Medical Director Blog: October 2022 – Dr Frankie Swords

31st October 2022

It’s been another immensely busy month for us all – and a new Prime Minister has taken up office since I wrote my blog last month!

I continue to be amazed by the sheer will and determination of all staff across Norfolk and Waveney. We continue to face huge challenges, but there’s a clear ‘can do’ attitude being shown by all.

Last month, I talked about our four system-wide priorities. On reflection and listening carefully to staff, people and communities, we have created a fifth, primary care.

Primary Care

So, let’s start with the latest in primary care, including a really good news story that our performance in primary care continues to be good and above the national average.

In August 2022, the latest data shows:

  • 40% GP appointments In Norfolk and Waveney were given on the day they were requested
  • 81% of all appointments took place within two-weeks
  • 73% of appointments were face-to-face, well above the national average of 66%

Looking at the overall numbers, in Norfolk and Waveney, we’re actually seeing more face-to-face appointments, more home visits plus more telephone appointments compared with the pre-pandemic year 2019-20. So, our primary care family continue to work their socks off, and none of these numbers include the huge number of appointments for the COVID-19 and flu vaccination programmes which continue with huge momentum – almost 300,000 COVID-19 vaccinations have taken place in Norfolk and Waveney so far (including mine!) this Autumn.

A national letter was sent this month, recognising the importance and pressure on primary care, which builds on the “Bureaucracy busting concordat” to support general practice published by the Department of Health and Social Care in August. I’m proud to say that we are already doing a lot in this area, with our monthly Primary Care Interface group and LMC meetings taking a really constructive and collaborative approach to cut out red tape, reduce duplication and to try to prevent inappropriate work from being shifted between our providers when we are all so busy already.

The Academy of Medical Royal Colleges (AoMRC) has also just been commissioned to identify what else we can do at the interface between primary and other care providers to have the most impact in managing winter pressures and beyond. As soon as this is published, I will share it here, and do all we can to implement any other ideas.

Urgent and Emergency Care

Around 80% of patients who need urgent help across Norfolk and Waveney are actually seen in primary care on the day. But, unfortunately, some people who need an emergency ambulance are having to wait far longer than we’d like at the moment. For this reason, we remain in a critical incident and have set up daily system-wide meetings of our chief executives and or chief operating officers to help improve flow through our hospitals, reduce crowding in our emergency departments, and get those ambulances back on the road. We also have a weekly clinical risk review panel with the Medical Directors and Chief Nurses to ensure we’re doing all we can to address the quality and safety aspects of the current situation and to try to minimise the impact this is having on staff and patients.

Our biggest problem isn’t actually an increase in emergency patients though, rather it is the high number of patients who no longer need to be in an acute or community hospital bed. Norfolk County Council and Suffolk County Council are pulling out all the stops to support much higher numbers of people to be discharged whether they need some care at home or a long-term placement. Together with community and other providers, as a system we’ve opened an additional 127 beds over the last few weeks, so things are improving but we’re not where we want to be yet. We’re also ramping up Virtual Ward across Norfolk and Waveney to help people to go home sooner, using technology to support this. This is planned to get even bigger and better over the next 12 months.

Finally, we’ve stepped up our communications and public health advice to remind our communities of the huge array of services available. We want people to think 111, not 999 unless it’s a true emergency so that they can get the most appropriate support, and to reduce the pressure on our emergency services during this time.

Unfortunately, COVID-19 is also on the rise and we are seeing a big increase in the number of people in our hospital settings receiving treatment for the virus, as well as an increase in staff sickness across all settings. Remember, all health and care staff can access the COVID and Flu jabs this autumn – it’s the best thing you can do to protect yourself, your family, colleagues, and patients.

Mental Health

Turning to mental health, Norfolk and Suffolk Foundation Trust has not received any formal feedback yet from their recent Care Quality Commission visit. However, the CQC is expected back in the next few weeks to undertake a Well Led inspection and so we really hope that all of the hard work to transform things will be recognised when their inspection report is published, expected to be early in the new year.

Elective Recovery

The first important milestone was to ensure no patients wait for longer than 104 weeks for treatment in Norfolk and Waveney, and we achieved that in July this year.

Our next target is to ensure that those who have a cancer diagnose receive treatment within 62 days. We need to achieve pre-pandemic performance by March 2023, as well as to clear the waiting list of people who have waited more than 78 week waits by March 2023. These are really important targets to meet, but incredibly challenging with our hospitals so full at the moment, and compounded by current levels of staff sickness, the need for staff to support patients in escalation areas and the ongoing Infection, Prevention and Control issues relating to COVID and Flu.

It is really good to see how well we are doing with Diagnostics though. Norfolk and Waveney is doing pretty much the best in the East of England region across multiple measures especially CT. There’s also exciting progress towards opening our diagnostic assessment centres (DACs) close to our acute hospitals as well as more community diagnostic hubs which we hope will include mobile solutions in time.


Our ICS digital strategy has now been completed. Thank you to all who contributed especially to the case studies and workshops, this will be published shortly. The digital roadmap for Norfolk and Waveney is also due to be published soon.

All three acute hospitals now have digital prescribing, NNUH and JPUH have electronic observations in place with QEH soon to follow and NNUH celebrated going bleep free in October too. Our community, mental health and primary care teams all have electronic patient records already though unfortunately, none of our acute trusts do yet. So, it’s been great to see the business case for a combined Electronic Patient Record for the hospitals across Norfolk and Waveney going through all of its local approvals this month, though we’ll have to wait for the Treasury for final sign-off early in the new year.  

Another exciting digital milestone is the Norfolk and Waveney Shared Care Record – phase one goes live in December, just a matter of weeks.

The national Future Records project also launches on 1 November. This is an NHS England programme which means that patients will now be able to access all of their prospective medical records held by their GP surgery. This is great news and I hope will be really empowering for patients. Please remember that this will include any and all letters sent to GPs though. Patients will be able to access these directly through the NHS or other app, so, it’s absolutely vital that we explain results and write to patients directly before or at the same time that we write to update their GP Surgery.

So lots of challenges continue, but we are making good progress. In case you haven’t seen it, a new survey was launched recently for all clinical and care professionals across Norfolk and Waveney. Please fill this in, it only took me 5 minutes, but it will help us understand what people want and how we can better support you and each other. A new web page has also been published, which will include information relating to the Clinical and Care Staff Leadership Programme; please take a look at this too.

Thank you for everything you continue to do.