Back to school

14 August 2020

I wanted to focus this week on the return to school for thousands of young people across Scotland.

This year’s return to school will undoubtedly look and feel very different to those that young people, parents and teachers have become accustomed to over the years.

My thoughts and best wishes are with all of those returning to the classroom after a really challenging period.

I appreciate that there is a great deal of anxiety surrounding this year’s school return and, in many ways, all eyes will be on Scotland to see how we manage this significant milestone in the context of COVID-19. 

Mental health resources and child protection

It goes without saying that COVID-19 has been a hugely anxiety-inducing experience for many people and young people are no exception.

In the months ahead, we are expecting to see an increase in the number of mental health presentations in general practice as the lasting impact of the pandemic becomes more pronounced.

Earlier in the pandemic, Young Scot launched an Aye Feel micro site which brings together resources and tools for young people geared towards looking after emotional wellbeing during this time.

I realise that we all have local resources that we draw upon for these consultations, but the Aye Feel site is well worth having a look at for further information.

Unfortunately, as children go back to school it is also likely that within general practice we may see a rise in child protection concerns being raised with us as vulnerable children return to their classrooms.

We know that the pandemic has been a really difficult time for those children who are particularly vulnerable due to the sudden loss of families' usual social and educational supports, social isolation and financial pressures.

It is also unlikely that the challenges relating to the pandemic are likely to ease any time soon.

I know these cases are always particularly challenging to manage - and indeed are made even more so as a result of the new ways in which we are working - and I would urge you all to do what you can to look after yourselves as well as your patients during this period.

Seek support from colleagues where you can, even if it’s just to talk things through. We’re all pretty tired now with a lot of decision-fatigue, the last few months having taken its toll, so it’s good to seek out peer support when possible.

In my own practice, we are unusually lucky in having a fantastic in-house mental health nurse team, working alongside us.

This has completely transformed the mental health care and support that we are able to provide for all patients over the age of 12 years.

Given the growing concerns around the lasting mental health implications of COVID-19, I’m pleased to see a growing political interest in the practice mental health nurse model and I hope this will lead to a wider roll out of this incredibly valuable and effective service. I’ll keep you posted on any developments on this front.

SQA announcement

I feel that I can’t dedicate a blog to the return of schools without mentioning the recent announcement by the Scottish Government to reverse the SQA decision on awarding of subject grades based on historical performances of schools. 

As results were received by pupils last week, it became clear that the original methodology being used was disproportionately negatively impacting those pupils from schools in the most deprived areas.

Of course, these exam results impact on individual student’s choices and opportunities for the rest of their lives and I was delighted to hear that the decision had been taken to revise those grades which have been downgraded to more fairly reflect teachers' predicted grades for students.

I hope that this levels the playing field somewhat. I am passionate about ensuring that general practice and the medical workforce more generally reflects more fairly the diversity of our society, and as a College we actively support widening participation to medical schools through the work of our Faculties.

Respiratory illness

Each year, the return to school season brings with it a high level of acute respiratory illness presentations to general practice.

This year will be no different, although it will understandably bring a higher degree of challenge and anxiety. In the absence of a vaccine, all acute respiratory presentations of new cough and fever, from patients of all ages, will have to be presumed to be COVID-19 until proven otherwise.

As we move into the autumn and winter months, we will need to have a way of continuing to protect frontline services from potential COVID-19 to allow us to safely manage all non-COVID acute and chronic illness and catch up on the backlog of health issues that patients are increasingly presenting with.

General practice workload levels are now widely reported to be back to pre-COVID levels, and so a clear plan for how this rising respiratory workload will be safely managed is an increasingly urgent priority. 

We are supportive of the proposals that are being actively considered for enhanced COVID-community pathways, bolstered and staffed from across the NHS, to allow all acute respiratory infection presentations of new cough and fever to be managed; infective exacerbations of asthma or COPD, pneumonia, influenza, or indeed COVID-19.

This will allow us to continue to keep general practice and emergency departments as COVID-free as possible and will build on messaging that is already familiar to, and accepted by, our patients through signposting to NHS 111. I will keep you updated on this too.

Continuing with the school theme, my blog will be taking a mini-summer holiday of its own over the next two weeks.

I will be working away on your behalf in the background, and in the meantime, I hope you all manage to enjoy some of the intermittent sunshine!

Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Her priorities during her time as Chair include a focus on practitioner wellbeing, improving the interface between primary and secondary care, and growing and retaining the GP workforce.

She has made tackling health inequalities a high priority and has consistently called for the need to engage the public in a national conversation about the realistic role of the modern NHS and the importance of collective social responsibility.

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