Routine PPE and advance care planning

17 April 2020

Monday was a strange day. Like many of you, instead of enjoying a family picnic or eating Easter eggs with my children I was working in my surgery. I am finding that while the general workload remains manageable with most contacts occurring over the telephone, there is a definite gradual increase in non-COVID or routine work.

PPE for routine work

One of my patients was a lady who had symptoms very suggestive of bowel cancer. She had no cough or temperature and needed to come into our surgery for assessment. Like you, I wore appropriate personal protection equipment (PPE) with face mask, plastic apron and gloves. As I was performing an examination, she wore a face mask herself.

There has been some dispute this week about whether GPs should wear masks or PPE when seeing routine patients in our surgeries, but we should be in no doubt – it is vital we protect ourselves and our patients. Please ensure you have sufficient supplies and if there are problems, please get in touch with your local medical committees (LMC) representative.

It is important that general practice still shows its worth during this time and the value of our daily general medical services (GMS) work is seen and recognised. If you would like to do a quick 20 second video log promoting what you are doing in surgery, it would be very helpful and a powerful way to promote our profession. Please email Áine Magee at Aine.Magee@rcgp.org.uk for more details.

Advance care planning

On Thursday, I appeared again to give evidence to the Northern Ireland Assembly Health Committee. I have been in post for less than five months and this was my third appearance already.

I was delighted to appear alongside our colleagues, Dr Hamish Courtney, Chair of Royal College Physicians, Edinburgh, and Mr Mark Taylor, President of Royal College Surgeons, London. We had offered to appear before the committee to discuss advance care planning (ACP). As GPs we have been doing this for years, but I wanted to raise three issues which have come to the fore during this COVID-19 pandemic.

  1. The Department of Health should make ACP a national conversation. This will enable families and their loved ones to start the conversation and will mean GPs and other health professionals will not be seen to be cold calling and discussions misinterpreted as rationing.
  2. The issue of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) should not be included as a mandatory element of any ACP. Currently our medical care plan Locally Enhanced Service (LES) does not make this mandatory, but the issue we have highlighted is that they are frequently linked. My own finding when discussing ACP with patients is that when DNACPR is introduced it tends to dominate the discussion, and is frequently unhelpful, and is often misinterpreted as not offering treatment.
  3. Any health professional who knows the patient best should be able to perform an ACP. Some of our patients with chronic conditions are better known to their hospital consultant so this issue cannot just lie with general practice.

It is important we do the difficult job of ACP well. There are many resources, including materials available from our own RCGP website and the new GP NI website so please keep learning and developing your skills in this difficult area. Macmillan has some great resources and their video library about having ‘Courageous Conversations” is excellent.

The Northern Ireland Palliative Care in Partnership (PCIP) has just launched its new website. It is still under construction but has some good resources on the important topic of ACP. I had a very brief meeting with Paul Turley, its chair, during the week, but I will be having further discussions with him soon and will be emphasising how much palliative care is provided by GPs in the community, and why this must be valued and supported.

Child health

Child health is an important issue during this time and it is vital we make sure our patients know we are available for them if their child is sick. UNICEF has urged that childhood vaccination continues, so please continue your great work to ensure our exemplary high vaccination rates continue.

Nursing homes

Our nursing homes remain vulnerable to COVID and I thank you for all you are doing. Please reach out to them and ensure that their residents continue to receive the best possible care. It can be difficult to contact our care homes at this time because, like us, their phone lines are busy. It would be good practice to share your practice direct line, if you have one , with your care home , and also to get theirs, so if either the care home or practice has an urgent issue, communication can be as efficient as possible.

During COVID-19 other relevant issues have been continuing and I am keeping up to date with developments on the difficult issue of termination of pregnancy. I fully appreciate this subject is very divisive, but we have frequently publicly called for clarity on how to care for women within the realms of the law. The interim service between November 2019 and 31 March 2020 was based on a phone number which enabled women to travel to England for services.

Terminations and signposting

We now have an initial service based in Northern Ireland. The access point to this service is through Informing Choices NI – formally known as Family Planning Association (FPA) who used to produce the helpful contraception advice leaflets for our practices. Women can access the services themselves by ringing a central number from 9am to 5pm on Monday to Friday and can be assessed to discuss early medical abortion up to nine weeks and six days.

I have spoken to some of the doctors involved with this service and they have given me assurances that the call handler will be well trained and will have the skills to directly refer to the Gateway team should there be any concerns about safeguarding and domestic violence. The number is 028 90 316 100.

We continue to monitor developments in this area and are in regular contact with the Chief Medical Officer. It is important to recognise that any practitioner performing terminations must report each one of these to his office, and there are significant sanctions written into the legislation concerning non-compliance with procedures.

Working from home 

I have found working from home difficult as I had intended to get out and meet more of you in your surgeries and to hear your stories. We will meet when this is over but in the interim, if you are having Zoom meetings with your federation or practice, please send me an invite and I will try to get along. It is very important to me to get to know more of you better.

One of the nicest comments a GP gave me about this blog is that she reads it with her Friday evening gin and tonic at 6pm! The thought that so many of you would care to do this while having a well-earned drink after another challenging week makes me very humbled - so thank you. This Friday evening, I will be working in the Banbridge COVID centre, so at 6pm I will be mentally toasting all your health and quietly feeling very proud of all the great care you provide.

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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