COVID-19 GP diary: Now’s the time for population health

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 has, at least in some ways, felt like the most positive week for me since the coronavirus crisis began. Perhaps that’s because the way we’re now working is starting to feel like the norm. 

That’s not to say there we aren’t still facing many difficult issues. It’s been incredibly sad this week to hear about colleagues across the country passing away. My heart goes out to their families and colleagues.

I think the change I’m feeling, that we’re all feeling, is that we’re more mentally adjusted to this new environment. And that’s helping me, and others I’ve spoken to this week, to see new opportunities for population health that could arise from the changes we’ve had to make to fight the pandemic. I’ll come back to those later.

It helps too, that we’re starting to see a reduction in the number of COVID-19 cases presenting to us. I worked in our local hot hub over the weekend and while it was still busy, it definitely felt quieter than previous weeks. It seems the lockdown measures are working. 

However, I know there are now increasing calls for restrictions to be eased. My gut personal reaction to this is worry – I worry that we will see a second surge and that the situation will get much worse again, both here in London and elsewhere. That said, I know many of my patients are struggling – both financially and mentally – with some living hand to mouth. There is no concrete answer to the question of whether lockdown should be eased or not.

Biggest challenges this week

Like all medical professionals, we’re still incredibly concerned about levels of personal protective equipment (PPE) available. We're in a position where we're having to pay out of pocket to ensure that we have the equipment we need.

Moreover, we’re not just worried about what we have now. We’re incredibly conscious that this protection is likely to be needed in the long term. GPs and care homes are worried about sustainable access to PPE. I forecast that we're going to need supplies until the end of the year at least.

Even though death rates are going down, we’re still seeing colleagues getting sick. And we know that we could also be asymptomatic but still pass on the disease. This is something that I’m sure is on the mind of every health professional right now.

What I would love to see is robust testing of antigens and antibodies – so we know when we’ve got it and whether we have immunity afterwards. Worryingly, I’ve seen two patients this week that have had second waves of infection. There's a lot we don't know. That’s why we're participating in a research trial run by the RCGP and why, as a practice, we want to be a part of as many good cause research trials as we can. 

Last week, I wrote that we’re now turning our attention towards continuing support for those with long term conditions and how we make that work in this new environment. That’s continued this week. In particular, with Ramadan starting, we’ve been very conscious of ensuring diabetes patients have the right support. And with pollen levels rising we’re also seeing increased numbers of asthma flare-ups, so that’s another important consideration. 

Another key challenge this week has been continuing to support patients who’ve been identified as high risk and in need of shielding. As well as talking to those who feel they’re at risk even though they haven’t received letters telling them that they are.

I also wrote last week that we were seeing an increasing number of mental health issues. This has continued, but worryingly I’m now also speaking to patients who are really struggling due to domestic abuse and other issues in the home – an incredibly concerning trend.

Positive moments

Something that I’ve begun to really focus on this week, and which has given me a new sense of hope, is that there is a genuine opportunity to make positive changes to how we work – alongside the necessary changes we’re already making. 

We’ve had to turn the way we operate on its head in recent weeks. Suddenly we’re digital-first, we’re working in hot and cold hubs, we’re planning a home visiting service at scale. We’ve had to do this for a horrible reason, but my feeling is that when we’re already changing so much, now’s the time to shake things up and make the changes that could prove most beneficial in the longer term. Especially as patients are now more open to these changes.

I don't believe that the way we work will revert to what it once was – I don’t think it's ever going to be the same. I spoke to Dr Shashi Khandavalli this week, a GP and PCN Clinical Director for Chorley Central Primary Care Network about how much his ‘big vision’ aligns with my own. It was brilliant to discuss something positive – to talk about how we can work more closely and what general practice ‘2.0’ will look like once the emergency response calms down. 

PCNs are meant to be vehicles to deliver population health with their communities – and I feel the urgency to get this done well has not gone away. I hope we are able to recruit the additional roles as soon as possible.

Just one example of this follows from my recent focus on patients with long term conditions. I want to create a team that serves multiple PCNs to help them manage their diabetes and other long term conditions patients. Historically, it's been up to single site practices to look after their own diabetes patients and tap into community and hospital teams. But COVID-19 has highlighted all the arguments for why population health matters. And this is a real opportunity to look at diabetes across our four PCNs with our community asset partners and residents and not have it fall to a single site service. 

I’m also working on a project with a GP federation in Hillingdon, which I believe will long outlast this pandemic. They’re an organisation that’s worked with Lantum and I’m now going to be supporting them with setting up a federation-wide online consulting hub.

Another positive this week came with the news that we had funding from our CCG to get oxygen sats probes which we can drop off to COVID-19 patients who are unwell at home. This means we can leave the probes with them, then call them daily to check in on how they’re doing and monitor their oxygen sats, without having to be in regular close contact.

A personal positive moment for me this week came from something sad. I had a phone call from a colleague, thanking me for the supportive conversation about end of life care that I’d had with her when her grandmother became ill. Instead of going to the hospital, with end of life support and appropriate PPE, her grandmother was able to spend her birthday with her family before passing away peacefully at home. A stark contrast to what would have happened had she gone to the hospital. I’m so glad I was able to support my colleague and her family at such a difficult time.

What’s to come?

Due to the increase in patient demand and the number of staff off sick, many practices have had (and will continue to have) a need for locum cover. The government has promised help covering the financial cost of this. This week we’re waiting to see what this reimbursement scheme will look like and how it will help us to manage our staffing levels. 

The reimbursement scheme will require accurate reporting to be able to distinguish between COVID-19 specific shifts. This requirement is something the Lantum team is currently developing and finalising as a capability within our product for both clinicians and healthcare organisations. We’ll be announcing the release of this soon.