We rely on the unsung heroes of our practice community
Dr Salma Ahmed
I woke up this morning and thought: ‘Thank goodness, I can go to work!’
I haven’t got a persistent cough, temperature or myalgia. With no symptoms of Covid-19, I’m fit to work.
It’s crucial for many people that I stay this way. I’m a Tower Hamlets GP, and look after 13,000 patients with an amazing team of people. My husband - a hospital consultant - is also going to work and in the same position, needing to stay well for his patients and colleagues. My son, who is home from his shut-down university, is symptoms-free, so none of us need to self-isolate.
But what about everyone else? I checked WhatsApp to see which of my colleagues are ill, not at work or self-isolating. Every time that happens, daily regrouping of staff is needed. The instruction to patients with symptoms to ‘stay at home so we can work’ is so important, so we don’t become infected and can stay active for our patients. But also in case we’re brewing the virus.
To prevent cross-infection, my practice has designated red (likely Covid-19), orange (possible Covid-19) and green zones (for video calls). The concept of telephone consultations isn’t new to us - we’ve have been doing it for years and have a room where doctors admin and the whole team can work together to do calls. In the current crisis, where we’re trying to reduce face-to-face contacts as much as possible, our telephone expertise and continuity has helped in managing patients and providing them with support and knowledge. E-consults are increasing daily.
Despite being a practice that’s prided itself in being able to change and adapt quickly, we’ve never instituted so many changes this fast. We have business continuity plans in place for the whole practice - second guessing what may or may not happen.
Some of our staff can’t come into the practice, because they’re self-isolating, unwell or in vulnerable groups. Therefore, we’re trying to get remote working up and running to an extent far greater than ever before. This needs extra resources, such as second-hand laptops bought from the amazing local IT/ mobile phone shop, webcams and headsets.
Over the weekend, I took part in an emergency online meeting for a group of over 200 health professionals across East London, where knowledge on remote working and seeing patients by video and Accurx (a brilliant SMS texting service) was consolidated. Since the outbreak, our mobiles have been pinging every minute as over 200 GPs nurses, practice managers and pharmacists from Tower Hamlets share their experience, tips, support and learning in this unprecedented situation.
Every single piece of knowledge gathered or known has been shared, and our knowledge has been pooled and passed on exponentially. What makes it even better is that a group of brilliant local colleagues set it up - all heroes working together. We’ve all supported each other to ensure we can save lives, look after our patients and staff, and help each-other to stay well and continue working.
My day is a ceaseless whirl of activity. Constant huddles and check-ins with in-house staff and colleagues working remotely; joint FaceTime video consultations with consultants, other NHS staff, carers and patients; emergency nursing home and care home meetings; and a constant awareness of inadequate PPE for staff and carers.
My adrenaline and stress were high all day, and I was crashing down by 7.30pm. But I was cheered up by two colleagues, ill or self-isolating at home, still working and calling patients, as well as our brilliant pharmacist. Despite everything, ordinary calls of GP life continue - urgent, non-Covid 19 referrals need to be done. Medicines need to be issued; non-routine things delayed, but we don’t know how long for. We’re dealing with queries from patients who can’t wait for NHS 111 or need more reassurance, and managing worsened mental health and heightened anxiety in people who already suffer from stress, OCD or depression.
District nurses, care navigators and carers still visit vulnerable patients at home, without adequate PPE
Who are the heroes I met in Tower Hamlets today? Too many to mention, but I think of the ambulance crew and paramedics who went to the nursing home to do resuscitation and take a patient to hospital. The care home staff and carers who work all day and night in the homes and won’t leave the vulnerable patients even if they have coronavirus-related symptoms. The nursing home manager who slept at the nursing home throughout the last few nights to show leadership and solidarity. The pharmacists and receptionists inundated with questions and requests from worried patients for their usual medication and emergency medicines.
The patients who are holding strong, resisting the urge to stockpile and understanding when we say we can’t give more medication. The district nurses, care navigators and carers still visiting their vulnerable patients at home, without adequate PPE. The phlebotomists taking urgent blood tests to help clinical decisions. Our GP registrars who have said they would give up annual leave to help us despite uncertainty about their own future exams. Our reception staff, numbers depleted by illness enforced self-isolation who take unprecedented numbers of calls and E-consults, and sit at the front desk not knowing who will walk in, despite signs saying to stop if you have symptoms. Patients still come, despite advice to first call or complete E-consults for queries. Our doors aren’t shut - we’ve kept them open and hope that trust means that our patients will stay at home unless essential. We constantly promote online services for everyone’s benefit.
Our hospital colleagues going above and beyond making joint decisions about management. The local pizza places, coffee houses and businesses offering their support when they’ve struggled to keep their businesses standing. Our in-house reception IT team setting people up remotely doing beyond their hours. Our patients bearing with us and thanking us for doing what we can do.
NHS 111 and the GP out-of-hours teams for getting through a lot of calls and assessing clinical risk in huge numbers. And the cleaners who come in routinely, making things better for us every day, ready to decontaminate if needed. You can’t be a cleaner and self-isolate…
We’re having to make really difficult clinical decisions daily, but it helps to be together as a practice and as a community in Tower Hamlets. I’m feeling grateful that I work with such amazing colleagues and teams.
As I drove home, I thought of my elderly parents and in-laws, and the vulnerable loved ones for many of our patients and staff self-isolating. I wished I was living closer mine - thank goodness for FaceTime! I was most grateful to my 20-year old son who made my husband and I a dinner of tandoori chicken and rice tonight, and offered me a cup of tea when I got home at 9:50pm. He said: ‘Mum I wanted to do my bit’. Thank you. Made my day.
Dr Salma Ahmed is a GP partner at The Jubilee Street Practice in Stepney, Tower Hamlets, London