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is directly linked to an increased risk of cardiovascular events such as heart attacks and strokes .’ High staff absence and high workloads mean progress on catching up on routine care and checks is slower than it needs to be , he warns .
Meanwhile , cancer services are a ‘ mixed picture ’, says Kate Sanger , head of communications and public affairs at Jo ’ s Cervical Cancer Trust . In England , cervical screening was suspended between April and June 2020 . While the latest national data 3 from November 2020 show coverage actually increased slightly , from 71 % of eligible 25- to 64-year-olds in 2017 / 18 to 72 % in 2019 / 20 , Ms Sanger says she has heard anecdotally that this figure varies significantly between areas – with some places struggling to deliver screening because of high workload , sickness among staff and rising demand , although services are now mostly back to normal .
Ms Sanger is also concerned about falling rates of human papillomavirus ( HPV ) vaccination , which offer protection against cervical cancer . Government data seen by The Guardian in November showed only 54.4 % of eligible boys and 59.2 % of girls in England received the HPV vaccine in 2019 / 20 , compared with 88 % of girls in the previous academic year . This is because schools closed in March 2020 , meaning all school immunisation programmes had to be paused . She says some schools are now prioritising Covid-19 vaccinations for pupils instead of HPV because of limited resources . ‘ The longer it goes on and the less opportunities there are to have the vaccine , the less likely vaccine-hesitant people or families will take it up ,’ she says . This could have a long-term impact on the rates of cervical cancer , underlining the importance of nurse-led screening .
Nurses rising to the challenge
The challenges of Covid-19 have been met with fresh ideas from nurses and their colleagues to improve access , provide more efficient care and make every contact count .
Greater use of remote care necessitated by the pandemic has increased access for many , nurses tell Nursing in Practice . Ms Berry and Ms Carrick say many busy or digitally literate patients are relieved they can now access care wherever they are . ‘ Most patients are working , and fitting in a telephone call is a lot easier than taking time off work ,’ argues Ms Carrick . And when this works well , it speeds up care and means the backlog can be tackled more quickly .
Dr Moore also says the rise in patients monitoring blood pressure at home – often led and supported by nurses – is a welcome efficiency for CVD care . ‘ In this way , we can engage people in a form of self-care which we have found is popular with patients and healthcare staff ,’ he adds .
How the backlog built up
Diabetes There were 7.4 million fewer health checks for people with type 2 diabetes in UK general practices than expected in March-December 2020 , according to University of Manchester research
Cancer Health and social care secretary Sajid Javid told the House of Commons in September that ‘ through the pandemic there have been 300,000 fewer urgent cancer referrals than were expected ’
CVD GP referrals to specialist heart doctors in England fell by nearly a third ( 29 %) in 2020 , according to the British Heart Foundation
There have been large amounts of weight gained during lockdown . People may have smoked more . All these are risk factors for some long-term conditions
References 1 NHS Confderation . Under pressure : NHS priorities this winter . 2021 . bit . ly / 3HxTvhV 2 Carr M et al . Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes . BMJ Quality & Safety . Online First : 12 October 2021 . bit . ly / 3DvT1pZ 3 NHS Digital . Cervical Screening Programme , England 2019-20 . bit . ly / 3DvkYyr
However , Dr Rebecca Rosen , senior fellow at the Nuffield Trust think tank , points out remote care is not always more efficient , especially for patients who might be less confident with the use of technology or who lack internet access . Finding a balance is key , she says : ‘ If you ’ re going to get that backlog managed and enable everybody to get through – not just the people with fast fingers at eight o ’ clock in the morning – you need to understand what model and level of remote care works best .’
Registered nurse and vice-chair of the PCN Network at the NHS Confederation Kat Dalby-Walsh says nurses have worked hard to make every face-to-face contact more efficient : ‘ That is what we and many PCNs are trying to do : if you see a patient , how much can you do for them in that visit ? So instead of having four separate visits for say height , weight , blood pressure and bloods , we do it all together .’
Ms Dalby-Walsh , who is also a clinical director for Yeovil PCN in Somerset , helped set up a local project called ‘ Murmurations ’ to help reach people who were not coming in for Covid vaccinations . Once a month , they walk around the local area to connect with and provide vaccines to rough sleepers , sex workers and other hard-to-reach groups . It is growing too , with people using the service to talk , have a health check or even play chess . ‘ The Covid-19 vaccinations were a real enabler for us ,’ she says . ‘ But there ’ s a load of people out there who need support and may not have been seen during lockdown . Nurses are on the frontline of that .’
Yeovil PCN also set up a young adult diabetes clinic , shared between secondary care , primary care and community care nurses and other clinicians , so young adults can access care , including mental health support and social prescribing . In addition , it is running atrial fibrillation ( AF ) checks at vaccination clinics , where vaccinators also take a person ’ s pulse . ‘ Its efficient , saves time and uses nurses ’ and vaccinators ’ skills ,’ says Ms Dalby-Walsh . ‘ We picked up five AFs out of 70 people we saw .’ The PCN has also visited housebound people to ensure they are not deteriorating .
Ms Dalby-Walsh offers an example of getting maximum value from a single interaction , where a patient came in for a smear test with a PCN nurse colleague but also mentioned a lump . ‘ The nurse referred them and thankfully it turned out to be benign ,’ she says . ‘ But it ’ s a good example of the holistic care nurses can give to make a person feel comfortable enough to share something . She points out that nurses are very good at gently making a referral or saying , it ’ s okay , we ’ re going to get you to see somebody . She adds : ‘ These kinds of projects are starting to grow everywhere – and all involve nurses . They are at the heart of these efficiencies .’
Practice nurses across the country have been working hard with limited resources to improve patient access . The anonymous PCN clinical director from London describes how their nurses are pushing hard on cervical screening campaigns , inviting nervous patients to ask questions in open Zoom meetings . Likewise , Ms Berry says she and her colleagues have made their practice as welcoming as possible to vulnerable patients : ‘ We ’ ve changed clinics around to fit more people in , created more appointments , changed timings so it ’ s easier for them .’ Ms Carrick describes how high-risk patients are given appointments in the morning , when the surgery at its cleanest and quietest . ‘ I am so grateful to my fantastic nursing team . They ’ ve really stepped up to the mark .’
So when will the pressure start to ease ? Ms Dalby-Walsh says one measure of knowing the backlog is under control will be the level of burnout among practice nurses and other clinicians : ‘ Are you enjoying your work now ? Do you still get really stressed ? Or do you actually get up in the morning and think , I ’ m looking forward to going to work today ?’ For now , there is no end in sight . Yet despite feeling unappreciated and exhausted , general practice nurses appear determined to go on working harder and more innovatively than ever . nursinginpractice . com Winter 2021