Primary Care changes in North, West and East Cumbria in reponse to COVID-19

The Trust and CCG  responsible for the NHS in West, North and East  Cumbia has made the following announcements today about how they are changing primary care provision (particularly  GP and pharmacy services) in these parts of Cumbria to cope with the COVID-19 situation.


Changes to primary care in response to Covid-19 across North Cumbria

Across North Cumbria all our general practice teams are working together on rising to the challenge faced by Covid-19. This might mean you see a change in the way you access primary care.

We want to reassure you that your family doctor and their wider team are working hard to keep you as well as possible at this challenging time, and explain why things might be different.

There are two main changes that patients might experience. They are:

• You won’t be able to have an appointment without a conversation on the phone or on-line – and your query might be dealt with on the phone or online. If you are invited for a face-to-face appointment you might be asked to attend a different surgery and see a different healthcare professional 
• GPs in your local area are working together to make sure that patients who are likely to have Covid-19 can be seen in one location which will become your area’s hub - or red centre - solely for use by invited potential Covid-19 patients 

Dr Colin Patterson, clinical lead for NHS North Cumbria Clinical Commissioning Group (CCG), said:

“The challenges facing the NHS are unprecedented, and we have been working on making sure our environment keeps patients and NHS teams as safe as possible by making use of telephone and online.


“It is important that our general practice teams remain resilient in the face of increasing pressures, and that GPs and their wider healthcare teams and our out of hour’s provider Cumbria Health On Call (CHOC) work together at a local level.

“Groups of practices – known as Primary Care Networks – are working together to make sure that they are reducing the risk of infection by consulting with patients as much as possible by phone and digital links.

“They are still seeing patients with health needs and are still offering essential routine appointments, but everyone will have a conversation on the phone before being invited for their appointment which in some cases might not be at your usual surgery.

“We are also planning those patients who need medical assessment and are poorly or potentially poorly with Covid-19 will be seen locally in one place with strict infection control measures in place.”


GP Service Area Hubs/Red Centres

These are the local designated hubs where doctors will see and treat symptomatic patients who have been invited by their GP for face to face assessment.

It is not a general public facility, and will only be accessed by appointment after referral from NHS 111 to a GP and telephone triage by a GP. It will NOT offer community testing.

In Eden this will be at Penrith Hospital.

In Copeland it will be Flatt Walks Surgery in Whitehaven.

Other areas are developing their hubs.


Pharmacy services

Our pharmacy teams are also doing their best during these difficult times to make sure that everyone gets the medicines they need.

Help them to help you:
• Follow Government advice and do not visit a pharmacy if you or anyone in your household has a temperature or a new and continuous cough, even if mild.
 • Plan ahead where possible. Pharmacies are working hard to provide prescriptions, but please try to order your next prescription seven days before it is due. This will help the pharmacist deal with urgent requests and queries.
• If you are handing in your prescription, please put your contact details on it so pharmacies can let you know when your medicines are ready. That means you won’t need to be in the pharmacy for as long. Please don’t ring the pharmacy unless it’s urgent.
• If you are self-isolating please ask family, friends or neighbours to arrange to pick up your medication for you. If you don’t have anyone who can collect your medicine, speak to your community pharmacy for advice about how they can help.
• If you are well and can visit the pharmacy yourself, think about how you can help family, friends and neighbours who are self-isolating by collecting their medicines on their behalf (you may need to take ID with you and will need to know the name and address of the person you are collecting for).
• Do not ask for extra medicine or an increase in prescription duration as this could lead to overall medicines shortages. Continue to request as normal and do not stockpile.

You may have to queue and respect social distancing at your pharmacy. Some pharmacies are closing for part of the day to enable them to respond to demand.

Our NHS teams across Cumbria are working really hard and need your patience and support to keep going.


Anyone who suspects they have Covid-19 is advised to follow this national guidance:

Stay at home if you have coronavirus symptoms

Stay at home if you have either:

• a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature) 
• a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual) 

To protect others, do not go to places like a GP surgery, pharmacy or hospital. Stay at home. Use the 111 online coronavirus service to find out what to do at 111.nhs.uk

Only call 111 if you cannot get help online.

Only get in contact with NHS 111 if you feel you can’t cope or your symptoms are getting worse and they will give you advice and may refer you to a GP.

Other useful advice:

How long to stay at home?

• if you have symptoms of coronavirus, you'll need to stay at home for 7 days
• if you live with someone who has symptoms, you'll need to stay at home for 14 days from the day the first person in the home started having symptoms
• If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.

If you have to stay at home together, try to keep away from each other as much as possible.

