View from the ground, by Dr Claire Davies
My initial feeling about my role as a GP at the start of the pandemic was one of frustration. The press were complaining about us with greater malice than ever, and many of our secondary care colleagues were criticising GPs on social media. We seemed to be the new fall guys of COVID-19.
Even though I spoke to scores of patients every day, I still felt useless. It wasn’t just that we lacked our own NHS hero hashtag or donut deliveries—I felt a huge sense of personal frustration that I wasn’t out there more. My natural inclination as a helper had been crushed. Even when I was asked to lead a speech in the practice meeting to commemorate healthcare workers that had been lost to the virus, I fudged it, mumbled, and cried. I felt that my mojo had not just been lost, but stolen from me—cruelly and unfairly—at a point in my career when I should have been stepping up and into the fray.
Moving forward to January 2021, COVID-19 hit our practice patients heavily. Half of the households in our densely populated patch of East London experience poverty or overcrowding, and they suffered greatly from the effects of the virus. The daily death toll was a heavy burden for GPs too. Families were traumatised by multigenerational hospital admissions and deaths; I was relieved when one of my more vulnerable regular patients phoned to let me know he had survived, but he then went on to tell me about all of the members of his extended family that had died, and his words made me weep. At the same time, I realised how important it was to witness the grief of these families and to begin to help them to pick up the pieces of their lives. I started to see the real point in my work, and that my role as a GP during the pandemic was really only about to begin.
Now, after the second wave, I look back and consider the role of primary care during the pandemic, and I am proud of what we have achieved. The move to digital has opened the gates to primary care, and most of us are trying to surf a gigantic wave of demand. We have stepped up to meet the needs of patients—for example, dealing with mental health problems, managing acute COVID-19, and palliative care. The move to remote working in our practice took place smoothly—almost overnight—but with a huge amount of work behind the scenes.
The pandemic accentuated many inequalities in the community. Our own practice undertook to carry on with some of the Quality and Outcomes Framework work during winter 2020–21, with a focus on the most vulnerable patients. Our reviews of patients with learning disabilities revealed huge problems, including with patients’ behaviour, struggling families, and surging weight gain, as well as the loss of exercise and socialisation and the structure of their schools and day centres. And we have learned a lot from patients, about the indirect effects of COVID-19 and how the most marginalised often do not speak up unless we reach out to them. Restarting some work on managing patients with chronic diseases also exposed some alarming deteriorations in diabetes control, with more sedentary lifestyles causing increases in glucose levels and blood pressure. Primary care has a vast role to play in the next few years to reverse this trend, and to help patients recover from the damage of the pandemic.
Finally, the success of the vaccination campaign has been phenomenal; this has largely been down to GPs—even though primary care does not appear to be celebrated much in the media. GPs have sourced and set up new venues, run 12-hour vaccination sessions, and worked throughout weekends, as well as answering patient queries, reaching out to book in vulnerable patients, and delivering vaccines to patients who are housebound. Primary care has also run question and answer sessions for different ethnic minority groups, with many GPs conducting these in other languages. It was always hoped that vaccination would be the way out of lockdown, and it is a team of committed, motivated, and innovative primary care clinicians who are leading the country along this particular route out of the pandemic.
There will always be criticism, but it is essential that we take a step back and celebrate ourselves. Some of our biggest roles during this pandemic are still in their infancy: in supporting patients with complex bereavements, managing long COVID, assisting with mental health recovery, and regaining control of long-term and chronic conditions. Challenges with vaccine supply and demand are bigger than ever right now, but once we see our way through this, I believe our most important work is just beginning.
Dr Claire Davies
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