In Conversation with a GP Surgery about the COVID-19 Crisis

Figure 1 - Thank you to the NHS! Reprinted from Ref [1].

COVID-19 has turned our world upside down, with lockdowns, social distancing and wearing masks. It is a new time for everyone, across the world. As of July 28th 2021, 4,183,365 people worldwide have died from the virus, with the UK having the 7th highest number of deaths [2]. 

But one force for good that has helped us, the UK population, get through the pandemic is the amazing NHS (National Health Service) staff; people who are risking their lives to keep us safe.

Yet, it hasn’t all been rosy for the NHS. The NHS has faced an incredible array of issues during the COVID-19 crisis, ranging from a lack of hospital beds to challenges with PPE (personal protective equipment) supplies. But it’s not just those who were working in ICU or COVID wards - the local primary care NHS staff (those who are often the first point of contact in the healthcare system) have had a huge impact.

So, to dig deeper into the true story of primary care NHS staff and COVID-19, I interviewed a team of GP surgery staff, to really find out what COVID-19 has been like for them. The names of these NHS staff have been removed to protect their privacy, but their words are their own. 

First off, what is the NHS?

The NHS stands for the National Health Service, and is an umbrella term used to describe the 4 distinct health services across each of the 4 UK nations (NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland). The NHS provides free medical care and services for all of the UK population and access to services is based on a person’s clinical needs, not their financial status [3].

Here is what each position mentioned in this article means and what their roles are:

GP: stands for General Practitioner. UK equivalent of Primary Care Physician [4]. 

Roles include: 

• Meeting patients

• Diagnosing symptoms

• Prescribing medications

• Giving health advice

• Carrying out body examinations 

• Referring patients to specialist services. 

Pharmacist: Also known as chemist or druggist [5].

Roles include:

• Dispensing medicines

• Giving advice on medications and prescriptions

• Ordering and controlling medication stocks

• Running screening programs 

GP pharmacists have slightly different roles adapted to GP surgeries.

Practice Manager: also known as GP surgery manager [6].

Roles include:

• Recruiting and training new staff (eg. receptionists)

• Paying wages to staff of GP surgery

• Managing patients and appointments system

• Managing maintenance of GP surgery

• Controlling stocks of medication and equipment

Next, the definitions of some NHS terminology, which are specific to NHS England, that are mentioned in this article:

PCN: stands for Primary Care Network. PCNs build on existing primary care services and make health and social care more accessible to people [7].

CCG: stands for Clinical Commissioning Group. CCGs decide which NHS services are needed for the population of their local area(s), and make sure that they are provided. All GP surgeries belong to CCGs, but CCGs also encompass other healthcare professionals, such as nurses and pharmacists [8].

Now here’s what the staff had to say...

What were your jobs and tasks in the GP surgery during the COVID-19 pandemic? How was it different from the pre-COVID time?

GP 1: “Overall, our jobs and tasks were the same. But the main difference was the way we had to do our jobs. We had gone from face-to-face appointments and clinics to remote appointments, essentially overnight. As a GP, the change from face-to-face to remote clinics definitely took a lot of time to get used to. We also had to reassure patients a lot, saying that this was a secure and safe way to talk about and show us their health concerns.”

GP 2: “We had to ensure all our staff were kept safe, protected,  and informed whilst also continuing to do the best we could for our patients. We also constantly had to deal with infection control and health & safety, while dealing with the constantly changing COVID-19 story.”

Pharmacist: “Overall my tasks didn’t change too much, but I did have to do a bit of work on COVID. For me, the main change was how my tasks had all changed from in-person to online.”

Practice Manager: “As a practice manager, my jobs were different to the other clinical staff. But the big and new challenges were working from home, dealing with isolation and using different tech and knowledge. It was quite tough training staff for online work and my day-to-day work had also changed a bit. It was mainly a lot of training and teaching staff for online work, which was quite different from their normal training. 

How has COVID-19 impacted your well-being, physically and mentally?

