


East Bergholt Medical Centre:

Tuesday 11th October, 2.00pm to 7.00pm


Capel St Mary Surgery:

Thursday 20th October, 2.00pm to 7.00pm


The clinics will run on the same basis as previously: all eligible patients will receive a letter by mid-September inviting them to attend on one of the above days. Patients may attend either clinic, irrespective of where they live, and no appointment is needed.


Training Days

Just a reminder that the practice will be closed from 1pm on the following dates for staff training:

15 September 2016 (Thurs)

12 October 2016 (Wed)

17th November 2016 (Thurs)


On these afternoons the doors will be closed so please ensure any prescriptions are picked up well beforehand. If you phone the practice the recorded message will ask you to ring 111 for medical assistance if your problem cannot wait until the next day.

Constable Country Medical Practice – Practice Update July 2016


Patient Participation Group and Patient Feedback

Over the last year there have been many changes at the practice. In addition to changes in the partnership and other staff, we have also changed our appointment system. Some changes take a while to have an impact on how the practice is perceived as some patients only occasionally have a need to visit the practice. However, we hope that our policy of always offering a same day face-to-face or telephone appointment is reassuring and patients understand they can contact us at any time of the day if they need access to a clinician.


We want to continue to improve the service we offer and our interaction with patients is key to helping us understand what works well and where we can improve. I thought it may be useful to summarise how you can improve your interaction with the practice:


Most importantly, please ensure we have up to date contact details for you, including home and mobile telephone numbers and email address. You can update these via our website (click on ‘update contact details’ on the home page) or by filling in a form available from reception. This will enable us to send appointment confirmations, notifications of test results and other important information we feel you should be aware of. Note that your details are strictly confidential and will only be used for practice purposes.


We are further developing our website to ensure that information you need is available. It contains PPG minutes and contact details, news items including regular practice updates, information on our appointment system, and the facilities to register as a new patient and provide feedback. Our aim is to improve the website over the coming months to ensure it contains up to date and useful information. We will also be introducing a twitter feed to inform patients of incidents, such as power cuts, or events such as flu clinics.


The PPG has been operating for over a year now and we are lucky to have such an active PPG. We meet monthly and discuss the day to day operation of the practice, new developments and any problems which come to their attention. The PPG are also proactive in helping the practice address wider health issues. They recently organised a very successful presentation on diabetes by Dr Gerry Rayman, and will be organising further events in the year ahead. Their contact details can be found on the website and they welcome feedback on how the practice is performing.


The PPG have provided feedback cards for patient use and collection boxes at Capel and EB, and these are reviewed regularly. We also have Friends and Family Test feedback cards available, and patients can provide feedback via our website and on NHS Choices. We welcome all feedback, though we hope patients will tell us when they have had a good experience, not just when they have experienced a problem.

Constable Country Medical Practice – Practice Update June 2016


Staff Changes

I’m delighted to announce that Dr Ewa El Graoui will be joining the practice on 13th June as a GP Partner. We will then have four GP Partners and are advertising to fill our outstanding vacancies for an additional doctor and a Nurse Practitioner. Many practices are struggling to recruit doctors, as there is a national shortage of GPs, and our practice is no exception. In the meantime, we will continue to use a number of excellent doctors on a locum basis, including Dr Johal, Dr Le Roux, and Dr Kunche. Dr Ewa’s arrival will help us to improve continuity of care to patients. Dr Omar left the practice at the end of March and will be moving to a different part of the UK. Until that time he will continue to oversee our four GP registrars.


Practice workload and operations

 We operate a very busy practice with demand steadily increasing in line with national trends. In order to cope with demand, and work within NHS funding constraints, the practice needs to operate in a way which offers the best service possible, with the finite resources at our disposal. I thought it worthwhile clarifying a few issues which patients have bought to my attention.

We feel that our new appointment system offers excellent access for patients. Some practices insist that all appointments are initially via telephone with a doctor, and others refuse to offer appointments when they are full. We do neither. We have some pre-bookable appointments, the majority are then available for booking on the day, and when they are full we operate an overflow list where we will never turn a patient away. Patients on the overflow list will initially speak with a doctor over the phone and then be seen in person if necessary. Although this does not work for everyone we feel this is an excellent compromise; patients will always be able to speak to a doctor whenever they contact us.

