10 COVER STORY
Innovating to clear the Covid backlog
Mimi Launder examines how practice nurses are rising to the challenges presented by the fallout from the pandemic , in the midst of a media-fuelled backlash from frustrated patients
DAN MITCHELL
While record-breaking hospital waiting lists continue to hit the headlines , it seems the message that general practice is also under significant pressure is not reaching the public .
Practice nurses have told Nursing in Practice that many patients are blaming clinicians for their struggle to access general practice – and , sadly , in some cases this has led to abuse of healthcare staff . Even worse , this anger comes despite the fact that practices are working harder than ever .
Overall , general practice delivered 28.7 million appointments in September , compared with 26.6 million at the same time last year . Of these , 13.1 million were delivered by a healthcare professional other than a GP , including nurses , up from 12.6 million year on year . And in contrast to the prevailing media narrative , face-to-face appointments have risen sharply , to 17.3 million from 15 million over the period . At the same time , the sector is spearheading both the Covid-19 booster programme and the biggest mass flu vaccination campaign in history , with nurses carrying out the majority of this work . But there is even more work to be done .
A backlog across general practice began to build when appointments in general practice fell by a third , from 24 million in March 2020 to 16 million in April . Delayed or missed consultations slowed patient progression into secondary care , impacting on the entire system . In turn , general practice has been absorbing work from busy hospitals , with both systems treating sicker patients than usual .
Efforts to clear the backlog in general practice may not be as attention-grabbing as those in hospitals , but they are just as essential to the recovery of the whole system from the pandemic . The nursing workforce , of course , takes an essential role in this challenge .
The backlog in numbers
4.7 million fewer patients in England were referred from places such as GPs for consultantled , routine hospital care in the first eight months of 2020 compared with 2019 , a 34 % reduction , analysis by the Health Foundation in November shows
nursinginpractice . com Winter 2021
5.8 million
This is on top of the 5.8 million patients who were waiting to start routine hospital treatment as of the end of September , according to official NHS data – the highest figure since August 2007
13 million
Health and social care secretary Sajid Javid warned in July that the waiting list ‘ is going to get a lot worse before it gets better ’ and could reach 13 million
In an NHS Confederation survey 1 of 451 NHS leaders , published in November , 48 % named pressures in primary care as their ‘ greatest concern ’– more than double the number citing urgent and emergency care ( 22 %). ‘ Being able to free up capacity to tackle the huge backlog of care for people whose care was cancelled during the pandemic feels like a distant ambition ,’ concluded NHS Confederation chief executive Matthew Taylor .
While demand in general practice is climbing , the number of clinicians is not , with nurses reporting increasing absences due to burnout and Covid-related leave , alongside the existing high level of vacancies .
Many general practice clinicians are calling for greater support . Although the chancellor Rishi Sunak earmarked £ 5.9bn to tackle the backlog of elective care in his budget in October , the NHS Confederation said that investment ‘ falls short ’, with the Health Foundation arguing it represents the ‘ first instalment needed ’ and calling for additional funding ‘ for many years to come ’ to tackle the backlog and rising demand in general practice services .
Nursing in Practice looks here at the challenges facing general practice nurses , with inspiring examples of new ways of working being led by nurses , each offering innovative and efficient contributions to help ensure patients receive the best possible care .
The backlog challenge
Bradford-based practice nurse Naomi Berry says demand and workload in general practice are so high that many nurses are now leaving the sector . And more staff are off work than would be typical – some because of Covid-19 burnout and others simply taking owed holiday time , she explains . Ms Berry herself is working weekends at another practice to deliver flu vaccinations , alongside her usual work . ‘ And yet patients don ’ t seem to understand how busy we are ,’ she says . ‘ They abuse us because they can ’ t get appointments or are waiting too long .’
When Ms Berry is not busy delivering flu vaccinations , she is working her way through a ‘ huge ’ backlog of routine care . ‘ Sometimes I look at the patients I ’ ve got to see in a day and think , how are we going to do this ?’ The patients are also tending to come in with more issues than usual because it may be some time since their last visit , she says . But she is also concerned about patients the practice has not yet been able to reach : ‘ Many
General practice delivered
28.7m
appointments in September , compared with 26.6m at the same time last year