Inside healthcare centre preparing for busy winter
BBCAs the NHS prepares for its busiest period, Radio Cumbria spent the day at a healthcare centre to find out the pressures staff are facing.
Carlisle Healthcare looks after more than 40,000 patients, nearly half the population of Carlisle across three sites.
On this morning the Locke Road centre has already received 194 phone calls and 245 online messages asking for appointments.
Clinical director Dr Robert Westgate said providing the service was "really challenging" because demand "outstripped supply".
Across the centres, 186 members of staff, including 25 GPs, as well as physiotherapists, care coordinators and health care assistants, are hoping to "build up a resilience" to deliver the best care.
Dr Westgate said this was being done through the triage system which assesses patients needs, whether online, over the phone or walk ins.
However, he said capacity was "not always there".
Triage brings order to chaos
He said a rise in the number of people with respiratory symptoms was one of many signs of winter's arrival.
He said triage was designed to "bring a degree of order to what is otherwise chaos".
Sarah Sewell, is an advanced clinical practitioner at the Carlisle centre.

She said advanced clinical practitioners can "see patients, treat, diagnose and prescribe".
"We are nurses that have advanced skills but are not GPs," she said.
"The patients are mine to look after, I can request their tests and I'm not having to ask a GP or another clinician for help and advice.
"It is nice to be able to do that care without the need to be directed."
Mother and daughter Jo and Nadia Beattie run a cafe at the centre.
Nadia said she felt "privileged" to work there and that they had received lots of support from customers, including patients and staff, since opening three years ago.

Jo said: "We are a little hub community here so if someone is feeling down you want to put a smile on their face by the time they leave the doors and that is what we love.
"The support we get week after week is amazing, we get regulars that come in every week and we are so grateful for that."

One of those is Neil, from Carlisle, who said he needs regular treatment and does not struggle to get appointments.
He takes the blood-thinner medication Warfarin and sees a nurse at the centre once a week.
"I've had a heart attack so if my wife phones up and they say no appointments and she says my name it alerts them straight away that I do need to be seen," he said.
Rachel Murdie is part of the centre's social prescribing service, a non-clinical role helping people with general health and wellbeing.
She said the advice she offers can make a real difference to patients by extending their social connections and getting them more active.
"What we do is more about engaging and motivation in a variety of services."





