These are the new buzz words of NHS Scotland. As we come out of the first wave of COVID-19 they apply across the system, although so far inevitably most of the focus has been on secondary care. General Practice is seeing a return to the level of activity approaching that seen pre-covid, but now access across the whole country is different with nearly all practices operating telephone consultation and triage as first line.
There’s a lot of focus on unscheduled care nationally, and how to keep A&E safe from COVID-19 and keep attendances down. However, it is vital to understand that most unscheduled care is actually seen in primary care, and most of those patients never see an A&E department. This is a point worth considering as movement is made to explore new ways of delivering this service. A key area as secondary care recovers is the interface with the community and that is where we have been very clear how critical it is that primary care/general practice is viewed as an equal partner in that redesign process, to avoid being seen simply as ‘ideally placed’ to pick up the pieces. Our view is that GP sub committees are ideally placed to lead these interactions from a primary care perspective, and they need to be at the heart of any reforms to patient pathways. Our 2018 Scottish GP contract was designed to make better use of GP time as expert medical generalists, so we must strongly resist any moves to go backwards and erode the very clear leadership role we are establishing for GPs.
We have remained open (including public holidays) throughout the first wave, dealing with everything that came our way and referring on whenever it was appropriate to do so. But some of our services had to be put on pause; cervical screening, chronic disease management and some immunisations. Now as we enter what may be a short period of respite before any possible second wave, we are being asked to restart these services. I have been very clear with Scottish Government that face to face consultations now take longer, and procedures like smears, perhaps twice or three times as long. But there’s a backlog of smear tests to be done and we have sensibly agreed to start with non-routine smears as they are most high risk. A key point is that we don’t have the practice nurse capacity for the full programme, including routine smears, so we have said an ‘all hands-on deck’ approach is needed to increase capacity and deliver the full programme and that means gynaecology nurse led clinics, sexual health clinics and pop-up community clinics. Similarly, due to social distancing and PPE the influenza vaccination programme cannot be delivered in the same way it was in previous years where typically 1000 patients were mass vaccinated in a practice in one day. Again, we are clear we need a full system response. And yes, general practice has its part to play in this, and I expect will do so, but if we are left to do it largely alone, I fear we will simply be overwhelmed and not reach the national targets. So, everyone needs to work together quickly to develop new ways of working; such as drive through hubs, assessment centres and other ways of adding to the capacity to deliver this.
Getting back to our contract and primary care transformation: we do need to get on with the Primary Care Improvement Planning process and the delivery of the new services promised in the contract. That applies particularly to the community Care and Treatment Centres (CTACs) which fit very well with the new ways of working and, if they receive additional funding, they could also assist secondary care in their plans to modernise how they work.
But we do still need changes to help us in general practice; we need to get on and deliver the terms of the GMS contract as planned, there needs to be more IT investment, in hardware and software, there needs to be better data sharing with other healthcare professionals seeing patients and we need to press on with the planned premises reform. We also need everyone – including politicians – to engage with our public, to help them understand where their NHS is at, that they have a crucial part to play, using self-help or on-line advice whenever possible and only using face to face services when it is essential. They need to understand that while their rainbows say they love their NHS, they also need to cherish it. The ‘new’ NHS will be a team effort, and everyone must play their part.
Dr Andrew Buist, chair of SGPC
Photo credited to Gordon Terris/Herald and Times Group
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