Adapting to change, maintaining continuity, meeting the challenge

9 April 2020

Practices are experiencing the COVID pandemic in different ways. Some have a massive workload and are struggling to manage ‘business-as-usual’ activities alongside dealing with COVID-19, particularly when staff might be off sick or self-isolating. For these practices, our workload prioritisation guidance might help.

Other practices have fed back to me that workload feels more manageable as a consequence of reduced administrative activities, as well as reduced presentations of self-limiting problems.

Relationship-based medicine

Whether we are coping or not, our work is different in many ways from what we did pre-COVID and the most obviously dramatic shift is from face-to-face to remote consultations. The College has already started work to understand when and to what degree the shift back to face-to-face consultations will be implemented post-COVID.

As a passionate advocate of relationship-based medicine, this is a key issue for me personally and I know many other colleagues will feel the same.

Our changing work

How else is our work changing? We’re spending more time prioritising our efforts on:

  • those at greatest risk
  • providing medical advice for those who are infected
  • supporting those with mental health problems resulting from the crisis. (I shared my own experience on Twitter earlier this week.)
  • providing palliative care

The drive to minimise face-to-face working can be particularly challenging when delivering palliative and end of life care – particularly the need to have highly sensitive, and sometimes unexpected, conversations with patients about their care plans and wishes. This is hard and we’re in discussions with government about the need for stronger public messaging on these sensitive issues to help prepare people. I hope this will aid us in doing our job of caring for patients.

We’ve also called for a temporary relaxation of some rules around controlled medication to make more efficient use of existing stocks in the face of growing demand during the COVID-19 pandemic, so that patients at or near the end of their lives can have the drugs they need to ensure they are comfortable. You can read more about our efforts in the Financial Times.

Continuity of healthcare

We know that during pandemics people are more likely to become ill or die from health problems unrelated to the cause of the pandemic. It is something we have seen with previous flu pandemics in the UK, and with Ebola in West Africa. We’ve been highlighting this problem by encouraging people who are, or think they might be, seriously ill to seek medical attention, either from their GP or NHS 111, or if an emergency, from 999 services. 

The College is currently carrying out work on ‘non-COVID morbidity’ to understand the nature and scale of problem. We’ve supported a statement from the Academy of Medical Royal Colleges and I’ve been doing some media on the issue, including an interview with BBC Newsnight, which should be broadcast this evening.

Shielding and changing criteria 

This week we saw updated guidance from NHS England on management and shielding of patients who have been centrally identified as being at the highest clinical risk of severe morbidity and mortality from coronavirus, as well as an updated Standard Operating Procedures for primary care

Some people are asking why the guidance seems to be changing so often. Put simply, we’re in a fast-moving situation. There’s a lot we don’t know about COVID-19 and we’re learning all the time. As such, the criteria for a patient to be considered ‘at highest risk’ is fluid and it will inevitably flex as we learn more about this virus. 

Thank you for your patience and your vigilance in ensuring the right advice gets to the right patients. I’ve recorded a vlog with Honorary Treasurer Steve Mowle on the issue.

Returning GPs

We continue to support efforts to get recent retirees back into the NHS. The priority area for GPs is the COVID response service that is supporting NHS 111. If you feel able as a returner or an established practitioner, please do volunteer to work in these new services which are delivering an essential service to patients.

Clinical trials

Our Research Surveillance Centre based at the University of Oxford continues to seek more practices to sign up and take part in clinical trials of repurposing medicines that could mitigate the effects of COVID. As mentioned previously, the potential here to overcome this crisis is momentous. If you think you can help, please get in touch

We continue to develop our website, including our COVID-19 resource hub, with huge amounts of information, guidance, blogs and vlogs about the pandemic. Key updates over the last week include a podcast on effective telephone triage, a helpful triage flowchart, resources on GP wellbeing, and much more.

Our magazine

On a lighter note, the College has published its latest edition of GP Frontline with a special front cover dedicated to the amazing work of you and your teams during the COVID-19 pandemic. Inside, it outlines the College’s response to this crisis, as well as featuring a ‘Big Interview’ with former President Roger Neighbour and a host of other interesting articles. It’s available for the first time online.

And another piece of good news: I’d like to congratulate my predecessor Helen Stokes-Lampard as she embarks on her new appointment as the President of the Academy of Medical Royal Colleges this Summer. It will be great to have a GP at the helm and I know she’ll do a brilliant job.

The biggest challenge

Finally, back to the biggest challenge that the NHS has ever faced. The situation feels distressing and surreal to so many of us and I want to say a huge thank you to all practices who are functioning with the highest of integrity and giving a new meaning to the phase ‘above and beyond’ in supporting their patients - demonstrating flexibility to support the wider health and care system during this crisis. It’s so tough but there really is a sense that we are all in this together at the moment. I have no doubt that general practice will emerge stronger in reputation and in substance from the crisis.

Thank you for everything you’re doing.

Post written by

Professor Martin Marshall, Chair of the RCGP Council

Professor Martin Marshall is a GP in Newham in east London and Professor of Healthcare Improvement at UCL, Programme Director for Primary Care at UCLP Partners. He leads Improvement Science London, an initiative to promote and embed the science of improvement across the health service and academic sectors. 

Previously, he was director of research and development at the Health Foundation, Deputy Chief Medical Officer for England, and Director General in the Department of Health, a clinical academic at the University of Manchester and a Harkness Fellow in Healthcare Policy.

He has been a GP for 28 years. He is a fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012.

He has over 200 publications in the field of quality of care and in 2005 he was awarded a CBE in the Queen's Birthday Honours for Services to Health Care.

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