Local democracy during coronavirus

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Agenda item

Verbal update on how GP Practices are coping with the Covid emergency

Dr Nigel Wells, Chair of NHS Vale of York Clinical Commissioning Group will provide a verbal update outlining how GP Practices have been coping with the Covid emergency.

Minutes:

The Chair of NHS Vale of York (VOY), Clinical Commissioning Group (CCG); the Accountable Officer, NHS VOYCCG and the Acting Director for Primary Care and Population Health for NHS, VOYCCG, gave a verbal update on how GP practices were coping with the Covid emergency.

 

Dr Wells explained that in March their priorities had been: saving lives; protecting the vulnerable and keeping services going, which is what Primary Care services have done for the last 9 months.

 

He outlined how they had protected the vulnerable and staff by providing telephone triage, remote working, and continuing to provide essential services via text messaging and phone calls.  There had been some video consultations however, the technology for this was not available as yet.  The priority had been caring for the most vulnerable and end of life patients. 

 

It was reported that the current activity at GP practices had included:

·        Attending to routine clinical demand; catching up with the deferred backlog of appointments and need arising from the first wave of Covid and helping those with long term conditions and mental health concerns. 

·        Responding to the increase in take up for the flu vaccination which had increased from approx. 60 per to over 75 per cent. 

 

Some of the challenges currently faced by GP practices (during the second lock-down) had included:

·        Staff absenteeism: practices have been subject to the same staff absences as can be seen in other workplaces for reasons such as needing to self-isolate, Covid fatigue, child care arrangements. 

·        Wellbeing of staff: and providing support, building resilience for the winter.  National and regional online resources were available.  The CCG had recognised the additional pressure that GP receptionists were under and had put in place  ‘wellbeing champions’ and were doing a media campaign on the back of national campaigns, encouraging patients to be kind to the GP receptionists.  Practices were signposting service users to 111 and encouraging patients to self-care, where appropriate.  It was explained that due to budgetary constraints it was not possible to recruit additional staff.

·        Face to face appointments - twice as long due to the time taken in relation to PPE and cleaning.

·        Service user’s expectation and communication:

o   Urban myth nationally that GP practices had closed its doors.  In March, the number of patients seen had been reduced.  Currently service had been restored and busier than ever, with more consultations undertaken than at the same period of time in the previous year.  York Medical Group had received 42k phone calls in September 2019, in September 2020 they had received over 50k phone calls. That was replicated with telephone and face to face contact.

o   The City of York was fortunate in that they had a service which was rated good or better, which was important in the context of discussions around patient expectation.  There are a number of practices which are larger than others.  Their combined resources had created a resilience that smaller practices cannot reach.  That hot and cold service is not available in other regions. (meaning: split 'hot' emergency and urgent care from 'cold' planned surgery).  York practices should be commended for having this outstanding resilience and flexibility.

o   Resident’s had reported that they had been asked to attend appointments across the City.  It was explained that it had been necessary to arrange face to face appointments, at protected ‘hot’ sites due to the infection risk in order to protect staff and the vulnerable.

o   In relation to criticism of the GP practices and services, Members agreed that there appeared to be a mismatch between the service offered and what residents expected.  The representatives from the CCG considered that what the NHS were communicating, for whatever reason, was not being understood and welcomed anything Members could do to speak in support of these services and clarify any misconceptions to its residents.  It was felt that change and understanding needed to come from a societal view. 

 

·        Managing resources

o   Additional resources to support Primary Care services were provided in March and had included: additional PPE; IT allocation; spend on the physical infrastructure such as plastic screen barriers, and some additional sessions to support clinical activity.  Further information on these additional sessions would be provided to Members.

o   There were 80 new staff appointments involved in social prescribing and link workers, which has enabled Primary Care services to work better with voluntary services.

o   The Covid crisis had created a new way of encouraging ‘returners’ back to the service.  The City was well supported in their recruitment and retention levels.

·        Increase in mental health concerns:

o   The representatives from the CCG confirmed that they were seeing an increase in mental health presentations across all age groups and that they were seeing people referred who had never met this service before.  They were working with our partners in Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust on long term projects in this aspect, over the next five years and beyond. 

o   From April onwards, new mental health workers would be available for practices to employ (April as posts are linked to training programmes).

o   The CCG were working with our mental health providers to ensure more joined up working and were signposting service users to available online services –which was acknowledged works very well for some, recognised it was not suitable for all.

 

Going forward, the representatives from the CCG reiterated that Primary Care services and GP practices were under extreme pressure with a finite resource available, therefore communication was key.  They talked about the need to move beyond reliance on services from primary healthcare and from looking at numbers, and instead look at societies wellbeing, outcomes and quality of life - looking at the whole person/family, because there is not always a medical solution, it is more about societies wellbeing and having a richness of communities, the prevention agenda.  For now, the message is look after your own health as advised and consider preventative health measures and how the City of York can be healthier.

 

It was reported that preparations were underway to roll out the new Pfizer vaccine.  The Director of Public Health reported that she had been working with colleagues in the CCG and Primary Care services on the first draft of plans that would need to be in place by the end of November.  The vaccine would be available in small quantities at first, likely to be administered after Christmas.  The first would be delivered in partnership with GP practices to people over 80 years, care home residents and frontline health care workers, then to the most vulnerable and so forth.

 

Regarding misinformation in relation to the vaccination, Public Health England had a behavioural change specialist unit that would be working on health promotion material, when the vaccine becomes available.

 

The Chair and Members thanked the senior representatives from the CCG for attending this meeting and sharing their thoughts and experiences with the Committee and reiterated their support in communicating clear messages from the NHS to residents on looking after their own health and looking after each other.

 

 

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