As time in lockdown creeps slowly onward, are you finding life as challenging as I am?

With NHSE emails and briefings, LMC and CCG emails, phone calls and an overwhelming tide of new guidance to keep an eye on, how are we all staying sane?

I’m struggling to stay ahead of the workload and have partners who are twitching nervously at the staff whenever they appear to be anything less than frantic.

Even though I’m very busy, I still seem to find time to browse through the Practice Index forum. I came across this post and suddenly a whole new world of ideas opened up:

Every practice has its unique challenges and staffing issues, but some of the ideas here were brilliant.

I’m a bit concerned that QOF is going to be harder to achieve this year, and despite assurances about income, I’m wondering how 2020/21 QOF income might be impacted, even if this year’s isn’t.

To head this off at the pass, we’re thinking about ways to make sure we still achieve our target, and part of that is data quality related. I’ve run some searches and I’m now looking at how we can improve our QOF without having to drag patients to the surgery unnecessarily. In particular, some of the criteria for the early diagnosis of cancer are going to prove challenging. We don’t have brilliant uptake of screening here, so I’ve asked the nursing team who have spare capacity to phone patients and try to get them to agree to screenings, if they haven’t had them done in the normal timescales. Admittedly, it’s a tricky one as we don’t have unlimited capacity for this. I do think, though, that the people they’ve managed to persuade might come in once they’ve been prompted – especially those patients who have attended at some point in the past. I’ve tasked a member of the admin team with chasing up parents who haven’t brought their children for routine imms, to see if they’d like to have catch-up jabs if they’ve missed some.

We’re also talking to our patients with learning disabilities. It saddened me to read about the reduced life expectancy of patients who have learning disabilities, and that has made me think about how we can look after them better. We’re hoping that by keeping in touch during the present crisis, we can try to make ourselves more approachable, and we aim to be more proactive with six-monthly checks rather than just annual checks. Even if it’s just a quick call to see how they’re getting on, that patient relationship might make a difference if they have concerns.

I’ve asked the nursing team to split up the list of our most frail patients to give them a call and check that they’re alright and have access to food and care if they need it. Some of our elderly patients hate to ‘bother’ us, and I’d hate to think we could have helped but they didn’t like to trouble us.

It’s probably how we always ought to have worked, but getting the nursing team on board with the technology has been a bit of a challenge. I may not have many good things to say about the COVID-19 crisis, but it has helped to force some issues that I’ve been fighting for years.

We decided that this would be a good time to audit the flu data. I have concerns about how on earth we’re going to manage our normal super-speedy flu clinics this year with the added twist of social distancing. I’m hoping to run audits of things like BMI data to look for any that are way out of line. I’m going to look specifically at obsolete codes, in case patients who have had a previous diagnosis are missing the correct codes. I can also get ahead with the prep for the PSDs and PGDs we’ll need. I know we’ll need to give a lot of thought this year to how we vaccinate for flu as we invite the most vulnerable to come to surgery. Perhaps I might need to investigate outdoor solutions for this one…

While the clinical team is now being kept busy with QOF audits, and some of the easier clinical bits to achieve, I’m left with a bit of a quandary for the admin staff.

I’ve asked them to have a look at ‘family’ mobile numbers, checking where we have multiple family members with the same mobile number, as this is a big issue for test-result texts. The reception team leader is looking at the processes we use for children who are reaching an age where parents will no longer have automatic access to their records, for bereaved family members, and for carers. The surgery has never looked tidier, and the walls are now strangely bare. I’m really reluctant to let any of them ‘tidy up’ the shared drive, as I’m still looking for things that were deleted ‘moved’ the last time they did!

More than anything, I’ve realised how much I took for granted the fact that things just tick along normally, and I’m longing for the day when I hear complaints about the mess the patients have left in the waiting room and that the queue at the desk is 20 deep!

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