As Easter approaches we are thankful to have put the second wave of Covid-19 behind us and continue to make our way through the Covid Vaccination Programme. This is fast moving and changing so please refer to the SALV updates (sign up to emails via the SALV link on our website homepage) or Twitter for the latest on this. At the time of writing we understand you will be contacted for second vaccination around 12 weeks. You can book a first vaccination following the link below:
Demand for our services has dramatically increased. One of the reasons for this is that outpatient appointments are happening on the phone and consultants are telling patients that their investigations and prescriptions will be fulfilled by the GP. In addition, patients are receiving clinic letters they don't understand and are consulting us to discuss this. Whilst we understand and want to help, the sheer volume of these requests is becoming unmanageable, so we are in discussion with our secondary care colleagues to try to find a resolution.
You may have seen our SALV update where we discussed our tentative plans to build an extension to help manage the increased demand. To try to offset the cost of the loan, we are looking at applying for an NHS Dental contract, in order to combine services on site. Clearly there will be many questions around this and we will be addressing these at our SALV Open Evening on 26th April.
By the time you read this I am hopeful that works to create drainage from Gomshall Lane outside the surgery will be complete, and that there is no longer a permapuddle by the bus stop and ambulance/disabled bay. In addition, the pavement works to address the tripping hazard created by tree roots should also be complete. This is the result of a lot of hard work over the past 18 months. I would like to express gratitude to Shere Parish Council for their support, both in helping increase the profile of the problem, and financial support at latter stages to ensure project completion. We are truly grateful, & I know our patients will be too.
As lockdown hopefully continues to ease, we look forward to starting to see groups of people out enjoying our beautiful surroundings again, hopefully in glorious sunshine!
Dr Emma Watts
Working through a Pandemic - 2nd wave: Seeing light at the end of the tunnel
- Dr Charlotte Knight
“In the aftermath of the first wave we had time to take stock. It was not as bad in the end as we had feared, and all our patients who required admission to hospital had a bed. Morale began to rise as the number of Covid-19 affected patients reduced, and we found a way to open our doors safely to increased numbers of patients, focusing on managing our patients’ general health as well as the increasingly high number of mental health problems that emerged in the wake of the first wave.
“Patient demand grew overall, which is what we wanted. We were concerned patients had been holding on to their medical complaints for too long, thinking that their problems weren’t important enough to merit an appointment or so fearful of the pandemic they stayed away. We were generally able to cope with increased demand at the surgery, but hospital appointments proved more difficult – there was a big backlog because hospitals had closed down all their outpatient services during the first wave, and patients became restive.
“The weather last summer was a wonderful spirit lifter, and with amazing community support we renovated our outdoor area so that we could enjoy occasional ‘air breaks’ outside; continuing through winter thanks to the kind donation of an outdoor heater. The one downside of the heat was that our PPE became less comfortable, particularly when it hit 36 degrees. Our nursing team were worst affected as most of their patients need face-to-face appointments, unlike many doctors’ appointments which can now be conducted online or over the phone. The cleaning of rooms between patients became an essential and sometimes much-anticipated break from the oppressive heat of gloves, mask, visor and plastic apron!
“We were delighted to reach the finals of the National GP awards for Public Health and Prevention, which recognise a team who have demonstrated excellence in improving local healthcare. One of the Covid-related improvements is our new Pharmaself dispensing system donated by the Shere and Local Villages Charitable Trust (SALV) supported by our incredibly generous patients and for which we are immensely grateful.
“In autumn we saw the second wave approaching, but this time we felt ‘battle ready’ and with high team morale and continued extraordinary community support we felt well equipped to protect our patients, our staff and the building. However this second wave proved very different from the first, with many more patients affected. With the new variant, clinical presentation has become more varied, and patients are now presenting with Long Covid. In the first three weeks of January, 1% of our patient population tested positive and this rose to 5% by the end of January. Patients were frequently needing admission and as a team we were shocked and saddened by the impact.
“During the first wave, we assessed Covid-19 patients in a tent or ‘Hot Pod’ in our garden area, keeping the surgery building safe for staff and patients alike. As the weather declined and the symptoms of the new strain became more diverse we had to reassess. We constructed a ‘Hot Bay’ at the far corner of our car park where patients with Covid-related problems could come in their car for a basic assessment and oxygen saturation measurement. This proved challenging in the wind and rain of winter as our equipment stops functioning when too cold, so swaddling both ourselves and our equipment became the key to success. We do see some Covid-19 patients in the building now, because presentations have become so varied and many patients need a general examination within a fully equipped consultation room. We’ve assigned a room by the back door for this, which is deep cleaned after use, but it has challenged our desire for a ‘Covid-free’ building.
“Thankfully locally numbers are now declining, and fewer are being admitted to hospital. Life at the hospital is slowly going back to normal. In the surgery we’ve recently introduced lateral flow testing (a rapid test that returns results within 30 minutes) for staff which is now done twice weekly, an immense comfort for patients, staff and their families, to know that we are not vectors of the virus.
“The vaccination programme is well underway. After such a long time waiting it’s been a real high point for our team to deliver the vaccine to our housebound patients. Our calls delivering news of vaccination appointments have been met with great excitement and to see our housebound patients face-to-face again has been a heart-warming experience. The vaccination programme has allowed us to raise awareness of the constraints of rural general practice. We’d hoped to deliver the service at the surgery but due to problems of cold storing the Pfizer vaccine and the requirement to give 975 doses in three days, our patients have had to travel. We’ve lobbied MP’s to allow us to deliver the more manageable Oxford/AstraZeneca vaccine, and are hopeful these representations will change the contract available to rural GP’s Nationally.
“We are beginning to feel optimistic that there’s light at the end of the tunnel, and we’ll soon be able to spend some quality time with our families and friends. The surgery team are continually encouraged and very grateful for the generosity and thoughtfulness of our patients during this challenging time. It is the strength of community that has helped deliver us through this second wave.”
