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Today Blue Stream Academy's Healthcare & Lifestyle Magazine Issue 7

The Challenges COVID-19 presents for Autistic People Dr Silvana Unigwe Page 6

Telephone Triage: Look Whoâ€™s Talking

Dr Toni Hazell Page 16

CoppaFeel!

The Importance of Boob Checking Page 18

See Back Page

Issue 7 Front Cover

BSA Today is the exciting Healthcare & Lifestyle magazine from Blue Stream Academy. We are the UK’s leading provider of online training for GP practices, nursing and care homes, hospices and urgent care centres. Our mission is to standardise healthcare training to ensure consistent delivery of quality care, through better staff education and development. Providing over 70 hours of eLearning, Blue Stream Academy’s suite of interactive training modules is easy to use, cost-effective and in line with Care Quality Commission (CQC) guidelines – our modules are also RCGP-accredited and CPD-certified. If you have any comments, suggestions or ideas, please contact our editor Brady Braddock via email: brady@bluestreamacademy.com Alternatively, you can write to us at the address below:

*See website for details. You may need to download a QR Code reader app on your device.

Blue Stream Academy Suites 11, 12 & 16 Riverside Business Centre Foundry Lane Milford Derbyshire DE56 0RN 01773 822549 www.bluestreamacademy.com The views and opinions expressed in this publication are those of the original author of the relevant content and do not necessarily reflect the official views and opinions of Blue Stream Academy Ltd. © 2020 Blue Stream Academy

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In this issue BSA Today | Issue 7

From the Editor's Desk...

e’re back in lockdown – well, at least for the time being, as the pandemic shows no signs of slowing down. In circumstances like these, knowledge is power, and information and guidance become pivotal. At Blue Stream Academy, we’ve been pulling together to do our bit. Our free-to-all COVID-19 Staff Support Toolkit has been a valuable information resource for many across health and social care. This, alongside the development of our brand-new platform, Blue StreamNet, has kept us very busy over the last few months. With all this activity going on, BSA Today wanted in on the action!

In this issue, we hear from those who are working on the frontline: health and care professionals like you, out there making a difference. We talk telephone triage with writer Dr Toni Hazell, who gives advice on how to handle sensitive subjects with 15 18 dignity, respect and confidence. Doctors’ Association UK tell us about their new hashtag #PrimaryCareNeverClosed, and autism specialist Dr Silvana Unigwe talks about what can be done to improve standards during the pandemic. We have treats in store for management staff too, with top tips for wellbeing in the workplace and advice about video-conferencing from Stuart Walsh, 12 Zooming in: How to Video Conference Security Chief Information Security Officer at Blue Stream Academy. Given the surge of video-conferencing services since the onset of COVID-19, we take a look at how to implement and use Let us inform and entertain you with even more exclusive content, including these services efficiently and securely. our fan-favourite lifestyle section, which is back by popular demand. Can baking make you happier? We think so. We also hear from mindfulness guru Jo Howarth about moving forward and making changes to improve your outlook, and our new creative writing feature gives you the opportunity to get inspired. With much more inside, including our in-house news, developments and module releases, BSA Today really is the magazine for you.

#PrimaryCareNeverClosed Doctors’ Association UK tell us about how their latest hashtag is supporting GPs during COVID-19 and let us know that primary care is never closed!

CoppaFeel! We’re encouraging people to regularly check their breasts as CoppaFeel! chat to us about early diagnosis, awareness webinars and increasing awareness to spot the signs of breast cancer early.

We hope you enjoy reading! Brady Braddock BSA Today Editor

Brady Contents

20 Moving Forward and Making Changes

It’s been a funny old year so far, hasn’t it? Here, The Happiness Club’s Jo Howarth gives us her top tips on achieving a brighter outlook.

22 Can Baking Make You Happier?

We say yes! We’re back by popular demand with our exclusive easy-to-follow recipes for delicious garlic braided bread and zesty lemon-and-lime curd shortbread biscuits.

04 Countryfile Ramble for BBC Children in Need

@BlueStreamNews, Ask Abi & #TeamBSA BSA Today’s resident agony aunt Abi answers a familiar workplace woe, and #TeamBSA discuss fundraising and what the future has in store.

06 The Challenges COVID-19 presents for Autistic People

Puzzle Corner Keep up to date with all the latest news, and find out about our recent module releases and updates. Got a spare 10 minutes? Just for fun, have a go at our sudoku and brain training teasers!

Treetops Hospice Care in Derbyshire chat to us about their latest fundraising effort for BBC’s Children in Need, involving Matt Baker and a ramble across the Peak District. 27 Dr Silvana Unigwe, a GP with a special interest in autism, tells us about the impact of COVID-19 on autistic patients and what can be done to change things.

Back Cover: iPad up for Grabs! Want to win an iPad? This is your chance! To enter, turn to the back page and answer a simple question. Good luck!

08 RESTORE2 Mini

We take an exclusive look at one of Blue Stream Academy’s upcoming releases RESTORE2 mini: Recognise Early Soft Signs, Take Observations, Respond, Escalate.

Telephone Triage: Look Who’s Talking

10 The New Normal

With top tips for employee safety and wellbeing, whether working from home or in the office, our HR Manager Sian Ratcliffe has got you covered..

www.bluestreamacademy.com

GP and freelance writer Dr Toni Hazell gives her advice on how to handle delicate subjects like mental health, sexual problems and pregnancy terminations over the phone.

Countryfile Ramble for By Treetops Hospice Care.

Treetops Counselling Client Featured on Countryfile Ramble for BBC Children in Need.

teenager from Derbyshire has taken part in this year’s Countryfile Ramble for BBC Children in Need. Sixteen-yearold Harvey joined Matt Baker in a one-to-one ramble around the Peak District, which was broadcast in a special programme ‘The Countryfile Ramble for BBC Children in Need’ on Sunday 1 November.

