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The Government and their scientists need a dose of the GP’s pragmatism



It’s been a logistical nightmare to deliver medical services in this ‘Covid-world’. As (hopefully) levels of Covid-19 recede, and the vaccine programme begins to significantly influence mortality rates, we’ll find ourselves at a turning point when it comes to managing the pandemic. As the rest of the country does, the NHS will need an exit strategy.  

If we genuinely believe that Covid vaccines are 76-90% effective at preventing serious disease after three weeks – once we’ve managed to vaccinate the first four priority groups which account for 88% of Covid deaths – the narrative around the dangers this virus poses must surely change. And yet, I fear they won’t, for quite some time. 

The past year has seen a media frenzy over the casualties from Covid. The public, having been reminded daily of the danger, will now find it difficult to accept the fact that for younger adults and children, Covid may actually be no more dangerous than the common cold or flu. 

And much as we may like to believe we’re impartial scientists, it will also prove challenging for clinicians to take necessary steps in relaxing safety measures. Once you’ve seen that horrendous film clip of a young woman visiting her grandfather and infecting him over a cup of tea, it’s hard to forget.

Many of my patients have been scared witless. The problem with using fear as a behavioural tool is that it appears to be most effective on those who need it least. So the already anxious and cautious 80-year-old will commit to never again hugging her grandchildren, but the 30-something-year-old builder watches the same footage and dismisses it out of hand as fearmongering. That builder may then go on to dismiss other warnings, as he feels the dangers have been overstated by a Government bent on controlling the population for nefarious gains.

The decisions taken by the Government around lockdown measures (on the advice of scientists), have inevitably affected the wellbeing of the population. From mental health issues, financial stresses and mounting debt (and therefore limited future public spending), to child poverty, increased alcoholism, increased child abuse, poorer educational attainment, and reduced levels of physical exercise – the harms are myriad, and expected to be long-lasting. 

I remain unsure how history will judge our nation’s response to Covid. Part of me wonders whether the next five years will see such a significant fall in deaths, that the death rate or life expectancy over this period (including 2020) will be relatively unchanged from the average. Yet I worry that the economic and wider societal harms and mental health issues may stay with us for several decades.

Will we look back on all the drastic things that were done, and wonder if some of it were disproportionate? What if a virus emerges next year which is ten times more deadly? What if we experience a severe environmental disaster, or economic collapse from deteriorating international relations?  None of us knows what the future holds. Right now, I believe it’s crucial that we don’t take too long to reduce restrictions, out of a sense of misplaced fear or caution.  

As GPs, we’re in the business of delivering pragmatic healthcare. We vaccinate en masse, and get through large swathes of the population annually. We perform blood tests at breakneck speed; we swiftly sign off repeat prescriptions; we manage mental health disorders within ten minute consultations. What we do is certainly not perfect (I’ve often felt uneasy about our prescription systems), but general practice is uniquely efficient and provides a great quality service, considering our restricted budget and limited workforce. GPs have never allowed perfection to be ‘the enemy of the good’.

At some point, before too long, we’ll need to declare that Covid has lost its sting. Will we dispense with wiping down every chair in our waiting areas; no longer insist on donning and doffing PPE; no longer attempt to manage everything remotely? Will we reopen our doors (and the wider NHS) to patients again, as efficiently as we previously did? It might feel uncomfortable – some may say it’s dangerous, and many will try to impede these changes. 

Yet I find myself more alarmed by the surgical waiting times; delays for outpatient reviews; and all those those cancers that remain undiagnosed partly as a result of our reduction in face-to-face consulting. 

Perfection (and a lack of pragmatism) can indeed be the enemy of the good. The NHS has never been perfect. When it works well, however, it can be bloody impressive.

Dr Katie Musgrave is a newly-qualified GP in Plymouth and quality improvement fellow for the South West

READERS' COMMENTS [9]

Simon Sherwood 10 February, 2021 9:59 pm

That is a really sensible and well constructed article.

