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'Ask Your Local GP' Q&A Recording and Transcript

Full video recording from 'Ask Your Local GP' Q&A Session. Held Wednesday 4th November on Zoom. Full transcript can be found below.


Saloni Thakrar: Okay hello and welcome everyone. My name is Saloni Thakrar and on behalf of Healthwatch Camden, I would love to welcome you all to this event. It's wonderful to have so many participants join us this evening.


We have about 100 people registered and joining us this evening. Because we're such a large number, I would like to go through some housekeeping rules which will allow for a better running of the meeting. Everyone joining this event will be put on mute. And if you try to unmute yourself, you'll be automatically muted again.


Apologies in advance for this. We also ask everyone except for our panelists and our BSL British Sign Language interpreters to keep their videos on. Everyone else if I could please request that you turn off your video. This is so that it helps improve your online connection and means that you can see us properly and our interpreters easily.


Also, there is no chat function tonight. For this meeting, it has been disabled. This is because we are so many of us and to minimize any distraction and disruption. We just wouldn't be able to keep up with the comments. And we want to keep up, keep up with the meeting, of course, and the event.


The meeting is being recorded so you can watch it again if you miss anything. And we'll also be providing a full transcript of the meeting will be available on the Healthwatch website. We’ll also be emailing you the links and the resources to everyone who signed up for this event.


I would like to take this opportunity to introduce our two British Sign Language interpreters Liz and Russell.


Liz, would you mind waving and saying hello?


Liz are you there?


Liz (BSL Interpreter): Can you see me? I am here.


Saloni Thakrar: Great. Thank you, and Russell.




Saloni Thakrar: Great. If you are a BSL user, you may wish to pin the interpreter so they can stay large on your screen. To do this, please hover over the images so that they remain visible. Elizabeth and Russell will swap over during the session from time to time.


For everyone else, the event will be best experienced in speaker view mode. So if you go and click on the right hand corner of the screen and put it on speaker mode. That'll be really helpful. If you're following us on social media, this evening, please tag us @healthwatchcam and please tweet about the event and tag @healthwatchcam. Thank you.


This is a question and answer session only and I will be asking the questions on behalf of our participants and all the members that have joined us this evening.


Thank you to everyone who submitted their questions, we received about 50 questions. And of course, we can't get through all of them so I'm going to ask about 18 to 20 questions based on the ones that you've submitted and I hope we will manage to cover many of the issues that you've raised.


Will also be sharing the full list of the questions with the panelists, so they can follow up later on if we missed anything. Here to answer our questions, I'm delighted to introduce our panel.


Dr. Neel Gupta, GP, Camden elected governing body member NHS North Central London Clinical Commissioning Croup. Also joining us is Dr. Caz Sayer, retired GP and chair of Haverstock Healthcare GP Federation.


We also have Dr. Daniel Beck, GP and chair Camden Health Evolution GP Federation.


We have Dr. Farah Jameel, GP, co-chair Camden Local Medical Committee and executive team of GP Committee England.


And we also have Amal Wicks whose a practice manager from Brondesbury Medical Centre and chair of Camden General Practice Managers forum.


The panelists today broadly will represent the views of GPs and practices across Camden. While your GP practice might not be referred to this evening, the views will remain mostly the same across most GP practices.


So to get started I’ll ask our first question for our panelists will be for Neel and Farah.


I think we're all quite concerned about our lockdown tomorrow as we enter another period of lockdown with rising Covid infection rates. What changes will patients see in GP practices. Farah, can you shed some light on this and give us some assurance around this?


Farah Jameel: Sure thank you very much Saloni. And thank you for giving us the opportunity to talk to patients quite candidly and openly. Thank you very much. So I think I want to say minimal given the huge change that has already taken place in lockdown version one.


So all the business change that was required overnight happened at a practice point of view and I recognize the frustration, the anxieties and how that has felt for patients.


And so I use the word minimal, but what sits behind that is remote working so overnight practices responded to the lockdown announcements based on guidelines that came down from NHS England.


And we moved to working in a way that protected patients, protected practices and their staff. So at this moment in time what we will start to see is perhaps more of that. We're still awaiting formal further guidance from NHS England, if things should change in lockdown version two.


But having said that, looking at some of the appointments data that has just come through nationally what we do know is that over this last month, more than 50% of appointments were actually delivered face to face. So I don't want colleagues and, you know, patients to feel that

GPs are closed. They're not. They're open, they're seeing patients in the usual way based on need, based on priority. So if you need to see your GP, they will organize to see you.


And hence why I use the word minimal at the start. But there are other things that are slightly different. So, PPE for instance, you might be rung up before your appointment and talked through about your symptoms. You might be asked to fill out forms. You might be taken through what might happen in terms of when you come in for your appointment. You might have to wait outside your practice and be called in specifically at a certain time. And that's really to minimize risk of infection, both to yourselves, to your family members, but also to the practice staff so they can carry on providing services and keep seeing you as a patient as you need to be seen.


I might just take a moment just to mention a few other aspects though. So, at this moment in time, we're currently faced with the largest flu campaign that we have ever seen in the country. And a lot of that is falling to general practice to deliver.


