Coronavirus. Chances are most of my patients didn’t even know what that word meant at the beginning of this year. And now it’s in the news headlines every day and may even be the first thing we talk about with the neighbours – at a safe two metre distance of course.
We have all had to adapt how we live, work or study at a rapid pace. My workplace has seen some changes, as have many others right across Greater Manchester. Except that GP practices right across the region have seen a major, once in a lifetime, seismic shift to the way they work in a remarkably short space of time. Pre-pandemic we were largely appointment based at my practice with 80-90% of all patient contact taking place in face to face appointments at the surgery. This has now reversed with over 90% happening remotely, so over the phone or online. Only around 5% is now face to face. Of course, there were moves towards digital technology before this and we were making some progress but it felt like a very big mountain to climb. There was resistance from some quarters. Many GPs understandably wanted to stick to doing things in a more traditional way, with a focus on face to face appointments and patients coming into the practice. Yet somehow coronavirus has changed all that. When faced with a crisis we knew had to find a way to provide the care our patients needed, in the safest way possible – and it had to happen fast!
Of course, there are challenges. The limitations of the internet capacity at my practice, and many others I imagine, means that we can’t all do video consultations at the same time. Using the phone remains the default but we can switch to video if needed. Patients can also email photos of some health concerns, such as rashes or moles, if a visual assessment is needed. However, unlike a pre-booked face to face appointment I can prioritise patients according to their symptoms and call those with potentially more serious problems first.
One of my concerns is that more patients should be coming to us in general practice and there is the worry that serious illnesses could be missed. The media has reported that many people are less likely to visit their GP with a whole range of concerning symptoms, including possible signs of cancer and other serious health conditions. Unfortunately, this is being borne out locally. We certainly have fewer parents calling about young children and this is a concern. Some people are unsure about coming into the surgery and I understand that. However, technology isn’t the only thing that has changed in general practice. Infection prevention and control now has to be a top priority too.
Practices are now asking patients to call or make contact online – so no drop in visits. This allows the practice to do an assessment first so that patients are only invited to attend a face to face appointment if it is absolutely necessary and will add value as part of their consultation with the GP. As far as possible, we are trying to deal with patients who have coronavirus, or possible symptoms of this illness, over the phone. If this isn’t possible, consultations are carried out in designated areas where staff have the appropriate PPE and away from other patients. This is being managed in slightly different ways in each of Greater Manchester’s boroughs. Some areas have designated ‘hot clinics’ whilst in others GP practices set aside specific areas that are deep cleaned afterwards.
So, what does the future hold for general practice in Greater Manchester?
As lockdown is eased a little and we begin the first tentative steps towards what is now being termed ‘recovery’, patient demand is starting to increase. Our new way of doing things has been working pretty well but is it sustainable as the number of phone calls begins to rise and patient expectations start to change? There is of course a real value to seeing patients face to face so I think we will gradually begin to increase the number of traditional face to face appointments but at the same time we must not lose the progress we have made in shifting to digital technology.
We’ve certainly come a long way in a short space of time, and this is an incredible journey, but I don’t know exactly where we’ll end up.
Right from the beginning, we’ve been constantly re-evaluating what we’re doing and how we’re doing it and I don’t think that’s about to change anytime soon. But we need to do this as safely and creatively as we can – taking our patient population with us. This is about partnership with our patients and the wider population, their input and feedback will be vitally important as we make changes to general practice.
In the midst of a crisis, we’ve succeeded in harnessing the most positive elements of disruption to modernise general practice, creating a health service that is more conducive to life and medicine in the 21st century.
One thing is for certain: we won’t be going back to where we were.
Tom is a practicing GP at St Andrews Medical Centre in Eccles. He is also clinical chair of NHS Salford Clinical Commissioning Group alongside his role as co-chair of the Greater Manchester Joint Commissioning Board.