Coronavirus BOA FAQs for patients
A message from the British Orthopaedic Association to people waiting for joint replacement and other orthopaedic surgery
Published 26 June 2020
We are acutely aware of the growing waiting lists that are affecting all planned surgery, but particularly orthopaedics (bone and joint treatment) which has the largest overall waiting list of any individual specialty. We have recently heard from people who are on waiting lists in very difficult situations and others who have been struggling to seek information about how long they might have to continue waiting. The message we have been hearing is one of concern, frustration and a lack of information. We know some hospitals have been actively supporting people waiting for surgery, but this advice has not been in place everywhere.Read the full statement here
Please note the guidance on this page is continually being revised to reflect the latest Government position and further updates will appear as they are available.
The information below is intended to help and support members and patients with questions.
Please note, we are monitoring the national and global situation and following guidance issued by Public Health England and in the Department of Health and Social Care’s coronavirus action plan. We are also liaising with Royal Colleges and other Surgical Associations to keep abreast as the situation develops. We have put together the below FAQs which will be updated as the situation evolves.
The most up to date information from Public Health England can be found here.
I have an upcoming outpatient appointment, should I still attend?
You should be able to check your local hospital website to see if services are running as normal. If there is a change to your appointment, you should be contacted directly.
Please follow hospital advice regarding your scheduled appointment.. If you do attend please follow any hospital guidance regarding bringing friends or family members with you.
If you have recently travelled to affected areas, had contact with a confirmed case of coronavirus, or you’re experiencing symptoms that concern you, please don’t go to your GP practice or a hospital. Please follow Government guidance on self-isolating.
My outpatient appointment has changed to a virtual clinic – what does this mean?
As part of planning for a possible rise in the number of coronavirus cases nationally, some hospital Trusts will be exploring ways to reduce the number of visitors to their hospitals.
As a result, you may have been invited to join a virtual clinic – meaning your appointment will take place over the phone or via a video calling service (e.g. Skype) – rather than face-to-face.
If your appointment is suitable for a virtual clinic, you may be contacted by your hospital team beforehand to arrange this. If you have any questions or concerns with these arrangement, please ensure you voice them with the hospital team at this time.
Can I visit a relative on a T&O ward?
The latest Government advice is that the public should greatly limit visits to patients, and to consider other ways of keeping in touch such as phone calls. You can check your local hospital website to see what their specific advice is, and what restrictions there are on visitors to certain wards.
To help stop the spread of coronavirus, you should not visit a hospital if:
- You have flu or cold like symptoms.
- You’re visiting someone who may have, or is suspected to have, coronavirus. Please speak with a member of staff involved in their care who will advise if a visit is possible.
I’ve recently been to my local hospital, do I need to do anything?
You do not need to take any action unless you are unwell. If you are showing any symptoms and you think you might have coronavirus or you've been in close contact with someone who has it, you should follow the latest Government advice, which can be found here.
I am self-isolating/I have been diagnosed with coronavirus, how do I cancel an appointment or a surgery?
Your appointment letter should include contact details for cancelling any appointment. Please try to contact the relevant teams in advance where possible, to minimise any disruption. Ensure you let the team know the reason for cancellation.
I have had contact with someone who is ill/self-isolating, and I have an orthopaedic appointment, what should I do?
Please follow Government guidance regarding whether you should self-isolate. If you need to cancel an orthopaedic appointment, your appointment letter should include contact details for cancelling. Please try to contact the relevant teams in advance where possible, to minimise any disruption. Ensure you let the team know the reason for cancellation.
What will happen if my elective (planned) surgery is cancelled?
Cancellations are now occurring widely and you may find that your planned surgery is cancelled at short notice. You should be informed of any changes to surgery by your hospital. We understand that this may be disappointing, especially if you have been waiting a significant time for surgery. If you have any questions about the rescheduling of your surgery please contact the team on your appointment letter, however be aware that members of the NHS healthcare team may be working in different ways to their usual practice, and so there may be a delay in response.
The GMC offers patients some advice about what to expect from their doctor during this period here.
What will happen if my surgery follow-up appointment is cancelled?
It is possible during the Coronavirus emergency that there may need to be widespread cancellation of follow-up appointments after surgery in the most extreme scenarios that are planned. We are working with NHS England to highlight that it will be important that there is a catch-up period to ensure that patients are followed up appropriately. If your follow-up appointment has been cancelled and you have concerns following surgery, you should contact your consultant in the first instance for guidance.
Some follow-up appointments will also be changed to ‘virtual follow-up’ – see relevant question above.
Should I expect my surgery to be cancelled?
Cancellations are now occurring widely in order to help the NHS cope with the expected number of coronavirus patients. The introduction of these measures varies by Trust and how long they would last for is unknown at this point. Unfortunately this will affect a large number of patients, and we are already highlighting to the NHS the need for a ‘recovery plan’ following this emergency, particularly since waiting times are already at significant levels across the country. If you are struggling with your health, including mental health, while you wait for surgery, please consult your GP for advice.