So there are competing priorities, one with the delivery of the flu vaccination. And you might have picked up today from the news about Covid vaccinations potentially on the horizon and the role that general practice as you can expect will then play in safeguarding our patients.


There's also other conversations being had around the clinically extremely vulnerable patients and the services that might need to be provided to them.


And I mentioned all of this because it all comes down to prioritizing where our time is being spent and how we provide care to those who are most need it.


So hopefully minimal change in lockdown version two, but these are some of the competing challenges that we are currently working with and I haven't even talked about the backlog. The secondary care backlog piece.


The diagnostics that are currently being challenged the systems being so challenged. Blood tests that can't be done. There's a huge waiting line waiting queue. So I appreciate again the anxiety and the frustrations, but do know that general practice is open, we are seeing patients all day long, every day.


Saloni Thakrar: Thank you for that. Thank you Dr. Jameel for those reassurances and the level of deep detail. Neel, did you want to add anything to this or comment on what Farah said?


Neel Gupta: Yes, thank you Saloni. Very nice to see so many familiar faces very fleetingly but really nice to see a lot of people. I'm going to try and build on what Farah said, rather than duplicate. I mean, I think I would echo what you said.


A lot of this depends on how high the levels of Covid get, but if things stay broadly stable than the change we’ll see in general practice will be minimal because the big changes have already happened and practice worked at incredible pace during the first lockdown in the first wave of the pandemic to put in place new processes such as increased use of digital tools, triage processes to make sure that we could provide a resilient and a safe service. And I think it's that key.

Safety is the absolute key. Keeping our patients and our staff safe. So all of our practices now have established an embedded safe ways of working.


In terms of the levels of Covid, Camden we have seen a rise as with every other area of the country since summer. Camden has consistently been the second or third lowest level of Covid and what we've seen in our hospitals is we still see only a fraction of the numbers of people admitted with Covid compared to the peak in March and April.


So if this lockdown, this national lockdown, has the desired effect, hopefully that will help to keep things stable or in fact even reduce the levels of Covid and we can carry on delivering comprehensive Primary Care. So that's both proactive and reactive care safely to all of our patients.


And I think, you know, I want to just echo that point there is a difference between this lockdown and the first lockdown. I think sometimes the language is unhelpful.


If you think about the first time around. There are quite significant changes here. Not everything is shutting down. So, the most obvious example is schools so schools and educational settings are open. But similarly from a healthcare perspective, during the first wave, large parts of the NHS did shut down and speaking personally from a general practice perspective because of the volume and the complexity and the novelty of what we were dealing with, we were largely left being able to deliver reactive care for people who were seriously unwell. We're not in that position at the moment and really want to emphasize that general practice is open.


And no one should shy away from coming forward to their GP if they are worried and no one should not attend routine appointments, such as a smear during this lockdown. The NHS is open and offering a comprehensive service during this second lockdown are hopefully that message comes across.


The one thing I would ask though general practice is open, but I would ask, and I think Farah’s alluded to this is understanding. So general practice is open, but everyone is working incredibly hard behind the scenes to make sure that we can offer that comprehensive safe service and everyone has been working incredibly hard since the start of this pandemic without a break. So if things don't always go as smoothly as they could, or if non urgent things take a bit longer than they would ordinarily, then please, a bit of understanding with your practice will go a long way.


Saloni Thakrar: Thank you, Neel. Thank you for clarifying and the in depth answer on this. Moving on.


The next question is, I know many people have expressed satisfaction with telephone consultations, most would like to speak to their named doctor each time, but are not often offered this opportunity. Are any practices, thinking of ways to address this issue? Dr. Caz Sayer, would you mind sharing your thoughts on this?


Caroline Sayer: Thank you very much Saloni, and it's great pleasure to see so many people. And I just wanted to start actually by thanking on behalf of the practices, they specifically asked me to thank the patients of Camden for their understanding and support during a really challenging time. So I just wanted to start with that feedback from the practices. So I know from Healthwatch’s own report that actually there are quite surprisingly really very high satisfaction with telephone consultations and the new digital systems that have enabled patients to be able to contact and be in touch with their practices, while keeping both patients and staff safe.


I would say that every single practice recognizes the importance of continuity of care, particularly for those with long term conditions, mental health and physical sort of complex cases. And we recognize the feedback from the Healthwatch that that has been an issue for some of those groups of patients.


But it has been, as Neel's already alluded to, quite a challenge to introduce new ways of working at such a fast pace and also given that quite a lot of staff themselves have been off sick or shielding and that continues to be the case.


I think it's fair to say that for some practices it's probably easier to address this issue and ensure that people have that continuity of care and speak to the same person probably, easier in some practices and others.


But some of the ways in which we're looking at it, or some practices are already offering routine telephone appointments for named people and that will, I think, as these new systems embed will become easier to do.


And particularly, hopefully as we move towards the end of the winter challenges we're facing at the moment. And I suppose the other way in which it's starting to be addressed is because quite a lot of the increasing demand and the resilience in practices is being met through the additional staff that are coming to join General Practice so people like clinical pharmacists, social prescribers.


