Published: 27 May 2020
Author: Dr Simon Munk

We interviewed a myriad of primary care leaders from the South East to understand their view on the recent changes at a PCN/ICP/ICS level.

Throughout the COVID-19 pandemic, all areas of the healthcare services have adapted and transformed how they serve the community.  Primary care services have rapidly shifted how patients can access treatment and support. With all these changes occurring out of necessity, how can Primary Care teams decide what innovations should become a part of the day-to-day?

It is no secret that all not sectors of the NHS are able to transform at a rapid pace, despite plans being in place to do so.  The hardest element of transformation, in any business, is to sustain the changes that have been made. Our interviews aimed to uncover how leaders felt about how a continued model of care can be delivered, how the recent momentum for change caused by the COVID-19 peak should be maintained and how the recovery phase could be a catalyst for making some challenging decisions.

Changes within Primary Care

  • Total demand on primary care has considerably dropped during the Covid period (c. 47%; CF analysis)​
  • Practices and PCNs are exploring how to proactively catch up on missed planned care appointments during the recovery phase​
  • Primary care is exploring how to reduce suppression of non-COVID-19 activity during future peaks​

Ways of Working:

While many practices still don’t have sufficient digital capabilities, there was a quick and unanimous transition to telephone consultations​.

Changes to be kept:

  • Continue to use digital, photographic, telephone and video technology
  • The only time a patient should be in a consultation room is if the doctor must physically touch the patients

Total Triage

There was almost an overnight switch to total telephone or virtual triage​

Changes to be kept:

  • Continue to carry out total telephone and virtual triage at a practice or PCN level

Zoning

Approaches to separating COVID-19 work and non COVID-19 has differed between regions, Federations, networks and practices. Many regions have implemented a borough-level hot-hub approach with specific sites dedicated to face to face for suspected Covid patients​. However, these hot hubs have generally been under-utilized (30-60% utilisation; CF analysis).
In addition to hubs, some practices have implemented drive-through clinics to minimise the contact between nursing staff and patients​

Changes to be kept:

  • Zoning must be kept whilst there are active cases of COVID-19
  • Limited 'drive-through' clinics to continue to reduce contact between suspected COVID-19 patients and others

Community care and care homes

Primary care has been expected to provide additional support to care homes as they manage challenges caused by COVID-19.

Regions with strong primary care support – e.g. those that have local enhanced services and where care homes are aligned with PCNs have coped very well.

Changes to be kept:

  • Remote triage for care home residents
  • Increase in 'at home' care for residents to reduce exposure to COVID-19 by reducing the number of external trips

Recovering after COVID-19

Systems need to take the learning from how they operated during COVID-19 and embed these changes (e.g. digital by default) into their ways of working.  The recovery from the COVID-19 peak will require a continued focus on maintaining recent innovation whilst moving forward with other strategic ambitions (e.g. PCN development, health and social care integration).​ Areas to be considered:

How is capacity best utilised?

  • Thought needs to be given to how primary care capacity is best distributed across Covid and non Covid zones to best meet demand
  • IT infrastructure needs to be improved so that clinicians can work from home when required
  • There is an opportunity to reduce primary care contacts through increasing integrated working with community health services

How can primary care reactive demand be reduced?

  • Telephone and e-triage needs to be scaled up (possibly at PCN level) to reduce the number of required primary care contacts (whether face to face or virtual)
  • This will lead to actual contacts being better utilised

How can future needs be reduced through proactive management?

  • Work is needed to ensure that specific population cohorts are increasingly identified and managed more proactively to reduce future primary care demand
  • The PCNs should use population health data to segment their patients to ensure they are responding to their particular needs including any health inequalities.

How can COVID-19 peaks be planned for?

  • There needs to be a focus on trying to catch up on planned demand before future peaks
  • There is an opportunity for a rise in primary care COVID-19 contacts to be used as a system early warning system for future peaks

How can COVID-19 peaks be differently managed?

  • A different model may be required to support Covid patients which recognises that Covid demand may be less during peaks than previously expected
  • Potentially COVID-19 demand could be less suppressed during future peaks
  • Planning needs to assume that less patients may choose to stay away in future peaks
  • Planning needs to ensure that primary care can adequately support care homes during future peaks