As we reflect on the sad milestone that is the 1 year anniversary of the pandemic, I look back at how my practice has changed, adapted, and coped with the Covid restrictions and guidance.
In January 2020, we saw the news reports of a new and frightening illness in China and how major restrictions were being put in place to contain and control the outbreak. For me, the concept of “Lockdown” was geographically and metaphorically thousands of miles away. In February, when Italy went into lockdown, it really hit home that the virus was spreading globally. GPs in the practice were becoming concerned.
By late February, our practice and the Clusters were discussing the implications for general practice. Guidance about the management of possible cases had been released and the focus at that stage was getting the right PPE, screening patients returning from high risk countries, and setting up Red Zones within the practice. Staff members were becoming fearful about the infection and the partners showed leadership to manage the concerns and to continue delivering patient services.
16th March 2020 was the day that our lives changed in the practice. The practice went into Escalation Level 1 as the rest of the country was poised to go into full lockdown. On that day, we converted all prebooked face to face appointments to telephone consultations. To reduce the footfall in the practice, all patients were consulted over the phone and only brought to the surgery if necessary for a physical examination. Over 11 months later, this is still how we are working. The transition within a day to a whole new system of working was remarkable and testament to the responsiveness and innovation that is the strength of general practice.
Practice workload was heavy, uncertainty was ever present, and the volume of national and local guidance was overwhelming. The need for staff members with respiratory symptoms to self isolate meant we faced acute staffing shortages. The shielding and ACP work along with a surge in prescription requests from a worried public added to the stress of an already stretched practice workforce. We were fortunate in the practice to be able to call on a group of medical students and school leavers who were able to be quickly trained up to support the administration side of the practice. I am enormously proud and grateful for all our dedicated admin and clinical staff who worked through those extremely challenging first few weeks of the pandemic.
There has been a flow of ideas from staff which has translated into new innovative ways of working, and keeping the practice safe for patients and the staff. A new one-way system, screening and temperature checks at the front door, a screen protected prescription window, new systems for handling special requests, cleaning regime for face to face appointments, and hands free door openers just to name a few. Scrubs for all clinical staff was promptly procured. IT innovation such as remote working from home, and video consultations, and Zoom meetings all contribute to revolution at work. All this in the space of a few weeks.
In the early months of the pandemic, there was an “all hands on deck” mentality and everyone mucking in to get the job done. Doctors taking phone calls from switchboard, doing the prescription line, nurses and HCAs screening the patients at the front door, and admin team cleaning the waiting areas. We worked through the Easter and May Bank Holidays. At that stage, there was a hope that the pandemic would be controlled and life would get back to normal later in the year. I recall the Thursday evening round of applause echoing across the country.
Wellbeing has rightly been a focus both in the practice and also nationally for health and care staff. The pressures of increased workload, the constant need for vigilance, the challenges of new ways of working and changes to daily life, compounded by the distressing reports of deaths and illness of the first wave has taken a toil on all our mental health. We were exhausted by July but there were glimmers of hope and positivity over the summer months. The talk then was of recovery and remobilisation. Smears and some chronic disease reviews were restarted. However workload levels and patient demand was increasing and showed no signs of abating.
As we entered autumn and winter loomed, it was clear that the public mood had shifted. The clapping had stopped and we in general practice were dealing with angrier and more demanding calls from patients, fed up with the pandemic restrictions and less understanding about new ways of working across the whole NHS.
The practice signed up to the flu programme for the under 65s at risk. We worked over the October Saturdays doing flu clinics maintaining strict social distancing and one way systems.
After a much needed Festive break, the pressure was back on with the planning for the Covid vaccination programme. The practice agreed to immunise our over 80s, over 75s, and the Shielding patients. Despite the difficulties and challenges with uncertain vaccine supply, the practice team did extremely well with first dose uptake and our patients have been immensely grateful. The vaccine has been a real ray of hope for the practice team and patients and we are well prepared for the second dose roll out.
Reflecting on the last 12 months has been an emotional journey. I have felt enormous pride in how the whole practice team, the GPs, nursing team, management and admin have pulled together and delivered safe and effective care to our patients. There has been fear and sadness along the way about the dangers and the impact of the virus on everyone. The loss of our old way of life sparking a deep yearning to return to happier and more sociable times.
Although the vaccination programme is showing signs of real progress against Covid, the road out of lockdown in the next few months will throw in new challenges for all our GP practice teams that are already fatigue and exhausted. Looking after yourself and the team has never been more important.
Dr John Ip is a GP partner in a Paisley practice looking after over 9,100 patients and member of the BMA’s GP committee