Great Expectations – A Very Personal View
These times are the most difficult we have experienced in our lives at work and at home, yet I have felt distanced from the seriousness of what has been going on for the last year and a half. When I was working, I worked from home. I have followed the News Channels and looked at the statistics avidly. I have heard of family members saying that they had Covid. I have not seen them. I have heard of thousands of people dying but apart from famous celebrities I did not know any of them and they would not know me. Yet my life and my movements have been restricted by an invisible force. It has all been very impersonal.
I have not travelled on public transport since last February but have attended both hospital and GP appointments in my town, other parts of my county and other parts of the country. I wear a mask, two sometimes, and I attempt social distancing but regret that others don’t. I have had my 1st vaccine and my wife has had both, but the venues used were far from perfect and social distancing was not apparent, one was 14 miles away and the other 24 miles. No public transport for these trips only my car!
During the early days and weeks of the pandemic, I supported a Practice attempting just to carry on. There were issues using the main and only entrance door – was it easily lockable and unlockable and where was the letter box. The waiting area was almost cleared of chairs. Thankfully, there was a screened reception counter. One particular day, however, there was an almighty scare as a patient displaying symptoms walked in and sat down and would not shift until seen. For the doctors and staff, the Public Health advice at the time was to wait five days to see whether symptoms developed. There were no rapid tests in the early days. It was all very scary.
As the weeks and months went by the way in which patient services needed to be provided was changing dramatically and the phone system and video messaging apps, such as My GP, were coming into their own, after struggles with the technology, especially on Mondays. Times were challenging and Practice clinicians and staff were falling like flies. There were those working from home and those shielding. There were those too wanting to be furloughed (but not to work)! There were debates about who covers what costs and let me just mention PPE! Enough said!
Now, April 2021 a year on, we move into a new more promising stage as lockdown softens, vaccinations abound and treatments improve, general practice can start to think about ‘catching up’. Will Practices ever return to ‘normal’ running? Has there been enough time to reach any judgements about the balance between face-to-face appointments and other forms of communication! Will a patient ever again been able to choose to book an immediate appointment whatever the type or book ahead. Will every contact need to be assessed before the type of encounter is chosen and agreed and if so, by whom? And yes, how do we make sure that patients understand the ‘system’ and what is on offer needs to be communicated very simply and very clearly.
Before Covid my general comment about where general practice has been heading in recent years would have been that a shift has taken place from full time working by doctors to part time working. As a result, you can end up with one committed GP running a Practice with part timers and locums as I found two years ago. But we now need to add to part timers the attachment of numerous ‘Additional Roles’ which enhance the choices for offering treatment and care that can be made. It all started with Phlebotomists and Health Care Assistants but now includes Nurse Practitioners, Pharmacists, Physiotherapists and others all of whom can add quality services to general practice (as long as the funding is maintained). It strikes me that value for money and evidence-based services are still phrases that need to be adhered to.
Practice Managers, I am sure have become fed up to their high teeth with the edicts from on high about standard operating systems, vaccine programmes and what have you, that take at least a month to read, but still must be given the highest praise for surviving the onslaught and working successfully with others, that they may not have worked with or wished to work with before to ensure the vaccine programme succeeds. Have Primary Care Networks found a real purpose?
Practices are now looking to restructure of their appointments systems and need to decide a way forward. Are there enough clinicians available to provide the level of service provision that is demanded and expected by patients? What are patient expectations? How long should a patient be expected to wait for a return phone call or a face-to-face appointment? Is a home visit and the resources it eats up really necessary from a doctor? Is the Practice communicating clearly and simply to its patients? Is the web site clear and informative and is the opening telephone message putting them off!
My main concern is whether the standard and quality of care can be maintained. I find it irritating to have my medication changed without discussion or an item withdrawn from my repeat prescriptions because I can buy a clone of it over the counter. Has general practice really got the time for this type of malarkey? Hopefully, there is a future for independent general practice not taken over by primary care networks, federations or alliances. I am sure they all have their merits, as well as their ambitions. But fundholding demonstrated that there were big winners and not so big winners and eventually the plug was pulled as the greed of some spoilt it for the many! Whatever is formulated for the future by Integrated Care Groups, over and above the demise of CCGs, they must be given the chance to work and succeed. Sadly, that has not happened in the last 50 plus years!!!!!!!
Robert Campbell – April 2021