My COVID Pledge - We’re in this together!

18 September 2020

How do you get to know someone? It was a question I posed myself after another brilliant dinner with 'our lot' recently one Saturday night. The kids are all back to school, but I really don’t envy their situation. As one friend said to me recently "The world has just become so… sterile".

My children’s world baffles me. Their smartphone dependence and reliance of social media to connect with their peers seems a strange existence. It appears so complicated just to meet someone let alone get to know them. I remember the excitement of receiving post while a medical student living in Queen’s Elms - and discos!

I had a great telephone consultation with one of my patients last week. It worked well because I was able to deal with their expectations remotely using my prior knowledge of them before the pandemic. Professor Martin Marshall sometimes feels his concept of Relationship-Based Medicine needs further explanation, but I feel it is spot on.

Getting to know someone needs a little give and take. Some of my patients are fascinated by my own personal story and there are some things I don’t mind sharing with a few select patients. “What age are the boys now doctor?” was a recurring question in the old days before COVID-19.

People seem to remember twins and I was aware how people used my personal story to help them relate to their own. We all do it to place people: sharing football teams, favourite holiday locations and milestones. "Your Natasha was born in the same year as our Jemma had her second child". This pitter patter of 'social shadow boxing' could go on and on until it grounded me with a sobering bump: "Your twins were born on the same day that Mummy died".


How do you open your consultation? An opening gambit is "an introductory remark or stratagem, especially designed to make social contact or secure one's own position" and is often referred to in chess.

Chess a great game and, in my humble opinion, it’s the only games app worth downloading to your phone! My favourite episode of The West Wing is the one where President Bartlett simultaneously plays two of his staff while giving them a lecture on the origins and intricacies of the game.

Dr Jenny Johnston posted a wonderful opening gambit she uses in her consultations on Twitter last month: "You’re not like yourself today". I like it a lot because it opens dialogue, but still utilises our relationship-based medicine skills.

Mental health

It was great to be involved in Suicide Prevention Day on 10 September last week. To mark the day, I joined BBC Radio Ulster’s Talkback programme to highlight the important role of general practice and the need for government to invest in multidisciplinary teams.

I also promoted the role of inhouse practice counsellors, which could be provided through a mental health hub model via GP Federations. I was joined on the programme by Professor Siobhan O’Neill who is the interim Mental Health Champion for NI and a world-renowned expert in mental health.

We have a meeting with Professor O’Neill planned at the end of the month and I will be sharing with her my positive experiences of having a Primary Care Mental Health Practitioner in my surgery. Do you have a question you would like to ask her? Get in touch with me and I’ll do my best.

At the end of the show we were joined by Alan Heron from Samaritans in Northern Ireland. I was a Samaritans volunteer in Belfast as a medical student and it taught me a lot about communication skills.

I always remember the opening gambit I was taught by the Samaritans. When presented with a caller who gave a story of unimaginable suffering and trauma it was frequently sufficient to say simply and quietly: "You sound really low". 

Frequently the response was less than polite, but it was a useful non-judgemental way to allow the caller to expand on their story and explain further why they felt so low. Do you have a preferred opening gambit to your consultations? I would love to hear it so please do get in touch so we can share them.

End of Life care

Thank you to everyone who tuned into our online tutorial on 'Shortness of Breath in Palliative Medicine: Why? How? Who?' As I said in the webinar, the key to symptom control is to establish cause, but more importantly is to take a close personal interest in our patient care and to make it our mission to provide the best possible care for every individual.

A patient may well have a large Non-Squamous Cell lung tumour, but their shortness of breath could be caused by their congestive cardiac failure or anaemia. It is our job as clinicians and expert medical generalists to establish this cause and use our skills to literally 'make our patient feel better'. The webinar is still available to watch

Congestive Cardiac Failure is a significant issue and it was great to chat to my local cardiology consultant Dr Patricia Campbell on how best to manage patients who are suffering this at end of life. There is good regional guidance on this topic which you can access now.

Patricia and I discussed the usual medical therapies for CCF, but all the main ones, such as ACEI, ARB, Beta Blockers and so on, all offer medium to long term benefits.

