Covid: So you think it’s all over?
There are some interesting substacks, that are free, which give updates on the latest numbers around Covid.
Click on the links and register for your regular updates from the people in the know.
https://christinapagel.substack.com
Winter
The NHS used to do something called ‘winter planning’ where providers made plans to make sure that they were able to cope with the expected increase in sick patients that inevitably happen in the winter months. However it seems that services are in a constant state of being overwhelmed and winter planning happens all through the year.
The NHS is in crisis. Long waits for ambulances. Hospitals full to overflowing, not able to discharge patients because of the lack of social care.
General practice is faced with unmanageable workloads, along with a shrinking and exhausted workforce. The Covid-19 pandemic has generated a vast backlog of care which GPs have to manage while patients wait for their hospital appointments.
The British Medical Association has even felt it necessary to publish a guide for GPs called ‘Safe Working in General Practice”. They acknowledge the need for practices to work closely with their PPGs. The paragraph below is taken from this publication.
“Patient Participation Groups (PPGs)
Practice PPGs are a crucial ally and resource for practices. We encourage practices to engage their PPGs, and to discuss openly the challenges being faced by all practices, and specific pressures locally.
The support of and consultation with PPGs is vital in any changes that practices are considering. GMS regulations allow practices to provide “services delivered in the manner determined by the contractor’s practice in discussion with the patient”. PPGs are an important conduit for communicating these changes, and reasons for them, to the wider patient population.
They may also be able to lobby on behalf of practices directly to ICBs, demonstrate patient engagement to ICBs, and give crucial insight into the needs and priorities of the patient population.”
Winter 2021
What patients want:
This is our response to the plans for the allocation of the ‘Winter Access Funds’. NHS England and NHS Improvement (NHSEI) has made a £250 million Winter Access Fund available to primary care health services from November 2021 to March 2022 to improve patient access. There is considerable focus on increasing the number of face to face appointments.
Continuity
The great thing about how general practice works in this country is the continuity of care. That doesn’t mean seeing ‘your own’ doctor every time, but it means that you feel that your practice knows who you are, knows something about you and your circumstances, and takes you seriously. It means that you don’t have to start from scratch every time you have a consultation. It means that they know you will enough to recognise that something has changed and pick up on what might be a serious problem.
Flexibility: Urgent/Serious? Today or next week?
Many of us know when we need to be seen. Often the lack of flexibility of the appointment systems works against us – only offering a choice of today or in 2-3 weeks time. So something that could wait for a few days becomes ‘urgent’ in order to fit in with the options available to us.
Barriers to Equality of Access
The COVID pandemic has changed the way we get access to general practice. We can’t just walk into the surgery and make an appointment; we can’t make appointments on-line. Triage has become the norm. This is fine, providing that patients understand what to do and it works effectively for everyone.
Equal access regardless of IT access/ability
Telephone triage – you call the practice, explain your problem and they phone you back within a couple of hours, and sort you out immediately, or offer an appropriate solution works well for patients.
The rise of eConsult is a mixed blessing. It allows those patients with access to IT to ask for advice from their surgery 24/7. Maybe it is too easy? Does it lower the threshold of self-care?
But what about people who have no access to IT, or whose problem doesn’t fit neatly into the pre-defined categories, or who can’t explain what they think is the problem? Do they have a second class service?
Telephone, video, face to face?
There is no single answer to this. The answer will be different for every occasion for every person. From the patient viewpoint sometimes a quick phone call will suffice. Video calls also work – but only for those patients who have access to the technology and feel comfortable using it. Sometimes only a face to face appointment will do – especially if you need a physical examination of some kind.
The requirement to increase face to face appointments is a ‘red herring’. Many of us have no desire to sit in a waiting area full of sick (with COVID or otherwise) unless absolutely necessary.
More People
The underlying issue behind many of the difficulties in access is that there are not enough staff – clinical or administrative available to work in general practice. GPs take 10 years to train, nurses half that, so any amount (and it’s not a lot) of short term funding will not solve the problems.
There is no magic primary care team tree!
Oxford Patient Network 