Remote consultations and GP wellbeing during the pandemic

24 May 2020

One of the advantages of the Covid lockdown is that I have been able to get out for more runs in the early morning.

The countryside of Co Armagh is beautiful now with vibrant yellow blooming whin bushes. The bird song seems louder, presumably because it no longer must compete with vehicle traffic, and it always makes me smile.

Listening to Greg James on Radio 1 this week, I enjoyed a feature of his show about random shopping requests!

Essentially listeners had to give examples of the most unusual shopping items they had been asked to get when offering to purchase milk and bread for family members.

Crystallised ginger was one suggestion, but my favourite was a request by one listener’s 83-year-old mother to just pick up some black olives and venison!

Changes in general practice during the pandemic

I hope you are all making notes about what changes in practice have worked well during this time and what things we would do differently.

As with requests for crystallised ginger and venison, we need to focus not only on what we have found helpful for ourselves, but what our patients are likely to need.

Telemedicine has worked well for lots of things but focusing too much on technological solutions risks leaving some of our patients behind.

These could include groups such as those with poor access to the internet, learning disabilities or the elderly.

Health inequalities are already high, so we must not inadvertently exacerbate them.

There is no easy answer to any of these questions, but we must start thinking about them now, so we can frame the debate of how our services will look in the future.

Caring for vulnerable patients in care homes

The focus of the pandemic in the media seems to have shifted from intensive care units to care homes. We know that they house some of our most vulnerable patients, so it is our duty to ensure they continue to receive the compassionate holistic care we pride ourselves for.

Please ensure your local nursing or care home has good access to your phone lines. This can be easily done through a separate back office line or even a mobile number held by our practice-based pharmacist. If you can, be proactive and make regular contact.

It can frequently be a good way to manage our own work load and ensure home visits are received in good time and minor issues dealt with early in the day.

The value of Advance Care Planning (ACP) has never been so important, so it is a good time to glance your eye over nursing home residents’ ACPs and ensure they are up to date.

Remember, there is no obligation to include DNACPR if you feel it unhelpful, so use the time instead to discuss what is most important to patients and their families.

The impact on trainee examinations

One of the many difficulties of the crisis is the impact on our professional exams.

I really want our Associates in Training and speciality colleagues who are reading this to know I am thinking of them.

These are very difficult times, particularly for our ST3 doctors, and I am working closely with the RCGP Exams Department to gain clarity on plans for the exam process.

Unfortunately, there are several key stakeholders involved, including Health Education England (HEE) and GMC.

Part of the exam is a statutory function, ensuring that a doctor is competent and safe, so there must be appropriate balances.

Whatever the outcome, I will feedback to our ST3 doctors as soon as possible but in the meantime, if you are an ST3 doctor please get in touch with me and let me know how you are getting on.

  • How are you finding remote consultations?
  • Do you have the correct IT skills?
  • What are your aspirations for general practice?

I intend to host a webinar in the next few weeks for our ST3 doctors and will send out details of this soon.

Reliance on technology

One recurring feature of these times is our increasing reliance on technology.
 
We have an important survey on technology, and I would be grateful if you would take just two minutes to complete it.
 
Please share this survey with all GPs you work with as we need as much data as possible to be able to map future services and to lobby for more resources where appropriate.
 
I am conscious that the actual number of laptops and modems supplied to practices is only half the story and any extra physical IT offer must be accompanied by a dedicated support service and user training, so we maximise the benefit from these systems.

A day at the surgery

My surgery on Monday was very busy and it felt like normal times with the usual case load of general practice with cancer diagnosis, palliative medicine and sick children.

I had a child whose vomiting was not abating despite usual measures, so I was very glad of the support from our hospital colleagues in their Ambulatory Care Ward.

Most paediatric wards are now well established to see children, so make contact if you have a concern – we do not want to miss anything.

RCGPNI is publicly promoting the importance of general practice this week with a series of positive messages to show that we are still open for business and the work of general practice needs to be valued.

Red Flag diagnoses and referrals

At my GP surgery I relied heavily on my intricate knowledge of my patients to support me with my remote consultations.

I am particularly worried about missing a cancer diagnosis and it was good this week to touch base with Margaret Carr who is Public Affairs Manager of Cancer Research United Kingdom (CRUK) in Northern Ireland.

CRUK is concerned that a large group of cancer diagnosis will be delayed because of Covid and so it is worth remembering this.

We will work together to obtain some more clarity of message about Red Flag referrals but in the interim my advice is that if you have a patient with suspected cancer – refer it or if possible, have a chat with your local specialist. My own experience currently is that our hospital colleagues are very supportive and willing to work together with us.

Feacal immunochemical test (FIT)

The regional faecal immunochemical test (FIT) was due to go live on 1 April 2020. Unfortunately, the screening arm of this has been delayed, but this would be a good opportunity to see if symptomatic FIT could be introduced earlier than planned.

I feel this would be a fantastic tool for GPs when a patient has vague symptoms which could be bowel cancer and would undoubtedly reduce our referral rates. We will progress this issue as much as possible and feedback any progress.

Taking care of our mental health

During these worrying times it has never been more important to look after our own mental health. We are all leaders in our practices and play a pivotal role in its management so this document from HSC Leadership centre is very useful.
 
While that is on your mind, please think about both your own mental health and that of your colleagues.

We do not share the same needs, so let’s start at the beginning by reaching out to each other, celebrating the great work we do and by having a little fun at times.

We can escalate our needs after we have these honest chats so just remember – its ok not to be ok.

The new GPNI website has some excellent resources, including a clear single page containing all the occupation health phone numbers for GPs, so please download the document and keep it in a safe place – these services are always there for you.

Mentorship

The NIMDTA mentorship project is still very active and some GPs may prefer a safe space to talk to a colleague about a range of issues including personal development. I can personally recommend this service to anyone.

Feedback

I have really enjoyed receiving some emails from members over the week so please keep feeding back to me any issues you have.

I particularly like hearing your stories about individual patient cases. When speaking to politicians and policy makers it is these individual stories that bring policies to life so please keep feeding them in as it is very helpful.
 
Please look after your own health and look out for each other – a friendly text or email can literally make all the difference.

Email: ChairNI@rcgp.org.uk
Twitter: @laurence903


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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