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29May

One Canterbury GP’s experience of Covid-19

This article is part of a series, which is recording how some of the Canterbury Clinical Network (CCN) team members have been supporting the Canterbury health system’s Covid-19 response. 

General Practitioner and the CCN Clinical Lead for Shared Care Planning Rose Laing, has been continuing to care for patients at Cashmere Health where she is an associate. 

“I have found it a strange time to be a GP. Practising physical distancing and being extra vigilant with wiping down furniture and equipment has been challenging, and at times we have had to wear scrubs and Personal Protective Equipment (PPE),” says Rose.

Different areas of the practice carpark were used for either patients with Covid-19 symptoms who needed to be tested by staff in full PPE or for a drive through style flu vaccination service. 

“Luckily we have had mostly warm autumn weather, which the team has been thankful for.” 

“We divided the building into red and green streams, putting up walls and covering the carpets with plastic on the red side to allow for full cleaning after a shift.” 

Anyone with non-Covid-19 related symptoms were seen in the green stream over the phone, online or inside the practice if needed. Those with Covid-19 symptom were seen in the red stream or the car park for testing. 

“In the early stages when public awareness was not as high, some patients didn’t realise overseas travel increased your risk of having Covid-19.  It wasn’t until you were examining them, that you learnt they had been overseas, so this initial stage of the response could be quite frightening.”

“Due to my own health and age I needed to be extra vigilant. At one stage I needed to be tested, but thankfully it was negative.”

Rose enjoyed the ingenuity needed to get the right information from her patients when doing phone consultations, such as asking patients with back pain to move in different ways. 

“We have also seen an enormous amount of photos, often of rashes, some we have been able to diagnose, but others have needed to come in.”

Many patients have delayed care and their flu vaccination because they have been fearful of leaving home, but appointments have increased in recent days as they become more confident or cannot put things off for any longer.

Rose has used enhanced capitation funding to proactively identify and phone her more vulnerable patients. This funding gives practices flexibility to provide care in different ways to their patients with complex health and social needs. 

“It’s refreshing to have a bit more time to talk to patients and many have appreciated the phone call and to know their wellbeing is being thought about,” says Rose.

The practice has been using a nurse phone triage to ensure patients most at need are seen first and to determine which stream they need to be in. As well as this they instigated virtual consultations for telehealth, setting up some computers for this purpose. These are also elements recommended by Health Care Home, a system, process, behaviour and clinical improvement programme for general practices. 

“Keeping up with the ever-changing messages about case definitions, who should be tested and flu vaccinations has been challenging at times. Also, not having access to all the services you would normally refer your patients to,” says Rose.    

“But, the constant highlight has been the people I work with.” 

“We have shared a lot of laughs and chocolate. I have so much respect for my colleagues, especially those who have helped at the rest homes with cases of Covid-19. They have been scared, but go in anyway, because of their duty of care for their patients,” says Rose. 

“It's also been an extremely stressful time for general practice business owners, who have needed to work out new ways of working very quickly and put in some long days with less income.”

During this time Rose has continued her work with the shared care planning team.

“It’s exciting to be involved because people have become so engaged and motivated to use shared care plans, particularly the Acute Plan.”

An Acute Plan is for people who often need health care and includes information about their health and what treatment they need if they are unwell.

“The plan can speak for the patient, if they are unable to do so, which would be particularly important if they caught Covid-19.” 

Rose has also become the Interim Falls and Fracture Service Level Alliance chair, since the previous chair Professor Ian Town had to step down due to his role with the Ministry of Health as Chief Science Advisor. 

She is looking forward to the different challenges the role of chair will bring. 

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