There will shortly be a surge in Covid-19 mortality rates. It will be substantially smaller as a result of our intense 'whole of society' response. We have carefully observed lessons from China and Italy, courage has not been wanting, and society has worked to prepare with focus, sacrifice and good direction. Churchill is in vogue - his 'end of the beginning' phrase (1940) springs to mind.
Most doctor/patient consultations happen in general practice. If you regard consultations as key units of medical care, community based GP-led clinics are where much medical care happens. That service is now changed profoundly.
This week, some GPs and practice nurses are being taken out of practices, on request from the HSE, to establish 40 community hubs.
There will be two in Co Kildare (Naas and Newbridge), for example. This enables GPs to stream high probability acute Covid-19 cases away from local practices, into hubs, where they can be more closely evaluated. GPs and nurses in hubs will have focused training, and will use high-spec PPE, to make the process safer. Hub triage will increase the probability that correct referrals to hospitals will be made. People in 'routine' general practice will be better protected.
This will make it safer for people to re-engage with local GP teams for key tasks of childhood immunisations, chronic disease management, antenatal care, palliative care, termination of pregnancy and first-line care for everything else. Many essential GP services appear halted these past six weeks, but it's now important to get them carefully moving again, despite Covid-19. If we fail, women missing antenatal appointments will have delayed diagnoses of gestational diabetes and eclampsia.
Despite flexibility around prescriptions, people with multimorbidity should not fall behind on care, or this will become another important secondary wave of Covid-19 'collateral' damage.
GPs express concern privately that the elderly are terrified of leaving home, and attending any clinic. This is an important downside to cocooning. They are presenting much later with 'routine' acute medical problems.
Other expressed concerns among GPs relate to their situation as employers in small businesses. Most of us are now engaged in very intense and challenging telephone consultations, and personally busy, but surgeries appear deserted. It feels profoundly disconcerting. The sense of uncertainty is intense.
What will happen next? Based on evolving guidance from the Irish College of General Practitioners (ICGP) and the HSE, we will be able to direct high-risk Covid-19 cases to community hubs, making practices safer. Many GPs are now working up 'no waiting' protocols for their teams.
Some office appointments will now resume. If you feel you need an office appointment, contact your practice.
You will be asked about Covid-19 symptoms. If you do not have any, you may be given an appointment, invited to park outside, text on your arrival and following a further text or call from admin, go directly into a clinic room, directed there by text. You will have a very focused discussion about key issues. You might not get to sit down. In consultation, the principals of social distancing will be maintained as much as possible, with PPE used selectively, and only essential examination and procedures performed.
In this way, childhood immunisations can resume, essential monitoring blood taken, and essential focused physical examinations carried out.
The ICGP and HSE have revised and updated protocol for termination of pregnancy, to reflect the growing need and value of telemedicine in this, as in other areas of GP care. Social welfare certs are increasingly electronic - thousands of pieces of paper simply vanished this week, so it's not all bad.
Every general practice is different. If your routine appointments are overdue, contact your practice. If you have a medical concern, leave a message for your GP. It's essential to communicate troublesome symptoms.
Some circumstances are outstandingly important. Over 32,000 people die in Ireland each year from all causes. Just under half do so in the community, at home or in nursing homes. If you are involved in caring for any of these, it's important to maintain close contact with GP and local palliative care services.
Dr Brendan O' Shea is Assistant Adjuvant Professor (Public Health and Primary Care) at Trinity College and a Kildare GP
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