Last reviewed 8 December 2021
Winter is a busy time for healthcare services in the UK, including primary care. Cold weather can have a serious impact on health, particularly for older or vulnerable people, and is responsible for many deaths and illnesses. Heart attacks, strokes and respiratory illnesses all increase in the winter, and an increase in flu also puts pressure on services. In addition, severe snow fall and floods can also bring disruption to both patients and staff in many parts of the country. What should primary care providers do to ensure the safety of their staff and patients when the cold and wet weather starts? Here are 10 key winter planning tips.
1. Review your emergency and business recovery plans
All primary care organisations should have contingency plans and procedures in place to cover emergencies and major incidents that might have an impact on their services or on the wellbeing of patients and staff. These should include emergencies caused by cold weather. See a template Business Continuity Risk Assessment and Contingency Plan here.
The plans should include business continuity measures designed to get the service back up and running if problems occur. They should be reviewed before the cold weather hits to ensure that adequate winter preparedness is in place.
2. Prepare for the inevitable cold weather
Looking after staff and practice facilities and vehicles is an important part of keeping services running through the winter.
Practice premises should be kept warm and comfortable for staff and visiting patients. Boilers should be well maintained and covered by emergency call-out arrangements. A supply of safe emergency lighting should be kept, including torches with batteries, and deicer/rock salt for paths, etc. Car parks and entrance paths should be gritted.
Unnecessary travel on icy roads should be avoided and any staff doing home visits should carry mobile phones and spare warm clothing in their cars.
3. Be aware of both national and local plans for service provision
Practices throughout the UK should ensure that they are aware of both national action plans and local resilience plans for cold weather.
In all parts of the UK, local authorities, NHS planners and health and social care providers are encouraged to have contingencies in place to cover winter risks.
For instance, the Department of Health and Social Care publishes a Cold Weather Plan for England which is regularly updated and designed to create a framework for responding to cold weather risks.
The guidance provides advice for individuals, communities and agencies on how to prepare for and respond to severe cold weather, encouraging organisations and local authorities to take a system-wide approach.
Practices should read the guidance and cascade essential information to their staff. The latest version of the plan can be downloaded from the GOV.UK website.
North of the border the Ready Scotland website contains essential information about coping with severe weather.
4. Listen out for Met Office alerts
The national plan in England is supported by cold weather alert services run by the Met Office. These are designed to give service providers early warning of any problems ahead.
The service works in collaboration with Public Health England. It consists of the following levels:
Level 1: Winter preparedness, is the minimum state of vigilance during the winter.
Level 2: Severe winter weather is forecast, is triggered by the Met Office as soon as the risk is 60% or above for any of the thresholds to be breached.
Level 3: Severe weather action, requires social and healthcare services to target specific actions at high-risk groups.
Level 4: Major incident, is reached when a period of cold weather is so severe and/or prolonged that its effects extend outside the health and social care system.
Alerts appear on maps on the Met Office website at www.metoffice.gov.uk
The warnings are given a red, amber, yellow, green colour depending on a combination of both the likelihood of the event happening and the impact the conditions may have.
Primary care providers should monitor the Met Office site for warnings.
5. Know how to respond to alerts
The Cold Weather Plan for England sets out the following actions.
At Level 1 services are advised to:
promote key public health messages
circulate cold weather alerts to staff
ensure staff are aware of cold weather dangers when conducting home visits for vulnerable patients
ensure that appropriate referral arrangements are in place if a patient is at risk and requires assistance
At Level 2 services are advised to:
implement locally agreed multi-agency plans
take advantage of clinical contacts to reinforce public health messages about cold weather and cold homes on health
when prioritising visits, consider vulnerability to cold as a factor in decision making
At Level 3 services are advised to:
be aware of a possible surge in demand in the days following a cold spell
ensure that staff are aware of cold weather risks and are able to advise patients appropriately
At Level 4 services are advised to maintain Level 3 actions and implement national emergency response arrangements and local business continuity plans. At this level, the health effects may occur among the fit and healthy, and not just in high-risk groups.
Working closely together in partnership with local authorities, with social care and with other NHS and emergency services is probably the key message in very severe cold weather.
6. Prevent the spread of the Coronavirus (Covid-19)
The Covid-19 outbreak has presented one of the greatest public health challenges faced in recent times. Primary care has dramatically changed during the pandemic with all staff, both clinical and administrative, modifying ways of working.
The winter could be especially challenging due to the impacts of Covid-19 on top of the usual increase in emergency demand.
To keep staff safe and at work is key for business continuity, care delivery and ensure other staff and patients are protected. Testing will allow those currently unable to return to work because they or a member of their family or household have symptoms of coronavirus to know whether they have the virus.
The Department of Health and Social Care (DHSC) announced an online portal developed by the Care Quality Commission (CQC) to enable health and care staff to book a test at one of the increasing numbers of national test centres. This online portal is a temporary facility and it will be eventually replaced by a permanent digital booking system.
7. Continue the flu campaign
Flu is a danger every winter and all patients eligible for a free flu vaccination should be encouraged to have one. The flu campaign started in early autumn and figures show that GP practices around the country have been doing incredible work in providing vaccinations. The flu jab saves lives and practices should keep a focus on uptake and ensure that as many eligible patients as possible are vaccinated.
8. Take the necessary precautions if in a flood risk area
Wet and stormy winter weather inevitably raises the risks of flooding, both from rivers bursting their banks and from tidal storm surges and gales in coastal areas.
Primary care providers should carry out appropriate assessments to determine flood risk and the possible impact on their patients and services.
Where a risk is identified the practice should:
ensure that buildings are designed and managed to be as safe from flooding as possible
put in place emergency plans for coping with both minor and major flooding disruption
have in place back-up staffing arrangements in case staff cannot get to work
train employees so they know what to do in the event of a flood emergency.
Practice managers in flood risk areas should pay close attention to flood warnings.
In England these can be obtained from the GOV.UK website at https://flood-warning-information.service.gov.uk/warnings
Flood warnings are issued as follows:
Severe Flood Warning (danger to life)
Flood Warning (immediate action required)
Flood Alert (flooding is possible - be prepared)
The website provides links to flood warning services in Scotland, Wales and Northern Ireland. Managers can register for email alerts or use the 24-hour Floodline number 0345 988 1188.
Local authorities and emergency services will have contingencies for flooding which include support for vulnerable people and for essential services.
9. Identify patients who may be vulnerable in the cold
General practices should ensure they have appropriate staff training, policies and procedures in place to help protect vulnerable patients from the dangers of cold weather.
Key actions include identifying vulnerable patients and planning for joined up support with partner organisations, including social services, care homes, hospitals and community groups.
Staff who visit patients in their homes should be encouraged take action if they find a vulnerable patient living in cold conditions. This may include advising patients and carers about how to seek help to keep warm and working with social care and other support services to help resolve heating issues. Help can also be encouraged from carers and neighbours.
Appendix 2 of the Cold Weather Plan gives advice on identifying vulnerable people. It includes an awareness of people who live in homes that are hard to keep warm or those in “fuel poverty” who cannot afford effective heating or live in “hard to heat” homes.
10. Promote key public health messages about staying warm
The practice should promote the key public health messages included in the Cold Weather Plan.
The plan recommends that people heat their homes to achieve indoor temperatures of at least 18°C (65F) in winter. It states that this threshold is particularly important for people 65 years and over or those with pre-existing medical conditions. It also recommends maintaining these temperatures overnight for at risk people.
A range of public information resources are available. For instance, Age UK produce excellent advice that can be given to patients and carers on their Keep well this winter webpage, including a useful guide, Winter wrapped up.