Bell Surgery Adapts to New Normal and Advises Patients Not to Put Off Calling

Not sure whether to ring your doctor’s surgery as your symptoms aren’t urgent?  Doctors at The Bell Surgery answer to this is definitely… RING!

Last week, the Herald was invited by the surgery to talk to three doctors and the Practice Manager to talk about how the surgery has adapted during Covid-19, what procedures are in place and their plans for the future.  The myth that the surgery is only open for urgent calls is one that they very much want to dispel.  Dr Shellani Knight said, “We’re very much open. Our worry is if patients are waiting for it to become urgent it might be too late.  We’re encouraging patients to call us as we can see them now.”

All patients calls are put through the triage telephone system, where their own GP, if on duty, will call back within a few hours. If not another GP appointment will be given if urgent. Louise West, Practice Manager said, “We are very much focusing on the continuity of care so where we can get their own GP to speak to patients, we will.  The first thing we now ask is who is the best GP for your appointment.” Video consultations and/or photos sent in on email are being used for things like skin conditions.  Dr Peter Reynolds said, “Video consultations have been really helpful in managing all sorts of things.  Patients like to see their GP and it’s good for us to physically see how well they look.  Occasionally we need to bring patients in and we’ll be wearing full PPE.”  If a patient needs to come to the surgery, they will be given instructions by the receptionist when they make the appointment and will be asked to phone when they arrive.  Louise said, “The key thing is to arrive at the time of your appointment and not too early as you may be asked to come back.  We’re mindful that not everyone has a mobile phone so we have an intercom at the door so that patients can speak to reception.”

Inside the surgery there is no longer a large waiting room, there are just three socially distanced spaced chairs for elderly patients to use.  The inner entrance door is only opened by the use of the intercom so there is no need to touch the door and there is hand sanitizer available on both sides of the door.  A gazebo has been put up outside for routine blood tests and injections. The reception desk has had Perspex screens installed to protect both the receptionists and patients thanks to the donation by the Design & Technology department at The Oratory School.

For patients that have Covid-19 type symptoms, they will be assessed in the car park.  Dr Knight said, “Patients are asked to walk around to see if they de-saturate (lower oxygen levels falling).  This is a really good sign to tell us if the patient has become compromised with Covid.  They will then be asked to call 111 to register for a test at one of the test centres.”  Dr Reynolds added, “If it was a Covid symptom patient that we need to examine further, they will go into our ‘hot room’ which pretty much has nothing in it and we use a separate entrance for this.  It is a quick examination and we talk on the phone afterwards.”

In terms of numbers of Covid-19 related patients at the start of the outbreak, the surgery were getting around 10-15 patients/day calling in and were seeing around 2/3 patients/day.  Over the last month this has reduced to 5/day and seeing 1/day.  Dr Knight commented, “It was never as bad as we were expected but remember 111 were taking some of the work from us and patients were bypassing our practice and going straight to hospital.”

All the doctors agreed that there have been some real positives come out of Covid-19.  One of the biggest is the total triage system will now be used going forward.  Dr Knight comments, “It’s a much more efficient and effective way of dealing with a patient.  We’re definitely dealing with more patients a day.  95% of patients are being dealt with remotely.  We’re embracing new technology and adapting our triage system that we had in place.”

An advantage to the surgery being quieter over the last few weeks is that they have taken the opportunity to deal with some of their chronic diseases e.g. asthma over the telephone.  Nurse Simone, their respiratory lead has contacted all the asthma patients and done their reviews and shown them new things using video links.  Dr Knight said, “She’s really changed some people’s lives with their asthma management.”

Do they think they’ll be a second wave?  Dr Knight replied, “Personally I think it will continue to be there in the background. If it comes I’m not sure it’s going to have a massive affect on our workload because we have set up a new way of doing things.  We are not going to drop our guard until this is all over or until we have a vaccine and we’re in a better position to deal with it.”

Dr Matt Norman has been working remotely from home for the last 8 weeks.  This was part of the surgery’s strategy to minimise the risk to all the doctors so if others became ill.  He said, “We have all had to adapt.  It’s been very effective.  I’ve been remotely logged into my computer where I can access all the patients’ records.  I’ve also been supervising trainees remotely.”  What has been reaction from patients? “When I’ve been doing video consultations some patients might be able to see that I’m not at the surgery and sometimes ask.  I explain the rationale behind me working from home.”

Looking back, would they do anything different?  Dr Knight commented, “During the time when we were discussing Townlands becoming a Covid clinic we must have changed the surgery set up three times which was frustrating. Moving forward we’re going to be a ‘cold’ surgery which I think our patients will want.”

Another positive is that two-way communications between the surgery and Royal Berkshire Hospital has improved.  They have now been invited to join weekly webinars giving updates on Covid-19 cases and what services are coming back on board.  Referrals have continued and some clinics at Townlands and RBH have already restarted.  Some of the clinics are also adapting.  Dr Matt Norman said, “ENT had a big routine waiting list. They don’t have any waiting time now.  They have changed their processes one of which includes a drive through assessment.”  Dr Knight added, “The Breast clinic were dealing with far too many patients and they have now changed their referral system and given us better guidance on how to manage those patients.”  They have also been working closely with other GP practices in the Primary Care Network in the area (4 practices).  Louise explains “We’ve been supporting each other and sharing knowledge and information.  It’s been a real reason to work together.  It has ensured that any patient in the locality would get the same treatment and it has meant we have not had to double up on our efforts of doing things.”

Antibody testing has been in the news last week.  What do they think?  Dr Reynolds said, “If you’ve tested positive, it shouldn’t change your behaviour or how you act until there is scientific evidence.”  Dr Matt Norman added, “Potentially it’s going to give you false reassurance.”

The surgery would like to thank the support from local organisations including Mike Fisher who provided twice weekly testing for staff and PPE, charities, schools (who have had key worker children), patients and their PPG (Patient Participation Group) who have all been very supportive.  Pictured above is Annelize Littlefair who has kindly sewn scrubs, wash bags and face masks receiving some thank you flowers from Dr Knight.

Below is a video that the surgery have recorded which shows the ‘new normal’.  They plan to film others to include a film to show children about what the experience will be for their vaccines.

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