Commissioner takes lead in staff testing (#DoingOurBit)

by Steve Brown

22 May 2020

The NHS response to Covid-19 has required numerous NHS staff to broaden their focus away from their day jobs. And for James Rimmer, managing director and chief finance officer for Southampton and City Clinical Commissioning Group, this has put him at the heart of the keyworker testing programme for Hampshire and the Isle of Wight.

Keyworker testing is a vital part of the NHS plan to combat Covid-19. At any point during the pandemic, large numbers of key workers are likely to be self- or household-isolating. And testing should enable those not actually infected to be released back to the frontline boosting much needed capacity – especially important in health and social care.Doing our bit_James Rimmer_204x307

For Mr Rimmer (pictured), who is also finance director for the Hampshire and Isle of Wight Integrated Care System, the major change in role came with the launch of the government’s new five-pillar testing strategy at the beginning of April. In particular, the challenge for Mr Rimmer was to support the region’s contribution to the challenge to create a mass testing infrastructure across the UK (pillar 2).

‘At the time we were anticipating a big peak in hospital admissions in mid-April and there was talk of 40%-60% of our staff being off work with Covid, with testing offering the best way to get many of them back to work,’ says Mr Rimmer. ‘I offered to get involved.’

The role has grown from there to the point where it is now occupying about 70% of Mr Rimmer’s time. ‘Deloittes were appointed by the government to identify suitable large-scale testing sites and they approached our local resilience forum (LRF), which brings together all the local agencies, asking us to find appropriate sites.’

A team including Mr Rimmer, the police, military and public health teams, set about this task and a facility was subsequently set up on a lorry park in Portsmouth that had originally been built in anticipation of a no-deal Brexit. This drive through testing facility site is operated by staff from pharmacy and retailer Boots and enables up to 1,200 tests to be delivered a day, with all tests then processed at commercial laboratories – meeting the government commitment that this work would deliver additional capacity.

The permanent site is supported by three mobile test facilities, operated by the military. The units rotate around established sites ensuring the whole of Hampshire has access to testing (separate arrangements have been made for the Isle of Wight). Each unit can perform up to 300 tests a day – giving the whole operation a capacity of 2,100 tests per day.

Activity through the facilities has built-up, with step changes as the definition of key worker has broadened in line with the government strategy. This initially focused on NHS workers and their families and moved on to other critical key workers. However, it was announced on 18 May that any person over the age of five showing symptoms would now be eligible to be tested, although employer-requested access to testing is still being prioritised.

Mr Rimmer says his role has changed dramatically. ‘I get about three MP queries about testing and testing results every day from across the whole Hampshire and Isle of Wight LRF,’ he says. ‘When things started, I was getting queries from the port and the coast guard, from the military and all sorts of agencies asking about accessing testing, so I’ve written ‘how to’ guides.’

The scope of his role has also broadened its focus. ‘Generally [in my CCG role] every meeting I would normally go to is health. Most days now it involves all of the partner agencies. Twice a week, we have a tactical coordinating group chaired by the police, which has two key priorities – personal protective equipment (PPE) and testing. And I’m giving an update on testing, how people can access it, what the access rates are looking like, any problems on site. And I also link in with the Department of Health and Social Care weekly. Not an hour goes by when I’m not talking to someone about testing or addressing an issue. It is quite full on, but each day these tests are helping get key workers across the area back to work.’

Some of Mr Rimmer’s CCG work has reduced – the suspension of the planning round and of the requirement to assess patients for continuing healthcare eligibility for example. But it remains busy with a large focus on ensuring both GPs and CHC providers are paid and working with its local authority as part of an integrated commissioning unit, supporting the voluntary sector with finance and PPE issues. There is also a big role in supporting its 27 GP practices, which have moved rapidly to virtual consultations.

The whole organisation (120 staff) has moved to home working and board meetings have also switched to online. ‘I’ve never felt busier,’ he admits. Realistically, he suggests that the 70% of time he is spending on testing needs to reduce to 50% and long-term arrangements will need to be made as testing facilities could well be in place for the next two years.

In the meantime, testing has its own challenges. For a start there is the likely return of staff involved in the permanent testing facility to their Boots jobs as the lockdown relaxes. And then there is the next phase of testing – as the country looks to roll-out antibody testing to gauge how many people have been infected to date.