Re: Covid-19: a remote assessment in primary care
Firstly thank you to Professor Greenhalgh and her team for the excellent BMJ article “Covid-19:a remote assessment in primary care”.
Locally we have been working through how we can best help as general practitioners using tour assets of knowledge of our patients, continuity of care, and a willingness to carry risk. We had struck upon phone and video support for those at home with symptoms as the key, and welcome greatly the helpful article and infographic, setting out an approach. We have developed lists of “covid likely” patients from our own consultations and from OOH reports, and call/video regularly with them at home to assess, reassure and determine if escalation is required. The service we are offering is deeply appreciated by anxious patients desperate for a trusted voice. The other front is the reviewing of Respect forms, ensuring clarity beyond a simple DNAR to incude intructions relating to ventilation and admission. Anticipatory care planning is for such a time as this!, We are also working with managers of nursing and care homes to discuss how cases of infection will be practically managed in the community.
Please may I share a concern about the next phase. “Hot hubs” re being rapidly set up within areas and within PCNs – not primarily to help deliver care for intercurrent illness to those with Covid symptoms, but rather to assess those deemed to be between advice to stay at home and advice to attend A+E. My concern is that the provision of a physical location for assessment will work to undermine the successful message to "stay at home", that we have effectively communicated so far. To me as a clinician, an oxygen saturation and a systolic BP will add little to the information I can gain through a video assessment in determining that a patient has deteriorated sufficiently to attend the acute hospital.
If we can draw on the undoubted skill and resource of UK general practice, and spread the word on the use of phone/video “ward rounds” for our self-isolating patients, we can keep the acute sector clear for those who may need escalation. We need somehow to emphasise that this is a key part of the "frontline” in this pandemic, and not move our focus onto a hub, staffed by fully protected clinicians working away from their home base, which may give the message that only when seen there, will a patient’s Covid symptoms have been "fully" assessed.
We need to show GPs the importance of supporting ill patients at home, enabled by this very helpful article. We need to somehow avoid the public and media focus moving to hubs, with the implied message that it is only within them and within A+E that the battle will be waged,
Dr Klaus Green MRCGP
The Mill Medical Practice
Competing interests: No competing interests