If there is either a serious outbreak of flu or if winter pressures are putting the NHS in your area under severe strain there will be a significant increase in workload in general practice. Below are some suggested steps that practices can take to help manage access and demand and deal with a flu outbreak.
Review your appointment system
It may become necessary to review the appointment system to see how you can identify the most urgent patients and reduce non-urgent work. The following could be considered:
- Cancellation of outside activities (meetings, teaching etc).
- Suspension of long-term condition management or consideration of how this could be managed in a different way (see group sessions below).
- Plan in more telephone or email appointments.
- Introduce a triage system if you don’t already have one to help manage acute and urgent flu presentations
- Suspension of new routine referrals.
- Increase repeat medication requests to 90 days for most drugs.
- Suspension of minor surgery and coil fittings.
- Emergency-only open surgeries.
It is worth considering how the practice can increase productivity in the existing appointment system by managing demand. For example the practice could:
Introduce group consultations
Could you do some long-term condition management via group sessions with a GP, nurse and HCA? For example, diabetes patients could be seen by the HCA first for bloods, weight, foot checks etc, then see a GP or pharmacist for medication review and have a group session around health promotion and education with the nurse.
Look at workflow optimisation
Review your non-patient facing activities such as prescription management, document workflow and other admin tasks. How can these be grouped so that if there is a serious flu outbreak and/or staff are off sick the most urgent ones such are seen and managed? This could mean training up senior admin staff to follow a process for triaging the admin and ensuring urgent paperwork is prioritised.
Start signposting patients
Run a session with your reception team on how to signpost non-urgent medical queries. Develop a script that staff can use to explain that the service is under extreme pressure and that all non-urgent queries are being re-directed. Make sure that there is a sentence about safety netting and how patients can access a healthcare professional, perhaps via email or receiving a telephone call from the practice.
If there is a serious flu outbreak, consider emails to patients or text messages to explain that their help in alleviating pressure on the service is appreciated and providing self care advice. You can provide links to useful information such as how to identify flu, how to manage coughs and colds and when to contact a health professional.
Robust infection control
If there is a serious flu outbreak, minimising the spread of infection in the practice will be key. Ensure that staff have done their mandatory training and are aware and regularly reminded about how they can contribute to minimising the spread of infection. Also consider the following:
- If you have space consider a separate waiting area for possible flu patients and have one or two dedicated consulting rooms. These rooms should be cleaned more frequently.
- Consider the segregation of doctors and staff managing flu patients (for example, one doctor and certain staff dedicated to flu patients)
- Staff dealing with flu patients should wear appropriate personal protective equipment. Ensure you have enough stock of this ordered.
Business continuity planning
All practices should have a business continuity plan which is regularly updated. It is worth meeting with all staff to review the plan and discuss what would happen in the event of a severe flu outbreak. Some issues to discuss or think about are:
- Ensure that you have a clinical protocol for managing flu and that everyone fully understands this.
- Make sure all staff understand that if they think they have flu they should not attend work as this may cause more staff to become sick. Once staff are fully recovered (immune) they could be assigned to dealing with flu patients so as to minimise the chance of other staff becoming sick.
- You could identify retired or non-practising colleagues who could be approached to see if they have any capacity to help on a short-term basis if you become short-staffed.
- Talk to local community pharmacies about how to manage a flu outbreak and whether patients could be signposted there rather than presenting at the practice
- Talk to other local practices and review staffing levels. Are there staff in another practice who would be willing to work additional hours for you, could you share staff for joint flu clinics?
One of the key ways to prevent a flu pandemic is to increase vaccination rates, especially in children.
- Regularly review your flu vaccinations statistics and consider how you might be able to increase vaccination rates (evening or weekend clinics, increased use of text messaging or phone calls to patients to encourage vaccination are some options).
- Ask all clinical staff to be vigilant and check every patient’s eligibility for flu and encourage uptake. Consider keeping track of who is giving the most flu vaccinations opportunistically and publicising this or incentivising increased uptake.
- Ask receptionists to check appointment lists and add flu to the appointment reason if a patient is eligible.
- Add a message to your telephone call waiting system to invite eligible patients to book a flu appointment.
- BMA template letters to help practices manage inappropriate work, in particular hospitals attempting to shift work onto GP practices. These can be imported directly into clinical systems and then personalised and sent to the appropriate CCG or trust.
- BMA information on list management, including advice on formal list closure and informal suspension of patient registration.
Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member