Covid-19, or more precisely the reaction to it, is playing havoc with our economic and healthcare institutions. So why is the waiting room in my surgery quieter than usual for this time of year? The sense among some other GP colleagues is that the NHS 111 phone line is doing a good job of directing possible cases to testing facilities in nearby hospitals (despite the stories of incorrect advice in some cases), while the worried well are staying away for fear of picking up something nasty in the surgery.
Mind you, as one GP said to me: “ Don’t jinx it. If you write that the waiting room is less busy, people will pile back. And anyway, this is just a temporary lull before a post-virus onslaught of all the saved-up problems.” The real worry is that some people are staying away who may be seriously unwell. The undiagnosed cancers, untreated pneumonias and poorly controlled angina, high blood pressure, diabetes and asthma that require medical intervention haven’t gone away just because Covid-19 has stolen all the headlines.
But there are some unintended positive consequences of the crisis. Of course Covid-19 is a highly undesirable, potentially dangerous and massively inconvenient nuisance at best, and a major threat to the public health at worst. But it is has catalysed change and nudged behaviour in some interesting and useful ways. NHS 111 has been catapulted into a role as a highly effective, national fighting force. It’s not perfect but it’s rapidly improving, and is a resource to be proud of and grateful for. One should contrast it with the reports coming out in the US about the patchy approach to testing and management. Once this storm has passed – be in no doubt, however scary it seems now, it will – using NHS 111 as an information resource will be more firmly embedded in the national psyche.
GPs have been offering phone consultations and communicating by text and email with patients for some time. But most of us haven’t offered the Skype consultations that innovative (or predatory, depending on your take on it) outfits such as GP at Hand, backed by the AI platform Babylon, have. Now we’re being forced into the 21st century at a dizzying pace. Cash-strapped clinical commissioning groups (CCGs) that until a few weeks ago had no spare money for anything are getting cash injections from government to encourage us to see patients remotely. It’s taken this modern plague to set up a system that should have happened long ago. It’s likely to be so popular with our patients that it will be hard to ditch it.
And another positive outcome is a level of personal hygiene among the public at large that has never been achieved before. Admittedly, it’s not an edifying sight when people repeatedly try to nick the hand sanitiser from under the receptionist’s nose. And some patients have been angry that we haven’t been given supplies of sanitiser, masks and gloves to hand out to them. But I’ve been ostentatiously washing my hands to a couple of “Happy Birthdays” before each patient, which is a good habit that I should never have got out of in the first place.
In the surgery, we’ve also become more conscious of the risk that our patients with poor immunity face every time they sit in our waiting room. This is true every winter when there are lots of people, a melange of viruses, long waits to be seen and, often, closed windows. We need to remember the lessons of this winter and find ways of making a trip to the doctor less likely to make you ill.
A haematologist told me today that their patients, who are often extremely immunosuppressed and susceptible to life-threatening infections, are now asked to stay in their cars in the car park and are texted when it’s time to nip up for the appointment. It’s a great idea, which could be rolled out across the health service. Let’s hope they don’t stop this considerate approach when the dust settles.
It’s not all good news, though. The disruption to travel risks jeopardising vital supplies for healthcare. Perhaps Brexit planning means that supply chains and contingencies are in place; that would be a welcome silver lining. But stem cells needed for vital bone marrow transplants for patients with blood cancers are sometimes brought in from countries such as Germany, and there is a real concern that couriers may not be able to travel to bring the precious cells. The more UK residents who are potential donors, the less reliant we will need to be on imported cells. If Covid-19 persuades more people to sign up to save lives, that would be a truly heroic response.
• Ann Robinson is a GP