Remote working, winter pressures and COVID Centres

4 September 2020

The first day back after my week off didn’t start according to plan.

On Monday, a busy day loomed and during my drive to work I mentally planned the various tasks ahead: catching up on letters, bloods and numerous phone consultations with patients.

Added to that was the need to finish up early to rush down the road to Stormont for a meeting with the Health Minister. 

My heart sank when my wife Joanne phoned as I arrived in Kilkeel at 07:45. Sam (twin one) had spiked a temperature that morning. It was 38.5 in both ears and was likely due to the grumbling gastroenteritis his brother had been harbouring the week previously.

There was no option but turn the car around and head for home. The COVID testing process was very impressive. Joanne used the Public Health Agency website at 8 am and had a test booked in Newry for 10:30 am.

Wisely, she turned off her COVID-19 track and trace app in the car park of the test area before she got numerous notifications of positive cases in the immediate vicinity.

I scrambled at home to dust off the laptop given to our practice by the Health & Social Care Board. It took a bit of work to remember the passwords but after 20 minutes I was up and running with remote access.

I was surprised how much I could do from home, dialling 141 in front of the number when phoning patients using my personal mobile phone.

If you have a laptop or method of remote access but haven’t quite got it working, please have another look at it now.

This winter is likely to see this scenario play out for all of us, so it is vital we retain maximal efficiency for our practices.

The process also highlighted to me the potential of remote working to help our colleagues who live with a disability.

If you have a disability and are working as a GP, please get in touch with me as I feel we have not to date thoroughly addressed the challenges you may face and I would love to hear from you and see how these advances in technology might help.

COVID symptoms in children

While it could have been easy to simply attribute Sam’s temperature to gastroenteritis (GI), it is important to remember how this can be an early symptom of COVID-19.

A recent study from Queen’s University Belfast (QUB) has shown that GI symptoms are far more common in young patients with COVID-19 than previously thought.

Many GPs families gave their time and bravely gave blood samples, so thank you to everyone who took part in this important work.

Medical education

As we end the first week of September and its association with new school and classes, I want to extend a massive welcome to all the new ST3 doctors starting in our surgeries.

One of my academic GP heroes is Professor Trish Greenhalgh, and her book How to Read a Paper undoubtedly helped me to pass my MRCGP, as well as enabling me to dispute some of the fanciful claims made by drug representatives.

Learning the skills of critical appraisal is useful for your entire career and NB Medical have an excellent sheet with important definitions (704 KB PDF) which is worth keeping. 

Our commitment to promoting undergraduate medical education has never been more important and we highlighted the various challenges of delivering this to the Health Minister last week.

When I took on this role, I anticipated my challenge to be encouraging new practices to become involved in undergraduate medical education.

Unfortunately, with the challenges of COVID-19 and our workforce pressures mounting, I have spoken to several colleagues who have been teaching for decades and for the first time they are asking themselves whether they have the capacity to continue this role.

We are arranging an important meeting with the Department of Health to highlight solutions to this and I will keep you informed of how we get on.

In the meantime, if you are a teaching practice and have reaffirmed your commitment to teaching, thank you so much.

The only way we will sustainably solve our workforce issues is through teaching and sharing our experience of the rewards of our job.

Robin Harland Award

I had my eyes opened to the commitment of educators when I recently assisted in the marking of the Robin Harland award for medical education.

I am delighted to announce that the winner for the 2019/20 award is Dr Naoimh White from the Rowan Tree Family Practice in Belfast.

Naoimh’s medical student was so impressed by her attachment and the range of cases seen (many while she worked on her own) and practical procedures such as venesection, phlebotomy and smear taking.

Like many of the experiences, this student was amazed that their GP tutor not only knew their name - an experience they didn’t often get on hospital rotation - but also asked about her weekend on a Monday morning.

It is easy to overlook these simple acts of kindness, but it was a recurring theme in the entries so thank you so much for your mentorship of these students and hopefully future GPs.

Medical school places

Continuing with the education theme, on your behalf we have written to both Economy Minister Diane Dodds and Health Minister Robin Swann following the A-Level debacle.

