Welcome to St Georges Medical Centre Patient Webinar

Welcome to St. George’s Medical Centre Patient Webinar MAKING SENSE OF THE NEW SYSTEM IN GENERAL PRACTICE. DR. CHARLOTTE BENJAMIN & PRACTICE MANAGER - RIZ HUSAIN.

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In March 2020 our lives changes significantly as a result of the Coronavirus pandemic. For some of us it affected education, for others it changes working lives. Some became unwell and others lost friends or family. The impact was different for everyone but significant for us all. Health and social care services changes overnight to respond.

Our Story at St Georges Medical Centre, Hendon. Practice list: 12, 000 patients. Open practice list (NHSE mandate). We lost 21 patients in March & April. Longstanding patients , known to practice for decades. Surgery staff affected with covid-19 – 4 doctors, 1 healthcare assistant, 2 receptionists.

Clinical Staff. Partners : Dr Mailoo, Dr Hoffbrand, Dr Benjamin, Dr Haria- Shah, Dr Magnus. Salaried Drs: Dr Alakakone, Dr Burman-Roy, Dr Siriwardena. GP registrar: Dr Patel. Nurses: Louise Moon, Emily Harvey. Health care assistants: Mary Montgomery, Dawn O’Sullivan. Pharmacists: Tanvi Kothari, Ibitola Elemide, Minal Shah.

Non Clinical Staff Practice Manager: Riz Husain. Deputy Practice Manager: Karen Le Roux. Receptionists: Pippa Harris, Leonie Lax, Anna Gorgey, Christine Jones, Janice Beck, Kuenga Choden, Paula Davies, Carla Cruz, Cristina Todd, Jenny Tarafder. Secretary Nick Kenedy. Medical summarisers: Vijaukumar Thamaraselvi, Osman Abdelshafi

Wider Support. Patient champions: Barry Cecil, David Morris, Liz Brimson, Fay Reeves, Jacques Dwek, Jeanette Antonian, June Shinkin, Pauline Wigman, Raisa Goligorsky, Richard Kravetz. PCN Social prescriber PCN physiotherapist – Self referral possible via practice website. Interpreters: Language Line now virtual. Pre- covid, Practice champions events: Coffee mornings, park walks, chair yoga, support to individuals.

What we do at the surgery. On the day management e. g. . Urine infection, chest infection, musculoskeletal trauma, mental health difficulties. Chronic disease management. e. g. . Diabetes, asthma, COPD. high blood pressure. Mental health support – significant mental illness, common mental illness. Vulnerable groups – learning disabilities, vulnerable children, vulnerable adults. Work with other agencies- health/ social care. Referrals. Analysis of diagnostic tests. Prescription management. Reports e. g. . DWP, DVLA Private requests – notes, insurance reports – life insurance/ private insurance cover, List not exhaustive.

The practice holds a contract with NHSE. Member practice of Barnet federated GPs, North Central London (NCL) CCG, Since 2019 work in PCN 5 with neighbouring practices. All GP practices were advised by NHSE early March to move at pace to remote/ virtual based model, to protect patients and staff from risk of coronavirus.

• Need to protect our patients from contracting covid-19 from our healthcare setting & need to protect our staff.

What infrastructure did we introduce at St Georges M/C in pandemic? IT infrastructure. Laptops for remote working. Cameras for computers. Platform for sending text messages (accu. Rx) and video links to patients. More telephone lines. Microsoft teams for meetings.

Practice interventions Surgery open – responding to patients throughout pandemic. Open over bank holidays in Easter and May. New ways of working for staff – doctors, nurses, health care assistants, practice pharmacists, receptionists and admin staff. Health risk assessments for our staff for covid. Some staff shielding.

Additional practice work during Pandemic Call to all shielding and vulnerable patients. Validation of national shielding lists. Assessment & follow up of covid positive patients for 2 weeks. Support to local covid hot hub (Edgware Community Hospital) - sessions by practice doctors.

Physical Changes to Practice. Front door: Intercom system March – mid August. Open since mid August. Green/red light system.

Glass screen in reception.

Microsoft teams meetings. Weekly practice meetings, clinicians, practice manager, reception manager. Connecting staff in surgery and those working from home, if isolating/ shielding. Educational meetings.

When you come to practice IPC (infection prevention control) Check you have no coronavirus symptoms (Fever > 37. 8 o. C, continuous cough, change/ loss of sense of smell). No contact with anyone with symptoms or positive test in past 14 days. Wear face covering (unless exempt). Use of hand sanitiser.

