Patients: Supporting the lonely, isolated and vulnerable - May
Queen’s Nurse Heather Henry gives her hints on dealing with loneliness and isolation during the coronavirus pandemic and how to support your team
1. Use your community link workers
Community link workers – now often termed social prescribing link workers – can help vulnerable and socially isolated people by offering daily telephone calls and general advice on keeping themselves well. Ask your staff to brainstorm a list of those patients whom they know are lonely or vulnerable for the link worker to contact. Think beyond the elderly to other vulnerable groups, including pregnant women and single/separated parents. Encourage your link worker to identify local sources of emotional support within your community and any volunteering or good neighbour schemes that have been set up in response to the pandemic.
During the current lockdown one of the best ways the link worker can support patients is to contact local third sector support organisations who may be supporting community and voluntary groups with crisis funding to give additional support.
2. Access the NHS volunteer scheme
GPs, practice nurses and community link workers can all refer lonely and vulnerable patients to the NHS Volunteer Responders scheme, a national volunteering initiative set up by NHS England and NHS Improvement, in partnership with the Royal Voluntary Service. You can refer patients via an online patient referral form, or call 0808 196 3382 to make a referral. Volunteers are undertaking duties such as ‘check in and chat’ – regular phone calls to check isolated people are ok – and tasks such as shopping or collecting medications.1
3. Suggest your patients volunteer
Be mindful that one way to improve wellbeing during the current period of isolation is to give back.2,3 Your link worker could encourage socially isolated people to help others and join the NHS volunteer scheme, or local Covid-19 aid schemes run by the Council and other neighbourhood groups, as well as the usual voluntary or third sector services. Ask your community link worker to support isolated people to volunteer themselves if appropriate.
Volunteers must be 18 or over, fit and well with no symptoms. Those in higher-risk groups (including those over 70, those who are pregnant or with underlying medical conditions) will be able to offer support by telephone.
4. Offer support with work, childcare, benefits and housing
People are worrying not only about catching the virus but about maintaining a roof over their heads, keeping their jobs, caring for children and paying the bills. And if you’re lonely and isolated these fears can multiply.
Signpost these people towards sources of support, such as the comprehensive advice given by Citizens Advice online, using text messaging, recorded messages on the surgery phone system, the practice’ social media pages and website. Ask your link worker and any volunteers they have identified to offer help for those unable to go online.
5. Anticipate family relationship difficulties
Being closeted together for weeks can put a strain on family relationships. The worst-case scenario might involve a rise in domestic abuse and an exacerbation of abuse of vulnerable groups.
Meet with your team to ensure that they are alert to these possibilities, have hard recent training around identifying signs of abuse and have relevant support group contact numbers.
The social enterprise IRISi has just produced a guide for general practice teams on identifying and responding to domestic abuse during telephone and video consultations. The guidance uses a framework of ‘ask, respond and risk assess’. If domestic abuse is suspected, the advice is to explain to the patient that you will ask closed questions, inviting yes/no answers. Respond by validating feelings and asking what support the patient may need. Finally, risk assess to check if the patient and any children are in any immediate danger and need police or safeguarding response.
6. Help parents of children and young people to cope
Prepare a list of prompts for your practice website and waiting room notice board to give to parents to help them talk to their children about the physical and psychological effects of social isolation. These could include:
- Give actual and accurate information but adjust the amount of detail being mindful of their age and ability to understand.
- Younger children may understand cartoons and pictures better.
- Help children to feel comfortable talking about the current situation so children see you (the parent) as their main source of information and support.
- Observe and record any significant changes in children’s behaviour such as withdrawal, changes in appetite or sleeping patterns, aggression and low mood, and seek professional support if the changes persist.
- Focus on the positives, such as: ‘Doctors are working really hard to make people better and find a vaccine to protect us from the virus.’
- It is ok for parents to say that they do not know the answers to all of the questions, but that they will try to find out.
- Manage your own anxiety; children are usually good at picking up behavioural changes in parents, which can increase their own anxiety.
