Dear Patients of The Windrush,
Firstly, thank you all for the well wishes and gestures of support you have given us – it makes a big difference to us. Thank you too for using the Practice’s services responsibly and for your understanding of new systems. All this helps us tremendously.
This letter is sent to you to explain the Practice’s response to the Covid pandemic and the measures we are taking to ensure we can care for you in the best and safest way possible. This is, of necessity, a long letter – but we have tried to include all the questions which you may ask at this time.
We have faced many challenges – identifying patients who may have the virus itself, identifying patients who are ill with other conditions, identifying our vulnerable patients and our vulnerable staff and also ensuring that all our staff are protected. In addition, we have needed to assess the continuous stream of information which is coming our way.
All of our staff have worked really hard to evolve our services to meet the demands of this unprecedented pandemic. The team have really pulled together and are giving up their free time and offering great flexibility so that we can optimise the service we provide to you. It’s been said that what the innovation seen in the NHS has achieved in the last three weeks is similar to the amount it has managed in the last 20 years – it’s amazing what increasing funding and reducing bureaucracy can achieve!
As with other GP practices and in line with NHS England advice, we have looked at measures to protect both patients and staff and to reduce the risks of spreading the virus. In doing so we have had to take the following measures:
- All patients are asked to talk to a GP or nurse before being given a face-to-face appointment. Often we can deal with the problem over the phone. If not, we have started using video consultations. However, if the patient does need to be seen in person, we can arrange that promptly, using a separate part of the building to reduce risks of cross contamination. All patients who had/have appointments booked will have been sent a text (where appropriate) to remind them not to attend the surgery and that the GP/nurse will phone them.
- Speaking to your own GP: please note that it will not always be possible for your own GP to call you back. We will try to ensure it is and if you are able to wait a day or so for you own GP to contact you then this may be better (especially for mental health problems as speaking to someone who knows you leads to better decision making). We do recognise that this may not always be appropriate to wait e.g. if you are acutely unwell.
- We are wearing “full PPE” for all patient contacts – which means an apron, gloves, face mask and eye shield, also uniform/scrubs that are laundered daily… Apologies if this seems impersonal but it’s necessary for infection control – and it’s pretty uncomfortable to wear!
- Prioritising clinically important work. We have looked at all the patients who need appointments or routine checks in the coming months. GPs and nurses are making clinical decisions to identify which appointments need to be done and which can be safely delayed. We will call you in for these as and when they are needed. You can help us with this by ensuring that your contact details are up-to-date – especially your mobile phone number. To do this please visit our website /practice-information/change-of-personal-details/)
- Working remotely. Rest assured that staff that need to be “shielded” and are working from home are in secure settings and working across secure IT networks.
- Working with other NHS organisations. We are in close touch with the other local GP practices and other services such as District Nursing and Community Services and also the Hospitals so that we can coordinate patients’ care This includes discussions about patients who may need admission or can be safely managed and monitored at home. The hospital has looked at the records of outpatients and, if needed will be contacting them by telephone in same way as we are. The hospital is currently not accepting any new routine outpatient referrals. We are writing referral letters as normal and keeping a list of all the patients; when this embargo is lifted, we will direct patients straight back in to the system. We are sending a text message to these patients; this includes the request that if their condition is deteriorating and becoming urgent, they must let us know. We are still able to refer those who have genuinely urgent problems and they will still be seen in outpatients.
- The “Vulnerable List”. NHS England compiled a list of “extremely vulnerable” patients and sent letters to them. However, this is only a part of the extremely vulnerable group of patients. The additional ones will be identified at a practice level using criteria which has still not been released to us. (Yes – we are frustrated by this and Yes – we have escalated this to our local MP!). In addition,, there will be patients who may not be “extremely vulnerable” but for whom shielding would be advisable. Again, we are awaiting guidance on this and have been instructed not to act on this until all is agreed. We realise that this is a cause of considerable distress for some patients and can have impact on employment. We will keep a “holding list” of patients who have queries so that we can respond when more information is available. Further information is available on our website. We ask that you bear with us.
- Having difficult conversations about serious illness e.g. patients’ views on admission to hospital, resuscitation and decisions about end of life care. This is a really important subject but one that needs to be handled with care and sensitivity. On the one hand we want to reflect the wishes of our patients who are or may become seriously ill but we also don’t wait to create alarm or add to individual’s anxieties. There is a useful document on the website – search by “Planning Ahead”. We are working with the Patients’ Group to explore other ways to talk with you about this. If you would like to discuss this with your own GP then please do ring us.
- Our dispensary team is extremely busy especially as their numbers are currently depleted due to self-isolation and shielding measures. This is being compounded by the usual shortage of medications so that alternative brands need to be sourced. In addition, we are aware of some “panic buying” and over ordering of items – especially asthma inhalers and paracetamol. Please note we have been instructed to not allow more than one month’s supply of medication to be issued and to refuse requests to stockpile medication. Please help us by not asking for this. To avoid risk of contamination from paper prescriptions, we are trying to send all prescriptions electronically direct to the relevant dispensary/pharmacy.
- Volunteers – we have set up our own delivery service for medication for those who are not able to collect prescriptions from the surgery – e.g. because they are unwell or shielding. This is being run by volunteers who are mainly are drawn from the PPG and local Scouts Group. Please note that the practice has not received any additional funding for this and is reliant on the volunteers to allow us to keep this going – for which we are very grateful. Other help with e.g. shopping, running errands or befriending can be accessed via the Witney Land Army on email@example.com. There is a lot of information on our website about this, but if you know of any other organisations offering support at this time, please let us know. Please note these are not Windrush services but part of the government lead NHS “army of volunteers”
- Non Covid illness. We are aware that not all illness is Covid related and we encourage those who are ill with other conditions to continue to call us to discuss any deterioration in their condition. Also those with worrying signs of cancer (https://www.nhs.uk/conditions/cancer/ ) to still contact us as the “two week wait” referral process is still in operation.
- Research – We are one of the leading research sites nationally for a pivotal research trial on trying hydroxychloroquine treatment for patients with Covid. We are looking to recruit over 40 patients and where appropriate we will discuss this with eligible patients. This is of national importance and we are proud to be part of it.
- Getting back to normal – we know that this will all be over and we will need to return to normal service. So we are starting to plan how we manage that process, how we prioritise that work and communicate this to the patients.
- Keeping hopeful. Due to the incredible hard work of our team, we feel as well prepared as we can be for the expected coming surge of Covid cases over the next few weeks, I cannot tell you how proud we are of our staff who have really pulled together, given up huge amounts of their own time to pitch in to get us through this crisis. In amongst the worst health crisis the NHS has faced, we are seeing the very best of those who work in it.
Thank you for taking the time to read this letter. We will get through this pandemic together and many things will change for the better. Until that time, you can do you bit by adhering to the government’s social distancing advice, using NHS 111, using the surgery when essential to do so and bearing with us as we operate in these challenging circumstances. In addition, words of support and encouragement do really help!
Dr Stephen Smith on behalf of The Windrush Team 10th April 2020