The Trinity Surgery came into being because of population growth in Wisbech in the late 1980's. Both practices in Wisbech at that time, had more patients than they could cope with, so to enable the GP's to continue to offer a good service, they agreed the solution would be a third practice for the town. With the approval of the FHSA and MPC, Dr Joe Neary joined the Clarkson Surgery as a temporary partner. All other lists were closed; so all newcomers were placed on his list, which grew from zero to 2000 within two years.

During this time Dr Neary developed his own cost rent surgery. The biggest difficulty was finding a suitable site. This was eventually found after 18 months of hunting. The time scale of development was impressive, from site to completion of a purpose built surgery in nine months.

The practice was cost-rented for occupation by two doctors, but was designed to ultimately accommodate three. The staff amenity area was designed to convert into consulting rooms and the large attic turned into a staff amenity and administration unit. This conversion took place in 1996.

By 1995, the practice list had reached about 4000 patients, which supported the expansion of the partnership. Dr Webb joined Dr Neary in July 1995. Growth continued and in 1998 the partnership expanded to three partners.

The surgery was the first paperless practice in Cambridgeshire. The surgery design and practice systems were designed for this objective from the start, and we have been more successful than most in achieving the efficiencies of IT.

We are an innovative and forward-looking practice. We were early advocates of developing skill mix in general practice. This included advanced nursing roles and tutoring Sister Julie Braine to nurse practitioner, which she completed in 1995. Since then she has taken over some of the traditional GP roles, diagnosing and managing many patient caseloads autonomously.

Practice meetings are held once a month, and full staff meetings quarterly. We try to take "time out" from the practice once a year, usually with a facilitator, to prepare practice/business plans. We are particularly proud of the friendly and supportive environment we work in and relationships are encouraged and developed by regular social meetings.

The practice has taken a lead role in encouraging cross practice collaboration; our existence is the successful outcome of this value. We helped to establish a locality group in Wisbech, which extended to the rest of the Cambridgeshire Fens in the shape of the Fenland Primary Care Group and ultimately the Fenland Primary Care Trust.

Patient Participation Group: This group has been welcomed with great enthusiasm by our patients. We hope it will grow in strength over the next few years. Of particular note is its achieving funding for and recent opening of a patient library.

Practice Infrastructure

During 2003, Trinity Surgery replaced its original Torex Meditel System 5, for EMIS GV. Consulting room workstations are equipped with Windows 2000®, Bodyworks and Microsoft Office® software. All surgery PC's are networked and have online access to the NHS net. We are linked for registration and hope to implement links with the local hospital laboratory imminently.

Our practice library has Internet access to Medline and a CD ROM library including 'Cochrane Library' and 'Best evidence'. We have an extensive book and journal collection.

Practice meetings are held once a month to discuss day to day management and issues. Shorter meetings are help weekly to address topics of a more urgent nature. The team for this is made up of the principals, practice manager, quality manager and practice nurse. Full staff meetings are held quarterly

We have weekly educational meetings for doctors, nurses and practice admin staff. Once a month, the practice joins the rest of our PCT in closing for an afternoon of dedicated educational activity. This alternates between practice based activity, and joint events with other practices across the Trust.

We also hold regular meetings to review significant events (monthly) and review a series of clinical topics in rotation, such as Children and Families, Coronary Heart Disease, Elderly and Vulnerable, each of which are reviewed every three months.

Because of the busy nature of general practice and the increase in demands we have a 'time out' each year for the core management team to look in more depth at major issues these can be both current topics as well as future arrangements.

We are proud of the friendly and supportive environment we work in and relationships are encouraged and developed by regular social meetings.

Recent Developments

In November 2000, Dr Neary announced his intention to move away from Trinity Surgery and Wisbech. Dr Webb was faced with the task of assembling a new partnership. This has been achieved, with a most promising start. Dr Bitar joined in May and Dr Wordsworth replaced Dr Neary in September 2001. Dr Tyler joined in October 2002, as part of a PMS pilot to improve patient access.

At the same time, the practice pursued the possibility of participating as a PMS pilot. This commenced October 2001. Development of the practice was approved as part of this pilot, including the expansion by a half-time partner (subsequently increased to full-time partner) and a full-time Nurse Practitioner.

Over the same period, Dr Webb worked with the PCT to address the recurrent problem of the growth of Wisbech and the lack of primary care facilities. All three town practices were once again full, with more patients than they can ideally manage and without the infrastructure to expand. The PCT developed imaginative plans to establish Primary Care Services at the North Cambridgeshire Hospital site. This is to include new general practice facilities, a Minor Injury Unit, a children’s unit, as well as enhanced care of the elderly and mental health services. This raises the exciting prospect of closer working of all agencies involved, including secondary medical care specialties, GP specialists, nursing and associated clinical staff and social services. Trinity Surgery has anticipated working towards this goal and establishing the new general practice facility at a new site, with a further expansion of the partnership and allied staff.  Unfortunately, for financial reasons, the PCT was unable to deliver this vision.

East Cambridgeshire and Fenland PCT acquired the North Cambridgeshire Hospital during 2002. It is now keen, and has identified funding, to commence its plans for that site. With the hospital site, it assumed responsibility for the inpatient wards: a 24 bed rehabilitation ward, a 21 bed psychogeriatric unit and a new 10 bed intermediate care ward. Trinity Surgery has negotiated a contract to provide the day time inpatient cover, which meant the expansion of the partnership by one partner.

 New Premises

Following the failure of the imaginative Primary Care Services, as detailed above, Trinity Surgery worked with the PCT and a private development company to build a new primary care facility. Building work commenced in late 2004. Trinity Surgery moved to its new premises in December 2005. The first patients were seen there on 19th December. Wisbech Town Mayor, Carol Cox, formally opened the surgery on 31st March 2006.

At the same time as the move to new premises, a sixth full-time partner joined the practice, to allow the practice list to fully open again for the registration of new patients.

The new building will also house a pharmacy and local Community Health Services.

The Future

The new premises will allow Trinity Surgery to grow and develop its services for the foreseeable future. Additionally, Trinity Surgery will continue to address the challenges of the new contract, QOF and Practice Based Commissioning.