Spring has finally arrived, and with it hopefully promise of some healthier months ahead. The Covid Vaccination Programme has been going really well, and 180 of you are now on the SALV email distribution list, receiving my updates when things change. At the time of writing, we have had excellent uptake from the Over 80's, the Over 70's, the Clinically Extremely Vulnerable, the Housebound & those with Learning Disabilities. We are continuing to work on our Homeless population and by the time you read this I hope we will be actively booking in anyone Over 60. I've spoken with a lot of pride about our hardworking team over the past year, but Reception and Admin deserve much recognition for the extra hours they have put in on the phones. Thank you for the positive feedback you gave from our virtual Twitter tour of the Surrey Hills on our Housebound Vaccination Day. We covered 140km of narrow roads in the Surrey Hills that day, against the deadline of vaccine expiry at 6pm. It was quite exciting, tiring, but lovely to see faces of those we haven't seen for so many months. We had a bit of fun stopping to take photos on the way and were pleased that this brought a bit of community cheer at a rather bleak time. We were followed online by 28,000 people at one point, from South West England to Scotland, including NHS England, which is staggering considering it was just supposed to be a bit of fun for our patients!
Second Covid Vaccinations: Keep your eye on the news as this has evolved over time, but once we are authorised to start giving second vaccinations, you will be contacted by the site that gave you your first. We are not expecting any involvement in this, and we won't be able to switch you to a different site. This is potentially subject to change, so keep an eye on Twitter, SALV updates, or posters at the Surgery. However, do not worry that you need to organise second vaccination, you will be contacted. Currently this is expected to be 12 weeks after the first.
Royal Surrey coped with the peak of the Second Wave really well, and we are so grateful to them, and to the Ambulance service, for helping to support our patients. Our thoughts are very much with the family members of our patients who sadly passed away during this time, but we are so grateful that the majority of our patients have recovered well.
SALV (Shere and Local Villages) Charity has been so supportive to us over the years, and over recent months I have been really grateful for the help with communication to the community. In the background, SALV have offered to buy us new seating for the surgery, which hopefully will be arriving soon. Our current seating is not coping with the degree of cleaning required now and is starting to fatigue, which could be a problem for infection control. We are gradually redecorating the building inside to make it feel more warm and welcoming for our patients, and for our staff. Local photographer Michael Hutchinson is letting us use some of his images to create some high impact artwork for our reception area. We have a new surgery sign on its way to replace the faded green one, and a team of local volunteers are going to help clean the algae from the building. The pavement repairs and drainage issues in the road and disabled/ambulance bay will be addressed at the start of April thanks to a significant funding contribution from Shere Parish Council, to subsidise Surrey County Council shortfall.
SALV have booked their Spring Open Evening for Monday 26th April. The format for this will depend on social distancing at that point, but I would encourage anyone who hasn't attended before to come along. SALV have supported the surgery for many years, but it really feels that the past year has been different in so many ways. It would be nice to expand their reach to enable us to evolve our services going forward to meet the requirements of our community more effectively.
Writing for the parish magazine this past year has been challenging as things at the surgery sometimes now change hour by hour. Therefore, submitting 2 weeks in advance is fraught with potential communication fails. In the early stages of the pandemic I felt we were managing to communicate fairly well, with boards outside, the Parish Magazine &Twitter. However, in December I began to feel unable to truly convey to our community what was happening at the Surgery regarding the Covid Vaccination Programme. We began to be so preoccupied with communicating above us to try to secure a contract we were able to deliver as a small rural practice, that communication with you took a back foot, as we had no updates. I know our silence led to worry, as I was watching the news which talked of the vaccination progress being made, and I know you weren’t feeling it here locally. Adrian O’Loughlin, SALV Chairman, kindly contacted me for a chat and, aside from updating him; we discussed the issues we were facing. Kindly, Adrian agreed to consolidate our chat into an email to go out to the SALV distribution list. This was brilliant as it meant we were able to communicate faster, disseminating news to our community better. The content hopefully reassured everyone that we were doing everything in our power to get vaccination underway (even if it couldn’t be at the surgery).
As a consequence of this, yet realising many are not on the SALV distribution list, I wondered if I could clarify how we intend to communicate with our community en masse. When we have an update we will:
1) Use Twitter- this is really quick. If you are able to join Twitter and follow us this will simplify things, but if not, the last 5 messages are available to view on the home page of our website at any one time, so you could choose to look at this regularly instead. (As I write, I am conscious that my children would eye roll to read me advocating social media! I completely accept social media is less than perfect. We will try to engage many methods, but it is the quickest.)
2) Email updates by SALV distribution list- Adrian has a cascade system to disseminate updates by email. These emails can go out daily if required. If you would like to join the SALV supporters, we have simplified our website and there is a simple SALV box to click on our home page.
3) Boards at the Surgery- we will update these as quickly as we can, but they reach the community far slower, and sometimes less accurately, leading to multiple phone calls.
We have decided to stop updating the website separately from the Twitter updates on the home page. This is because the home page had become so busy that it was hard to see the pertinent communications.
At the time of writing all of our over 80’s should have a planned vaccination. The next group will be the over 75’s. I cannot stress enough that we will call you, and keep calling you until we get you! Please don’t call in and block our lines for vaccine queries unless you are in a completed group and are unvaccinated. We will continue this way until the process is complete.
Please keep a pen and paper by your phone to write down your appointment details. It delays us if you need to call to check. We don’t have the ability to cancel appointments made, so please bear this in mind.
Covid Precautions: We continue to experience really high demand for appointments despite the pandemic. From the outset we have continued to see patients face to face when clinically indicated and this has not changed. We need you to be aware that, if visiting the building, your appointment will be as swift as we can make it as additional face to face time (even with masks) increases risk for you, and for our team who spend a lot of the day in face contact. Anything that can be dealt with on the phone/remotely will be. We want you to contact us if you have clinical need. If it is something minor that can wait, please could you do so. However, we DO NOT want you to hold back if you are worried about something more significant.
Seasonal Flu Vaccination: This is a funny one… we had an incredible flu clinic series run by our epic nursing team, who adapted to circumstances and delivered outdoors. When we ran out of vaccine (as more people wanted it this year and we put our orders in many months in advance) I worked hard to secure additional supply to ensure everyone in the standard cohort (& in the new 50-64 cohort) could have access to a vaccine. We achieved a significant delivery but have been a bit disappointed that appetite for seasonal flu vaccine seems to have dwindled? The importance this year was because if you were to have both seasonal flu and Covid combined (or one followed by another) mortality rates were far higher. We have excess flu vaccine in our fridges, and I would be devastated if it were wasted…
Covid Assessment Bay: We are now assessing potential Covid patients in their car in the car park, as this reduces transmission risk. If you are attending the bay, please can you try to keep warm on your drive to us and maybe keep engine on and heaters on while you wait? We particularly need your fingers to be warm so if driving please wear gloves, and maybe passengers could wear gloves but keep hands squished between thighs for warmth on the journey? We are experiencing difficulty with our kit working in cold temperatures and are looking at ways to manage this.
