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The primary care response to coronavirus – a GP reflects on their experience of the crisis

April 14th 2020

In this guest blog, a GP details how those on the frontline in primary care are handling the crisis and adapting to maintain patient access

There is a fear. There simply is. The training a GP goes through is very comprehensive but now whether a recent graduate or an experienced hand, we are all facing a challenge that is new to us. For a few weeks it was a matter of preparing the best we could for the coronavirus tsunami we could see hitting other nations. It was known that a pandemic would eventually come, but that is a very different matter to understanding the nuances of a new virus. While there are occasional points of disagreement over approach, there is an over-arching understanding that we, our patients, the NHS, the government and the nation as a whole are all in this together.

It has now been accepted that initial provision of personal protective equipment (PPE) was insufficient and the guidance and kit provided has been improved. In the future, there will be discussion about preparedness and resilience in the system, but for the moment the focus is on the practical. Improvements are welcome, as is the innovation from businesses not normally used to producing medical equipment who have turned their hand to PPE or hand sanitiser production.

In the opening weeks of this health emergency, the advice not to visit a GP surgery if you had symptoms was reiterated at every opportunity. Nonetheless, some patients with concerns did turn to the only arm of the health service they might have known since birth – the local GP. Furthermore, as became apparent from the very rapid spread of the virus in northern Italy, carriers could be asymptomatic for days. This meant that we simply couldn’t know if a patient could be inadvertently exposing other patients, practice colleagues or the GP to Covid-19 without being aware they had it themselves. This point takes me back to the reference about fear. If such a scenario occurs, am I then going to walk the virus back through my front door putting my family at risk? Every member of the practice team is thinking the same thing.

So far cases of coronavirus have been limited, but given current modelling, we have to prepare for a difficult few weeks in the second half of April. GPs are, however, becoming concerned that the focus on coronavirus is resulting in a relative neglect of our patients with other conditions.  Such patients seem to be staying away, perhaps reluctance to visit healthcare premises or more likely not wanting to trouble a profession they see under workload stress.  It is important that patients understand that our practices are open, taking all possible precautions to minimise the risk of infection to all and stand ready to help.

That help, might come in a different form to that which patients have been used to. What was once a gentle move towards new ways of working has rapidly accelerated over the last few weeks. Telephone consultations are now the norm and increasingly video and email consultations are being utilised. Although not completely replacing the need for face-to-face consultations, these innovations offer convenience and safety to both patient and clinician. It will not be the solution for every patient, but it does broaden the scope of what we as GPs can do for our patients. Of course, not all new ways of working are quite so high-tech. In some practices the reception desk has now been moved next to the window so that rather than a patient coming in the building, they are now met before they enter. Such different ways of interacting look set to become a development theme over the next few years and will permanently change some of the ways that General Practice works.

Given the current pressures GPs recognise that patient experience and service is not ideal at present.  Our teams are doing their best, prioritising the most vulnerable and maintaining key services.  We’ll learn lessons from the current crisis and emerge stronger and more adaptive to our patients’ needs.  In the meantime, excellence in clinical care is what drives us and communities can be confident that we will be there when our patients need us most.

 

This article has been submitted anonymously by a GP in Wales

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