Addressing GP concerns on the role of COVID-19 assessment centres

19 June 2020

As we all struggle with lockdown, I must confess my children present me with some of my greatest support - and biggest challenges!

We all try to pass our cultural references to our progeny, so it has been interesting to share some experiences as a family together during this time.

I was cutting the grass last weekend. In a corner of our garden we have a cherry tree and as I was cutting it, a small frog hopped out to safety. Excitedly, I asked our nine-year-old twins, Sam and Tom: "Guess what I saw under the cherry tree?" Sam looked up, and quick as a flash replied: "A big black horse?" 

Black Horse and the Cherry Tree is a song by KT Tunstall. I think you can agree my work as a cultural influence on my sons is complete!

Flexibility of practice

We are entering a difficult phase of the COVID-19 pandemic.

The feedback I received from colleagues in our virtual roadshows last week was loud and clear:

  • our surgeries are busier
  • it is taking longer to do 'normal work'
  • many are tired of working in COVID-19 centres
  • many are struggling to meet both their practice and COVID-19 centre commitments.
  • many GPs have genuine concerns about what will become of them and whether changes are a prelude to compulsory out of hours (OOH) or a way to relieve pressures on emergency departments.

It’s important issues such as these that I feed back to the Primary Care COVID-19 Centres Clinical Leads Group, and they are heard at the highest levels. The group has reflected how much practices have contributed and how much busier GPs have become. 

I am delighted to inform members that the obligation for practices to work OOH shifts will be removed. Practices will be remunerated at day-time sessional rates to help employ locums to cover their shifts. 

Rotas will continue to be reduced to reflect patient demand.

Many practices have struggled to employ sessional doctors, so if you are working as a locum, please register your details with your local Federation Support Unit (FSU) to facilitate the exchange of contact details.

This support to practices is an acknowledgement of the incredibly hard work everyone has done by rolling up their sleeves and working extra hours during the crisis.

While the compulsion to work OOH has been lifted, can I gently and respectfully ask that if you do have some capacity, please be mindful of the pressure our OOH colleagues are facing and help with either COVID or traditional OOH shifts if you can.

Importance of GP practices working together

The model of the COVID-19 centres only works if we contribute as one team.

I have met many colleagues who wonder, would it not be better if they put in place their own procedures to keep hot and cold cases separate.

To me, this does not consider the bigger picture.

As we know, many of our colleagues work in buildings and premises which will not facilitate modern infection control or patient flow standards. Some do not have car parking, so would be unable to put in place a suitable alternative to the current arrangements.

If we all start thinking of just our own practices, we will put intolerable pressure on our colleagues, some of whom are already struggling.  

News today from the Northern Ireland Statistics and Research Agency (NISRA) has shown that four more practices have either closed or merged in the past year.

We all know that if one practice is in trouble and closes against its will, it does not just affect that practice, but its ripples inevitably destabilises the area.

I worked in our own COVID-19 centre last week and was struck by the quality of some of the referrals.

Although the numbers were low, patients were definitely assisted in managing the potential for symptoms of COVID-19 presenting in their community.

One patient was referred by one of our ST2 colleague’s Dr Gillian King in Annalong. It was a superb referral with clear, precise documentation of the problem and her query.

The patient was examined and managed safely in their community. You have a bright future in general practice, Gillian, and I look forward to following your career! 

The future of COVID-19 centres

It was great to meet with RCGPNI Council on Tuesday night and discuss with colleagues the issues facing our practices, including reform of our health service.

We debated the COVID-19 centres and the burning issue: "What do they become"?

We do need to ensure COVID-19 centres continue to meet the needs of our practices by offering a safe area where patients can be assessed face-to-face by senior GPs wearing appropriate PPE in secure and safe structures.

However, there are no plans to take the GPs working there to solve pressures which are being felt in other parts of the health service.

Imagine your own COVID-19 centre. There are very few of the actual buildings that could facilitate investigations or any more sophisticated treatments, and the effect on our whole health and social care system would be catastrophic if GP staff were pulled out of practices.

What we do need to do is take what we have learned from how we deal with COVID-19 patients; how we focused on a specific issue, triaged it safely and ensured the correct patient was sent to the right person, ensuring it was completely dealt with on that day.

