“Baby, it’s cold outside” – Ray Charles

Let’s talk about . . . winter pressures.

It is a well-known fact that winter occurs every year. This generates predictable increase in illness, predominantly respiratory infections. The bulk of this increased work is managed (brilliantly) in primary care, despite media coverage of either hospitals or ambulance services.

What helps?

• GP+ appointments: these are available for practices to book. We provide nearly 5000 appointments per month. We usually have empty capacity at weekends, particularly on Sunday. Please encourage your receptionists to book patients into them. There is a risk that if we do not use them, we will lose them.
• Flu vaccination: rates have stalled. An imaginative approach involving CCG, hospitals and, dare I say it, community pharmacies, could improve this. An extra 10% could make a difference. Staff vaccinations should be incentivised.
• Collaboration across practices: anything that makes us less vulnerable to staff members being absent will improve our resilience.
• GP-led urgent care service: we know the hospital approach to patients with chest infections/Upper Respiratory Tract Infections (URTIS’s) is often blood tests and investigations, rather than the primary-care approach of experienced clinical assessment and safety-netting. See sepsis, below.
• IT solutions/home working: there is a workforce out there that could manage a few hours in the daytime. Identifying them and bringing them on-line would have additional impact.

What doesn’t help?

• Unrealistic expectations: these illnesses take longer to clear than most people realise. There needs to be an education campaign advising on the honest duration of winter illnesses. This is compounded by patients who have been seen in other services, eg ED, by pharmacists, given optimistic timescales for improvement, and advised to see their GP urgently if not better.
• Antibiotics: antibiotic prescribing in primary care has reduced significantly, a great testament to our work. This generates complaints from patients and clinicians should be protected from these when they are providing good, evidence-based care, and not have to deal with the time-consuming, upsetting process of dealing with those complaints. NHS England needs to do much more to address this.
• Sepsis: flu-like viral illnesses will often trigger the National Early Warning Score (NEWS) for sepsis. You feel very unwell with flu: fast breathing, fast pulse, high temperature and confusion will generate a score requiring urgent 999 ambulance to A&E. This will overwhelm the hospital services very quickly. True sepsis is quite rare. I am not aware of any plans to manage this impact.

Enjoy the winter. Keep warm, keep well.

Let it snow, let it snow, let it snow . . .

Paul Driscoll, Medical Director