It's a huge update this month; considering that holiday season is upon us, there might not be an issue next month, therefore we've decided to cram more news into this issue. We hope that's all right for you.
Official figures from NHS Digital show that GP practices in England carried out a record 31.5 million patient appointments in April, whilst there has been a net reduction in the number of full-time equivalent GPs when compared to the same time last year. The GP service, along with other parts of the NHS, remains under huge pressure.
As a workplace ourselves, we are no different from others and not immune to the effects of the third wave that we are currently experiencing. We too are having to cope with staff off sick, either with stress or illness, or having to self-isolate due to personal or household contact with coronavirus. It is not uncommon for us to be one or two clinicians down at least once in the week. Due to this, we might sometimes have to cancel booked appointments at very short notice. We are also dealing with greater numbers of patient contacts with fewer staff. We therefore ask for your patience and understanding whilst we do our best to continue providing a high quality service for you.
We kindly ask for your consideration before choosing to contact us, and check if your condition can be managed by self-care or by another service, especially when dealing with minor illness, or conditions best managed by other professionals. Of course, if you have symptoms that could indicate serious illness, then please do not hesitate to contact us [a previous update has discussed so-called red flag symptoms].
As we progress deeper into the third wave, with daily cases having risen by nearly 75% just in the past week, we need to give you some important updates so that you can all continue to keep yourselves safe.
We are continuing to see much inappropriate use of lateral flow tests for symptomatic patients. Please note that we don't blame patients for this at all and feel the issues are a result of a real failure of government to educate patients on appropriate use of the tests when they were first rolled out.
DO NOT USE LATERAL FLOW TESTS IF YOU HAVE COVID SYMPTOMS
We don't need to go into too much detail about the science behind the tests other than to say the two tests are definitely not the same and definitely not interchangeable in usage: lateral flow tests are very specific at detecting those without disease (that is, they are designed for picking out true negative cases), whereas PCR tests are more sensitive at detecting those with disease (they are designed for picking out true positive cases).
So, lateral flow tests are to be used for regular screening of people without symptoms as part of a home, educational or workplace environment, to provide quick results and pick up additional infected cases which would otherwise have been missed (as up to a third of coronavirus cases show no symptoms at all).
PCR tests are for any child or adult with symptoms, to be ordered online or by ringing 119, and sent off to the lab, with results usually within 24 hours.
IF YOU HAVE COVID SYMPTOMS PLEASE BOOK A LAB PCR TEST
If you have covid symptoms, then please book a PCR test. You and your household must self-isolate, only leaving the house for your PCR test. Results are generally available quite quickly, often next day.
The sooner we can control the virus through identifying cases and preventing spread, the sooner we can be out of this pandemic.
The UK's official list of symptoms of coronavirus is limited to only three, i.e., new continuous cough, high temperature and loss of sense of smell or taste. There are increasing calls to expand the list to reduce the risk of missed cases, improve tracking and tracing and to get back to controlling the virus.
The following are some of the symptoms one might experience with coronavirus, with symptoms generally developing within about 5-6 days from contracting the infection:
Symptoms of coronavirus infection
indicates common symptoms for mild to moderate coronavirus infection
As coronavirus is a viral illness, viral symptoms are typical for the condition, but these general symptoms are all rather non-specific as many other conditions can also cause these symptoms, so we would advise that it would not be just a single symptom above that would indicate coronavirus, but more a combination or range of these symptoms that should increase your suspicion that you might have coronavirus, especially if you are not feeling very well overall.
Have a low threshold for booking a PCR test if you have a range of symptoms suggesting coronavirus
It has also been noted that many of these symptoms appear sooner than the official three symptoms, and especially more so in younger people who have not been vaccinated, therefore increasing the risk of transmission of infection.
We therefore urge any patient who is not 100% well and who is displaying a range of viral symptoms above to try and book for a PCR test sooner rather than later, so that any potential coronavirus cases can be identified quickly. As indicated above, please do not use a lateral flow test if you have symptoms - always book a PCR test.
