Changing Times in General Practice, COVID-19

Thursday 12th March 2020 will stay etched in my memory for many years to come.

I was doing what I really enjoy which is helping to support GPs and their Staff. I had travelled to the Practice location the previous evening and enjoyed a wonderful meal in lovely company. As we sat talking and enjoying our meal, we could sense a change in atmosphere as the phone was ringing in the background with many customers cancelling their dinner bookings for that evening.

The following day as I worked, there was a growing sense of unease as I supported the Practice in developing a plan to support them in moving forward, using the information that we had at that point. We all realised that General Practice was going to have to adapt pretty quickly to ensure the safety of the GPs, their staff and of course their patients.

Later that afternoon as I was driving home, the announcement was made that all schools would be closing with immediate effect and would remain closed up until the 29th March 2020. Suddenly, this was all becoming very really and quite scary.

Very quickly, GPs had to introduce new policies in their Practices and there was little to no patients attending any Practice throughout the Country. Thankfully, most GPs have access to networks of other GPs so that ideas could be shared and policies and protocols developed to ensure best practice was being followed.

When we consider the pressure that General Practice had been under up to that point with the excessive demand for services and many GPs unable to accept new patients. Here they were now, dealing with thousands of patients who either had, or feared that they had, symptoms of COVID-19, and all of whom had been advised by the HSE to contact their GPs.

This proved to be chaotic for the first few days as there was a lack of clarity around getting tested and GPs were spending a significant part of their day on the phone not only to Patients but also the HSE trying to access information on testing. Sourcing PPE was also a major challenge and every day was spent phone triaging with the very odd exception where a patient had to attend in person. Everyone’s function within the Practice, without exception, had now changed as the entire focus was around managing phone calls, sourcing PPE Equipment and referring patients who were symptomatic for testing.

A couple of weeks later, the goalposts changed once again, Due to the massive demand for testing, new Public Health guidelines were issued which changed the criteria for testing. This meant that anyone who had previously been referred for testing and had not yet received an appointment date was being asked to re-contact their GP So that they could be re-referred or told to self isolate depending on their symptoms.

This added another layer of pressure to Practices, many of whom felt like they were starting all over again. There was also the added challenge that many GPs and their staff were developing symptoms themselves and had to self isolate. Some continued to work from home doing phone triaging and others were unable due to the severity of their symptoms.

I really wanted to do something to support Practices, so in late March and early April, I did a couple of webinars for GPs to see if I could offer support in some small way. The theme was ‘Surviving the next 30 Days in General Practice’ and the intention for the Webinars was to talk about the challenges that were being experienced and to see if I could offer any assistance. Practices needed to set up new systems to cater for new ways that care was being provided to Patients.

We talked about how the demand for appointments had reduced significantly. We debated whether this was due to Patients being fearful and maybe perceiving the GP Practice as being unsafe, or was there an element of patients looking at how they can manage and treat some conditions themselves.

Of course, there are many conditions that cannot be self-managed and require patients to be seen and reviewed. This continues to be challenging, depending on what resources each individual Practices have in terms of staff and infrastructure.

One GP has told me how he found phone triaging to be particularly difficult. He would call patients who had left messages or those who had completed the COVID-19 Screening Form. This excellent resource was developed by Dr Knut Moe and supported in its development by GP Buddy and Medvault.

For this GP, there was the frustration of patients not answering their phones when called and constantly ensuring that he was safety netting, which was taking up significantly more time than traditional consultations. He also found that he wasn’t moving around as much and he was beginning to feel quite overwhelmed with this new way of working.

On the Webinar, we discussed the new ways of working such as video consulting with platforms such as doxy.me and Nua Health. Both of these have different features that can benefit both the Healthcare workers and the Patient. They also have the added benefit of being able to accept payments.

Charging for the provision of services is one thing that many Practices struggle with. Although claims could be submitted for all COVID related phone triage, many other income streams had either reduced significantly or completely stopped. Some Practices have had no choice but to lay some staff off or to place them on short time as the situation continues to evolve day to day.

As I am writing this, just over one month has passed. Legislation has been passed for Electronic prescribing which eliminates the need for Patients to collect their paper Prescriptions. Electronic certifying is also live in many Practices with some delays depending on what Practice Management software is in use. It remains to be seen if some of the ways General Practice has had to adapt will ever revert back to the way things were. Many GPs will say that we are now learning a new way of providing services and that many lessons have been learned. To even consider going back to the way it was is simply not possible as it was a service that had very recently been under huge and unsustainable pressure.

More investment will be needed in GP IT and in the broadband infrastructure and training and support will be needed to support GPs and their staff. Technology will almost certainly play a bigger part in the provision of care in both Primary and Secondary Care. Many initiatives have been fast-tracked that will serve to make some systems much more efficient. Patient information and education will be a significant part of making this work. We will all have to get used to new ways of working.

What we have seen and continue to witness on a daily basis has been the incredible response from Public Health, HSE under the leadership of Paul Reid and the leadership from the ICGP in its support of its members. We acknowledge our Frontline Healthcare Workers, some of whom have returned home from abroad to assist in this Global Pandemic that has pulled the rug out from under all of us. Many of the principles of Sláinte Care have already been enacted within a much shorter timeline. Hopefully, we can continue to expand on this and see the value of Patient-Centric Care as we come out on the other side.

Let’s hope that when we come out the other end of this, and I know that we will, many lessons will have been learned by the Policy Makers, Healthcare Providers and the general public who access the services. Let’s hope that everyone realises the sacrifices that have been made and the leadership that has been shown by many in helping to combat this terrible virus.

Most importantly, let’s remember the many people who lost their fight against COVID-19 and that as a Country, we can pull together to support those who are grieving for their loved ones. There will be many scars both visible and invisible.