And that is designed really to be able to free up Dr. time and to enable the doctors to be able to spend the time with those people whom particular and necessary and there's a particular need to have that kind of continuity of care. So I don't think it's perfect. And I do reiterate what Neel says bit of understanding, just to understand how quickly and how complex it has been to introduce new systems. But I think it is starting to improve and certainly the practices are looking at ways to address this.


Saloni Thakrar: Thanks Caz. That was really helpful and really clear honest reply there. Amal, would you mind taking this question:


When are GP services going to see patients again, face to face, as the primary mode of operation?



Amal Wicks: Yeah, well, before lockdown we were seeing patients face to face as the main mode of operation was first for telephone triage, assessing needs and then calling the patients in. The GPS at our practice are very keen to see patients face to face. They just feel that a lot more can be done face to face.


As we just started in July, August, and open the front doors and started the process again, this is now version 2.0 has kicked off, will kick off from tomorrow. So I think the ambition is there to see to do face to face as the main mode of operation, but we also have to do some assessments of risk on our staff and of our premises. Because If we get sick, then if the staff gets sick, especially the clinicians, then we would need to be more mindful. So I think it is.


The desire is there, but I think we need to take a practical approach first and assess risks before we say yes, we want to do it face to face all the time. I think it's taking a sensible, practical approach.


Saloni Thakrar: Thanks for sharing that.


Dr. Farah Jameel, our next question is for you.


One of the participants asked, I am really dissatisfied with GP appointments. I must wait four to five hours for a call back, sometimes even longer. I feel totally forgotten, neglected and abandoned. I am shielding and isolating. Would it be possible to have an experience nurse or trainee doctor on hand to answer telephone questions that patients might have? What's your position on this and what are your thoughts?


Farah Jameel: So I'm going to try and divide this question up into three different areas. And I think, really, to begin with, I just want to acknowledge the frustration, you know, and I'm sorry that this has been your experience and I share that frustration. Two years running, I have still not been able to register with the dentist. That's a slightly different problem but I acknowledge your frustration.


And I just want to then try and move into the shielding aspect, specifically, and I'll come back to address the beginning of the question again as well. So shielding in its original form has changed and I think it's important for that nuance to be because it is different. Government has moved away from the concept of shielding this time around. They are describing it as clinically vulnerable patients and then providing guidance saying if you cannot work from home, if you fall into this list of clinically vulnerable patients, we are writing out to you so you will know who you are and you can use that letter as proof to your employer or for things like statuary sick pay, etc.


So shielding as a concept has slightly moved on. They're not necessarily advising everyone to stay indoors stay at home, but definitely minimize contact where possible is what's being recommended at this moment in time. And again some of this is very much being driven by government and the chief medical officers office. So we're all still learning about some of these concepts. I would say for the most up to date information if you are a patient who identifies with the concept of shielding and clinically extremely vulnerable, you will be written to nationally and it will tell you what you must and mustn't do that's the bit on shielding.


In terms of services then. So taking four to five hours to receive a call back. Based on that, what I understand from it is that the patient is trying to access further advice from their GP surgery for a condition or for a specific issue, and the GP is having to go through their list of patients and prioritize and accordingly get back to the patient in due course of their day.


And I guess what is not necessarily always visible to everybody is all the other competing priorities coming into the GPs workbook.


So 111 for instance directly books into a GP’s appointment slots and they can be a whole variety of different things that get booked in and I might have to drop something and focus on that. Another team member might be dealing with something complex in the surgery and I might have to drop what I'm doing and deal with that specific issue.


And this is just describing the normality of what might occur within a practice. So the four to five hours can seem a very long time, but it is because of the list of priorities of the GPs having to deal with.


The other thing, perhaps to also mention is there are other wider members of the team. And I think the question does reference trainees and nurses who are constantly and they are part of our team providing care to patients. They are constantly fielding queries coming in, requests for further clinical advice, etc.


But there's also other ways of being able to see a GP. So some surgeries have switched on direct bookable appointments. Some surgeries are making available E-consult to access advice through that means and if there's an absolute emergency and you cannot wait, the GPs taking far too long to respond to your, to your needs, we would always recommend that if things are changing that 111 is reliant upon or A&Es are relied upon if there's a changing situation.


So there is always clinical advice on hand and I'm sorry that we can't always get there immediately, but we are working through and getting there at some point through the day.


Saloni Thakrar: Thanks Farah I’m going to move us on that was a really comprehensive answer. Thank you for that. Neel, would you like to take the next question from one of the members.


Is it possible for the medical record system used by University College London Hospital, My UCLH, to be merged with existing systems from other hospitals and GPs so that appointment details and letters for each patient are easily accessible to both patients and medical practitioners?


Neel Gupta: Okay, thanks Saloni. Similarly, I'll take that in two parts, because I think there are two different facets to that question. One is about access to that sort of information, letters, results, etc for healthcare professionals and the other is for access to that information for patients themselves.


Firstly, in terms of healthcare professionals. I think this is this is a good opportunity for me to highlight an important change that's happening in Camden. Some people will be aware of, but perhaps not all.


So many of you on this in this meeting will be aware that we've had for a long time the Camden Integrated Digital Record or CIDR.


Which brought all together information from the major health care providers in Camden alongside information held by adult social care.