For those who are going to travel abroad, just a reminder to use the NHS App if you need to obtain your covid vaccination passport. Please do not contact us to prove your covid vaccination status.
Use the NHS App or ring 119 to get your covid vaccination/passport status
We are aware that some airlines are requesting patients obtain GP letters to support or confirm exemption from wearing masks. Notwithstanding the fact that anyone can self-declare exemption from wearing a mask, there are in fact very few medical reasons for not wearing a mask and we are not in a position to support not wearing one, especially in a confined and cramped aircraft cabin.
We do not provide mask exemption lettters
As the vaccination programme continues, we are finding some previously vaccinated patients are not coming forward for their second dose of vaccine. Please remember that with the new delta variant that is circulating and which is accounting for almost all new cases, you will get over 90% protection from covid with the second dose, whilst with only one dose, protection is down in the mid-30%.
To get full protection from covid, get both doses
We are informed that the delta variant is surging in the younger age group in various areas in Derbyshire and we are awaiting an official response from Public Health regarding the action plan. We therefore strongly urge anybody who has not yet been vaccinated with both doses to come forward as soon as possible and for all of you to follow existing guidance on hands, face, space and fresh air.
More than 90% of patients who are hospitalised with covid either have not been vaccinated at all or have only had one dose. And for those who had been jabbed, they were infected before immunity had a chance to develop.
Most patients admitted to hospital have not had covid vaccine
As we move down to younger age groups, we are finding that booking rates have dropped off. We are also finding that for those who have booked, missed appointment rates have increased.
We still have a significant number of patients with medical conditions who have not completed either one or two covid vaccinations and are therefore at risk should they contract coronavirus infection. Please therefore help us to help you by booking for your vaccination and by attending your booked appointment. Those at risk should receive letters shortly - if you are one of those, please look out for your letter and please book your appointment - it is in all our interests to get our vaccination rates up as high as possible.
If despite recommendations, you wish to decline the vaccination, please do let us know so that we can concentrate our efforts on continuing the programme. For those who do not respond at all, after three or more invites or attempts to contact, we will automatically record that you have declined the vaccination and move on to the next patient.
We advise all patients to continue to exercise a degree of caution when the country will very likely open up on July 19th. Clearly the virus will have not suddenly gone away the next day.
Whilst it does appear that vaccinations have broken the link between infections and hospitalisations, and hospitalisations and death, as the third wave progresses, cases will continue to escalate (up 75% in the last week), leading to increased numbers of hospitalisations (up 55% in the last week) and in turn, though thankfully fewer in number, more deaths.
It is a fact that those who have been fully vaccinated are at lower risk than those who have not, both to themselves and to others. Whether you consider it discriminatory or not, various countries around the world are now offering priviliges to those who have had both covid jabs in terms of travel and freedom from quarantine.
It is expected that all previous restrictions will be lifted on July 19th, including the requirement to wear a mask, however even if this is the case, you may wish to consider continuing to wear a mask when in a crowded situation, or if amongst the vulnerable or the sick, or within a health care environment, as was the custom in some countries, especially in Asia, pre-covid. It's entirely up to you, but it is also a known fact that masks do help to reduce the spread of infection and respiratory illness. Of course we will have to wait for what the formal guidance tells us on this matter.
Our point overall is please do try not to become a statistic, be aware of how the virus spreads, maintain excellent hygiene and good ventilation and exercise caution around those who have not yet been fully vaccinated.
We are now hearing that there will likely be an autumn covid vaccination booster programme starting around the same time as seasonal influenza vaccination. Initial interim advice suggests that the programme will be in two stages with vaccination of the most vulnerable first:
As soon as we get more details on the practical implementation of this programme we will of course update you. Please do not contact us about the booster programme as we have no further information to provide other than that which is already currently available in the link below:
We are having increased contact with patients who are suffering with ongoing symptoms after having contracted coronavirus. It is estimated that more than a million people have post-covid syndrome, with some estimates even nearing 2 million. The condition, also known as 'long covid', consists of debilitating symptoms such as tiredness, breathlessness, chest pain and palpitations, difficulty sleeping, poor memory and concentration (brain fog).
