At a time when the British Medical Association is complaining to the government about lack of PPE (personal protective equipment), we are publishing here an interview by Dave Cartwright, on behalf of Left Horizons, of a GP working in Glasgow. She was able to speak about her experiences of caring for patients during the pandemic, and these are her own words:
In the first few weeks of the virus outbreak, we were busy with preparation, making sure all records were up to date, in case patients needed to go into secondary care. It was very quiet. Patients were holding back on presenting; they didn’t want to go into hospital. But in recent weeks it’s become busy. Patients have been very good, knowing they shouldn’t come to the clinic and that we need to practise a different way. But we have lots of “multi-morbid” patients with lots of diseases. We would normally see these patients face to face, which is the best way to understand which of their diseases is the current problem, but we’ve had to weigh up the risk of passing the infection from us to them or vice versa. We follow national guidelines and do consultations by phone. We have to practise in a very different way to keep patients safe.
Struggling with lockdown
The other reason we’re busy is that patients with mental health problems are struggling with the lockdown. Our staff members don’t sleep well, so if you compare that with patients with anxiety and depression it’s much, much harder for them. It’s really challenging for those who are “shielding” and have to stay at home for 12 weeks. It’s reassuring – the letter they got from Government – giving them a number to text to get food deliveries. In Scotland, we have also link workers attached to some practices who can support patients.
I think that the UK Government probably admits now that the approach taken to testing initially was not right. To me it seemed very important to follow what the WHO was saying and that was “test, test, test” and that probably wasn’t on the Government’s horizon at the beginning. In the Lancet at the end of January there was an article saying that Covid-19 was the stuff of an epidemic. But the response was probably affected by the ideology of the decision makers. I think the UK was a bit slow out of the starting blocks. Without enough testing early on it meant we didn’t know where we were and the virus spread. The herd immunity idea is something that is probably regretted now. And when we moved from the ‘contain’ to the ‘delay’ phase the failure to quarantine people returning from high risk countries could have enabled the virus to spread.
Given apron instead of a full gown
With regards personal protective equipment (PPE) the initial explanation was that there were difficulties getting it to the places where it was needed rather than the fact that we just didn’t have enough. PPE is now clearly a global market. All countries are struggling. I was initially critical when I was given an apron to wear instead of a full gown. But I see the need for prioritisation. Carers need it most, nurses and hospital staff and those in other hotspots. We have good guidance on how to deal with patients safely. At the moment we have enough supply. But will we have enough in the future? With a world market for test kits and PPE it’s a question of survival of the fittest. Where does that leave poorer regions like Africa, Latin America and India? We need a co-ordinated world-wide effort to increase production.
Privatisation pursued more aggressively
I think Scotland has a slight advantage over the UK as a whole. The virus started here later but we went into lockdown at the same time. The extra couple of weeks will help. From talking to colleagues in England, Scotland appears to be better resourced. Also, privatisation has been pursued more aggressively in England. England also has mega practices in primary care. I prefer the small practice model where you know your patients better. That has helped during this crisis compared to those mega practices which can have anything up to 60,000 patients.
The problem the UK is facing in general, is health policy over last 10 years. The Kings Fund had a publication in 2017, updated in March 2020 about NHS hospital bed numbers. It reported that the UK has fewer acute beds per head of population than comparable health systems. In 2018-19 bed occupancy averaged 90.2% and regularly above 95% in winter, well above what is considered safe. I understand that the experience from other countries is that, if you are able to admit people earlier into hospital you might have a slightly better outcome. But we start with not having many beds. A report on the BBC website about critical care beds showed that the USA had 34.7 per 100,000 population, Italy 12.5 and the UK 6.6.
We have to mention something else that’s very important. In a clip from Newnight, Emily Maitlis clearly describes how much harder it is for the socio-economically deprived. Starting with lockdown and it’s effect on mental health, it is harder if you’re in a small flat, no garden, with two kids in one room, with all the tensions that brings. Then you add in other risk factors like obesity rate and diabetes that are more common in these areas, it means these people are getting sick earlier. Scotland is slightly more unhealthy than the UK as a whole creating bigger risks here. People have longer periods of ill health. We know the virus is indiscriminate but people in poverty are harder affected. With the lockdown it’s harder for the support networks to operate. And it’s harder to get people into these support networks as face to face contacts have to stop.
Ideological undermining of NHS for ten years
People around us have responded in a really positive way. They have gone above and beyond. Like the IT Teams who have set up remote working and videoconference facilities. We have also had good management support. Red tape has been put to one side. I’m not saying there’s a good side to this, people aren’t sleeping well, but everybody is pulling together and trying to support each other.
Going back to PPE and testing, these were all mistakes that were made. It was annoying but for me the main issue is the ideological undermining of the NHS for ten years. Recruitment and retention was an issue especially in England. Staff who were caring left the profession. They were sorry to leave a job they loved but felt they couldn’t provide the level of care they thought was the minimum. At the moment you have lots of people returning, because this is different, with resources being made available. If you look at the wider workforce, cleaners, nurses, doctors we are all trying to work together to provide a really good service for our patients. But we shouldn’t forget that the NHS had suffered really hard from 10 years of ever increasing “efficiency savings”. And we also need to consider the social care sector. They both need to go together and be sorted out together.
April 11, 2020
