I have penned a short description of the effects of the pandemic on primary care together with some thoughts. It reflects my experience and my opinions and I accept that many will have different ones. Comments and sharing for comment are welcome. I hope this finds whoever reads this well, safe and tucked up at home. Thanks and Per Ardua. John
This has been an incredible few weeks for all of us. It has been spoken of as if we are on a War footing as a nation. Personally, I feel the better analogy is one of a counter-terror or counter-insurgency campaign, especially for primary care. We are preparing for and dealing with events that are hurting or could hit our communities in a number of ways. Firstly,the most obvious threat from the virus. Our role as gatekeeper altered, now more like a protector or deflector. But then there are the more collateral threats arising from the changes in the way care is being delivered, availability of medication, delays in referrals or earlier discharges from secondary care. We then have more asymmetric threats from alterations to our social systems and the challenges arising in mental health, isolation, safe-guarding and the effect of potential poverty from the impact on the economy. And of course there are the effects on ourselves and our teams, direct and indirect.
In less than a fortnight, less than a week, as a service, we have shifted massively onto our digital platforms; we use klinik and matters would have been much harder without it. Patient access is being robustly triaged, routine care has been thinned out to the most essential and anything respiratory is being cared for at “hot” sites with staff in PPE. We have risk assessed staff, rearranged working patterns to protect the more at risk, with many operating from home and some rearranging their personal lives to ensure care can continue; one young GP sleeping in his shed rather than risk cross infection with his family and another, a mum, choosing to socially distance in the spare room in the loft. If this is a conflict, it is multidimensional, and while at present it “feels”as if there is a “front” where skilled colleagues diagnose, treat and care for those with the virus, this is a modern, total campaign where battle leaks back and affects “civilians” such as shop workers and the “rear”. All the while there is an awareness that more is coming, the science and the evidence says so. Although nerves are present, moral is solid. There is a calmness in the surgeries and an air of utter commitment to this cause. As in any challenging time heroes emerge and others step back, but mostly our teams have stepped up to meet changes, risks and challenges with a will and professionally. There are criticisms of the centre, around speed of decision and lack of PPE for instance, but largely there has been fast reassurance and guidance about contracts and resources, for example. And good collaboration with organisations like the RCGP and BMA to provide policy and best practice. We are as ready as we can be and honing that readiness every day. Importantly, on the home front, our patients are supportive, appreciative and understanding.
Like many major conflicts, tragic though they are, there will be benefits arising from all this. The use of tech in our services, which was developing slowly and significantly, has taken an exponential leap onwards. This, and the demands of the threats faced, is altering the way medicine is practiced. Patient and clinical behaviours are being altered. The decision by the centre to cut us lose from the bonds of contractual performance management and focus on need professionally has moved mountains, cut away wasteful practice and is an opportunity to be built on. To be dragged back into the micromanaged bean-counting that Wellington raged about in the Peninsular campaign would be a tragedy. More widely, the use of tech, and direct involvement in community social care and support is moving; my partner posted 100 letters offering help to neighbours if needed and the result is a vibrant social network and people who never spoke waving to each other across the street.
But there are more challenges to come. Using another Wellington analogy, we need to see over to the other side of the hill. What comes next ? We think we are ready for the now, the more immediate. But are we ready for the later deeper stages of this crisis? For the collateral damage treatment, the resurgence of the virus if it comes and, importantly, what is the long term exit strategy. Can there be one? We live here, this job never ends. What will normal look like for our industry, our communities, in eighteen months to two years’ time? What will be the issues,ranging from the exhaustion of a long term campaign and a damaged economy,to further developments in technology? We must prepare and discuss that now if we are to learn from other “shooting”Wars. Looking at what primary care, the NHS and everyone around us in industry and society have achieved already I believe we have the ability to do that, we just need to make the time.
It is a privilege to be part of the response to this great challenge and I am proud of, and moved deeply, by what my teams and primary care have achieved already. Stay safe, stay home if you can, and every success in whatever you do.