Visit Your COVID recovery site for help and support after covid
In order to help our patients, we have collected many resources on this emerging condition and we can also direct any patient who believes they are suffering from post-covid syndrome to the officialYour Covid Recovery NHS website. The site contains lots of useful and practical information on what you and your carers can do to help. See below.
If you are affected, please do visit these resources to start getting the advice and support you need, and if you still need help from us, please get in touch.
You may have seen mention in the news of the latest NHS data grab. Data extraction was due to start July 1, 2021, but has now been postponed to September 1, 2021 due to adverse publicity and to allow patients more time to be informed.
Deadline for opting out of the NHS data grab is August 25, 2021
However, in the absence of any official information campaign, we have set up a new page on the website to help our patients find out about the campaign, and to opt out if wished. As with all these things, we anticipate there being a mad rush as the closing date draws nearer, and we therefore encourage any patient considering an opt-out to put their request in to us sooner rather than later, so that we can ensure that your data remains safe.
Those of you ringing in for a same day appointment will have noticed that our receptionists are asking a series of questions about your general level of health, likely pain levels and the nature of the problem. We have authorised our receptionists to obtain this information so that we as doctors can review your request and assess the level of urgency required.
This enables our acute care and urgent duty clinics to run more smoothly and efficiently, and also represents a return to the ability of our receptionists to actively signpost patients, depending on symptoms presented, to the most appropriate professional, which may not always be a GP.
Active signposting will help us to provide appropriate and timely care to those in need
Please note that should your symptoms indicate that you need to call an ambulance immediately, for instance in case of suspected heart attack or stroke, again, our receptionists are authorised to advise you of this, without the need for any doctor to confirm this decision. This defined protocol is in place in order to keep you safe and to ensure that you get the right care from the right person at the right time.
We know that this represents a cultural change to what patients might traditionally be used to, but Ivy Grove Surgery is not just making these changes up as it goes along; 'Active signposting' and 'care navigation' are part of official NHS England guidance on freeing up time to care for patients in its 10 High Impact Actions as part of the General Practice Forward View.
Please bear with us whilst we introduce these changes; by doing so, we can help more people, and provide appropriate and timely care to those in need.
Thousands of patients missed their blood pressure (BP) checks last year during the heights of the pandemic. Unfortunately, given the sheer number of patients involved, and current workloads, we do not have the capacity (either space-wise or from the point of view of free appointments) to bring in every patient needing a BP reading for a face-to-face appointment. This is a nationwide issue and not confined to our surgery.
Accordingly, and also in conjunction with support from the CCG and our care co-ordinator team, we are starting an initiative to get BP readings from patients and once received, we will take any necessary action on the readings.
Reliable BP monitors can now be purchased quite cheaply
In terms of getting readings from you, many patients already have BP monitors or have access to one. For those who do not have one, recommended and reliable machines can now be purchased quite cheaply for around £20. We consider them to be a worthwhile one-off investment in your health, not just for now during a pandemic but for your future health too. Please check links below for recommended monitors.
For those of you unable or unwilling to purchase a BP monitor, we will have some available for short-term loan, but supplies are limited. As an alternative, we are aware that there are some chemists offering a free BP service.
You may therefore receive a text inviting you to submit readings to us. We encourage all patients to respond to the invite by submitting readings to us for review - the messages will inform you how to respond.
If you have specifically been told to take one week of home readings, we also have the chart that you can download to complete (only do this if we have directly told you to submit a week's worth of readings).
Just an update for all patients in receipt of hospital, repeat or private prescriptions.
Hospitals, under their terms of contract, are obliged to provide you with your prescription there and then, if this is required urgently or same-day. It does not matter if your appointment was face-to-face or remote, or if you have left the hospital already - it is still the hospital's responsibility to supply you with any medication that you require urgently. If the hospital has assessed you but is then telling you to contact or see the GP for an urgent prescription, then it is not fulfilling its contract of care towards you.
