The health services in Marshfield are used by most people in the parish, whether ill or healthy, at some times in their lives.
In the 2001 census, the population of the Marshfield parish was 1616, with 260 people over the age of 65 (16%), 200 people with limiting long-term illness (12.3%) and 150 unpaid carers (9.3%).
Marshfield has a GP practice with dispensary, which is part of the larger Three Shires Medical Practice, also covering Wick, Pucklechurch, and Colerne. The Marshfield practice provides for 2400 patients, and so includes some from outside the parish. It is staffed by one full time GP (4days per week) with support from another GP from the Shires (1 day), a locum GP (1 day) and a Nurse Practitioner (3 clinics).
Services provided by Marshfield Surgery include GP, Nurse Practitioner, child clinics, immunisation, and Practice Nurses. Antenatal clinics, run by the community services, were withdrawn from Marshfield a few years ago and women had to travel to Yate. The practice appealed, supported by the Parish Council, and a limited service was reinstated in Wick to serve Marshfield. There has been an increase in the use of nurse led consultations in the last few years, both nationally and locally (especially with regard to annual checks and health promotion).
Extended Surgery Hours (18.30-19.30pm) occur on Tuesdays twice a month at Marshfield but residents can attend late surgeries at other practices within the Three Shires if needed. An out of hours service (18:30pm-08.00am and weekends) is provided by Wiltshire Medical Services, staffed by local GPs and Nurses at Chippenham Community Hospital. The geographical position of the village means that NHS services are provided by a range of different providers outside the Parish, such as Physiotherapy and Chiropody. The main Acute Hospital referred to is the Royal United Hospital (RUH) Bath. Chippenham Community Hospital also has a minor injury unit, stroke and rehabilitation wards for patients referred from the RUH.
Marshfield Surgery holds a register of carers but does not have a Patient Participation Group (PPG) at present. although this is something that the NHS is keen to promote. These aim to work in partnership with their surgeries to help patients take more responsibility for their health; contribute to the continuous improvement of services and quality of care; foster improved communication between the practice and its patient; provide practical support for the practice and help to implement change.
The NHS is undergoing major changes at the moment. The Primary Care Trusts, which were responsible for commissioning services, have been replaced by Clinical Commissioning Groups including GPs. These changes come into force in April 2013. It is uncertain how this will change the services available for local people in the future.
The size of the Marshfield Surgery is adequate for the current population it serves. However, it is located in an end of terrace house on Back Lane and ideally needs to be within a new purpose built building within Marshfield. There are no plans to develop this at present. The Pucklechurch Surgery is currently located in part of a private house and requires new premises. A new build project is likely to go ahead there in 2013. However, this will not affect the Marshfield Surgery as there are no plans to centralise services.
Some other alternative medicine services such as homeopathy, reflexology, massage and acupuncture are available privately within the Parish.
The village has a hospital transport scheme to help people get to appointments at a range of hospitals in Bristol and Bath, and the local surgery. There are 26 volunteers so the work load is not too onerous for the drivers but it is for the hard pressed organisers.
At the time that the transport scheme was set up, two years ago, a more comprehensive LINK or Good Neighbour scheme was looked into. This would have provided help for older or ill people with transport to medical appointments, shopping, befriending or household jobs, but there was no one to organise it.
There are times in anyone’s life, either when ill or as a carer, when they may need more help than they feel comfortable asking for. It can be particularly difficult for ill people in isolated rural homes. To support them, there might be a place for a wider volunteer scheme linking people of all ages, young helping old, and old helping young in schools or as substitute grandparents, widening experiences, lessening isolation and making each generation feel useful.
Informal Patient & Carer Groups could also be set up for mutual support within the community. These might, for example, involve coffee mornings for sufferers of chronic illness. The village already has an established Parenting Group and there are plans to develop a Dementia support group.
Sometimes, one problem may snowball: a health problem leading to an employment problem, leading to money issues and on to family issues, depression and so on. Then you may not want to talk about your problems, and, when you are ready to do so, it can be very time-consuming and frustrating to access the advice and services that you want. In the village there is no comprehensive source of information relating to health and carers, disability, benefit help-lines, financial advice and information about social services. It would be helpful if this information could be made available or advertised in the village. The suggested LINK scheme might also be helpful in these situations for practical help as could advice sessions in the village by experts.
Disabled access in the village is generally good although there is a lack of wheelchair accessible walks or footpaths. Also some organisations, including the parish council, hold public meetings in upstairs venues.
Another health initiative, which has been implemented in many local communities, is a First Responder defibrillator to be used in emergencies by local people trained by the ambulance service.
Most of the above information came from interviews with the local GP practice manager and people who run or take part in the relevant activities or organisations.
To obtain patient information, a small questionnaire was placed in the surgery for one week and achieved a response rate of over 70%. Of the 52 questionnaires completed, 69% were by older people. 94% were in favour of starting a LINK or Good Neighbour scheme in the village. 62% were in favour of forming patient and carer groups. 48% felt that more health related information was needed in the village.
In the comments sections, people felt that patient and carer groups would provide mutual support, empathy, friendship and information. Many people praised the hospital transport scheme but felt there was no other help in the village except neighbours. Most were happy with the services the surgery provides although a few would have liked evening surgeries, and the two younger respondents wanted antenatal clinics in the village. About half of the people who commented on the lack of health-related information suggested that a Marshfield website would be the best place for such information.
Most of the same questions have been re-asked in the Residents’ Views section.