And it's with quite heavy hearts early this year we made the decision to decommission CIDR and I'll say a little bit about why that was.


But speaking as someone who's been quite heavily involved in that program for a number of years is probably the most difficult place from which to access and extract data is the hospitals. And that's because they all use multiple different IT systems.


And even within our hospital there are multiple different record systems multiple different IT systems. And so there is a huge amount of effort and ultimately cost that comes with trying to do that. And it's not always feasible.


And you compare that to general practice where nationally there are two maximum three different IT systems in use in general practice across the whole country.


And so I think our experience with CIDR was that when we tried to work with our hospital colleagues at UCLH or the Royal Free, quite legitimately there were challenges and said, Well, if you want us to do this and Islington wants us to do something slightly different, and Barnet wants us to do something slightly different, still that's a huge cost and huge amount of work and we're not really sure with everything else that we have to do that we can do that. And actually probably the weakest part of CIDR ultimately was the hospital information so we know in particular from UCLH.


So as we speak in Camden and having said that we've decommission CIDR, that is being replaced by something that is a tool covering all five boroughs in north central London which is called the health information exchange. In contrast, to CIDR I would say the, the strength of that system is the ease with which it can extract that sort of information: letters, appointment details, results from our hospital systems. So, you know, so I think that's a huge benefit for us.


So practices are starting to switch this on it is available to all practices in Camden, they're starting to switch it on as we speak. And for those who are interested, you could pick that up with your practice, just to understand when they're planning to go live with that.


So for example, you could be seen at University College Hospital and clinicians there would have access to your GP report and your letters and notes from the Royal Fee, which I think is a big step in the right direction.


And so I wanted to flag that. In terms of patient health records and the situation I will be frank is much less promising. And this is something we've talked about for a number of years about bringing together all the different patient portals into one patient held record that would cover information from all different health care providers, if I'm being honest in the last five to 10 years that I've been part of this I haven't seen a huge amount of progress in that. But I think being realistic, you know, in the foreseeable future. I think people are going to be left with individual means to access their information from the GP, individual means access it from UCLH, etc.


And in my experience speaking to patients, I think people are comfortable with that so long as those things work. Well personally heard very good things about the UCLH portal.


Saloni Thakrar: Thanks. Thanks, Neel. To all our panelists, we've already reached halfway and we still got another 12 questions to ask. Can I request that you that you limit your answers to two minutes or slightly less because we've got quite a few more questions to get through. And I know this, you know, these are really important conversations. But I'm going to have to request that you know limit your answer to two minutes. Neel again over to you,


The next question is, we have received a lot of feedback about e-consult both good and bad. Please, can you explain what is e-consult and how effective is it? What steps have practices and the clinical commissioning group taken to find out about patients experiences of making appointments online, telephone triage, and visiting surgeries?



Neel Gupta: After my lengthy answer the last one. So I'll try and be as succinct as possible. So I think a lot of people will already be familiar with e-consult but it's essentially is a tool to communicate with your practice.


Without having to pick up the phone, wait for a long time. You've already heard about that experience, without having to make a face to face appointments. In very simple terms, it is a an electronic form which will allow you to convey information to your practice. It will do that by asking you a series of structured questions and allow you to enter some free text.


Essentially it's allowing you to outline your needs. Some of those needs could be fairly simple administrative, in which case that will be dealt with by the administrators in the practice.


Some of it could be complex clinical information and that will be reviewed and I'm going to speak just personally about our practice that will be reviewed by a clinician, a doctor or a nurse and you will get a response by the next working day.


And I think in terms of where we are now, it's been an absolutely essential tool in our armory in terms of putting in place those safe arrangements for offering that comprehensive service through the pandemic. It's something we talked about for a long time, but it's really accelerated through Covid.


In terms of the evaluation this is new, but not new to the NHS. This is used throughout the UK. So, there hasn't been a specific Camden evaluation, but evaluation has happened across the country in different sub sites and generally patient satisfaction is high for memory 70 to 80% bracket. I think that what that says is that this works really nicely for most but not for all. So I think there is a real, you know, there was a real benefit for a lot of people, but it's really important. The practices have alternative methods of communication for those for which this isn't suitable. So, for example, people with communication difficulties frail elderly patients.


And I think that's that part of setting this up is making sure that everyone still has access to the practice and then we don't create a two tier system.


Saloni Thakrar: Thank you, Neel, and thanks for highlighting those that you know may be limited by this. Dr. Daniel Beck, thanks for waiting so patiently. The next question is for you.


I would like to ask if more home video calls and phone calls can be introduced and made permanent? I found recent contact better when visiting a practice. Will there be more weekend and evening opportunities for phone calls and video calls? We'd love to hear your thoughts on this question.


Daniel Beck: Absolutely. That's, this is actually wonderful to hear a really positive example of how the system has changed and actually benefited some people during this pandemic. And I think the first thing I'd say is that many practices already offered telephone appointments, whether that be in terms of assessments or routine appointments and so there was a significant amount of experience among the clinicians and amongst the practices there.


