In April 2020 we spoke to Dr David Griffiths, practising GP and the Medical Director of Consultant Connect. He shared what it was like being a GP back then and his thoughts on the challenges ahead.
6 months later, we caught up with Dr Griffiths, and here’s what he said…
Uncertainties in challenging times
What can we expect from wave 2? There is understandable anxiety in the NHS. Clinicians, support staff and managers have all been working under high levels of stress for many months now. I am hearing lots of stories of practice staff burning out and, unfortunately, we are certainly not approaching this situation with well-stocked psychological reserves.
Our understanding of COVID-19 has increased but there remain significant uncertainties in its management. What is more we are now going to be managing COVID plus the usual winter viruses. The diagnostic challenge will be high, let alone management and infection control. Add to that the fact that we don’t know how long immunity will last, meaning recurrent infections are possible and life is getting complicated.
Other challenges include the significant group of patients suffering from what is being called ‘long COVID’. Again, we don’t really understand this condition, have limited advice and no treatment to offer. The mental health burden of COVID-19 is also significant whether because of the infection itself or due to the effects of lockdown; this has been by far the most obvious change in my personal workload over the past few months.
In summary: this is shaping up to be a challenging period for clinicians.
New ways of working
Many GP practices are working with new or significantly tweaked systems, often a version of total triage, where all requests for support are reviewed by a clinician prior to allocation of resource. This can be very effective (personally, I like it) but not all patients like it and the cognitive load for clinicians is high. Many GPs also feel they are not getting as much face-to-face patient contact as they would like.
We have also been adding back in our usual non-urgent work, such as the management of patients with Long Term Conditions (LTCs). This includes trying to work through the backlog from the initial lockdown period. Ongoing collaboration and communication between care providers and patients will be hugely important, especially during the next few months. Read this recent blog article: LTCs during COVID-19: Five ways to improve care for patients.
Advice & Guidance can really help
When our usual working patterns change, we can find ourselves with difficult decisions to make. For example, I sense that I am receiving more calls from ambulance crews lately, probably because the implications of conveying patients to hospital are even greater than usual during a pandemic. Consultant Connect has experience of providing a line for ambulance crews to sense-check their assessments with GPs, who are not necessarily in the same locality. For example, South Central Ambulance Service 999 CSD and Ops teams can access immediate advice from a team of experienced GPs, who volunteered for this service. Feedback has been very positive: the crews appreciate the real-time advice and the GPs enjoy the challenge of the scenarios and the chance to offer support. This blog article details examples of the different ways Ambulance staff across the UK are using Consultant Connect’s Telephone Advice & Guidance service to improve patient care.
I believe there is quite a bit of variation by region but, for our practice, few of our local referral pathways are operating. Many departments are still shut for all but the most urgent referrals. The knock-on consequence of this is more work for us in General Practice, managing folk with challenging symptoms and, also, resulting in more follow-up investigations and assessments. Advice & Guidance has a huge part to play here, supporting GPs to ensure that management plans are appropriate.
A related problem facing us in General Practice is access to diagnostic investigations. Personally – and I know not all GPs agree with this – I am happy to organise investigations but I’m aware I don’t always know which is the best test in a given situation. This is where real-time Advice & Guidance for GPs can add huge value in driving effective and efficient use of diagnostics and, in parallel, reduce the need for outpatient appointments.
So, while I’m anxious about the apparent state of General Practice as winter comes towards us, there are reasons to be grateful and opportunities to feel positive about the future.