Helen Salisbury: Clutching at straws (and sticky tape)

Doctors like to have answers: it makes us feel useful. GPs take pride in our tolerance of uncertainty, but even we are being pushed beyond our comfort zone by current circumstances, and many of us are very apprehensive. Having lost patients and colleagues during the first wave of the covid-19 pandemic, I now fear—despite voices raised in dismay, then and now—that some of the mistakes from March are about to be repeated.

We were told in June that a functioning test, track, and trace system was the key to getting England safely back to work, but it’s still lacking.1 As schools go back there’s an inevitable rise in viral illnesses, and the resulting fevers keep whole year groups and their families off school and work. At the time of writing the demand for tests is massively outstripping supply, which has apparently taken Dido Harding, head of the testing service, by surprise.2 Would someone with a health background have been a better pick?

Last week in our primary care network, we had a new member of staff delay starting by two weeks because of fever in the family. Our winter plans need to allow anyone with children to be able to work from home at short notice. This may not leave many of us available at each practice to provide face-to-face consultations—but thanks anyway, NHS England, for that ill judged and insulting letter reminding us of our obligation to do so.345

Leaving aside the thorny problem of where to assess febrile children without any increase in risk of infection to the rest of our patients, we’re generally confident at judging how ill a child is. However, for reasons clearly outlined by Rammya Mathew in The BMJ,6 we’re unable to say whether their symptoms are a result of covid-19—and that’s the crucial piece of information parents require. They’re understandably baffled, and sometimes angry that, on top of this, we can’t help them access a coronavirus test either.

In the face of all this, how do we keep going and stay cheerful? This weekend, practices around the country are pulling out the stops to run socially distanced flu vaccination clinics. It brings gratitude from patients, for administering this simple procedure, and satisfaction in a job well done. It’s a great team building exercise, and it certainly beats crafting a tower from straws and sticky tape or other “training day” specials.

We must keep this team spirit going, looking out for people who are struggling and doing our best to remain calm and positive. Personally, I’ll try, at least in public, to steer a midcourse between Pollyanna-ish optimism and showing my real fears for the winter ahead.