Preparing for a 'new normal' and protecting the most vulnerable in society

24 April 2020

As we move through this pandemic, it is becoming clear that the effects of Covid-19 will be felt long after lockdown measures are eased.

Preparing for 'hidden harms'

Earlier this week, we heard from the CMO that suspected cancer referrals have reduced by 72% compared to the weekly average.

This is of course not a sign that significantly fewer people have possible cancer, but rather that we are simply not seeing them in our practices to refer. This is deeply worrying and is an issue that requires urgent attention.

The ‘hidden harms’ of Covid-19 are stark and likely to have a lasting impact on patients’ long-term health and consequences for the health service as a whole.

Discussions are underway about how we can best prepare the NHS for recovery after the worst of Covid-19 and I’m working to ensure that the needs of general practice are prominent in this planning to ensure that our patients can continue to receive the care that they require, when they need it most as we move into the ‘new normal’.

An exit strategy

This week, a framework for decision making regarding an exit strategy from Covid-19 was published by Scottish Government detailing the conditions required for easing of the restrictions. 

It is increasingly recognised that the lockdown is not only affecting people’s non-Covid-19 physical health but also their mental health and wellbeing.

The new mantra is ‘test, trace and isolate’ in an attempt to more rigorously control the spread of Covid-19, as testing capacity increases.

Continued GP contact

Over the past few weeks, we have been promoting the message that general practice is open through our comments to the press and on social media – special thanks to the Chair of our patient group, P3, Sonia Cottom for helping us to get this message out there on social media.

Anecdotally we hear that patients are worried about contacting the NHS for fear of overburdening it, or for fear of infection through visiting health premises.

This week I was pleased to be able to support the national messaging around this by filming a Scottish Government national information campaign advert which urges the public to continue to contact their GP by phone if they have concerns about their health.

The advert will be going live from today – so please do watch out for it and help us to spread this message when you can.

The role of GPs to reach out to, and protect, the most vulnerable

The health service has to be at its best where it is needed most and providing care to the most vulnerable in society has never been more important than it is during Covid-19.

A key part of our role as GPs during this crisis has been to reach out to vulnerable groups. Those who are in the ‘vulnerable shielded’ groups are more clearly defined, due to their underlying physical health conditions that put them especially at risk of serious illness if they catch Covid-19.

The socially vulnerable groups are far less easy to define, and require a more active outreach approach, based on our knowledge of the patients we care for.

Guidance on health inequalities

Over the last few weeks, I have been working as part of the RCGP Health Inequalities Standing Group with input from the Deep End group to produce guidance for GPs who care for patients living in areas of higher deprivation.

This guidance provides some really useful suggestions for how we can ensure that our socially vulnerable patients don’t get forgotten in all of this. It encourages us to work alongside colleagues such as, health visitors, district nurses, community link workers, welfare advisors and care navigators to reach out to the patients that we worry about in ‘normal’ times.

These may be those patients with significant mental health issues, learning disabilities, victims or perpetrators of abuse, vulnerable families, more generally those who are considered ‘marginalised and excluded’ or who are often labelled (unhelpfully) as “non-engagers”.

We won’t necessarily hear from them in all of this, and a phone call from the practice to check in goes a long way. It’s an opportunity to ask about food, money, their safety and mental health, however briefly.

Helpline and resources

A new national helpline for vulnerable people was established last week to provide essential support to those who do not have their own networks and need additional help. This is separate to the dedicated helpline already established for the vulnerable, shielded group of patients and is very welcome.

The helpline can be reached on 0800 111 4000 and more information can be found on the Scottish Government’s website.

I also wanted to share with you an excellent podcast on this topic, recorded by Dr James Matheson, GP in Oldham, and Chair of the RCGP Health Inequalities Group.

It suggests many practical ways that GPs can reach out to their socially vulnerable patients during the Covid-19 pandemic and is well worth a listen. The RCGP guidance for vulnerable groups should be published very soon, so please do look out for it on our Covid-19 resource page.

Thank you

Finally, I wanted to say a big thank you to the members of Scottish Council who were able to join me for a virtual meeting this week.

It was good to see everyone’s faces and hear about the challenges, the learning, and the silver linings occurring across the country. It reminded me again of how proud I am to be a GP and how lucky I am to have such a great bunch of colleagues.
As always, I am grateful to hear from you on

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 for its use.

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