Important Practice Update - Wednesday 28th October

A reminder to all patients that Llanfyllin and Four Crosses flu clinics will go ahead as planned tomorrow (28th October)

**Please note that due to staff shortages medication collection times at Llanfyllin and Four Crosses will be 9am until 11am only tomorrow**

Llanrhaeadr surgery is closed as usual on a Wednesday

· Flu vaccination from your GP Practice will be different this year as you would expect due to COVID-19.
· We have had to make a number of changes to our usual campaign to allow us to work through the added challenges of meeting infection control and social distancing requirements.
· We ask for your support and understanding to enable us to vaccinate eligible patients as quickly and safely as possible.

· Powys Teaching Health Board will be providing Shropdoc cover from 1pm on the below dates to allow the practice to have protected time to deliver our campaign:

· • Tuesday 6th October
· • Wednesday 14th October
· • Tuesday 20th October
· • Wednesday 28th October
· • Tuesday 3rd November
· • Wednesday 11th November

· We have 2800 eligible patients to vaccinate during this protected time, these are large numbers for us to manage safely and for this reason on these dates we will cut short our normal services as follows:
· 💊Medication collections will be available until 1pm only - (Llanrhaeadr closed on Wednesdays)
· ☎️Practice telephone lines will close at 1pm.
· 📞All flu vaccinations will be by booked appointment only. We will not be offering a walk in service and it is vital that you do not attend the practice without making a prior appointment.
· **Please check the criteria below and if you are eligible for a flu vaccine you can call our dedicated flu booking line from Wednesday 23rd September between 11am and 3pm on 01691 649293

· 🟡Eligible patients:
· The flu vaccine is free (for people from six months of age) if:
· •You have a heart problem
· •You have a chest complaint or breathing difficulties, including asthma that needs regular steroid inhalers or tablets
· •You have kidney disease
· •You have lowered immunity due to disease or treatment (such as steroid or cancer treatment) or are in close contact with or live in the same house as someone in this group
· •You have liver disease
· •You have diabetes
· •You have had a stroke (or mini stroke)
· •You have a learning disability
· •You have a neurological condition, such as multiple sclerosis (MS), cerebral palsy or post-polio syndrome
· •You have a problem with your spleen, such as sickle cell disease, or have had your spleen removed
· •You are an adult with a higher body weight (a body mass index (BMI) of 40 or more)
· It is also recommended and free if:
· •You are pregnant
· •You are aged 65 or over*
· •You live in a residential or nursing home
· •You are a carer
· •You are a community first responder
· •You are a member of a recognised voluntary organisation and provide planned first aid
· •You are a household contact of someone on the NHS shielded patient list
· 🟢Additional ages may be invited for a flu vaccine when more vaccines are available. Please check beatflu.org for more information)
· 🔵Health and social care workers: if you have direct contact with patients or clients, a flu vaccine is recommended. (This includes those working in residential care homes, and those who work as a carer, caring for people in their own home who can get their vaccine from a local pharmacy).

· 🟢Things you can do to help us:

· *Please do not attend the practice unless you have booked an appointment in advance. We will not be seeing anybody on a walk in basis and you could potentially put other patients at risk by not booking in advance as we are operating under a strict risk assessment and clinical guidelines
· *Please attend at your appointment time; it is essential you do not arrive early or late
· *Please wear appropriate clothing so that the vaccine can easily be given in your upper arm
· *It is essential that you wear a three layer face covering to attend your appointment
· *Please do not attend if you or a close contact has symptoms or have had recent contact with a suspected/confirmed case of COVID-19
· *Please come alone unless you need the help of a carer
· *You may be expected to stand in a socially distanced queue for a short time which could be outside. If you are not able to do so please let reception know when they book your appointment
· *Please do not bring any unnecessary bags/clothing. There will be no waiting room facilities available
· *The toilet facilities will not be available
· *Understand the clinics are for flu only, please don’t ask for other advice during your appointment
· *Primary school children will be vaccinated in school as normal and will be contacted by the school or school nurse
· *Entrance and exits may be different from usual and will be marked clearly
· Please keep up to date with the practice via our social media and website:

We know there’s been a lot of discussion in the news this week about GPs providing face-to face-appointments. We wanted to take this opportunity to keep all of our patients updated on how we are operating at the practice and the reasons why.