- Give your children practical guidance, for example for hand washing, using games or a different song every day.
7. Emphasise positives in communications
Practices are having to work in an unusual way, with many staff working remotely and patients having less access to immediate clinical support. Patients will be anxious about these changes. Try to keep them informed about the changes and the positives by:
- Maintaining human contact and avoid relying on faceless emails, posts and messages to ‘broadcast’ news. Record short videos that can be shared by text messages to ‘speak’ to staff and patients to thank them. You could remind patients that you are still available for the conditions they would normally see you with, or encourage them to help you by avoiding over-ordering medications, such as in this video here.
- Call members of the team who are working remotely for a quick check in.
- Share good news whenever possible and celebrate achievements, however small.
- Consider making short videos to share important messages such as this on social media to maintain a ‘human’ face.
8. Value your older patients
Older people will be more vulnerable during the pandemic, but they can also be a great resource for guidance on dealing with challenging situations. During consultations, listen for their advice on how they maintain their resilience. This is the time to benefit from their experience. At the same time, showing you value their perspective will give them a sense of purpose and hope. With permission, you could even share the wisdom of older patients, using quotes, photos or videos on your website or social media accounts to raise morale.
Remember older people often have caring responsibilities for other older people, such as siblings or spouses, so may also need extra care and support at the moment.
9. Consider the impact on staff too
With the change in working, your staff may also need support. Consider the following steps to keep up staff morale:
- Establish a regular forum for your multidisciplinary team, for example on a video conferencing platform like Zoom, and ensure there is time for staff to safely discuss emotional and social challenges.
- Have frank conversations with staff, avoiding euphemisms and false reassurances.
- Especially reach out to those who repeatedly say they are too busy to join the forum, and have a sensitive discussion about why they can’t attend, whether something is bothering them and if there is anything you can do to help.
- Visit Our NHS People – a new website offering short guides on activities such as finding a quiet mindful space, apps and a phone line for health and wellbeing support.
- Refer those in severe distress for professional support from their own GP or the NHS Practitioner Health scheme.
- Remember to thank your volunteers and make a special effort to think about how they are doing.
- Make meetings fun – for example #SpoonRoom on Twitter, an invention of the social enterprise @Camerados, aims to make video calls more fun by waving spoons about.
There may be a temptation to ‘fix’ every problem. Give yourself and those around you permission to ‘be a bit rubbish’ at times and let them know it’s ok.
10. Prepare for any impact on your own health
Isolated team leaders may succumb to loneliness, isolation and resultant mental health problems themselves, especially when dealing with additional anxieties around practice finances, managing staff sickness, patient demand and personal family issues.
Make contingency plans with your team in case you need time out. Share resources and contingency planning tips with fellow practices in your primary care network. In Wigan, for example, local and national guidance is distilled and shared in an updated daily ‘FAQ’ timesaving format. A group of senior primary care leaders in Greater Manchester maintain a regular WhatsApp conversation, discussing issues such as certification of deaths training and group purchasing of personal protective equipment.
Confidential WhatsApp Groups are also useful for sharing worries and getting peer support. Remember you can also access the NHS Practitioner Health scheme if you need further support.
Heather Henry is an independent public health nurse and managing director of BreathChamps CIC, based in Greater Manchester
1. NHS England. The NHS Volunteer Responders information for health professionals. 31 March 2020. Version 1.
2. Aked, J. Marks, N. Cordon, C and Thompson S (2008) Five ways to wellbeing – communicating the evidence. New Economics Foundation. London.
3. Stephens, L. Five ways to wellbeing at a time of social distancing. New Economics Foundation. 30 March 2020.
British Psychological Society: Responding to Coronavirus: resources and support
Buffel, T, Rémillard-Boilard, S & Phillipson, C. Social isolation among older people in urban areas. A Review of the Literature for the Ambition for Ageing programme in Greater Manchester, University of Manchester Institute for Collaborative Research on Ageing, Manchester. 2015 Holt-Lunstad, J, Smith, TB, B