Agenda item

The Chairman welcomed Rachel Perry – Head of Integrated Services (SEL ICB), Lindsay Pyne – Head of Adult Therapies (BHC), Ellen Shiner – Physiotherapist - Long Covid (King’s) and Dr Zia Buckhoree – GP Partner, Co-Clinical Director Beckenham PCN to the meeting to provide an update on the Post-COVID syndrome service.

The GP Partner, Co-Clinical Director Beckenham PCN informed Board Members that Post-COVID syndrome was the signs and symptoms that developed during or after an infection consistent with COVID-19; it was ongoing for more than 12 weeks and could not be explained by an alternative diagnosis; and was also known as Long COVID. The Bromley Post-COVID pathway was an integrated pathway that had been established to educate and empower individuals to manage their symptoms and improve their health outcomes (both physical and mental health). Advice, guidance and signposting, as well as one-off interventions to support patients, were provided via:

1)  Self-management ‘Your COVID Recovery’ website

2)  Primary Care

3)  Post-COVID community services

4)  Specialist Post-COVID Syndrome Assessment Clinic.

The GP Partner, Co-Clinical Director Beckenham PCN noted that it had quickly become evident that a national response would be needed. There had been more than 120,000 case of COVID-19 in Bromley and a research study estimated that 5-10% of these people (6,000-12,000) would have ongoing symptoms of Long COVID. In spring 2021, a Post-COVID Syndrome Assessment Clinic had been established at the PRUH to undertake a holistic assessment including respiratory or neurological symptoms to rule out serious underlying pathology. This led to a single SEL assessment referral form and protocols developed for GPs and a Post-COVID community pathway accepting direct GP referrals. By the end of 2021, weekly Post-COVID Multi-Disciplinary Meetings (MDMs) were being held. These meetings had input from Occupational Therapy, Physiotherapy, Respiratory Consultants, Improving Access to Psychological Therapies (IAPT), GPs and Bromley Well. Progress to date included:

-  A locally developed integrated Post-COVID pathway;

-  Use of a single assessment referral form and protocols agreed across all SEL boroughs;

-  Collaborative MDMs held weekly with input from community, secondary and mental health services professionals;

-  Care Navigator role with knowledge of the third sector and able to signpost;

-  Transition of the acute assessment clinic to include a therapy lead clinic resulting in a reduction in waiting times; and,

-  The Bromley Post-COVID service had won the One Bromley integration staff awards in 2022 under the ‘successful collaboration working in Primary Care service’ category.

The Physiotherapist - Long Covid (King’s) advised that, in autumn 2022, the acute care Post-COVID clinic switched from consultant led to a therapy led model. Therapy led triage involved checking that all bloods and chest x-rays were normal to indicate that a Long COVID assessment was appropriate and there were two physiotherapist and two occupational therapists in post completing new patient assessments across SE London. Consultant supervision and MDMs ran alongside this to discuss caseload, and referrals were made into community settings across the boroughs with a personalised approach. A snapshot of the data for Bromley patients attending the Post-COVID assessment clinics indicated that attendance rates were good and the majority of the referrals into the service were from Primary Care.

In response to a question regarding the performance data (page 76 of the agenda pack), the Physiotherapist - Long Covid (King’s) advised that 58 patients booked into the PRUH’s Post-COVID Assessment Clinic over the last 6-month period was a lower figure that expected. They had undertaken lots of work with the Guys’ and St Thomas’ Charity and they believed there were some areas of the population that were not being reached. Referrals in April 2021 had been at a much higher level, but had since reduced – it was considered that learning had been taken from the therapy led approach and more referrals were being made into community services. The Head of Integrated Services (SEL ICB) noted that the 58 patients referenced were referred into the acute therapy service model.

With regards to the Post-COVID community services, assessments were currently completed via the phone and all patients were discussed at MDMs. The majority of individuals were invited to attend the 8-week group community programme, which could be attended face-to-face or virtually – these sessions were delivered by different professionals, and focussed on a number of areas including fatigue and breathlessness. Follow up phone calls were made to individuals after 12 weeks and 6 months and a peer support group was held every fortnight, provided by the Care Navigator from Bromley Well. In terms of next steps, additional funding had been received which would be used to expand the Post-COVID community services, and a number of additional staff would be appointed. They were aiming to deliver more face-to-face sessions; individualised care (including home visits) to improve recovery; exercise sessions; and a living with COVID recovery app across SEL. The outcome data indicated that, at the 12-week and 6-month follow ups, the overall scores were reducing (with a score of 0 representing no issues). On occasions there were relapses at 6 months, with a reoccurrence of symptoms being seen, and this was a pattern being reflected nationally. The Head of Integrated Services (SEL ICB) noted that the use of performance data to review individual outcomes to refine and improve the service would be further developed, and they would continue working with colleagues across SEL to share best practice.

A Board Member congratulated those involved with the Post-COVID syndrome service on the work undertaken, and enquired if they were contributing to any live studies. The Head of Integrated Services (SEL ICB) confirmed that the service was involved in several research studies. Guy’s & St Thomas’, Brompton & Harefield Hospital, Evelina London Children’s Hospital and King’s College were leading on a programme researching Long COVID, working with health professionals and communities. Patient co-production workshops had been held in Bromley and recommendations were made in terms of enhancing the model of care for people living with Long COVID. It was noted that the service was also part of the SEL Long COVID Programme, led by NHS Charities Together, which had focussed on the mapping exercise and there was now a programme of pilot workstreams in place. The Head of Adult Therapies (BHC) advised that, in Bromley, they were focussing on the impact on staff in care homes. Patients and staff in Bromley had also been involved in the research undertaken by London Southbank University, and they would continue to participate in any further studies. The GP Partner, Co-Clinical Director Beckenham PCN noted that the outcome measures and interventions used in Bromley were the same that were being used by King’s and Guy’s & St Thomas’ – this provided a collective data set which was comparable.

The Chairman thanked the Head of Integrated Services (SEL ICB), Head of Adult Therapies (BHC), Physiotherapist - Long Covid (King’s) and GP Partner, Co-Clinical Director Beckenham PCN for their presentation to the Board and requested that a further update be provided in spring 2024.

RESOLVED that the update be noted.