When the UK government declared a national lockdown on 23 March 2020 in response to escalating rates of covid-19, Elliott Hall Medical Centre (EHMC) was overwhelmed with calls from concerned patients and queries from staff. EHMC is a general practice in North West London serving a population of 11 250 people. Our practice area has one of the highest populations of older people in North West London. We recognised that many of our vulnerable patients would find it difficult to cope with lockdown measures. To address this we sought help from volunteers within our patient community to help us support our most vulnerable patients. We describe what we did and how we are continuing to work with patient volunteers in the next phase of the pandemic.
Chris Jenner, Carly Szasz and Jacqui Martin
Setting up a patient volunteer to vulnerable patient matching project
With the onset of lockdown, the senior management team at the practice (lead GPs, nurse practitioner, and management support) endeavoured to link vulnerable patients with healthy volunteers. The practice team was aware from those patients already on the practice’s “Supportive Care Register” (3.5% of total list size) that many patients would struggle to obtain medications and food provisions. Our initial strategy was to contact a relatively healthy proportion of the practices’ patient population. A text message was sent to all patients aged 18-65 who are not normally eligible to receive an annual flu vaccination, asking for volunteers to help vulnerable patients in the practice who were in need of support. We chose this cohort on the grounds that they were at relatively low risk of complications if they contract covid-19.
The response was heartening. We received 268 offers of assistance including several from medical students, some formerly attached to the practice, a couple of whom are also registered patients at the practice. The medical students proved an invaluable resource and enabled us to reach out to all patients from vulnerable groups, including those shielding, in addition to all patients over the age of 80. In total 1,099 patients who needed to self-isolate or who had self identified as vulnerable were phoned by the medical students to ask what help was needed. Of these, 252 patients requested some help due to a combination of complex health and social needs.
From the list of 268 patient volunteers responding to the SMS text message, the clinicians in the senior management team identified 10 potential lead patients known to have the skills and experience to play an active part in implementing what was, in effect a patient volunteer to vulnerable patient matching project. We called it the EHMC Patient Heroes Project. All 10 lead patients accepted our invitation to take on an active role as “locality stewards” of the project.
The medical students sent them names of the patients who needed support in their area and a list of local patient volunteers all of whom had consented to this sharing of information. The first vulnerable patient was supported within five days of the project’s inception. Within four weeks the medical students had telephoned all the patients and the locality stewards matched them to volunteers. In all the 10 locality stewards paired 180 vulnerable patients with a volunteer. Some (N=71) already in receipt of community support accepted the invitation to receive a regular call from the locality steward, but were not formally paired to a volunteer. This proved very helpful when their existing support network broke down during lockdown.
The medical students took the lead role in documenting all the details of the pairing scheme, responding to emails from the locality stewards and patient volunteers, and ensuring good communication via Zoom calls. In addition they were the first point of contact for patients who phoned the practice asking for social support or advice about shielding status. When they had concerns they escalated these to senior practice staff who met up with them briefly most days. The students also set up a rota to maintain the service, helped in reception when the medical centre was short staffed, and assisted clinicians to review hundreds of medical records to identify patients who needed to shield. In addition they called and reassured patients who had been erroneously advised to shield because of inaccuracies in the NHS Digital releases of the Shielded Patient List (SPL).
Development of the volunteer programme and next steps
Volunteers initially received a weekly email called Heroes Bulletin to keep them updated. This included a Q&A and emerging best practice on shielding and covid-19. The students also learnt to respond flexibly to patient needs.
Four months after starting the EHMC Patient Heroes project it was still supporting over 160 patients. Seven months on 40 patients still receive regular weekly help from patient volunteers; mainly with shopping and also obtaining medication from the pharmacist. The project has given us valuable insight into the unmet needs in our practice community, but also the solidarity and resourcefulness within our community of patients.
Around 80% of our patient volunteers have either continued to work in this capacity, or offered to do so if the need arises in the future. Some have shown interest in other initiatives being launched by the Patients’ Association, including a new companionship group. Others have offered to help with IT support for otherwise isolated patients. Several of the medical students remained with us from the start of lockdown until the end of August when their academic courses restarted and they remain in touch.
Eight months on our project has fuelled new ideas on how the practice can continue to help vulnerable patients who remain socially isolated, and in a future post covid-19 world. By publicising our achievements via the Patients’ Association newsletter—the “ElliottEar”—which is delivered to all households in the practice, we have generated positive feedback and enthusiasm from a younger group of volunteers.
During the project patient volunteers have also offered a wide range of practical help including creating volunteer ID badges, providing high-vis jackets for shoppers and “surgical scrubs” for EHMC clinical staff, visors and face coverings.
Learning how to work as a team
Initially the medical students needed close daily support to answer patient queries and learn how to use the practice IT system ensuring documentation of the volunteer pairing, and the information and advice given. We also encouraged them to regularly scrutinise the gov.uk government websites and provide clinical colleagues with updates. The students attended the practice’s daily clinical meeting to share their experiences, ask questions, and develop a wider understanding of the broader clinical impact of the pandemic. All students were offered a temporary contract including a confidentiality clause.