By the time you read this, I hope we are well and truly into the vaccination programme and that you feel that you are being involved with the issues along the way. If you have any suggestions for how we can involve you more, in a swift and efficient way, PLEASE do let us know, as currently this feels like a priority.
Dr Emma Watts
Special Article: Working Through a Pandemic - First Wave
Dr Emma Watts
In the early part of 2020 we began to realise we were going to need to prepare the practice for something which had the potential to become one of the biggest challenges in the history of the NHS. Early projections of potential Covid deaths led us to believe we could lose 80,000 people nationally, and we started to prepare our local response. Having never been through anything like this before in our many years working for the NHS, it felt like we were preparing for War. The partnership felt a huge and emotional sense of loyalty and responsibility toward our staff. People were afraid about coming to work, unprotected by absent PPE, fearful of taking disease home to vulnerable loved ones. We felt the same feelings about our patients, and started to reflect on the numbers of vulnerable patients we have, feeling anxious about how the community could possibly cope with potential losses of so many vibrant personalities.
This took us swiftly into active pandemic planning. The early signs of mixed political messages (news on the TV that didn't reflect experience on the ground) came right from the start. There was a delay in guidelines being cascaded down, and the GP community responded by creating our own guidelines & policies, sharing them widely on social media with other practices. We formed closer bonds with colleagues from neighbouring practices.
From the sense of inadequate leadership from above, came a sense of unity within our profession, and an increased speed of sharing consensus on good practice.
Very early on we were closed due to proven Covid-19 within the building, and from the point of the closure and deep clean we started to experience admission of sick patients, friends, and colleagues. Then, for me, the first death of an old colleague, and one of my best friends, his ITU consultant, blaming herself for failing to save him. Meanwhile, my nephew Thomas, aged 14, became the first person to upload specifications for a working 3D printable ventilator solution for mass production in hospitals. It blew me away with pride that he would use his time, age 14, to try to make a positive impact in the world.
Instinctively we began to counter emotions with action. Staff worry about safety at work was met with an increased resolve to keep the building safe for staff and healthy patients, leading to the set up of the HotPod outside, to keep Covid patients separately managed. Upset about the barrage of mixed communications from the media and our governing bodies, was met with the introduction of a daily SitRep (situation report) meeting for the entire team at 1pm daily, to update on new policies agreed by the partnership, help iron out any worries & provide camaraderie with an increased sense of cohesion.
Not having time to queue to buy groceries led to supermarkets offering an NHS hour. Our team experienced a horrible feeling of judgement when they were allowed in as others queued for mainstream opening, with negative emotion expressed at them. We countered this by giving them NHS lanyards to make their NHS ID cards look more obvious to the public, and car stickers to try to achieve the same. There are too many examples to list here, but we learned that the best way to counter difficult emotion was to meet it with a corrective action, as best possible within the uncertainties of a global pandemic.
Lockdown one brought a new influx of emotion, mainly guilt. Our entire team was working hard, working long hours, feeling emotionally drained, but lockdown brought a new problem with the obvious differences the population were experiencing. Our children became sad that their friends were home with their parents, experiencing a time like never before, showing pictures on social media of family walks, board games, gardening, cooking and an unforgettable family bonding experience. Our children were experiencing the stigma of being ‘keyworker kids’ and school communications repeatedly referred to needing to remain open to cater for them. This was just clumsy wording in school communications, when the teachers were also under strain, but enough to lead me to allow my children (who were luckily old enough) to stay home alone. Looking forward to Bank Holidays and Easter, to try to compensate for these lost family times, led to disappointment as General Practice was ordered to remain open, but our staff rose to the challenge of this, and we met the feeling of disappointment with a drive to spend any spare moments tidying up our outside space to make our environment a bit more homely.
The evolving emotions within the surgery throughout the First Wave were also countered by actions outside of the surgery… from our community. Too many wonderful actions to list here, we discussed them at our SALV zoom meeting and we have them documented so that history never forgets them, but they range from small children washing cars to raise money to buy us PPE when we had none, patients donating us anything they had to protect us, cakes (in some cases regular cake making!), a garden table for our staff, land rover on loan for home visiting, all the way through to the SALV community fundraise for the incredible dispensing machine. The community spirit that was evoked by the First Wave was really humbling, and no amount of Thank You messages will truly convey how much this meant to us when things were hard.
We prepared for First Wave as if preparing for War. We tried to cover all aspects we might need and prepared for the worst, expecting the NHS to be overwhelmed very swiftly. The reality was that, at the peak, the NHS coped and the danger abated for a while. The First Wave battle had passed, but the war continued…
Dr Emma Watts
Happy New Year from all of us at the Surgery!
This time last year none of us really knew what was ahead of us, and I sincerely hope that 2021 brings us a widespread vaccination programme and that life can gradually return to some form of normal.
At the time of writing, Pfizer vaccine is being given from Royal Surrey County Hospital and other sites that can accommodate the cold chain demands of the vaccine. We are hoping that other vaccines will be licensed shortly as these are the type that will be deliverable from the surgery similarly to our seasonal flu vaccine programme. We have doubled our refrigeration capacity in anticipation.
Please watch our website, Twitter (@ShereSurgery) and posters at the surgery for updates.
Regarding seasonal flu vaccination, you will remember we ran out of vaccine and applied for more to cover the new cohort of 50–64-year old's. We were lucky to be sent a top up delivery. Surprisingly uptake of the vaccine was poor, with only 16% of the eligible population taking up the offer of the vaccination. We have spare vaccine, so please do contact us if you wish to be vaccinated and we will try to fit you in if possible. We had hoped to do these vaccines in our saturday clinics so as not to block our weekday nurse appointments, but we were unable to even half fill the final saturday clinic.
