Winter pressures – again

Dr Jeremy Carter, Pulse PCN editorial board member and clinical director of Herne Bay PCN in Kent, discusses why it’s time for a different approach to winter pressures.

Winter is upon us.  We have seen the usual, predictable, steady uptick in demand associated with the seasonal change. Thankfully, as yet, Covid and flu have remained manageable, and there has been no sudden surge such as we saw last year with Strep A. 

In parallel, we continue to face the familiar challenges – an ongoing limited workforce that sometimes does not relish working additional hours well over a ‘baseline’, estates that are creaking at the seams, and an IT infrastructure that is often simply not fit for purpose, and in itself causes huge loss in effective delivery of healthcare.

The response this year to these predictable challenges has been all too familiar. Last-minute scraps are dangled, giving no ability to meaningfully respond to the increased pressures other than applying some minor sticking plaster. Inevitably, this causes difficulties for patients, and it puts additional pressure on staff. Without any additional resource, staff have a choice; either turn patients away (noting our Capacity and Access requirements), or work even harder, possibly at unsafe levels, for little or no reward, therein exacerbating the vicious cycle of worsening staff morale.

Even where there has been funding into primary care, there seems to be an inconsistent approach to deploying the investment.

Winter pressure inconsistency

In our area, the initial plan for the primary care investment was for two hubs across a ‘place’ of some 720,000 patients, covering a large geography. It is unclear how much the patient experience was considered in this plan. But our PCN patient participation group was very clear that adding capacity that may be well out of area and hard to access would be futile to meet their needs in primary care.

Thankfully, after much discussion, we have now agreed on a more locally accessible model. Surely, delivering primary care at an accessible venue has to be at the heart of what we do. After all, this is one of the key reasons why PCNs have been able to deliver so many positives for our patients. There seems to be a reluctance to invest additional resources at the level of the practice / PCN, where arguably it would have the most effect.

Aside from the inconsistency, this annual last-minute approach to winter planning causes many other problems. Patients take time to learn new systems of access and develop confidence in using them. Leaving planning to a matter of days before winter is upon us means any new system implementation will likely only become fully understood by patients about the time winter ends and the additional services are stepped down.

Mobilising the required workforce to conduct this extra work, over and above our existing duties and clinics, is not something one can reasonably expect from staff with a few short days or weeks’ notice. And planning for estates and IT solutions to support this additional work, especially if looking to more innovative neighbourhood-level solutions, is not something that can be measured in days but rather weeks or months.

Winter workforce challenges

Workforce is a particular challenge. There is a finite general practice workforce, even with the additional highly skilled ARRS staff and other advanced clinical practitioners. Particularly for the GP workforce, one cannot help noticing the incongruity of policy.

GPs are asked to step up again and again, year after year, and respond to this predictable problem. They work additional hours, presumably with the expectation that they will be paid for them. At the same time, GPs are vilified for earning money – this group of medical professionals are singled out with the declaration of earnings. Is it any wonder that GPs may not want to step up and work the long hours asked of us if a by-product will be criticism for earning money for the hard work?  

Next winter will roll around and we will face the same winter pressures. So, rather than a last-minute response, perhaps the solution is to have a policy of winter resilience with known investments in the right place – that is, planning of staff, infrastructure and IT, and patient engagement. Combine that with a shift in attitude towards the profession, embracing those in a finite workforce who work hard to provide this care, and things may start to look up.