For more information about Covid-19, go to:

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.gov.uk/coronavirus

South Cumbria and Lancashire health update

Morecambe Bay University Hospitals trust has followed the example of their opposite numbers in North Cumbria and largely suspended visits to the hospitals they run in South Cumbria and Lancashire.

The Trust has issued a statement which reads as follows.

Due to the current risks associated with COVID-19, University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) is temporarily suspending visiting for patients in its hospitals with immediate effect.

Sue Smith OBE, Executive Chief Nurse and Deputy Chief Executive (UHMBT), said:

“We are extremely sad to have to make the decision to temporarily suspend visiting at our hospitals but it is necessary to keep our staff and patients safe.

“We understand that visiting is very important to our patients and their loved ones and as soon as we are able to lift the suspension, we will. In the meantime, we would ask for the public’s help in respecting these rules to help us all stay safe.”

Until further notice, visiting is only permitted for: 

• Patients who are receiving end-of-life care  
• Birthing partners in the Maternity Units  
• Parents or legal guardians in the Children’s Wards 

Visitors for the above must be agreed with the nurse in charge of the ward before attending the hospital. Please agree one main point of contact per patient and this should be the only person that contacts the ward by telephone to arrange visiting.

The Morecambe Bay trust has also making changes to the maternity service due to Coronavirus, affecting home births and the Helme Chase unit at Westmorland General in Kendal.

They have issued a separate statement on this one, as follows:

University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) has today made the decision to temporarily step down its home birthing service across Barrow, Lancaster and Kendal to ensure the safety of its patients and staff during COVID-19. 

It is also temporarily suspending some of the service at Helme Chase in Westmorland General Hospital, meaning women will not be able to give birth there. 

Both of these changes will come into effect from Monday 30 March 2020. 

Mums-to-be who had planned to give birth at home or at Helme Chase will be contacted by their community midwife who will support them with any worries they may have and talk through alternative birthing options. 

Clinics and breast feeding support at Helme Chase will carry on as normal. To offer the current service at Helme Chase and the home birthing service, the Trust has to have six midwives on call, every night, once a mum-to-be reaches 37 weeks up to delivery. 

Carole Carlile, Head of Midwifery, Obstetrics and Gynaecology, UHMBT, said: 

“We have taken the decision to temporarily stand down the service at Helme Chase and our home birthing service due to the ongoing situation around COVID-19. 

“The Trust feels at this time that it is important to utilise our midwives in a different way which will ensure both the safety of our patients and staff. 

Midwives who would normally be working at t] Helme Chase or on call for home births will be deployed to other areas of the service, including helping to support more complex births within our hospitals and helping to support women in the community. 

“We will continue to monitor the situation carefully and follow national guidance. We will keep our website and maternity app updated and urge any mums-to-be with any concerns to contact their community midwife.”

Statement from North Cumbria Integrated Care NHS Foundation Trust.

The following statement was issued yesterday by Doctor Craig Melrose, who is the GP clinical lead for urgent and emergency care, North Cumbria Integrated Care NHS Foundation Trust.

“We are part of the huge effort underway within the NHS nationally mobilising to change the way that hospitals and GP practices run, freeing up tens of thousands of beds, bringing in more staff and ventilators, getting protective equipment to where it is needed and ramping up testing.”

North Cumbria Integrated Care NHS Foundation Trust:

Across the Trust we are pulling out all the stops.  We are caring for more people with coronavirus in our hospitals each day and we are preparing to see a lot more. 

We have developed plans to significantly increase our critical care capacity by postponing routine procedures.

  

This has enabled us to train theatre staff to deliver critical care and free up a large amount of beds.

We have developed plans to zone our hospitals so that there are clear pathways for patients with COVID symptoms. 

Yesterday we suspended visiting to our sites - this is a sensible step to help avoid unknown cases of Coronavirus in our hospitals and in our communities across North Cumbria. 

We understand that people will be disappointed by not being able to visit loved ones in hospital and we would appeal to keep in touch with loved ones via their phones, as we do have access the NHS Wifi on site. 

We have agreed that there will be small exceptions where visitors will be permitted, including:

• For patients who are receiving end-of-life care
• For birthing partners in maternity units
• For parents or legal guardians in the children’s unitWe have also changed many hospital appointments, either postponing them or delivering them in a different way.  

Where we are making changes, we are contacting patients directly.  If you haven’t been contacted, please attend as normal and we would ask you to attend on your own if possible and not bring children or extended family members.

Our teams other essential workers are coming to work to save lives, please help us to help you - stay at home.

