Flu vaccine shortages, practice continuity and prison healthcare

23 October 2020

Flu vaccine shortages

Over the past week I have experienced a rollercoaster of emotions! Last week my practice performed our flu clinic using the local Church facilities, located next to our surgery. The car park was used to provide a drive-through service, with the hall for children and walk-in patients. It warmed my heart!

Patients were greeted frequently by their first name with a friendly welcome and a "good to see you again!". I had forgotten how much we had all missed seeing our patients face-to-face and it was lovely to reconnect, albeit in a slightly surreal way. Our clinic ran from 8am until 8pm and I have been so heartened to see so many of you working so hard to provide innovative solutions by offering Saturday clinics and extended, patient-focused opening hours. 

My sense of pride, however, quickly turned to feelings of anger this week when we heard how the supply chain of the flu vaccine has been interrupted. It is very easy for Public Health Agency (PHA) to produce headlines that this has been the busiest flu campaign ever and uptake rates are at their highest levels, but unfortunately this is not an isolated event and year after year we have witnessed similar disruptions in supply.

Working with Dr Alan Stout, Chair of the NI General Practitioners Committee, we have raised our concerns directly with the PHA and I have also issued a public statement on behalf of members to voice our frustration. You may have seen some coverage this week in the Belfast Telegraph, Newsletter and elsewhere, as we tried to ensure patients knew to check practice communications on how their GP practice clinic may or may not be impacted.

Prison healthcare

We send our sincere congratulations to our colleague Dr Joseph Palmer, a GP in Co Tyrone who was recently awarded an MBE for his services to prison healthcare. Typically, Joe has viewed the recognition as one for his team, so we extend our sincere congratulations to him and his extended team. We are very lucky to have one of Joe’s team members, Dr Richard Kirk as a representative on RCGPNI Council. Richard has shared some of his thoughts here:

"Prison Healthcare in Northern Ireland is delivered by the South Eastern Health and Social Care Trust and is based in three locations covering four separate sites - HMP Maghaberry, HMP Magilligan and Hydebank Wood College in Belfast. These prisons accommodate everyone in custody in the NI criminal justice system from 18 years old to our current oldest patient at 93. It is important to remember that the population includes both remand and sentenced, so approximately 30% of our patients have not been found guilty of a crime. 

"Each year over 5000 patients come into our care, with the majority staying less than three months. The normal steady population is approximately 1500 but this fluctuates and unfortunately in Covid this has increased significantly, which is a surprise. Only 10% are life sentence prisoners and there is no one on a ‘whole life’ tariff at present in NI, so essentially everyone (with some exceptions) will return to the community.

"Most of the prison population come from areas of deprivation, where health outcomes are poorest, needs are most substantial, and resources are least. Health inequalities in this group are significant and we often see patients presenting with interesting and considerable pathology. Logistics are often a part of our job; trying to manage the patient who needs radioactive iodine or the people on hunger strike are just two examples, but no day is ever the same! We run Hepatitis C in-reach clinics (with over 20 effectively cured per year), dermatology, GUM, diabetes and minor surgery, as well as a wide variety of Allied Health Professional-led services, such as specialist respiratory physiotherapy COPD/asthma clinics, musculoskeletal physiotherapy and dietetics to name a few. It is a true multidisciplinary approach."

I witnessed several patients in Newry Hospice who had been through prison systems and I found it a sobering experience. They had all experienced deprivation and adverse childhood experiences making it difficult for them to make good life choices. We will continue to raise this issue of health inequalities and if you would like to know more about prison healthcare in the meantime, please contact Richard through our office. RCGP has done some significant work around prison healthcare which is worth looking at on our website, including a guidance on prescribing in prisons (769 KB PDF) which is very interesting.

COVID-19 spread

The incidence of COVID-19 continues to rise to concerning levels in our community, leading to the NI Executive introducing new restrictions on society. I do not envy any politician who has to make these tough decisions. There are few right or wrong answers, just best estimates. It is worth remembering this is a disease which we only learnt about eight months ago. This second wave will be different to the first, as our patients will still expect services from their NHS.

We are very concerned that routine services will be simply switched off by Trusts. Last week, just before the executive announced their new restrictions for NI, Ursula and I wrote to the Health Minister and Permanent Secretary outlining our concerns. Our waiting lists are already some of the longest in Europe and if elective surgery is postponed, such as orthopaedics and cancer operations, then patients will suffer, and GPs will experience a significant increase in our workload. 

