View from the ground, by Dr Jonathan Griffiths
As a GP, I was embarrassed when my neighbours were outside clapping and ringing bells every Thursday night during lockdown. I didn’t feel that I was doing anything remarkable. I was undertaking most of my consultations via telephone, with some video, seeing very few patients face to face. The very few possible COVID-19 symptomatic patients we triaged were being seen at a local ‘red clinic’. The work of managing the pandemic appeared to be all within the hospitals. They had the ventilators and the oxygen. They were working hard and they were putting themselves at risk—not me.
On reflection, however, I think I was doing myself down.
The NHS, and indeed the wider health and care system is exactly that—a system; every part of that system needs to function well for it to work as a whole. General practice has performed a critical and important function this year, and it has not been easy or straightforward either. General practice has worked hard to change its model of care in order to keep patients and staff safe, and carried a lot of risk in the process.
The move to total triage was stressful. We were not used to working like this, nor were our patients. Much time was spent working out how to safely manage our patients and keep them from harm. General practice remained open throughout the pandemic, taking calls from patients, assessing remotely, seeing patients where needed, and ‘holding on’ to patients for long periods of time while outpatient services were shut down.
As time moved on and we entered phase 2 and then phase 3 of the pandemic response, general practice rapidly increased the services provided, seeing more and more patients face to face while continuing to manage those who still could not access an outpatient appointment. Our patients were now coming to us in large numbers and with complex presentations. Many delayed seeking help either through fear of the risk of catching COVID-19, or because they mistakenly thought services were not open. There has been an explosion in those contacting us with mental health problems, local mental health services are struggling and GPs are, once again, picking up the slack. It is really busy now and we are dealing with that, as well as coming under fire from those who, for some reason, still think we are closed.
If you read my blogs, you can see how general practice has changed this year.1 It did not come about through a single change to a new way of working, but through a continual adjustment of how we provided services. At some points, guidance seemed to change several times per week—it was hard to keep up. Through these changes we ensured that we could continually comply with the latest government guidelines and reduce the risks to our patients, while still dealing with their medical concerns as they arose.
We were all worried that getting through April 2020 would be really difficult. In reality, the work is getting harder and harder all the time. We are being asked to open up our services (which have been open already, and which we are already looking to extend), and let’s not forget that COVID-19 cases are resurging in a second wave.
General practice has remained open throughout the pandemic. General practice has responded to the changing needs of the pandemic, and continues to do so. GPs are concerned for their patients and are doing all that they can to assess and treat them appropriately. The pandemic has changed many things, general practice included. GPs should be proud of what they have done this year, and it is clear to me now that we were very much deserving of the applause we received all those months ago.
Dr Jonathan Griffiths
- Dr Jon Griffiths. Blogging about healthcare and the NHS. drjongriffiths.wordpress.com (accessed 6 October 2020).