As long as we have your mobile number, the practice will send you a text message confirming your appointment. Please note that Constable Country Medical Practice refers to the East Bergholt site and Capel St Mary to the Capel site. For technical reasons we are unable to change ‘Constable Country Medical Practice’ for ‘East Bergholt’ but are exploring the possibility of doing this.

Our doctors have 10 minutes for a face-to-face appointment, as specified by NHS England. However, when patients attend with serious or multiple problems, consultations can take longer. Doctors may also have to see additional urgent cases or make an urgent visit to a patient’s home. Please be patient, but if the doctor is overrunning and you cannot wait then let the receptionist know.

Along with all other practices in Suffolk, we are working with the Clinical Commissioning Group (CCG) to reduce NHS prescribing costs. A pharmacist from the CCG helps us to identify patients who could be switched to identical, but non-branded medication which is often considerably cheaper. The pharmacist will then write to the patient informing them of the change. All medication changes are approved by our doctors before they are made, and if the patient experiences any problems, e.g. because of a different coating, the doctors are happy to discuss with the patient and switch back if necessary.

Finally, just a word about test results and medication. Our doctors review hundreds of test results and letters every week (often hundreds a day!). If a patient has been referred for a test the practice will inform them if further action is required. We will not contact patients if no action is required though patients can contact the practice to find out their result. With regard to medication, when medication is requested by a consultant following discharge from hospital, the doctors will enter the medication on to the patients record. However, the prescription will generally only be printed out, signed and ready for collected when requested by the patient. This is because the hospital is obliged to provide 14 days medication following discharge and the patient may not require further medication depending on the nature of their problem and speed of recovery.


Constable Country Medical Practice – Practice Update February 2016


Managing Winter Demand and Prescribing

This is one of the busiest times of the year for the practice and on some days demand can be extremely high. Since last September we have operated a triage system. When all our doctor appointments are full, and you feel you need to speak with a doctor, you will be placed on a list for the doctor to phone you back and either address your problem over the phone or ask you to attend an appointment later in the day. Each day, one doctor has responsibility for contacting patients added to the list.

 Some days, this list has extended to over 40 patients and the nominated doctor for that day will contact them all in addition to their morning surgery and dealing with the clinical administration work (test results and letters from the hospital relating to patients they have referred).

Many of the problems patients present with can be addressed by our excellent Nurse Practitioners and our Minor Illness Nurse. Many of their appointments are pre-bookable as well. These include problems such as cough/colds, rashes, headache, earache, minor injuries, conjunctivitis etc. Our reception team can advise on whether our nurses can treat you.

Also, pharmacists can provide sound advice on many conditions and treatments are often available over the counter without prescription. Please note that the Clinical Commissioning Group (CCG) have issued guidelines for our clinicians not to prescribe treatments which are available over the counter. Paracetamol, for example, is available very cheaply in supermarkets but cost the NHS is significantly greater if it is prescribed.

The CCG have recently issued guidelines on prescribing gluten free products. These can no longer be prescribed for patients over 18 years old, and only in limited quantities for patients under 18.

Our clinicians have also been asked to reduce antibiotic prescribing. This is because many viruses are becoming more resistant to antibiotics and very few new antibiotics have been discovered over the last 20 year or so. This means that if they continue to be prescribed at high rates then there is a very real danger that the antibiotics currently available cease to become effective. Our clinicians will, of course, prescribe the medication they believe is most appropriate to treat a problem.


Christmas Gifts

Thank you to all patients who handed presents to the practice over the Christmas period. All these gifts were distributed to all doctors and other members of staff. Last year was very challenging for us and we were all very grateful, and moved, to receive so many gifts of appreciation.

