01 April 2020
Stakeholder briefing

GP Services

• Patients continue to have access to GP services but all consultations are now by phone, with face to face consultations and treatments only as strictly necessary.
• Patients who need a face to face appointment may be asked to attend a different GP surgery or site to receive their care.
• We monitor all practices daily; to date we have had no practices unable to provide a service to patients.
• As in other parts of the NHS, staff absence due to self-isolation or shielding is a problem.
• Absence rates are 20% on average in practice teams.
• Staff self-isolating are working remotely wherever possible and we are prioritising the necessary IT kit to allow this.
• There may be some delay in responding to requests given the level of demand and the impact of self-isolating and illness across the workforce, but we are doing everything we can to make sure our population is cared for appropriately.
• Visiting to hospitals and units
• All our hospitals and units are now closed to visitors.
• The only exceptions are for:
  patients receiving end of life care
  patients on children’s wards and neo-natal units and
  patients with specific conditions such as a dementia or a learning disability.
• Individual visiting arrangements will be made for patients receiving end of life care and with specific conditions such as dementia or a learning disability.
• Visitors to children’s wards and neonatal units must be parent or guardian visitors only and are limited to a maximum of one visitor per patient.
• Women in labour can be accompanied by one birthing partner.
• We are encouraging those who would usually visit to embrace technology and keep in touch using mobile phones to call and message.
• Our hospitals are also relaxing the rules around video calls to help keep people connected during this difficult time

GP 999 car

• Given the current circumstances the GP 999 car contract has been extended to December 2020.
• We will review the contract in September 2020 and provide you with a further update on this at that point.

Mental health

• The Somerset Mental Health Alliance has expanded its services to support adults and older people who may be struggling with their mental health as the county responds to the Covid-19 pandemic.
• Somerset Mindline, a service which provides people with a safe space to talk, has increased the opening hours of its phoneline in response to the current crisis to provide people in Somerset with support. Somerset Mindline – 01823 276 892 (Mon- Fri 9am – 11pm & Sat & Sun 8pm – 11pm).
• Partner mental health and emotional well-being organisations in the Somerset Mental Health Alliance have also stepped up additional services that Mindline can direct people to, depending on their needs and circumstances. This will help people in the county to access additional support more easily if they are struggling with their mental health.
• Similar plans are in progress to support children’s mental health.
• Staff across all mental health (adult, children and young people), learning disability and dementia services are working extremely hard to support our services users.
  

Non-urgent elective surgery

• Trusts are currently in the process of cancelling routine surgery where a delay will not cause an impact on the survival or long term health of the patient concerned.
• This means people will receive cancellations for things like, planned hip or knee surgery
• While we acknowledge the impact this will have on individuals, our priority is maintaining capacity for life saving surgery, and those requiring intensive care support for COVID-19 related conditions.
• As soon as we are able, routine surgery will be recommenced.

Outpatients

• Trusts are beginning to cancel non-urgent outpatient appointments or change these to non-face to face where they are urgent
• Important cancer treatments and cancer two week wait appointments are still taking place
• We are working with secondary and primary care to ensure referral pathways remain open and patients waiting are triaged where appropriate.
• People will need to wait far longer than normal for routine outpatient appointments or referral advice, but where the concern is urgent this will be addressed by the relevant teams.
• If people are concerned that their symptoms are deteriorating, they should contact their GP surgery by telephone, but be mindful of all the caveats outlined above.
• For people attending outpatient appointments they are asked to attend alone if at all possible. If they need to be accompanied due to mobility issues, one person may accompany them.
• No children are to enter the outpatients unit unless they are the patient.

Community hospital beds

• We are temporarily consolidating the beds in our community hospitals onto fewer hospital sites which will enable us to open more beds with a smaller number of colleagues overall.
• This is important at a time when we anticipate increased illness among colleagues and difficulty in attracting temporary staff.
• We have already temporarily closed the 8 inpatient beds at Shepton Mallet Community Hospital.
• We will also be temporarily closing the 10 inpatient beds at Wellington Community Hospital.
• We will be temporarily increasing the beds at five other Community Hospitals including Burnham on Sea, Minehead, West Mendip, Williton and Wincanton.
• At the same time the NHS nationally has struck a deal with the independent sector to increase the number of beds, and that includes the treatment centre in Shepton Mallet.
• These changes are solely in response to the COVID19 outbreak and are temporary. They are being made so that we can care for as many people as possible who may need our support during the COVID19 outbreak.

