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Cab service, oximeters and PPE: How one GP is filling in service gaps

When the Covid- 19 pandemic started, the sheer enormity of the impact of this new condition on public at large; on our patients, and their loved ones; on ourselves, as healthcare professionals; and on key NHS services, proved overwhelming. This was particularly apparent in my work within the London 111 service.

Having identified some of the main areas that could make a real difference to coping better with the pandemic, in particular the PPE issue, need for ‘Covid cabs’, and the wider availability of oxygen saturation probes, I founded the Covid Crisis Rescue (CCR) with operational support from Alex Adams, a social entrepreneur, on 21 March 2020, to address the emerging Covid crisis.

We have recently established a charitable foundation for the purposes of sustaining and developing CCR’s activities and reach.

PPE to the frontline

A major focus of the work of Covid Crisis since its inception continues to be the need to supply PPE to frontline NHS staff. We started off with a number of international supply chains, enabling us to procure and deliver nearly 30,000 items of protective equipment and medical devices directly to healthcare professionals working on the frontlines across the UK, side-stepping procurement processes, red tape and unnecessary delays, while also ensuring that all products procured have the necessary certification.

Since having set this up, we are now working with dozens of hospitals, Covid ‘hubs’, homeless shelters, hospices, care homes, ambulatory services, as well as London based ambulance services and domestic abuse shelters across London, and further afield in the UK, to try to ensure that no healthcare professional goes to work unprotected.

Our average delivery times to the frontlines are one to two hours for London, and one to two days for the rest of the UK.

Pulse Oximeter campaign

Whilst tackling the need for PPE, I ensured we maintained our focus on the other key priorities identified at the outset of the establishment of Covid Crisis Rescue.

As we are all aware Covid-19 can lead to silent hypoxia, which can be fatal. Since the outbreak of the pandemic, I have been highlighting the paramount need for patient- held oxygen saturation probes to aid self-assessment, and to help facilitate remote assessment of Covid-19 symptoms by a clinician. A one off reading would not be sufficient, as it was clear that oxygen saturation levels could fluctuate, and in some cases, deteriorate over time.

I felt that ensuring that patients with suspected or confirmed Covid-19 had an oxygen saturation probe, with the appropriate clinical guidance and follow up, would help reduce unnecessary burden on the healthcare system due to contacts from the ‘worried well;’ would ensure that those patients requiring emergency or urgent medical attention would receive this in a timely manner; and would also facilitate ongoing monitoring of patients with Covid-19 discharged from hospitals.

Given the recent exponential price increase in – and scarcity of – pulse oximeter devices, CCR has established supply chains with four suppliers, so far procuring 1,400 devices and donating several hundred for trials with various healthcare services.

As part of this campaign, I recently launched a petition calling on the Mayor of London to take strategic ownership of the procurement and distribution of oxygen saturation probes to every home in London, with significant support from key medical professionals and healthcare organisations.

Realising that this petition would take time to gather speed, and being acutely aware of the immediate need for the ready availability of oxygen saturation probes, I devised a plan for the first 24/7 oxygen saturation probe loaning service, to serve the whole of London. I originally came up with the idea for this service on 6 May, and thanks to the support and hard work of various professionals, services and volunteers, the Urgent Oximeter Response service launched five days later!

The service is a collaboration between Covid Crisis Rescue, The Bike Shed Community, Team Rubicon, with the support of the Royal Free Hospital, the North Central London Integrated Urgent Care Service, LCW Unscheduled Care Collaborative, and the following amazingly helpful colleagues in particular – Dr Tara Sood, ED Consultant, Dr Fiona Sim, Public Health Consultant, Dr Simon Douglass, Dr Cecile Wabnitz, Dr Dan Bernstein and Dr Ro Sri-Pathmanathan.

The Urgent Oximeter Response arranges delivery of probes by DBS checked volunteer bikers in an hour and a half from the time a request is made to our hotline. At the last count we have nearly 200 DBS checked biker volunteers prepared to deliver probes at any time of the day or night anywhere in London. The service is by clinician recommendation and oversight only. The vision is to replicate this service nationally.

We are now working with dozens of hospitals, Covid ‘hubs’, homeless shelters, hospices, care homes, ambulatory services and more

‘Covid Cab’ Service

During the initial days of the pandemic, it was clear that arranging face to face clinical assessments for those patients without private transport, including those living alone and the homeless, was proving challenging.

GP home visits and urgent ambulances were often being arranged by clinicians when private transport would have been a more timely solution, also placing less pressure on stretched resources. This was particularly an issue at the height of the pandemic when ambulance response times were impacted by the unfolding Covid crisis.

I felt there was a need for a designated and ‘protected’ cab service to transport passengers with suspected Covid-19 to hospital and Covid hot hubs for face-to-face assessments by clinicians, in cases where patients did not have the option of private transportation.

In order to ensure that the risk of virus spread is limited, I formulated a Standard Operating Procedure, which has now been adopted by a London cab firm operating across the city.

The Covid cab service, now with a fleet of over 100 vehicles was established on 29 April 2020, and has already reached in excess 200 journeys per day in London, with extra capacity in the works. CCR is now looking to expand this service to other cities.

CCR has funded the establishment of this service, including the insertion of screens into each vehicle and the provision of PPE. In addition, CCR have undertaken to cover the cost of journeys in cases where passengers, such as the homeless, are unable to pay.

Covid Creation Capsule

A further project CCR will shortly be launching is an art-focused fundraising initiative, the Covid Creation Capsule, in collaboration with a cadre of world-renowned artists .

This forthcoming, fundraising project will bring together leading and emerging artists in a unique form designed to educate, engage and galvanise the public through the medium of art. I felt that this project would enhance a sense of positivity and mental well-being in these challenging times.

‘In Your Shoes’

Bearing in mind the impact of the pandemic on my GP colleagues, both personally and professionally, I am embarking on setting up a new service to provide remote one to one peer support for fellow GPs, called ‘In Your Shoes,’ by GPs for GPs.

Covid Crisis Rescue depends on donations to continue our work.

Dr Sharon Raymond, is a GP in London and a lead for 111/ integrated urgent care, as well as Named GP for Safeguarding Children for 2 London CCGs, a Clinical Lead for the IRIS service, and a GP Appraiser in the London Area, You can donate to Covid Crisis Rescue here