Please can everyone be careful on the pavement outside the surgery. This has become quite bumpy due to tree root disruption. Shere Parish Council have offered to contribute to works undertaken by the council, but there has been a significant delay. In December, despite us keeping the path free of leaves twice weekly, we had two patients with significant head injury from falling. I have been reassured by Surrey County Council, after members of Shere Parish Council helped highlight the issue, that the work will be prioritised. Please tread carefully in the interim, especially as we head into the season of ice and snow.
At the time of writing, we are running at full capacity at the surgery, with a significant increase in demand compared to the same time in 2019. This increase in demand is reflected nationally, but leads us to have some concern with the busier months ahead. Please bear with us if you feel we are responding slower than usual.
Finally, the Dispensary machine has been really active, and we have had lots of positive feedback from patients. Please do remember if it is your first time using it, there is a video on our twitter feed running through how it works. Our dispensary staff are happy to pop out and help anyone who is not sure also. Thanks again to SALV for fundraising for the project, I really do think it will be a godsend through the winter months. Now the install is complete, we are slowly working to improve the planting outside the surgery for everyone to enjoy.
We look forward to 2021 being another really strong year for our community, and very much hope it leads somehow to us all being able to celebrate the positives that came from facing a pandemic together.
Wishing you a happy and healthy New Year,
Dr Emma Watts
At the time of writing we are approaching Christmas with uncertainty about what will happen after lockdown. Things are busy at the surgery with appointment demand at mid-winter levels. We may be told we have to be open on the Bank Holidays over Christmas and New Year (as with Easter and other Bank Holidays earlier in the year) but we are hoping our staff can have some well-earned time with their families. We currently plan to be closed on Sat 26th Dec. Due to increased demands at Christmas we request you put in your repeat prescription requests as early as possible.
As we progress through the second wave, with patient demand already at high levels, we are seeking advice on how to manage when we reach capacity for safe practice. We will update you when possible, but this may involve a traffic light system or a scaling back to urgent services. We await advice.
Covid vaccination has featured heavily in the media. Although it is an exciting development, we have no certainty yet. We were asked to provide an 8am-8pm 7 day a week service, on top of our normal roles, with no additional staff available as our staff are working at full capacity. The service required to achieve this would dwarf our busy flu clinics. We are 100% committed to ensuring safe delivery of an effective vaccine and are working hard at trying to design a service which can be responsive as soon as a safe and effective vaccine is available.
The DVLA are struggling with backlog and have started writing to patients suggesting that their GP can verify their fitness to drive. This puts us in a difficult position with our patients, whose expectations have then been raised, as we are not trained or indemnified to do this. An error in deciding fitness to drive could have catastrophic consequences, which is why there are doctors specifically trained in this area. Unfortunately this has led to patient upset recently. If you have been diagnosed with a condition that legally requires you not to drive, we cannot override this, even though we have a huge amount of sympathy for the consequences, especially in our rural area.
Finally, some happy news… The dispensing machine (nicknamed Brenda the Vendor) was finally installed in November and we are currently learning how to use her! We have had a lot of fun loading up, and watching patients do a collection. Initial feedback is great. (Please bear in mind you only have 60 seconds to push the flap open and retrieve your medication once it has been dropped into the tray). We are already seeing benefits, for example at 7pm Friday, when we were closed, I needed to give an urgent prescription out, so I loaded it into the machine, and the patient’s relative came to collect. I hadn’t foreseen this additional benefit.
2020 has been an extremely demanding year for the surgery. The one enduring positive throughout has been the feeling of community, and the support we have had. Thank you to SALV and all donors to the innovative Pharmaself project, and thank you to all of you who have been supportive and understanding, as we try to do our best for you in challenging circumstances. We wish you all a Merry Christmas and a Happier 2021.
Dr Emma Watts
At the time of writing, we are heading into the second wave of Covid-19, but so far local services are coping. We will continue to keep you updated via our website, and via Twitter (@ShereSurgery). You may have seen nationally there are issues this year with regard supply of flu vaccines, together with the expected increase in uptake this year. We started talking about the importance of this year's campaign back in the August issue, but I am disappointed to report that, at the time of writing, all of our promised stock has been allocated to patients who are on the vulnerable list. We do have vulnerable patients who have NOT been vaccinated, and I can assure you we are working tirelessly to access further supply to cover this population. We will post updates on our website, on Twitter, and on noticeboards at the surgery. You may have seen the Government announce some time ago that a new cohort (healthy 50-64 year olds) would also be offered a flu vaccine this year. If we are allowed further supply, and if we have vaccinated our vulnerable population, we will put on further clinics to vaccinate this group. Again, please look out for further updates.
We have also struggled recently with a national supply problem of blood test reagent. We believe this has been to do with the company prioritising Covid testing kits, but the impact has been a national one, with reduction in ability to perform routine blood tests at our local laboratories. There will be more news nationally on this, but please be aware that we may need to cancel/not order blood tests.
This year the flu clinic had to take on a different, outdoor format. We worked hard to ensure these have run smoothly, avoiding queueing by running as seamlessly as possible. I feel extremely proud of our team for delivering over 1500 vaccines safely. I also feel proud of our patients, for understanding the difficulties, and embracing the change in system with good humour!
If you are passing the surgery, you will see we now have builders fencing surrounding the Pharmaself installation site. We have had numerous hiccoughs along the way, but work is now in progress. I really hope that by the time this is published we will be almost ready for the machine to produce it's first prescription! The strength of community spirit allowed this project to come this far, and we really hope it will allow easier access to medicine, especially over the winter months, and substantially reduce the need for queuing.
Finally, a goodbye.... Sarah Ingram retired as Dispensary Manager at Easter 2020. However, we were mid pandemic and as the incredible team player we know her to be, she swiftly shifted her retirement in order to try to help us get through those difficult first few months. Finally, we said Good bye at the end of August 2020...although she has been back covering a few shifts here and there!!! Sarah worked at Dispensary for 25 years. She has been a highly valued member of our team, and remains a highly valued member of our local community. For me, I think the fact that Sarah struggled to leave us at a difficult time, and the fact the we struggled to let her go says everything about what she has meant to us in the building. Sarah has helped new Dispensary Manager, Sharyn Mackay, to settle in to her new role, with a really supportive handover in order to ensure the service runs smoothly through the second wave of Covid-19. We will miss Sarah greatly, but wish her the very best in retirement.
Please continue to keep an eye on our website/Twitter/noticeboard for updates on the evolving pandemic.
