Dr Aravinth Balachandran, an NHS GP in Kent and Chief Medical Officer at eConsult describes three ways to help keep the NHS functioning over winter:
Dr Balachandran explains how this winter will provide;
an opportunity to assess how we manage contagious diseases, treat patients and keep staff safe going forward
While lockdown measures in the UK have eased since the emergence of COVID-19, the pandemic has not gone away. With a rise in cases in parts of Europe such as France and Spain, as well as regional lockdowns being implemented in England and Scotland, there is a real concern that a second wave of the virus could be here soon and last throughout winter.
What will probably make this wave different from the first is that it will coincide with the ‘normal’ flu season. We all know that this winter period is a traditionally busy time for the NHS, with vaccinations needing to be provided to the elderly and vulnerable and the occupancy of hospital beds increasing as cases rise. Adding scores of COVID-19 patients, with similar symptom profiles making it hard to differentiate between the two, will create a real problem for a health service that is typically strained over the winter period. With the Government also announcing that flu jabs will cover all over 50s, this widening of the eligibility criteria will only further add to this.
There is no doubt the NHS and our clinicians were put under tremendous pressure when the pandemic first hit. If a second wave does strike during flu season, we must come together and do all we can to alleviate pressure on the health service during what will be an extremely testing time.
As a GP, I see three ways in which we can all help the NHS to keep functioning this winter while also dealing with COVID-19 fluctuations:
1. Reducing unnecessary face-to-face contact
During the height of the pandemic, in the interest of safety, it was imperative to reduce unnecessary face-to-face contact between clinicians and patients and maintain social distancing. While traditionally a physical appointment in the GP practice is the main point of contact between patient and doctor, we were already starting to see this change through the use of digital consultation platforms. This usage has accelerated rapidly since the pandemic began, with 71 per cent of consultations being delivered remotely during the first wave. Remote consultations were embraced by GPs as a way to keep safe and prevent the spread of COVID-19 while still allowing patients to receive the care they need.
Continuing to use these platforms and raising awareness of their availability before a second wave occurs will mean that more patients will be able to share information on symptoms or seek advice from home. This will help stop patients catching or spreading the disease in practices, particularly in the winter months when demand rises, preventing cases increasing and rising numbers of people needing treatment for COVID-19. As well as this, it will free up space for the higher than usual numbers of patients that will have to visit their GP to receive a flu jab, relieving pressure on staff who will have a lot on their plate already because of this increase. With pharmacists and more healthcare professionals to be trained to give the flu vaccine, easing some of the pressure on clinicians could also give them the time to provide this training, ensuring as many staff as possible are prepared to vaccinate patients.
2. Preventing infection and spreading in practices
With all over 50-year-olds requiring the flu vaccine, large numbers of people at higher risk to the effects of COVID-19 will have to attend GP practices to receive their jabs. If a second spike does occur, these patients need to be protected so that they can be inoculated without the risk of being exposed to Coronavirus.
Practices need to ensure that they assess anyone with COVID-19 symptoms and determine if they need a face-to-face assessment or can be safely managed at home. If patients are able to contact their GP before attending the practice, clinicians can assess them remotely and determine what the subsequent management steps should be.
By limiting the potential of patients with COVID-19 symptoms entering the surgery, more vulnerable patients who are attending their practice to get their flu jab or receive any other face-to-face care will be doing so in the safest possible way. This assurance that high-risk patients are in a low-risk environment when receiving care, particularly during flu season, could also have wider implications on how we deliver healthcare going forward. It could ensure we are keeping both patients and staff safe even in a non-pandemic environment as exposure to infectious agents and patients is minimised.
3. Dealing with backlog
During lockdown, practices had to adapt to circumstances which may have impacted their usual activities such as chronic disease management. Focus understandably needed to shift to triaging patient demand to better identify not only critically sick patients but also patients with COVID-19 symptoms. Getting used to new consultation methods, and limiting the number of patients brought into the practice has impacted care delivery, as demonstrated by the worrying statistics on decreased cancer referral rates.
Tackling growing backlogs in routine work will help to prevent these lists growing in the case of a second wave of COVID-19. Holding a face-to-face consultation to conduct an annual review takes time and effort for both parties and some of these annual reviews could be more efficiently managed through online consultations. If patients can provide updates on their long term condition remotely, the GP can quickly review and decide the most appropriate course of action, be it via text, telephone, video or, if deemed necessary, a face-to-face consultation.
No one can say for sure what is around the corner but what we can do is prepare and be ready for what might come. Staff and patient safety need to be at the forefront of our thoughts as we approach winter, flu season and a possible second wave of COVID-19. Through reevaluating established processes and embracing alternative solutions, we may be able to ease some of the pressure the NHS will face in a worst-case scenario and give it the best possible chance to tackle both viruses. This also provides us with an opportunity to assess how we manage contagious diseases, treat patients and keep staff safe going forward. Looking for and embracing new solutions could change how we provide care, ensuring everyone can give and receive the best care possible.