To all of our registered patients:
The term – “we live in unprecedented times” is all too often used. However, we can all agree that the year 2020 will certainly be looked back on as an unprecedented change to our world.
The disease known as COVID-19 and the virus it contains (SARS-CoV-2) has been the most significant health crisis for our world in many generations. It has sadly resulted in many people becoming seriously ill and tragically has contributed to, or has resulted in (at time of writing) over 44,000 deaths in the UK alone. We would like to offer our commiserations to our patients who have been affected.
This previously unknown virus, become known to the National Health Service in January – and as patients will know only too well, spread to pandemic proportions very quickly. By March, the NHS was immediately placed into emergency pandemic status – and this sudden crisis has resulted in the most significant change to the NHS model of care since it was created.
Primary Care (GP Practices) were required to immediately implement dramatic changes to how we operate to Contain and Delay the virus spread. The reasons for this are now fully understood by the whole country (and indeed the whole world).
Primary Care services are particularly at risk during viral pandemics. Patients, who feel unwell with viral symptoms, have always approached their GP practice for advice and treatement. With COVID-19 there was immediate and serious viral spread that occurred. As GP practices see patients of all ages, for many conditions, vulnerable patients were suddenly exposed to this highly contagious virus.
Therefore, in early March the NHS implemented a closure of all Primary Care buildings across the country. Nationally – GP’s moved to a ‘TOTAL TRIAGE’ model of care delivery. This resulted in patients requesting appointments being ‘pre-screened’ by a clinician. Patients, who required further assessment, were in all but essential situations, to be handled remotely (via video consultation or via telephone). Patients who did require examination (FACE TO FACE), needed to be separated (co-horted) into different buildings (or if this was impossible – into separate parts of buildings). This is necessary to remove cross infection to the most vulnerable.
It is important to remember that Primary Care employees were not immune to this infection – and their exposure resulted in many members of staff becoming ill (requiring isolation and treatement) for the virus.
Nationally – many GP practices were forced to cease services entirely due to staff illness – unsafe premises – or following COVID-19 infections. Thankfully, we were not one of those affected in this way.
Our service provides Primary Care for patients registered at 6 practices – Adlington Medical Centre - Buckshaw Village Surgery – Croston Medical Centre – Eaves Lane Surgery – Medicare Unit Surgery and Lostock Village Surgery for over 23000 patients.
In March we implemented a COVID-19 plan that enabled us to provide the safest service possible during the Pandemic. All buildings were reviewed and it was immediately clear that some buildings were unable to continue.
- Buckshaw Village Surgery – although the largest and most modern facility we operate from, is a shared location, without separate entrances or separate waiting areas. The risks to patients (both GP patients and those receiving treatment by the Community Provider – and the Dental Service) was too high – and patient co-horting was impossible. The building was therefore deemed appropriate for only specific services for specific patients on specific days.
- Eaves Lane Surgery – The current location was, prior to COVID-19, unfit for purpose – when viewed in line with the requirements of the virus it was clear this building could not operate safely for any patient care.
- Medicare Unit Surgery – Shares the same location as the Lostock Village Surgery (which has recently been comprehensively refurbished – increasing ground floor clinical rooms). Therefore the Medicare site was made a safe haven for specific patients on specific days only.
Our three remaining sites were then altered and adapted to focus on three patient types.
1. COVID-19 (VIRAL) PATIENTS (SUSPECTED AND CONFIRMED)
2. SHIELDING (VULNERABLE) PATIENTS
3. ALL OTHER NECESSARY CONDITION PATIENTS
(For confidentiality reasons – it is important not to identify which site is which).
We implemented an immediate change to how patients could request appointments. As pre-screening was (and remains) essential – it was necessary to remove all online access to appointments. Appointment ‘times’ were no longer made available – and instead all of our clinical teams were diverted to carrying out Telephone Triage screening in the morning.
With the constraints we face in the NHS with regards capacity – it is not possible to have unlimited access to our service – however this triage service has spoken to over 18,000 patients in this time.
Patients – in the vast majority of cases have been able to receive the advice and support they need during the call – and in many cases following video consultation. Those patients who did require face to face support were asked to attend the most appropriate site for their condition (Virus patients – to the viral site, vulnerable patients to the Shielding site, and other serious medical concerns to third site). Over 3000 face to face consultations and examinations have been carried out throughout the pandemic.