Dr Emma Watts
As I write this we are feeling disappointment with the media portrayal of GP work during the pandemic. The suggestion that we are not seeing patients is frustrating for our staff, as we are currently running at winter appointment levels, near full capacity. Whilst I believe some practices did close their doors, we have continued to see patients face to face throughout the pandemic, where appropriate. In order to protect both patients and staff we have reduced face to face contact to only when needed, using other methods where possible. We purposely chose to set up our HotPod in the garden because we wanted to assess you ourselves, as we feel we know you best, rather than sending you to a HotHub elsewhere to be seen by a Doctor you don't know. As soon as we were able to reopen after our deep clean, we brought nonCovid patients into the building to be seen where appropriate. We have had lots of positive feedback from the community, and some frustrations expressed about the imposed new ways of working, which we completely understand.
As we move toward winter, we will have to slightly rethink the HotPod, as the weather becomes colder. We will update you next month. We now have amended planning permission for the Pharmaself machine, and the access ramp is under fabrication. This will need to be in place prior to installation, as the machine itself is heavy to be moved into the building.
We were delighted to see so many of your faces on Zoom at the recent SALV Autumn Meeting. Whilst it was not the same as meeting in person, we loved seeing you all, and having the chance to update you on many (not all) of the things that have happened at the surgery over the past 6 months. Thank you for attending, and for your continued support.
Currently, Covid-19 infection is increasing in our area, and we expect this to continue. Please keep an eye on our website for updates. Dr Wardrop has kindly created an infographic to advise parents on how to manage unwell children as winter approaches. This is aimed at answering some of our current frequently asked questions, so that hopefully we can reduce phone calls around this.
Finally, we look forward to seeing you at Flu Clinic. We are trying to make it as jolly as possible, despite being outdoors and potentially cold. There will be hot drinks available to purchase. Many of our patients have said they are looking forward to seeing friends in the queue, and we find this really lovely, but PLEASE remember we need to keep socially distanced in the queue. We will be on hand to remind people, but it will reflect badly on us as a community if we don't achieve safety at the Flu Clinic. I'm looking forward to seeing you in person too, and will be interested to see how the new style of clinic works out!
Please continue to watch out for each other as autumn approaches and the weather becomes less favourable.
Dr Emma Watts
When you read this then, pandemic dependent, schools will be hopefully be returning, and we will be heading toward winter. Summer at the surgery has been a hot and busy one, with high demand, and more complex turnaround with distancing measures. Our staff have coped admirably with wearing plastic visors, scrub hats, plastic aprons, gloves, and of course, masks, in the heatwave.
A few updates:
Leaving our practice boundary
We often get asked by patients who are leaving the area if they can stay on as patients at Shere. This is a source of great encouragement for us and shows we are doing a good job as a practice. Indeed, in the past, the practice was able to keep patients on despite them moving outside the practice boundary.
However in the current climate, particularly as a rural practice, this is not practical, and sometimes might even be unsafe as we only have enough resources to look after the patients in our designated practice boundary which already covers 45 sq. miles, [as set by the Clinical Commissioning Group (CCG)].
Furthermore, there is no NHS funding available to extend the building and accommodate more patients and staff – we are already at capacity at present. In addition, in common with most other practices, we already have difficulty recruiting staff for our existing area.
Sometimes a move may not seem geographically very far out of our boundary but causes safety and logistical concerns due to being served by different community services to the ones commissioned by our CCG with whom we normally correspond, have regular meetings, and streamline referral pathways.
It would not be fair to patients who live in our area to experience difficulty receiving medical attention because we are overstretched by caring for patients who live outside our practice boundary.
Please do not be offended when we have to decline such requests but it really is the only fair, and safe, way of operating.
It is important to note that existing registered patients who are outside our boundary, based on historical agreement of a previous partnership, will not be affected.
There was an expectation of a centralised response to coordinate the flu vaccination programme this year, but thus far we have heard nothing, so are moving forward with our own plans. We have little time, so I am sharing our provisional plans, but please be aware these are subject to change.
Our nursing team have our staff and patients well trained to deliver a swift turnaround on vaccination. This year we will be limited by social distancing. We plan to deliver the vaccine in the Covid HotPod, set up in the carpark as a two lane walk through service. We are trying to create a more jolly atmosphere by demarcating the socially distanced queue using bunting, made from spare shirts from our early shirt campaign. (We had hoped for 50 shirts, were donated about 400, and subsequently were donated washable handmade gowns). We wanted the shirts to be a reminder of the kindness of our patients, donating the shirts from their backs, and we hope that you feel happy the spares are being repurposed as a further part of the pandemic effort.
There will be separate clinics for the Over 65's and Under 65's, as the vaccine is different, as are delivery dates. We will make separate arrangements for those too frail to queue in a wheelchair. The new cohort of all Over 50's, added by the Government recently, will NOT be part of the above plan YET as we ordered our stock according to our eligible population. We have not been allocated any additional vaccine stock for the additional cohort, and will prioritise the MOST vulnerable. If/when the Government guarantee us further stock, we will simply elongate our campaign until we have everyone vaccinated. Clearly we are expecting a huge increase in uptake this year.
Provisional dates: provided our stock arrives on time we will have 500 vaccines for Over 65's on 3rd October, and 200 vaccines for Under 65's on 10th October. There will be more dates announced as and when we have more information. We are not yet booking, but keep an eye on Twitter, our website & posters outside the practice for updates.
If a centralised vaccination plan emerges the above may change, but our plan is to celebrate the best of our community spirit by trying to keep our clinics as close to normal as possible, and make the best of the difficulties.
Pharmaself Dispensing Machine
I have been lucky enough to see a sneak preview of the machine facia, in British Racing Green....it looks fantastic! We are currently awaiting an amendment to planning permission for the access path, which needs to be of stronger build to cope with the installation weight of the machine. All contractors are poised for action once this is approved.
Don't forget to sign up to use the Pharmaself machine, using the form available on the website or from Dispensary.
Finally, we were delighted in August to receive a donation of £111 from Sophia & Sebastian Ackroyd and Arabella & Oliver Hill. They had washed cars, and painted pebbles to raise money to buy us 250 masks, as we were struggling to get PPE. There have been many humbling moments through the pandemic so far, and this was certainly one of them. The fact that four young children were prepared to use their time and energy to help to protect our staff brought tears to our eyes. Thank you, you are clearly going to grow up to be wonderfully selfless individuals of whom we can all be proud.
