Tag Archives: Primary Care

‘It’s not OK’: healthcare staff stand together against unacceptable behaviour

Local NHS health and care organisations are repeating calls for people to be kind and respectful, following a rise in violent, aggressive and abusive behaviour towards staff.

Whilst the majority of patients and visitors to healthcare settings are respectful and appreciative, there has continued to be a worrying rise in abusive behaviour during the pandemic.

Healthcare staff know and appreciate that there will be occasions where patients, due to the nature of their condition or through cognitive impairment, may become confused or stressed in unfamiliar environments; which can lead to challenging behaviour. Staff are offered de-escalation training to help deal with these kinds of instances in an appropriate manner.

However, there are many violent, aggressive and abusive incidents which do not involve such patients and can have a lasting impact on NHS staff who deserve to be able to feel safe when they come to work.

A campaign called ‘It’s not OK’ is under way, which features healthcare staff sharing their experiences and urging the public to respect healthcare staff and remember that they’re people, too, following the rise in incidents.

Lizzy Hooper, deputy matron at Yate’s Minor Injury Unit (MIU) says: “I shouldn’t have to be fearful for my team’s safety, yet this is a large part of what I am facing at the moment. We work very hard to ensure people in our care can be safely assessed and supported with their health care needs. It can be very challenging when individuals expect us to be able to see conditions we are not able to treat; we can only see minor injuries less than two weeks old. Some people visiting the department are reluctant to accept there are more appropriate options available to meet their needs. We would ask people to be kind and understand the pressures that we are all facing in these challenging times.”

Hannah Walker, a sister in the children’s emergency department at the Bristol Royal Hospital for Children which is part of University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), said: “Unfortunately, we have seen a significant increase in the number of incidents of violence and aggression displayed towards staff by members of the public. This is not acceptable. It impacts on how staff feel at work and can also be really challenging for other families to witness. Please remember our staff are people too, please treat us with respect.”

Donna Walker, receptionist for Yate’s Minor Injury Unit (MIU), says, “I can feel quite vulnerable while working at the front desk and not knowing who I may deal with every day, particularly when it is really busy. It can also feel very unsettling and demoralising when trying to help a person, only to be yelled at and sworn at along with negative and quite mean comments made towards me and my colleagues.”

Michaela Winkworth, a call handler for the outpatient appointment centre at UHBW, said: “I absolutely love my job as a call handler and find it very rewarding to help patients. Unfortunately, there have been many occasions when patients call and can be verbally abusive and use abusive language. This can make me feel deflated and drained and can be quite stressful.”

Robyn Clark, practice manager at Kingswood Health Centre, said: “There is enormous pressure on the healthcare system at the moment and surgery staff are doing their best to support and assist patients wherever possible. Sadly the amount of abuse being directed at them is still continuing and I have had to write to more patients regarding unacceptable behaviour in the last six months than in the previous four years. Many reception staff are now leaving their roles as a result, making it even harder for patients to get through and obtain the help they need. We want to reinforce that healthcare staff are people too, and patients should treat staff how they would like to be treated in the same scenario. We are all in this together.”

Dr Katrina Boutin, GP at Old School Surgery in Fishponds, says: “Unfortunately, we are still seeing too many cases where patients become violent and aggressive with our clinical or reception staff, which is extremely distressing for them. Staff in GP surgeries are working harder than ever to see and speak to as many patients as we can in the face of extremely high levels of demand.

“We want to make sure that you see or speak to the person who can best help you with your concerns and that we prioritise those who have the greatest clinical need. We understand that this can be frustrating at times if you have to wait longer than you’d like for an appointment, but aggressive or abusive behaviour makes things even more challenging for us. We would really appreciate your patience and understanding.”

There are a number of measures in place to support healthcare staff when experiencing violent or aggressive behaviour from patients; ranging from warning letters and acceptable behaviour contracts to patients being excluded from the premises and, in some circumstances, involving the police.

NHS staff should be able to carry out their work free from the threat of aggressive or abusive behaviour, while being treated with respect and remembering they are people, too.

Number of GP appointments rising across BNSSG

Patient contact with GPs in Bristol, North Somerset and South Gloucestershire (BNSSG) continues to increase.

Last week (8-12 November), there were a total of 112,031 appointments across the 77 general practices in BNSSG.

The number of patients to see a GP was 60,237, which is higher than at any point in 2018/19 or 2020. This equates to 54% of all the appointments that took place over the course of the week.

Meanwhile, there were 19,074 appointments with nurses (17% of total appointments) and a further 32,720 with other clinicians (29% of total appointments).

Click here to enlarge the graph.

GPs, their teams, and patients have faced an extremely challenging time during the pandemic and face-to-face contact has been limited across all NHS services to protect patients from the risk of infection.

As the data suggests, not everyone needs to be seen by a GP. All practices offer appointments with a range of other healthcare professionals, and this ensures patients see the right person for their condition as quickly as possible. The general practice team continues to grow, and practices may offer patients an appointment with a physiotherapist, mental health nurse or pharmacist, among others.

To view the latest data around telephone calls, urgent appointments and flu and mass vaccination programmes representing practices across BNSSG up to 12 November, click here.

Receptionists continue to be a key part of the practice team and the questions they ask are to ensure you are seen by the right person at the right time.

This week is national self-care week and doctors and pharmacists in BNSSG are encouraging people to get ‘self-care aware’ by practicing a healthy lifestyle and familiarising themselves with how to treat minor ailments and illnesses at home.

