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A new way of working: a view from general practice during a pandemic

An anonymous GP details life working in general practice during the ongoing COVID-19 crisis 

CREDIT: This is an edited version of article that originally approved on The London Economic 

In early March, as the country headed towards lockdown, general practice changed, almost overnight. As practices across the country closed their doors to patients for the first time in my memory, GPs had no choice but to adapt to a new way of working.

Gone were our faithful 10 minute appointment slots and, in their place, telephone triage, video consultation and electronic consultations (e-consults). And how they flooded in. Most noticeably for me, in those early days of confusion and fear, was the very apparent lack of guidance and direction from above; NHSE and our local CCGs were disconcertingly quiet.

We survived on our daily updates from Boris, and social media hints and tips from other GPs around the country, rapidly putting practice policies and protocols together only for the advice to do a 180 degree turn the next day.

Overwhelmed by the huge amount of information

In a blizzard of emails, tweets and Whatsapp messages we all quickly became overwhelmed by the huge amount of information circulating about this unknown virus.

GPs around the country shared their experiences, suggesting useful examinations, investigations and treatments but it really was, and still is to some extent, the blind leading the blind.

The government issued a centrally sourced list of patients who should be ‘shielding’ – that is not leaving their homes at all for 12 weeks. Despite our objections that we really should generate this list of patients ourselves, the list was released and caused mayhem. Some patients felt they had been missed, others felt they had been unnecessarily included.

Cue a barrage of telephone calls, emails and e-consults jamming our already busy lines.

A new way or working

As time has gone on, we have adapted – really quite remarkably so. Regardless of this, consulting via telephone or video will never feel like the norm. I miss the face-to-face interaction and rapport with my patients.

At my practice all of the doctors work from one list of patients, calling them up and assessing how we can best help them; because we no longer have defined appointments, there is no set end point to this list and so it really is all hands on deck to make sure that each patient is dealt with safely and efficiently.

We, typically, deal with 60 or 70 ‘phone calls, and a similar number of electronic consultations, in the average day; that’s not to mention the patients who we ask to come in for a face-to-face assessment and the home visits to those who cannot come to the surgery.

Outdated computers and clunky software

Suddenly we are very much aware of our outdated computers and clunky software; everything is painfully slow, even more so for our poor colleagues working from home.

Screen messages and texts fly back and forth, with colleagues apologising that they aren’t making headway with the list because computers have crashed, servers are down or patients’ ‘phones keep going straight to voicemail.

It can feel like ‘wading through treacle’ just to get through a few names on that ever growing list; I also worry that I will miss a serious diagnosis.

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I find myself lying in bed replaying a telephone or video consultation in my head, fretting that there may have been more to it than I had thought. Doctors will often speak of their ‘spidey sense’ – an indefinable skill developed over many years of clinical practice that gives you a gut instinct about a patient.

Does my spidey sense still work over a dodgy wifi connection?

Patients seem more apprehensive about accessing medical care now and I worry that this prevents them from seeking help when they need it.

I recently spoke to an elderly gentleman living with his wife who has Alzheimer’s. He called to tell me that he had noticed blood in his urine. I reassured him as best I could but told him he needed to be seen in hospital within the next two weeks. I made the referral but he called back the next day to say that he wouldn’t be going as, “I’d rather take my chances than put my dear wife at risk”.

This is not uncommon. Patients avoid A&E like the plague, and steer clear of their outpatient appointments, opting to stay at home instead.

We have had to adapt to this, managing very complex cases in the community which previously would have been managed by a specialist in secondary care. Not only this, but our resources are often limited as we can no longer access community services or outpatient investigations like ECG or x-ray.

Personal safety

Of course we also worry about our personal safety. The issues surrounding PPE are well documented and the shortage is certainly something that is felt in general practice. Last week, in our team briefing, we were told that we no longer have masks to give to our ‘cold’ patients and that we should tell them to bring their own from home.

Given that the definition of ‘cold’ versus ‘hot’ patients is that we think that they don’t have COVID symptoms, this is far from safe practice. Our local CCG recently removed our COVID home visiting service due to lack of funding; this means that the task of visiting housebound patients with coronavirus now falls to us.

Yet, conflictingly, we are advised not to see both ‘hot’ and ‘cold’ patients on the same shift or even, the same week. With half of our GPs currently working from home this places us in a difficult predicament.

Every cloud…

But it’s not all doom and gloom.

From the outset of the pandemic we have been supported in prioritising essential clinical work over everything else; for the first time in my career I have had the power to turn down non-medical work.

Gone are the mountains of requests for letters excusing kids from school trips, permitting charity skydives, cancelling unwanted gym memberships or missed flights. Our tick-box targets have been temporarily lifted, our appraisals and revalidations postponed.

For this first time in my career as a GP I feel that I have the time to focus on being a doctor – and not just the time, but also the freedom. Guidelines and pathways are now to be applied, according to the powers that be, ‘With the doctor’s clinical judgement’.

We feel valued and recognised as the experienced physicians that we are.

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