Covid-19 and the impact on general practice

I think few would disagree with the assertion that the arrival of Covid-19 on to these shores has prompted a fundamental, dramatic and sudden shift in the practice of primary care within the UK.

Martin Marshall, chairman of the Royal College of General Practitioners, said in a recent article that it has taken €œtwo and bit weeks to achieve more than we have achieved in 20 years€ in adopting new technology. Other changes have been a huge rise in remote consultations such a telephone consults and video consultations at the expense of plummeting numbers of face-to-face consultations.

Interestingly, Professor Martin Marshall also said that prior to the Covid-19 outbreak, not every patient was being triaged before a planned GP consultation. However, he said: €œNow 100% are triaged and around 7% or 8% are face-to-face.€

Of course, this was a sudden and reactive change, forced by the impact of Covid-19 on UK society and specifically how primary care functioned. Practice meetings rapidly moved on to digital video platforms such as Zoom and Skype and managed quite well. Extended members of the team were also invited to parts or whole of the meetings, irrespective of their geographical location. Software was also used to support video consultations and text exchanges with patients and this integrated with clinical systems; it all seemed to work quite well.

I have used AccuRx initially recommended by colleagues and I found it to be very useful. It’s spread of use has been impressive and according to a BMJ article, a significant number of practices are using this software.

Remote consulting techniques could become standard practice

Now that some of these facilities have been used and seemed to be effective, it is likely that in the near and further into the future, many of these remote consulting techniques will become standard and mainstream practice. I have found that many patients prefer the convenience of telephone consults, found video consultations novel and useful whilst transmission of information by text was also positively received. I am sure these services will become entrenched in our standard daily practice and become more widely and regularly used.

However, like all new medical interventions, all these communication methods should be studied, assessed and results published in respected peer-reviewed journals. Safety and effectiveness of all these methods of consultation, including face-to-face consultations needs to be evaluated and national evidence-based guidance from respected organisation needs to be issued to GPs. This will take time (possibly years) to do the proper evaluation and for the information to be adopted and actioned at the front line.

A break from stifling bureaucracy has been welcome

A number of regulations around normal GP activity have been eased and for many GPs who have complained about stifling bureaucracy in the past; this has proven to be a welcome relief. I suspect as normality returns; we will see much of the regulation and state control returning back to normal.

However, we have had to deal with other new administrative issues as a result of the Covid-19 crisis. There has been a flurry of email and communications sent to GPs with changes of policy and sometimes these policies may quickly change as events unfold and our understanding expands. It is not easy keeping track of all this information and incoming data and one solution I have used is the excellent NHS England Coronavirus links page at NHS England.   

Although the NHS has reacted quickly and impressively to deal with the incoming Covid-19 crisis, there are some worrying aspects. For example, how many people with non Covid-19 illnesses or issues have had their healthcare delayed or ignored by the dramatic pivot to managing the Covid-19 crisis. I am sure there will be significant morbidity and mortality and we may not see the full effects of this in years to come. 

It is easy to be critical of the government and NHS responses, but these are unprecedented times which will be studied extensively in the future. This will guide future policy as this will not be the last time we face a pandemic and without doubt GPs and their staff will be in the front line. We can all learn from this experience which will put us in good stead for the next pandemic.

Finally, the stress due to this crisis that GPs, their staff and patients have had to face could be immeasurable and the toll on their mental health may not be apparent for some people for some years to come.

Dr Harry Brown is medical editor of GM and a GP, Leeds