Pandemic Practice

• Written by: Dr. Graham Kramer
• Published: 30th April 2020

GP Graham Kramer discusses the role of a GP and practice team during the COVID-19 pandemic.

It is a strange time for us all and General Practice is no different. Practice teams have never known such dramatic disruption that has turned us upside down and inside out.

We have gone from being burned-out by multidimensional demand to empty waiting rooms, consulting over the phone, “Zooming” over newly installed video links and in some cases, drive-through tents in the car park. Gone are our tweed jackets and Pringle sweaters and in are the “ER”-scrubs, gloves and masks. This pandemic disaster has strangely energised our flagging spirit and generated a joyous collegiate spirit of collaboration, team working, barrier breaking and innovation that would have been impossible to contemplate just a few weeks ago. Our mania however is tempered by the anxiety of taking coronavirus home with us and a genuine sadness for the hardship and loss of those we look after. There is also a nagging feeling of incompetence in trying to manage a disease we have little experience of. This is all mixed in with a generous dollop of uncertainty when making remote decisions with people.

Whilst we are not sitting behind our computers twiddling our thumbs there has been an unnerving drop in people seeking our help. It is interesting to speculate why. Clearly people perceive the NHS is terribly busy and are worried about bothering us. There is concern they might have to come down to the surgery or be admitted to hospital and worry about catching the virus. We are obviously not seeing the usual numbers of people with coughs and colds as they heed the advice to self-care and self-isolate or seek help via NHS 24 if they do need help. Quite a lot of our usual case load is when people seek advice for symptoms that might impact on school, work or an impeding holiday,  but with schools shut, people working from home or furloughed and flights grounded, they are not needing us. The way we work has changed. It would not be unusual for you to be having a telephone or video consultation with your GP who may be at home (either because they are self-isolating or looking after their home-schooled children) accessing their practice computer system remotely. Our nursing teams especially are seeing patients in the surgery or at home endlessly “donning and doffing” personal protective equipment (PPE).

Our big worry, and a great unknown, is the health impact the lockdown could be having on everyone. We know from the experience of other humanitarian disasters that generally people’s health gets worse;  long term conditions such as diabetes and high blood pressure, increased mental health problems such as post traumatic stress disorder, depression, anxiety, loneliness, grief and substance misuse. People will have lost jobs and have significant financial issues, deprivation and inequality will not have improved. We worry what may be going on behind closed doors and the effects on families with increased domestic abuse in all its forms. People have had operations postponed and cancer treatments have been held up. Tumours have not stopped growing in the lockdown and with cancer screening suspended, and people holding on to symptoms, we expect a surge on demand for urgent cancer referrals which could clog up NHS capacity.

To some extent we have been trying to keep tabs on things by contacting our patients who are shielding or at high risk. However, we are actively planning how we might respond to the expected over-bounce of people seeking our help once the lockdown is relaxed. Firstly, we are asking people to contact us now. We are open and can still address these issues. Secondly people’s needs and goals may have shifted, and we need to adapt to how we can understand what matters most to people.  Thirdly, we will need to maximise our new ways of working – whether with improved online communication, collaborative working with all the new networks of neighbourhood support that has sprung up, and perhaps releasing  capacity by letting go of some old ways of working that had been entrenched but suddenly seem obsolete. Lastly, the pandemic has rightly shone a spotlight on our Health system but also the struggles of our Care system. We hope good things can spring from this

There will be many other good things that become apparent when we re-boot after the pandemic. There are great stories of how people and communities have been looking out for each other. Some people with anxiety and depression have found long suppressed courage and purpose. People, through necessity have been finding a confidence to adapt and self-manage. How we harness and nurture all this will be crucial.

Finally, to compensate for the human tragedy of the pandemic, along with the dehumanising effects of masks, the two-metre-wide-berths and the hands-off distancing, many of us sense a more subtle outbreak of warm appreciation and kindness for each other. We really do not want to flatten the curve on this!

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