I think my sense very strongly from practices is that the future will hold a mixed model. It will be resuming a business as usual face to face elements, but it would be wrong to dispense with something which has proven so valuable for so many in terms of the convenience, in terms of the accessibility, I mean, an example especially during the Covid pandemic when we were assessing children with fevers, adults with breathing problems to be able to very quickly switch to a video consultation and assess someone’s breathing state, look at a child rash say okay well let's do this again tomorrow. Let's speak again by video tomorrow and see how your daughter, your son has that condition has changed.


It really presents enormous opportunities there. And I think we all really value that and it feels in some ways like 10 years of tech progress has happened in 10 months and at the beginning within 10 days. Some people love video and I've had feedback patients who suffer with things like social anxiety, they really they really value the ability to to speak and share their thoughts and without the stress of being in front of another person. Many others greatly missed the connection the subtleties of seeing their GP their clinician in person.


So I think evening and weekend appointments absolutely they've moved almost exclusively to telephone and video and can largely remain that way and I really think it's worth flagging that they've been advantages for our diverse workforce. Also, and it's amazing what can now be done without being in the practice and we were talking about highly secure internet connections for viewing medical records remotely, for being able to issue prescriptions remotely, it has it has tremendous benefits for our workforce also.


I think it's really nice to be able to focus on some level of the positive benefits and opponent positive effects of the pandemic and in terms of digital inclusion.


Saloni Thakrar: Thanks, thanks for sharing so much light on this and also highlighting that we, you know, we hope to hold on to some of the areas that you know have really worked. And, you know, particularly for our patients around access. The next question is,


I'm concerned about digital exclusion of people with no access to digital equipment. Do practices know which of their patients cannot effectively use a digital device? What provision will be made for patients who do not have a computer or telephone or the patient has a disability or sensory impairments? How are practices managing this?


Daniel Beck: There's a lot to unpack there. I think that's a really fantastic question. There's, there's a lot to that, that I think and I just want to start by saying that it's worth really acknowledging that one of the tragedies of the pandemic is how that it's really exacerbated the inequalities that already present within our communities and made the lives of those living in challenging circumstances, even more challenging.


We're really having to think creatively about how to circumvent that so I mean if we should try and take the question, piece by piece. And I'm trying to briefly as possible mindful of the time, I think. And we do have patients with no internet. We've got very few patients with no telephone. And yes, I think we do know who the patients are and because we've been engaging with them outside of the normal appointment booking process for some time.


It's worth saying that email, even amongst the very frail amongst very elderly is that is even more vital tool for some of those people housebound living with severe disability and I think that there's incredible solutions and creative ways our patients used to text to speech and speech to text on phone devices and accessibility on smartphones is quite remarkable.


In terms of meeting people's needs where the these remote solutions aren't possible, the default is always seeing people face to face. People attending the practice and practices are aware that specific arrangements have to be made. As Neel said at the start, practices are able to see people safely in the in the vast number of cases.


We're also working really closely with our community providers on mental health trust, our community nursing teams and they're integrated primary care teams to really support the frail and vulnerable who struggle, either on the telephone or on video, or come into a practice.


Perhaps who are living alone, perhaps, older people with mental health problems. And there's been a real value and working with age UK and Voluntary Action Camden around their volunteer networks, they rapidly mobilized really identifying those who are who are very isolated either physically or digitally. And one example just to briefly mentioned was the Covid testing buddies service that we rapidly mobilized and with voluntary action Camden and from the Federation's to support those that were requiring a Covid test, but couldn't navigate the online test requests or the 119 telephone number and linking them with a volunteer who would support them through the arranging and the test and doing the test and posting it back.


And then I think my, my final point on this is around our, our shielding patient lists.


That it really provided a wonderful opportunity to do some proactive reaching out to those people who we knew to be vulnerable to be frail to be isolated.


And to really take a proactive look at addressing some of their needs and tapping them into some of the support services that rapidly sprung up at the beginning of the pandemic.


Saloni Thakrar: Thanks, Dan. Thanks, that so that was really, really helpful. And it was just really reassuring to see that you know you're working so hard and also reaching and working so collaboratively with, you know groups from the voluntary community sector and, you know, working on solutions to support you know some of these groups.


The next set of questions are on flu vaccines.


Caz, what are your thoughts on this. Is there sufficient vaccine available for everyone to receive their flu vaccination? Is there a consistent approach to rolling out the vaccination to vulnerable people or groups?


Caroline Sayer: Thanks Saloni. The first part of that question is a qualified yes. So just to give a little bit of context to that. So practices and pharmacists order their vaccine at the beginning of the year.


And they do it based on last year's numbers. And of course, this year, there's a significantly widened group of people and a drive to try and vaccinate as many people as possible.


So it's just within that context. And what we have done is to use what we call a flu calculator, which estimates by practice. How many people need the flu vaccine, how many vaccines were ordered earlier in the year, and then what the gap is so that we can ensure that further stocks are ordered.


And I think the first thing to say is that, in general, it's been more of an issue of encouraging people to have it. I would like to take the opportunity to really, really encourage everybody who is eligible for a flu vaccine to have it because it's important this year.