Vitally – we have also provided care to Care Home residents. The extremely sad situation with multiple Care Home virus outbreaks has been widely reported – and this has been a particularly difficult situation for all involved. Once again our thoughts and sympathies are expressed to those affected.
In addition – our clinicians were asked to concentrate on the Government Shielding Programme – with multiple contacts made to all of the patients at severe risk of serious complication if exposed to the virus. Over 1000 patients needed this care.
Routine Health management – including repeat medications, vaccinations, investigations and referrals have continued throughout the crisis and our practice nursing team have continued to provide essential chronic disease management (remotely and face to face).
It is important for patients to know that although the doors of our buildings have been closed – this has not meant no care has been provided. In-fact, our clinicians and administration teams have worked seven days per week including Easter and Bank Holidays – with all annual leave cancelled. Many of our staff have themselves been impacted by the virus, but continued to work from their homes. Many of our clinicians have volunteered and supported secondary care services at the peak of the virus in addition to their normal primary care work.
We do understand that there have been frustrations for patients during this time, and we wanted to thank you all for your understanding during this time.
Mercifully – the national situation for the virus would indicate that the virus is in decline, and the ‘peak’ of infection has now passed. We must, however, remain extremely vigilant. The COVID-19 virus has not been ‘cured’ – and is growing at its fastest rate yet (at time of writing) in other parts of the world. A second ‘wave’ is on all of our minds in the NHS and we have therefore moved into our Phase 2 planning.
We therefore feel it important that we outline the situation for our registered patients and how we intend to provide the safest service possible for you in the NEW NORMAL world.
It is important to look at the lessons we have learned during these most challenging of times to help explain what has informed and determined the future delivery model
Prior to COVID-19 – across the country – Primary Care services had reached crisis point with regards patient demand and clinical supply. For many years – the requests for appointments for GP’s have risen exponentially. Many of these appointment requests are for conditions that can be dealt with via self-care or following a visit to the local pharmacy. This increased demand for minor conditions has resulted in severe constraints on our ability to provide care to those patients who require it.
COVID-19 has forced Primary Care and indeed patients to consider the need and priority for an appointment. There are a limited number of appointments that can be safely delivered by clinicians, and we must collectively work to ensure that this limited supply is concentrated on those who need it.
The NHS has realised that the pre COVID-19 situation was not sustainable – and therefore the TOTAL TRIAGE service provision is to be deployed fully in the NEW Normal world. Patients will continue into the future to be assessed prior to an appointment. Those patients who do not need to see a Primary Care Clinician will be directed to the most appropriate care (including self-care).
Seven Day isolation for the viral Illness will continue to be the advice and guidance provided and self-care via a pharmacy will be the requirement in the majority of minor cases. COVID-19 is not the only infectious virus that can be spread – and the best way to avoid infections spreading is to prevent exposure to other persons. It is especially important to stop infection spreading to the most vulnerable in society.
If a condition is more serious (or a patient has pre-existing long term conditions) then they will be given priority for access. Through necessity during the pandemic – we have rapidly deployed technology that enables patients to be remotely consulted. This continues to be the NHS plan and is now the default position. GP Practices nationally will soon be deploying further ways for patients to assess their symptoms via APP’s and via websites. The outcome of these comprehensive self-service options will direct patients to the correct health service and determine whether there is a need for an appointment.
Before COVID-19, the NHS realised that the Primary Care estate (the buildings) were in many cases unfit for purpose. In 2019 the NHS asked all GP practices to join Primary Care Networks to enable delivery of care to HEALTH POPULATIONS. It is recognised that it is no longer possible for all GP buildings to offer the same services from all buildings. This is due to both the availability of clinicians – but also due the lack of suitable facilities. Therefore practices were already planning to specialise their workforce to deliver specific services from across their network of buildings –and for a virtual list of patients. For example all midwife services to be provided from a single location for multiple buildings.
With the COVID -19 pandemic, the need to cohort patients has accelerated this plan and in the NEW NORMAL we will be further developing this way of working.
Our organisation of 6 practices is a Primary Care Network in its own right – and therefore we are much further ahead than other practices in this requirement.
We have throughout June been reassessing our buildings in line with the Government requirements for COVID SAFE environments. We have also been required to assess our workforce risk in line with the concerning evidence of disproportionate impacts for Black Asian and Minority Ethnic (BAME) populations. These reviews have determined the next phase of our COVID plan.
