The evolution of the frontline

19 June 2020

I never envisaged in January 2020 that by March my life as a GP would have changed so significantly. What started out as a normal year is now so different.

As a partner in a practice and established GP, I am very comfortable with consulting. My practice would have been considered a conventional model of on-the-day 'urgent' and pre-booked 'routine' slots.

I work in an area of high deprivation, but we have worked hard as a practice to ensure patients get the time and access they need. It seemed to work well. On 23 March, this all changed.

Lockdown consultation

Initially, we were directed to stop all non-essential services. For the first few weeks of lockdown this meant a reduction in contacts; space and time to adapt.

Being able to consult remotely from home has been one of the best things.

When one of the GPs in the practice has been off having to self-isolate, we are still able to work, and clinicians who have been identified as high-risk are able to continue to work from home.

GPs will all now be familiar with remote consultation and telephone as the first point of contact, with advice not to see the patient unless telephone or video is not suitable.

Delivering a usual service in unusual times

Now, my day starts with a full appointments screen of phone contacts. Most of these will be telephone consultations, some will be via video, and 20 to 25% will be face-to-face.

People still have medical problems and will need to be seen, treated and referred in a timely manner.

It’s been a challenge to make sure people attending are able to socially distance, and keep shielding patients separate, but like other practices, we adapt.

I live with the daily routine of PPE when seeing people, anxiety over whether the febrile illness and cough I had in March was COVID-19 or not, and the question if that would confer immunity.

And all the while being vigilant for people with COVID-19, to remind them to test and isolate.

Adapting to changes

I have found the lack of routine hard. The unpredictability of workload can be challenging, and I worry that patients who are fearful to contact us will be harbouring illness not yet discovered.

I worry that if we rely on remote consulting, this could lead to inequity of care.

It is rewarding too; I have more time to deal with complex medical problems, and we had the opportunity to review many vulnerable patients as part of our review of shielded patients.

I think general practice’s strength is our ability to adapt. Remote consultation and social distancing have led to challenges and I am certain primary care will not be the same.

RCGP responds

On Saturday, RCGP Council will be debating the College’s response to COVID-19 and the future of general practice following the pandemic.

Post written by

Dr Isolde Shore-Nye, Chair of South East Wales Faculty

Dr Shore-Nye is a GP Partner in the Abertillery, Blaenau Gwent. She qualified from Cardiff in 2000 and qualified as GP in 2011. She is the Cluster Lead for Blaenau Gwent East.

Dr Shore-Nye has previously been RCGP First5 representative for Wales and is now the South East Wales Faculty Chair.

She has an interest in mental health and is passionate about encouraging more people to choose a career in general practice.

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