Over the last 5 years, Harvey has had to come to terms with the loss of his older brother Ed, who died in 2015. Harvey and Ed shared a passion for farming and the great outdoors. To help deal with the loss of his brother at such a young age, Harvey found the support he needed at Treetops Hospice Care in Derbyshire. Treetops provides counselling and emotional support for children, young people, adults and families who are dealing with a life-limiting illness or bereavement. The charity supports young people like Harvey with their emotional wellbeing, giving them the tools they need to be open about their feelings and

helping them live with the loss of their loved one into the future. Despite the challenges he has faced, Harvey still has a passion for farming and enjoys spending the holidays helping out on his greatuncle’s farm. Ahead of the ramble, he said: “I can’t wait to get going with my ramble. I really enjoy being in the outdoors, and spending time with Matt Baker and the Countryfile team will be a great experience. I’m so happy to be taking part in something I know will go on to support others who, like me, have had to deal with bereavement and the loss of someone close.” Harvey’s mum, Amanda, added:

“As a family, we’re so grateful for all the support Treetops Hospice Care has provided to us and Harvey. We’re thrilled Harvey will be joining Matt on this ramble, and we are all so proud of him and what he will achieve.” Treetops Hospice Care currently receives a grant of £30,000 from BBC Children in Need to provide counselling sessions for children and young people who have lost someone close to them. During the COVID-19 outbreak, the charity has received an additional grant of £4,500 from BBC Children in Need to provide care packages for bereaved children and young people.

About Treetops Hospice Care Treetops, based in Risley, Derbyshire, provides nursing care and emotional support for adults with life-limiting conditions and those who’ve been bereaved. The hospice is doing all it can to continue to support those in most need during the COVID-19 pandemic, including by providing ongoing support for over 70 patients with terminal illnesses who are shielding at home.

for our patients are very important because they give them one-to-one contact. They can see other people on the screen who they used to meet with, so it gives that familiarity, but most importantly it means they’re not so secluded and isolated. “Mentally and physically, it’s the way forward until things change. We have some quite elderly patients who have been so determined to access the virtual classes that they’ve taught themselves how to use Zoom and developed new skills, which is brilliant. It shows their resilience and that they want to keep in contact with us. “It’s been very hard without our patients here on site and an emotional time; we miss them.”

More Information For more information about any of Treetops’ services, to make a patient referral or to give a donation, please contact:

Treetops Hospice Care Derby Road Risley Derbyshire DE72 3SS Email: info@treetopshospice.org.uk Registered charity number 519540

www.treetopshospice.org.uk

0115 949 1264

The hospice welcomes donations to the Treetops COVID-19 Appeal to ensure the future of the hospice and its services.

The hospice provides patients with ‘Cake and Care’ packages of treats and activities, as well as making regular wellbeing calls. It has also moved some of its services online, including a carers’ support group, a virtual café and chair-based exercise groups. Clare Downing, Wellbeing Space team member at Treetops Hospice Care, explained: “Virtual sessions

www.bluestreamacademy.com

The Challenges COVID-19 presents for Autistic People

t would be an understatement to say that this year has taken all of us by surprise. The coronavirus pandemic has radically changed the way we live.

Dr Silvana Uniqwe

Dr Silvana Unigwe is a GP based in London. She has worked with the Royal College of General Practitioners to enhance autism awareness in primary care and has collaborated with the National Autistic Society and Autistica. Dr Unigwe is interested in improving access to healthcare and promoting mental wellbeing in vulnerable patient groups.

With the first wave of COVID-19, healthcare systems had to adjust to large numbers of people becoming unwell and needing hospital treatment. This led to the postponement of outpatient appointments and treatments, as well as elective operations. In general practice we moved to a largely telephonebased triage appointment system. Most consultations are now conducted remotely (by telephone, video or online platforms), although face-to-face consultations still occur when needed. Some patients appreciate the convenience of engaging in remote consultations from the comfort of their home, and technology has made some aspects of our work as health and care professionals more efficient. That said, there are concerns that many patients have experienced barriers to accessing healthcare during this pandemic and that this might have led to delayed diagnoses and premature mortality for some.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition that affects approximately 1% of the population, occurring more in males than females. Presentation differs from one person to another, but the core features are persistent difficulties with social communication and social interaction, as well as restricted, repetitive patterns of behaviour and interests. Many individuals also have sensory sensitivities. Various conditions can co-exist with autism, such as learning disabilities, attention deficit hyperactivity disorder (ADHD), depression, anxiety and epilepsy. A study conducted a few years ago in Sweden reported increased premature mortality in people with ASD compared to the general population.1 In the UK, the Westminster Commission on Autism reported that 74% of respondents to their survey felt that autistic people receive a “worse” or “much worse” health service than their non-autistic counterparts.2 With this in mind, we need to be especially aware of the impact of COVID-19 on the health of autistic patients, who as a group were already at a disadvantage before the pandemic.

Indeed, a UK study conducted earlier this year reported that 86% of family carers thought that the needs of autistic people and their families had not been adequately addressed during COVID-19. Coping with Change and Uncertainty Repetitive behaviour and fear of change are common features in autism. The uncertainties that we have all felt are likely to have been magnified in autistic people, causing heightened anxiety.3 Some may experience an intense fear of catching COVID-19 and may find the ever-changing public health advice confusing. Others may lack safety awareness, such as with social distancing, and be at increased risk of exposure to the virus. With many autistic adults and children already experiencing or being at risk of mental illness before COVID-19, there is concern that the pandemic has caused a deterioration in mental health for those who have found it difficult to cope with the rapid changes. It is worth noting that some people may have experienced positive effects from the move to remote communication. The challenge here will be to support their transition back to usual life and increased demands for social interaction. Reduced Support Services There has been ever more reliance on autism charities and private therapists for the care that would otherwise be provided by schools and other statutory support services. Carers have had fewer opportunities for respite, and this is likely to have taken a toll on their own health. Scheduling Healthcare Appointments Some GP practices require patients to submit their requests for a GP appointment via online forms, which can be quite complex to navigate through. The process may be tedious and confusing for some autistic patients and put up a barrier to engagement with healthcare services.

