GENERAL PRACTICE has changed drastically in the wake of the Covid-19 pandemic, adapting for the safety of both patients and staff .
Face-to-face consultations and packed waiting rooms have been replaced with video assessments and phone calls, as GP practices across Cork and Ireland have met head-on the constraints brought forward by the global crisis.
But while general practice has changed, Cork GP Dr Nick Flynn emphases that services are still very much there for patients during this difficult time.
“General practice is open for business, not business as usual, but open for all the usual business,” he said.
“It’s so important that the public understand this and know that general practice is still there for them for the routine stuff during this difficult period.
“We’re worried that people who are sick are not contacting us.
“At the moment, patients think we’re busy with other issues and they’re right, but those other issues are not more important than their own.”
There are real concerns about increased illness and mortality in relation to non-Covid-19 conditions.
“It’s important that patients contact their GP for advice on how best to manage their existing illnesses,” said Dr Flynn. “It’s important that people know general practice is open.
“Things like COPD, asthma, diabetes, heart disease, kidney disease - if we’re not managing those, patients are at home disimproving, getting sicker and things will be harder to manage down the line.”
Dr Flynn also explained that while GPs are there for their patients as usual, the times and challenges they face are not ‘the usual’, and that general practice has had to adapt to strange circumstances.
Five weeks ago, almost two dozen other medics from across Cork, including Dr Flynn, started holding weekly video conferences to discuss the challenges they face on a daily basis and how best to overcome them.
The group, which includes a professor of general practice, experienced GPs, nurse managers and nurses, use the opportunity to discuss PPE, infection prevention and control, care pathways, training, vaccinations, antenatal care, video consultations, vulnerable patient groups and more.
“It’s a chance for up to 22 of us to discuss things like personal protective equipment (PPE), training for PPE, vaccination programmes, blood clinics, antenatal programmes, patient care, and to figure out a new way of doing this,” he said.
“We’ve been using phone calls and video calls with the help of the WebDoctor app, which has been a big help.
“These meetings genuinely have helped us sort out care pathways, how to see people carefully, the important steps to take straight away and, now that we’re further down the line again, how we keep providing our services,” he added.
“We are back providing the care that needs to be provided but it’s just being provided in a different way.”
His own practices saw a 100% increase in calls in the weeks surrounding the HSE’s decision to broaden the criteria for Covid-19 testing.
“Our calls doubled for two weeks - we went from 2,000 to 4,000 calls in a week,” said Dr Flynn.
“Even now, we’re still dealing with more than 10% more calls every week, which is still around 40 or 50 calls every hour.
“We do a zoom call with the admin team every fortnight to see how they’re doing with the new technology and new care pathways, where patients are assessed first over the phone and then given a video or face-to-face appointment if needed.
“We have protocols in place to ensure patients can be seen face-to-face safely, to protect the patient and ourselves.”
As well as a patient safety station containing antibacterial aids and protective equipment at practices, Dr Flynn and his colleagues have changed their own work practices to protect staff as well as patients.
“We’ve introduced daily temperature checks for ourselves as well as handwashing and social distancing guidelines and infection protocols,” he said.
“We also started using cotton face masks for all staff recently.
“In preparing for this, we’ve spent around €8,000 on PPE and we’ve spent over €10,000 on our IT infrastructure to facilitate doctors working from home,” he added.
“It was a big ask for us to do that but we’re happy to do it for our staff and of course, our patients and service.”
Like many practices and healthcare settings around the country, Dr Flynn has lost colleagues to the Covid-19 testing hubs.
“Two doctors from our practice are going to the Covid hubs, which we’re happy to support them in, but it is a drain on our own resources,” he said.
“It makes the other doctors that little bit busier here but it’s still important for patients to get in touch with any concerns.”
Dr Flynn explained that most general practice clinics are now working through similar methods due to the current pandemic.
He explained that, due to the unprecedented circumstances, healthcare services have had to determine their previous output and try to continue to match this despite the constraints.
Looking to the future, he believes the methods introduced now can have a positive impact on general practice in the long run.
“I think that there are some things that needed to change,” said Dr Flynn, citing figures that suggested 80% of SouthDoc attendances were non-urgent prior to the Covid-19 pandemic.
“We’re not seeing the majority of those attendances now and that’s a good thing, particularly for rural areas, which are more likely to gain more doctors if the SouthDoc rota is less onerous.
"The introduction of video appointments for our own patients - where doctors know their patients and there is continuity of care - is a great addition,” he added.
“The tagline for these video appointments have been ‘the patient will see you now’ rather than the other way around so it’s great for patients.
“If a patient has an 11.30am appointment for a video call and they’re at work or at home, they can just go into a private room and take the call - they don’t have to physically go to the practice and take hours out of their day.
“If the video call needs to be transferred to a face-to-face appointment, they’re not charged any more for that - it’s a great service.
“I think it will make general practice more efficient in the future.”