Eddie Duller OBE, a director of health and social service watchdog Healthwatch Oxfordshire, looks at plans to change the first port of call in the health service- the GP practices – and gives his personal view on the proposals.

We think our GPs are wonderful.

Hopefully we don’t need to see them too often, but when we do they give a first class service.

Of course, there’s a snag. It is still difficult to get an appointment, unless it is very urgent, and in some cases it can take up to three weeks to see your doctor.

So, nothing much changes on that front.

Those are the main findings of a Healthwatch Oxfordshire survey designed to see how matters have changed since a similar survey was done three years ago.

However, there is a change of heart from the public in that they recognise that GPs are stretched and under pressure, like most people at work in today’s world. Some are open to new ways of seeing the doctor, or at least getting some form of advice and treatment from practice nurses and the neighbourhood chemist.

The Healthwatch survey found that most people still prefer to make an appointment by telephone, although waiting for up to five minutes in some cases for the phone to be answered did not do a lot for their blood pressure, and the number of people making online appointments is rising slightly.

There is also a small rise in the number of people who are happy to talk to the doctor on the internet based Skype or Facetime video links.

That’s just as well because medical help closest to home could change out of all recognition in the next five years because of a reorganisation being powered through by the Oxfordshire Clinical Commissioning Group, which pays for GP and related services.

They say the aim is to improve access to the first layer of care, but that doesn’t necessarily mean you will see a doctor.

There are plans to increase the skills of nurses and other medical practitioners such as pharmacists and physiotherapists to cut down the doctors’ workload.

GP practices are being encouraged to work together to serve populations of 30 to 50,000 organised through central hubs in areas roughly similar to town and district council areas.

The plans also envisage multi-skilled teams to treat people at home for ongoing illnesses and for end of life care. It is not clear to me, however, how this fits in with social care run by the Oxfordshire County Council – particularly as the county council is currently being difficult over taking part in so-called consultation over the transformation of the health service.

Doctors will still only work during the week in the main and evening and weekend services will be provided through the 111 phone line, with patients being seen at a designated centre.

How this will work in rural areas where public transport is limited or non-existent, as opposed to Oxfordshire towns, is still unclear although it is apparently hoped that volunteer drivers will fill the gap.

The commissioners claim that patients have had an input to this, although I am not aware of the scale of that.

However, it is time for patients to speak up as they did in Banbury, Chipping Norton and Wantage when the news broke that their community hospitals were under threat of closure or a dramatic change in the way they were run, and in Witney when a GP practice closed.

In the case of Chipping Norton and Wantage the protests fell on deaf ears, but the good news is that after being elevated to government level the commissioners have been rapped over the knuckles over the way they dealt with Witney’s Deer Park practice closure and have been told to come up with a new plan for the area.

Significantly, a Government commission ruled the public must be involved in any new plan for GP and neighbourhood care plans for Witney and that the plan should cater for population growth.

This month sees a new chapter in the saga of changes at Banbury’s Horton General Hospital, which appears to be heading for downgraded status for its maternity department.

But the real decisions of stage one of the health service transformation could be in August.

The commissioners are the only people who think the consultation should have been held in two stages, but despite opposition to this they have ploughed on with this top down revolution.

Hopefully the Government intervention over the closure of Deer Park surgery may have changed all that.

Stage two of the consultation goes much further, taking in services to all of Oxfordshire and there are already fears that community hospitals will face closure as has happened with the small community hospital at Thame, to be used for other purposes including physiotherapy for the elderly.

It is vital for people to take part in this consultation, despite the view held by many that the changes are being put into operation as the consultation goes on.

As far as the GP framework is concerned, patients can contact their GP’s practice manager and join the Patients’ Participation Group so that they can have their say in their local situation.

It would help if the practice managers and groups emailed the plan to members of the participation groups to ensure a fruitful discussion.

The general message is: speak up. I think it is worrying that hospital beds are being closed before a reasonable structure is in being at a local level.

A ruthless change in the mental health field took place some years ago and it is no secret that the service in this area has worsened considerably.

Do we want a repeat of this in relation to the GP network? More explanation by the authorities and more consultation is needed now.