www.bluestreamacademy.com

Remote Appointments Although some autistic patients may prefer remote consultations, others may find explaining their symptoms over the phone difficult and stressful. In addition, some may have difficulty localising their symptoms and are unable to give a clear enough history by telephone. A rigid insistence on phone consultations could therefore be inappropriate and alienating, so there should be a lower threshold for offering face-to-face reviews. Things We Can Do to Help 1. Be flexible. Ask autistic patients and their carers what would make access easier, and flag their patient records with details of reasonable adjustments. For example, allow them to make appointments by phone if they struggle with the online forms. 2. Be proactive about contacting patients to check on their wellbeing. Encourage them to attend health checks, flu jabs and diseasemonitoring appointments. Monitor them for signs that their mental health is deteriorating. 3. Promote structure and reduce uncertainty where possible. For instance, rather than telling them they will get a call back from a GP â€œat some pointâ€? on a given day, offer a specific time. 4. Pay attention to the needs of carers, who are likely to have experienced increased demands during this pandemic period. 1. Hirvikoski T., Mittendorfer-Rutz E., Boman M., et al. (2016). Premature Mortality in Autism Spectrum Disorder. British Journal of Psychology. doi:10.1192/bjp.bp.114.160192 https://pubmed.ncbi.nlm.nih.gov/26541693/ 2. The Westminster Commission on Autism. (2016). A Spectrum of Obstacles: An Inquiry into Access to Healthcare for Autistic People. https://westminsterautismcommission.files. wordpress.com/2016/03/ar1011_ncg-autismreport-july-2016.pdf (Last accessed November 2020) 3. Pavlopoulou G., Wood R. and Papadopoulos C. (2020). Impact of COVID-19 on the Experiences of Parents and Family Carers of Autistic Children and Young People in the UK. UCL Research Briefing. https://discovery.ucl.ac.uk/id/eprint/10101297/3/ Pavlopoulou_COVID19%20AUTISM%20FINAL%20GP. pdf

RESTORE2 mini

By Shelley McCart

ESTORE2 mini is aimed at people who work in nursing homes, residential homes, independent supported living and day activity services, in addition to care home support teams.

The module includes: • Introduction – sets out the components of RESTORE2 mini.

Research has shown that spotting when someone • Knowing Your Resident – explains what you is unwell can be particularly difficult in a care home should know about a person in order to spot setting. This could mean missed opportunities to when something is wrong. help someone at an early stage – especially now, with concerns about COVID-19. • Soft Signs – these are especially valuable when someone finds it difficult to communicate when It’s important to make sure that any illness or cause they are in pain or unwell. This section explains of deterioration is identified quickly, so that people universal soft signs (mental, physical and can get the right care for them as soon as possible. behaviour or ability) and other soft signs that may be unique to a person. To ensure that caregivers understand what they should be looking for and know the correct procedure for dealing with anything that suggests a person is not as well as usual, we have innovated an eLearning module on RESTORE2 mini to add to our extensive suite. The focus of the module is on detecting ‘soft’ signs of deterioration in residents, facilitating earlier treatment and avoiding unnecessary transfers to hospital. The guide will also support conversations with GP and ambulance services. 08

•

Raising the Alert – this section looks at the escalation tool, the SBARD (Situation, Background, Assessment, Recommendation, Decision) action tracker, calling an ambulance, and medical emergencies.

• Case Studies – these allow trainees to understand RESTORE2 mini through real life situations.

Each trainee will be able to log on to the Blue Stream Academy Management of Information System so their progress can be tracked through the module, and a certificate will show that they have completed the training.

â€œ

This could mean missed opportunities to help someone at an early stage â€“ especially now, with concerns about COVID-19.

This training module will be free to use nationwide, and the certificate will be stored and can be printed if required.

Leading the Way for eLearning in Healthcare Proud to support trainee compliance across 5,000+ organisations

Each of our eLearning modules are written by subject matter experts, and one or more new modules are released by a team of in-house specialists on a monthly basis.

Our in-house team of support specialists and system trainers offer friendly telephone, email and online chat support, alongside complimentary system training sessions available for any system managers or administrators.

Annual subscription is quoted on the number of trainees, and the single annual fee includes unlimited access to any existing and new modules added throughout the year.

Blue Stream Academy have developed an online suite of over 95+ eLearning modules certified by CPD, available to access 24 hours a day, 7 days a week.

www.bluestreamacademy.com

01773 822549

IS 704740

nch@bluestreamacademy.com

The New Normal By Sian Ratcliffe The year 2020 has seen huge changes in the office environment, leaving many organisations with big decisions about whether their employees will be based at home or at the office as we move forward. Either way, employee wellbeing is key. Here are some top tips for making sure your people are being looked after, wherever their new normal has them clocking in…

It can be easy to work for longer hours at home and to skip breaks, so make sure your team has a good work/life balance.

Make sure your remote employees have an appropriate work set-up. This means good lighting, a good-sized desk and a suitable chair. Consider conducting new display screen equipment (DSE) assessments for staff who are working at home.

Home workers may feel isolated or disconnected from the office team, so it’s more important than ever to stay in touch with them.

10 08

Be emotionally supportive. Many people have experienced big changes in their working and personal lives, and this may induce a range of emotions.

Make time for small talk and camaraderie. This is often an enjoyable part of an employee’s day, and remote workers may miss it.

Ensure that your workspace is set up safely. This may mean adding dividing screens between desks, installing hand-sanitising stations and asking staff to wear protective masks.

If your organisation provides wellbeing packages, remind employees that these are available and encourage people to make use of them if needed.

Encourage your office-based employees to keep in touch with their remote teammates. Video calls are especially good for this – who doesn’t love seeing a friendly face?

www.bluestreamacademy.com

Monitor your office employees’ health. Many organisations are making temperature checks compulsory upon arrival.

As important as it is to check in with remote workers, make sure you do the same with your office employees – the new office environment may take some getting used to.

Be emotionally supportive – many staff have experienced big changes in their working lives, and this may induce a range of emotions.

09 11

For many organisations, the COVID-19 pandemic has led to a large number of employees working from home. This increase in remote working has resulted in a proliferation of video-conferencing applications.

ideo-conferencing services can do a lot to help organisations overcome many of the difficulties they face, but it’s important to perform certain checks when choosing a video-conferencing application and make sure you configure it securely.