David jenkins 11 February, 2021 10:54 am

what a sensible lady !

let’s pray she stays in medicine – and doesn’t get tempted into politics, where her undoubted common sense will be ignored by the idiots running the show !

Naomi Phillips 11 February, 2021 11:36 am

what a sensible article , but as mentioned by DavidJenkins , will it be ignored

Patrufini Duffy 11 February, 2021 3:39 pm

Nice read. I cannot see any intelligent GP team opening that second door. Period. The permutations and consequences are massive. Especially in transient big city hubs. That is the fault of the Government. It ignored a suppressive strategy, for this casual acceptance strategy. And yes, people died. Friends too. That has scarred us all. Going forward, believe in what you think is right, that famous gut feeling, immune to upcoming NHSE pressures, scrutiny, monitoring and further public demands. Your life and career cannot entertain amnesia, nor the threatening chirades of others.

Barry Moyse 13 February, 2021 12:11 pm

When you read common sense from a young doctor like this it gives one hope for the future of our profession.

Steven Hopkins 13 February, 2021 2:07 pm

Unfortunately, the people advising the government on reducing bureaucracy will be the current administrative class, including doctors, who got us into this mess.

Was called to do a MHA assessment the other night in our local hospital. Had to go through A & E and noted one harried doctor, two nurses, a porter and eight ladies in reception busily tapping on computers and ignoring the three patients quietly stand two meters apart.

When about to see a patient, I have to hunt through System One under new journal, Heamatology, Biochem, Letters, summary, then quick look at DART to see if notes there, then back to System One, see the patient using the agreed formula, make a diagnosis, agree treatment, back to Dart to organise click in 15 links to organaise a Cervical & Vaginal swabs, Hand write “chlamydia” on the labels, (if the printer works) and then write up the patient’s notes back in System One. All in 10 minutes.

How about the Government do simple things. Get rid of the CQC and its staff. It didn’t stop the N. STaffs scandal, nor the Bristol Scandal etc. Get rid of it.

How about we clip the GMC’s wings. They should be responsible for registering doctors and making sure they behave. Get rid of their involvement in training, (the colleges did that very adequately), get rid of Appraisals, limit how much the GMC can raise from each doctor to £100.

Get rid of CCGs. Let each GP Practice have a budget and let them buy what ever service they need.

Cut demand. The introduction of a 10 pence tax reduced the production of carrier bags by 85%, Stop the prescription charge and charge a £5 or £10 to have an appointment with the GP, Charge to handle complaints.

You could easily do the same in A & E. Demand would shrivel.

Too radical? Yes, I suppose so. Nice to dream though!

Steve

David jenkins 14 February, 2021 3:07 pm

Steven Hopkins

can i have some of your tablets ? what planet are you on ?

brilliant ideas, but unfortunately in the politically correct, customer-is-always-right, do-as-i-say-not-as-i-do, all-you-can-eat-for-nothing-buffet, real world it is never, ever, going to happen, even when the money runs out.

as long as we continue to medicalise all society’s ills, and encourage jo public to believe that the nhs is there to sort out all their problems, and clear up their mess (at no cost to themselves), things are going to continue to get worse.

get out. come to locumland. life is not perfect here either – but at least you can control your workload, plan time off, decline (compulsory) working at weekends, bank holidays etc etc etc

Sam Macphie 15 February, 2021 11:36 pm

Primary school children are 50% less likely to spread Covid than teenage school children and adults. The youngest school children whose education and social skills are most important, need to be back in schools sooner than older children, if we are getting back to normal in a graduated approach. I expect most teachers want to get back to doing the job they do best in a normal classroom where they are most effective. Teachers who are often young and fit, will not have greater risks than the average person when taking reasonable precautions. A child
age 5 or 6 to 8 years old especially, will miss so much by not attending school; it’s essential.

Patrufini Duffy 17 February, 2021 11:11 pm

David

Spot on: “as long as we continue to medicalise all society’s ills, and encourage the public to believe that the nhs is there to sort out all their problems” – then this is all becoming one faecal rabbit hole.