GP 1: “The way I work is that when I’m given a job, I just get on with it until it’s finished. Along with being a GP, I work for a PCN for this borough, and that meant I had to do a lot of work, not just meeting and discussing issues with patients, but also trying to keep the whole borough as safe as we could from the pandemic with different schemes, like vaccination buses. It was essentially quite a rapid learning curve, having to deal with 12-hour shifts turning into 14 hours and other problems like that. Thankfully, I can say that the pandemic hasn’t affected my physical and mental health as much because we have an extremely good support network in our GP surgery, so we can always talk to each other if we ever have any problems or concerns.”

GP 2: “I’ve essentially been running on adrenaline for 9 months and I totally neglected myself and my well-being due to being totally immersed with COVID related issues, like case rates and vaccine clinics.”

Pharmacist: “Mentally, the pandemic had a toll on everyone at the surgery. Knowing that quite a few of the patients had passed away was quite distressing for me. I also work for a local CCG, and a lot more has changed at the CCG compared to the GP surgery, including managing and visiting care homes. Visiting care homes during the pandemic was extremely distressing, because of all the suffering during the pandemic. I also work at the vaccine clinics, and all of the stress and long shifts made me feel both physically and mentally tired.”

Practice Manager: “In terms of my physical health, I myself had tested positive for COVID-19, so it took me around 6-8 weeks to go back to my normal self. In terms of my mental health, I was initially very stressed because my working patterns changed and we didn’t have a plan for the future. This meant that I had to adapt to the situation very quickly, to get work done.”

How do you think the UK Government managed the COVID crisis?

GP 1: “Overall I think that until the vaccination program started, the COVID crisis was quite mismanaged and disorganised by the Government, and it could have been managed better, especially the Test and Trace system that was implemented. In my opinion, they should have given the Test and Trace system to primary care staff like GPs. We know our patients quite well and can efficiently deliver a system like this, as we’ve done with the vaccination program. It was a good idea to give the vaccination program to primary care staff, but lockdowns could have happened a bit earlier as well.”

GP 2: “In my opinion, the crisis was poorly managed on several fronts. There was a lot of conflicting advice and there was a complete disregard for the welfare of front line workers and the most vulnerable in our society, such as elderly people in care homes.”

Pharmacist:  “The crisis was extremely poorly managed, some other people could have managed it much better. The way COVID was managed here was shocking and I was really not impressed”.

Practice Manager: “Overall, the pandemic was managed quite well by the UK Government, because it was a new situation. From my point of view, everything was managed quite well, except for the PPE situation. There were ups and downs but overall it was good.

As an NHS staff member, what was your opinion on the lockdown plans by the UK Government?

GP 1: “In my opinion, the first lockdown was a bit too late because many deaths and cases were already reported. Also because we essentially had a hiatus of lockdown in the summer of 2020, cases started rising again and that definitely helped fuel the 2nd COVID-19 wave in September 2020. So if the 2nd lockdown also happened a little earlier, it would have helped decrease our overall case and death count.”

GP 2: “Overall it was too little too late. If they had introduced the lockdowns earlier and stronger restrictions, it would have been more beneficial for all of us”

Pharmacist: “It was too late by around 3 weeks. The Government could see what was happening to the world, yet their actions were very poor. They had a wrong attitude about this pandemic and they should have acted much faster.”

Practice Manager: “It wasn’t pre-defined well, so people didn’t really know what was allowed or not allowed during lockdown. The lockdowns had a big impact on everyone and gave people a lot of mental stress. The lockdowns weren’t too well managed though they were good for the country. What was allowed and not allowed should have been defined better, to give more information to the population. 

What is your opinion on the current status of the vaccine rollout? How can we improve this further? 

As of 11th July 2021, 87.2% of UK adults have received a first COVID vaccine dose and 66.2% of UK adults have received a second COVID vaccine dose [9].

