Your comments: 20 July 2016

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Thank you for publishing Dr Hammond’s column on uniforms in the 6 July’s Views and opinions pages 

Though there are many strong points for maintaining uniforms in hospital settings, uniforms reinforce hierarchical structures and control. Moreover, they suppress individuality.

I’m one of Grayson Perry’s ‘default men’. As soon as I set up in private practice I chose to wear stiff collared shirts (without tie, rolled or short sleeves), dark trousers and socks and slip-on shoes in black or brown.

I felt far more professional than I ever did wearing a hospital-designated uniform. I think my patients felt less threatened: I wasn’t going to do something physical to them or with them in a gym. After all, they were there for a consultation with a professional and how many office-based professionals wear polo shirts or zipped tunics to work?

• Vincent Lyles

Doctor’s notes

I am a salaried GP at the Bannockburn health centre in Stirling featured in Frontline 

I joined the practice when it entered a ‘crisis period’ over a year ago. We have now become a stable practice with a cohesive and forward-thinking team working with advanced nurse practitioners, primary care mental health nurses, physiotherapy practitioners (extended scope practitioners or ESPs), and pharmacists. Their new roles had to be clarified as did how patients are triaged and referred in the practice – the usual teething problems.

They have all become invaluable to the practice, allowing GPs to focus on the more complex cases, but also being able to provide patients with quicker access to services they would otherwise have to wait a long time for.

The physiotherapy practitioners were the last services to join us. Initially, we were not very sure as to how they would be able to support us since we used to refer patients to them externally. We were aware that they could provide acupuncture, splints, injections, physio sessions and so on, but would that be replicable in their new roles?

In the current practice model, patients with musculoskeletal (MSK) needs are filtered out through triage telephone consultations. The feedback we have been getting from patients is that the ESPs have managed to get them on the path of recovery by deciding on the most appropriate and relevant treatment plan.

Improved understanding of the ESP role and ensuring the patient is aware that they will not provide physiotherapy sessions are crucial to avoid unrealistic expectations.

This is not a fast track into physio – if treatment is required then patients are referred through the normal channel. Advising them that the ESPs can see them in a week to provide them with a diagnosis, management plan, and/or initial treatment instead of referring them externally to physiotherapy greatly increases their engagement and satisfaction with the services as well as with the practice. So it’s a win-win situation and we hope to be able to continue to provide this service.

Practice manager’s view: With the ESPs on board there has been greater patient satisfaction. Patients are seen in a shorter period of time compared to waiting to see a GP. The ESPs encourage self-management and safety is enhanced through early identification of serious pathology.

• Christina Cairns, GP, and Kathleen Burns, practice manager

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