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Thoughts from my experience in primary care at this stage in the pandemic and the busiest week I can remember in 20yrs. Firstly, it continues to get busier. Although covid contacts are up, that seems not to be driving it directly (Thread)
The biggest source of pressure seems to be easier patient access, delayed contact with us (for many reasons, not wanting to bother us, a perception that ours is a location to catch covid etc) and delayed 2y care review despite fab 2y care colleagues pulling out the stops
Ours is a tired workforce and triage/remote review is mentally exhausting. I suspect that “decision fatigue” is underestimated. Ten hours+ of more or less continuous quickfire decisions (some are big calls and require broad shoulders) is unsustainable.
I calculated that if the previous week’s contacts were replicated on last week’s on call day with a few staff down, it would be impossible to finish before midnight (fortunately didn’t transpire, so cross bridges etc)
Telephone contact continues to dominate but still seeing all F2F where necessary and everything takes longer - masking and gloving, cleaning down kit and couches/contact points between each patient. Video hardly used - resolution too low to add v much
Asynchronous online contacts are on the verge of tipping point and suspect additional growth in this area may prove unmanageable at current staffing levels. Easier contact is laudable but staffing may be overwhelmed
Primary care is more than GPs and I continue to be struck by the dedication and hard work of our admin and nursing colleagues. 2y care, too, going flat out and supporting us as best they can. Blessed that our fab patients also overwhelmingly understanding - it makes a difference
House visits - a more haphazard environment- to proven covid cases, in flimsy clingfilm apron & gloves/mask, takes courage for NHS workers (especially for those in high risk groups, which doesn’t include me) but who have, like me, not knowingly had covid.
On a personal level, it’s been sad for me to relinquish a (modest) academic university external role to focus on my patients. Sometimes works the other way, but only so many hours in a day and NHS work currently too demanding to take on too much extra work
Where next? I suspect the “return to normal” will crank up workload and I’m concerned about a significant silent cohort of colleagues for whom triaging and remote work is an unpleasant and stressful ordeal. Needs to be some sort of limiter on workload
Finally, despite work pressure, thanks to my fab colleagues, I had the pleasure of participating in a brief workshop on remote consulting last week. Our academic colleagues have our backs and gathering evidence to support us with a clearer picture of what works.
