Working together to tackle loneliness

11 December 2020  

COVID-19 vaccine

Please allow me to start with important information about the COVID-19 vaccine. My heart sang with hope on Monday this week when the COVID-19 vaccine launch was announced. 

My optimism was replaced by concern on Wednesday when we heard that two people had 'anaphylactoid' reaction after receiving the vaccine in England. Both had severe allergies and carry adrenaline pens, and both are recovering well. 

The MHRA is now advising those with histories of adverse reactions to vaccines not to have the Pfizer/BioNTech vaccine.

There have been additional difficulties this week in Northern Ireland including a misunderstanding by Belfast Health & Social Care Trust on Wednesday where we understand a vaccinating team contacted practices requesting "permission" to vaccinate their patients. 

Alan Stout, Margaret O’Brien and I went to an emergency meeting with the Chief Medical Officer, who was most apologetic that some of our practices had been inconvenienced in this way and he was keen to make things right.

Please let me be explicit. The ask from Trusts is for information only. The governance arrangements and the decision whether to vaccinate patients still lies entirely with the Trust. 

You will have had correspondence from the Health & Social Care Board this week to formulate lists of our patients in care homes and to support the provision of information to our Trust vaccinator colleagues. 

Unfortunately, due to the adverse incidents earlier this week the letter has had to go out again to practices to include important information about allergy. Can I please ask you all respectfully to reply to this as quickly as possible. 

The number of patients with a history of anaphylaxis should be small in care homes, but to play our part in the delivery of COVID-19 vaccination, it is important we share this important information.

At the time of writing we are still waiting for official approval from MHRA for the Oxford-Astra Zeneca vaccine and this is likely to make up the majority of our workload when vaccinating our patients. 

To share more information about the process and requirements for practices, RCGPNI will host an educational webinar on Wednesday evening, so please keep an eye on your email accounts for information on this important event. 

Your College is working hard behind the scenes to produce educational resources to support you in performing this important role, so please keep an eye on the COVID-19 educational hub on the RCGP website.

Loneliness campaign

One of our main aims as a College is to get policy makers and stakeholders to see our point of view and gain an insight into our work as GPs. We have been part of an action group to raise the issue of loneliness for some time and this work is now seeing fruition.

Please do not be alarmed - this is not about generating additional work! Instead, it recognises what we already see in our surgeries, week in week out, all those patients who are lonely but whose needs are not being met by a health system which is primarily set up to address physical illness.

Our focus for this campaign is to highlight that we need support to help this group of patients which will inevitably grow due to the pandemic. We need extra time to provide longer consultations, better community support including social prescribing and, most of all, the full roll out of the MDT programme to all practices with their unique first contact social worker and mental health practitioner.

My own mental health practitioner stunned me last week when she exclaimed that before working in primary care she only thought she was aware of the charitable and community resources that were available. This is from an experienced community psychiatric nurse!

I have lost count of the amazing services our patients have been directed to within their own community, so it is vital that all practices get this MDT resource to ensure all of our patients receive the best care and we have easy, seamless links to the plethora of resources available to us in our own communities.

Meeting the Health Minister

On Thursday, our Deputy Chair for Business & Finance, Dr John Goodrich and I met the Health Minister for an update. We were able to reiterate our support for the COVID-19 vaccine but stressed that we must be supported to deliver it.

Communication will flow to your practices soon about what extra resource will be available, but at time of writing, the Astra Zeneca vaccine still has to gain MHRA approval and little can be done until we receive clarity on this.

We had flagged the logistical challenges the 15-minute post-vaccine wait could pose and we will continue to seek clarity on this issue but given the events of this week, safety must be our number one priority and it is likely to be in any MHRA recommendations.

We also highlighted to the Minister the importance of ensuring multi-disciplinary teams (MDTs) are established in all practices and how inequities of access are building up fast. The Department is finalising guidance on how the next GP Federations will be chosen for roll out, as well as practical steps which could be taken while those areas are waiting.

We also discussed COVID-19 centres and urgent care centres and urged the minister to be mindful of our GP workforce, which continues to face huge additional asks.

Mental health policy forum

It was great to have the opportunity to present and appear on a panel at the Health Policy Forum Mental Health Discussion on Wednesday.

I was on a panel which included Mental Health Champion Professor Siobhan O’Neil and I was able to highlight the pressures on general practice, both before the pandemic and now.

Obviously, we highlighted the benefits and opportunities of MDTs as well as urging for full regional roll out.

Dr Ursula Mason also presented at one of the sessions highlighting the potential of federations delivering mental health hubs with lower tier services being delivered to our practices using these mechanisms at scale.

Care Home Local Enhanced Service (LES)

I have received communication from many GPs who have concerns about the current Care Home LES.

I have raised initial concerns with the Health & Social Care Board and I would be grateful if you could share your constructive views with me.

We support the general principles of 'one practice for one home' and any work which helps support a more proactive level of care for patients in care homes is most welcome, but it is important that practical solutions are put forward, so this work can help our patients while remaining doable for practices.

Conversion therapy

It was great to meet up with Drs Gareth Patterson and Gary Gilliland-Adair to see how we can better support our GP colleagues who are members of the LGBTQ community and end the harmful practice of conversion therapy.

We have written this week to Minister for Communities Carál Ní Chuilín who is leading on policy in this area. We will also be sharing the letter with the Ministers for Health and Justice.

If you have any ideas about how the College better supports members of the LGBTQ community, please get in touch with Michelle from our office.

This is open to all GPs, not just RCGPNI members, so if you know a colleague who would like to link in please forward them this blog.

We can put in place ways to ensure your anonymity initially, and Gareth and Gary have kindly offered to link in with you and see if there are any issues we need to address as a community.

Does your practice have specific policies to make it more user friendly to members of the LGBTQ community? Please get in touch so we can share best practice.

One of the issues raised at our discussion was the stereotypical portrayal of members of the LGBTQ in exam questions and curriculum examples.

Many of the gay men had been identified as having an STI or HIV so we will make representation to NIMDTA to ensure that members of the LGBTQ community are seen as people who can suffer from diabetes, hypertension and mental health issues - just like anyone else.

Climate change and environment

It’s been great over the past week to catch up with our colleague Bláthnaid Cullen who is working as a GP in Portadown. Bláthnaid is passionate about climate change and environmental issues and we are keen to support her to amplify her voice.

Your College takes its responsibilities on climate change very seriously and we have a range of resources to help you on our website.

Have you an interest in climate and environmental issues? Please link with Bláthnaid and me and we will see how we as NI GPs can play our part.

Help shape your College

We are very keen to hear your views on what learning opportunities (clinical, wellbeing and personal/professional) you would like us to provide over the next 12 months and any other support we can offer.

Please take two minutes to complete this very short survey. If you have any queries at all regarding your membership or events, please contact Michelle Newell at the RCGPNI office.

We have a guest First5 blog this week from Dr Gill Norris who has shared some of her wisdom as she comes to the end of her first five years as a GP. We also must thank Dr Nicola Topping who is finishing up her tenure as NI First5 Representative.

Nicola has achieved so much through this role, including establishing a First5 Group and delivering the brilliant First5 Conference last year.

So if you would like to engage with local members, support your colleagues and shape the agenda for First5s in Northern Ireland, apply now for the position of First5 Representative (298 KB PDF)!

You can also contact Michelle Newell who will be happy to answer your queries.  

Thank you all for your incredible hard work over the past few months. It has been incredibly busy in our practices and working remotely can be very difficult and isolating.

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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