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Independents' Day

Can us GPs do more to help during this pandemic?

A locum writes that there is time and headspace for GPs to help more in the management of Covid-19

There is no question that this disease is a bigger threat to doctors than any of us have ever faced. I have huge respect for those doctors who are taking this risk on a daily basis in emergency departments and hospital wards across the UK, as well as huge sympathy for the sick and dying and their families.

And the NHS failure to support GPs by providing adequate PPE, Covid testing, and large supplies of tools needed such as oxygen sats monitors has been pathetic, and it is entirely reasonable for us to complain about that as well as the shielding list farce.

But, do the majority of GPs really deserve applause for our work with this crisis? Not yet, in my opinion. Admittedly, we have had to deal with a deluge of paperwork, but I don’t really think that counts.

The truth is, we haven’t had the deluge of work that some might have feared at the start of the pandemic. From my experience as locum in an area which is seeing some cases but is not yet a hot spot, I have seen the demand for GP locums disappear. Before the pandemic, practices were desperate to get locum cover even outside the holiday season as many practices in our area are severely undermanned with 3,500+patients per  full time equivalent GP.

Why this lack of demand for locums? First of all, patients are staying away and not calling us. Partly because of the national publicity about protecting the NHS, partly because they don’t want to come in to the surgery and catch the virus, and partly because they think we are working hard dealing with sick Covid patients. And NHS 111 has not yet been booking a significant number of GP appointments, at least not in our area.

Secondly, a lot of regular GP work is being cancelled or postponed. As well as all chronic reviews, there is no QOF, CQC, extended hours, etc - which is a break GPs probably need. So the total number of consultations per day has been reduced by at least half in some practices.

Only a tiny fraction of the normal number of F2F consultations are being done. In some large practices it is two or three per day and sometimes less. In some areas, many F2F patients are travelling a long way to be seen in so-called hot hubs which have no continuity, and of course no Covid testing.

But there are serious downsides to the present situation, which is clearly going to go on for many months if not years. Some patients with serious non Covid disease are being missed: meningitis, MI, appendix etc. Paediatricians have been noticing that seriously sick kids have been presenting later and sicker than usual. A&E attendances and acute hospital admissions are down in many parts of the country. Ambulances are recording a rise in calls in which they arrive at a house to find the patient has already died. Excess deaths are on the increase.

The behaviour of GPs now will have an enormous influence on the future of the whole profession

Within such an environment, I feel we can do more, starting off with the management of Covid. To sort the mild to moderate Covid patients from the really sick ones, NHS 111 phone triage doesn’t cut it. You need basic observations, most obviously pulse oximetry, as many hypoxic patients aren’t obviously breathless, and there have been deaths shortly after telephone triage has categorised patients as mild. NHS 111 is not doing this - but we can. If patients called their own practices and had Sats monitors collected for them, and then had a phone or video consultation with someone who has access to patients GP records, we could assess patients remotely much better than 111.

Secondly, someone is going to need to sort out care for Covid patients who are frail and for whom hospital admission would separate them from their families without giving them any useful treatment. They will need symptomatic treatment, and their families will need support. We need teams of (maybe young?) GPs and nurses to deal with this, especially for residential homes, who are dealing with increasing numbers of Covid patients, and whose staff really are heroes!

Finally, we can do more to get the message out that general practice is open. Some practices might be doing this, but plenty aren’t. If we do this we will improve patient care, including for seriously ill patients, avoid some pretty damning journalism from the likes of the Daily Mail, deal with some of the pent-up flood of demand that we are going to face anyway in coming months, and also deserve and get gratitude from our patient populations.

Yes, we lack equipment and support, but it is surely possible, partly because we do have some spare time at the moment to work on this. The publicity about not calling your GP - ‘save the NHS’, which has left patients apologetic about calling us - needs to be changed urgently. And all those doctors who have been volunteering to help NHS 111 need to resign as they are a problem, not a solution as phone triage has been fairly useless.

This is a historic crisis, and the behaviour of GPs now will have an enormous influence on the future of the whole profession, as well as really helping patients in need.

