COVID-19 GP diary: We need to take the initiative


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.

There’s been a lot of coverage in the news this week about lockdown, with increasing speculation about when it will end. Last week, I wrote that this worried me, particularly because we’re located in the middle of a COVID-19 hotspot. However, what I find reassuring is that I know we’re better prepared, were we to see another rise in cases.

By acting early, we've already completely changed our whole operational infrastructure and how we manage patient demand. And even how we use our physical buildings – we've now split our site into green (non-COVID-19), red (COVID-19) and blue (shielded patient) zones, which we expect to keep in place at least until the end of the year. So while I very much hope we won’t see another surge, I feel we’ll be in a better position to manage it if we do.

I know I’m not the only one to feel this way. This week, I spoke to Dr Will Dawson, CEO of One Medical Group in Leeds. His practice group, like mine, didn’t wait for the lockdown announcement to start making changes to the way they work. This means they’re now in a good position to continue treating patients in this new reality for the foreseeable future.

I believe we all have to continue acting on our own initiative. While it's good we have guidance on what's expected of us, I feel we have to continue to take ownership of how we want to run our services. Of course we must always look to do things the right way, observing guidance, but we can’t wait for the government to tell us how to manage our patients. We don't need them to tell us how to do it – we know how to do it. Even in this time of change, we must have confidence in that.

Biggest challenges this week

For me this week has been more about concerns than challenges. I continue to be concerned about PPE, as we all are. I’ve written about it many times already and the situation hasn’t changed.

We’re also continuing to track and monitor our COVID-19 patients, and while the numbers we’re tracking haven’t risen, they also haven’t fallen. We’ve lost more patients this week and that never gets easier. 

Another concern is the evidence that's emerging on BAME clinicians and patients being at higher risk. I want to spend some time learning and trying to understand what this could mean for us at our practice and within our patch. Eight GPs across the country have now died from COVID-19. It’s clear we need to do another round of risk assessments for our staff – reexamining our workforce to understand how to implement additional precautions for those who are over 50 and BAME.

Talk of the vaccine trials for COVID-19 starting in Oxford this week has also brought up some big questions for me. On the one hand, I realise how important it is that we have a vaccine. On the other, I’m aware that vaccines are normally put through rigorous research procedures that take years not months to understand longer-term consequences. There is a big question for me about whether I would trust a new vaccine developed so fast – I hope that as and when the time comes, the evidence will be robust enough to dispel these concerns.

I’ve also been working hard in my position as digital lead, helping other boroughs in north-west London roll out their online consultation models. I read this week that 58% of practices across the country now have a procured provider. It has to be more than this if we’re to continue to manage our patients effectively over the long term.

There’s a lot of variation in terms of how people want to roll out these online models – from PCN-wide hubs to single site offerings. For me, this comes back to the fact that PCNs are so new. It takes time to build trust in having other clinicians manage your patients and access your medical records. While some PCNs have actually been working collaboratively for years, some only started to really get to know each other in the last 18 months. So you've got to respect where people are in their relationships and realise that there isn’t only one way to do things. 

Positive moments

A big positive this week was discovering, during my weekend sessions at the hot hub, that we’ll be offering testing for key workers. That’s made me feel that finally there’s some movement from the government in terms of ramping up testing.

It’s also been reassuring to us that we’re busy this week. I’ve read in the news and heard from colleagues the concerns that patients aren’t getting in touch when they’re ill – and this is something we were also concerned about in previous weeks. Thankfully the messaging we’ve been putting out to patients seems to be working and we feel that we’re hearing from patients more and seeing the people who need to be seen.

We’ve all been incredibly touched that we're receiving lots of lovely cards from patients. Our practice manager is regularly sharing photos of the nice things people are sending in, and it genuinely brightens all our days.

I was also very excited this week to speak with Mike Holmes and Thomas Patel-Campbell who are both senior GP partners at the Haxby Group in Yorkshire and Hull. They've partnered with a Finnish company to co-design live dashboards on patient demand and the number of COVID-19 patients they’re processing via an online consultation in real time per site. 

It’s really got me thinking about how we could visualise demand and capacity data more effectively to implement total triage at scale in our efforts to improve access and support patients. I don’t see the traditional 3-4 hour face-to-face session coming back anytime soon. We have lots of sessional GPs who are an essential component of our ecosystem and contribute vastly – perhaps the way they work should also adapt to an agile “plug-in and process” system for online consultations during surges. Where they can work at their convenience in a way that complies with patient safety turnaround times and can be flexed around their personal or other professional commitments. 

For our four PCNs I can complete 25 to 30 clinical online consultations in three hours and I can flex it around meetings and my portfolio commitments – the practice, the system, the workforce, and the patients win. 

The final positive moment for me this week has been the involvement I’ve had with the Lantum team on some exciting testing. Our product gurus have been working hard to ensure our platform can cater for the changes we’re seeing due to the COVID-19 response, from the organisation side through to supporting clinicians.

This week we’ve launched the early stage testing of COVID-19 specific tools and we'll be making sure these tools are accessible to everybody as soon as possible. Watch this space!

What’s to come?

Last week, I talked about how we want to manage our patients with long term conditions. With that in mind, I've been researching how we could set up virtual group consultations and upskill our practice nurses to deliver them.

The evidence I've read for group consultations for diabetes patients, for example, is really strong – not just because it’s more time efficient, but because it actually successfully lowers patients' HBA1C levels. The opportunity to share their experiences with their peers helps patients to know they’re not alone in their challenges and they get support and ideas from each other, as well as the person facilitating the group.

So I know the theory, but now we’re actually looking to put it into practice in a virtual setting – and I’m really quite excited about that.

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