Ours is a three-GP practice in Co Kildare, with two practice nurses, four administrators and a visiting psychologist. We moved premises in December last year after 20 years in the previous location. We felt that as we were bedding in to the new set-up we had experienced rather enough profound disruption for at least a decade. But of course we had no idea what was coming down the line…

In recent weeks, as the national response to Covid-19 progressed beyond containment, we have been making profound changes to the way we care for people who attend the practice, and those who work in it. This process has benefited from a steady and focused stream of advice and guidance from the ICGP and the HSE, augmented by some common sense and a bit of best-guessing.

We have had regular management huddles, with extra cohesion provided by the practice WhatsApp group. By the third week of March, the number of people attending our practice for medically non-urgent conditions rapidly approached zero, and the volume of telephone consultations rapidly increased. Our concerns at the feasibility of all of this quickly vanished as everyone understood the need for, and listened carefully to practice guidance on the new way that care is to be provided.

People having telephone consultations were appreciative of the advice given, even if we didn’t always have complete answers to all of their queries. They greatly appreciated reasonably prompt call-backs, and not having to sit in waiting rooms. The introduction of consultation fees for phone consults resulted in exactly zero complaints, and it is welcome that this cost to patients is now being covered by the State. The fact that people still clearly have direct contact with known and familiar healthcare professionals appears to be critically important, even more so given that the healthcare professionals concerned clearly have access to comprehensive electronic medical records and know their patients well.

The emphasis in our advice has been on reassuring patients where we can reasonably do so that the vast majority of healthy individuals who contract Covid-19 get through it reasonably well. We express concern regarding people who are medically complex and vulnerable, and emphasise the importance of their avoiding infection by all means practical, even at the risk of lengthy social isolation. We are emphasising the importance of maintaining contact by phone and FaceTime where possible, particularly with older members of both family and community networks.

In recent weeks we have streamlined and modified several tasks in order to minimise risk of infection. Prescriptions are delivered from the practice to the pharmacy downstairs in batches and medications are collected directly by people from the pharmacy, greatly reducing surgery footfall and therefore the risk to all involved. Where there are respiratory symptoms the pharmacy has requested that the patient has an asymptomatic family member or friend collect their medication, rather than attending themselves.

In the practice, we have our isolation room ready and we have an updated inventory of essential infection control materials. We have a second issue of warning notices, liberally posted throughout the building. Webcams are being installed on the computer terminals. 

Protection of reception staff has been improved by the installation of a glass door at reception, with a chair placed in front of this, and a notice asking people to stand well back from the hatch. Swing doors separating the waiting area from the foyer and the consulting rooms have been kept open, reducing hand contact with the doors as reduced numbers of people move within the office suite.

Much of this will in some ways be inadequate, but it will reduce harm overall and it also provides reassurance. While several planned medical meetings have been cancelled, we have been glad to learn that staff at our local Naas Hospital, and our GP co-op, KDOC, are also actively responding to and communicating with patients and preparing for the next stages of the pandemic. There will continue to be ongoing contact between practices and the co-op.

The outlook remains uncertain. While extremely serious, by comparison with the ‘Spanish flu’ of 1918-19, Covid-19 does not appear, at the time of writing, to be as lethal or virulent a pandemic, although obviously the world situation is worrying. It remained to be seen if our preparations will give us better public health outcomes in Ireland than in Italy. 

It is likely that some aspects of general practice have changed forever, and not all entirely for the worse. In the actions we have taken in our practice, we can see many innovations we had already been thinking about; Covid-19 has transformed those thoughts into actions, including greater integration with pharmacy, online consulting and a significant reduction in non-essential face-to-face consults. While the current situation is profoundly disturbing, it is not all entirely bad. Best of luck to everyone in the months ahead, and stay safe!