Frontline Perspectives on Covid

Over the coming weeks Resolute will be carrying out a series of interview seeking the perspectives of those who have served on the frontline during this Covid-19 pandemic. They will be asked about their experiences and share their thoughts for the future.

 Interview with Dr Ursula Brennan

Current Role: COVID-19 Lead at Beechall Covid Centre, Belfast

Dr Brennan is a GP Partner in Mount Oriel Medical Practice in South Belfast. The surgery has a patient cohort of 7200.

She is also a Speciality Doctor in Diabetes at the Ulster Hospital, Assistant Secretary on the Eastern Local Medical Committee and a member of the Northern Ireland General Practice Committee.

Dr Brennan is also a Director for the South Belfast GP Federation.

Describe your current role at the Covid Centre in Belfast?

My job was to set up the Covid Centre in Belfast. In a period of 10 days we went from finding an appropriate building that allowed us to take social distancing into account to seeing patients. This work covered a wide range of tasks including getting excellent staff, designing governance and safety for staff and patients, setting up infection control and decontamination processes.

All of this was made possible by having the support of an amazing team that includes our cleaning staff, nurses, drivers, security, allied health professionals, pharmacists, doctors and a wide range of others.

What happens at the Centre?

The Centre is not a walk in facility. Patients need to be referred by GP appointment. Anyone who is concerned should not hesitate in contacting their GP they want to hear from you.

At the Centre a person will be examined by a GP in PPE who will assess if further treatment is needed. If a patient is sent home, they are given all the appropriate information to enable them to manage. They will be fully supported by their GP.

A minority of patients will be sent to hospital for further treatment.

Visits to home still happen?

Yes, we are determined to see to all the needs of our patients at this challenging time. So home visits do occur but as you might expect there are significant differences. These visits are conducted in large buses in order to meet social distancing requirements. GPs along with support from Medical Technicians and Specialist Nurses to help with putting on and taking off PPE.

 PPE that we commonly use include gloves, visors, masks and aprons. We also have access to FFP3 masks that we use if a patient needs specific assessments or in the unlikely event of a resuscitation.

 The buses are also specially cleaned and there are decontamination procedures at the Centre that are designed to ensure that GPs and staff are safe to return back home or elsewhere. All of this was designed in close partnership with Infection and Protection Control Teams from Belfast Health and Social Care Trust.

How has working changed for GPs because of Covid-19?

General Practice has been extensively changed by the Covid pandemic. Overnight we have had to change to a service that is based on telephone and video. My own practice is using AccuRx as a video consultation tool.

Zoom and other technologies have been used to interface with medical colleagues and hold meetings with the Trust and others such as Out of Hours, Care of the Elderly, Emergency Department and Palliative Care.

Patients are still being seen in practice but processes are very different. Waiting rooms are socially distanced and consultations are completed with staff in PPE.

Whilst things may look different what has not changed is the patient being central to all of our considerations.

It has also never been more important to be mindful of the psychological impact on our patients, teams and families. During Covid the stresses on everyone have been huge. We have to make even more efforts to be kind to everyone as they may be fighting battles that you know nothing about.

There are significant stresses on GPs as well as patients. Many of us have families and children who are needing support. Many of us work very long hours and burnout is a real potential issue. We are so grateful for the support shown to us on a daily and weekly basis by the public but we must not forget the unsung people and families helping us in the background.

The future Covid issues for General Practice

We are still not through this wave of Covid-19. Thankfully the mortality rate appears to be reducing. However, we cannot underestimate the potential for higher figures especially as many people appear to be breaking the social distancing guidance from government.

There is a fear that there may be a second surge of Covid that could hit us in September or October as we face flu season and winter pressures. This could happen months before there is a vaccine.

 I am confident that we are in a good place operationally to handle future Covid outbreaks, staff are now trained, structures are in place and can be restarted. My biggest concern would be for our colleagues across the health service who are tired and need rest to renew energies for any potential next phase.

 Any post Covid concerns?

As we slowly and cautiously come to accept a new ‘normal’ it is clear that there are many conditions that our health service will have to face. Covid has hit the confidence of the public and this has led to people not seeing their GPs for various reasons. An example would be our cancer referrals are down by around 70%. This means that we can expect a surge of cancer issues to arise and because of the delays they may be much more serious.

We are very likely to see a significant rise in other conditions including mental health, respiratory and cardiac conditions as well as domestic abuse.

 Rebuilding the Health Service

?Our Health Service will need to be rebuilt as we look to the future. It is important to note that there were many problems facing our health service prior to the Covid pandemic.

The solution will lie in immediate and inclusive communication and consultation on the way forward. Those who have to deliver services must be involved at the very outset by those who will be crafting the outlines of our new system.

Our politicians will always face unenviable decisions around budgets but without a Health Service with the ability to protect and heal patients then our economy and society will not be sustainable.

The Health Service that we rebuild must be better and more responsive than it was before the Covid pandemic. It is the responsibility of all of us to ensure that we look after our Health Service.