Two years into the pandemic, with most restrictions lifted and serious illness on the wane, it is perhaps a good time to stand back and take stock of the things that we have learned.
One of the key positives is that general practice has been a core part of the response. Because we are generalists, we have been very much at the coalface of dealing with the wide spectrum of illness severity presenting throughout the pandemic. We have played an important role in the health service, with our patients and in our communities. General practice came of age and stepped up. It was important to have general practice representation on NPHET. It helped improve the understanding of our health authorities of the role of general practice and primary healthcare and allowed us to assist in the national response.
I don’t think general practice can ever go back to working the way it did before. Many of us have found our buildings are not fit for purpose. We can’t go back to a scenario where people with respiratory illness come into our waiting rooms and sit in a crowded room coughing over everyone. However, there are resource implications to solving this, so it’s a challenge.
I think the novelty of video consults has worn off. They will continue to have a role, but I expect their range of use as a part of routine clinical work will be relatively limited. Telephone consults have proved far more useful and I think a certain amount of GP ‘business’ can be conducted this way. The majority of patients prefer face-to-face consults, with good reason, as I think do GPs, and phone consults can support routine care but not replace it.
Positive electronic innovations
There were many other positive electronic and online innovations. Electronic prescribing and social welfare certs are here to stay. Another useful innovation was the expansion in the use of WhatsApp groups among GPs for rapid fire information sharing, plus the huge role played by webinars, particularly the massively popular College webinars, in keeping us up to date. We are returning to in-person meetings, but GP WhatsApp groups and webinars are here to stay.
A big challenge for GPs will be dealing with an increasing workload, including catching up with significant volumes of illness presentation deferred during Covid. Due to underfunding and staff shortages, some GPs have been close to being overwhelmed. Despite FEMPI being reversed, it will be another 10 years before the harm caused by those cuts will be fully undone. Much of the workforce crisis has its roots in FEMPI. The government is finally investing in general practice, eg. the CDM scheme, but the problem is it is investing in a sector that is understaffed and struggling to keep up with demand. One-third of GPs are due to retire in the next 10 years. We need imaginative workforce solutions now – the pandemic made that abundantly clear.
I believe the ICGP’s role and status have been enhanced immensely during Covid. Our profile might currently be the highest of the postgraduate colleges. It is a credit to all the College staff who adapted with such commitment to keep the show on the road.
Our whole educational model has changed. Maintaining the innovations necessitated during Covid of hybrid or blended learning across the College’s educational and training spectrum will be a challenge. There will obviously be a desire to go back to in-person meetings and conferences, but many GPs appreciate the convenience of having online meetings and avoiding travel time after a long day. I’m sure the College will come up with the right balance. There is certainly an increased appetite for both.
Increase in collegiality
If I were to be asked to name the biggest positive that came out of the Covid time I would say it would be the increase in collegiality and solidarity among GPs. We reached out to and supported each other at a time of crisis, from rapid information-sharing, to helping out practices that temporarily closed, to PPE supplies and many other things. We listened to each other’s frustrations and shared ‘graveyard humour’ jokes. Everybody pulled together.
In terms of things we would do better or differently, early on many of us would have liked to have had increased awareness of the nursing home outbreaks. Given the virulence of the virus, to be honest, we probably could not have acted much differently to prevent it spreading to the extent it did. It was a fast-moving pandemic and unfortunately this was our most vulnerable population. It was very difficult to witness this. For those of us who have patients in nursing homes or elderly people in our families, it was very challenging and upsetting.
Another issue and a regret in general is that the most vulnerable and marginalised in our society suffered the most during the pandemic. This was not just a Covid issue but is an ever-present health and social care challenge. GPs will continue to advocate for these patients. If we don’t do it, who will?