View from the ground, by Dr Gail Allsopp
The ancient Chinese philosophy of yin and yang, or dualism, is the principle that all things exist as contradictory opposites, such as light and dark. For me, COVID-19 has also exhibited this yin and yang. The darkness of fear. Fear of the illness, the unknown, the risk of the NHS being overwhelmed, of how high the peak would be. And the fear of death. I faced my own death; I rewrote my will, and had extraordinary conversations with friends and family. We have all sacrificed our freedoms, family, and friendships. And so many have lost their lives—in some way or other, every single one of us has been affected by the darkness of this pandemic.
Yet intertwined in the darkness and threat is the opposite. Although it sits uncomfortably, there is the light of opportunity, of change, and of growth. The positive behaviours I have experienced during the pandemic have kept me going. People have shown kindness, increasing strength of community, and togetherness in so many ways. Friends sending random positive messages of support. The solidarity of the practice team. Patients accepting, uncomplaining, and helping us navigate the new technology. Understanding when it goes wrong. Persistently and patiently helping us take care of them by turning on lights, focusing their cameras to enable us to see them clearly, to count their respiratory rate, view their rashes, and examine them in ways none of us ever expected to do.
Even within this light however, there is still darkness. The impact on care homes is clear. Health inequalities become more visible. The technological divide more evident. Total service delivery transformation in primary care relies on telephones—not just any telephones, we need smart phones. We also need our patients to be tech savvy. To enable them to receive a message, allow us access to their cameras and microphone, to be able to focus the camera and hold it still; and all this while talking to us about their most intimate fears. Many of my patients don’t have this equipment. They have old mobile phones, or none at all. If they do have a phone, they often can’t work out how to allow access to their microphone, so we talk over a landline while looking at a video on their mobile. Or they call in their relatives to help, assuming they are not shielding alone, and we all do our very best.
However, despite the darkness, the brightness of continuity—one of the best aspects of primary care—has sparkled during the last few weeks. Knowing our patients as we do, their families and their baseline level of need and support has enabled us to provide proactive care. Making ‘wellbeing calls’ to our most vulnerable has often resulted in positive action. Social support, food bank referrals, and importantly the identification of those who are ill, yet staying away due to fear, or a belief that we are overwhelmed and have no time for them. Many of our patients care as much for us as we do for them, our permanence as GPs in their lives is significant. They gave us the space and time that we needed to cope with the crisis and to transform their care. Thankfully though, they are now returning to us, we are treating their co-morbidities, diagnosing their cancers, supporting their mental health, and I feel like a truly holistic GP again.
We know the future will be different but can’t yet see what it looks like. We are all working towards a new normal, but we don’t know what that is yet. The weeks and months ahead are full of opportunity for a new way of working, but they are also full of threat. This is the yin and yang of COVID-19. As the threat of a second peak surrounds us and the light of opportunity and change glows ahead, we must fight to ensure that we never lose what’s great about primary care. The knowledge of our patients, the individualised approach to care, and most importantly the continuity, often ignored by policy makers, that defines the care we give and serves us all so well.
Dr Gail Allsopp
Clinical Associate Professor Primary Care, University of Nottingham
Clinical policy lead, Royal College of General Practitioners