For example: • • •

Some video-conferencing services implement end-to-end encryption, how the provider implements so that all data is encrypted in basic security controls transit and can only be decrypted by participants of the meeting. where your data is held Others encrypt data between user what they can do with it. devices and the service, which allows them to provide more functionality.

Choosing a Video-conferencing Service

Many video-conferencing service providers also offer premium options, which provide extra features or levels of service. These may include enhanced security, configuration and privacy options.

If your organisation already has access to video-conferencing applications as part of its software services, you should do a risk assessment (even if it has been done before) to make sure they are suitable for remote working. If your organisation is considering a new service, you should do risk assessments and perform checks for a shortlist of service providers. The results of these assessments, considered alongside the provider’s terms and conditions (and privacy statement), will give you an understanding of what is required.. 12

If your organisation needs to use video-conferencing for more sensitive meetings, you should follow the National Cyber Security Centre’s (NCSC’s) Cloud Security Principles1 to determine whether a service meets your organisation’s security needs.

Cloud services often store and process data in (and route traffic through) data centres across several countries and jurisdictions. It’s important to know where your data is, who can access it and under what circumstances they can do so. If your organisation is in a regulated industry or handles government data, you should again refer to the NCSC Cloud Security Principles to find out whether a service is secure enough for your organisation’s needs.

Using and Configuring a Videoconferencing Service When configuring a video-conferencing service, set companywide defaults and controls if this is possible. Carefully consider which settings to enforce and which to set as a defaults that can be overridden in particular meetings. You should configure the default settings in a way that balances user needs with security. For example, the ability to share screens may be appropriate for some users but not others. Employees will need to log in to the video-conferencing service to be able to schedule meetings. Some services also allow or require users to authenticate their details before they join meetings. A single sign-on is recommended, which can be done by integrating the video-conferencing service with your existing corporate identity. This means that the service will inherit the identity protections that your other corporate services have. It will provide a better user experience by reducing the number of times that authentication is required. If it isn’t possible to provide single sign-on, you should configure the service according to your organisation’s password policy and include multi-factor authentication.

“

It’s important to know where your data is...

Some employees will need accounts with privileges that allow them to, for example, configure the service or access logs, transcripts or recordings. Apply the ‘concept of least privilege’ by using a rolebased access control to ensure that no one has more privileges than they need. www.bluestreamacademy.com

Being able to control who can join (or start) meetings will help keep the discussions confidential and prevent unwanted interruptions. Usually, participants click on a link or enter a unique code to join meetings that have been arranged in advance. It is recommended that: •

users from your organisation (and guests who were invited to the meeting) are allowed straight into a meeting

• unauthenticated users are required to enter a passcode •

unauthenticated users are held in a waiting area (often referred to as the ‘lobby’), and only admitted to the meeting once their identity has been confirmed by a trusted participant.

Some video-conferencing services allow users to make a call to users inside or outside your organisation without arranging it in advance. If this feature is available, consider blocking calls that originate from outside your organisation if they are not in a user’s contacts list. If you do not block such calls, you should still configure the service to block calls from unidentified or unauthenticated users.

If employees need to use these features, you will need to decide whether you trust the service enough to protect the extra data that will be sent to (or through) the service. If you do, you’ll need to choose whether to enable these features by default or make them options that need to be chosen for each meeting. If the service allows you to record calls or save text chats and shared files, make sure you know where this data is stored and who can access it. Cont...

Video-conferencing services often include extra features, such as: • file sharing • screen sharing • instant messenger chat • automatically generating a transcript of the call • remote control of another participant’s device. Continued overleaf...

Cont... Using Video-conferencing Services Securely Employees who are working from home for the first time might not have used video-conferencing services before, so give them clear guidance on how to use the service securely. Users should test that the service is working before they use it for real meetings (some include a ‘test’ feature that can help with this). They should know how to mute the microphone and how to turn off the camera. This will give them more control over what they share with others. You should also advise employees: •

to treat the details explaining how to join a meeting as if they are as sensitive as the meeting itself

•

to consider blurring their background or using a background image (if this feature is available)

•

how to check when their webcam is active, so they can be confident that it is no longer active when it is not in use

• how the service indicates when the meeting or call is being recorded. The meeting organisers (and sometimes their delegates) will have more controls than are available to the other attendees. You should ask employees who host meetings with participants from outside your organisation to hold a test meeting to familiarise themselves with controls such as approving participants in the lobby, removing participants from the call and muting individuals. 14

When setting up the call, the meeting organiser should consider which features (such as screen sharing and file sharing) are appropriate for the meeting and whether to make them available to a subset of participants only. If meetings are password-protected, the meeting organiser should share that password with participants only. For example, the organiser could send an email containing the password to participants direct, rather than including it in a calendar appointment (which could be seen by everybody in your organisation). During the video conference, the meeting organisers should be responsible for: • •

verifying the identity of all participants on the call appropriately approving participants being held in the lobby

• removing participants who have not been successfully identified. You can find more guidance on using video-conferencing securely on the NCSC website.2

1 National Cyber Security Centre. (n.d.) Implementing the Cloud Security Principles. https://www.ncsc.gov.uk/ collection/cloud-security/ implementing-the-cloud security-principles (Last accessed November 2020) 2 National Cyber Security Centre. (n.d.) www.ncsc.gov.uk (Last accessed November 2020) Article by Stuart Walsh Chief Information Security Officer (CISO)

#PrimaryCareNeverClosed

Doctors’ Association UK (DAUK) is a professional association for UK doctors and medical students. As a grassroots campaigning group led entirely by frontline doctors actively working in the UK, we are uniquely placed to be the voice of frontline doctors. Our national campaigns have reached international audiences and we have delivered significant policy change. Our notable prominent campaigns have been #ScrapTheCap for Tier 2 visa caps, Learn Not Blame, #CompassionateCulture and #ProtectTheFrontline.

ere at the Doctors’ Association UK, we have become increasingly concerned about the growing narrative in the media that primary care is closed and not seeing patients. This view was further cemented by an article reporting that NHS England was “ordering GPs to see patients face to face” following a leak to the press. As anyone who works in general practice knows, the reality is more complex. In March, GPs completely changed their way of working overnight. They are working flat out to try to provide remote consultations wherever possible in order to prevent waiting rooms becoming areas of COVID transmission and avoid becoming vectors for the disease themselves. As more appointments are happening remotely, there seems to be a growing narrative insinuating that GPs are not working or are refusing to see patients face to face.