We are also looking to the future health considerations in line with our building cohort plans – with specific focus on ensuring a Seasonal Flu vaccination service is available at significantly increased volumes – and delivered safely. This is particularly important in this year – following the COVID impacts and the potential for a serious flu outbreak.
Work is being carried out during July outside of and inside buildings. During July we are ensuring we are able to continue offering a safe ‘social distanced’ service in a way that recognises the unique challenges faced by Primary Care services. Our service, will, in future continue to look different to that we used to offer, and I hope the above provides a full and detailed explanation as to why. Therefore the service will broadly be as follows:
From Week Commencing 3rd August:
Appointments requests:
- In line with TOTAL TRIAGE requirements – patients will continue to contact the surgeries via telephone where they will initially be booked for call back from a clinician. This will be every morning – between 08:00 – 10:30 am and then again in the afternoon from 2pm – 3.30pm
- In addition – triage appointment slots will be made available via the MyGP App for direct booking (without need to telephone).
- Where a Clinician cannot deal with the problem remotely – and you are asked to attend a practice – you will be asked to attend one of the following 4 safe sites (based on the condition and assigned cohort patient type)
Adlington Medical Centre
Buckshaw Village Surgery
Croston Medical Centre
Lostock Village Surgery
(Note Buckshaw now able to operate as a safe location)
- Specific Nursing appointments will be pre bookable (via telephone and via the MyGP app). Dependent on the condition – you will be asked to attend one of the following 5 sites:
Adlington Medical Centre
Buckshaw Village Surgery
Croston Medical Centre
Lostock Village Surgery
Medicare Unit Surgery
- Midwife Services will be provided from Buckshaw Village Surgery for all patients.
- Community Phlebotomy services are currently suspended – and if re-instated at this time will be held from Buckshaw Village Surgery. All patients should continue to attend Chorley and/or Preston Hospital clinic for routine phlebotomy.
- Weekend and Evening appointments will be booked following clinical assessment only – and will not be available for pre booking.
Prescriptions
- For August – we will continue to accept telephone requests for repeat medication.
- During August – patients on repeat medication will be asked to register for the online and mobile MYGP app for future prescription requests. In September – telephony will be switched off for prescription requests to allow focus on the flu campaign.
Please note: All prescriptions must be issued via EPS – direct to pharmacy (unless the medication cannot be provided via those means). All patients must have a nominated pharmacy at point of request as collection of prescriptions is no longer possible.
Medical Notes (including sick notes)
These have remained un-changed throughout pandemic and patients should request as normal. From September we expect a new online/app system will be deployed for sick note requests and at that time all requests will need to be made that channel.
Accessing Buildings
All of our locations will be operating STRICT social distancing and specific Health Service requirements for patients who attend a site. Each site will have its own unique requirements.
Adlington Medical Centre
Patients should use the side entrance and use the intercom where they will be advised on when and how to enter the building.
Access will be limited in two ways:
- To those who have been requested to attend
- Limited in number for those requiring reception assistance.
- Number limitation will be to a maximum of 2 adults (and only if there to support patient) and/ accompanying children.
All patients must wear a face covering prior to Admission (under 5 years olds exempt) unless a medical condition exemption exists and this has been agreed by the Clinician when booking appointment.
No more than one patient (bubble) will be allowed in the waiting area at any one time – other patients will be asked to wait outside.
Entry and exit will be via different doorways.
Please note – toilets will be closed to patients (unless a sample is requested during consultation).
There are plans to change the entrance door to a lock and release mechanism – until such time we ask patients to observe the above and read the note on the doors.
Buckshaw Village Surgery
Patients should use the front entrance (Main Door) and use the intercom where they will be advised on when and how to enter the building. The door remains locked until released by the appropriate service (GP practice – Lancashire Care). Dental Patients will use Dental entrance which is also locked and released by Dental service.
Access will be limited –
- To those who have been requested to attend
- Limited in number for those requiring reception assistance.
- Number limitation will be to a maximum of 2 adults (and only if there to support patient) and/ accompanying children.
All patients must wear a face covering prior to Admission (under 5 years olds exempt) unless a medical condition exemption exists and this has been agreed by the Clinician when booking appointment.
No more than two patient (bubbles) will be allowed in the waiting area at any one time – other patients will be asked to wait outside.
Access to the left-hand side of the building (if facing reception) is restricted to GP patients.