The national campaign aims to help people to better look after their own health – including self-treating very minor illnesses or injuries with help from pharmacists and the NHS website, taking steps to manage long-term health conditions and making healthy lifestyle choices such as exercising and eating well.

Community Phlebotomy successfully rolled out

One Care has been involved in supporting general practice and system partners to develop a new process for taking bloods in community settings. 

Prior to the Covid pandemic, there were 18,000 bloods taken across general practice and acute outpatient departments every week via the North Bristol Trust (NBT) and University Hospital Bristol (UHB) labs, with additional bloods being done at Weston General Hospital.

For many years, general practice has taken outpatient bloods on behalf of secondary care (hospitals), taking responsibility for both the phlebotomy but also the interpretation, communication and risk holding associated with these blood results.

This has been a significant workload for practices, but they have not been contracted to do the work. It is beneficial for patients to have their bloods taken in general practice as it means they can access care closer to home.

The community phlebotomy programme – otherwise referred to as secondary care bloods – has sought to address the governance of this work, ensuring blood results are returned to the requester in secondary care and to properly resource general practice to deliver this service. Over the last year primary and secondary care have been working together, supported by the CCG, to establish a standard process for this, putting patient experience and safety at the heart of the programme. This collaborative approach saw general practice and the trusts working as equal partners in the design of this new way of working.

The community phlebotomy service was fully launched on 31 October after a soft launch on 1 July, which saw primary and secondary care all working to the same standard operating procedure. Primary and secondary care will continue to work together with the CCG in this new phase of the programme to ensure a smooth transition into this new way of system working and to scope out further potential for development.

One Care have been well placed to support practices in the programme’s development due to the trusted relationships already established with practices.

As an integral part of the working group, One Care was involved in the first aspects of building up the business case for the programme, including initial data collection to confirm phlebotomy volumes and negotiating an item of service fee so practices were sufficiently remunerated for the work.

Throughout the programme, which has supported the outpatient transformation in a clinically safe, understood, and funded way, One Care has provided support for practices, in the form of regular communications, training for practice staff, trouble-shooting issues practices are having and developing EMIS resources to support the programme.

The next steps will see One Care analyse the data being collected to monitor the numbers of secondary care bloods being done in primary care and develop a dashboard to present this information back to practices. This data will also be used to monitor the success of the programme and will highlight any areas for improvement.

GP Collaborative Board Coordinator Rosie Southwell said: “A huge thanks goes to Nicola McGuinness (GP Collaborative Board lead) and Geeta Iyer (CCG Primary Care Development Clinical lead) for their leadership in the programme.

“It’s been really inspiring to see how general practice can influence positive change in the system when we come together with one voice. This has been one of the first programmes of work driven forward by our newly formed GP Collaborative Board.

“Practices have been really supportive and engaged throughout the programme – the feedback we’ve received has been extremely encouraging.

“We have lots of learning to take forward into the future as partners across our system begin to work even more closely together in an Integrated Care system. This is a great example of what can be achieved when we work collaboratively to find a solution that works for our population.”

PCN mental health analytics project

One Care has been working with a Primary Care Network (PCN) over recent months to identify patients with an active mental health condition who might benefit from a tailored intervention.

The overall aim of the project is to improve outcomes for groups of patients with mental health troubles.

It has been widely recognised that Covid-19, and the wider effects of the pandemic, have significantly impacted mental health, aggravating pre-existing conditions as well as affecting people who have not previously experienced poor mental health.

One Care has been working with PCNs and system partners to understand how general practice can be supported to use data and analytics to get a better understanding of their population needs, highlight inequalities, and identify cohorts that would benefit from intervention.

One Care is delivering this mental health project to the unnamed PCN through a series of presentations and meetings, sharing an excel based tool and several reports produced using the system, R.

When comparing data from the PCN’s population between 2019 and 2021, as per the below graph, it’s clear to see the different percentage changes in patient activity for mental health (mh) and non-mental health cohorts.

January to March 2020 saw more patients across the two cohorts require medical attention in comparison to the same period in 2019, with the first lockdown reducing activity for both. But from June 2020 to present, there has been a substantial rise in activity for the mental health cohort.

To achieve the desired outcome, One Care identified all patients with active mental health conditions using clinically agreed code sets, before they were narrowed down further using demographic, social and health information.

The below graph is a visual representation for how data was used to agree a criteria to identify a cohort of patients from the PCN population that will benefit from a specific tailored intervention.

Having collated all the data, One Care is able to compare the group with the rest of the PCN population, highlighting how their health needs and health service utilisation differ.

One Care’s business intelligence team have begun to uncover and highlight how within patients with an active mental health condition there were some distinct groups and outliers that might benefit from specific intervention.

Applying these pre-identified criteria means One Care can provide a list of patients, alongside their health and demographic information, to PCN clinical leaders and managers. These clinicians can now review the list of patients and decide on suitable intervention, which One Care can support.

One Care offer a number of direct support services to our practices, PCNs and localities. Our analysts have access to local practice data which we present back to our practices through the General Practice Intelligence Dashboards. Our team can work with practice or PCN staff to analyse the data and turn it into intelligence, empowering practices to make decisions based on up-to-date information about activity in their practice.

One Care is working on a model of support to offer this service to more PCNs in the future, so if you would like to carry out a similar piece of work in your area, please contact rhys.lewis@onecare.org.uk.