The Secretary for State for Health recently announced an extension to the Seasonal Influenza Vaccination Programme commencing 1 December 2020, specifically to patients aged between 50 - 64, without medical conditons that would otherwise make them eligible for a seasonal influenza vaccination.

We had been awaiting details of how to procure the additional vaccinations and we have now been able to order them with an expected delivery of the week commencing 30 November.  We will update the website once we have received the vaccinations with details of how to book a flu appointment.

Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.

What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.

Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.

Find out more or to make a pledge go to:  https://antibioticguardian.com/

Phio is an innovative digital assessment tool which allows patients to access support for their condition 24/7. Designed by expert physiotherapists and underpinned by the latest clinical guidelines Phio is an instantly available, digital consultation. It uses efficient clinical decision trees to accurately assess and signpost patients to appropriate care pathways. Phio will ask questions about you and your symptoms then, based on your responses, signpost you to the most appropriate level of care, for example face to face physiotherapy, extended scope physiotherapy or telephone/remote management.

If your condition is not suitable for the Physiotherapy service, or there are any clinical concerns, these will be detected by your responses and Phio will signpost you accordingly to the most appropriate service. For peace of mind all assessments are reviewed by a physiotherapist to ensure the correct decision has been made.

Due to the COVID-19 Coronavirus pandemic, we will continue to minimise face to face appointments in favour of using eConsult, phone and video (through a secure link on your smart phone). We are encouraging everyone who has internet access to make initial contact from the eConsult link on the website. We will be able to reply to some queries by email or text so please ensure we have up to date contact details for you. We will speak to anyone who might need to be seen face to face before deciding whether it is appropriate for them to come in.

For those needing to attend the surgery you will find that access is restricted so you cannot simply walk in. On arrival, you will need to phone reception from your mobile (or ring the doorbell next to the front door if you are unable to phone) to gain entry. We don't want this to seem distant and impersonal, but are committed to maintaining the safety of our patients and practice team by minimising close contact where it is not completely necessary. We will continue to ask patients to remain in their cars and the doctor, nurse or health care assistant will meet them outside and check their temperature before proceeding further. Patients should wear their mask before entering the surgery, and will wear basic personal protective equipment ourselves (mask, eye protection, apron and gloves) during all patient assessments. 

We would encourage all our patients to keep up with the latest guidance through the NHS website which is constantly being updated and has links for questions about travel, contacts, symptoms, self-isolation, social distancing and shielding. We do not have the capacity to give general advice to all our patients so would encourage everyone to view this information before making contact with any questions.

Boundaries Surgery Dispensary remains open to those who usually get medications from us. If you come to collect medication, please ring reception on arrival and you will be met outside (at right hand side of the building) where your medication will be placed on a small table so you can receive the bag while maintaining social distancing. We have a wireless contactless card reader so payments can also be made safely.

For those unable to safely collect their medications from the surgery and who do not have someone able to collect on their behalf, we are arranging a limited delivery service to ensure people can get their medication at this time. Thank you to everyone who has volunteered to help make this possible.

Symptoms of COVID-19 infection can vary between people and age groups but most commonly include:

• a high temperature (37.8C or higher) – you feel hot to touch on your chest or back
• a new, continuous cough – this means you've started coughing repeatedly
• loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

Stay at home for the current government recommended isolation period if you develop symptoms which could be due to coronavirus or someone in your household has symptoms. If you become unwell during this period of isolation you should then continue to self-isolate. Do not go to a GP surgery, pharmacy or hospital. You do not need to contact 111 to tell them you're staying at home. Testing for coronavirus is not needed if you're staying at home. Read the summary for advice about staying at home. For comprehensive advice about self-isolating visit COVID-19: stay at home guidance. If your symptoms worsen during your period of self-isolation or if you still have a fever then please go to NHS 111 online or call 111 if you do not have internet access. You can also obtain an isolation note for your employer from the 111 online service if you or someone in your household have symptoms. Testing is now available for people with symptoms aged over 5 years and information on how to obtain a test is available here. You should apply for a test within the first three days of symptoms so it can be done within the first five days of symptoms. We have suspended the facility to book appointments online. Please make use of eConsult to make contact about clinical and administrative issues which can be dealt with appropriately within 48 hours. In the short term, we will be reducing routine appointments for people who are otherwise well, e.g. medication reviews. Please make use of eConsult to access information about medical problems, learn about options for self-treatment and to make contact with a GP if this is required.

For questions relating to the COVID-19 Coronavirus and travel, visit Travel advice: coronavirus (COVID-19).

During the COVID-19 Coronavirus pandemic, we are aware that many of you will have less individual contact with us due to restrictions in entering the surgery and routine appointments. The things listed below are some reminders of existing resources and services, as well as a few additional things to consider at this time:

• Keep an eye on our website for information relating to any change in the services at Boundaries Surgery. We will be working closely with neighbouring practices and at times may be helping to look after each other's patients.
• Buy a thermometer. Thermometers are currently in short supply but will become available in the near future. We recommend that every household has a thermometer so you can take your temperature if you suspect you may have a fever (which can be a sign of infection). This helps us greatly when assessing you by phone.
• Use online resources to help you manage minor medical conditions at home.
• The NHS website has lots of information on medical conditions, symptoms and treatment as well as medications which you may have queries about.
• Patient.info has online versions of all the patient information leaflets we often print to give to patients during consultations. There are also 'Patient Plus' articles which are written more for medical professionals but in an accessible way if people want more depth. Symptom Checker, Health Information and Medicines Guide.
• Boundaries Surgery eConsult allows you to contact us at the surgery - we will try to respond in the usual way within 1 working day of receipt. It also has a huge amount of information about common symptoms and conditions and has a useful feature where you can use the 'body map' to localise your symptom if you don't know which condition you need to search for.
• Healthier Together - The Healthier Together website provides information for parents and their children and those who are pregnant. The midwifery and health visiting services can also be contacted for advice.
• Remember that the local minor injury services based at both Chawton Park Surgery and the Alton Health Centre is still operational. It is worth ringing ahead so they are expecting you and can triage your problem before you attend. Alton Community Hospital will be starting to do some XRays again but by appointment only - the walk in service will not be resuming at present.
• Unwell Children

We have been asked to share the following statement written by our Local Medical Committee (LMC):

'At this challenging time, it is extremely important for you to know that COVID-19 is unlikely to make your child unwell, but they like everyone else might be infectious so staying at home when well remains the message. However, all the ‘normal’ illnesses that can make children severely unwell still remain and there is a major risk that parents may delay bringing their child to the attention of a healthcare professionals even if they are unwell because of concerns about COVID-19. GPs and hospitals are still providing the same safe care that they have always done for children. If you are not sure if your child is unwell and whether they need to be seen, click here, call 111 or contact your GP. For information about crying babies, click here. If your child appears severely unwell and advice is not quickly available call 999 or take them to ED as you would in other times.'

Adult and child Safeguarding/Domestic abuse

During the Coronavirus Pandemic calls reports of domestic abuse and calls to national agencies and helplines have risen greatly. A new section with useful advice, links and contact numbers can be accessed through a new button at the top of the home page.

• Managing Long term conditions

We will be less able to do in depth medication reviews over the coming months. We hope to continue doing some reviews by phone but realise this does not always give us the same level in interaction or information as a face to face review. It is worth looking up information about your condition on the links above. Below are a few specific pointers

If you are treated for high blood pressure, it would be helpful to obtain a home blood pressure monitor. These can be purchased from local pharmacies or online. The electronic monitors we tend to use at the surgery are generally made by Omron and a model such as the Omron M2 is reasonably priced (about £25) and perfect for basic home use. Many makes and models are available and some will allow you to download information to your computer if you wish to.

If your blood pressure has been well controlled and you feel well there is no need to regularly check your blood pressure. If you feel unwell or have an inter-current illness then it may be useful to check it. It is helpful to us to have some readings from you once or twice a year unless there are problems in between. Click here to download instructions and a form for recording home blood pressures.

Some blood pressure medications should be temporarily stopped if you have an illness which could make you dehydrated. This includes illnesses causing diarrhoea and/ or vomiting and also illnesses where you have a fever. Temporarily stop blood pressure medications in this situation include ACE inhibitors (eg Ramipril, Lisinopril, Perindopril, Enalapril) and Angiotensin 2 inhibitors (eg Candesartan, Losartan, Telmisartan, Valsartan) until the cause of dehydration has ceased.

If you suffer with Asthma or Chronic Obstructive Pulmonary Disease it is important to ensure you have inhalers which are in date and that you do not run out of them. However, it is also important not to order more than you need to ensure everyone can get the medication they require. It is important to know what to do if your symptoms are not as well controlled as usual. This will usually start with increasing your preventative medication but you should make contact if you have concerns over your symptoms and are unsure how to manage them. There is a useful link on the Asthma UK website with videos of how to use every inhaler device and how to use spacers, where indicated: https://www.asthma.org.uk/advice/inhaler-videos

Diabetes. During the next few months you may find yourself having different foods and finding it more of a challenge to remain active. If you take insulin to control your diabetes you may need to make some adjustments and monitor your sugars accordingly. We can provide telephone advice if needed.

Vitamin D deficiency. Over the coming months we will be remaining at home much more than we might choose to. It is important for us all to maintain our vitamin D levels which are low in a significant proportion of the population even during a normal year. Vitamin D supplements can be bought over the counter or online and the usual dose for adults is 400-800 units/ day (10-20mcg). It is especially important for younger people to have adequate vitamin D while they are growing so we recommend obtaining a preparation for all children, suitable for their age.

Mental Health and Wellbeing. Many people will be experiencing symptoms of stress, anxiety and low mood over the coming months. It will be natural for people to experience some fear and/or uncertainty over the COVID-19 Coronavirus, whether for their own safety or the safety of others. For families, remaining at home while looking after and teaching children will present all sorts of challenges, as will working from home. Those at home on their own may experience loneliness and isolation. Many people are unsure of the stability of their employment and finances.

Mind have a section on their website for mental health in relation to the COVID-19 Coronavirus as well as a comprehensive A-Z of mental health related subjects and conditions.

Please note that, if you are aged between 50 and 64 and not in a clinical at risk group, the earliest you will be offered a flu vaccination is November, providing there is sufficient vaccine.  No appointments will be offered for people in this age group until then. This is to ensure that those who are most at risk are vaccinated first.    If you are aged 50 to 64 and are in a clinical ‘at risk’ group which is eligible for the flu vaccination, for example you have a health condition which puts you at risk from the flu, you will be invited earlier.