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Medicine is an art, not a science, and that doesn’t change in pandemic times.

Subsequently, there seems to be a disconnect between patients’ expectations and what care can realistically be provided during a pandemic. Conversely, we are very worried that some of this negative press will discourage patients who need to see us from coming forward. It is vitally important that patients are able to see us in a timely manner, either remotely or, where indicated, face to face. www.bluestreamacademy.com

There is a danger to patient safety and, we think, a significant contributory factor to additional GP stress. We want to try to turn the tide on this story, so we have taken two major steps. First, on 17 September we penned a letter to Dr Nikita Kanani, Director of Primary Care at NHS England, which was signed by almost 1400 doctors and primary care staff. This led to the newly formed DAUK GP Committee’s first meeting with NHS England, where we were able to put across our view of how damaging this has been. While our concerns were acknowledged, we are still awaiting their formal response. Our second step was to launch a nationwide campaign, #PrimaryCareNeverClosed. We are encouraging GP practices to post to social media with their name, their role and something about their day. Maybe they could also state the number of interactions or the types of problems they have seen that day. We’re inviting them to tag us by using the @theDA_UK handle on Twitter. Our hope is to start to turn the tide, for our patients to know they can come forward with worrying symptoms and for primary care staff to feel validated in the vitally important job they do. For press queries, please contact us on: press@dauk.org

Telephone Triage: Look Who’s Talking

Dr Toni Hazell

GP in Tottenham Dr Toni Hazell qualified from St. Mary’s Hospital Medical School and did her Vocational Training Scheme at Northwick Park Hospital. She is a GP in Tottenham and was instrumental in her practice’s move to full telephone triage 7 years before everyone else started doing it! Toni has a strong academic background and works for the Royal College of GPs as an eLearning fellow. She also writes continuous professional development programmes for a variety of organisations, is an appraiser and sits on the Local Medical Committee for Haringey East. When not at work, she is kept busy by her two young children; in the occasional moment of spare time, her hobbies include running and playing the piano.

ack in 2013, our practice took a bold decision. Faced with a mismatch between supply and demand, we started triaging every request for a GP appointment. Anyone wanting to see a GP in person would speak to one on the phone first. I still remember my fears that the system would collapse by mid-morning on the first day, but on the whole it was a success. Patients liked being able to talk to us on the phone, we could signpost them to the most appropriate professional, and tests could be done before an appointment so that the patient needed to come in only once.

But what about vulnerabilities that are to do with the subject, not the patient? Talking about sexual health, mental health, contraception or the need for a termination is hard enough face to face and often worse over the phone. What if the GP calls when you’re on the bus or at work? Teenagers are worried about confidentiality within the confines of a consultation room; how much worse is it when Mum might overhear from the kitchen? And how embarrassing is it for some people to have to tell the receptionist what they are calling about?

Fast-forward 7 years and telephone triage is now the done thing for everyone, important for reducing footfall in the context of COVID-19. Tips and tricks for effective, safe triage are being shared widely, and I doubt that things will ever go back to how they were. With better text and video technology, phone triage is great for many, especially those who work. We must, however, be careful that no one gets left behind and put thought into some of the people who might, such as those who don’t have access to a mobile phone, don’t speak English, are frail, are deaf, are homeless or are vulnerable in some other way.

As doctors, we need to gatekeep without discouraging those with sensitive problems. It’s useful for reception to get a brief idea of what the problem is so I can work out the order in which to call people back – it’s never great to get to the last call on your list and find that they are vomiting blood or have central crushing chest pain when I’ve spent the last hour talking to people with ingrowing toenails. But it can’t be compulsory; every day I have some calls where the clinical details just say “personal”, and that’s fine. Most of those will be about sensitive subjects,

although occasionally someone is embarrassed about their ear wax or eczema.

achieve on the phone. When possible, I try to lower my threshold for a face-to-face appointment if I think there are significant mental health issues. If I’m thinking about prescribing antidepressants for the first time, or if a patient with mental health problems has had several phone calls without improvement, it’s probably time to see them face to face – even if it is through a mask.

A downside of phone triage is that you don’t know who is in the room with the patient. Face to Medicine is an art, not a science, and that doesn’t face, I often ask the patient’s change in pandemic times. That elusive quality, parent or partner to leave the the GP ‘spidey sense’, should be our final arbiter, room while we talk (how many along with the insomnia test. If your antennae are teenagers will be open about their twitching or you think you won’t sleep tonight if sex life or smoking habits in front of you haven’t seen the patient, they need to Mum?), but when they’re at home I don’t know come in. who is around. Could the patient’s controlling Good luck to all those or abusive partner be in the room with them walking the triage or listening through paper-thin walls? Closed tightrope. questions with a yes/no answer are useful here. Are you on your own? Can anyone else hear you? If you feel unsafe and want to be seen face to face, just say “yes”. It’s important not to make assumptions about the patient’s situation. If I jump in with “Lovely news, congratulations!” when a woman tells me she is pregnant, that makes it much harder for her to say that she wants a termination – something that she may already be feeling sad and guilty about. “How do you feel about that?” is a great question to ask when a woman discloses her pregnancy to a health or care professional, as it leaves the door open for an honest discussion about feelings and worries. Decisions about who to see face to face are difficult at this time. There is a need to reduce footfall, maybe more over the coming months of the second wave, and there is a temptation to see only those who absolutely need it. You can’t lay a hand on someone’s belly virtually, nor can you look in an ear or do a gynaecological examination. Taking this view of face to face only when there is no alternative isn’t a great thing for those with mental health problems, either. Yes, depression can be discussed on the phone – no physical examination is needed – but it isn’t nearly as good. All the non-verbal cues are lost, and the therapeutic effect of the ‘doctor as drug’ that you get from a good consultation is difficult, maybe impossible to www.bluestreamacademy.com

CoppaFeel! This year has been particularly tough on cancer services in the UK, with huge delays and backlogs in screening and diagnostics, and a significant decrease in diagnostic referrals.