Hospitals must provide you with a prescription if it is required urgently or same-day
Hospitals have the capability to supply prescriptions and in some cases can send them via electronic prescribing. We are often told that no prescription pads were available on the ward, or that it was a nurse seeing the patient and no doctor was available, or that it would inconvenience the patient to come back to hospital to collect the prescription - can you imagine what responses we would get if we gave you any of these as reasons for not providing you with an urgent same day prescription that we ourselves had determined that you needed?
We are often presented with hospital prescriptions that were meant to have been dispensed at the on-site hospital pharmacy, but which ended up not being dispensed. It might be that there was a long queue at the pharmacy, or that car parking was about to expire or that the prescription was just forgotten about.
Notice is required for issuing hospital prescriptions
Invariably, these prescriptions are presented to us as urgent, requiring to be converted to a 'normal' prescription as soon as possible, often while the patient waits. In fact, these prescriptions are NEVER clinically urgent - the required notice period for a GP to issue the prescription will always be printed on the prescription paper itself and will vary from 48 hours notice to 5 working days.
The reason for these timescales is so that such prescriptions can go through our normal prescription issuing process, which takes two working days minimum, and which involves such things as checking for interactions and ensuring such treatment is appropriate when considering the person as a whole. Ultimately it is the doctor signing the prescrption who would be responsible should any errors arise and we need to make sure that we continue to prescribe safely. Rushing us runs the risk of harm to patients which none of us want.
We kindly ask any patient presenting a prescription that should have been dispensed at a hospital pharmacy to please bear these timescales in mind, as we do have other priorities that must take clinical precedence.
If the stated timescales are not acceptable, patients are at liberty to present their prescription to the hospital pharmacy to obtain their medication sooner.
Sometimes we are asked by hospital doctors to prescribe specialist treatments on their recommendation, often after the patient has either already seen the doctor face-to-face or had a remote assessment. In the past, GPs could freely prescribe anything that was available, however for decades now, our prescribing has been strictly governed by central guidance which we have to follow in order to avoid repercussions.
Sometimes these medications are so specialised that they are 'consultant only' medications, or they are medications that are to be used 'off licence' (that is, for reasons that have not been specified by the manufacturer), or they might be medications for which guidance indicates that hospital doctors need to prescribe first and which require monitoring and stabilisation before passing the prescribing onto the GP.
Often the GPs will have never issued such specialist treatments before, yet are expected to prescribe outside of their skills, knowledge or experience. This is against good medical practice, where any doctor prescribing should be fully appraised on the medication, its effects, its interactions and side effects and be able to counsel the patient on appropriate use. By being in this position, the risk of errors and problems is reduced. This is important as it is the doctor signing the prescription who is ultimately responsible should any errors arise, and not the doctor or clinician who recommended the treatment in the first place.
In certain circumstances, we may politely refuse to prescribe and we will inform the hospital of our decision and leave it with them. We do realise you might be frustrated and feel stuck in the middle, but we are not being awkward or obstructive to you here - we are simply following good medical practice and being responsible doctors.
There is nothing stopping the hospital issuing any prescription that you require
Ultimately, there is absolutely nothing to stop any hospital doctor prescribing what they feel you should have, there and then, and/or posting the prescription out to you in the same way that we use the post as part of providing our service.
Just a reminder that normal prescription processes take 48 hours. If you write a request on your repeat slip or send a message when requesting prescriptions online, please be aware that doing so may delay your prescription as we investigate your request. As with other prescription requests, the time taken involves things such as reviewing your medical record, checking if it is appropriate to restart a previous medication, passing your request to the relevant doctor for review, and overall to ensure that we continue to prescribe safely. So, please bear with us whilst we perform essential checks.
A private prescription might be issued as part of a private consultation. We must remind patients that all GP surgeries are under no obligation to convert any private prescription to an NHS one - these will be considered on an individual case by case basis. Again such prescriptions are not clinically urgent and will be reviewed and issued if appropriate, as part of our normal processes and with timescales as described above.
The only medications we as doctors would consider to be clinically urgent would be those treatments that cannot be stopped suddenly, otherwise harm might arise. There are a certain number of drugs in this category and they include drugs like heart medications, blood thinners, certain painkillers.
