(a)

OPEL (Operational Pressures Escalation Levels) from 1 to 4 with 4 being the highest.  The hospital were currently operating on OPEL 4 which meant that they were responding to a major incident.  The fantastic work from staff the hospital meant that they would be imminently out of OPEL 4;

(b)

to avoid future escalation to OPEL 3 or 4, the hospital were looking at systematic improvements such as improving the system of care at the weekends and same day emergency care by providing a high quality pathway for patients that do not require an overnight stay.  By looking at each of the pathways could start to see where they were making a difference;

(c)

resilient staffing was critical moving into the winter period and the hospital have more staff available than last winter.  The hospital have a portfolio of services they have to provide and if they have staff shortages within urgent and emergency care then staff would be moved from other areas to ensure service continuity.  The hospital’s mission this winter was to continue to provide high quality emergency and urgent care as well as surgical care to patients;

(d)

last year they worked as one system and nominated a chief operating officer to ensure the right levels of staffing were in place across the system.  They were also reviewing the role GPs play and to ensure there were have enough out of hours GPs;

(e)

they were looking at different options to bring people that may have recently retired back into work at short notice if required;

(f)

the uptake of the flu vaccination were similar year on year.  However the vaccination programme led by NHS England was focusing on the hard to reach groups but despite this the uptake was still around 70%;

(g)

an on-line repeat prescribing function had been set up in Plymouth allowing patients to phone a separate number to receive their repeat prescriptions and this was starting to reduce the pressure on GPs;

(h)

there was a co-ordinated approach to communications and how to get information out to the population on the different options available other than presenting at the GP practice and/or emergency department;

(i)

the complex care response team has a good rate of accepting patients to be cared for at home but have had an arrangement that the patient would be seen by a GP before being referred to the team.  This year they had invested additional money into highly trained nurses and paramedics for them to undertake the visit on the GPs behalf and this idea was shared at a recent GP forum and was received positively;

(j)

they were undertaking a piece of work looking at high intensity users of the emergency department and doctor surgeries and trying to understand why they are using these services which were often not health related and how they could have been better supported within the community.   GPs were also taking a proactive approach with the frail elderly patients.