Nationally, all GP surgeries should switch to a phone-first triage system, to minimise patient contacts with NHS staff, and eachother (in waiting rooms). It might even be worthwhile moving waiting areas outside to reduce potential transmission between patients.
CCGs should organise local hubs dedicated to seeing any patient with acute onset respiratory symptoms or fever. The staff here would obviously need to use full PPE – which remains an issue – and have extra cleaning support. They would adopt the same phone triage approach (calls having been diverted from the routine GP surgeries). Only those deemed to need assessment would be seen in the clinic, and hospital admission arranged if needed. Patients should expect to transport themselves or family to hospital in all but the most life-threatening cases.
Those GPs who are seconded to this service should expect to remain working here for several months. Any symptomatic frontline staff should be prioritised for testing, and work from home until given the all clear. Self-isolation for two weeks isn’t feasible if we are to keep the health service running.
Obviously, these hubs will treat many without Covid-19, for many other acute respiratory conditions, but the separation will mitigate against wholesale mixing of an infected population with those yet to be exposed. Perhaps we could remind the population that the common cold, or a sore throat, very rarely require medical attention?
The NHS has been allowed to become the sick man of Europe, and we all know what coronavirus is expected to do to the sick
If CCGs are unable to organise hubs, as well as designating isolation areas as per NHS England’s advice, practices should ideally have separate entrances, and patients would be advised to wait outside, or in their cars. The GP could ring their mobile to advise them to come in through the ‘potential coronavirus’ entrance.
Finally, a home visiting strand to the GP service is going to be needed. Those patients too unwell or frail to attend the acute hubs will still need medical care and advice. If they have respiratory symptoms, a GP or paramedic should attend – and full PPE for us all must be ensured. Difficult conversations will be needed, to advice on care at home wherever possible, and comfort care in those thought least likely to benefit from a hospital admission.
Wherever possible, family members should be asked to be responsible for additional care needs, help with shopping, collecting medications. The Government could issue a statement urging the population to care for their relatives if unwell this winter, and make arrangements for additional paid leave where needed.
I also agree with calls for any extra work should be taken off GPs – QOF, CQC inspections, appraisals and mandatory training. Patients may need to be advised that all routine secondary care referrals will be suspended.
We’ve been warning politicians for years about the precarious state of the NHS. Allowing a health system to function beyond capacity for so long was foolish at best; negligent and criminal at worst.
Since qualifying as a doctor in 2010, I’ve been despairing at chronic understaffing across the board, inadequate numbers of hospital beds, consistently below inflation increases in funding, an ambulance service on its knees, and a social care system not fit for purpose. The NHS has been allowed to become the sick man of Europe. And we all know what the coronavirus is expected to do to the sick.
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West