If you have run out of a medication that is on the urgent list, we will issue these same day, but we kindly ask that all patients ensure that they always put in their repeat medications well in time to avoid a situation where they could potentially miss essential treatment.
It is now over three months since Dr Wordley retired - hasn't time flown? And we didn't appear to update you all on the event. Dr Wordley's socially-distanced get-together went very well, considering the covid restrictions.
We made the most of it, using zoom to allow family and also former staff to join in on the celebrations. Speeches were made and we enjoyed a glass of bubbly, before presenting Dr Wordley with his retirement gifts. It was thoroughly enjoyed by all, with us all having missed this sort of thing for the last year, and it also emphasised just what a great team we have here at Ivy Grove.
We must thank all the patients, staff and other professionals who took the time to submit hundreds of messages of goodwill, which we then compiled into a photo book for Dr Wordley and which we presented to him on the day. Dr Wordley said that this gift alone meant the world to him and he would treasure it forever.
We wish Dr Wordley well, with all good wishes for a long and happy retirement.
Since the get-together, Dr Wordley has reported that he is really enjoying his retirement, getting out on his bike and not missing the work at all! We don't blame him! We all look forward to spending some overdue time with him at a proper BBQ party in due course when restrictions have been completely lifted.
The Derbyshire Times ran an article on Dr Wordley, along with some lovely recollections from his career over the years.
Without a doubt, hayfever has been extremely bad this year. The coincident events of warm weather, getting out more and the summer's grasses coming has caused many people to really suffer this year.
Unfortunately, there are still no miracle cures for hayfever, and you cannot completely stop your reaction to the pollens, so antihistamines and practical measures remain the main things you can do to help you cope with the miserable symptoms.
Please check the links below for advice.
There are currently severe shortages of various brands and formulations of antihistamines, however, whilst we cannot magic supplies of antihistamines out of thin air, we can advise patients that up to a whole year's supply of genuine tablets can be easily obtained from certain popular next day delivery online retailers (as well as discount stores on the high street) starting at around half the price of a normal prescription charge (only £5). This might help some patients to obtain the supplies that they need.
There has been an increase in calls relating to children with mild temperatures and respiratory symptoms probably as a result of lack of resilience-building exposure to usual childhood viruses during the lockdown and increased mixing of children in various environments.
In the vast majority of cases, mild fever does not indicate anything serious to worry about and as such can be managed safely at home with paracetamol and/or ibuprofen and general self-care such as plenty of fluids.
We kindly ask that all parents familiarise themselves with official NHS advice on managing a child with a fever and to be aware of the signs or symptoms that would indicate the need to call a GP or even an ambulance. Links are below.
Advice is available to help you identify if your child is poorly
Things to look out for include a persistently raised temperature, evidence of dehydration (such as poor urine output), breathlessness, a worsening of general condition or level of responsiveness, such as being drowsy, floppy, difficult to wake or agitated, or a suspicion that something more serious is going on, like meningitis. Special concern should be given when the child is a very young baby, that is, less than 3 months old.
We do realise it is sometimes very difficult to know if your child is poorly or not. We are therefore providing links below to some very useful resources for parents; for instance, a colour coded leaflet of symptoms and signs to look for that might indicate a poorly child and what to do about it; links to the widely used HANDi app that gives advice on common conditions and which can increase parents' confidence when dealing with minor conditions.
And please remember, cough and fever are still coronavirus symptoms, so if your child has a new cough or fever, even if you think you know the cause, please book a PCR test. And the household should self-isolate till you get the result. Do not use a lateral flow test.
We are getting lots of calls from patients asking about their hospital care, their appointments, results of tests, and other queries. In the vast majority of cases, this is before any attempts have been made to contact the hospital directly themselves.
If you are waiting for a hospital appointment or results, please be aware that we cannot speed this up for you. It is the hospital's responsibility to manage their own workload, tackle their backlogs and to contact you when necessary.