I have other health conditions and am worried about going into hospital for my operation. What should I do? Can I ask to delay until the situation with Coronavirus improves?
If you have an existing medical condition and are concerned about going to hospital for your appointment or surgery, let the appointments team know. In some cases, virtual appointments (by phone or using online video conferencing) are going to be set up that will reduce the need for patients to attend hospital.
My NHS elective surgery is due to happen at a private hospital, or I have a privately-funded operation booked, will this be affected by cancellations?
This may vary across different regions and hospitals, and it is difficult to give a specific answer. It is possible that a stage will come when the Coronavirus emergency means that all surgery stop, but it is difficult to stay at the moment how this will pan out. The hospital should keep you updated if and when anything changes.
Will having orthopaedic surgery have an impact on my immune system?
Any surgery and recovery can impact the immune system, though usually not significantly. There are already widespread suspensions of planned surgery. Regrettably this does mean that some people currently waiting may need to wait longer for their procedure.
Is there a higher exposure to Coronavirus in a hospital setting?
The answer in many cases will be yes. If you have an existing medical condition and are concerned about going to hospital for your appointment or surgery, let the appointments team know. In some cases, virtual appointments (by phone or using online video conferencing) are going to be set up that will reduce the need for patients to attend hospital.
Should patients cease their medication as a precaution?
Some orthopaedic patients, particularly those on steroids and biologics, will be immunosuppressed and could therefore be considered ‘high risk’. All patients should however continue to take their medication unless directed otherwise by a healthcare professional. If you are planning to start or switch to a new medication this may need to be reviewed.
If you are struggling with your health (including both physical and mental health) while you wait for surgery, please consult your GP for advice. We appreciate that the current coronavirus situation can be frustrating for those already waiting, and we will work with the NHS once the situation improves on a ‘recovery plan’ to tackle the waiting list.
Further advice can be found from Mind here.
- Managing your bone, joint or muscle pain (External resource from The Chartered Society of Physiotherapy).
- Arthritis and COVID-19 - your questions answered (External resource from Versus Arthritis).
- Exercise and physical activity for osteoporosis and bone health (External resource from Royal Osteoporosis Society).
- Coronavirus and osteoporosis (External resource from Royal Osteoporosis Society).
You may be asked to attend a virtual clinic rather than a face-to-face clinic. It would be good to prepare in advance anything in particular you would like to highlight to your Consultant and any particular questions you would like to ask. As an aid, you could note down:
- How are you feeling
- How your condition is affecting you
- Any new health problems that have occurred since your last appointment
Below is a video from the Royal National Orthopaedic Hospital which gives you an example of how a virtual clinic can be run and how to prepare. All virtual clinics will vary across trusts and by hospital and may be run on different systems such as via video call from your smart phone or computer, or a normal telephone call, but the principles are largely the same.
When the appointment is set up, it should be explained to you:
- What system will be used.
- Whether there is anything you need to do in advance, such as downloading an App for your phone or logging into a specific website.
Healthcare providers aim to make it simple to hold these appointments. If you have any questions do ask the reception or administration team at your hospital or clinic who can advise you, or if possible see if you have a friend or family member who has used the system before and can talk to you about how it worked. Many appointments are now taking place remotely and lots of people are new to this, so your clinician will understand this may be the first time you have attended an appointment in this way.
Can you give me some idea how patients will be prioritised when services restart and how long I may need to wait?
As services do resume, there will be a careful consideration of how patients should be prioritised and the details may differ from one unit to another based on local factors. Overall, a large focus of this will be prioritisation of operations based on clinical urgency. During the pandemic, surgery has only been able to continue for the most urgent and emergency patients, such as those with major injuries, but many semi-urgent patients were not seen and so there is a backlog of these patients who have very time-critical conditions and whose care is being prioritised. We obviously fully recognise that everyone who is on the waiting list is there for an important reason, and needs that surgery. We are working with national bodies and charities for musculoskeletal disease to ensure that orthopaedic patients get the care they need as quickly as is possible.
We realise it may be very frustrating and disappointing if you started the waiting list with an idea of how long the wait would be in your area, but now have much less of an idea about how long you may be waiting. At the moment your local setting is likely to still be planning and prioritising and may not currently be able to give an idea of the likely wait. We expect timescales will become clearer over the coming weeks.
You may also like to be aware of a national prioritisation document, for which we contributed to the trauma and orthopaedic section, and which categorises procedures according to the urgency. You can find this online here.
Why is it taking time for services to resume?As well as significant changes to practice to ensure safe operating, there are other factors that are affecting the restart of surgery: the continued diversion of resources to COVID-19 and other very urgent patients; increased staff absences due to shielding or caring for those shielding; and in some cases where operating theatres were repurposed during the pandemic and have not yet been returned. In addition, for surgery to go ahead this needs anaesthetists available and (for many
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