GP 1: “Overall, the vaccination program has been great up and down the country, and primary care staff like us GPs have definitely helped a lot with tasks like background work all the way to vaccine administration. Our volunteer staff have also been helping a lot with the vaccine program, all the way since December 2020. Factors that have been limiting our progress though are workforce problems, because most of our volunteer staff have to now go back to their normal day jobs and most of our staff are also just tired from having to do shifts until 9pm or 12am. Another problem has been how much vaccine has been available. We’ve only been getting a vaccine delivery schedule every 2 weeks, meaning we have to plan our vaccine clinics in extremely short periods of time. Vaccine shortage has also been an issue because we’re trying to get everyone vaccinated as fast as we possibly can”

GP 2: “It honestly seemed like a disaster waiting to happen but we turned it around thanks to the superhuman efforts of our colleagues in the NHS and the army of volunteers who busted a gut to get things going.”

Pharmacist: “Nationally, the rollout was decent, but it was all down to the work of frontline workers and other vaccine staff. A problem we had to deal with was the conspiracy theories that had been made about the vaccine, though all of them were found to be false. In my experience, these theories were mainly in the South Asian community, which was also the main ethnic group that was hospitalised in this local area. People didn’t know much about the vaccine, so trying to get information and the overall message across was a lot of work”

Practice Manager: “The current rollout is going well, but there should have been better planning. If the Government had opened more larger spaces and walk-in centres, then our vaccinations would have been done a lot quicker. We started our rollout quite early, back in December 2020, yet we are still behind. 

What do you think was the worst time during the pandemic for local NHS staff, like yourself?

GP 1: “I think that the beginning of the pandemic was the worst time for us local NHS staff. We were essentially dealing with a virus that none of us knew about that well, and many people were contracting COVID-19 and others were dying in hospitals. Many of our patients were also extremely worried about this new virus, so overall, it was quite disorganised for all of us NHS staff at the beginning. As the pandemic continued, we learnt more about this disease and were able to manage patients and clinics much more easily.”

GP 2: “Probably April-May 2020, because we were honestly expecting the worst for the UK after seeing the carnage that had stuck Italy”

Pharmacist: “January 2021 was probably the worst month. Though it was bad for us, it was especially bad for secondary care. At a local hospital, the ICU had a 100% COVID mortality rate. One good thing about working in primary care was that we were shielded from the horrors of hospitals.

Practice Manager: “The peak in January 2021 was the worst time. The pandemic was very badly managed everywhere. Our first phase of vaccinations had started but January was very horrible and had a big impact on primary and secondary care. There was a cycle going on, in which people were going to secondary care, but then they were referred back to primary care, though we didn’t have the capacity to handle these problems. These problems are normally dealt with in a hospital.”

In what ways could the impact of the COVID-19 pandemic have been reduced in the UK?

GP 1: “The main ways were definitely earlier lockdowns along with a better managed and earlier occurring Test and Trace system. The vaccine program is currently going well, but they need to be better structured to allow more people to receive the vaccine quickly.”

GP 2: “Preparation is the key, in a situation like this. We need to ensure the nation has a disaster recovery plan that is backed up by sufficient reserves of essential stock. Allow the experts and not the politicians to run the programme.”

Pharmacist: “The main way would have been earlier action. If lockdowns and restrictions had started earlier, we would have been able to avoid a lot of deaths and hospitalisations. 

Practice Manager: “I am not completely sure, but in my opinion, earlier lockdowns and faster vaccinations would have sped up our recovery from this pandemic.”

Why were primary care staff so important during the pandemic?

GP 1: “Essentially, primary care is like the backbone of the NHS. I would say around 90% of NHS appointments and encounters are with primary care staff. People also know primary care staff, like their local GPs and nurses, much better than they would know hospital doctors. We, as primary care staff, are constantly in our patients’ lives and our patients put a lot of trust in us because they know us very well. Hospitals are important but primary care is extremely important, especially in an unprecedented time like this.”

GP 2: “As primary care staff, we are the backbone of the NHS. Over 90% of NHS activity occurs in primary care so naturally, a lot of the work falls on us.”

Pharmacist: “Primary care staff are the first medical staff that are consulted whenever there are any health issues for someone, and that includes COVID. Most people consulted their GPs first when they had initial COVID symptoms, though hospitals had to deal with severe symptoms. 

Practice Manager: “As primary care staff, we are the first point of contact for everyone with medical concerns. Patients need health advice and support, which is really important. But they can’t talk to a hospital directly, so instead, they ask us.”