• Throughout the COVID-19 pandemic, we’ve remained open to patients. We’ve offered appointments using new ways of working and new technology. We’ve worked hard to make sure we’ve remained available to speak to throughout and to quickly signpost patients to the most appropriate care.
• At the onset of the pandemic we changed our way of working overnight as we identified quickly that without making these necessary changes we ran the unthinkable risk of being unable to provide a safe and effective clinical service to our patients.
• We know that patients sometimes prefer to see a GP face to face, but there are reasons why we went to a triage model offering video and telephone consultations, and government guidance has played a big part in this. It has remained the case that if we’ve needed to see a patient face to face we’ve asked those patients to come in to see us following clinical triage taking place. This system will remain, Coronavirus is still with us and we must ensure that the only patients being seen face to face are doing so because it is clinically appropriate to do so.
• If you are offered a face to face appointment we will look and feel a little differently when you attend at the surgery. You will be met at the door by a team member wearing PPE who will check you in.
• Please only attend at your appointment time, we will not be able to see you earlier as we have strict infection control processes in place between patients to ensure we keep both patients and staff safe.
• Your clinician will see you wearing PPE which can include a mask, visor, apron and gloves.
• All patients are being asked to attend the surgery wearing a face covering, this is in line with Welsh Government guidance.
• Offering new ways of working has helped some patients to access appointments who wouldn’t normally be able to due to other commitments, such as their work or caring responsibilities but we are aware of the IT challenges in our beautiful rural area, we know that some patients have difficulty getting mobile phone signal/internet access or who find using technology a challenge, we will continue to strive to overcome these challenges and highlight concerns to the relevant authorities.
• The cleaning required between patients during the pandemic means that if all patients were to come into the surgery, we wouldn’t be able to offer the same number of appointments because of the amount of time that cleaning between each patient takes. However, we’ll always see patients face to face who need to be seen face to face.
• Changing PPE (Personal Protective Equipment) between each patient adds additional time to the end of each appointment. Prior to Coronavirus a face to face appointment with a clinician would be 10 - 15 minutes. Now an appointment will often involve a 10 - 15 minute telephone triage call followed up if appropriate with a face to face appointment of 10 - 15 minutes and a further 10 - 15 minutes of PPE change and cleaning. This adds an additional pressure on the clinical time we have available and one of the reasons we must ensure patients who are seen face to face are only seen when clinically appropriate.
• The difficulty in obtaining PPE has also meant that we’ve needed to be more cautious than normal about the way we use scare resources. We continue to work hard daily to source the PPE we need.
• We understand that some patients are reluctant to come and see us in the surgery as they’re worried. We’re making sure that social distancing is as good as it possibly can be and that we maintain a ‘COVID-secure’ environment. Some of the things we take into account when we’re considering this are: the number of people in the waiting room, the number of people who pass each other in the corridors, and the toilet facilities that are available.
• Our staff are people too, and some may have ethnicity or health issues that make them more vulnerable to the effects of COVID-19. As caring employers, we need to ensure that we keep our staff safe as well. We take the necessary precautions to keep both our staff and our patients safe.
• We have many elderly and vulnerable patients with health conditions that make them more vulnerable to coronavirus than most. We also know that there are young and healthy people who have been seriously affected by COVID-19, so it isn’t just the elderly or infirm we need to protect.
• Increasing the number of patients in the surgery would mean that we’d increase the risk for everyone – particularly if some of those people had symptoms of COVID-19 and were unwell enough to need to be seen. For this reason, we will continue to triage and ensure we are only asking patients where there is a clinical need to do so to attend our surgeries.
• There’s nothing we’d like to see more than a return to ‘normal’ life and the easy face-to-face care we’ve always provided, but at the moment offering fewer face-to-face appointments keeps patients safe and provides the maximum number of appointments we can.

 We are open and we are here for you but we must continue to work differently for some time for all of the reasons detailed above and to allow us to use our limited resources in the best way possible.

We’re available to talk to, and we always want to hear from, patients who need us. While we understand patients’ frustrations with the current situation, we hope you’ll continue to help and support us, as you’ve always supported the us so that we can go on providing you with care and support in the coming weeks and months.

Finally we are immensely appreciative of all of the support the practice has received from our wonderful community and the respect you continue to show on a daily basis to our team, many of whom have worked without a break over the last few months to ensure we have been able to remain open to help you throughout this difficult and challenging time for us all

The practice are asking all patients to please wear a face covering when entering any of our surgeries - this does not apply when you are collecting you medication but we do ask that you to adhere to social distancing by queuing two metres apart

For more details on how to make your own face masks please visit https://gov.wales/face-coverings-frequently-asked-questions