During the coronavirus pandemic the normal rhythms and patterns of general practice have been disrupted, with surgeries asked to continue to provide core service while protecting both patients and staff.
GPs have responded by adapting services at great speed, with most practices now offering enhanced digital services - just a quarter of appointments in England were delivered face-to-face in the past month.
Surgeries have also set up ‘hot hubs’ to allow patients with coronavirus symptoms to safely access face-to-face consultations with GPs. But practices have also had to consider how to provide care to high-risk patients who are shielding.
Super green site
Herefordshire-based GP federation Taurus Healthcare has responded by opening a ‘super green site’, which allows shielded patients to continue to receive routine care during the pandemic in a safe environment.
The nurse-led service, run from Sarum House GP surgery in Hereford, links 20 practices and covers a population of around 190,000 people. GPs are able to use the service to refer patients for interventions, such as medication appointments, blood tests and essential injections.
Associate medical director at Taurus Healthcare Dr Lauren Parry explained the idea behind the 'supergreen' site. She said: ‘Right at the very beginning of the pandemic we developed our amber sites, which are hot clinics for patients who are unwell. But we realised very quickly that, for patients who have been advised to shield, we didn’t have any provision for where they could be seen.
‘We asked ourselves what would be the best infection control process whereby we could protect those patients and still provide the routine care that they needed. So we decided to open a ‘super green site’ for patients who need additional protection.’
She added that close relationships between practices had helped the federation to get the service up and running quickly, with all decisions being made via a clinical director group linking the federation's four primary care networks (PCNs).
Dr Parry said it was essential that clinicians working at the site had robust personal protective equipment (PPE) to protect both themselves and patients. Meanwhile, she added that the chosen GP practice had to be stripped to the bare bones to protect against the risk of contamination.
Patients are invited to the 'super green' site following a referral from their GP and receive a notification via text or email. GPs from the federation refer patients via EMIS, with care co-ordinators responsible for arranging appointments. Results are sent back to the referring practice.
Director of nursing Nikki Marriott said appointments at the super green site had been easier to manage than those at the amber sites because of the ‘scheduled nature’ of the interventions.
She described the patient journey: ‘The car park is essentially the waiting room. So we have nurses and a patient co-ordinator, who will take the temperature of the patient, offer them a mask and then escort to a room where the nurse will see them.
‘Following whatever the nurse has done, they will clinically wipe everything down and this is then followed by additional processes from the patient co-ordinator, including mopping the floors in between patients. It's a very robust process.’
Patients are briefed about the process when they arrive in the car park using a leaflet and given a face mask, which they are instructed to wear during the consultation. Clinicians wear PPE including a fluid resistant surgical mask, an apron and gloves, which is replaced after every consultation.
The site, consisting of four clinical rooms, is staffed by clinicians from the four PCNs in the federation as well as volunteers. Those working in the clinics are not allowed to have worked in the federation's amber sites or to have been in contact with COVID-19 positive patients. They are also unable to work at another site during this time.
Finding more staff members to work at the site will determine how the site expands its patient list in the next months, according to Dr Parry, who said that practices have been asked to identify shielded patients who need regular monitoring.
The federation will also make its super green service available to housebound patients, by operating a visiting service in collaboration with the district nursing team.
The site has been key to giving patients assurance that they can receive treatment for ongoing medical needs in a safe environment. Dr Parry said: ‘The NHS isn't closed. The government campaign highlights that the NHS needs to be protected, but we felt that [has been] making people stay away inappropriately, so we've given assurance to them.
‘It's also enabled practices to really think through where is the most appropriate place for each of their patients to be seen, or to be managed. So, it's supported practices because this is a cohort of patients that they don't need to worry about.'
Although the super green site will not be needed permanently, Dr Parry and Ms Marriott said the work could be used to benefit practices in the future. They explained: ‘We want to future-proof this because, if we get all the processes right and how to work together, we can up-scale this to support primary care network working and multi-disciplinary teams.'