A Doctor Writes – Business as Unusual?

Published: 24th April 2020
Dr David Griffiths is a practising GP and the Medical Director of Consultant Connect. In this article he shares what it is like being a GP right now and his thoughts on the challenges ahead.

I keep hearing the phrase the new normal in relation to the situation we’re in right now with COVID-19. It’s not normal, it’s anything but! We are operating in unusual times.

As a GP, I agree that there is a massive opportunity for greater use of remote Advice & Guidance (reducing referrals or re-referrals, more Patient Initiated Follow Ups – PIFUs). Even high functioning hospital departments will now have backlogs and will be under stress.  It sounds a bit melodramatic but one saved trip to hospital really might save a life, which might save a whole load of lives.

Dermatology is a specialty which excels at Advice & Guidance generally. The consultants are usually highly pragmatic and very helpful. As I carry out more and more remote consultations, I have forwarded photos from patients direct to the local consultants for review several times recently. But I’ve also received photos which are unusable: grainy or out of focus. Given the pressures we are facing at the moment, the hassle of sorting this out is not inconsiderable. Getting the photo right first time will be a huge help that’s why I am really excited to share the new ‘How to take the best photos for teledermatology’ with my patients.

Do GPs like the way they are working right now, with many more phone and/or video consultations? I think it varies. One of my personal reflections is that I don’t actually convert many phone calls to video because it doesn’t add value that often – I am seeing similar comments on social media. I find video helpful for supporting folk with mental health issues and for improving my assessment of ‘quite sick’ patients, especially children.

Most GPs I know are looking forward to doing some face to face consultations again. Most, I reckon, are also thinking that they don’t want to slip back to exactly how things were before. Things feel quite well controlled at the moment in most practices, or so I’m hearing, partly because the Long-Term Conditions (LTC) work has been paused.

I’m expecting quite a lot of places to stick with total triage – even our more traditionally minded GPs have loved having a single ‘on-the-day’ urgent list and working as a team to get through the work. However, we will have to re-integrate a lot of core work and get through a significant backlog. Will the team spirit hold as the pressure increases?

I have started to hear of GPs telling my national colleagues they ‘just want it to be over’ and to get back to normal, so there are obviously those who are finding this all difficult and who are less engaged with the tech. It’s probably harder in areas with poor broadband, for example. And some have terrible hardware. If each digital interaction is painful it won’t be surprising if the new ways of working don’t survive long-term.

One of the big uncertainties is how much post-COVID-19 work we’ll have in primary care. There will be folk with physical consequences of COVID-19, in particular physical deconditioning and frailty, being discharged from hospital soon and they are going to keep us busy. My experience, to date, is that COVID is a very difficult condition to manage as a clinician as we don’t have a good sense for how it progresses. This will be true for complications as well. And uncertainty always makes me work more slowly, makes me more likely to bring folk back and causes me stress. Rapid, simple to access A&G will be very important for me to manage this new workload effectively.

A final thought: the challenge for GPs is that the job can sometimes feel surprisingly isolated. We don’t always have the time or the structures available for clinical discussions and peer support. Caring for patients with mental health issues is a huge part of the role of a GP and also one of the most challenging. The psychological consequences of COVID are likely to be significant and, again, we are in uncharted territory with no clear map.

It can be extremely helpful to verbally discuss complex mental health cases with a specialist. I am sure that GPs will be making regular use of Mental Health Advice & Guidance in areas that have this valuable resource available.


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