And in terms of how we get enough supply. There have been some delays in supplies, particularly for the under 65 but that's actually resolving and we now have access to additional supplies. I really don't think that's so much of an issue. In terms of is there consistent approach, yes, there is a consistent approach.


It's about doing high risk first that so that's the elderly, those with long term conditions, children and pregnant women.


The focus has been on delivery through the usual routes first, as far as possible. So that's practices and community pharmacists.


Particularly for two reasons. The first is to because obviously they have the experience of running these clinics. The second I think is really because we want to reconnect people with their practices in particular and take the opportunity to do checks and to assure people that their practices are open for business.


But we also collecting at the same time feedback from the practices and data around those groups who are not accessing the normal routes for the flu vaccination and trying to understand, firstly, who they are and then secondly why they're not accessing it. Largely that is either a communications issue. So we're working with public health and local authority and community leaders to try and encourage people to have the flu vaccination.


But the second thing is that many of them are fearful about actually coming to health care facilities. So we're also looking at additional places where that flu vaccine could be delivered in settings which are both culturally and accessible to people, places like community centers or where food banks are so that's really how are we trying to address the the consistent approach.



Saloni Thakrar: And Caz this one's for you again.


Could you explain advanced care planning and the importance of advanced care planning in the context of Covid. How does general practice support advanced care planning in care homes, very briefly. Thank you.


Caroline Sayer: Okay, I'll try to talk through it very briefly. So the concept of advanced care planning is really to allow discussion between professionals and patients and the families and carers about their preferences and wishes regarding their care and treatment and to then agree plans to ensure that those preferences are delivered and that those care plans can then be shared across different settings.


And that helps them to make decisions in a crisis when it could be that somebody is transported, for example, to A&E, they themselves may be very poorly, it may be difficult to get hold of their relatives. But if you've got a care plan it then sets out for people. What the preferences of the patient and the family are.


Obviously that's very important in Covid partly because people become unwell quite quickly. And there's obviously a much higher risk of hospitalizations if you are elderly and have Covid.


But also because there are barriers to being able to have your family in that setting to help make this decisions during Covid in terms of the fact that, you know, it's very difficult to visit people, for example.


In terms of the care homes being supported. So that care homes all have named GPS and a fundamental part of the work that those named GPS do is to work with other professionals and the staff at the care home with patients, their families and carers to actually draw up those care plans and make sure that they're kept up to date.


And available and it forms the basis of any discussion as well. So supposing somebody is actually taken into another healthcare setting and the GP might get contacted to get a little bit more context around a patient that they know well. Again, they can use the care plan to share the preferences of the patients and their families and carers.


Saloni Thakrar: Thanks Caz that was really, really helpful and very clear. Dan the next question is for you in relationship to mental health and homelessness.


What is general practice doing to help the health needs of the homeless population in Camden? Can you explain the role of CHIP, if you could tell us what the acronym is, and how does a homeless person register with a GP?


Daniel Beck: Thanks. I think there's a there's a couple of different parts to that. And so I'll start with what GPS of doing supports our homeless population. I think the first thing to say is that through a really well established GP education program. And there's been an annual trading floor GPS in Camden around homelessness, where we brought in various experts as well as people with lived experience of homelessness. It's because of Camden's position as a central London borough it's a topic that I think GPS locally have a relatively good amount of experience with and I think it's something that we can be quite proud of, of how we address it.


So every practicing Camden maintains a homelessness register, and that includes street homelessness, as well as people living in hostels or sofa surfing or another precarious have an equal housing situations.


As part of something that Camden commission's locally as we have an enhanced service and where all practices signed up to a process by which we proactively invite all of our people on homelessness register for an annual Health Check. And that's a physical health jackets and mental health check. It's an opportunity to make sure that people are taking up their screening opportunities. Be like cycles and screening sexual health HIV, hepatitis.


And also, really, to see how the person is doing holistically. Do we need to tap them into mental health services, have they formed an ounce of referral pathways and addiction services, and Drug and Alcohol services.


And I think that all practices do and it's something that I think that largely we do, we do relatively well though it's a constantly evolving problem.


I think that it's worth acknowledging that especially during Covid we've really seen and everyday the precariousness of some people's lives and with regard to the housing.


And at the stress the physical health consequences of poor quality or unstable housing and how quickly people can fall through the cracks. I think that probably brings me on to CHIP which is Camden Health Improvement Project, which is a bespoke homelessness practice and based in central London on Hampstead way and it's a service that's been commissioned for the last few years and they register patients who are predominantly street homeless and especially patients with substance misuse, sexual mental health problems or those who find it difficult to engage with mainstream services and they provide a really holistic approach supporting the range of their patients needs.


They’re co located in the Margaret center which is where the mental health Trust have some of their services, especially around an opiate substitution and alcohol services and they have an outreach function as well.


I Have been able to confirm with chip that they've remained open and for face to face and assessments throughout and the Covid pandemic.


And they appreciate that, that they're able to register patients often have chaotic and lives. They've never abridged an appointment booking process. Their registered list know that they can they can turn up and that they will be seen and they’ve been able to continue to operate in that way albeit with PPE and social distancing and all the precautions that they're able to take.


Just mindful of time. There was something about registering and how do homeless people register. Past education part of the training for GP practices is that there is an obligation for practices to register any homeless person that comes and seeks to register at their practice as long as they are within their area.


