COVID-19 GP diary: How do we adapt now we’re past the peak?

Our co-founder Dr Ishani Patel is a GP based in north-west London and the eHub lead for four primary care networks. In this series of weekly posts, she explains how she and her colleagues are managing in the face of the coronavirus pandemic.

This week, NHSE announced that practices could have a break this coming Bank Holiday Monday. Not only will this be a well-earned day off for our staff, but it’s also heartening to see that the number of cases has fallen to the extent that this is now possible.

It struck me, however, that COVID-19 will continue to change the way we in primary care operate, long after the peak has passed.

Hubs are taking a more central role

The team at Lantum is speaking to practice managers and PCN clinical directors on a daily basis: both on behalf of the locum community to help support the ecosystem and to understand the capacity and demand trends. 

What we’re seeing is that our clients who have workforce banks powered by Lantum are now setting up novel hubs (such as home visiting services and shielded sites) and new collaborative services. The sessional workforce is seen as a vital component of this – helping to make sure these services are successful and sustainable, especially as we prepare for winter pressures and a potential second surge. 

At regional level, Lantum has also built a dashboard to support these complex systems, so practices can access the locums that form such an integral part of primary care. 

Digital health will come to the forefront

Since the beginning of this pandemic, technology adoption in primary care has accelerated and completely changed the way we deliver care overnight. There are plenty of opportunities here, but we must think strategically about what we want to continue as we move beyond the peak of infections.

If you get the chance, I’d love for you to watch myself, Dr Saumya Jha, and Professor Shafi Ahmed’s panel discussion on digital transformation during the COVID-19 crisis and the challenges ahead. It was recorded as part of Medical Realities Global Virtual Grand Rounds and you will be able to find the recording here soon.

I also look forward to hearing more about the contact tracing app rollout and how I can encourage my patients to use it. I want to know how we, as GPs, can support Public Health England. I believe our role will be key to ensuring we keep the transmission rate low. 

Even the way we fight COVID-19 is evolving

It was announced on Monday that anosmia – loss of taste and smell – has finally been added to the UK’s official guidance on symptoms that require isolation.

For many of us within the healthcare community, this will not result in major change. Our practice took this issue into our own hands some time ago; after the updates from ENTUK, we advised staff and patients showing this symptom to isolate. This update, shared by ENTUK, went out on 6 April. Here’s the crux of it:

“We remain confident in our earlier assertion that, during the current COVID-19 pandemic, a patient presenting with new-onset anosmia, in the absence of a head injury or nasal obstruction, should be considered likely to have COVID-19 infection.”

But we’re only one practice. And while I’m sure many others have done the same, I’m relieved to see it’s now part of the national guidelines.

Primary care is under financial pressure

In addition to the changes in the way we deliver care, COVID-19 is affecting primary care financially. I'm hearing from practices across the country that they haven't received their usual contract money (which was supposedly guaranteed). People are incredibly concerned about how they can keep running. This cash flow risk is so extreme that I’ve even heard of GPs who are having to take loans out to keep practices afloat.

I worry about GP practices, which are facing financial difficulty in the same way companies are, but are still waiting for support. If you're a company, you can apply for a ‘bounce-back loan’ of £50,000, interest-free for a year. But this support isn’t yet available to us. I’m concerned that, as a result, we’re going to see a wave of GPs retiring, stretching an already overstretched service.

Locums are also struggling, feeling compelled to secure salaried jobs, which may force them to sacrifice much-needed flexibility or make them vulnerable to dysfunctional working environments, just to gain financial security. Some are even having to apply for Universal Credit to protect themselves. I will be personally reaching out to the RCGP to see how we (at Lantum) can further support locums nationally and at faculty level. 

Ultimately, the usual ways of financing primary care don’t apply during this crisis; now we’re beyond the initial crisis, we must think creatively and practically to ensure everyone gets the support they need.

NHS England announced the reimbursement scheme for practices (as I wrote last week), though we are waiting on final Treasury authorisation. The Treasury has been able to sign off the complex bounce-back loan scheme in record time; hopefully, the COVID-19 fund can be approved to support the NHS infrastructure and alleviate these problems.

We must safeguard our mental health – all of us

These financial concerns have knock-on effects for mental health. Financial pressures on practices mean that many are not advertising for locum cover (even though in many instances they need it), resulting in overworked practice GPs, as well as locums across the country struggling financially – at a time when their help could have been so vital in easing the pressures on the system.

Adding this untold worry to a workforce that has just been through an incredibly difficult and stressful three months is a recipe for a build-up of mental health issues within our workforce. As we adapt our care delivery and financing, we will need to consider mental health implications as part of the mix: how we can sustainably support one another. I’m thinking of reviving Lantum’s ‘21stCenturyGP’ workshops – virtually of course – where mental health at work is a regular feature. 

Closer to home, we held a Lunch and Learn session here at Lantum about mental health first aid and work-related stress, as part of our Mental Health Awareness Week activities. I like the resources from the Mental Health Foundation here. 

Meanwhile at my practice, a morale boost will soon be with us, in the form of a new practice puppy. We’re lucky to have a practice setup that will allow us to do this safely (such as having completely separate entrances for staff and patients). I genuinely believe it will be a mental health boost for all of us.