As I write we are at the beginning of the pandemic in the UK. We still have relatively small numbers of cases but they are steadily increasing along with, tragically, associated deaths.
There is a very fine line between not fuelling mass panic, which is unhelpful, but also in taking sensible precautions.
Public health messages such as thorough hand washing and minimising touching our faces and each other are very important. This will have some effect in slowing the spread of the virus. However, we only have to look across to Italy to see how it has quickly overwhelmed their health care system, even when they have twice the number of critical care beds per person than we do in the UK.
In my view, our responsibility is to try to slow the spread of the virus, to minimise the pressure on critical care (though of course the pressure is still likely to be huge), and also to demand that the government increases the number of critical care beds as a matter of urgency by requisitioning private hospitals, upgrading existing beds in NHS hospitals and if necessary setting up field hospitals.
This will also require immediate training of NHS staff to look after critically ill patients as there are not enough at present. The last 10 years of systematic underfunding and dismantling of our NHS, along with massive cuts to social care, is now having devastating consequences.
Primary care is where 90% of NHS encounters take place, so it seems obvious that most cases of COVID-19 will be dealt with here. It is important that health workers remain well as far as possible and so are able to continue to treat patients. Unfortunately, personal protection equipment (PPE) that has been issued to GP practices is more or less useless – simple paper surgical masks which do not stop infection.
Many GP surgeries are moving towards a system called Doctor First, where patients are not allowed access to the premises without first speaking to a doctor over the phone. This is to protect staff and other patients from people who may be infectious with COVID-19.
Patients are being advised by the government to self-isolate and sweat it out at home if they become unwell, and to contact NHS 111 if they cannot manage self-isolation. NHS 111 has rapidly become overwhelmed, and there are reports of 12 hour waits for a response.
Understandably patients are not all going to meekly wait at home. Some will either come to our surgeries and demand to be seen or go to A&E, spreading the virus.
There is a debate about self-isolation, closing schools and universities and whether these are the correct strategies. I think it is not possible to say with any certainty yet whether we should or should not adopt these measures. If we do, are we just pushing another peak further down the road? What happens to, for example, children who live in poverty and rely on free school meals, or families where parents have to work to pay their rent? Will such strategies push the burden of childcare for school age children to vulnerable grandparents?
What we can say with certainty is that years of austerity have decimated our NHS, and that despite this NHS staff are, as always, rising to a very difficult challenge. While we wait for a vaccine and more critical care beds, we need to try to slow the spread down.
We should demand:
Immediate requisitioning of private hospitals to increase the pool of critical care beds.
Immediate training of NHS staff who are willing, to help look after critical care patients.
Adequate supplies of proper PPE for all staff on the front line.
Suspension of all non-essential work, for example CQC inspections, appraisals and enforcement of key performance indicators such as QOF and enhanced services. No practice should be financially penalised for dealing with this unprecedented crisis.
Adequate IT and internet connectivity to cope with the rise in remote working.
That sick pay is paid from day one. Staff should not suffer economic hardship for self-isolating or being off sick. Anyone who comes to work who is potentially infected is a danger to everyone else.
Sick pay be extended to those on regressive employment contracts, such as zero hours contracts.
No penalty for those people missing DWP assessments as result of self-isolation.
Provision of centralised primary care type services in each borough for those patients who are too sick just to sweat it out at home, but not ill enough to go to hospital.
Much more testing. We can learn from South Korea, where mass testing is being performed via drive through test stations.
Dr Jackie Applebee is a GP and the chair of Doctors in Unite.
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