We’ve heard a lot from your Public Governors about what they do across the Trust so we’re now going to hear from one of our Staff Governors.
We appointed our very first Staff Governor for Community and Primary Care, Ruth Bentley, who was elected and took her seat on the Council of Governors in January 2019. Ruth is a Salaried GP at Rectory Road Surgery in Staveley, part of our Royal Primary Care arm. We thought it would be interesting for you to find out what had been happening there during the COVID-19 pandemic to give you a clearer picture of how services had been changing and how our GP colleagues have adapted. Here is what Ruth had to say…
“General practice has had to react to the pandemic, just as other health services have. It was clear very early on that our GP services had to change in response to the national advice to stay at home and the demands of social distancing. The team had new systems in place within a week with many services completely redesigned. It really is amazing what can be achieved when necessity takes over.
“At the heart of all of this was our leadership team which has been exemplary. We had daily conference calls to make sure we were all kept up to date with the developing situation regarding changes to daily operations and use of sites as “red” or “green”, as well as the ever present PPE discussions. Our Local Medical Committee sent daily email briefings on the issues that were affecting us on a national and county level and we were kept fully informed on what services were still available so that we could act accordingly. Some services were rapidly being commissioned across our Primary Care Network (PCN), such as the Covid home visiting service and the “Red Hub” for face to face assessments of possible Covid patients in the community. There was a lot of information to absorb about these new and evolving services. There was so much going on behind the scenes that people wouldn’t have known about from checking and rechecking lists of shielding patients to national changes in death certification for us all to understand.
“Our communication with patients has been very quick and efficient and I have to say that the patients and communities that use our services have been outstanding in their support. They know that they can’t come into the surgery unless they have an appointment. They also know that if they do come in to make sure they’re only a few minutes early so that our waiting areas don’t become overwhelmed and we can socially distance.
“With more people using the phone as a way of accessing a consultation, our admin and reception team has done a tremendous job. Their hours and days have had to change to suit social distancing and the management team has made certain to do all they can to accommodate each individual changing situation. As with all professions, our team have had to adapt to their own personal circumstances due to things like school closures and shielding or the need to self-isolate, so we’ve had to work together to adapt.
Working from Home
“This is where our management team have come in and made sure that those who can work from home have the tools to be able to do that. They’ve managed to source the hardware to make our patient records system available securely, at home and the CCG stepped up to help. This has all helped to make sure that home working is as effective as possible for those who need it so that we can serve our communities, and has meant we have not lost the expertise of those required to shield or isolate.
“Staying with the use of IT, we have been able to send the majority of prescriptions electronically direct to pharmacies to reduce foot fall in the surgery as well as waiting times in the pharmacies. The management team have enabled the clinical team to access the patient records system for each of our sites from any site. We have been able to absorb clinical activity across the whole organisation to enable prompt assessment of clinical need as well as keep up with the administration of lab results, letters and electronic prescriptions across the whole organisation. This is a great example of how we have pulled together as a team, to cover each other during times of heavier demand and make use of the capacity we have as a wider group.
“Throughout the multitude of changes there has remained a focus on staff wellbeing. One of the best things from my perspective has been the RPC support WhatsApp group which exists solely so we can keep in touch on a pastoral level. A photo of my morning dog walk is often shared despite the early hour – all the better to facilitate social distancing at 6.30am!
Restoration of Services
“We’ve now reached the point where a lot of the talk is turning towards restoration, how we change things back and what we might want to keep. There’s no denying that a lot of the changes we’ve made have worked very well. The team are looking at ways to incorporate those areas going forward. The possibility of video consultations is on the horizon which has the potential to bring how we manage various conditions and challenges into the 21st Century and increase choice and availability of appointments.
“For me, a perfect example of how necessity has driven positive change is our use of Consultant Connect which gives specialist help and advice for GPs across Derbyshire. It has been available for a while now, and the telephone advice has been well used to link in more closely with the Chesterfield Royal Hospital’s clinical team as well as a national network of consultants. However it is the tele dermatology option linking with the Dermatology team at Chesterfield Royal Hospital that has really come into its own. The RPC team set up a dedicated email account for patients to send in pictures of lesions or rashes which clinicians can directly access. We are then able to send the photograph alongside specific clinical information directly (and securely) to the Dermatologists who can analyse the image and give us a response often within two hours which is phenomenal. This means that we have a good idea about the next steps required for that patient and decide on a course of action whether that’s a referral or other type of treatment. It can potentially speed up urgent referrals as there is no need to wait for an appointment to “see” things in person. That is definitely a keeper.
“Many New Skills”
“We can tell from the prompt letters coming out from The Royal that telephone clinics have become the norm there as well. A summary of that call has been useful in the same way clinic letters from face to face consultations have been. I have also been receiving the excellent updates from Director of Nursing and Patient Care Lynn Andrews. I think one of the genuinely positive things to come out of this is that it has brought health organisations together in terms of how we work and share information. It’s also honed a number of skills and taught many of us new skills – including the use of Microsoft Teams for Governors Meetings. We’ve been able to reassess how we operate, how we approach certain decisions such as what we can and can’t do over the phone or virtually and our patients have been very supportive throughout. That can only be good for those who work here and for patients who use the services as we look at how we come out of this.
“That’s the next step, restarting services. It won’t be easy and there’s a lot to consider. For example these services will need to incorporate social distancing. The period of adaptation is far from over. It may be a slower process because changing services going into lockdown was done very quickly out of necessity but we need to be more considered coming out towards the “new normal”.
“All of our community services have been affected in the same way, whether we’re talking about midwifery, school health, community nursing or Child and Adolescent Mental Health. We’ve all made changes based on the evolving situation, some of which will stick and others will return to a different kind of normal. From my personal perspective I’d like to pay tribute to all of my colleagues who have done an exceptional job in exceptional circumstance but we couldn’t have done it without the cooperation and vigilance of our patients…a true collective effort.”