The following are all initiatives that have originated on the Fylde Coast.
Support to primary care for practice changes
The Primary Care operating model has changed significantly over the last 12 months to cope with the COVID-19 pandemic. Most patients now have a telephone appointment to begin with which will then result in the patients being offered a video consultation or a face-to-face consultation. The pandemic has tested the resilience of Primary Care, but the practices have continued to offer services to patients whilst dealing with many challenging situations.
COVID vaccination hotline
Communication with our residents has been a crucial aspect of the response to the COVID-19 pandemic.
The Fylde Coast COVID-19 vaccination hotline launched in February 2021 to provide an alternative source of accessible information. The call centre receives a steady volume of calls offering advice and guidance on COVID-19 vaccinations to residents and frequently asked questions are monitored to assess any recurrent themes and trends or issues.
Across the Fylde Coast we are working with partners to further develop our neighbourhood care teams to create fully integrated community-based healthcare which will transform the way patients are cared for out of hospital. We are transforming the way care is delivered through a targeted and highly co-ordinated integrated model of delivery, bringing health, social and third sector services together based within Primary Care Networks with a focus on prevention, early intervention, shared decision making and self-care.
Primary Care Networks (PCNs) are key in the development of the neighbourhood care teams and are working collaboratively to support the implementation of the NHS 10 Year plan and the national service specifications within the Primary Care Network direct enhanced service across the Primary Care Network footprints. Standardised protocols and pathways have been developed/are in development to support patient care which Primary Care Networks, neighbourhood care teams and wider partners are fully engaged with. For example, respiratory, diabetes, intermediate care, community stroke rehabilitation, end of life care, neuro development pathway, and community frailty. Further community services will become part of the neighbourhood care team including the care home team to provide a more holistic care coordination model.
Patient involvement community and volunteers
The Fylde Coast has a long-established relationship with its cohort of patient representatives. Volunteers offer advice on commissioning decisions, patient experience, communication and engagement and equality and inclusion. In addition, patient participation group (PPG) members provide invaluable support in their local communities and many initiatives have been shared as case studies in previous annual reports.
The COVID-19 pandemic has had a significant impact on our patient representatives and the way in which they continue to support the work of the CCG and primary care. However, there have been some real examples of where these volunteers continue to make a difference. During the pandemic, volunteers have assisted in supporting shielded residents and the most vulnerable as well as volunteering to help marshal at COVID-19 vaccination clinics. Our patient representatives have remained our ears and eyes on the ground and have continued to make us aware of any issues and more importantly, support us to seek solutions to improve patient experience across the Fylde Coast.
Keeping our population informed
Although our public engagement meetings have been reduced during the COVID-19 pandemic we are still committed to keeping our population informed. As well as our website we quickly utilised our Influence newsletter system to send more frequent email updates.
The newsletter is sent to 1,194 people and over the last year 43 issues have been sent.
Digital based platforms have been invaluable on reaching a wide audience and ensuring that people are equipped with the most up to date guidance on infection prevention and appropriate use of services.
Across all social media and all workstreams there have been 3,197 posts over the year resulting in 17,391,774 people seeing the information shared (average of 5,365 people per post) and 57,974 clicks to our website for more information.
Our COVID-19 related social media posts alone have reached 5.2 million people across 477 posts to our joint Facebook and Twitter accounts.
All our posts are also shared via Blackpool Teaching Hospitals NHS Foundation Trust’s accounts which have seen a huge growth in followers this year and as such has been essential in increasing the reach of the information the CCG has shared.
Where possible we strive to reply to questions and comments to our social media within 24 hours although the comments from over the weekend are often picked up on a Monday. In the last year we have had 1,910 comments to our posts however it should be noted that only around 20 per cent of these require a response.
We have used videos to convey messages as much as possible organising our YouTube channel; in the last year the channel has received 2,856 views. We hope to develop the channel even more in the next year.
Our website has been visited 274,905 times with the most popular pages all being related to our response to COVID-19.
We have relied heavily on community groups, friends and families to spread information to those who do not have access to online information resources. For this we have used our links with the local media, local authorities and voluntary sector.
Patient and Public Engagement and Involvement Forum (PPEI):
CCGs have a statutory obligation to involve patients in the decision-making process. The PPEI Forum advises on appropriate levels of engagement with the wider public and acts as a critical friend to make sure we are engaging with the right people at the right time during any form of service redesign.
As this and our other patient groups regularly met face to face, these were initially paused during the pandemic. The forum was reinstated in August 2020 for a number of months before being paused during wave 2 of the pandemic. Meetings which have taken place are held virtually online. They have discussed a number of topics including
- NHS 111First
- The GP patient survey
- Self-Care week
- Winter planning
- The CCG’s Equality Delivery System (EDS) grading
They have also been fundamental in disseminating information across their wider networks to support COVID-19 messaging.
The Influence Panel is a group of local people who come together each month to discuss a set topic and to help the CCG to make important decisions about health services on the Fylde Coast.
The Influence panel met only twice in the last year as regular meetings were stood down. Members were called together via a virtual platform to discuss winter planning in August and primary care insights in November.
Patient participation group (PPG) network meeting
PPGs have remained involved in the work of GP practices. Some have helped with checking on vulnerable members and volunteered to help with vaccination clinics.
The meetings with the PPG network were initially stood down but were picked up again in a virtual environment. They have discussed:
- access to general practice throughout the pandemic
- NHS 111 First
- mental health services
- winter planning
- public experiences of primary care services
- ways to improve the network going forward
- this annual report.