I apologise for the length of this article.... I am longing for a quiet month in General Practice! In the interim, please continue to look out for each other. Our strength is community.
Dr Emma Watts
As lockdown continues to ease, we would encourage everyone to remain mindful of social distancing, and the reasons for it. We are gradually returning to normal service at the surgery, but are still aiming to only see patients face to face when absolutely necessary. This is for our safety, as well as yours, as the healthcare profession have been more unwell with Covid-19 due to higher viral load exposure from sick patients. We need to protect our workforce as best possible. You will notice our turnaround is slower between patients due to enhanced cleaning processes, and changing PPE. We are being supplied 50 masks per week as our NHS allocation, which is inadequate, but are currently still able to purchase what we need.
We are delighted to inform you that our planning application was approved for the Pharmaself machine. It has been ordered, and we are hoping it will be installed in the next 4-6 weeks. This will hopefully dramatically reduce the queue for Dispensary, which will be lovely as queuing without seating in hot/cold/rainy weather is less than ideal.
We are starting our advance planning for the 'flu vaccination clinics. We have been told to expect far higher demand this year for obvious reasons, and our usual format of 300 appointments each saturday morning at the practice will not be possible, due to social distancing and PPE restrictions. We have a few ideas for how we might run the service efficiently, in order to safely deliver the vaccine, but I am raising this now so that you can ensure you keep your eyes out for notices about the new plans, which are likely to be dramatically different to previous years.
Finally, a huge Thank You to those who supported my daughter Sienna and I with our Virtual version of the cancelled 125 mile Devizes to Westminster International Canoe Race 2020. We raised £5648.75 for the Royal Marsden Cancer Charity, and we are featuring in their August magazine as their most successful lockdown fundraisers! In addition, we have been nominated for The Pfeiffer Cup, which aims to reward fundraising as a motivator for completing the race. Thank you all for your support.
Dr Emma Watts
Again, it is hard writing this as I’m not sure what Covid-19 will be bringing us by the time of publication. We are following guidelines with the idea of getting the building up and running efficiently as quickly as possible, but we have continued to manage numbers of appointments as before Covid-19. We have achieved this by consulting remotely, reducing face to face contact to essential only. We have missed seeing you, but have loved having video consultations, where we can see smiles again. It has felt amazing to have a video consult with someone who stops in the middle of their run with their dog in the woods to chat on video, and use the camera to help demonstrate the problem. Innovation appears to have evolved from this difficult time.
I have been asked to talk about numbers of cases in our villages, but I am unable to as we are only just getting the results of testing sent from the test providers into our computer system. The likelihood is that actual case numbers will exceed the test positive numbers for a multitude of reasons. However, I can completely understand why this is information that is pertinent. Obviously we are aware of the patients that we have lost, and our thoughts go to their families. Equally, we have had some patients who have been extremely sick who have made incredible recoveries, and this has been brilliant as a morale boost, so amazing to see. General population estimates for our area will probably take many months to generate. Anecdotally though, I feel we have been relatively spared compared to other areas of the UK. Certainly Royal Surrey seem to have coped well, and Intensive Care & high intensity care has been able to match demand. Overwhelming the NHS with a surge was one of the main worries as we planned services, but so far locally we have coped, hence we hope that going forward case numbers remain low and predictable.
The update on the SALV Dispensary Machine project is that we have so far had one comment to the council, which was one of strong support, Thank You! The council have indicated that they are hoping to complete the planning process quicker than the normal projected time, and we are grateful for this. We have been organising the building aspects in anticipation, with the hope that we can progress as soon as we get a green light. Initially, when we proposed this idea, it was as a response to the immediate problem facing us, but as time has passed it has become more apparent that there will be a new normal going forward. None of us like seeing the 2m distanced queue along our pavement, and the thought of this continuing into winter is unimaginable, so I truly hope that SALV’s expedient response to the pandemic will deliver a long term resolution for all.
If you follow us on Twitter you will have seen the picture I posted showing the volume of wasted medication. Strangely, we are finding currently that people are requesting medication, but after 2 months haven’t actually collected it? This is tricky because we are still struggling with medication issues around Brexit. Whilst we understand issues around shielding etc, we have an incredible community support network, so nobody should feel unable to receive medication. Please contact us if you are struggling and we will find a solution.
Finally, a sad goodbye.... Cathryn Bovingdon has been our Business Manager for 16 years, but has progressed upward through the practice since she arrived as a young dispenser! Throughout, she has been utterly dedicated to issues surrounding rural dispensing, progressing to being an absolute advocate for retaining the integrity of General Practice as an independent arm of the NHS. Politics, and the fear of erosion of the continuity of care that is pivotal to what makes General Practice valuable, are beyond the scope of this article, but it is important to note that Cathryn has been a stalwart, encouraging neighbouring practices to adopt a Shere model. Cathryn’s children have now flown the nest and she is moving to a business development role nearer to home. We will miss her desperately, but are delighted to announce that Tamsin Barnard will be moving from Deputy, to Practice Manager.
Finally, please continue to be considerate to each other. We have been humbled by the community spirit we have witnessed, which has helped us deliver person centred care at a tricky time. We will definitely need a time to reflect on all the wonderful positives once this is all over, but in the interim, please continue to look out for each other.
Thank you, Dr Emma Watts
SALV: Wall Dispensary Project & broadband
In late April SALV started on the ambitious task of raising over £40,000 to supply Shere Surgery with an external wall dispensing machine so that patients could collect their prescriptions 24/7 and avoid unnecessary queueing in the Surgery with the potential risks that entails. I had expected this to be a long-term project, but thanks to the amazing generosity of our community we have already received, or had promised, our initial target – a truly amazing local effort of large and small donations. Sincere thanks to everyone. The next step will be to await planning permission for the installation, and thereafter we hope the project can move forward quickly. A typical dispensing machine is pictured left.