We must prevent non-COVID harms where we can and ensure as much elective care as possible continues. Working with colleagues in some of the other medical Royal Colleges, we met with the Minister on Thursday 15 October to show a united front on the importance of these messages. I shared examples of patients who are suffering and reminded the Minister how general practice responded together when faced with a health emergency, enabling the separation of 'hot' and 'cold' patients so our core services could be protected.

We have urged the Minister and his officials to ensure Trusts work more constructively together so that operations and services can be provided across the region. The Colleges also issued a collective statement earlier this week to reiterate these messages publicly.

Practice continuity

In the weeks ahead, we face some very challenging times and all practices are likely to face some staff having to self-isolate or test positive. It is impossible to issue a blanket contingency plan which covers all our practices as we are so diverse. Please start thinking about how your practice will cope if you have a staff member who tests positive and how you can maximise your team’s ability to work from home if necessary.

If you encounter problems, please get in touch with your local LMC lead. They are hugely experienced and professional leaders and can help your practice implement practical support. You do not need to be a member of BMA to avail of this service.

Data, data, data...

Last Monday in practice was a particularly mad one for me! I was dutifully at my desk doing bloods and letters by 07:50 to enable me to start morning surgery at 08:30. By 13:00 I had performed 34 telephone consultations alone let alone the huge range of prescriptions, letters and out of hours documents. Your College will always represent you to ensure government acts to reduce unnecessary paperwork.

However, please allow me to offer some encouragement to each of you to ensure you submit your data collection to the Health & Social Care Board using the Survey Monkey link that has been issued. This week sees a change in our reporting, with just four separate groups, but it is vital we participate in this. I don’t mind working hard for my patients, but it would really irritate me if all the work I do goes unrecorded! This data helps show what we are doing, which then influences commissioning of our services and eventually impacts on our workforce planning.

Cancer diagnoses and services

I have just completed my own findings for the National Cancer Diagnosis Audit (NCDA). The hardest part of my data collection was sitting down and getting on with it, but the whole process was relatively straightforward. I look forward to finding out more about how my results tie in with the NCDA findings more generally. My initial observations were that my practice was good at referring quickly to a service, but some of my own records could have included more codable data, including patient symptoms in the history function. There was a glaring need for improved efficiency in respiratory medicine, with several patients referred via Red Flag with clear lung cancer findings on CT who were appointed to a clinic rather than fast tracked to bronchoscopy.

I hope the findings of this audit can help improve services. RCGPNI Executive Member Dr Gerry Millar has led on a fantastic new development in the Southern Trust to establish a new scheme to allow GPs direct access to request CT chest scans. If you are a GP in the area and use this service, please feedback to me and we will see if this welcome new scheme can be rolled out across the region and help to improve survival in this deadly disease.

Information evening

The Faculty of Sexual & Reproductive Healthcare is hosting an information evening on 9 November on the topic of abortion reform in Northern Ireland. The session aims to provide information to GPs and other clinicians on the interim Early Medical Abortion services, including referral pathway, legal framework, conscientious objection and training in conducting a consultation with women who present with an unintended pregnancy. Learn more and register.

Get involved

We have been working more closely with our Republic of Ireland colleagues and I am delighted that this year’s Sheppard Memorial Prize is open to all undergraduate medical students and First5 GPs. It would be great to have some good representation from NI in this competition, so please do consider applying. Find out more.

I’m keen that we view ourselves as a team with a common aim - providing the best primary care for our patients. With limited resources, it can be difficult to decide which areas we prioritise and to do this, we need your help. I’m really keen to meet as many of you as possible and hear your views, so our 'Click and Connect' lunchtime meetings are now available at 13:00 on the first Friday of the month. They run from 13:00-13:30 and you can drop in for three minutes or 30 minutes. There is no agenda and are very informal. Please drop in - it would be good to see you. The next one will be held on Friday 6 November.

Finally, can I send out huge congratulations to all our newly qualified GP colleagues who passed their MRCGP this year. Saturday 24 October should have been our New Member’s Ceremony in Belfast. It is always a fantastic event and I love the opportunity to celebrate your achievements with you in front of your family and friends. Unfortunately, we have had to postpone this year’s event (for obvious reasons) but rest assured we will double our efforts to make sure we take the time to formally celebrate and welcome you to our GP family.

Until then, please stay safe and thank you all so much for all you are doing for your patients - you are brilliant, and it is an honour to be your colleague.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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