As well as writing a big explainer article about the structure of the NHS in London, Joshua Neicho has been talking to healthcare workers in different settings during the coronavirus crisis. Below is the extraordinary and moving account of Francina Hyatt.
“Driving home from the surgery where I work as a practice nurse one day a week, I get a lot of people waving at me. I’ve never had that before in my career. The surgery is near Ikea in Croydon and run by AT Medics, the biggest GP consortium in London. I work as an hourly-paid sessional locum alongside four days a week as a senior lecturer/practitioner at Kingston University.
For face-to-face consultations, I’m donning PPE and making sure I’m social distancing. There’s a point when you realise a child is looking at you and thinking, Who are you? So you take your mask down, smiling, but you’re safeguarding them and trying to safeguard yourself. You’re playing with the child’s dolly and explaining to the parents things such as their child may get a high temperature immediately after a vaccination, but this doesn’t mean the whole family need to self-isolate unless other symptoms are seen suggesting Covid-19. You’re thinking ‘virus’ all the time.
I’m doing a lot of telephone triage. You explain to callers that there’s an impact on services, that the NHS is working differently. You’re sitting a lot, which gets uncomfortable – I have found that I’ve had to stand. I’m typing as I go, which I don’t like to do as patients think you’re doing a checklist, but it’s the only way to keep up with the information.
When you’ve worked a long time in one place, you know your patients. You’ve got a list in your head of the vulnerable ones – the lady who’s had domestic violence, the nursing home patient on lockdown – since you can’t see them to check how they are. Deaths feel very personal, such as one patient who I’ve been doing years of diabetes reviews for.
In late March, together with my twin I nursed my father and stepmother at home with Covid-19. The Princess Alice Hospice Clinical Nurse Specialists enabled dignified and peaceful deaths. For me it was very sudden. I had three weeks off, and both my twin and I got Covid-19 very badly ourselves. It was frightening: it felt like my lungs were on fire. I got to days five and six and thought this could go either way.
We had to self-isolate at my dead parents’ house for seven days. It was really hard emotionally to be in the house so soon after their death and away from our husbands and children. As Christians, we received tremendous support from our church ministry team and friends, which gave us ongoing strength and peace at a difficult time.
At the practice we are delaying some interventions, for example by encouraging patients to obtain blood pressure machines. The chair of South West London Primary Care has written to practices reporting back GPs’ concerns about fewer patients presenting with non-Covid conditions, and fears about sick children, those with serious mental illness, and domestic violence victims who are not being seen.
There’s a lot of fear out there. We’ve had dozens of patients get in touch with suspected Covid-19. If patients don’t have a sats probe [blood oxygen saturation probe], you might need to work out how sick they are on the phone, leaving GPs having to make a decision without all the physical assessment data they normally have.
Video consultation makes this easier in many cases, as patient respiratory rates can be assessed and a quick look at the patient can aid clinical judgement. Our surgery’s homegrown online consulting platform, Dr. iQ, allows the whole clinical team to consult with patients using video or messaging.
Practice leader Dr Quraishi says, “We were getting wonderful feedback from patients about using Dr iQ before Covid-19. This period has significantly accelerated uptake of the app. I am pleased by this trend, as we want to ensure patients do not feel worried about contacting us or visiting the surgery, but we must also ensure choice and safety for patients who may not have access to the internet or a smartphone.”
The surgery now offers access to online consultations seven days a week, from 8.00 am to 8.00 pm. In addition, to reflect the rapidly evolving situation, all clinicians are encouraged to attend webinars taken by the most senior GPs in the group covering a range of skills and best practice issues.
We’ve got algorithms, but at the end of the day you have to use your own clinical reasoning. There’s really clear worsening care advice –if that happens, you do this, if the other happens, you do that. There’s plenty of safety netting as you don’t know how patients are going to fare. It’s an emotionally draining experience, and you think how many families are going through the same thing.”
On London is very grateful to Francina for finding the time to talk.
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