We urge all patients with any query regarding their hospital care to contact the hospital directly. For your information we have set up two information pages on our website to advise you:
At a time when abuse of healthcare staff and the general level of GP bashing in the media has hit an all-time high, and when we have never worked so hard under such difficult conditions, we are so grateful to receive your messages of support. They make very welcome reading for all our exhausted staff and they do make a difference, so many thanks to those of you who have taken the time to come back to us with your comments. We really appreciate it and we do share all your comments with our entire team.
If you wish to submit feedback, please do get in touch:
Thank you once again for every interesting and informative newsletter. Ivy Grove Surgery has been my Surgery for over 40 years and I can have nothing but praise for all the doctors and staff past and present. Thank you for all your hard work it is much appreciated. It has been a terribly difficult year for everyone and I cannot start to imagine the problems you've all had. Carry on with the newsletter and with your excellent service. Thank you all once again. - JB
Great care provided. Doctor rang me the same day, good discussion and medication prescribed plus advice on self referral. Thank you to all staff for all your help. Receptionists are lovely to speak to. - LM
A huge thank you. - LB
Today I had the pleasure of bringing my mother-in-law to your surgery for covid jab. I would like to say a BIG THANK YOU to all staff involved - a lovely smiling welcome and very professional staff all the way through. Very slick, well informed and a credit to the NHS. Please pass my thanks to all staff and ensure the GPs are aware of the good work. - VM
Just want to say I hope you are all alright and I think you have all being doing a terrific job in the pandemic. - KM
Thank you all very much for your services, especially Dr Shial, we are very grateful. - ANON
Dear Ivy Grove Surgery, first of all, thank you for all of your hard work. We do appreciate it. Secondly, thanks for the updates. I find these incredibly helpful and it's good to feel empowered to be able to access the right help at the right place. - JW
Thank you for your hard work, your patience, your dedication and compassion. Thank you for keeping your doors open during this nightmare. You ARE appreciated!! - LT
Very informative and thought provoking. Thanks for the always interesting newsletters. - JH
Please pass on to everyone how grateful I am for everything you have done for me, I am really so thankful, so well done to all of you!!! - KA
I brought my father to surgery today and saw Dr Shial. Please pass on our thanks for the kind and sympathetic way he dealt with my elderly father. The service we have received today has been outstanding. - SH
Thank you for the latest update on the practice. I would like to congratulate everyone at Ivy Grove for their patience and help during this last terrible year. Luckily I myself have not had to use your services only for my health reviews. The vaccine programme was fantastic well set out and delivered swiftly. You have all done a wonderful job in the most awful of situations and all deserve recognition of this. Thank you once again and keep up the good work. - JB
Please pass on my thanks to you all for your help, I realise that I have needed your help a lot recently and would just like to say 'THANK YOU' - GH
Please continue with the newsletter, it contains excellent & informative info, excellent to read plus also keeping us informed and updated. Well done to all. - JC
I would like to thank Mandy on reception for her kindness, patience and professionalism today when I called to make an appointment. It is so refreshing that your staff are kind and courteous towards patients who are unsure as to the right person to discuss matters with. Thank you. - JW [a different JW]
Hopefully we will get a summer this year. So, just a reminder that if you are due a blood test, please do make sure that you drink enough water especially when the weather is hot! If you are in a state of dehydration, even if only slight, then this will likely show up in your blood results. This may then unfortunately mean that your blood test will need to be repeated unnecessarily.
Multiplied many times, this means greater inconvenience for you as our patients in terms of rebooking and reattending for bloods and also increased workload for us and our team in generating more tests and processing more results. Making sure you stay well hydrated in hot weather also means you will feel better in yourself, have more energy, feel less tired, be able to think and perform better and be less likely to feel muzzy-headed and constipated. And we don't want any of that when the weather is great! [Fingers crossed].
As we approach the summer, we hope that those in power will plan sufficiently well and make careful preparation in the precious weeks we have before autumn and winter and the schools re-opening. We really do hope we do not have a repeat of the events of last summer when much tactical advantage was squandered in the fight against the virus.
Whatever happens, we hope that you will all continue to keep yourselves safe.
Written by Dr M. Wong
© Dr Michael Wong 2021