Resolve to plan in advance for predictable winter pressures

Dr Jeremy Carter, Pulse PCN editorial board member and clinical director of Herne Bay PCN in Kent, discusses winter pressuresChristmas and New Year are not just deep midwinter – they are deep mid flu season – and with that predictable regularity I hope that one of NHS England’s New Year resolution was about advanced planning.  

General Practice continues to be under immense challenge. We face ongoing financial pressures with potentially crippling National Insurance issues looming on the horizon. We are in the midst of ongoing collective action, with a variety of forms of this occurring. And we continue to face challenges with workforce – be that the ongoing debate over physicians associates, or the recent challenge of doctors struggling to actually find employment.

Adding workforce through the GP ARRS role in October should have been a positive, and timely addition for winter, but as ever, the devil has been in the detail; this has not been as easy as perhaps thought with the extremely restrictive criteria for this funding, and areas where recruiting has been challenging, still facing the same challenges.

Despite this, General Practice is managing to provide more appointments than ever.

Winter is a timelessly predictable season, and has challenges that we are all too familiar with. The so called ‘Quademic’ (norovirus, influenza, rotavirus and Covid) is taking its toll. Recent data suggests the influenza spike is coming earlier than last year – last month there were four times as many influenza patients in hospital than seen in December 2023. Assuming the trajectory is similar, it could mean a substantially higher peak than last year.

We hear that the spike in activity is putting significant pressure on secondary care, and A&E departments, and in turn on ambulance services, not only through demand itself, but through longer handover times.

Again, therefore, it is vital for the GP’s and community providers to do all we can to meet this additional demand, though our practices and PCNs, and perhaps more widely through better access to services such as urgent treatment centres. We must focus on being able to manage the extra demand, but also look to prevent illness from occurring, and where possible, avoid unnecessary demand on hospital services.

Noting the increased focus on preventing ill health, it would be opportune to consider the preventative measures we have implemented in our PCN. Covid and influenza vaccination programmes continue, and last year did see a degree more stability in those programmes than the previous year, with consistency in the delivery timeline. Our PCN also undertook a programme for the second year to improve uptake of influenza vaccine in preschool children. Having done a pilot last winter, whereby 26 children were vaccinated in the nursery setting, this year, we repeated the pilot, and expanded that to reach 105 children across 10 local nurseries.

Of course, we know from experience that these preventative measures only go so far, and there is a degree of inevitability that we will see more illness, and greater demand on our service.

Once again this winter, the decision making for our area was left until the eleventh hour. First notification of the Winter Pressures plans were shared in the second week of October, with further supporting information shared in the third week, with expectation to start in November. Despite the very short lead time, we have once again shown our ability as GP Providers to be responsive providers and adapt to the requirements of this additional capacity.

That said, the capacity that has been added in our area does appear to be one of the most efficient models we have seen to date which is a significant positive.

In our PCN, we have offered various formats of delivery at scale. We are fortunate to have a centralised facility from which we can deliver a limited number of PCN level services, and in previous years, winter pressure capacity was added by delivery out of this central hub, to the whole PCN population. 

Last year, we were mandated not to provide from this centralised location, due to the proximity of an Urgent Treatment Centre, so we delivered a town wide model, with clinics running from a number of practices in the PCN area, with both patients and staff being able to work from, or be seen in any practice in the PCN area, regardless of registration.  With this came additional challenges. Obvious ones included logistical issues of booking, and the inevitable small number where patients arrived at the wrong location, and staff having to integrate quickly into buildings they may not be familiar with, and ensuring IT interoperability for staff working cross site.

This year, we are delivering with perhaps the best model, that being additional appointment delivered out of each practice within the PCN. The coordination is ‘at scale’ by the PCN, but delivery is done on a pro-rata number of appointments based on practice list size.

Time will tell how effective the preventative measures have been, and how well our additional capacity deals with any spike in activity. What I think I can confidently say though is that when we are looking back in Spring, we will be saying it was vital to have the additional capacity.

Perhaps this year, as a system, we could give certainty in advance for this annual exercise.