Reflections on COVID-19
With the gradual lifting of lockdown we wanted to share with you some of what we have experienced and learnt over the past few months and how services at Kingston Health Centre will adapt as we move forwards.
With the arrival of a global pandemic and reports from abroad warning of overwhelming pressures on healthcare systems, GP practices and hospitals around the country needed to prepare, and do so quickly.
At Kingston Health Centre we needed to ensure we could manage cases of suspected Coronavirus but also continue to care safely for our patients with other health conditions. We would need to change the way we worked to do this.
To reduce risks to patients and staff we moved to remote working, with the majority of patient consultations taking place via video or phone. This proved surprisingly effective, with the transition to remote working was almost seamless. Over the past year we have offered video appointments that have attracted only a few patients, but within the space of a week most patients were embracing the change. There are always situations where patients need face-to-face assessment and we were able to provide this safely with minimal footfall in the building. Staff members having to isolate at home were able to continue working away from the surgery on laptops.
Treating patients with COVID is challenging. Every day there is new information and its spectrum of symptoms seems ever-changing. This is a new virus and healthcare professionals all over the world have been ‘learning on the job’. Regular webinars, sharing of scientific papers, and remote teaching sessions have enabled us to upskill rapidly by learning from each other’s experiences. We have learnt that COVID is not like flu, and that there is a lot more to it than cough and fever. For a few it is a severe illness that can have devastating impacts on many different bodily systems, requiring prolonged ITU support and long-lasting physical and mental health effects in survivors.
It was important to identify vulnerable patients at highest risk of severe disease if infected with COVID so they could be given advice on shielding. The admin team ran searches to help identify these patients so that shielding letters could go out promptly. They also had an important role in contacting patients on the shielding list to ensure that they were aware of local support with shopping and prescriptions and helping patients access these services.
Initially we established a ‘red zone’ on the first floor of Kingston Health Centre to keep patients with possible infection segregated from the main areas, but as the number of cases of suspected COVID-19 rapidly increased, it became clear we would need a dedicated clinic at a separate site.
‘Hot’ clinics were set up and used by GP practices in Kingston to assess and manage patients suspected to be suffering from COVID. Staff from Kingston Health Centre were at the forefront in setting up and staffing these clinics. Our skilled management team are highly efficient; it was a remarkable achievement to be able to get clinics running within the space of a few days. GPs, nurses and paramedics were used to assess patients. The patient would have an initial phone appointment then physical assessment with staff wearing full PPE whilst the patient remained in their car outside the clinic. Those who needed hospital admission could be referred immediately, with appropriate advice on home care for others. Some patients seem particularly at risk around days 7-10 of the illness and the hot clinic allowed us to follow up patients daily for as long as needed with repeat visits. Members of our reception team were drafted to the clinic to ensure its smooth running.
There have certainly been challenges – particularly with many routine hospital services such as outpatient appointments and diagnostic tests postponed or unavailable. Routine GP services such as diabetic reviews, screening and minor surgery had to be stopped temporarily to enable us to provide more care to unwell patients and avoid risk of infection to others. We had to reduce our opening hours while staff needed to shield or self-isolate or were working in the hot clinic. As well as managing those with suspected COVID infection, patients were able to contact us about the usual wide range of other health concerns. Throughout we wanted patients to know that they should contact us rather than worry about their health and that we would be able to assess them safely.
Looking to the future
Predicting what will happen in the coming weeks and months of this pandemic isn’t easy. Coronavirus isn’t likely to disappear anytime soon. It will have a profound effect upon how GP practices around the country work as we move forward.
Video and phone consultations will be the new normal for the foreseeable future. Social distancing measures are already in place and we cannot return to the crowded GP waiting room of the past. Some patients will need a face to face appointment to assess their condition, and this can easily be arranged after a remote consultation, usually later the same day.
Letters, medical certificates and prescriptions are now sent electronically so that no-one needs to drop in to collect.
Patients who have come in for a face to face assessment have noticed our clinical staff using PPE, and this is likely to continue. We ask patients attending the practice for any reason to kindly wear a face covering.
Many of the more routine services available at Kingston Health Centre are reopening over the coming weeks. We have increased our opening hours again back to 7.15am to 8pm, resumed the Saturday clinic and will soon be restarting minor surgery and women’s clinics.
We are already planning how best to manage the winter months, particularly when it comes to the potential difficulties of differentiating COVID from the usual infections that are widespread at this time of year.
We are focussing work on those who are likely to be at highest risk of severe disease were they to become infected and looking at how we can help reduce their risk. For those with long-term conditions such as diabetes we will be trying to work more intensively with those with the greatest need. We are also looking at rolling out our weight loss programme ‘Weight- 2-Go’ remotely as obesity has been shown to be a risk factor for a more severe COVID illness.
There are likely to be continuing challenges ahead, but our priority will always be to provide safe and exceptional care for our patients.