Back in March 2020, when people were just beginning to realise how infectious Covid-19 was, GPs changed the way they worked almost overnight.
Surgery doors were locked, and patients had to explain their symptoms by phone or video link before the doctor decided whether it was necessary to see them in person. Electronic prescriptions, long sought by GPs, were legalised within weeks, and everyone – medical and administration staff and patients – wore masks for every encounter.
Magazines were taken down from racks, chairs were placed more than a metre apart, one-way systems were created for patients to enter and leave surgeries, and a squeaky-clean atmosphere was the order of the day.
'I look back now at waiting rooms full of patients, some with coughs and colds, looking at magazines and spreading their viruses, and sick children handling toys,' says Dr Velma Harkins
The big question now is how many of these new practices will continue when Covid-19 ceases to be the international emergency that it has been for the past year.
Dr Velma Harkins, a GP in Banagher, Co Offaly and chair of the quality and safety standards committee at the Irish College of General Practitioners, or ICGP, believes there won't be waiting rooms full of patients in the post-Covid era.
“I think phone triage will continue and patients with acute respiratory illnesses will be seen at the end of clinics. We might have some people waiting for vaccinations or to get their bloods done. But we’ll continue with a buzzer system which will let patients who are acutely ill in separately.”
She says she has become acutely aware that full waiting rooms weren’t ideal places for sick people to be. “I look back now at waiting rooms full of patients, some with coughs and colds, looking at magazines and spreading their viruses, and different sick children handling toys and playing with them,” she says.
GPs say that the wearing of masks is very likely to continue as standard practice. Dr Diarmuid Quinlan, clinical lead at the ICGP, says that patients and doctors alike will still expect masks to be worn, particularly by patients with respiratory infections.
“There have been far fewer respiratory infections – and almost no influenza – because people are wearing masks when out and about,” says Dr Harkins. “We’d like to see the hand-washing, sneezing and coughing etiquette continuing, because there will be other infectious diseases in the future, and we know now the important things we have to do to protect ourselves.”
GPs have also noticed that prescriptions for antibiotics have declined during the Covid pandemic, which they put down to the stronger infection-control practices that many of us have adopted.
The use of eprescriptions will definitely be continued. “We wanted it for so long and got it within weeks of the pandemic. It did require legislative change, but eprescriptions are so convenient for patients, because doctors can send the prescription to any pharmacy in the country if people are away from home. It also stops prescriptions getting lost or stolen and controls forgery,” says Dr Quinlan.
With many employers now used to employees working from home, doctors hope that people will work from home in the future if they have colds and coughs, so that these respiratory infections aren’t spread through workplaces.
GPs have also had to work from home at time during the pandemic, either because they were close contacts of Covid-infected people or when they were doing telephone or video consultations. Weekly educational webinars run by the ICGP became both a social and an educational opportunity for many of them. “We’ve had between 1,000 and 2,000 GPs joining these educational webinars, and we will continue with them, as they have been an excellent way of supporting GPs and enhancing patient care,” says Dr Quinlan.
Although it's easier for some patients to talk on the phone, doctors realise that they can miss out on seeing the patient's body language
The Medical Council has also created an online guide to telemedicine for doctors and other practitioners in response to the increased shift to phone and video consultations. Research in October 2020 found there had been a fivefold increase in the use of telemedicine since March 2020, with one in five of the population having a telephone or video consultation with their doctor, compared with one in 20 before the pandemic. Researchers found that 80 per cent of those who used telemedicine were either satisfied or very satisfied with the consultation.
Dr Harkins says that many GPs have commented on how they have missed seeing their patients during the pandemic. They also say that although telephone and video calls can be more convenient for patients, they often take longer. “Although it’s easier for some patients to talk on the phone, doctors realise that they can miss out on seeing the patient’s body language and the issues that usually come up at the end of an appointment,” says Dr Harkins.
Dr Quinlan adds that he can see the benefits of phone triage – especially for patients with chronic diseases or for when patients require oral contraceptives (with blood pressure checks carried out in pharmacies), but, for more complex cases, doctors will always need to see their patients.
“If a parent is worried about a child, they need to be seen, and face to face is better for people with mental- health issues, as the doctor-patient relationship is important. And 25 per cent of a GP’s workload relates directly to managing mental-health symptoms such as anxiety, depression and addictions.”
And although GP surgeries might be different post-Covid, Dr Quinlan says that he expects doctors will be very busy dealing with “the legacy of trauma from isolation, grief and bereavement” from the pandemic.
“There will be a huge impact on the national wellbeing, both physically and mentally, from people not being able to grieve the loss of loved ones in the normal way. I’ve stood on the side of the road myself as a coffin passes as a mark of respect to the family.
“There will also be non-Covid morbidity due to the pausing of breast- and cervical-cancer screening programmes. There will be implications from occupational therapists not assessing older people in their homes. And, then, patients themselves who have ignored symptoms because they didn’t want to go into hospital to have a procedure.”