For particularly chaotic or difficult to manage homelessness, the CHIP obviously has, it has a specialized expertise but the nearly every practice in Camden will have a cohort of homeless patients registered in their books and they can use a variety so some will use the practice addresses as their registered address. And that's something we all have experienced on.


Saloni Thakrar: It's very impressive to understand, you know, the amount of work that's going in this area. So thank you for that.


Moving on, Caz our practices working more closely to get up. Sorry, I think I've missed one.


Is there a risk that video or telephone consultations will miss certain serious symptoms such as cancer that would be identified during a face to face consultation? How are GPs supporting people who are on waiting lists for hospital care. Can you share your views on this?


Caroline Sayer: Sure. So, I mean, the first bit of that the risk of it that we will miss certain serious symptoms, I think that is a fear that is shared universally amongst professionals GPs as well.


And I think it's something that's particularly at the onset of the introduction of these new technologies, people were extremely worried about. I actually think that the evidence probably doesn't bear that out as it being any more of a risk than the risk that exists anyway.


The reason for saying that is that there is the telephone consultations are often quite detailed. There is the ability after the phone or video to offer further tests and patients have been able to access those throughout.


And course the other the other potential is to bring somebody in for a face to face examination to examine them, and as Farah pointed out that it's about 50% of the work that's currently happening.


The evidence is that while two week waits which are the way of actually referring people urgently because you think they may have cancer did dro in the first few weeks of the of the first wave. But they have steadily picked up to near normal rates now. So that suggests that people are continuing to be referred where there's a concern that they've got something serious matter.


In terms of have that being supported I think everybody feels very sorry for those people who are stuck on waiting lists for hospital care, even if you understand the reasons for it.


GPs have taken on enormous workload from secondary care in terms of organizing investigative tests checking up with people. If there's a deterioration finding urgent ways to get them actually seen in the hospital by emails or via two week waits.


And I think they're also doing a lot more in terms of advice and guidance of phoning up the hospital consultants and having advice on how to manage people during this very difficult time, but I don't think anyone can take away from the fact that it is a very difficult time for those on hospital waiting lists. And I think everybody feels very sad about it.


Saloni Thakrar: Thanks Caz. That's very helpful and some very useful information there.


Our next question is how are practices managing the routine care of patients with long term conditions?


Farah Jameel: So I'm just going to turn this a little bit on its head because I think nothing feels like routine at this moment in time.


But it was used earlier. proactive care. And I think that's something that practices have been doing where possible right from the start of the pandemic proactively reviewing their patients reviewing the most vulnerable.


Reviewing the shielded group, the shielding group by the way is a dynamic registry, so it's constantly changing. So on a daily, weekly basis practices are going through this those lists and looking at whether they need to put other things in place, contact the patient and organize further care for them. Now that might perhaps pick up a subsubsection of patients with long term conditions, but that does pick up a certain chunk.


Outside of that, and for patients who are on long term medications, there will be a process of clinical review that practices do every time they sign off a script.


When was the last time the patient had a blood test. When was the last time their parameters were reviewed, does this patient now qualify for instance for a diabetic check?


Do I need to review their asthma indicators. Do they need to come in for a check and this is constantly happening behind the scenes in practice. So where relevant, the patient will be contacted and either they will organize a remote review, where possible, and, if necessary, bring the patient in for a face to face review.


But it's proactive would be perhaps the word at the moment I would use and then perhaps the other thing is the flu campaign at the moment is again that other opportunity to check in with the patient because a large number of people with long term conditions actually fall into the at-risk group for flu vaccinations.


So that's another checkpoint to review the patient when they're coming in for their jab and just assessing them for their long term condition.


Saloni Thakrar: Thanks Farah that was that was very helpful. Neel. I'm going to move on to you.


The next question is what is the general practice doing to help patients from the Black, Asian and minority ethnic communities. And how is the Camden Clinical Commissioning Group working with the Council and public health in supporting the residents from these local communities? Can you shed some light on this?


Saloni Thakrar: We can't hear you.


Neel Gupta: So let me unmute yeah thanks Saloni. So you'll appreciate this is a very complex issue. We don't have a huge amount of time. So I'll try and cover some of the key points.


I think one of the things when we first started to see there was a disproportionate impact on BAME communities from Covid, as healthcare professionals I think our mind sort of gravitate towards biological, physiological explanations. Was there a genetic explanation?


Receptors, enzymes, all of those sorts of things. But actually, the reality is far more simple and far more depressing.


A lot of this is down to the same reasons that we've known about health inequality for years, and they're not they're not medical and they're not biological, a lot of this is societal so a lot of our people from our BAME communities working in sectors where they can't work from home there on the front line and they don't feel empowered to get the protections that they need at work.


I know lots of small contributing factors to this. I think from a healthcare perspective. One of the things that we identified very early on was about the importance of the public health messaging cutting through to all of our communities. And actually, if we go for a one size fits all approach as the NHS does NHS England does, it's very likely that those key messages will not reach all of our communities and they certainly won't be understood by all of our communities.


