Dr Rachel Tunbridge has worked as a GP in Croydon for nine years. She shares some of her experiences during the 2020 COVID-19 pandemic as a GP caring for her patients at East Croydon Medical Centre.
“One thing I can say with certainty is that six years of medical school, five years of junior doctor training and nine years of working in general practice could not have prepared me for this year!
“At the start of 2020 GPs were alerted to the outbreak of a new respiratory virus originating in Wuhan, China. We were sent memos and guidelines to enquire about travel history in patients with cough and fever and the number for Public Health England was pinned up on the wall in our consulting rooms. This all felt vaguely familiar – we had similar experiences with new respiratory viruses in the past– most recently one known as MERS (Middle East respiratory syndrome – a rare but severe respiratory illness) and followed similar processes for short period of time. However, as the days and weeks went on there was a growing sense of unease that this was different and within a matter of weeks general practice as I knew it had changed almost beyond recognition.
“Suddenly the waiting room was empty; my appointment screen which would have been filled with a list of what we would call “face to face” appointments with patients was replaced with a list of telephone calls. We knew we had to do this to protect our patients and our staff, but it was a significant challenge and not “general practice” as we and our patients knew it.
“The general practice consultation is so much more than a simple exchange of info, even with our newly adopted video consultations it did not feel the same for me. The subtle changes in body language and eye contact that can reveal so much, the confidences a patient might impart when they feel comfortable and heard in a safe space with the doctor cannot be easily replaced using technology. We also recognised that in certain circumstances “remote” ways of consulting may not be suitable for some of our patients.
“Face to face consultations took place wearing PPE (personal protective equipment) – a new experience for us. It’s no secret that obtaining appropriate PPE was problematic at first and we are very grateful to kind volunteers who worked incredibly hard making scrubs, face visors and the like to support us.
“We were also making sure we were keeping up with the stream of new information and guidelines we had to read, digest, and follow. And in some cases, develop ourselves! The situation was changing on a daily, and sometimes hourly, basis.
“Patients look to us for certainty and reassurance; and we will always do our best to help them through what was an anxious and uncertain time for everybody. And we do care for and worry about our patients – doctors are not immune to feeling the same worry that the entire nation was feeling. We worry for our patients about COVID-19 but we also worry about the other consequences of the pandemic on their health and wellbeing. As GPs we see the “whole” patient and often know these patients over a lifetime. We always work hard to do the best for them – for both their physical and mental health needs – particularly during this unprecedented time.
“I look after three large care homes and I could not do this talk without referring to the impact of the pandemic on our care home residents and colleagues. COVID-19 has shone a spotlight on our care homes over this time. They too had issues with obtaining appropriate PPE and keeping up with rapidly changing and evolving guidance. As GPs we had to change how we worked with our care home colleagues and establish “remote ward rounds”, we worked closely with our community teams, including our rapid response team, to support the homes during this time and we also had the Immedicare Telemedicine Service providing 24/7 support.
“So what else did we do in general practice?! We adapted and quickly – we embraced technology to use video consultations to see patients. We texted patients – a lot! Paper prescriptions became a thing of the past. We used the skill mix in general practice to reach out to vulnerable patients to make sure they were getting the support they needed both medically and socially: practice paramedics supported home visiting; our community rapid response team supported us to manage patients in their place of residence and avoid admission if appropriate; our practice meetings, including multi-disciplinary teams, continued virtually; and, we found ways to continue childhood vaccinations in a safe way and to see those patients who needed to be seen. We became experts at “donning” and “doffing” PPE and we started to wear scrubs!
“As GPs we worked with all system colleagues in a way we have not done before – as an example we established a weekly Croydon GP network call where we were able to discuss issues with our clinical colleagues.“We have learnt a lot from the last seven months and we continue to be here for our patients
“So, yes, the doors to the surgeries may be closed but we are definitely open and will continue to be so as we head towards the winter.”