CoppaFeel!

coppafeel.org

CoppaFeel! is a breast cancer awareness charity, based in London. The charity focuses on promoting early detection of breast cancer by encouraging women under 30 to regularly check their breasts.

t CoppaFeel! we know all too well the importance of early diagnosis in breast cancer, and how it can make the difference between life and death. For that reason, we share the concerns of NHS England about the impact of COVID-19 on early diagnosis. Breast awareness is more crucial than ever. The good news is, we’re here to help with that. Our mission is to:

• Encourage young people to regularly check their boobs, pecs and chests • Educate them about the signs and symptoms of breast cancer

Our work is motivated by the Our work is motivated by the knowledge that early diagnosis saves lives. The relatively high survival rate for breast cancer is predicated on the fact that 75.4% of patients with breast cancer are diagnosed at stage 1 or 2. The NHS long-term plan for cancer services aims to increase that number to 90% of breast cancers diagnosed early by 2028. Self-checking is the first line of defence, so by informing and empowering people to know their bodies, we aim to stamp out late diagnosis. This is especially important at the moment, given the pressures on diagnostic cancer services.

Young women have told us how important GPs and other health • Empower them to seek medical and care professionals are when advice if they notice anything that it comes to encouraging them to check themselves. isn’t normal for them.

Here’s how we can help you to help them:

How to Check Your Breasts

1. We provide breast awareness webinars for health and care professionals. Among the topics we cover are: • information about the benefits of early detection in breast cancer • the impact of COVID on breast- cancer services • breast awareness versus breast self-exam • information about breast awareness in pregnancy • National Institute for Health and Care Excellence (NICE) guidelines for referral. 2. We offer free packs of materials for your practice or clinic, including handy wallet-sized checking cards Go to www.coppafeel.org/at-surgeries to request your free pack. 3. Digital resources! We have a digital information pack just for doctors and nurses, a digital information pack just for midwives and health visitors, and a Code of Breast Practice for GPs.

The Signs of Breast Cancer to Look Out For

4. We provide downloadable posters and digital slides for use in your waiting rooms. Visit our website for more information about all the work we do! Drop us an email at clare@coppafeel.org to find out about webinars and other ways we can support you with breast awareness.

www.bluestreamacademy.com

Moving Forward and Making Changes

t’s been a funny old year so far hasn’t it? So many changes, so much upheaval, so many new things to cope with and, in the midst of all this, it has never been so important to look after ourselves, both physically and mentally. But how do we actually do that? This article is here to answer that question, so grab a cuppa, sit back and relax.

Jo Howarth Jo Howarth is a bestselling author and inspirational speaker. She is an uplifter, an inspirer, a helper and the founder of The Happiness Club. You can reach Jo at jo@ thehappinessclub.co.uk and find out more about the Happiness Club at www.thehappinessclub.co.uk

Do you ever? Relax, I mean. Do you ever purposely, actively, make time to simply relax? When we talk about physical wellbeing, we automatically think of exercise and nutrition. But relaxation is as vital to your health and wellbeing as eating and drinking the right things are. It’s not a nicety, it’s not a luxury, it’s not something to do when you have the time; it is vital to your health and wellbeing but it’s the thing that gets forgotten because we are so busy. Some of us have been cooped up inside for a while now with lockdown measures in place across the country, some of us have been forced to stop and do less than usual, and some of us have had ‘relaxation’ pushed upon us. Doing less and relaxing are not necessarily the same thing, though; if you struggled to relax when you were busier, the chances are that you will struggle to relax now you have less to do. Whether you find yourself more or less busy than usual, making that time to relax is vital.

So, how do we relax? Start by taking just 1 minute a day. Find somewhere comfy to sit, set a timer for 1 minute, close your eyes and for that 1 minute focus all of your attention on your breathing – on each breath in and each breath out. Every time you notice that your mind has wandered away from that focus, gently bring it back to your breath. Do this for just 1 minute a day. When you get used to doing it for 1 minute, do it for 2, then 3, then 4. When you get to 5 minutes it is officially called meditation, and this is the most beautiful way to practise relaxation that I have ever found.

Another way to look after ourselves is through physical exercise, whatever that looks like for you: running, swimming, yoga or HIIT classes. Exercise is the single best stress reliever there is. It burns off the stress hormones that flood your body in challenging times, as well as keeping your body fit and moving. We were not made to sit around; we were made to move about – so find a way to do that. Get up every so often and walk around the space you’re in; stand up and do five star jumps; tap your feet on the floor while you’re sitting down; stretch those legs and arms out on a regular basis; lift your shoulders up towards your ears and then gently let them drop. Find a way to build movement into your day. Regular relaxation and exercise will help us to look after our physical and mental health, but what else can we do to build our mental and emotional resilience?

“

... it has never been so important to look after ourselves, both physically and mentally. But how do we actually do that?

One of my favourite ways to look after my mental wellbeing is to practise appreciation. Alongside love and joy, appreciation is one of the purest, most positive emotions that you will ever experience, and it is totally possible for you to create that feeling inside yourself at any time you choose. Top Tip Look around you right now. Look at what’s right in front of you: your desk, your workspace, wherever you are. Pick something, anything, that you can see. It might be a pen, a mouse mat, a cup or a pair of glasses – anything at all. Now say out loud at least five things that you appreciate about that thing. Those things might be to do with how it looks or feels, or they might be to do with its function or where it came from. They can be anything at all, but really take a moment to study that thing and find as many reasons to appreciate it as you can. Let yourself feel appreciation for that thing. Then carry on with whatever you were doing beforehand. Repeat that exercise as many times as you can during your day. Then take time at the end of each working day to reflect. Find at least three things from that day to be glad about. They might be things you have achieved, jobs you have done well, conversations you have had, or quiet time you have enjoyed. Whatever they are, write them down and take a moment to notice and appreciate them, giving yourself a pat on the back at the same time. Over time, these simple techniques will help you to boost and look after two of your most important assets: your body and your mind. Life is the most precious thing we have, which means that looking after your health is the most valuable thing you can do. So, be kind to yourself. Move forward and make changes! www.bluestreamacademy.com

Garlic Bread Twist • • • • • • • • • •

Can Baking Make You Happier?

by Ellie Stanton

We think it can! In this issue Ellie Stanton, National Trainer and Care Certificate Manager at Blue Stream Academy, shares her love for all things baking by creating some delicious recipes that will bring a smile to your face. We hope you enjoy making – and eating – these tasty sweet and savoury treats.

