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Interview: Resuming routine appointments is necessary, but GP practices need freedom to decide when and how

27 May 2020

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NHS England recently suggested that GP practices should soon resume routine work, but only if it can be done ‘safely’. It hasn’t provided much guidance in this respect – which is an approach that Chief Executive of Wessex Local Medical Committees, Dr Nigel Watson, says he supports. 

GP practices need the freedom to decide when and how they are going to return to routine work during the Covid-19 pandemic. 

Each GP practice is unique, and they all have different challenges and need to work out what they need, suggests Dr Watson, who has been involved in a recent series of webinars to discuss plans for practice reopening.

There are a range of factors to take into consideration. For example, practices can have huge variations between them in terms of geography or the local population. 

‘In my area, we have a huge number of care homes, so that work is significant,’ he comments. 

Wessex LMC has published advice and three GP webinars to discuss reestablishing routine services, with hundreds of practice managers and GPs from around the country tuning in.

One of things they discussed is logistics. ‘Previously, on a regular Monday morning, our waiting room would be heaving. Now we have to think about how we spread patients over the day, so they can be two metres apart. You can’t have doctors only seeing patients from 8 to 10am and then 4 to 6pm. 

‘Also, we have to look at spreading out video consultations, as one after the other can get quite wearing. We might also have to consider PPE, especially if we are going to carry this on in the coming months,’ suggests Dr Watson.  

In an ‘amazingly short time’, GP practices created both ‘cold’ and ‘hot’ sites to better protect patients, particularly the vulnerable, he says. They may need to now start looking at stepping down the latter, especially in areas that have not seen the expected peaks. 

‘It’s about being flexible. What practices will do is plan for it – but be prepared to change that if necessary. Rather than having a hot site for a PCN of 30,000 patients, they may look to cover a larger area or keep it open for a shorter time during the day. But if things start to get really busy, they’ll need to be able to ramp it up quite quickly.’

Being adaptable will be critical if the predicted second peak does come or if other regular viral infections build around autumn, making it difficult to distinguish between those and Covid-19 symptoms. 

The need to resume routine services 

Despite these difficulties, it is important to get back to some level of normalcy at some stage, explains Dr Watson. 

‘We are now coming to the phase where we need to restart the routine appointments, including screenings, immunisations, contraceptive services and managing long-term conditions, while continuing to look after shielded patients and the care homes.

‘We are still in the early stages of opening that up, but recognising that if we leave it closed down for too long, there will potentially be quite a lot of patients getting sicker.

‘People are missing that face-to-face contact. GPs are not saying, we’re missing it, so we’ll put the patients or ourselves at risk by making patients come in for a face-to-face, but we’re making the judgment that though there is still a risk, it is probably smaller than it was before.’

Practices, however, still need to be cautious, as providing those services still carries an innate risk, as the patients could be a-symptomatic, he adds. For instance, they should continue using video consultations where face-to-face is not necessary.

Speaking to our sister publication Pulse, East London GP and PCN clinical director Dr Farzana Hussain last week explained she was concerned about resuming normal services, given her staff are predominantly BAME.