Maternity services

• We are currently reviewing the continuation of the home birth offer
• Only one birthing partner is currently permitted in our Maternity Units due to visiting restrictions
• Common approach being developed between our Maternity Units to make sure there is parity of offer across the county
• Maternity Voices Partnership developing information on services and FAQs for parents
• Self isolating staff are working from home, taking phone calls and booking appointments
• We are contacting recently retired staff to increase the workforce and recalling all seconded staff

End of life care

• We are working closely together with our partners and providers as a system to make sure that that people receive the best in end of life care wherever they may be, in an acute hospital, community hospital, residential or nursing home or their own home, and have access to specialist advice and support as needed.
• It is likely that some of that support will need to be provided remotely, or by health or care professionals from other parts of the system who have been redeployed to support the COVID-19 response and end of life care whether as a result of COVID-19 or pre-existing conditions.
• Everyone working within this area will have received appropriate training either in person or digitally over the coming weeks, including pastoral support for care workers and health professionals alike.

Community Pharmacy

• Changes to opening hours have been agreed nationally; most pharmacies will now be closing for two hours at lunchtime each day to catch up with prescription requests.
• Community pharmacy is under significant pressure as patients can no longer walk into their GP surgery.
• We monitor all pharmacies every day; to date we have had no pharmacies unable to provide a service to patients.
• Delivery of medication to patients is a concern- we are expecting a national arrangement but in the absence of that we are exploring other options using trusted agencies such as Village Agents.

Optometrists

• Many optometrists have closed as the retail element of their operation is not currently viable.
• However we continue to commission local optometry services including acute eye care for people with sore or injured eyes.
• These services are still available to patients.

Dentists

• All routine dental services have now stopped.
• Dental urgent care hubs are being established in Bridgwater and Taunton so that urgent dental services remain available to the people of Somerset as required.

Fit for My Future health and care strategy

• Following the completion of the consultation and engagement programmes on 12 April 2020 our Fit for My Future programme will be paused for the next 4-6 months while we focus on keeping the people of Somerset and our health and care staff as safe as possible.
• All public facing events and activities have been cancelled. People can provide feedback and comment via freepost, telephone, email or via our online questionnaires.
• Adverts promoting the mental health consultation and how people can have their say have been placed in the Wells Journal and several other local newspapers.
• The independent analysis of all the feedback from both programmes will go ahead as that can be undertaken by the independent company without impacting on our ability to focus on frontline care.

Digital

• We are encouraging people to use the 111 online symptom checker (via website and NHS App) before contacting services by telephone
• GPs are offering online and video consultations as well as telephone consultations
• We have rolled out Microsoft Teams across our workforce for multi-organisational video conference calls, supporting staff who can to stay at home and supporting business continuity
• We are reviewing the potential to fast track digital information sharing to support patient care – Public Health led data sharing to identify and advise vulnerable patient cohorts

PPE

• Like everywhere in the country we have struggled to obtain sufficient supplies of PPE for our NHS providers (including primary care), adult social care, domiciliary providers etc.
• On 28 March 2020 together with Somerset County Council we wrote to local businesses to ask for their support is making commercial PPE stocks lying idle within organisations or businesses that are currently temporarily closed due to the outbreak available to us.
• We will also be receiving our first army delivery of PPE early this week which will be the start of a routine delivery of equipment.
• These actions should significantly improve the availability of PPE across all our providers including primary care, care homes and domiciliary care as well as in our NHS trusts.

Staff testing

• National testing plans should be rolling out across the regions this week with the initial focus on critical care, emergency departments and ambulance services.
• Our trusts have been asked to identify staff in those cohorts who are currently unable to work because of the requirement for 14-day self-isolation (including those staff living in a household where another individual may have COVID-19).
• They will be prioritised for testing with the aim of supporting people to return to work as soon as it is safe to do so.
• We are also identifying other high priority areas for testing.