My wife and I have been self-isolating at home for over a month now, only going out for a major shop once a week and a cycle ride every other day. We live in Cumbria, so the countryside is just a mile away. We’re very lucky, but even so there are 936 cases in Cumbria as I write. I’m helping a practice in the north-west via email and phone calls so I’m aware of the stresses and strains that the clinicians and staff are under and the variety of ways in which practices are trying to get through such difficult days. Major changes are taking place in the way general practice is provided and it struck me a few weeks ago that there may well be ideas and concerns that we could share.

‘Heroes’ – David Bowie

Hence, the poll: ‘What steps are you taking to make your staff safe?’ At the time of writing, there are over 300 responses to the poll – a brilliant response considering the circumstances you’re all working under. I’d applaud every single one of you, but my hands are sore and cracked from constant washing…

Here’s a summary of the results and the threads:

Main entrance that can be locked down: Achievement rate of 81.5% (leaving 18.5% unlocked)

Appointments booking online switched off: Achievement rate of 88.5% (I suspect that this might have altered by now)

Appointments touchscreen switched off: Achievement rate of 83.7% (Are screens cleaned after use?)

Prescriptions online promoted: Achievement rate of 96.2% (There’s an opportunity here to ask for up-to-date phone numbers and an email address – if you have the time.)

External letter box: Achievement rate of 76% (A relatively cheap improvement, if not already provided)

Patients seen face to face only after triage: Achievement rate of 98.4%. (Almost 100%, and I wonder whether this will continue after the pandemic!)

Screened reception counter: Achievement rate of 58.1%. (With modern surgery design, there was a movement that promoted open reception counters. As someone who approved plans at an FPC, I was never happy about this. I can remember the arguments. Many pharmacies have built temporary screens at their counters.)

Constant cleaning regime: Achievement rate of 84.7%. (This might range from a cleaner being permanently on duty to regular deep cleaning, hopefully with the additional cost being borne by the CCG.)

Sufficient personal protective equipment (PPE) available: Achievement rate of 68.4%. (This means that 31.6% of practices have insufficient PPE. I find this the most worrying thing of all, and lockdown and distancing measures become all the more important in these practices.)

‘Something happened to me yesterday’ – The Rolling Stones

The responses to the ‘something else’ question have been excellent, and we thought it would be helpful to summarise them here:

Paying staff: I started off by highlighting that paying staff who are absent might be an issue. Looking at the threads across the forum, that certainly is the case. In simple terms, my view would be to pay staff what they are entitled to, including for overtime and bank holidays. I see no room for TOIL, but that’s just my view.

Social distancing: I highlighted the need for measures in surgeries to keep staff apart as far as possible, and I know that practices are trying to achieve ‘social distancing’ by restricting movement around the surgery, keeping staff in a ‘staff zone’, allowing staff to work in rooms by themselves and restricting entry to the kitchen.

Staff rota arrangements: More than one practice has organised two teams of staff to work on separate shifts, mixed with working from home.

Homeworking: Many staff are now working from home, after overcoming the technical difficulties of logging on to the NHS Network. I know that there have been problems with both computers and phones. At least the staff can still claim their full pay. There may be expenses that apply when working from home too, depending on your Wi-Fi package. Alas, this will not continue once the pandemic subsides… but it might!

Sickness absence: I’m not sure what the rate of absence is in general practice, but I hear of doctors off, practice managers off, and the rest of the staff affected by this. In some cases, there may be as many as 50% of the staff absent. I hope by now it’s clear how these staff ought to be paid, and I don’t think it helps that practice staff may benefit from different levels of Employers Sick Pay and in some cases only SSP. What will CCGs make of this when they see huge variations on claims for excess costs?

Hot hubs: Getting together with other practices as part of a PCN, CCG or Federation appears to be common.

Bank holiday working: In all my working life, I’ve only worked over a weekend once, and it was when we moved premises in London in the 1970s. Now it looks like a precedent has been set for practices to take the strain at weekends and on bank holidays.

Triage: The use of triage has almost been forced on general practice as has the use of video consultations. One practice has a hot and cold hub with separate entrances.

Branch surgeries: Normally practice staff move between the branch and the main surgery. One practice has stopped doing this for the time being.

Surgery entry: One practice uses a telephone to speak to patients who wish to enter the surgery. There’s also a covered tent to receive suspected COVID-19 patients in the car park.

And what of the future?

I’m sure there are many other innovations taking place in practices throughout the UK and when you have the time, perhaps you could tell us about them.

In the meantime, thank you to all of you and my very best wishes to you all.

Author – Robert Campbell