Accessing GP Practice Care during the COVID-19 Pandemic

Face to face appointments with GPs or members of the wider primary care team, (*see below) are taking place where there is an identified need. This need may be clinical e.g., a patient needs to be seen in person to assess their condition or non-clinical e.g., a patient is unable to use a telephone or digital portals to communicate (see also total triage below)

• Appointment levels in County Durham have increased by 9.3% since the Covid-19 pandemic began

• Face to face appointments in County Durham, overall, remain the primary method of consultation.

Patients are encouraged to contact their practice online, via the NHS App or using the telephone in the first instance.

This is to ensure practices are accessible and safe for patients. By working in this way practices can observe social distancing measures safely. (see also total triage below).

Additional GP hubs have opened across the County which allow practices to book appointments for patients, if all their own appointment slots have been filled.

This Extended Access to Primary Care is delivered from various sites across County Durham and is available to support patients who require urgent same day assessment.

The service operates seven days a week (6pm – 8pm Monday – Friday and between 8am – 2pm on weekends and Bank Holidays) to provide additional appointments to patients outside of practice hours. 

The Extended Access Hubs are booked appointments only (no walk-ins) via GP practices or NHS 111 following triage, with patients who need to be seen offered face to face appointments.

All surgeries altered their ways of working within days of the pandemic arriving to run a “total triage” model or “talk before you walk”, enabling patients to be directed to the most appropriate service including telephone, e-mail or video consultations, referrals to external services or if clinically appropriate a face-to-face appointment.

Patients contacting their GP practice are asked to provide information to the practice reception team about the reasons for their contact.

All receptionist staff work under a strict confidentiality contract. The information the patient gives allows the clinical team to make an informed decision on the most appropriate service.

This may be a call from the GP, an appointment to visit the practice or another part of the health service such as a pharmacy.

In many cases, the matter can be resolved entirely over the phone.

Total triage is important to reduce avoidable footfall in practices and protect patients and staff from the risks of infection.

A telephone assessment enables patients to see the right person at the right time.

Every practice member has different skills and expertise, and it may not always be the GP who is the best person to help, for example pharmacists can deal with any prescription issues and concerns. It helps the practice to have an indication of what assistance the patient requires so that they can be directed to the right person.

If a patient still does not feel that a telephone assessment is sufficient then they can discuss this with the practice team.

Almost half-million pounds has been invested into primary care telephone systems over the last 12 months to support the move towards total triage and to respond to increasing volume of telephone calls.

If patients need to speak to their GP practice and phone lines are busy, they can access help or advice by completing an e-Consult confidential online form, through the practice website or NHS app.

Following the online consultation, practice staff will advise if a video, phone, or e-mail consultation is required and will contact patients to arrange an appointment if needed. All online requests receive a response within two working days.

e-Consult also allows patients to access information on health conditions, self-care and local pharmacy services.

Patients can also register for an online account with their practice to order medication, view their patient record or see test results using the practice website or NHS app.

Covid 19 has:

• increased primary care capacity, via telephone and online, to respond to demand
• improved partnership work between organisations and agencies to improve health, wellbeing and care co-ordination
• improved the understanding of work undertaken by volunteers and community
• increased the number of different ways for patients to access primary care 

People living in care homes are entitled to the same access to services as those people living in their own homes.

Community nurses visit care homes across the County on a regular basis and work with the care home team to ensure the health and wellbeing of people living there is monitored and supported.

For those people with more complex health needs, there are multi-disciplinary teams operating in and around primary care reviewing the needs of people living in care homes.

To respond to the increasing demand for health care service, the size and diversity of primary care team members has increased. In County Durham over the last 12 months 110 additional practitioners have joined our primary care workforce* including:

• Nurse practitioners
• Pharmacists
• Physiotherapists
• Mental health practitioners for adults and children
• Social prescribers and health coaches
• Paramedics

In addition, primary care teams are working more closely with colleagues from local hospitals, the local authority, voluntary organisations and community groups including sharing office space/facilities.

This approach ensures that primary care is able to offer more rounded and holistic care and reduce “hand-overs” to other agencies.   

Pharmacists are experts in medicines who can help you with minor health concerns. They can answer your questions on prescription and over-the-counter medicines.

All pharmacies provide the following services:

• dispensing of NHS prescriptions
• access to the repeat prescription service (with agreement from your GP)
• an emergency supply of medicine, subject to the decision of the pharmacist (you may need to pay for an emergency supply)
• non-prescription medicines like paracetamol
• disposal of unwanted or out-of-date medicines
• advice on treating minor health concerns and healthy living

Pharmacy technicians can help with things like:

• inhaler technique
• how to take a medicine safely
• helping you understand the correct dose of a new medicine and how often you need to take it

Pharmacies can give treatment advice about a range of common conditions and minor injuries, such as:

• aches and pains
• sore throat
• coughs
• colds
• flu
• earache
• cystitis
• skin rashes
• teething
• red eye

Other services that may be available at your local pharmacy:

• you may be referred to a pharmacist for advice after contacting NHS 111 or a GP
• emergency contraception
• asthma inhaler use and advice
• chlamydia screening and treatment
• stop smoking service
• blood pressure, cholesterol and blood sugar testing
• substance misuse service, including needle and syringe exchange schemes
• weight management service
• flu vaccination

Support onward communication of this briefing to help people understand the changes to accessing primary health care:

• the changing nature of our primary care teams and the different ways that patients can interact with primary care

• that workforce is key to delivering quality health and care services and that primary care health teams have been under particular pressure.