Waiting room reopened. (socially distanced)

Face Coverings. Disposable masks, material, make your own. Wear over mouth and nose. Reduces spread of aerosol droplets (main mode of transmission) Who is exempt? – children < 11 years, physical or mental disability, speaking to someone relying on lip reading.

Survey of practice patients across NCL Healthwatch - > 1, 000 patients surveyed. Anxiety and worry. Finances, jobs, life and covid. Changes to the world including medical system. Unclear about covid guidance.

Previous system, pre-covid, (Disadvantages). Long wait on telephones, Many enquires – did not want face to face appointment. Waits for non-urgent appointment. Some pre-emptive booking of appointments (just in case scenario).

St Georges M/C, pre-covid work Aim to improve access to our patients, on phone and appointment. Wanting to move to triage system pre-covid. Looking to implement gradually , with input from our patients to find and implement the most appropriate system.

New ways of working. Model moved from seeing most patients F 2 F (face to face), to mostly virtual by telephone or video or e. Consult. Nurse - 1 seeing face to face throughout covid i. e. , vaccinations for children, wound dressings. 50% of our nursing/ HCA staff – shielded population. Continuation of F 2 F 6 week baby checks.

Where are we now? (early September 2020) More nursing staff able to resume direct contact with patients. Cervical smears, vaccinations part of national immunisation schedule restarted. Doctors seeing approximately 2 -3 patients face to face per surgery/ per doctor. Most GP consultations telephone/ video link/ electronic.

E consult System for NHS practices to offer online consultation. Allows patient to submit symptoms or requests to their own GP electronically. Round the clock NHS self-help information/ signposting to services/ symptom checker. Safety inbuilt – information governance, highlighting emergencies (red flag) – to be deal with by alternative e. g. 111. Designed to enhance patient access, improve practice efficiencies and signpost patients to right place at right time for their care.

New system. Accessible 24 hour / day. Encourage most patients – e. Consult. We recognise that not all our patients are able to use e. Consult. Submit symptoms/ clinical questions, Upload photo if appropriate (particularly good for rashes). e. Consult admin – shorter route, if admin request. Telephone free for those not able to access internet/ e. Consult. (less traffic on telephones).

Help us to help you (1) Stay healthy - physical and mental health. Understand new system, where to access support. Flu vaccination – even more important this year. Consider buying blood pressure machine if needing regular monitoring. Stock up medicine cupboard, - thermometer, paracetamol/ pain relief, antihistamine, oral rehydration salts, indigestions treatment, sun screen. First aid kit.

Help us to help you (2) Where possible improve digital literacy Local support: (Age UK Barnet). 020 8432 1415/ joanna. patel@ageukbarnet. org Support your community around you (volunteering opportunities)

Phlebotomy Historic clinics, phlebotomy provided by Barnet Hospital. Stopped last year. Nurses/ HCA – blood tests for vulnerable patients, who find it difficult to travel. Half our nursing workforce shielding during covid, not possible to continue to offer. Current provision: Edgware Community Hospital, Finchley Memorial Hospital, Royal Free Hospital, Chase Farm Hospital, appointment needed. District nurses for housebound. Local work – to try to repatriate phlebotomy back into general practice across NCL.

Flu Clinics Flu vaccine due: Outdoors walk through clinics, 26/27 th September, 3 rd/4 th October. Rationale for outdoors clinics – minimise risk of covid-19 transmission, maximal efficiency for IPC. Working together with PCN – alternatives.

What can you do to help practice Understand changes. Feedback thoughts. Practice champions. Webinar to go on practice website. Opportunity for further questions. Generate FAQ (Frequently asked questions) Further webinar if needed.

Questions?

Themes of questions. Personal care from own GP – can state preferred dr on e. Consult. Difficulty logging onto e. Consult, - email/ telephone practice. Telephones – difficult to get through. Phlebotomy Flu clinics.

Covid vaccination – promising start to research in UK & internationally. Too early to know when mass vaccination would be, and how it would be delivered. Hospital follow up – hospitals working on recovery, Nearly all services changed with covid surge, to cope with significant numbers of covid patients. Currently in recovery, aim to get services back to usual levels by October, but large backlogs. Urgent work did not stop (cancer referrals, emergency treatment).

Thank you so much for your time tonight.