Mword Issue 69 - Dr Michelle Drage's latest update for GPs and practice teams

15 October 2020

Dear Colleague

With a challenging winter looming, I think it’s important for us all to take a moment to reflect on just how much we have achieved over the past 7+ months.

Confronted with news of a novel coronavirus, a global pandemic, and the resulting uncertainty, we all thought about the impact it might have on our patients, our friends, our families and ourselves, we took a collective deep breath … and rose to the challenge.

Pretty much overnight, we completely adapted to the need for maximum infection prevention and control to ensure the safety of our patients, our teams and ourselves so that we could continue to give of our best; we collaborated with each other to deliver safe services to our communities - even creating hot and cold sites to protect our staff and patients and help support our local A&Es and other hospital departments; we rapidly adopted digital tools to triage and manage patient needs in a safe and contactless way to minimise spread; we transitioned significant chunks of our duties to the virtual space, enabling those with caring or health needs to work remotely; we protected our vulnerable patients and helped them to shield themselves from infection; and we worked with care homes, delivering virtual ward rounds and reviewing patients, despite the challenges the virus presented.

You should be proud of what you have achieved professionally, and in your practice. And we at Londonwide LMCs will not submit to these efforts, and your continuing efforts, being undermined by poor reporting or darker forces. We will be by your side.

As we enter Tier 2 and prepare for further restrictions on how we work and live, just ten weeks out from Christmas and the winter breaks that would usually bring us closer to friends and family, my plea is this: look after yourself. Each of us face the prospect of being apart from friends, family and loved ones for far longer than we might ever have envisaged at the beginning of the year.

Alongside Covid, we have flu, winter pressure, dealing with the backlog of work built up since March, dealing with new work resulting from the network DES, screening, immunisations, shared care planning, minor surgery, contraceptive services, LTC management, non-Covid routine and urgent care, prevention and cessation work, changes to NHS 111 and A&E admissions, new roles to on-board and old targets to perversely hurry up and meet. But let’s be honest, the start and end of what we do as GPs is to provide holistic care to our patients. And we can only do that if we look after ourselves and each other. Our GP Support Platform is newly launched to help you through these difficult times, offering peer to peer professional advice and support, educational supervision and support, professional coaching, and talking therapy support. And our Londonwide LMCs Living Guide continues to set out what you should and shouldn’t do. I encourage you to continue to use it. Latest updates include a flow diagram on the febrile child, flu advice, and a pan-London testing update.

1. Truth to power.
   1. Interface issues.
   2. Covid safety and IPC.
   3. Inappropriate expectations.
   4. ARRS.
2. Cancer.
3. Flu.

a) Interface issues.

Despite reassuring comments that we are all in this together, reports of workload dumping continue. This activity, and the backlog, is having an unprecedented impact on GP and staff time and, we know, will impact on access and exacerbate health inequalities. We are calling on Trust executives to work with us to improve GP clinician/hospital clinician collaboration to resolve this. Please continue to share examples of inappropriate transfers of work to you and your practice.

b) Covid safety and IPC.

We take seriously the threat of infection and whilst it might seem obvious, we make the point whenever and to whomever we can that practices need IPC measures and safe PPE - just like hospitals – and that the necessary consultation spacing and infection controlling wipe-downs impact on time, footfall and F2F appointments.

c) Inappropriate expectations.

We are concerned that inappropriate expectations of general practice from the public, stirred up by negative media messaging, is being fuelled by the oft-repeated "Business As Usual" mantra, and the focus on the need to return to economic normality sooner rather than later. The resulting conflict and disconnection from the realities of the pandemic is undermining confidence and trust amongst some patients, and morale and resilience amongst some practitioners.

d) ARRS.

The ARRS needs to be flexed to allow any employment that will help right now, and the High Cost Area Supplement (London Weighting) needs to be funded as the entire scheme is under-recruiting, and underspent. We continue to push for London’s specific recruitment and workforce challenges to be recognised and not overlooked! Practices are so much more than the sum of their parts and I know how vital every team member is to the smooth running of an effective practice. I am currently working with Healthy London Partnership and Capital Nurse to highlight the value of general practice nurses in London.

Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs