Workload and winter indemnity
There could be a surge of appointment either over the festive period or after the new year. Many patients prefer to wait to attend their own practice during normal hours rather than the out-of-hours service, and it may be difficult to predict the workload.
- Plan the staff rosters in advance and consider having contingency plans in case of staff absences.
- GPs should ensure that they have adequate time for house visits, as patients, especially elderly ones, may be housebound if the weather is bad.
- Locums should be provided with a good induction, in advance if possible. Avoid leaving new locum doctors holding the fort themselves during this potentially busy time.
- Clinicians should ensure that they have the appropriate cover for their work, and review their requirements regularly. GPs who provide additional care outside of their core hours can access the NHS Winter Indemnity Scheme via their medical defence organisations.
See also our guide to coping with winter pressures.
Referrals and postal services
Hospital laboratories may have a reduced collection and test results schedule. Coupled with the Christmas post, this may lead to delays in the usual services. GPs should also be aware of their practice secretary’s time off, so that referrals are made in good time.
- From mid-December, try to make electronic referrals instead where possible, so that they are not subject to postal delays.
- If a test result is essential, request it urgently so that it is phoned back to the practice the same day.
- Important monitoring tests such as INRs should be done a few days before the long holiday period.
Opening hours and important contacts
- The practice’s festive opening hours should be advertised in advance using various mediums such as the practice website, notice boards, leaflets, text reminders and newsletters.
- Publish and display details of out-of-hours services, pharmacy opening times and details of walk-in services and minor injury units.
- Find out which hospital clinics may be closed, so you know where to direct patients should they require treatment over the holidays.
The season of goodwill means that patients sometimes provide staff with chocolates, flowers or alcohol. Gifts can also be in the form of a discount or an offer of services, such as hotel accommodation.
- Remind employees of your practice’s gift policy, and remember to maintain a register of all gifts received. If you receive any gifts over the value of £100, you should inform your local commissioning body or health board.
- If in doubt as to whether to accept a gift, consider its purpose. If a gift appears to be an expression of gratitude, when making a decision about accepting the gift, assess whether declining the gift could cause the patient distress.
- Gifts should not be accepted if they may be given with the expectation of preferential treatment. GPs should also politely decline gifts where they could be perceived as an abuse of trust.
- Consider sending thank you cards to those patients who brought you presents. GPs may wish to let patients know when gifts will be shared with other practice staff.
- GPs should keep thank you letters from patients for their appraisals.
- Store gifts out of sight, especially alcohol in consulting rooms, as it may give the wrong impression to incoming patients.
Weather policy and festive decor
A white Christmas may be an exciting prospect for many, but it can be risky when snow and ice accumulate outside the practice premises. Practices could find themselves liable, under the Workplace (Health, Safety and Welfare) Regulations 1992, if a patient or staff member has an accident on practice grounds.
- Whether snow is forecast or not, be sure to fill up the grit bin and keep a couple of snow shovels at the practice.
- Practices may wish to have a rota for clearing snow in car parks and on pavements. Conduct a thorough risk assessment and provide training, supervision and provision of suitable equipment, in order to protect employees involved in clearing operations.
- Ensure that you have adequate public liability insurance.
- To prevent frozen pipes keep the temperature of the practice at a suitable temperature.
- If you have a Christmas tree, ensure baubles are child-friendly and not made of glass.
- If your practice uses fairy lights, use a socket with a built-in surge protector. Keep cables well out of the way of the walking or seating areas.
- Avoid Christmas soft toys, as these can be a source of infection.
- Remind patients to request prescriptions in advance of the holiday period, especially if they are going away. You could provide reminders to patients on the practice website, notices, during consultations, via texts and placing reminders on the right-hand side of prescriptions.
- Allocate extra time in the week before the holidays to deal with extra prescription requests.
- Make sure the practice emergency cupboard is well stocked.
Winter bugs and misdiagnoses
While winter brings its own set of illnesses, the festive period is a time when signs and symptoms may be dismissed as harmless typical festive ailments, such as those caused by alcohol and over-eating. Consultations may present challenges if doctors see patients without access to their medical records, for example if they are here from abroad or live outside the area.
- Encourage eligible patients to have their annual influenza vaccinations.
- Vulnerable patients, such as the elderly and homeless people, may feel even more isolated during the festivities. Practices should liaise with district nurses, social services and consider offering telephone support to these patients between Christmas and the new year. Information regarding charities and crisis teams could be publicised in practices leading up to the holidays.
Good preparation should manage these medicolegal risks and ensure the smooth running of your practice, but do contact your medical defence organisation if you need further advice.
- Dr Rachel Birch is medicolegal consultant at Medical Protection