Some of our patient volunteers had previous experience of working in a supportive capacity in the public sector and had existing DBS (Disclosure and Barring Service) checks. These individuals were paired with the most vulnerable patients. The others were encouraged to register with the NHS GoodSam scheme (https://www.goodsamapp.org/NHS). Locality stewards initially called their patients on a weekly basis and each volunteer was encouraged to log each patient contact . Any concerns were escalated via a WhatsApp group shared by the locality stewards, medical students and the practice GP leads, but excluded patient identifiable information. Social distancing rules were promoted at all times.
At the time of writing, we are in a second period of lockdown with continued uncertainty about the trajectory of the pandemic. Our plan is to continue helping those still in need, interestingly many of our initial cohort of vulnerable patients have made their own arrangements and some have re-escalated back to their initial volunteer. We have identified only a couple of new patients who became aware of our project through our practice newsletter and fell outside our initial target population.
Laura Herman, Volunteer Locality Steward
When a volunteering request landed in my inbox I was happy to step forward for the practice, which has long supported me and my family. As a Locality Steward I was allocated a list of patients in my area who had been identified as needing support and a (larger number) of volunteers to provide it. It was my job to pair them up, and ensure the volunteers were supported to do their work. Each week they told me what they were doing for their patients. This included anything from shopping, and collection of medications, to simply having a friendly chat.
The advantage of our programme over the NHS GoodSAM scheme was the speed at which we were able to initiate the intervention and link the patients and volunteers. This has helped develop new friendships at a local level. Everybody involved was made to feel valued and part of the community. For me it also provided an opportunity to transition from being a patient to a colleague within the medical team.
My first action involved calling all the patients on my list. I knew all of them had a level of need, but I had no personal details, and I was aware that I needed to explore these sensitively, and respect people’s wishes for autonomy and independence. Some accepted help readily; others deemed it unnecessary. All however, agreed to me initially calling them once a week and this helped foster trust. If I had queries the surgery staff and medical students provided speedy answers and I kept in regular touch with fellow Locality Stewards via Zoom.
As the weeks progressed my role focused on ensuring the volunteers were coping and were well supported. The surgery provided lanyards so they could access supermarkets with NHS workers. A medication delivery service was set up between several pharmacies to reduce the need for numerous collections.
When patients from other GP surgeries heard about our initiative we were asked if we could extend our support system, but we did not have the capacity to do this. I do, however, think this is a model that could be replicated around the country.
Many patients have told me it’s a comfort to know there is somebody at the end of the phone. While it’s hard to quantify the extent to which the scheme has reduced harm and distress, I think it’s likely to be large.
In late summer, volunteer involvement reduced as people returned to work, but meaningful relationships and ready communication had been established. At the time of writing, the rates of people infected with covid-19 are rising again, and the Locality Stewards have just met via Zoom with the surgery to discuss plans for the next phase.
Josh Bekhor, 4th year medical student, GKT School of Medical Education
Participating in the Elliott Hall Patient Heroes volunteering programme was immensely rewarding. Highlights for me were learning about the value of leadership and team working. Being part of a group of medical students with a shared mission was another highlight. It is rare that medics from different medical schools interact, and it gave us the opportunity to work together and learn from each other about how to tackle new tasks. As well as setting up the Patient Heroes scheme, we got a chance to assist the receptionists in dealing with patient queries, and learn how to use the practice’s IT system.
There is value in having fresh (younger) eyes within an established GP practice. We think out of the box, and unlike most practice staff, we have not (as yet) been worn down by grinding work in a high demand, highly regulated professional environment. Medical students are also in a good position to develop Quality Improvement Projects
A key take away for me from the project was just how much can be learnt about medical conditions by talking to patients and working on the reception desk, rather than studying text books. It’s illuminating and makes a refreshing change to conventional academic studies.
My experience at Elliott Hall also helped me address personal challenges. I have always struggled with finding a balance between sympathising and helping patients and protecting my own emotional wellbeing. I learnt a lot about how health professionals must protect their own health and personal space in the course of their work. I have also learnt that the GP-patient relationship can be very special.
Watching a local community respond to this pandemic has been eye opening. I am aware that we live in an ageing and unequal society, but I have been struck by the sheer number of disadvantaged and vulnerable patients. It was far more than I expected.
But hearing the gratitude in the voices of some who we helped has been motivating and inspiring. Becoming a GP is now top of my list of potential future medical jobs.
Chris Jenner, GP partner, Elliott Hall Medical Centre, Harrow, London, UK
Carly Szasz, GP partner, Elliott Hall Medical Centre, Harrow, London, UK
Jacqui Martin, chair of Elliott Hall Medical Centre Patients’ Association, Elliott Hall Medical Centre Patients’ Association
Laura Herman, volunteer locality steward, EHMC Patient Heroes Project
Josh Bekhor, 4th year medical student, GKT School of Medical Education, London, UK
Competing interests: none declared
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