GP Patients will be required to exit the building via a separate door off the GP corridor.
Please note – toilets will be closed to patients (unless a sample is requested during consultation).
Croston Medical Centre
Patients should use the main entrance and use the intercom where they will be advised on when and how to enter the building.
Access will be limited in two ways:
- To those who have been requested to attend
- Limited in number for those requiring reception assistance.
- Number limitation will be to a maximum of 2 adults (and only if there to support patient) and/ accompanying children.
All patients must wear a face covering prior to Admission (under 5 years olds exempt) unless a medical condition exemption exists and this has been agreed by the Clinician when booking appointment.
No more than one patient (bubble) will be allowed in the waiting area at any one time – a second patient bubble will be able to stay in the foyer (prior to waiting area). All other patients will be asked to wait outside.
Exit will be via the side door (onto carpark).
Please note – toilets will be closed to patients (unless a sample is requested during consultation).
There are plans to change the entrance door to a lock and release mechanism – until such time we ask patients to observe the above and read the note on the doors.
Lostock Village Surgery
Patients should use the main entrance off public car park and use the intercom where they will be advised on when and how to enter the building.
Access will be limited in two ways:
- To those who have been requested to attend
- Limited in number for those requiring reception assistance.
- Number limitation will be to a maximum of 2 adults (and only if there to support patient) and/ accompanying children.
All patients must wear a face covering prior to Admission (under 5 years olds exempt) unless a medical condition exemption exists and this has been agreed by the Clinician when booking appointment.
No more than one patient (bubble) will be allowed in the waiting area at any one time
All other patients will be asked to wait outside.
Exit will be from either the main door or a door from consultation rooms (onto staff carpark).
Please note – toilets will be closed to patients (unless a sample is requested during consultation).
There are plans to change the entrance door to a lock and release mechanism – until such time we ask patients to observe the above and read the note on the doors.
Medicare Unit Surgery
Patients should use the main entrance off car park and use the intercom where they will be advised on when and how to enter the building.
Access will be limited:
- To those who have been requested to attend only. Access is granted by the clinician.
Any patient queries requiring a receptionist must be taken to the Lostock Village Surgery across the public carpark.
All patients must wear a face covering prior to Admission (under 5 years olds exempt) unless a medical condition exemption exists and this has been agreed by the Clinician when booking appointment.
No more than one patient (bubble) will be allowed in the waiting area at any one time
All other patients will be asked to wait outside.
Exit will be from either the main door or the rear door onto car park.
Please note – toilets will be closed to patients (unless a sample is requested during consultation).
There are plans to change the entrance door to a lock and release mechanism – until such time we ask patients to observe the above and read the note on the doors.
Eaves Lane Surgery
Regrettably – it is not possible to safely operate any patient services from this location. We do not anticipate this situation changing in the near future. Due to this reality – we are now working closely with Chorley Borough Council and the Chorley and South Ribble Clinical Commissioning Group to rapidly commence a relocation of the practice onto a new location in the Eaves Lane locality.
As this is likely to be a new surgery – the timelines will be longer term an interim solution (such as a porta-kabin) is being considered.
As has been outlined above – it is important that we highlight that patients registered at Eaves Lane will continue to access services in the same way as all other patients. Virtual consultations and telephone consultations are carried out at the patient’s home and if a face to face appointment is required – this is at the location that is safe and appropriate for the condition and patient cohort. Eaves Lane Patients should therefore contact the practice by telephone for queries that would normally be brought to a reception desk.
Seasonal Flu Vaccinations
The NHS are now asking General Practice to consider how we will be able to provide patients with the seasonal flu vaccination in the constraints we now face. This is a challenge – however, we are currently considering possible outdoor facilities (drive through and Under Marquee) methods alongside possible walk in clinics and technology that will allow patients to wait in their cars before their treatment. We will communicate this further when these plans are finalised.
It is important that we make patients aware that should there be a second wave of COVID-19 infections nationally – or if there is a localised lock down requirement – we will immediately return to full lockdown provision. To this end – we ask all patients to continuously check the website and in future the MyGP app for latest updates.
Finally, we have watched with some concern the national picture – which has highlighted the issue of extremely sick patients not seeking care from their GP due to either fear of contracting the COVID-19 virus – or due to feeling they are placing a burden on the system.
It is vital that should you feel you need to seek medical attention that you continue to do so.
The surgery team thank you for all your support during this time.