The CCG adopts a range of techniques, approaches, and software to engage with disadvantaged populations, black, Asian and minority ethnic (BAME) communities and people with a range of disabilities.
The CCG works with public health data, mosaic profiling, population health management data and the Joint strategic needs assessment (JSNA) to identify population profiles across the Fylde coast.
The CCG undertakes a robust equality and inclusion approach with equality impact and risk assessments (EIRAs) being completed to ensure that the protected characteristic groups are not adversely impacted by service development. Where a need is identified bespoke communications and engagement approaches will be adopted to mitigate for any disadvantage or health inequality.
This approach utilises population segmentation and targets appropriate approaches based on risk stratification. As an example, patient cohorts or individual patients will receive a bespoke communications and engagement offer based on their identified need. In the case of vaccine uptake and covid-19 health inequalities this results in messaging being nuanced to feature specific information about vaccine content for BAME populations, clarity around fertility and conception for younger female audiences and targeted health prevention messages to vulnerable groups e.g. those who have a long term condition, are obese or BAME groups.
An example of this is a ‘walk through’ video of the mass vaccination site at Blackpool Winter Gardens for patients with a learning disability. This video has been approved by learning disability leads and is intended to provide reassurance to residents with learning difficulty attending dedicated clinics for their COVID-19 vaccination.
To assist with the vaccination programme vaccination leads in the CCG have built robust relationships with the Imam and chair of the local mosque in order to seek innovative approaches to support the BAME population to make informed decisions about the COVID-19 vaccine.
The CCG launched a test and adjust survey in May 2020 which ran for a period of just over one week. There were in excess of 700 responses to the survey and the data was used to inform future approaches to communications and engagement during the pandemic.
The CCG has established a Fylde Coast communications leads group which includes senior communications and engagement leads from local authority, provider services including the Trust, out of hours and hospice as well as community engagement managers with close links to the VCFSE sector, This groups meets twice weekly at present (although this was weekly during the height of the pandemic) to share consistent and accurate messaging to the population and to identify any gaps or target groups and take action to mitigate for any disadvantage.
On the Fylde Coast all health and social care organisations collaborated to produce a robust plan for dealing with the expected winter pressures. This incorporated added consideration of changes to accessing services, and the potential for reduced bed capacity due to COVID-19 admissions and extra pressures on care homes.
Priorities were established that looked in to: preventing pre-existing conditions becoming exacerbated to the point of needing medical intervention, having resources available to treat conditions early so the patient dos not need admitting to hospital, ensuring patients receive the best care for their needs once in hospital to ensure a safe and timely discharge and ensuring health and social care services have capacity to support patients leaving hospital.
Some of the main schemes that were implemented were:
- Reinstatement of the extended access to GP appointments.
- Increase of packages of care to support hospital discharges.
- Increase of clinical capacity over the festive period in the Urgent Treatment Centres.
- Increase of patient transport.
The key was to communicate with our residents and an extensive campaign of information was implemented through the use of posters, social media and local press.
Our winter campaign focussed specifically on the priority cohorts of residents most at risk of Covid 19 for example, those with long term conditions such as respiratory conditions, diabetes etc. as well as residents who were more vulnerable due to race and ethnicity.
The Fylde Coast flu vaccinations programme started in September 2020.
Many of the practices on the Fylde Coast held vaccination clinics at weekends as well as during the week to vaccinate as many of the eligible people as possible.
Many practices used innovative solutions to keep patients attending for their vaccinations suitably socially distanced. For example, many practices made use of community centres.
The learning and experience of setting up these innovative flu clinics was fundamental in setting up the COVID vaccination programme.
Once the COVID-19 vaccinations were available Flu vaccination uptake started to decline.
Blackpool uptake of the flu vaccine is lower than the national average in the under 65s and pregnant women despite extra efforts to reach out to these cohorts.
Extra vaccination sessions were put in place within the maternity unit and at times where clinics for pregnant women were being offered.
NHS 111 First
On the Fylde Coast we have always encouraged residents to use services appropriately and keep A&E for life-threatening emergencies only. Around 60 per cent of attendances to the A&E at Blackpool Victoria Hospital are walk in patients. The other 40 per cent are sent by other services or taken by ambulance.
During the COVID-19 pandemic social distancing was critical in the A&E department at Blackpool Teaching Hospitals NHS Foundations Trust Victoria hospital. With 60 per cent of patients to the department being walk-in (unheralded) patients, this created issues with providing suitable space for patients to remain socially distanced.
Many of the unheralded patients could have been appropriately supported by other health services such as their GP or the urgent treatment centres.
Nationally the NHS 111 First programme was created. Where patients needed immediate medical assistance but did not need a 999 response, they are asked to contact 111 first. By doing so the patient could be directed to other health services that are more suitable to their needs. If they did need to go to A&E the department could be notified and a time slot for arrival arranged. This allows the department to make provisions to ensure social distancing.
The Fylde Coast was one of the first in the country to launch the programme in August 2020. Locally this meant creating extra capacity in the NHS 111 service to handle the extra demand. A clinical assessment service was set up to triage patients who needed more specialist medical advice.
Since the launch of the service the emergency department at Blackpool Victoria Hospital has seen a decrease in the number of patients attending as walk-in patients. In February 2021 around eight per cent of calls to 111 required an ambulance and only another nine per cent have been sent to A&E. That means around 87 per cent of callers to 111 ended up with other health interventions which included direct referrals to a hospital specialty.