  

We all have a part to play in and out of work in our local communities.  Following the Governments advice around social distancing will help reduce the speed of the virus and help our hardworking NHS staff continue with their jobs.

Primary care:

Our healthcare teams in primary care are working really hard to support patients during the pandemic. General practice staff are still seeing patients but everyone is being triaged first, on the phone or on-line consultations.

GPs are still offering essential routine appointments for baby immunisations and essential blood tests, but everyone will have a conversation on the phone before being invited for their appointment which in some cases might not be at your usual surgery.

Cumbria Health On Call (CHOC) is working hard to support patients out of hours.

Community pharmacy:

You might have seen people queuing outside your community pharmacy – this is to keep the staff there safe so they can keep dispensing your medicines.

You don’t need to order more than usual of your prescriptions, but be mindful you need to social distance when queuing.

Our NHS teams across Cumbria are working really hard and need your patience and support to keep going.

Covid 19:

If you think you have symptoms of Covid-19 the advice is to

• Stay at home,
• Treat yourself by staying hydrated and taking paracetamol.
• You only need to contact 111.nhs.uk or NHS 111 if you are getting worse and can’t cope.
• NHS 111 will give you advice on the process if you need to see a health care professional
• Don’t go to your pharmacy or into a GP Surgery if you have symptoms 

Visiting suspended at North Cumbria's hospitals

Visiting to be temporarily suspended at Trust hospitals

In light of national guidance to reduce the risks of bringing unknown cases of Coronavirus into our hospitals, visiting has been suspended at North Cumbria Integrated Care NHS Foundation Trust hospitals, with effect from today (Monday 23 March 2020.)  This includes the Cumberland Infirmary, West Cumberland Hospital and all of the community hospitals in the area.

Professor John Howarth, Deputy Chief Executive at North Cumbria Integrated Care NHS Foundation Trust, said:

“This is not a decision we have taken lightly.  However, it is a sensible step to help avoid unknown cases of Coronavirus in our hospitals and in our communities across North Cumbria.

“At this time, we must do all we can to protect our patients and also our staff who we need to be well in order to care for those who need their help.

“Whilst this is a temporary measure, we cannot say at this stage how long it will be in place.

“We understand that people will be disappointed by not being able to visit loved ones in hospital and we would appeal to the public for their support and co-operation at this difficult time. All patients staying in our hospitals do have access to our free NHS Wi-Fi that is accessible through smart phones which they can use to keep in touch with family and friends. 

“We have agreed that there will be small exceptions where visitors will be permitted, including:

• For patients who are receiving end-of-life care
• For birthing partners in maternity units
• For parents or legal guardians in the children’s unit.

“Additionally if there are exceptional clinical or social reasons why someone wants to visit this will be decided on a case-by-case basis and we would urge people to liaise directly with the senior nurse on the ward.

“We would also like to remind patients attending outpatient appointments that they don’t bring others along with them unless it is absolutely essential.”

The trust is reiterating Government advice for people not to come into hospital, or their GP practice, and to stay at home if they have a high temperature (37.8 degrees or higher) and/or a new, continuous cough. In addition:

• if you have symptoms, stay at home for 7 days
• if you live with other people, you should stay at home for 14 days from the day the first person got symptoms
• If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.
• If you have to stay at home together, try to keep away from each other as much as possible.

People should use the NHS 111 online Coronavirus service if:

• you feel you cannot cope with their symptoms at home
• your condition gets worse
• your symptoms do not get better after seven days.

Hospital Beds

When the coronavirus pandemic is over, one of the things which I hope we can learn something from is to get a more balanced policy on hospital beds.

Over more than forty years, starting as a teenage volunteer, during which I have been involved in the NHS - as volunteer, campaigner, health authority member, hospital manager (unpaid, holding this legal status for the purpose of Section Two appeals) and health scrutiny member, the thread which has most consistently run through my experience as I have heard members of the community debate with those who run the NHS has been the prayer,

"If only each side would listen to the other more and recognise that there are things about which the other side is right.

One of the most positive developments in the last few years in North Cumbria has been that under what is called "Co-Production" or "Working together" some of the barriers have come down and the community and NHS leaders have listened to each other more in both directions. We need to do much more of this and I hope it is not a casualty of the pandemic.

I've thought that community, staff and NHS leaders need to listen to each other more about maternity, accident and emergency services, stroke services, medical records, mental heath provision, vascular services and paediatric care, but the classic example has been hospital beds.

For decades under governments of every party, in every in of financial position from boom to bust and from rapidly increasing spending to times of austerity, the number of NHS beds has been trending down. 