500g bread flour Pinch of salt 7g yeast 1tbsp olive oil 300ml water 25g butter 4 garlic cloves, finely chopped 1tbsp garlic powder 2tsp mixed herbs 3tbsp parmesan cheese

1. Sieve the flour and salt into a bowl. 2. Add the yeast and oil, and gradually add water until the mixture forms a dough (you might not need all the water). 3. Turn the dough out onto a lightly floured surface and knead until smooth. 4. Put the dough into an oiled bowl, cover with cling film and leave for roughly 1 hour or until it has doubled in size. 5. While the dough is rising, melt the butter. 6. Mix the chopped garlic, garlic powder, mixed herbs and 2tbsp of parmesan cheese into the melted butter. Put to one side for later. 7. Once the dough is ready, place it on a lightly floured surface and roll it out into a large rectangle. 8. With a pastry brush, brush the garlic butter all over the rolled-out dough. Then sprinkle the remaining parmesan cheese over the dough. 9. Roll the dough into a long sausage (go from long side to long side). 10. Cut down the middle of the roll, leaving a few centimetres uncut at one end (to stop it from falling apart). 11. Then twist both strips so the contents are facing up. 12. Twist the two lengths together, and bring the two ends together to form a ring. 13. Place a sheet of greaseproof paper on a flat baking tray and carefully place the ring onto the tray. 14. Cover with cling film and leave to rise for 30–40 minutes. 15. Preheat the oven to 180C fan. 16. Remove the cling film, loosely cover with tin foil and place in the oven for 20 minutes. 17. Remove the foil and bake for a further 30–40 minutes until the bread is cooked all the way through and golden. (If the bread starts to catch and burn, cover it with tin foil again until the end of the bake). 18. Then serve! The bread makes a perfect side for any pasta dish.

Juicy Facts About Lemons That You Didn’t Know

Lemon and Lime Curd Biscuits

Lime curd ingredients • 2 eggs • 100g caster sugar • 3 limes • 50g butter (cut into cubes) Lemon curd ingredients • 2 eggs • 100g caster sugar • 3 lemons • 50g butter (cut into cubes) Optional – icing sugar to thicken the curd. Biscuit ingredients • 125g butter • 55g caster sugar • 180g plain flour 1. Preheat the oven to 180C fan. 2. To make the biscuits, mix the butter and sugar together until the mixture is light in colour and smooth. 3. Gradually add the flour, keeping the consistency smooth. 4. Turn the mixture out and gently form it into a ball. Then roll it out to a thickness of half a centimetre. 5. Cut into 20–24 rounds. This will make 10–12 biscuits. 6. In half of the rounds, cut a smaller circle out of the middle (so they resemble a doughnut shape). 7. Place the rounds on greaseproof paper on a baking tray and bake for 15–20 minutes. 8. While the biscuits are baking, start making the lime and lemon curds. 9. For the lime curd, start by grating the zest of the limes. Then juice the 3 limes. 10. Beat the eggs and mix them in a heatproof bowl with the caster sugar, lime juice and zest. 11. Place a saucepan on the hob and add water. Then place the bowl over the top of the saucepan. Heat at a low level. 12. Gently whisk the mixture until it starts to thicken. 13. Once thickened, add the butter and stir until it has melted and combined with the mixture. 14. To make the lemon curd, repeat the process used for the lime curd, but using lemons. 15. Once the biscuits and both curds are cool, put the curds into separate pipping bags. If the curds are too runny to pipe, try adding some icing sugar to thicken the mixture. 16. Pipe the curds onto the solid biscuits. Then place the biscuits with the cut-out centres on top of the curd. 17. Eat and enjoy! www.bluestreamacademy.com

Not Just a Citrus

The lemon is a hesperidium, a berry with a leathery rind.

Preventing Scurvy

The British Navy requires ships to carry enough lemons so that every sailor can have one ounce of juice a day.

Hybrid Fruit

Lemons are believed to be a hybrid between a sour orange and a citron. There are three common lemons which are Bearss, Eureka and Lisbon.

Conducting Electricity

Attaching electrodes to a lemon can create a battery that produces electricity. Several lemon batteries can power a small digital watch!

Introducing

The New Blue StreamNet Platform Training and Management Solutions at Your Fingertips

Over the years, as the healthcare landscape has changed and organisations have needed to adapt, many new challenges have arisen for managers, their organisations and the staff who power them. At Blue Stream Academy, we have listened carefully to our customers to ensure that the system we provide contains the features that are needed.

Our aim has always been to improve user experience, reduce wasted time and be as economical as possible. We have now developed Blue StreamNet to help streamline an organisationâ€™s business needs into one easy-to-use platform. It couldnâ€™t be easier!

Blue Stream eLearning

Blue Hub MIS

Blue People HR System

Blue Recruit Recruitment System

Blue Books Bookkeeping

Blue Check DBS Checking System

Blue Pay Payroll System

Blue Connect Video Conferencing

Our team is on hand to discuss the different ways that we can support your organisation and transform your daily processes. Please get in touch by emailing info@bluestreamacademy.com to 26 find out more about our effective, efficient and easy-to-use new platform.

@BlueStreamNews

s the leading provider of CPD-certified clinical and non-clinical eLearning to health and care professionals across the UK, we release new modules throughout the year. Our newest modules cover the following key topics: Effective Supervision Effective regular and ongoing supervision is vital for everyone working in health and social care. Our Effective Supervision module covers several key areas, including: • • •

what the functions and benefits of supervision are why supervision is essential in order to provide high-quality care for those using a service how supervision helps to support those who are providing care in an accountable organisation that meets the required standards.