Constable Country Medical Practice – Practice Update January 2016


Practice Rated as ‘Good’ by Care Quality Commission (CQC)

The Practice was inspected by the CQC on 2nd November 2015. This was a follow-up to their last inspection on 10th March 2015. Six inspectors spent the day at both East Bergholt and Capel St Mary sites. They spoke to patients, staff and members of the new Patient Participation Group (PPG). They also requested evidence that the practice was meeting its contractual and regulatory obligations, including infection control, staff training, prescribing, patient confidentiality etc.


After the inspection in March, the practice quickly put in place an improvement plan, which it agreed with the CQC and Clinical Commissioning Group (CCG). Over the following 8 months, all staff have worked exceptionally hard to implement the plan. We have made many internal changes which aren’t immediately evident to patients, such as the way we review and learn from events that happen. We have also made changes which have had a direct impact on patients, including the formation of our new PPG, and a fundamental change to our appointment system. Judging by comments left on the NHS Choices website and comment cards in our waiting areas, the changes we have made have had a very positive impact on the quality of care we provide to patients.


This was recognised by the CQC and we are delighted that they have rated the practice as ‘Good’ overall, and ‘Good’ for every area they assessed. The report is very positive and all issues highlighted in the March 2015 report have been addressed. The CQC were particularly impressed with how we had engaged with our patients to understand how they wanted us to improve the service we offer. This includes the open evening we held in June 2015, which ultimately resulted in the formation of our new PPG, and the engagement with Healthwatch to survey patients and understand their needs.


Being rated as a ‘Good’ practice is a great achievement which we are all very proud of, and we would like to thank all patients who have supported us through the last 8 months. The environment in which we operate remains challenging and with increasing pressure on the NHS we cannot be complacent. We intend to continue to work with patients and other organisations to understand how we can deliver high-quality primary care health services as efficiently and effectively as possible.


The full CQC report can be viewed at We issued a press release on 24th December which can be viewed on our website at We also welcome comments on the service we offer including any ideas on how we can improve it further. Feedback can be left via our website or using the Friends and Family Test or PPG comment cards available in the waiting areas.

Practice Feedback

We have been monitoring patient feedback over the last few months since we started to address the concerns highlighted by the CQC in April. We are delighted to have received generally positive feedback on the changes we have made so far. On 7th September we launched a new appointment system and this appears to be working well. We have committed to never turn a patient away, though they may need to speak to a doctor or nurse practitioner on the phone and then be seen if person if necessary.


We have taken notices down from doctors’ doors stating that only one problem is to be discussed per 10 minute consultation and our doctors will aim to spend the time necessary to fully address a patient problem. Of course they do operate under time constraints and appointments are nominally 10 minutes long, so if you think you need longer then please let the receptionist know and they can book a double appointment. However, feedback is positive and suggests patients feel they are being listened to and treated appropriately. We have also been working with all staff to ensure that the overall experience when patients need to contact the practice is professional and helpful, and again your feedback is generally very positive.


We value feedback, both positive and negative, so please either the Friends and Family Test or PPG comment cards available in waiting areas, or leave a comment on the NHS Choices website. Clearly we should be alerted when problems arise but we also want to hear about positive experiences as this provides confirmation that the changes we are making are having the desired effect.

Syria Appeal

Dr Ayache would like to thank all patients who have donated bedding to the Syria Appeal over the last couple of years. The response has been extremely generous and all items donated have been transported to Syrian refugees. Unfortunately, the cost of transportation is now prohibitive and we are unable to accept any further items.

Ring Back

Please don’t use the ring back facility as this will not work with our phone system. When all our phone lines are engaged you may get a ‘press 5 for ring back’ message from your phone provider. This will only work if you are calling a residential number and will generally not work if you are calling a business number. The BT network cannot differentiate between residential and business numbers so may still offer you a ring back option even if it is not available. This isn’t a fault with our phone system.

Restricted Prescribing list


Last year in Ipswich and East Suffolk, over £1m was spent on prescribing paracetamol, which can readily be obtained from pharmacies without prescription. The Clinical Commissioning Group is advising all practices to limit prescribing medication which can be obtained without prescription, often at low cost, from pharmacies and supermarkets. Such medicines include analgesics, emollients and antihistamines. There are always exceptions but please don’t be offended if your GP or nurse asks you to purchase medication yourself.


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