It is over 100 days since the World Health Organization declared COVID-19 a pandemic on 11 March. Healthcare services have adapted fast and continue to adjust. With UK case numbers falling, lockdown restrictions are being progressively lifted. GPs and other healthcare workers must prepare for increasing demand for routine care alongside possible local flare-ups of COVID-19.
A survey by the British Medical Association (BMA) (18 June) revealed that over half of GPs have little or no confidence in their department being able to manage patient demand as normal services resume. Many are understandably concerned about a second peak of COVID-19.
So how should you ensure safety and wellbeing of staff and patients as normal services restart?
Keep up-to-date with practice guidelines
As priorities change, keep up-to-date with the latest guidelines. Be aware of the new standard operating procedure (SOP) for general practice in the context of coronavirus (COVID-19) from NHS England. Health Protection Scotland and Public Health Wales have issued their own guidelines.
To help make sense of the new guidelines, the Royal College of General Practitioners (RCGP) has published ‘Coronavirus –Top 10 tips on what to do in primary care’ and BMA provides COVID-19: toolkit for GPs and GP practices.
RCGP and BMA also provide joint guidance on workload prioritisation during COVID-19 – pandemic level reducing.
For nurses and paramedics, the Royal College of Nursing (RCN), College of Paramedics, and The Royal College of Emergency Medicine (RCEM) offer specific COVID-19 resources.
Maintain social distancing
Social distancing measures are still essential. Where possible, telephone or video assessments continue to be a first step for patient appointments. The RCGP COVID-19 Resource Hub provides advice on remote consultations and triaging.
Guidance for people with symptoms of COVID-19 remains unchanged: those who have symptoms should self-isolate for 7 days and their household contacts must self-isolate for 14 days.
Advice for those who have been advised to shield is changing so review this regularly.
Know the latest on testing
Anyone with COVID-19 symptoms can now access swab testing in England and Wales to see if they currently have the virus. In Scotland and Northern Ireland, this applies to anyone aged 5+. Tests for essential workers, including NHS staff, are prioritised.
You can find out how to access testing for staff and patients in guidance from GOV.UK.
Of course, no test is 100% accurate and BMJ has published a useful guide to interpreting a COVID-19 test result.
You can also find information on the NHS test and trace system. This system will contact people who have been in contact with a known case and ask them to self-isolate for 14 days.
Prepare for questions about antibody testing
In May, the government announced a programme of antibody testing in England. Lab-based antibody testing of blood samples is now available to NHS and care staff. Where appropriate, clinicians may also request tests for patients in hospital and social care settings.
Antibody testing indicates who has had the COVID-19 virus and developed an immune response. Results help to improve the accuracy of data on how the virus is spreading.
Importantly, there is no strong evidence that if you test positive you will have long-term immunity that protects against re-infection, so social distancing is still important. However, research on immunity to COVID-19 is underway in a PHE study, SIREN, involving 10,000 healthcare workers.
Maintain appropriate use of PPE
Follow updated guidance on COVID-19 personal protective equipment (PPE). Advice includes specific recommendations for primary care staff, as well as ambulance staff, paramedics, and other settings.
PHE offers additional COVID-19 guidance for ambulance trusts and RCN provides its advice on PPE.
According to BMA tracker surveys, while PPE supply remains a concern, there have been improvements since the start of the pandemic.
If you need information on accessing supplies, NHS England provides details.
Care for those who’ve been caring
COVID-19 has placed many healthcare staff under immense strain. According to the BMA tracker survey (18 June), over a quarter of GPs reported worsening mental health since the pandemic.
This highlights the need to support the mental wellbeing of healthcare workers. RCN Chief Executive & General Secretary Dame Donna Kinnair urged: “As we move past the peak of the epidemic, we must care for those who’ve been caring.”
You may find the following resources helpful:
Medical Defense Society is available 24/7 to provide support for peace of mind. If your clinical duties have changed during the pandemic, or you are returning to the workforce, contact Medical Defense Society for advice about membership.