How has the virus changed the way the practice has been working during this time?

The coronavirus pandemic measures have meant that we had to make rapid changes to the way we work at many levels. We have received frequent guidance updates during the week from Buckinghamshire CCG as well as information from NHS England in regular webinars.

Our aims have been: 1. to keep the surgery functioning as long as possible by minimising the chances of coronavirus spreading among staff and 2. to continue to see as many patients as possible. To achieve this we have had to minimise the risk of coronavirus entering the surgery and if it does of spreading to staff and patients.

The surgery front door is now locked. People may enter the front door but must leave by the side or rear doors to minimise the chance of passing other patients closely in the waiting room or corridors. Patients with face to face appointments ring the front doorbell at their appointment time and speak to the receptionist first. All patients are screened for COVID19 symptoms before appointments. Only one person may normally accompany someone to a face to face appointment if essential and is also screened in advance. Patients are socially distanced in the waiting room so it is important that only people with appointments are allowed in near their appointment time.

Patients and staff must now wear face coverings in surgery. Clinical staff now all wear surgical scrubs and wear the recommended protective equipment of gloves and plastic aprons. They also wear eye shields. Our hands are being washed frequently and we encourage all patients to do this on coming into the surgery and leaving. Perspex screens are now up around our reception desk. We also ask people to stay a metre away from it rather than lean on it. There is a “hot” room ready for suspected COVID19 patients and a “green” room where staff prepare to go into the hot room in personal protective equipment. Our COVID19 waste bin lids are now hands-free. We are about to change out toilet lids and taps to hands-free ones and also to install more screens in the back-office parts of the practice.

We can no longer look into noses and mouths or do procedures which may generate aerosol droplets, such as spirometry or peak flow monitoring. The majority of appointments are now done by video consultation. This has been more convenient for people with childminding problems, transport, or mobility issues and those who are shielding. If essential, we will convert video or telephone appointments to face to face ones. Our home visits also follow the same procedures above.

If we suspect someone may have COVID19 symptoms, then we will arrange for an assessment by the Bucks COVID19 teams. At the start of the lockdown, we were only able to see patients with urgent problems. This was due to concerns about how much coronavirus was circulating in the community or a higher R number. Our receptionists were on a steep learning curve as they changed the way in which they book in or signpost patients. The clinical team spent a lot of time on learning to use video consultations and learning to put on and take off protective gear. One of our Doctors and their Personal Assistant spent many hours identifying patients who needed to shield due to being at very high risk of COVID19 disease, researching support for them and contacting them.

We have gradually started to see patients with essential non-urgent problems such as drug monitoring blood tests, diabetes, respiratory and vascular reviews. Our prescriptions are now all sent electronically to pharmacies. We are very grateful to our community pharmacy colleagues and to our patients for being patient with us while this change was taking place.

The effect of the lockdown on other providers has impacted on our patients and on how we work. With routine appointments being delayed and new non-urgent referrals not being accepted by some departments, patients are understandably worried, stressed, and anxious. We are increasingly providing emotional support to people because they cannot at the moment progress to receive the care that needs to be provided elsewhere. This is in addition to supporting people who have been impacted by lockdown due to isolation, loss of social activities, schools being closed, remote working, reduced income and job uncertainty.

How did you let your patients know about these changes?

We used several different ways to let our patients know about these changes. Some were given one to one information as the need arose because often changes had to be put in at short notice once recommended by NHS England. We also informed patients by letter and SMS, posters on the surgery doors and windows, electronic newsletter, and our website. The lockdown has seen us really focus on social media with increased relevant posts on Facebook and Twitter and a new presence on Instagram.

Will you be asking patients for feedback on the changes? Will this involve the PPG?

Our PPG has been active throughout, now meeting virtually. We will be asking for feedback on changes with the help of the PPG in the near future.

How do you see this changing the way the practice works in the future?

We don’t know how long coronavirus will pose a potentially life-threatening and life-changing risk to us. We have no plans to ease up on our infection control procedures as we have no idea who among the public is infected and who is not without testing, whether immunity exists or whether and re-infection can take place. We will continue to screen people for symptoms before we see them. Video consultations will be more convenient for working people and now that we are gaining experience in using them, we aim to continue to offer this service for the future. We will continue to see patients face to face if we are unable to give advice safely unless we do so. We are now planning this winter’s flu clinics and how they can be held to make sure that coronavirus spread is reduced as much as possible.

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