To me, this is a preferable model to escalate patient care where issues are dealt with completely, instead of ending up on long waiting lists, inevitably meaning more work for primary care with repeated review consultations.

Discussions on how this could be done are taking place now and we must be part of these negotiations.

We need to highlight the importance of general practice, how we use this learning and make the most of the improved communication with our secondary care colleagues. 

We discussed this issue and many more at our meeting and it was a very helpful and informed debate.

It is important you understand that when I engage with any of our stakeholders, I am representing your views, as members of the College, and not my own. Check to see who your regional representative is, if you're not sure. Please talk to them, raise whatever issues you have and help steer our path.

Ensuring children have their educational requirements met

NI Council debated several other important issues.

We voted to support the justice minister’s proposed legislation on coercive control and a letter from doctor parents of children in NI was endorsed and supported.

I feel this letter is very important as there are many children in our society who are missing significant amounts of education and the unrecognised protection and safe space that school often gives.

In addition, children with learning difficulties are being let down, putting pressure on families.

Children from lower social economic backgrounds are most at risk and the pandemic will widen our divide drastically if we do not take emergency action now.

Chronic disease managment

During last week’s virtual roadshows and listening exercises, I was very proud to hear how many practices have restarted chronic disease management - not because we have been mandated to do so - the Quality and Outcomes Framework (QoF) is still suspended - but because it is the right thing to do.

It is not in our patients interests if their diabetic control declines, and from a selfish point of view, it makes picking up their care later much more difficult.

I will seek clarity from Health and Social Care Board (HSCB) and our General Practitioners Committee (GPC) colleagues about whether QoF will return later this year, but in the meantime, thank you to all of you for your professionalism and commitment to patient care.

Sharing concerns

We are all tired and fed up with COVID-19 - I fully understand.

An excellent article was sent to me by my old friend and mentor Dr Maeve Lambe. Maeve has used her skills as a teacher to set up brilliant Zoom educational meetings for us in our locality and she shared her blog, which I think sums up well on where we are with managing the phases of the crisis.

Last week, several of our colleagues went to the media to voice their concerns.

I fully appreciate their fears, but instead of engaging in a public facing dispute, our GPC Chair Dr Alan Stout and I will invite those involved to a Zoom meeting early next week.

I am very happy to be challenged and am keen to hear your views.

However, I would urge caution when using social media. It is vital we retain our professionalism.

Some online posts can be quite personal, so always remember our trainee colleagues and medical students who aspire to be GPs are listening, as well as our patients who are also confused and worried about the future. 

The flu vaccination scheme is on everyone’s mind and no official guidance has been provided yet.

We will let you know when we receive clarity but, in the meantime, if you have an innovation you would like to share, let us know and we can spread your good idea.

NI GPs leading in education

Education remains at the fore and I was delighted to see Northern Ireland lead on some excellent resources recently.

The Jolly GP Trainee Podcast continues to be excellent and I have enjoyed listening to Dr Richard Bothwell and Dr Daniel Butlers' podcasts while in my car.

The latest episode has an interview Richard did with Dr Roger Neighbour.

What I really liked in this podcast was how Roger reacted when an orthopaedic surgeon threw him off guard by his introductory gambit at an appointment: "Tell me what you want me to hear in your own words". I think this is quite brilliant and will save it to use for future consultations and meetings.

Our own Dr Stephen Harte has done a brilliant vlog on growing pressures and increasing workload, his message about the AT20 rule and how we feel we need to be 'busy'.

It has reached a very wide audience and I was impressed when my sister, who is a physiotherapist in London, texted me to say how helpful she had found it.

I hope you all get a rest this weekend. If you use the weekend to catch up on reading, the BJGP has a good editorial from Domhnall, and it painted a sad picture I have witnessed, too.

The BJGP Life continues to impress me and I look forward to watching the Richard Horton interview on Primary Care and the WHO over the weekend.

Please, as Stephen says, take time to "let yourselves off the hook". Take time to recharge this weekend and I look forward to meeting up with as many of you as possible in the weeks ahead.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful 'Dear Colleague' initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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