GPs are already overstretched. We need better planning to tackle the coronavirus

It is 8 am and amid the morning rush of calls for routine appointments, urgent prescriptions or home visits there are also many patients requesting same-day advice from the duty triage doctor. These calls are added to the triage list for the doctor to either offer advice over the phone or a face-to-face appointment with a colleague.

Inevitably during winter pressures there can be 20 to 30 calls each day regarding respiratory tract infections like colds and flu from all types of patients, including the very young, frail older people and those with chronic conditions. We are also now getting queries about the coronavirus. Although there have been few cases in the UK so far and the problem is largely being contained, it is now part of our daily conversations and planning at work. I have also taken some calls from worried patients who think they are at risk of the coronavirus because they have been away, but to a non-risk area.

In any GP practice many of those who are vulnerable to the flu would be at risk from the coronavirus if there were a widespread outbreak. I last saw a case of flu two weeks ago. We know that nationally levels of influenza cases are steadily going down – around nine to 10 patients consulting with GPs per 100,000 population. Flu affects millions every year, with a mortality of around 0.1% – so far coronavirus mortality is 2% of those infected with the virus.

The current guidance from the government is that any callers with, or without, symptoms but at potential risk of coronavirus (namely having travelled from certain countries or contact with those at risk) should stay at home and call 111 for further advice and screening. This is what our staff are telling patients over the phone if they are deemed to be at risk.

We are also ensuring that for online appointments measures are in place so that patients potentially still in the incubation period do not present for a face-to-face appointment at the practice. Reception has a checklist to go through on the telephone, and if in doubt the duty doctor can direct them to 111. However, there have been cases where 111 has told patients to contact us to discuss coronavirus concerns and then ask us to refer them to Public Health England. This has been contrary to the guidance, and has created confusion and delays. We have had to liaise with different agencies to discuss screening and containment measures. On one occasion this took three hours of a colleague’s time.

A GP practice near us in Bristol was closed last week as a precaution against potential coronavirus risk. It reopened after 24 hours following a deep clean. There have been a few other instances of temporary practice closures elsewhere in the country and patients have been directed to call 111 or attend local walk-in centres. Although this has had minimal impact, there are concerns that wider or longer practice closures (such as for deep cleans or staff in quarantine) would have an impact on remaining practices and create a ripple effect on emergency departments and hospital admissions. General practice is at a precipice and any small shifts in workload – whether through staff sickness or extra patients on the practice list – could send it into freefall. This is particularly a concern for smaller practices or those already in distress.There is currently no system for flagging workload pressure and rising demand, such as the Opel alerting system in hospitals. Devon GPs are planning to use a new colour-coded alert system to report weekly on the scale of the problems. I hope our clinical commissioning group will consider adopting something similar.

If the containment measures are not successful and coronavirus infects wider populations, then GPs or other doctors could be involved in the screening, or screening could be abandoned altogether if numbers were huge. There is little surplus capacity in the community or hospitals, which could quickly be overrun with new patients in a pandemic.

GPs need more clarity – and forward planning – to make sure there are sufficient resources to screen patients and measures to contain and treat the virus. Some expects are predicting it could infect up to 50% of Britons, although the vast majority would have a mild illness and recover well. In addition, there need to be easier ways for us to engage with all agencies involved in screening and contingency planning. We also need a renewed focus on vaccinations for other illnesses so that health workers, young children, pregnant women or older people don’t fall ill to other outbreaks, making them more susceptible to contracting the virus.

Only if such measures are put in place will GP practices be reassured that they could cope if inundated by anxious patients fearful of catching the virus or presenting with the symptoms.

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