Our next initiative, which will be a longer process, is to try to secure superfast broadband for the Surgery through B4SH, Broadband For the Surrey Hills. It would be good to identify a small group of Shere residents to act as ambassadors and to keep up the momentum. Everyone wants superfast broadband and our hope is that by maximising local support we can move the project forward and get the Surgery high on the waiting list. If you are interested in becoming involved or finding out more, please contact me at
Adrian O’Loughlin, Chairman
Writing this article for the past few months has been extremely difficult, as everything seems to be changing so fast. I would continue to point you towards our website, , and for up to date advice on Covid-19. We have had lots of patients who have recovered from Covid-19, some of whom required hospital admission and some of whom remained at home throughout, and it has been lovely to see these positive outcomes. We have sadly had some losses too, and our thoughts are with the families of those who have lost a loved one.
In the HotPod, our outdoor tented consulting room set up in the Surgery garden (which we told you about last month), we have been able to use one of our scanners to scan lungs if appropriate, and have used the facility to decide if we can manage people at home or if we need to admit them to hospital. But we are still being advised to see patients face to face only when absolutely necessary.
We have been using phone and email to consult, but in May we have been excited to introduce secure video consultations. These are great as we can see you, and you can see us, which is nice at a time when things can feel a little lonely. We have been stunned to see how much we can “examine” on video with the help of patient and family, and we feel this has been a great development.
The Dispensary is still closing at 4.30pm to allow them time to catch up with the increased demand. This was a national directive, allowing all pharmacies to reduce opening hours and give them time to get the medications ready. Please continue to be patient with them – they are working as fast as they can – with many staff doing additional hours.
This crisis has highlighted the incredible strength of our community spirit. As a response to the demand on Dispensary, we have come up with a solution that will take us forward, and SALV has managed to raise funds to pay for this in an extraordinarily short time (see SALV report above). This machine will really put us at the forefront of General Practice. We were also stunned to have been given a substantial donation by Hilly’s Tea Room, who raised funds by selling cakes (and delivering many to us – yum!). We have used the money to buy our own PPE in order to protect our staff, and we are truly grateful to all donors to both of the above projects. In early May I also took delivery of 500 masks imported for us especially, and donated by Shere Village Cinema. The generosity we have received has been truly overwhelming. Thank you all so much.
Finally, you may remember that my daughter Sienna and I had planned to complete the Devizes to Westminster 125-mile international canoe race over Easter. This was cancelled, but we didn’t want to let down the Royal Marsden Cancer Charity and our sponsors, so we set up a pair of kayak machines in our back garden and completed the 125-mile race “virtually” in 20 hours, 45 minutes! The Canoe Show on YouTube picked this up and you can view it on ; the picture shows Sienna and me after finishing the race!
Please continue to look after yourselves and each other, and I truly hope it won’t be long before we can get together as a community and reflect on all the incredible ways everyone has pulled together during this unprecedented time for the NHS.
Dr Emma Watts
Life in General Practice has changed dramatically. Our technology partners have stepped up, and we have been able to offer video consultations for the first time. We have made other dramatic steps forward for the NHS, such as sending sick notes as an attachment to a text message, with a digital signature! When we do need to see patients face to face, they are being seen in our HotPod, which is an outdoor tented consulting room. This allows good ventilation, is easier to mop down, and allows us to try to keep the building virus free for those vulnerable patients we do have to bring down. We are also using our ultrasound skills to scan patients lungs. This is usually done in hospital, and we are hoping that we can use our skills to try to pick out which patients might be at higher risk, and need priority hospital admission.
We have been preparing for a massive increase in home visit demand, which will be challenging with our staff numbers and huge catchment area. There are significant worries about this with inadequate PPE. Many of you will be aware our appeal for men's shirts to use as gowns on visits had a tremendous response, with over 400 shirts in 36 hours (we were hoping for 50!). Our community literally has given us the shirts from their backs, and you have no idea how wonderful it feels to be at the receiving end of this kindness. Worries about infecting our own cars, which have to carry our children, with high levels of virus were met with 5 offers of easily cleanable cars on loan, 2 of which we have kindly accepted. Again, it is difficult to articulate how valued this makes us feel. We will be using our bikes too, where possible.
We are truly blessed that SALV have been actively fundraising for our next project, as have Hilly's Tea Shop, and we will provide updates on this as soon as we can.
We are trying to think laterally and innovatively at the moment, at is hard to predict quite how the pandemic is going to hit us in our villages. Community spirit is high, and we aim to respond to the different demand by changing our service delivery as appropriate, but whilst keeping the main treasure of General Practice, which is continuity of care by clinicians who know you well.
The strength of community spirit we are witnessing is humbling, and we plan to share fully with your our experience of your support once this is all over.
Please continue to look after one another and keep an eye on our website and Twitter feed for the latest updates.
Take care and stay safe, Dr Emma Watts
At the time of writing we are experiencing a dramatic increase in COVID-19 cases. Services are currently reduced with no face to face contact. By the time this is published the hospital may be struggling and we may be managing more cases at home in the community.
In order to get the most up to date information please consult our website (), our Twitter feed (@ShereSurgery) or Public Health England ().
I would like to thank our community for all its support so far, for both the surgery, and for our vulnerable patients. Particularly through Shere Parish Council and by the initiative set up by Christian Staunskjaer.
We will continue to provide as full a service as we can. This may focus mainly on essential services, and the way we work may change over time as different needs evolve.
Despite this time of unprecedented stress, please remember to be kind to one another, set a good example by our own behaviour, retain integrity, & remain loyal and committed to the community in which we live and work. If we can achieve these values we will come out at the end of this pandemic with a sense of togetherness that will help us rebuild again.
At the time of writing, novel Coronavirus (COVID-19) has not yet reached pandemic status, but it may well do. Currently it is believed the virus remains viable for 9 days on door handles etc, so we need to be extremely careful in the surgery to prevent temporary closure.
Our AskMyGP service is suited to managing this, as we have an opportunity to speak to patients before they come to the surgery, so hopefully we can prevent risk cases coming in to the building. The current advice is to phone 111 who will go through the risk template, sending risky cases to the special pod at Royal Surrey.
For up to date information, please visit
Dispensary have noticed that, for prescription queries, AskMyGP is providing a quicker response. If you do have a medication question and have internet access, please could you try to use this route for a faster response? Please also try to remember that repeat prescriptions require 3 working days to prepare. Phone lines remain open for those who don't have access to the internet.
