Latest update: restarting community services

Update correct as at 20 October 2020

All of us within the mid and south Essex Health and Care Partnership continue to face significant challenges as a result of the Covid-19 pandemic and will continue to do so for some time to come. This communication is to update you on the current status of services for the three community providers in our area – Provide CIC, NELFT and EPUT.

We continue to operate in a Level 3 incident with the additional pressure of a potential second wave. Unfortunately, we are seeing an increase in the positive cases of Covid-19 as well as an increase in hospital admissions. This is compounded by the pressures associated with the winter months ahead. Recovery of elective pathways and cancer care also remains a top priority.

Whilst many services have remained open throughout this period, significant progress has been made by community providers to restart non-essential services that were put on hold as a result of the pandemic and in line with national directives; acknowledging that the ‘new normal’ means services may be delivered differently from what we have been used to. Further changes may be necessary in view of emerging pressures.

Colleagues are also asked to note the following key points:

The ‘new normal’

Whilst the majority of services are now operating, the need to continue to be ‘Covid secure’ combined with ongoing pressures, such as complexity of case-mix, means that service delivery is likely to be different from pre Covid-19; a ‘new normal’. For patients and referrers this could mean some of the following changes:

• Digital / virtual / video as the preferred format for interacting with patients in order to maintain social distancing
• Limited face to face interaction. Where this does take place:
  • The overall number of patients seen in a day / week will be reduced compared to pre Covid-19, as a consequence of following Infection Prevention and Control measures
  • Staff will require appropriate levels of PPE along with suitable premises, to follow both the national clinical guidance and estates guidance to ensure care is ‘Covid secure’
• Enhanced levels of supported self-care where clinically appropriate
• A change of clinic location
• A longer period of time between appointments, or targeted follow-up

Patient waiting lists and managing risk

A number of services are seeing increasing waiting times due to Covid-19 and the suspension of non-essential services as part of incident management. This is a combination of more timeconsuming delivery due to heightened safety measures and infection prevention and control procedures, a delay to reset as a result of sourcing Covid-19 secure estate, redeployment of staff to higher priority pathways and increases in complexity of case mix.

Therefore, whilst almost all services and interventions are now operating, throughput of patients may be affected. All patients are being triaged and risk stratified and those with high or urgent clinical need will be prioritised, while teams are working hard to expedite waiting times across the board.

Furthermore, a joint review of the impact on waiting times is also underway to target any potential areas of clinical harm or risk.

Please be aware that patients should contact the community service if they experience difficulties whilst waiting – patients are not being routinely asked to contact primary care in the interim. However, it would be helpful if colleagues were able to please advise patients of the likelihood of longer waiting times in order to manage expectations, whilst not deterring appropriate access to care.

Self-Referrals

Whilst EPUT, NELFT and Provide CIC have a number of services able to accept patient selfreferrals, which will continue to be supported, there are no plans at this stage to significantly increase the offer more broadly (although we wish to standardise this across the three providers, which we believe will have a positive impact on primary care). This reflects the need to ensure demand is appropriately filtered to community teams, supporting the management of already challenged waiting lists to ensure timely prioritisation of higher acuity and/or urgent cases.

The ambition to expand direct access will be revisited as soon as demand and capacity stabilises in line with a lessening of Covid-19 pressures.

Useful contacts

If you require information regarding specific services, the three community providers can be contacted as follows: