How Covid-19 has impacted the GP surgery

General practice has been at the forefront of the fight against Covid-19. David Lynch reports on a recent online conference looking at the impact of the pandemic on the working lives of GPs

Concerns over a possible ‘winter of discontent’ later in the year regarding the Covid-19 pandemic have been raised by north Dublin GP Dr Ray Walley.

On 4 June as part of the online Future Health Summit ‘Leadership Series’, the former IMO President discussed the topic of Covid-19 and general practice.

“The problem is, when you have flattened the curve, people basically start feeling that they have successfully dealt with everything,” Dr Walley warned.

“I’m afraid we are very aware of a winter of discontent coming up, whereby you potentially have an individual ringing us who could have the flu [or] who could have Covid. We still have capacity problems in our system. We still have too few medical practitioners.”

Telemedicine

Addressing the variety of ways the pandemic has impacted those working in general practice, Dr Walley noted how telemedicine has been increasingly deployed in recent weeks. However, he cautioned that this must not be at the expense of “continuity of care” between GP and patient,

“Certainly, I believe general practice has always practised telemedicine, predominately by way of telephone,” Dr Walley told the online conference. 

“I have access to using a televideo and I have used it [during the pandemic]. Where I have specifically used it is for mental health consultations and it has been very important. The same way the human touch in mental health is very important in terms of literally shaking hands with someone or smiling at someone, obviously you can’t touch someone through a screen, but basically I have been able to see someone, which is important… what I would emphasise is, the biggest thing that we have been successful with has been with the continuity. So I think telemedicine by way of continuity with an individual general practitioner is so important.

“My patients don’t need to necessarily see me by way of video; I give them the option.

“A lot of them say, ‘to be honest, I don’t want that, I am happy to talk to you’. Telemedicine is another tool, but I can’t see that it will replace face-to-face consultation.”

‘Crucifying diary’

Dr Walley is a member of the Covid-19 GP liaison committee and he praised the work of the membership of the committee and the HSE and Department. He described the meeting schedule of the committee early in the pandemic as “a crucifying diary”. There were teleconferences with the committee every evening, Monday to Friday, from 6pm to 7.30pm  “and then [as well] three times a week with the HSE and Department of Health and those [meetings] were generally 7.30pm to 8.30pm”.

“We developed a good relationship, I would say it has been a very positive relationship. We have had robust discussions; you need to, in a pandemic, have robust discussions,” he added.

“But it has been a ‘can-do’ idea… the agenda was very fluid, the agenda could be set the night before you get documents, or early in the morning you would get documents to read.”

Dr Walley added that he was “very proud of the resources that have been provided by our college [ICGP] and with our union, the IMO”.

Mental health

Answering a question posed by the Medical Independent on the longer-term impact of Covid-19 on doctors and patients, Dr Walley said mental health was his chief area of concern.

“I have significant concerns in regard to mental health. If you have seen various studies, something like 40 per cent of people in Ireland have no contact in a day with a human being,” he said.

“Human contact is one of the single most important things in regards to maintaining mental health…

“I also think we do need to get back to seeing people in the hospital. A real priority is acute medical assessment units, surgical assessment units, paediatric assessment units, getting us [GPs] diagnostics, making sure the cancer pathways are opening up — we need all of that happening promptly.”

Regarding the impact on the wider health service, Dr Walley said “general practice is now opening fully, but the hospital system hasn’t. It is important that we get that going again.”

Answering a question from Dr Tom O’Callaghan on the future of general practice after Covid-19, Dr Walley said he was “optimistic”.

“I think what we have learned is that we have first-world trained individuals; they were dynamic, they were flexible, all quietly done,” he said. 

“What it brought out is the importance of general practice. We have been the ‘Cinderella’ in regards to funding; we need to ensure that is escalated. We need to ensure that all those medical practitioners who have returned from abroad are retained here, we need to retain our GPs. There are many practices that have let staff go, because remember, 60 per cent of our workload is private practice.

“General practitioners are not unaffected by the same things that affect other business. We are small-medium enterprises. I have been lucky in my practice in the fact that we have kept all our staff, but we have not been able to take on other staff that we were about to take on.

“So all of those things need to be dealt with the Government, the HSE, the Department, as well as our college and our union, which has already led the way.”

Life as a GP on the Covid frontline

Dr Walley on…

Keeping healthy during the pandemic

“I am a person who believes in simple methods… I have three kids and two are waiting for Leaving Certs and all of that. My wife is a teacher, so we have seen it [the pandemic] from all angles. A lot of it is basically putting your family and putting yourself at the centre. It starts with a good night’s sleep, a good routine, finding protected time, good diet, exercise, all of those types of things… simple things, like getting back to reading novels in the evening… Drinking enough liquids to make sure you are hydrated, getting some sunshine; we have been incredibly lucky with the weather. A lot of it is very simple stuff and being organised. One of my learnings was, I stepped back from the media, because you can’t do it all.”

Preparing his practice at the start of the pandemic

“A lot has been learned during this. We started off in this practice, and most other practices, with a morning huddle, discussing the priorities, figuring out what we are going to do. We agree that everybody is to have their own room; you stayed in your own room. Rather than someone making a cup of tea and delivering it to everyone else, you make your own tea. Everything was two metres apart…all the communications was done by phone, or computer with Internet, text or whatever. Rooms were cleaned, and [you had] responsibility for your room for the day. Simple things like making sure you cleaned it, and leave a yellow sticky note saying ‘clean on exit’. Everything was transparent. We agreed that if people were sick, there would be early notification by text in the morning, and there was a buddy system to cover people…previously, a lot of the registrations of blood testing was done by the nurse in the practice. Now that is done by administrator, everyone knows how to do it, we have ended up multi-tasking, knowing what each of us do. So if one person goes down, we can all do it….everything is very structured and very organised.”

Sláintecare during the pandemic

“We didn’t really have time to be engaging with the Sláintecare people as such. A lot of what we are doing… we have been 20 years shouting about the importance of general practice and community care. All of what we are doing is community care-orientated, it is all about Sláintecare. Sláintecare is something, I hate to say, that politicians have sort of caught up with. We have all advocated that [community care]… What we are talking about is the importance of general practice with community care. I am a believer in primary care, I am also a believer that we need to be starting to use general practice and community care as the language… The problem with the words ‘primary care’ is that you get general practice hidden in that.”

The rescheduled  Future Health Summit 2020 is due to take place on 23-24 September in RDS Dublin. For further information, visit: https://futurehealthsummit.com.