COVID-19 has challenged the NHS like no other public health emergency in living memory.
Faced not only with overwhelming levels of patient demand from those struck down by the virus, doctors have also had to contend with scandalous shortages in protective equipment, shortfalls in staffing and drastic changes to their day-to-day operations.
Time and again doctors and other healthcare professionals have not only risen to these challenges in the battle against the pandemic but demonstrated levels of ingenuity and determination in responding to the unfolding crisis.
London out-of-hours GP Sharon Raymond is one such doctor.
Dr Raymond, who is also a lead in London for integrated urgent care, devised and co-founded CCR (Covid Crisis Rescue), a voluntary initiative which since March has spearheaded a number of programmes in the capital designed to support doctors and patients during the pandemic.
‘I had a couple of visions of things that I wanted to achieve in terms of services,’ she says.
‘It wasn’t happening via the powers that be like clinical commissioning groups and NHS England, so I decided to set up these services myself.’
CCR was formed on 21 March by Dr Raymond and trained lawyer Alex Adams in response to the difficulties GPs were facing in getting hold of adequate supplies of PPE (personal protective equipment).
Using charitable donations raised online, CCR was able to source a range of PPE such as masks, gowns, visors and gloves and, to date, has distributed more than 30,000 such items.
Since then, it has expanded into a number of other areas including partnering with a taxi firm to set up a dedicated ‘COVID cab service’ for patients.
Patients attending COVID-19 ‘hot hubs’ are often required to stay in their cars while they are assessed or tested by staff in PPE. Dr Raymond says this means homeless people and those without access to personal vehicles can face problems when attending these sites.
This lack of access to personal transport also means that doctors are having to make home visits or resort to ambulances at a time when operating on razor-thin margins in terms of time and resources.
‘I noticed in the course of my clinical work that there was a limited capacity for ambulances with some at times taking more than two hours to reach a patient when it would normally take 18 minutes,’ explains Dr Raymond.
‘There are some patients who could potentially get to hospital without needing an ambulance but who did not have access to personal transport.
‘I approached a cab firm and, after drawing up a standard operating procedure, we now have the first cab service running throughout London.’
Using donations to CCR, cabs participating in the scheme have been fitted with protective screens and PPE, costs of journeys for patients unable to afford them also covered by donated funds.
Perhaps CCR’s most ambitious project to date, however,has been an oximeter loan service to patients, including those self-isolating, to allow remote monitoring of their oxygen levels.
‘We were ordering these probes in and sending them out but after a delivery of several hundred of these probes, I realised that once given out it might take a while to obtain more given the strain on medical supply chains,’ she says.
‘I felt so strongly that we need to have more access to probes because there is a risk with COVID of silent hypoxia … so it’s really important to have these probes to see objectively what is happening to oxygen levels.’
To combat this risk while minimising the need for patients to unnecessarily journey to and from hospitals and other healthcare settings, Dr Raymond hit upon the idea of a loaning service incorporating the assistance of motorbike couriers and the Royal Free hospital.
Patients in isolation can request an oximeter which is then delivered directly to their home. Once they’ve been used, probes are returned to the Royal Free hospital where they are sterilised, checked and stored ready to be sent out to the next patient in need.
Dr Raymond says the probe-loaning service, which covers the whole of London, has now been extended to places outside the capital such as Kent and Bradford.
‘We’ve got about 200 volunteer bikers who are willing to deliver probes 24/7 within one hour and 30 minutes of a request being made direct to a patient’s doorstep or care home,’ she says.
‘While there has been recent NHS guidance [for clinicians] on how to use oximeters it’s important that the infrastructure is in place so that people can get hold of them, and I hope that this service extends nationally to address that.’
While social restrictions imposed by the national lockdown have started to be eased, Dr Raymond and CCR have lost none of their impetus.
Following the Government’s announcement on 5 June calling for all staff across primary and secondary care sectors to wear face coverings at all times, CCR was able to donate 10,000 masks to 50 GP practices across the country.
Looking to the future, CCR is hoping to work with public health and rough sleeper services in the City of London to run a pilot scheme aimed at testing homeless people for the virus with the use of rapid point-of-care tests.
Dr Raymond will also be looking to launch a telephone-based, peer-support service called ‘In your shoes’ for doctors at risk of burnout as a result of the pandemic.
‘I find it hard to keep up with myself,’ she jokes.
‘[However] we can’t sit back. People have got needs and the situation is fluid and it’s about being able to react quickly.’