In England, there has been agreement to increase medical school places so students who have met the conditions of their offer can enrol.

We have called on Ministers to support local students and do what they can to increase medical school places in QUB for the September intake.

Again, this will put pressure on general practice to accommodate these extra students if agreed and we will be raising this issue at the highest levels.

Work experience for school pupils

Now that schools are back it is worth remembering that Observe GP is there to help if practices are receiving requests for work experience.

Observe GP is a free, interactive video platform for aspiring medics who are aged 16 and over was launched during the pandemic to provide a digital solution to those unable to obtain work experience at this time.

It provides insights into medicine and specifically the inner workings of general practice through eight pre-recorded videos, interspersed with activities.

In the first month post launch 113 participants came from Northern Ireland.

For more information, visit our Observe GP web page. Please note the platform will be deactivated on 30 October but will be relaunched in Spring 2021.

COVID Centres and winter pressures

I am very busy in my own practice and I’m aware of the challenges we all face this winter, keeping our practices safe by using and staffing COVID Centres.

We are all very worried about the safe assessment of children - particularly those under 12 years old.

I have raised these issues with Dr Margaret O’Brien and have had discussions with our colleagues in Royal College of Paediatrics and Child Health.

We remain committed to keeping everyone safe from COVID-19 and the best way to do this is to risk manage using internationally recognised, evidence-based strategies - separating 'hot from cold'.

Patients who have COVID19 can be asymptomatic but those displaying temperatures and coughs are much, much more likely to have the virus.

We are saddened to hear of the death of one of our Welsh GP colleagues and RCGP member Dr David Wood and I will send our sincere condolences to his family and colleagues in Wales.

We must not let our guard down or become complacent about the risks of COVID-19.

My brother is a consultant anaesthetist and worked in the Nightingale Unit where patients were ventilated. His stories about how quickly patients became sick still frighten me.

I will feedback any updated advice on how best to assess children in our practices, which must ensure children are assessed safely and that our practices are protected.

In the meantime, thank you for your continued commitment to this important work which is at the frontline of our fight against the pandemic.

Click and Connect

Thank you to those who dialled into our monthly Click and Connect meetings at 1pm on the last Friday of the month.

I find it really helpful to be able to meet you and hear about the issues that you and your teams are facing.

The next meeting is on 25 September at 1pm and as previously, you can drop in anytime over the 30 minutes and stay for three minutes or the whole 30. There is no fixed format and it is very informal.

Palliative Care Week

As part of Palliative Care Week, I am presenting a lunchtime talk at 1pm on Tuesday 15 September focusing on 'Managing Breathlessness: Why, How, Who?'

We are running it in association with the All-Ireland Institute of Hospice and Palliative Care and it is the first time RCGPNI has done an all-Ireland educational session.

I am hoping it will be the first of many, so watch this space. You can register now to attend this session. 

Taking time for you

We are now well into September with summer fading fast. Did you get a chance to read any good novels over the holidays? My two books were slightly eclectic.

My brother recommended Shakespeare on Toast by Ben Crystal which was a great way of hearing how Shakespeare used his language to direct his cast and why his plays still resonate around the world today.

The book that really made me think was American Dirt by Jeanine Cummins. A sad story about how one family suddenly became part of the migration crisis in America. Worth reading if you need a book!

While you are reading it, it’s well worth listening to my musical hero Jamie Cullum’s song 'The Age of Anxiety' which has just won an Ivor Novello award this week.

I was lucky enough to see Jamie perform this live in Dublin just before lock down and the song’s themes of migration are very prevalent today with over 400 migrants try to cross the English channel last week alone.

Has your practice been involved in providing care for migrants or vulnerable groups?

Please get in touch with me as I would like to hear how we can play our part.

Guest blog

Next week, I am delighted that our terrific colleague Dr Miriam Dolan will be providing a guest blog.

Miriam is our rural representative and is a dedicated teacher. I can’t wait to read about her insights into rural practice and undergraduate education. 

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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