I think the focus and I have to give huge credit to Camden council, one of our key partners, they have taken this issue very seriously from the onset of the pandemic, not just considering the health implications for certain communities, but also the economic implications of Covid and the disproportionate impact on.


Working collectively with the Council and Public health in terms of short term approach is really the focus is on getting those public health those key public health messages out there working with local VCs groups to try and do things differently and not going for that one size fits all, to try and make sure that the messaging that we have is supportive. It's culturally competent.


And it's not just about Covid so obviously there are messages around Covid initially it was there to protect the NHS all of that sort of stuff.


There is a risk of a double whammy of non Covid harms as well. So probably the thing that we've talked about a bit on this in this meeting is the flu vaccination. So actually really important thing is maximizing flu vaccination amongst these groups. And actually, can we use more targeted, more nuanced messaging to get to reach into our communities and make sure that we maximize flu uptake amongst these groups.


From a commissioning perspective, we've specifically incentivize GPS to target BAME groups for flu vaccination, because we know that traditionally rates can be a little bit lower in there and it's a really important potentially life saving intervention.


There's, there's lots more I could talk about. But I'm very conscious of the limited time we have, but I think it is about that and more nuanced form of communication.


Saloni Thakrar: Thanks Neel on thanks for touching on the main points there on. I just want to apologize ahead of time that you know we are going to be running slightly over. I think this is a really important conversation. We are going into our last question, but I'm apologies if we run over. Farah, this one's for you.


Many people are becoming increasingly inactive with closure of services and fear of using gyms. How a health care professional supporting residents to become physically active during the pandemic and what services or activities are you referring towards?


Farah Jameel: So this one's a slightly challenging one, isn't it, because I'm with you there. I'm one of those people who was scared to go to the gym. I used to go to the gym five times a week, and I was absolutely not going to step inside the gym, not with the current, you know, with the rising levels of Covid. In any case that we have now approached with now going into a lockdown and gyms will be closed.


I did though through lockdown managed to lose 10 Kgs so there are a few things that we can do. We can all encourage each other and we can all support each other in terms of actual services. I think again services are very much reliant on groups motivating each other and at this moment in time, it's very hard to train as groups, it's very hard to meet as groups, but there are a lot of virtual forums. So things like Slimming World, etc. They've set up virtual forums.


But I'm just going to talk a little bit about exercise because I think it's a moment to sort of plant the seed and encourage people to consider going out for a walk.


Or perhaps just walking indoors in your house. So one of the things I did was I went on YouTube. And I looked up walking videos and I broke them up into small chunks 5, 10, minutes 15 minutes and did them throughout the day.


No less to give me a break from some of my meetings or some of my working day, but I did them through the day. And that helped.


Joe wicks let's not forget the nation's PE teacher, you know. He has announced that he's going to be doing three sessions a week through lockdown. They're not going to be at an ungodly hour anymore. They're going to be on YouTube so you can engage with it as and when you want to. So that's another option, possibly.


I know there's a lot of personal trainers all over Instagram and YouTube are uploading video workouts with you can go and engage with their free content so the key message really is keep moving. Keep Active. Don't lose faith. As soon as it's possible and safe for us to restart groups and services, they will be backup.


But in the meanwhile, there's so much more that can be done. You can still go out for a walk with up to one other person from outside of your household within the rules as long as you're not within a clinically extremely vulnerable group.


Saloni Thakrar: Thanks for thanks for sharing those very practical tips and ways of staying active, especially as we move into the second lockdown. It's really important that we maintain, you know, fitness levels and take care of ourselves.


We've received 50 questions from our participants. Thank you. Thank you to everyone that's come this evening and for submitting your questions. We've tried our very best to answer your questions. Many of you won't have heard the specific question.


But I hope our panel has captured something that you want to know. Please continue to email us with your queries we will try and get them answered.


Neel, Do you have any thoughts about, you know, if our participants have any concerns or one further clarification, where should they look for these answers.


Neel Gupta: Excellent. I think probably the simplest thing if people are contacting you with questions. They're very happy for the CCG to be the conduit for those questions and we what we may not be able to answer them directly. But we'll make sure we connect people with the right person to get those questions answered and Martin Emery, who many of you on this call will know well will be a good person to be that conduit.


Saloni Thakrar: Thank you. So please share your questions with us on or if you have anything that you'd like to ask. We will forward that to Martin at the at the clinical commissioning group and we'll have those answered.


Thank you again to our panel. Dr. Caz Sayer, Dr. Dan Beck, Amal Wicks, Dr. Farah Jameel and of course Dr. Neel Gupta, for taking the time to join us this evening and took all your staff in primary care and at the Commission in your practices for your incredible devotion, your hard work and care throughout this time. And of course, going forward, we want to wish you the very best.


I want to also thank the Healthwatch team, Martin and Colette, working behind the scenes for making this happen. And to all our participants for joining us this evening.


It's always awkward and frustrating, not being able to see each other and apologies that this wasn't an interactive session where you weren't able to ask your question.


That's just the nature of this meeting and I apologize again for that. But before I end, I would really like to invite all of you to switch on your cameras so that we can see you and wave.


Thank you. On that note, I'm going to say goodbye. Thank you.