Finally, my daughter (Sienna) & I are competing in the Devizes to Westminster (125 mile) International Canoe Race on 10th April 2020. We are attempting to achieve the fastest Women's Junior&Veteran time in the history of the race. The race starts in sleepy Devizes, onto the Thames tideway, finishing at Big Ben. We will be travelling in a wobbly boat, measuring 6.5m long by just 40cm wide. With 77 portages (jumping out and carrying boat around locks) we will run the distance of a half marathon with the boat on our shoulders during the race.
We are doing this in support of The Royal Marsden Cancer Charity in the name of Henry (one of my patients, and one of Sienna's friends), but also for all of my patients who I have cared about deeply, who have received exceptional care from The Marsden.
If you felt able to support our charity endeavour it would be hugely appreciated. You can find out more at
January is always the busiest time of year at the surgery, and this January was no different. We were nervous about how this would be, entering the busy season with the new AskMyGP system in place, especially as both staff and our patients are still learning how to make it work for our population here in the Surrey Hills.
So far it feels that we are coping. We have been receiving up to 180 requests per day. The vast majority of requests have been responded to and a plan made within 90 minutes. We anticipate this will improve as we all understand the system better. Around 85% of patients are being dealt with by the Doctor they requested, and 93% say the new system is better than the old one (data captured up until 31/12/19).
On a personal level, I am finding I have to be mentally very nimble keeping up, but I am also feeling that it is improving my relationship with my patients. Instead of feeling quite so fraught through the day, the service feels more personal, and more responsive, so that people haven’t been worrying for weeks before they are seen. So many have thanked me for seeing them so swiftly, to allay their concerns or manage a problem, that it feels personally more rewarding than the slowness of the old system.
If I could offer any advice it would be that, if you are able, you access the system via the website. This allows us to respond to you more quickly and leaves the phone lines open for those who can’t use the online version. I am enjoying being able to send a summary of a discussion via email after the consultation, sometimes with a link to a patient information leaflet, so that patients can read it again later or share it with family. This feels like dramatic progress, but I can only do this for patients who access online.
We continue to listen to your feedback, and are working to create themes of things that aren’t going so well, so we can address these. As well as being able to leave feedback online, we will be discussing the service at the next SALV evening meeting, and can respond to some questions there.
Finally, you may have been reading about National issues with a new GP contract attempting to force us to work more at scale with neighbouring practices. In our area this presents significant issues. You can be absolutely reassured that we are actively engaged with the process and will not allow the local service, that is so dear to us, to be eroded. I will update on this as soon as I am able.
Dr Emma Watts
All at the surgery wish you a Happy & Healthy New Year!
By the time you read this we will be 6 weeks in to our new computer system, AskMyGP. I wrote about the reasons we had to make this change in the December magazine, but now for an update on the bedding in process. There has been a lot of worry about access, about how appointments can be organised, and whether patients will be able to be seen. The actual system seems to be working really well, with patients giving positive feedback about the speed of response and not needing to wait a few weeks. As a doctor, it has felt lovely to be able to respond swiftly, having heard so many complaints about waiting times in the preceding months. In addition, the new ability to have email consultations, and longer telephone consultations has led to some really lovely doctor:patient interactions, which is really positive for doctor and patient alike. I believe we are now able to offer improved access to our working population, and those with mental health problems or other issues that make coming to the surgery more difficult.
The feedback remains predominantly positive, but the main concern seems to be around access and understanding the system. Ultimately, with 75% of access requests coming in through the website, it will free up our phone lines for people who don't use the internet to phone in to request an appointment. Currently this is not working because for every phone call our receptionists have to explain the new system, which is time consuming, and keeps the phone lines busy. Once our patients have tried the system, we hope that they will have more faith in it, and as it becomes more familiar, the phone lines should become much more free.
We are collecting feedback along the way and will be reflecting on this and addressing concerns. We will be providing updates via Twitter @ShereSurgery, via this magazine, and via the SALV meetings. We would like to try to reassure you that our aim is to maintain a high quality service for a rapidly expanding population, whilst also being able to provide speed of access.
In other news, I am delighted to report another award for Dr Helen Barnes. You will remember the surgery won at the National GP Awards 2018 for the Women's Health Initiative. Dr Barnes also lectures nationally on Women's Health with the aim of improving the knowledge of other GPs so they can provide a superior service to their patients. Dr Helen Barnes & Dr Lucy Cox (also from the Women's Health Initiative) have been producing webinars with company Red Whale, and have just won the ON24 Webinar of the Year 2019 for their Menopause webinar, beating multinational companies such as Siemens. (ON24 is an American Tech firm that provides webinar platforms). This is a huge achievement, their excellence being recognised despite stiff competition from very large companies. The highlight for me, was Dr Barnes with her apron on in 'the kitchen' comparing prescribing HRT to making a Victoria sponge cake! We are super proud of you Helen!
Finally, we look forward to helping you with New Year's Resolutions, but also remember that January can be a bleak month. So please be kind to yourselves and make some nurturing resolutions alongside the common ones about stopping bad habits.
Happy New Year,
Dr Emma Watts
The big news from the surgery is the new computer system Ask My GP. The move to providing our services differently was not taken lightly, but as a response to increasing demand for access. We are all living longer, with more complex problems, whilst getting used to instant access to services.
I spoke about this on Radio 4's Farming Today on 19th November as it is as significant problem affecting General Practice nationally, with GP numbers falling at the same time as demand is increasing.
The old 10 minute appointment system had become unfit for purpose, & increasingly unsafe.
Change is always difficult, & it will take both Doctors & patients time to get used to the new way of working. We hope it will mean that people who want instant access, email & telephone consultation, will be helped swiftly online, keeping the phone lines less busy for those who don't use the internet. Complex patients will be managed better, and unnecessary trips to visit us can be avoided. The service aims to manage everyone the same day, thereby avoiding the wait to be seen.
Ask My GP told us not to announce the full detail of the change until the actual day (although we did talk about it at the SALV meeting) because we were already struggling to meet demand, and simply had no capacity to manage people panic booking appointments.
There will be teething issues as we work to adapt this service to suit our patients. Your feedback is important, both good and bad, so we can reflect on it and adapt. We are proud to provide services to all of our local villages. Please trust that this change was a very considered decision, with the aim of maintaining high standards, alongside continuity of care from us, a group of Doctors that you know well, rather than partnering with a faceless external provider.
I will update you on our progress, and I will continue to represent our local needs at the General Practice Committee, UK.