Different directions

GPs have adapted to COVID-19 in many varied ways. Two RCGP members give their accounts of the past few months.

Simon's story...

Dr Simon Hodes safely transformed his GP practice in Zones to use as COVID-19 'hot hubs'.

Dr Simon Hodes, Bridgewater Surgeries, Watford

“The initial outbreak sparked a practice ‘COBRA’ meeting,” explains Simon who practices at Bridgewater Surgeries, Watford. “We are very patient centred, and continuity of care is important to us. We knew we wanted to remain as visibly open as possible, and to protect our patients and staff.”

Like many GP practices across the UK, the surgery adopted a telephone triage service, with most patient care being delivered remotely, but with face to face appointments for those patients who needed them.

“We were lucky, our practice is over three sites – we closed one as a clean ops centre; the main site is extremely spacious, so we were able to segregate the ground floor for patients presenting with potential COVID-19 symptoms and the first floor for patients without symptoms. We also set up a 'Hot Clinic' at our branch surgery with a one way flow using the fire exit. "Upon arrival, any patients seen were handed masks through a window to wear before entering the practice. Appointments were strictly for patient examination only, with conversations on diagnostics and treatments delivered via phone to limit the amount of close contact between GP and patient. Doors and windows were kept open to maximise ventilation as we had understood this reduced risks."

Like other GPs they were only provided with basic PPE, which they were concerned did not meet WHO guidance, so investments were made to acquire more sophisticated kit that included goggles, full head covering masks and full length, arm covering single use surgical aprons, which ’definitely made us feel safer’, says Simon. Another challenge was staying updated with all the latest clinical guidelines, which at times were changing daily, and ensuring they were adopted in the practice.

Bridgewater Surgeries’ temporary hot hub was in operation until an official centre opened in the area. But Simon was also aware of the strain the pandemic was having on wider NHS services and was keen to support them. He launched #TeamGPvCovid, with the support of Dr Nikki Kanani, Director of Primary Care at NHSE England and Iain Pickles, Lead for NHS Clinical Review of Standards, to recruit volunteer GPs to reinforce NHS 111 and 999 services. The campaign was a huge success: within 48 hours, 300 GPs had signed up. In total over 800 signed up to volunteer.

“Primary care should be exceptionally proud of what it has achieved during these unprecedented times. We have been the epitome of keeping calm and carrying on. We've reconfigured, maintained a service and adapted to new technologies” said Simon. 

Hareen's story...

Emerging from the Costa Rican jungle after a 10-day expedition, Dr Hareen De Silva’s phone was alight with notifications on the rapid global escalation of the COVID-19 crisis.

Dr Hareen de Silva at NHS Nightingale Hospital, London

On arrival back in the UK, the country entered lockdown. Hareen, who usually practises in Doncaster, began to look for locum GP work but changes to the way general practice was working, meant few vacancies were available.

A social media post advertising a six-week contract as a ward doctor at the Nightingale Hospital, the temporary COVID-19 hospital at the Excel Centre in London caught his attention and he applied.

Hareen received training on how to work technology on the wards and several days later, started his first 12-hour shift. “I felt incredibly nervous, it was like I was starting my first F1 placement all over again. One thing that initially struck me was the sheer vastness of the Excel centre. Each bed has a computer, ventilator, obs machine, a dedicated clinical support worker and nurse, and is overseen by an ITU nurse.”

He was initially allocated six patients to monitor: “There was a real sense of staff collaboration and a fighting spirit from the clinical support workers to more senior members of the team. Our uniforms were colour coded to make everyone’s roles easily identifiable.”

He saw the devastating effects of COVID-19, first-hand. “As a GP you develop strong palliative care skills, particularly when doing home visits to terminally ill patients. We were surrounded by critically ill patients and I was able to deliver this care to these patients and provide support to their families during the brief moments they were allowed to visit to say goodbye.

“The hospital made a real effort to keep up staff morale. Companies donated food, some hospital walls were decorated with drawings from local primary schools and there was always an onsite psychologist or member of the wellbeing team to chat to.”

Hareen summarises his work at the Nightingale as ‘harrowing but incredibly humbling.' He says: “COVID-19 has shown me the sheer power of nature, but I feel that the skills I have acquired in general practice have allowed me to cope well in these uncertain times.”

Hareen has been awarded a British Empire Medal in the Queen's Birthday Honours for his work. 