Whatever your politics are, right, left or centre, if you think this is all down to people who have different political views from yours or of spending policies you don't like, you are wrong. Because people of every political colour from UKIP to the Labour left and of no party politics at all have been involved and have been at the heart of such policies, and both shortage of money or extra investment equally seem to drive the process faster.

For as long as I have been in a position to have a view about what was going on in the NHS, successive generations of NHS leaders - and I don't just mean the administrative management, this has been coming from doctors and other clinicians and professionals as well - have been seeking to find more efficient ways of care by treating people "closer to home," which includes reducing the length of stays in hospital and redirecting care into the community (a phrase which originated with mental health but is often used for other forms of care.)

This is rarely about saving money because the new policies are usually more expensive. It's about reducing the damage to people's health which long stays in hospital can cause, from bed-sores to hospital-acquired infections. 

Often the broad thrust is right. Sometimes it is absolutely wrong, as when  my wife scathingly and rightly in my opinion, suggested that a North Cumbria health strategy called "Closer to Home" should be called "Further away from home" because the consequences would include moving services from West Cumbria to Carlisle, Hexham or even Newcastle.

But the one thing which seems to go wrong every time, even when I think the overall policy is right, and has been an issue in each of the four decades I have been involved in the NHS is that whoever is running the service, when they reconfigure the service, they always take too many beds out.

I had this discussion thirty years ago with Roger Stokoe, later president of the Institute of Health Management and a man for whom I had a great deal of time, when he was general manager of North West Herts Health Authority and I became a member of the authority in my twenties.

I had the same discussion as a member of the public and campaigner with his and my successors as managers and members of the trusts which provided NHS healthcare in Hertfordshire over the ensuing decade.

In the first decade of this century I had a similar conversation in Cumbria with Professor John Ashton when he was Director of Public Health and an employee rather than a critic of the then government (although to be fair he was often nearly as rude about the health policy of his own party as he has subsequently been about Conservative policy!) From the second decade of the century and into the twenties I have put the same points to Steven Eames when he was running the "success regime" consultation and to both him and other leaders of the NHS in North and South Cumbria much more recently as a health scrutiny councillor.

Each successive plan, however well intentioned, however often most of the principles are right, invariably seems to make assumptions about demand for beds, about how successfully some beds can be "ring-fenced" for operations, and hence about bed utilisation which turn out to be too optimistic. And we always end up running too close to the line, and with bed numbers which are not high enough to be sustainable for the pattern of service.

I said earlier this year at what may turn out to have been the last Health Scrutiny meeting for some time that next time we come up with a reconfiguration - and hopefully improvement - in the service which reduces the needs for beds, instead of taking all the beds theoretically saved out, we should take the opportunity to plan for a lower utilisation rate. 

If we did that, fitting all the patients into the beds available might be less like one of those puzzle games where you have to slide tiles with the pieces of a picture around until you can assemble it into the right shape. It might mean there was more time to clean the beds between patients and a lower rate of hospital-acquired infections.  

The whole world is in the process of learning the hard way how much you can sometimes need to expand health service capacity.

The deal which has been struck in the UK with the private sector, providing 8,000 more beds and 20,000 more medical staff will undoubtedly help - but the pressure on NHS resources and staff is, and will remain for weeks, enormous.

This probably won't be the last pandemic. The next new bug may be more lethal than COVID-19; at least this one hardly ever kills children or people with their whole lives before them. I hope we are all ready to recast our views on what it means to be prepared.

Everyone involved in planning for health care - clinicians, administrators and politicians alike - is going to have to learn lessons from this, both in terms of planning for future unexpected shocks to our health service and in terms of what it tells us about how things run on a normal basis.

It's too early to predict what many of those lessons are going to be. But it is probably not too early to suggest that we need to have a good hard think about how we use hospital beds and how many of them we need to have available.

NHS staffing and COVID-19

The government has announced that the NHS is taking the following action to help get staffing levels up to deal with Covid-19.

Today, the NHS is calling on more than 65,000 former nurses and doctors to re-join our NHS to help tackle coronavirus and save lives.

Our NHS is working night and day to ensure that anyone and everyone who needs medical assistance gets the highest level of care and support – it’s only right that we give NHS staff our full support in return.   To further boost the ranks of our NHS, we are asking more than 65,000 former nurses and doctors who have recently left the healthcare professions to bring their experience and expertise back to our health system. These staff can play a crucial role in maximising our capacity to fight this outbreak - and wherever they can help, they will be hugely welcomed.   This continues to be a huge national effort to protect lives and protect our NHS but together we will ensure that we bring about the downward slope of this virus and with it the prospect of normal everyday life returning.