Our module looks at: • signs that may mean that there are issues with the delivery of supervision in an organisation • the aims of supervision and who should provide it • information on suitable training for supervisors • the importance of the relationship between a supervisor and their supervisee • how access to appropriate formal supervision can deliver significant benefits, including increased job satisfaction and better staff-retention rates. Medical Gases This module focuses on administering the medical gases medical oxygen and Entonox (50% nitrous oxide and 50% oxygen). It has been developed for use by health and care professionals who are suitably trained in delivering medical oxygen and Entonox via different sources.

www.bluestreamacademy.com

The module covers the key areas of: • administration • safety and precautions for use • side effects • storage • handling and disposal • safety warnings It aims to raise awareness of the essential information that should be understood by anyone working in a setting where medical oxygen and Entonox are administered. Autism Awareness (Tiers 1 and 2) – NOW AVAILABLE! Following the announcement in BSA Today Issue 6, our Autism Awareness module (Tiers 1 and 2) is now available If you would like to discuss these new modules – or any other Blue Stream Academy eLearning resource – please contact us either through email at info@bluestreamacademy.com, or call us on 01773 822549 and a member of our friendly team will be happy to help. Be sure to follow us on Twitter (@BlueStreamNews) to get our updates and module announcements as soon as they happen!

Hi Abi,

We need your help! One of our admin assistants who has been working from home has recently complained about getting a bad back from working at his kitchen table and using a wooden chair.

Ask Abi...

Blue Stream Academy team member, Abi, is here to answer your questions and give advice to our readers. If you have a question or problem and would like some advice, please feel free to contact Abi via email at: bsatoday@ bluestreamacademy.com

He’s usually fine when in the office, but during a recent catch-up he made the odd joke about “putting a claim in”, which of course we need to avoid. I’ve told him that he needs to find somewhere more comfortable to work from, but I’m wondering if we could do more as an employer. What would you recommend? Practice Manager, Burnley

Thanks for getting in touch about your employee’s working-from-home woes! When staff are working from home, employers have the same duty of care that they have for people who are working in the office, and it’s just as important to complete a thorough display screen equipment (DSE) assessment. As part of this process you should assess your employee’s workstation, chair, screens, keyboard and mouse to reduce any risk of poor posture. It’s also important to remind them to take regular breaks to reduce the risk of developing any musculoskeletal disorders. As with all staff who are working from home, it’s important to ensure that you maintain regular communication with your employee so he can bring up any issues that arise while he is working remotely. I hope these tips will improve his situation and resolve his bad back. Stay safe,

#TeamBSA

his October, Blue Stream Academy hosted a COVIDsecure charity breakfast for our onsite staff to raise funds for The Prince’s Trust’s Women Supporting Women initiative. According to Pricewaterhouse Coopers (PwC), 80% of those who have lost their jobs since the COVID crisis began are women, and two-thirds of them are aged 18–34.¹ How is the initiative helping women affected by this? As a team, we are delighted to announce that we raised a total of £1,542 from the event! This donation will make two big contributions: •

£500 will unlock one young woman’s confidence with a 12-week personal development course that builds the practical and emotional skills needed to take that next step into work, education or training

For more information on the initiative and how to get involved, visit www.princes-trust.org.uk/support-our-work/major-gifts/ women-supporting-women Fundraising is at the heart of Blue Stream Academy’s culture. As soon as it is safe to do so, we’ll be ready to resume our usual fundraising efforts – locally and further afield! ¹ Narwan G. (2020) Women and Youngsters Lose Most Jobs in Crisis. The Times. https://www.thetimes.co.uk/article/womenand-youngsters-lose-most-jobs-in-crisis-05bw5hsll (Last accessed November 2020)

In our last issue we wanted to lighten the mood and mend your lockdown blues with our ‘Photo’s That Make You Smile!’ competition. Congratulations Bev Elliot, from Hawthorn Medical Practice for winning a £150 Amazon voucher! Bev was pleased with the news

‘Wow! I never win anything - I could never win so much as a goldfish at a fair when I was a child!! lol Thank you so much’

It was great seeing your weird and wonderful sense of humour. Just remember, there is always a reason to smile if you look hard enough. Thank you, Team BSA.

Abi

• £1,000 will give laptops to five young women who are struggling to make ends meet during the COVID-19 pandemic so they can further their education.

Competition Winner!

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Dear Reader,

Puzzle Corner Enjoy this month’s Sudoku puzzle and Brain Training! Last issue’s answers can be found on the right. Want to win a FREE IPAD? Details are on the back page.

This Issue’s Sudoku (Rating: Hard) 1 2

2 3

1 4

8 6

9 5

3 7

9 6

7 8

5 9

Last Issue's Answers Sudoku Answer:

Word Fit Answer:

S V

Z W P

A N

B G

A O

O W N

J F

O N

I N

H K

B A

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Last issue’s Brain Training Answers: Beginner = 10, Intermediate = 23, Advanced = 14

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TIMES IT BY

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How can I reach out to friends suffering with bad mental health?

With the uncertainty of Lockdown 2.0 and Christmas celebrations looming, you may wonder how your friends with mental health problems are coping. Just by wanting to be there for them, you’re already being a great friend! Remember that everyone is different, it’s important to talk with your friend about what they need. A little ‘I’m thinking of you’ text can help. Texts are easy to send and transmit love and acceptance, and let them know that they are not alone. Please see our message ideas to help you reach out. They may not reply to your message with much enthusiasm or at all. But when responding to them, be a good listener by paying attention and acknowledging their feelings. Don’t try to solve their problems for them or judge what they say, even if you don’t agree.

www.bluestreamacademy.com

If you feel like they need more support than you can give, you could suggest charities such as Mind. Their Everyday Living page is packed full of topics and their Coronavirus Hub has reliable information and tips to help people cope during this time. For further tips on how you can help support someone, please see our website. 27