The writer is a locum GP in the East Midlands, who wishes to remain anonymous

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Readers' comments (63)

  • Go take a partnership and do it all then... I.e, You first!

    Easy to wax lyrical about what others should do, less so when it comes to whether you would do the same. I noticed you failed to mention all the other variables and pressures surgeries/partners might have to deal with. Or that nothing is stopping patients from sourcing their own sats monitors...

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  • its all very well, but nobody wants to pay you to do it.......

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  • No wonder you wanted to remain anonymous. I'm pretty busy and don't have any ''spare time''...speak for yourself....still doing same amount of work but just in a different way. It seems unless you are seen to flog yourself to death for NHS you're considered not to be doing enough.

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  • I’ve read some right old cobblers on here but this pompous windbaggery marks a new low. Congratulations!

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  • A poor article!!! Typical locum comments who do not understand what running a practice means

    Yes patient demand did drop off for a few weeks, but demand is much greater now

    There was massive changes we had to make quickly. Like retraining reception staff, changing to telephone triage, video consutlations, making sure risk assessments were done, changing patient flows, reading the masses of information that was coming out and most practices have helped out with hot hubs, red visiting etc etc

    A lot of locums are looking for work - it has always been one of the risks of being a locum. A very helpful workforce - but going forward - I think general practice can funciton with less locums. We can triage more and save time and hence the need isn’t there. We have a 7 sessions locum - we are keeping them out of goodwill rather than need

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  • A bizarre article. Lacking grounding and clearly distant. 70% of GP consultations are a COMPLETE waste of time. These burdens pushed consultations to 400 million/y. Walk-in and NHS 111 packed with nanny self-care statements and medicolegal documentation and pat on your back. That isn't commendable, it's plain stupid.

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  • @Patrufinito - I concur Im afraid... its another reason I left UK general practice, it was mostly admin, people who thought they were depressed, those who actually were, and trivia. There was very little real medicine left. And if you had anything interesting you were allowed to do so little in the UK as the specialists have claimed it all as theirs.... leaving me wondering why I went into General Practice at all. It is only good in a few remaining pockets...... mostly the rural areas, but the on-call commitments there can be arduous, you can be professionally isolated and most people would not move their families to those locations. RCGP has failed to maintain and defend General Practice. It could and should be an excellent job.....which is why I think the only solution now is mass resignations and a new contract drawn up from scratch - where we are allowed to prescribe more drugs with the right training, and more interventional work, including radiology.... just like in Australia.......In the last two weeks we've dealt with Necrotising Fasciitis, two Stonefish envenomations, acute COPD, acute asthma, an acute MI which was thrombolysed, suturing wounds from a Moray eel bite, removed several skin cancers, including one on the face, ordering MRIs/CTs etc without permission, as well as the usual UTIs, antenatal care, prescriptions, many of us have our own ultrasound (Butterfly).... this is how general practice should be.... the governments model is to flood the system with too many desperate trainees to further reduce pay. RCGP is part of the problem sadly, they are too close to their bongs and big pensions to see/care about the profession as a whole. We need to refocus what we do, claim back much of what we have lost, and make it a job worth doing again. We wont get there without breaking a few, actually, no, a lot of eggshells......being nice at negotiation time isn't getting us anywhere...

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  • Not in my experience, I have used every resource available to me and continued to provide care to my patients. Using video consultations / hot hubs / doing two week wait referrals / blood tests / I am “seeing” the same number of patients ie majority of these telephone consultations and using VC if necessary. And mental health consultation , that’s just skyrocketed!
    Like someone else said in the comments , doing the same amount of work just differently and we will
    take some of this forward when managing demand for appointments, I do hope this will bring about lasting change in health seeking behaviour.

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  • Oh I should’ve added we are doing visits too. The point being majority of GPs do understand their patient needs and right at the start organised themselves so that they could continue to provide care under the circumstances. GPs are very good at adapting , given the changes thrown at us , and we have ! There will be some unfortunate deaths and the EDR is high but that’s not because the message is GPs are not open but that Hospitals are unsafe !!

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