The main benefit we get for acute terminal failure is by using loop diuretics and oxygen. I remember working as a Junior House Officer (JHO) with my Senior House Officer (SHO) Dr Michael McCormick who is now a Consultant Geriatrician in our Trust.

A lady had been admitted to the Emergency Department with terminal heart failure and as the medical team we did everything we could to ease her dyspnoea. We gave Furosemide IV then when this didn’t work, Metolazone.

Eventually as a last resort we had to perform a venesection, removing two units of blood, but it was all futile and the patient didn’t recover. 

Palliative Care is an area of our work we pride ourselves in. We know it needs to be done well. Our MacMillan GP colleagues host frequent educational sessions and on Wednesday 30 September between 19:00 - 20:15 Dr Sinead Hutcheson (Consultant Palliative Medicine) and Dr Catherine Doherty (Specialist Registrar) from the Belfast Trust will be hosting an educational Webinar on Advance Care Planning and Anticipatory Prescribing. This session will be done in collaboration with GPNI - please register now.

Anticipatory Prescribing can make such a difference to patients in their last days of life and it was good to see an article from BJGP raise the importance of this issue. NB Medical are also hosting an important webinar with Cancer Research UK on quality improvement for patients with lung cancer, which is free.

RCGP also works closely with Marie Curie and have together developed joint Daffodil Standards. We are grateful to Dr Grainne Doran for representing NI and feeding into this work, but we are also keen to hear from members.

What would encourage you to engage with this work and what puts you off? Do the Standards need to change and how do we ensure the Standards tie-in with NI specific guidance?

The NI focus group will be held virtually on 29 September 2020, 18:00 - 19:00 and if you are interested in attending please contact Justyna Rafalik. We would also really appreciate if you could take five minutes to complete this short survey to share your feedback on the Daffodil Standards.

COVID Centres

It is extremely busy in my practice and I would like to personally thank all those GPs working in Covid Centres for physically assessing my patients who have presented to my practice with symptoms suggestive of COVID which need face-to-face assessment. I pledge to do the same for your patients too and again commit to doing my share of COVID Centre shifts. 

RCGPNI Council met this week and unanimously supported the principle of COVID Centres (where hot/cold is separated as much as possible) but with the proviso that support is given to practices who are struggling with issues of workload and workforce. We will be raising these concerns directly with the Department of Health soon.

The Centres are getting very busy, so we must all do our utmost to triage our patients well. Before you refer a patient for assessment, please ask yourself if you would be happy to receive the same referral.

If our referrals go up much more, the rotas will also have to go up, so it’s in our own interests to ensure we refer well. Its well worth having another look at the referral criteria (192 KB PDF) which are on the GPNI website.

Appraisal and revalidation

Your College is working extremely hard to represent you at the highest levels. I recommend that you read our policy paper, General practice in the post-COVID world (337 KB PDF).

It makes three commitments including reducing unnecessary paperwork. Your College nationally is progressing our case to make appraisal a much more paper light and simple process through the work of RCGP Revalidation Lead Dr Suzi Caesar.

In the interim, it is very important that all GPs are aware that there will be no appraisals in NI for GPs until January 2021 and that only a selected group of GPs will have to undergo an appraisal between January 2021 and March 2021.

Encouraging activity in older people

As part of The Generating Active Lives in Older People Study, a new survey has been launched by the Institute of Public Health to develop a greater understanding of the knowledge, practice and decision making among health professionals in relation to physical activity promotion with older adults on the entire island of Ireland.

If this is of interest, I encourage you to participate in the survey. A CPD certificate is available for everyone who takes part (one for everyone in the audience!) 

General practice is open!

As we heard this week in the media, myths are circulating that GP practices are not open! We have set the record straight very loudly and have informed all stakeholders very clearly: we are open, we are very busy and our worth to our entire health and social care system has never been more deeply felt.

However, to do our job well, we need support and primary care must be appropriately funded and our calls for workforce investment heeded.

We will continue to broadcast this message to everyone but in the meantime - thank you all for your incredible hard work and commitment to patients. I am so proud to be your colleague.  

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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