GPs have been seeing patients F2F throughout -yes smaller numbers, post triage with and without adquuate PPE. At least 12 have died so far. Let's not forget this.
My current bugbear is Hospitals doing telephone consultations (only) no triage, and asking GPs and staff to don PPE to do their blood tests, ECGs for their patients.
The half-empty A&E depts during covid were not having to manage continuity of care for any patient, unlike us, nor manage teams and premises.
I feel we have been having to manage hospital workload completely for 3 months plus -not the other way round.
I can feel a downdraft of blame coming to GP partners.
We need clear guidance from above as to what risk levels are acceptable (death rate of 6/1000, 3/1000) once we've done our assessments.
Clearly then all have a risk, and absolute risk will depend on local prevalence as much as personal factors.
Lots of covid around = high risk.
F2F is increasing -we are going to need significant increase in staff funding to be able to meaningfully act on the assessments we make.
Thought it was called Test and Trace -not enough Testing going on.
If some of the contacts test positive, their contacts need tracing too.
Why now? And why not gloves too?
I guess now we are testing, we can't pretend we're not going to spread it.
Guidance again based on what PPE is available at the time.
NZ did well -but the whole country survives in near lockdown from the rest of the world.
Presume they can't have much immunity there -so what happens when borders open? Or can they stick it out til a vaccine arrives.
Not a huge surprise -they are asking PCNs to co-ordinate and provide care for nursing home patients without any more doctors or nurses to do the job.
All very well funding social prescribers and pharmacists, but they won't carry risk, and they don't have the skillset.
If PCNs had fully funded workforce of a 2 or 3 dotors and nurses to do the ward rounds and manage care- it might be feasible. Otherwise we're just draining resources from Primary to Intermediate care.
What about staff that have been shielded, taken off frontline duties or under-employed and back filled?
I accept we get our normal budget but what about additional staffing costs to cover covid?
Please let the doctors do the doctoring decisions.
We make decisions on who to test for every other test /scan available- just make it available and we will use our clinical judgement, training and exepertise.
Oh, and by the way -why to Trust Staff get first dibs, then "patients", then GPs last. We are in the frontline remember and at least 11 have died. Would be useful not to go back to work if igM still positive, to protect workforce if nothing else.
Shielded staff who remain negative (assuming test works) will be more vulnerable than exposed staff -we need to know this.
Quick... some government bad news -lets have some giveaways to deflect the attention.
Bozza- Now let me see.. normally we use tax give aways before elections for this.
Rishi- No can do old chap, no wonga
Dom- No worries -let them all go to the beach instead, free ice-creams in the sunshine.
Hanky Good idea -its all over now isn't it?
Bozza -Lets just stop everything- this is getting tiresome. Let them all out in the sunshine to mix -that should get the herd immunity up again. And they'll forget about Barnard Castle soon enough.
Would be good to know if there is a Covid Spike around Weston /South Bristol -do we have any figures for cases?
Mind you doesn't take much pressure on Weston General to close services...
None of our local hospitals are accepting referrals other than suspected cancer.
We have already been doing as much as we can "safely" and have used our judgement and common sense using PPE throughout.
The guidance we have so far received, changes so often and contradicts itself that had we followed it diligently we would have closed down long ago.
How about some support/ backing from NHSe - we don't need more orders/ directives?
Isn't this like saying that Hospitals are obliged to meet the needs of sick patients, so that cost of the Nightingale Hospitals and responsibility for running these will fall on your hospital trust.
Always different rules for primary care.
Please will someone wake the government up?
For some reason, the government has been under the illusion that it would be able to source most of its PPE from China -despite a) China being the epicentre of the pandemic b) the whole world being in a queue for PPE. c) the UK having cut its trade ties with Europe with Brexit.
Every country has locked down its own borders early -it was clear we needed to be self-sufficient.
I understand at last that there will be some Scottish manufacture of surgical gowns- 4 months in, not before time.
We need UK sourced masks and fast!
Come on Dr K! Stop telling GPs off as if this unholy mess is their fault.
Please can someone answer:
1) When does the 12 weeks begin/ end -this has been going on 4 weeks already.
2) What about the housebound patients who we already have to home visit/ frailty /male/ 85+? They are according to guidelines only moderately at risk unless they have had an organ transplant? Presume we are visiting these but not writing to them, and they won't get a shopping delivery slot.
3) Please stop trying to micromanage this? Let us manage our patients in the best way we can given our limited workforce & geography and common sense.
I'm sorry - but why should the NHS workforce believe this latest non-evidence based guideline?
Staff wear masks for totally different reasons than the man on the street -patients will have coughed on the outside depositing millions of virus particles. The mask becomes a fomite.
So we don't touch the outside, and double bag it like we were told previously?
Handling it daily and putting it in and out of a bag with you name on (contaminated all over) , then leaving it lying around for a colleague or cleaner to touch.
This has created a huge amount of unnecessary work. Huge numbers of phone calls at the minute are patients asking whether or not they should be on the extremely vulnerable list.
But what about the 95 year old men with heart disease and frailty -no longer particularly vulnerable?? Really? No shopping delivery or shielding for them.
This sounds like a typical government response which adds in more complex control loop and new systems when existing ones are in place. CCAS seems to have been put in as another tier, rather than integrated into 111 or General Practice.
1) Patients ringing 111 inappropriately with other stuff in hours just should be told to ring GP. No complex referral needed.
2) Patients with likely covid who are mild need to stay at home - 111 can cope with these.
3) Patients deteriorating day 8-12 need to be in hospital- 111 with CCAS should be able to make decisions on this.
4) Anything that 111/ CCAS needs our help on - PICK UP THE PHONE to us. We can help
Making us read through an incoherent 3 page reports won't help patient care, nor will spending hours on IT appoointment release, and checking if these are filled.
Hilarious! How many GPs do they think there are? We had another edict that we should be working 3 weeks on 3 weeks off (thats 50% of the workforce gone), then another saying we need to constantly watch appointment lists from CCAS in case, another to set up hot and then cold sites- all at no notice. Then in next breath cancel all leave and all bank holidays!
I am hearing that CCAS won't have access to patient records -despite all our efforts with data sharing with 111 service. Thats isn't going to help the looping.
If 111 needs us to assess patients -please send your records stating why, and what is being asked of us. Telling patients that they were "told to phone their GP" is not really safe.
I think once again Stable Door.
Now all patients are deemed likely infected and we are using PPE there is no such thing as cold!
Maybe when we can test and there is a point to bringing them up.