The peri-COVID surge    

General practice is clearly very busy at the moment – how can we adapt and not buckle under the pressure?

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It seems to be really busy in general practice at the moment. Off the scale sort of busy, where we are struggling to cope to deliver on patient demand and expectation. Just yesterday, our on-call list of patients was the longest I have ever seen and it has been a similar picture every day over the past month.

Clearly, many of us working in practice saw this perfect storm of demand coming as soon as lockdown was in place and the NHS was turned on its head.

There is the pent-up demand of patients who have been putting off or ignoring symptoms for fear of adding to the NHS workload. These patients are now contacting us with their symptoms seeking a solution. The trouble is that we don’t have that many options for onward care. We have urgent 2WW pathways which still seem to be functioning but for the routine care it is proving more difficult. Initially, we were told that GPs should just refer for services such as advice and guidance and that patients could be managed in a primary care setting. It wasn’t difficult for GPs to see that this is simply a primary care work transfer but without any additional funding for more resources. We are now told that we can refer but it is not clear what patients will receive and in what timeframe. Routine care waiting lists are enormous and the COVID backlog is clearly significant. Secondary care is trying to deliver care in a virtual manner, but I am unclear on what that actually means. For example, this may mean that any tests required are bounced back to general practice to arrange and follow-up upon.  

Take phlebotomy for example, many secondary care trusts have closed down the blood taking facilities, so anyone who needs blood taking in a virtual appointment is told to go back to their GP to get it taken. The request then needs to be added by us, physically processed and then interpreted when it drops into our pathology boxes. I can’t help thinking that secondary care never really wanted to be taking blood anyway, so this is a perfect opportunity to jettison this away from their hospital buildings thereby allowing them to get on with other work.

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Luke Koupparis

Medical editor, OnMedica

I am a GP in the Bristol area and also work as medical editor for OnMedica.
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