GP offers insight into the impact of COVID-19 on Primary Care
THE COVID pandemic has had a huge impact on all aspects of our society, but the changes it has forced on healthcare systems have been particularly significant.
As one of the first points of contact for patients, GP practices have been required to quickly adapt as they have sought to ensure a continuity of service in the most challenging circumstances – helping people to continue to safely access the help they need.
Offering an insight into what COVID has meant for so many GPs across Dumfries and Galloway, in his own words, Dr Charlie Dunnett, a partner at Galloway Hills Medical Practice in Newton Stewart, looks back over the past year, updates on how things stand right now, and looks to the future.
The arrival of COVID-19
“When the first COVID wave hit we didn’t really know what we were dealing with – other than it was a highly transmissible, highly infectious condition.
“So for the first month or so our NHS world went into an emergency mode, really, we could only deal with the most pressing issues.
“Once we got a better handle on what it was we were dealing with, Primary Care rapidly went back to being able to deliver as much of its service as it could – but it had to do it within quite considerable restrictions.
“The limitations that we had were that it was an infectious condition. Therefore, we could not simply have waiting rooms full of people because that’s how the disease spreads. It was the same principle behind why schools were closed and why office blocks were asked to work from home.
“So we had to then work in a different way, but while continuing to keep delivering all the services that we try to do.”
The need to adapt
Dr Dunnett explains there was a recognition that adaptation was required in order to keep providing much-needed help in the midst of the pandemic.
He said: “We had to move more towards remote consulting, working by telephone and by using the Near Me video consultation technology which we knew had been out there but we’d not really had a chance to fully embrace prior to all of this.
“In addition, we then had to work out how to keep practices running. We are frontline healthcare workers – that’s what we do. But we’re human beings just like everyone else, and if an office worker has to shield because they have an underlying condition like asthma that puts them at particular risk then in the same way so does a doctor, a nurse or a receptionist. So we had to keep doing our work, but with a reduced number of staff, or staff working in different ways, changing working patterns, or working in smaller teams so that if one person tested positive for coronavirus we didn’t lose the whole practice team.
“And we’ve had to continue to work in that way because we’re still in the midst of a pandemic. We’re only just a few weeks out of our formal lockdown, and able to travel out of Dumfries and Galloway.”
Ensuring the safety of patients and staff
As practices moved out of that short initial emergency phase, measures were required to help ensure that patients who needed to be seen in person could still be brought into the practice safely – protecting them and staff.
Dr Dunnett said: “Controlling the flow into buildings is the purpose behind what some people might still regard as being restrictive measures for patients.
“In the same way that we still need to wear face coverings in a supermarket, and we still need to sit a distance apart in restaurants, that ruling hasn’t changed for any of us and healthcare is no exception. In fact, healthcare is where the most care is needed, as so many of the people we are seeing are among those most vulnerable to the effects of COVID-19.
“In my waiting room in Galloway Hills – when applying physical distancing we can fit five people in, and every morning these are patients for a practice nurse, a healthcare assistant clinic and at least one or two GPs or advanced practitioners.
“So it’s dramatically reduced the capacity in the waiting room, which means that for in-person appointments we’ve had to space out waiting times, control patient flow, and importantly we’ve got to change the personal protective equipment (PPE) and clean each room between every single patient.”
Keeping the bulk of services running
Dr Dunnett acknowledges that in order to continue to providing vital services there has been a need to adjust the services which practices can offer.
He said: “GPs have services that are core to their work, and when the virus arrived we saw a focusing on those vital core services.
“In order to ensure that teams could deliver the most essential, vital help, some of other day-to-day work which would normally have been undertaken was paused.
“This meant that the likes of yearly routine check-ups were paused, but it provided that assurance that we could provide help in situations where there was a need for immediate support, and allowed some colleagues to provide support within the COVID-19 hub.
“So although some of the routine background disease monitoring was put on hold, many practices are now bringing this back online.
“In the meantime, we’ve continued to provide the help that’s been required – whether someone’s been getting migraines, had concerns about a lump or a mole… whatever it is, we’ve been continuing to deal with all of that since last May.
“All the routine core work has continued, in spite of COVID – we’ve just been doing it in a different way.”
New ways of working
“We’ve been using phones for decades, and I can do a lot of things on the phone fully and safely.
“What I can’t do is have a nurse dress your wound over the phone or have a healthcare assistant take your blood. And these are things that we’ve kept doing throughout 90 per cent of the pandemic. These people still need to come in.
“Our practice nurse and healthcare assistant appointments have been consulting in person for a number of years, because they’re roles that can’t be done by phone, and because of the measures designed to ensure patient and staff safety they’re down by about 50 per cent across a practice.
“On a normal morning pre-COVID a healthcare assistant in my practice might have had 20 appointments, 5 or 10 minutes apart. Now, they’re 15 minutes apart and we get through about a dozen in a three hour session if we’re lucky because they have to clean the room, change the PPE, change the kit, and space out the flow of patients.
“But although we’ve got reduced capacity in the flow of face-to-face appointments which is healthcare assistants and nurses, we’ve not got reduced capacity in terms of GP appointments because they’re just being delivered in a different way.
“In fact, I’m doing more appointments a day now than I was pre-COVID because of workload. I’m busier than I’ve ever been.
“We do have a tranche of the population who just want to see their doctor face-to-face, and who believe if they don’t get to see their doctor they’re not getting cared for, but that’s very much not the case.”
Looking to the future
Dr Dunnett says that the arrival of COVID-19 created a new perspective on the approach to Primary Care services, forcing an evaluation of approaches which had previously been taken for granted.
He said: “You can blame COVID for a lot of things, but what it has done is forced us to stop, pause, reflect and do things differently.
“What COVID has done is focused our ways of working to allow us to see, in person, the people who have most need to be seen in person, and those that that can be assisted safely and remotely are dealt with safely and remotely.
“And gradually, we’ll be shifting from COVID response to an approach that’s fit for 21st century healthcare in Scotland in line with Scottish Government plans.
“We still have the same expectations and demands from patients, and in fact those were increasing nationally before we were hit by COVID-19.
“It’s been a difficult time, and negotiating our way through these challenges has made it a more stressful working life than it was before the arrival of the coronavirus.”
“But while it’s really important that we acknowledge all the changes that were required to be put in place, we also need to look to a future and embrace all that is good about the new ways of working.
“We made these changes because we had to – we had to keep everyone safe – but now that we’ve made those changes we recognise that a lot of it is stuff we can do well in a different way.”
View of the Deputy Medial Director
Dr Grecy Bell is a GP and NHS Dumfries and Galloway’s Deputy Medical Director.
Looking ahead to the short-term future of Primary Care, as the nation emerges from lockdown, Dr Bell said: “The efforts and sacrifices made by people across the region helped to significantly bring down the number of cases of COVID-19 from the very high numbers we were seeing at the start of the year.
“The fall in cases and the excellent progress around the vaccination roll-out programme really does give cause for some cautious optimism as we head into the summer months.
“However, in all health and social care services, including GP practices and all those services within Primary Care, we’re still some way from a return to anything exactly like normality
“We’re all going to be living with COVID for some time, and likely with ongoing restrictions. It’s entirely possible that we’ll have to continue dealing with concerns around the dangers posed by variants.
“There’s also likely to be an extended period of dealing with the indirect consequences of COVID. The priority will be helping those who need immediate attention while working to recover our systems and help those people whose treatment and support has been impacted and delayed as a result of the coronavirus.
“Primary Care has a big role to play, but we’re going to rely on people working with us as we continue to adjust to a world where we can adapt to co-exist safely with this new virus.”