Yesterday The Times reported that our worst fears are likely to be realised. Firstly, COVID is going to be with us for many years to come. Secondly, the pandemic will be worse in the cold weather of winter. COVID and flu together will likely be the biggest challenge the NHS has faced in its history. Preparations have got to start now.
Your area’s strategy for COVID will have to be wide ranging. At the heart of it will be the need to ensure that only those patients who need to be seen face-to-face by a clinician attend their GP practice or hospital. A good place to start is communications. Your guiding principle should be “talk before you walk”.
Talk before you walk – a starter strategy
1. Patients phone first – including in A&E
This is now common in GP practices, using patient conversations to decide who needs a F2F appointment and who can be dealt with by remote consultation. It’s not at all common in hospitals, though, where patients will turn up and wait at A&E.
This looks set to change now. Our project in Cardiff is trialling a phone first approach for the Emergency Unit called CAV 24/7. Patients call ahead and, if appropriate, will be given an appointment slot, which saves them waiting hours in A&E. If alternative options are better for the patient, for example a trip to their GP or pharmacy, they will be signposted, again saving them hours.
It’s an approach that is better for many patients and for the NHS, so we expect to see it rolled out in England.
2. Expansion of Clinical Assessment Services (CAS) for 999, 111 calls
The role of Clinical Assessment Services and Clinical Support Desks will become more critical this year, as call handlers and paramedics work hard to find alternatives to A&E for patients. Clinical advice ensures that patients are taken to the right place first time, which will be valuable in avoiding unnecessary hospital attendances this winter.
One of the questions to get an early grip on is “who will provide the clinical advice”? We recently wrote about GPs taking calls from 999 ambulance crews and the 999 Clinical Support Desk, but you can also provide direct telephone links to secondary care Consultants for more specialist advice. Once you know where the advice is coming from you can consider how you want the lines to be used. Whatever your approach, a 999 and 111 CAS will help to keep patients out of hospital.
3. Make your Advice & Guidance work for both urgent and non-urgent GP referrals
We’ve spoken at length about how effective advice and guidance can be at preventing unnecessary hospital trips. During the pandemic we saw a significant rise in patients avoiding a trip to hospital in areas where COVID had hit hardest. Advice and Guidance, over e-RS or on Consultant Connect, means that many patients can get the input of a consultant into their care without a F2F appointment. It’s another “remote-first, talk before the patient walks” approach with obvious benefits.
We often find, though, that the NHS talks about urgent care separately from elective care when it comes to advice. We advise that you treat them the same. Put advice and guidance at the centre of the primary to secondary care communications process. For elective care, e-RS and Consultant Connect together will result in maximum uptake of advice & guidance. For urgent care, there is no substitute for advice over the telephone if you are thinking of sending a patient in as an emergency.