Looking back, I vividly remember the BMA Northern Ireland GPs committee meeting in January when chair Alan Stout made a quick comment about a new virus from China and how hopefully it would only have minimal effect on our work in general practice.
None of us had heard of COVID-19, and we really had no idea just how much it would turn all of our lives upside down.
My regular job is as a GP in a busy practice in south Belfast; I work there for three days and one day in a local hospital. On 20 March 2020 my job changed overnight when I agreed to be the lead GP for the Belfast covid assessment centre. The centres were set up across Northern Ireland to see and assess patients with COVID symptoms, we wanted to ensure that any extra pressures would be prevented from negatively impacting the work of GP practices and emergency departments, and in doing so protect as much ‘normal’ work as possible. It was to be a new way of working for everyone.
My practice team was also trying to rapidly readjust and overnight our practice changed, from a face-to-face based service, to one in which all of our care would be provided via telephone and video appointments. We had to bring in social distancing for staff, ensure we all had enough PPE and knew how to use it appropriately and we had to try to get as many staff working from home as we could, and as fast as possible.
Setting up the centre was a daunting task. There were a large number of people involved from general practice, the Belfast Health and Social Care Trust and the Health and Social Care Board. We were all committed and driven to rise to the challenge; we were all too aware of the news images coming from Italy and elsewhere.
I was truly amazed at how fast we were able to make changes when we had to do it.
In a matter of days we agreed a suitable premises Beech Hall Primary Care Centre in Belfast – big enough for social distancing, good transport links, car parking, the right infrastructure to provide the necessary clinical environment to assess patients with suspected COVID 19 infection.
Next we had to work out how to set up the rooms and decontaminate safely and effectively. Patient flow and scheduling for base attendances and home visits had to be carefully considered. Equipment – what we needed and how were going to get it. Staffing – deployment and training considerations. Signage, showers, toilets, changing rooms, PPE, donning and doffing, referral pathways. Decontamination, transport, security, catering for staff, IT systems and phone systems, reporting procedures and governance. Communication and linking with media outlets. My to-do list had never looked so big.
All of this from concept to opening was 10 days.
The first day we opened we were nervous, hoping that it would all work as we had planned. Would we get any patients, would we get too many? There was a nervous energy in the air.
I was very aware of watching the faces of colleagues as they arrived for training and induction, I was aware of their apprehension and fear. I knew that my role was to reassure, support, engage and lead.
I saw one of the first patients who arrived to be assessed that day, it is a memory that will remain with me. I could see how frightened they were to see me in my full PPE. I couldn’t shake his hand, something that is so normal in ordinary times. They couldn’t see my face behind the mask and visor. I was all too aware of their distress both physical and psychological.
Work and family life
Working on the covid assessment centres was a huge change in my normal working pattern and it impacted massively on my husband Terry and our two young children. Their schools closed, as did all day-care and after-schools. I am not as home as much as I used to be or as I want to be, my children miss their routine, their friends and teachers. Home-schooling has been a challenge.
My husband has his own business that has been severely impacted as well and this has been felt by us both, practically and emotionally. I can see this right across the GP community and indeed with all the staff I work with. The prolonged uncertainty is still very palpable.
The support from friends, family, neighbours, colleagues and co-workers and indeed the general public has been overwhelming. In the first number of weeks we had meals left on our front step by neighbours and of course the Thursday clapping. Those actions were so kind and humbling. It has really meant so much. I have become been deeply aware of the power of the community spirit and resilience.
Easing of lockdown
As the number of cases is thankfully declining, we have been able to reduce the levels of services. Whilst I am currently still working in my role as the GP lead for the Belfast COVID centre, I am happy to be back working in my GP practice, albeit in a reduced capacity.
Getting back to my work in practice was really important, I needed to bring a sense of reality back to what I was doing and work out how I was going to move forward in this “new normal”. I was also concerned for our patients who whether through shielding or testing positive, being bereaved and the constant changes to guidelines have been through so much mentally and physically.
I still worry about a second, or even third, wave of cases but I feel we are much better prepared now to deal with it. The assessment centre will still function in a limited capacity for now. Additionally, in recent weeks it has become a testing centre only for those patients referred for assessment. Our collective experience means that it should be easier to increase staffing if we have to that start again from scratch.
My main worries are for the long-term impacts on our patients physically and mentally and about the urgent need to create confidence in our patients that GP surgeries and hospitals are a safe place to be seen and treated.
On the home front my children are excited that its now the ‘end of term’ and we even managed a sports day for them in the garden. My long-suffering husband has more time to focus on re-building his business.
Covid has changed all of our lives both personally and professionally. We will now work very differently in the future. I am so proud of all the GPs and all staff who have worked with me in the Centre and this in itself gives me the confidence that our profession can adequately handle any challenges presented to us in the future.
Ursula Brennan is a Belfast GP