Strengthening relationships during COVID-19

19 June 2020

This week has seen Scotland enter into Phase Two of the COVID-19 lockdown recovery. This includes a gradual easing of restrictions for the general public and for those who are shielding.

It also introduces the mandatory wearing of face masks on public transport, unless there are reasonable health grounds that would prevent this from being possible, such as physical difficulty, pain or severe distress.

I have discussed with Scottish Government the potential implications of this exemption clause on requests to general practice for 'exemption notes' for wearing face covering, with reports from some practices that they are already receiving calls from patients around this.

I was reassured to hear that essentially people will self-identify if they feel they cannot wear a mask and there is no requirement of proof. 

While not all changes included in Phase Two will be introduced immediately, we are thankfully making progress towards some of kind of new normality.

As we continue this journey out of lockdown, it is more important than ever that we reflect and learn from this exceptional period to ensure that our health and social care system can be strengthened as it recovers.

This leads me back to my 'silver linings' theme, so that we can build on the positives that have emerged at this time of crisis.

Strengthening our interfaces of care

A system under chronic stress tends to create silo working.

What we are currently living through is the most significant period of stress that the NHS has experienced in its 72-year history and yet what we have witnessed is a desire - and a necessity - to break down these traditional silos and work together to find solutions and safe ways forward.

Improving the interface between primary and secondary care has long been a priority for the College in Scotland, and we have come a long way in the last few years in raising the profile of this work at a national and a local level.

Interfaces of care, where patients cross from one complex system to another, are known to be areas of high risk - with around 50% of medical errors occurring at these points and one third of these taking place at the primary-secondary care interface.

Highly functioning interfaces are not only safer for patients, but they create efficiencies for the wider NHS and improve the experience of being both a patient and a clinician working within it.

Supporting and sharing

Over the last two years, our Clinical Lead for Interface, Dr Elaine Turner, has worked across all health board areas in Scotland to support the establishment of dedicated local interface groups comprises local GPs and consultants.

These groups are more established and active in some areas than in others, but where interface groups were already functioning well with strong inter-professional relationships, they have more than demonstrated their value to whole-system working during the pandemic.

For example:

  • interface groups in some areas have enabled clinicians to work together to share the work of shielding and care planning across primary and secondary care
  • through collaborative working, they have developed ways to safely re-open referral pathways
  • they have worked to ensure that approaches in one part of the system do not adversely impact on other parts of the system.

In recognition of this, I was pleased to see a specific, strong recommendation from Scottish Government to health boards to establish interface groups (where not already established) to support the recovery of services.

RCGP Scotland recommends that these groups should be a mandatory component of every board, with adequate support and resource to allow clinicians to fully participate to allow the groups to reach their full potential.

At a national level, we have also seen highly productive and supportive interface working occurring within the Scottish Academy of Medical Royal Colleges and Faculties, with Dr Miles Mack in the Chair.

Our regular weekly meetings throughout the pandemic have not only offered an invaluable opportunity for us all to better understand each other’s roles and challenges, it has also fostered a strong collective voice, which can be heard in the joint guidance we have created and the recent recovery guiding principles document that we have produced.

Building these relationships with colleagues across all specialities during this period of challenge for us all has truly been a silver lining for me. 

Primary Care Resilience WebEx

Throughout this pandemic, we have seen strengthening of other interfaces too, especially between health and social care.

I was proud to stand alongside our nursing and social care colleagues at the start of the pandemic to amplify calls for adequate PPE in community settings, and to write jointly with Dr Donald Macaskill, Chief Executive of Scottish Care to reinforce the close working relationship between GPs and care homes, and highlight the invaluable work that our colleagues in social care have undertaken during the pandemic, in extremely challenging circumstances.

We have also participated in joint learning events, and next week, our Deputy Chair for Policy, Dr Alasdair Forbes and our Executive Officer for Quality, Dr Scott Jamieson will join Dr Macaskill to discuss how we can continue to build relationships and collaboration between primary care services and care homes in Scotland.

This promises to be a really valuable discussion. Be sure to register for this joint Healthcare Improvement Scotland, Scottish Government and RCGP event and tune in on Friday 26 June from 13:00 to 14:00.


Finally, I was delighted this week to chair a #RCGPTogetherLIVE webinar on health inequalities, which was live streamed on the RCGP YouTube channel.

The panel comprised:

  • Dr James Matheson, GP and Chair of the RCGP Health Inequality Standing Group
  • Dr Rachel Steen, GP Trainee and co-founder of Fair Health and the Trailblazer Scheme
  • Dr Becks Fisher, GP and Senior Policy Fellow at the Health Foundation
  • Dr Andrea Williamson, Academic and Clinical GP for homeless and marginalised groups and founder member of the Deep End Group in Scotland
  • Dr Zana Khan, GP Clinical Lead at the Pathway Homeless team in London.

Questions were submitted through social media and our Members Forum, generating lively discussions. 

The COVID-19 pandemic has shone a light on the severe health inequalities that exist across the UK and, as the economic impact of COVID-19 unfolds, these are set to deepen further.

I believe that as GPs we have a crucial role to play in helping to mitigate against worsening health inequalities for our patients and I will continue to work alongside my inspiring colleagues in the RCGP Health Inequalities standing group in the months ahead to ensure that the College plays a leading role in lobbying for equity to underpin all health policy relating to recovery, so that the NHS can be at its best where it is needed the most. 

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.

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