The outbreak of Covid-19 in south Wales has been challenging, at a time where practices were already under huge strain. However, as with all challenges, there are opportunities to learn and develop.
For my practice in Swansea, it has certainly been an opportunity for us to put in place a number of changes to the provision of care we provide, so that patients could continue having access to their GP practice in a timely fashion.
We, guided by our senior partner, looked at the information coming out from other parts of the UK (and wider) on patient contact numbers and decided that we did not, at that time, need to participate in the local cluster Covid hub (where some practices chose to provide care in one place, cross covering each other). We felt that the best model for our patients would be to see our patients ourselves, with the proviso that we would support and remain engaged in the cluster hub proposal as needed. Other practices made similar decisions. At the heart of everything, we all want to do what is right for our patients.
So, what changes did we make? As a split-site practice, we identified that the upstairs suite in our Uplands site could be easily and cost effectively redesigned into a direct access Covid ‘hot hub’, where our patients with suspected Covid could be seen. This area had been an upstairs reception and waiting area for clinicians consulting in neighbouring rooms.
We sectioned this off to create a clinical area with a wipe down examination couch, chair and all relevant equipment. There was an adjacent area for putting on and removing PPE and all the cleaning equipment. Protocols for keeping the area appropriately cleaned between patients and deep cleaning at the start and end of each day were laminated and put on walls, as was the register to show we had completed this each day.
We designated all areas of the practice into green, amber and red zones, depending on what activity would be undertaken in each and all staff were aware of the processes and procedures in place to see patients safely.
This allowed us to continue to care for our most vulnerable safely, including our elderly and cancer patients and meant we could still offer baby clinics and vaccinations. We undertook regular tutorials and updates on protocols, weekly meetings across sites using Microsoft Teams and had informal catch ups to iron out any teething problems or new issues as they arose.
We also set up an accessible shared Covid intranet folder with all relevant documents and stored them on the Microsoft Teams site so that we could access it in and out of practice.
As time progressed, we decided that a drive-in Covid tent would be useful. It meant we could avoid bringing some patients indoors and lessen the viral load by being outdoors, protecting staff and patients. We purchased a marquee tent, which one of our reception team member’s family constructed for us (luckily their business is in marquee erections). It’s been a huge success and our patients welcomed this.
We also purchased and loaned thermometers and oxygen saturations to patients. This enabled us to monitor their symptoms when they didn’t need admission but were concerned they may worsen.
We rolled out video consultations, texting, photos by text and email consultations early. These can take longer at times, as you often need to ask further questions when not seeing a patient face-to-face.
We’re awaiting an all-singing all-dancing telephone system to make things work more effectively; this will come into place shortly as it’s been delayed due to Covid.
The roll out of ‘Consultant Connect’, where we have ready access to certain specialities, has been helpful and the rheumatology email advice line continues to be so helpful when faced with unusual presentations, along with our dermatology colleagues providing advice.
It has been great working more closely with our pharmacy colleagues – getting to know each other better and enabling rapid change to procedures so that we can all work efficiently together.
It hasn’t all been plain sailing. Initially, there was real concern about the provision of PPE. As a practice, we reviewed all the guidance and decided that we needed more protection to minimise risks to us and patients.
We scoured local shops, Amazon and uniform shops for scrubs. We even resorted to eBay to secure the equipment we felt was needed. A number of amazing local firms and schools stepped up and made face visors and hand sanitising gel, and my lovely friend Jill made us all head caps. That meant we felt more prepared and safer.
The tsunami of ever-changing guidance, protocols and evidence has been hard to keep on top of. With a new infection, we understand that there will continue to be a rapidly changing and evolving landscape of recommendations, but it eventually got to the stage where most of us in practice actually carried around ‘Covid files’ of information to make sure we had the right information at hand.
The shielding letter process and testing procedures have not been as effective or efficient as we would have hoped, especially in the early stages and in particular, concerns around shielding inclusion, exclusion and occupational advice has added significantly to our workload.
It has been frustrating and disappointing to see some blame for the care home outbreaks being placed on GPs. I feel this is unfair.
Practices (including my own) have worked long and hard developing their relationships with care homes and caring for these vulnerable patients, who by their very nature of being in care homes, are at risk of serious complications, including death, if they get Covid 19. GPs have and will continue to provide good care to care homes.
Looking forward, I cannot see us going back to having lots of patients in waiting rooms and I think the role of technology will expand further as practices and patients get more used to the benefits of using this, where it is appropriate to do so.
GPs and their clinical teams will always remain available to patients, as they have throughout Covid and receptionists will continue to help sort out queries as needed. Long may the model of GP care, from the cradle to the grave, continue, where we are the patient’s advocate.
I love being a GP and being part of a great team, as do my colleagues. The Covid outbreak has brought us even closer together as a team. Yes, we are all tired, mentally and physically, but we are all looking out for and supporting each other. Let’s cross our fingers - for the entire NHS and social care staff – that there isn’t a second wave. When this is over, I’m sure there’ll be a big party in the Covid Marquee. We certainly all deserve it.
Dr Charlotte Jones is a GP partner working in Uplands and Mumbles Surgery in Swansea and a member of the BMA’s General Practitioner Committee Wales