Finally, what advice would you give about staying safe with COVID? Especially since there are new variants (such as the Delta variant) that are on the rise.

GP 1: “Honestly, my advice would be to stay vigilant and not let your guard down during this pandemic. Follow all the Government regulations like washing your hands regularly and covering your face with a mask or face shield. Also when given the chance, get vaccinated, because the more people that get vaccinated, the quicker we can be out of this pandemic.”

GP 2: “We just don’t know enough about the disease as of now, especially the new variants, so for now, let’s lean on the side of caution and safety and continue to stay on our guard.”

Pharmacist: “First of all, get vaccinated. If you are given the chance to get the vaccine, take it. The faster everyone is vaccinated, the faster we get out of this pandemic. But even if you have been vaccinated, continue to take precautions and follow the restrictions that are in place. If you don’t follow precautions, you could still pass the virus onto others, like the elderly. That is specifically for young people as well. Not all, but some young people have been very selfish during the pandemic and not been following restrictions.”

Practice Manager: “We should protect ourselves and stay safe. Continue to wear your mask and social distance. Follow guidelines until everything is gone. Also, get vaccinated when you can and avoid big gatherings. Essentially, protect yourself to protect others.”

Conclusion

Overall, the responses show that COVID-19 had an incredibly large impact on our local NHS staff. The pandemic is not over, meaning that these surgery staff will have to deal with this virus until COVID-19 is eradicated. But the efforts of all the NHS staff in the country have not gone to waste, because their collective fight against this virus has helped us come to the place we are today in the UK. This is where SDG 3 comes in. The NHS and their staff, whether primary or secondary care, help the UK population maintain good health and wellbeing, and are the ones we turn to in times of health and medical crisis, no matter how big or small.

Acknowledgements

Special thanks to the 4 members of NHS staff who took the time out of their busy schedules to contribute to this article.

References

[1] Nicolas J Leclercq, “purple and pink heart shaped illustration photo,” Unsplash, July 14, 2020. [Online]. Available: https://images.unsplash.com/photo-1594760394382-150da4d8c2b1?ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&ixlib=rb-1.2.1&auto=format&fit=crop&w=1350&q=80. [Accessed 9 June 2021].

[2] J. Elfein, “Number of novel coronavirus (COVID-19) deaths worldwide as of July 13 2021, by country,” Statista, July 13, 2021. [Online]. Available: https://www.statista.com/statistics/1093256/novel-coronavirus-2019ncov-deaths-worldwide-by-country/. [Accessed 13 July 2021].

[3] Department of Health and Social Care, “The NHS Constitution for England - GOV.UK,” gov.uk, January 1, 2021. [Online]. Available: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england. [Accessed 17 July 2021].

[4] National Careers Service, “GP | Explore Careers | National Careers Service,” gov.uk, n.d. [Online]. Available: https://nationalcareers.service.gov.uk/job-profiles/gp. [Accessed 13 July 2021].

[5] National Careers Service, “Pharmacist | Explore Careers | National Careers Service”, gov.uk, n.d. [Online]. Available: https://nationalcareers.service.gov.uk/job-profiles/pharmacist. [Accessed 13 July 2021].

[6] National Careers Service, “GP Practice Manager | Explore Careers | National Careers Service,” gov.uk, n.d. [Online]. Available: https://nationalcareers.service.gov.uk/job-profiles/gp-practice-manager. [Accessed 13 July 2021].

[7] National Health Service England, “NHS England >> Primary care networks,” NHS England, n.d. [Online]. Available: https://www.england.nhs.uk/primary-care/primary-care-networks/. [Accessed 13 July 2021].

[8] National Health Service England, “ NHS England >> Clinical Commissioning Groups (CCGs),” NHS England, n.d. [Online]. Available: https://www.england.nhs.uk/ccgs/. [Accessed 13 July 2021].

[9] GOV.UK Coronavirus (COVID-19) in the UK, “Vaccinations in the UK | Coronavirus in the UK,” gov.uk, n.d. [Online]. Available: https://coronavirus.data.gov.uk/details/vaccinations#card-vaccination_uptake_by_report_date. [Accessed 17 July 2021].