Dr Tom Kneale gives an insider view of how GPs in Wales have dealt with the pressures of the pandemic, the vaccination programme and new technology.
It can be difficult to find five minutes to reflect.
The workload in general practice at present is a combination of the typical cases for this time of year with the addition of those who might have delayed seeking care in the midst of the pandemic and patients who have found that the challenging circumstances of the last 15 months have exacerbated their condition.
In doing the everyday, we can sometimes miss that we are also doing the extraordinary.
The contribution of primary care to the vaccination program in Wales has been outstanding. To many of us who work in general practice, this should come as no surprise. We are a relatively quiet cog in the NHS machine.
Where press attention does come our way, it is often a concern over appointment booking processes or, as we have seen recently, misunderstanding about how general practice has had to adapt but has remained open and operational throughout the pandemic.
Of course, we should always strive for better where concerns are raised. We should probably also allow ourselves a moment to take stock of what has recently occurred and focus on what should be an astounding news story.
“General practice has continued to run and adapt despite the pressures of the pandemic, rapidly adopting technology and integrating it to our patients benefit.”
In Betsi Cadwaladr University Health Board (BCU) two-thirds of vaccinations for COVID-19 have happened in a general practice setting; whether this be in individual practices, by GPs in local vaccination centres, or delivered by district nurses and advanced nurse practitioners to housebound or nursing home patients.
This equates to over 383,000 vaccinations in BCU primary care – a phenomenal achievement.
For this to happen it has taken a collaborative effort between GPs, clusters (local groupings of primary care services), and the health board.
While there were some initial concerns early in the rollout, these were worked through and trust was placed in primary care. It is very clear that we have delivered above expectations.
We should not forget the huge effort which has gone on behind the scenes to get vaccines to practices, vaccination centres, and the community with at times daily and even hourly fluctuations in the supply chain.
Once in practices and centres, the organisational effort to vaccinate in a socially distanced manner during the second wave of the pandemic has been exceptional. All of this in the background of an estimated 25% increased workload compared to pre-pandemic levels.
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As we move with cautious optimism towards a post-pandemic future, GPs, their teams, and primary care colleagues will continue to be the first port of call for most patients.
General practice has continued to run and adapt despite the pressures of the pandemic, rapidly adopting technology and integrating it to our patients benefit.
We have seen missteps elsewhere in the UK about how to strike the right balance with this new technology, I hope this can be avoided in Wales.
The simple fact is that we now have more ways for general practice and patients to engage than was the case pre-pandemic.
The correct answer cannot be an over-reliance on remote consultation or a diktat to focus on face-to-face but instead, a blended approach decided between GP and patient depending on the circumstances.
“GPs cannot consistently be working beyond their capacity or we risk burn-out… It takes a toll.”
For generations, general practice in north Wales has given and continues to provide high quality, individualised patient care and team leadership.
This is not to dismiss the challenge of producing an ever more improved service, but if there was a time to stride forward with confidence it is surely after our key role in the world’s fastest vaccine roll-out programme.
The Welsh Government’s ‘A Healthier Wales’ report called for a shift towards preventative care and GPs are delivering their part of that vision. Of course, the service needs to be sustainable.
GPs cannot consistently be working beyond their capacity or we risk burn-out and losing the enthusiasm of a profession that gets to see every human emotion on an almost daily basis. It takes a toll.
Yet, every morning GPs across Wales are upbeat about the role they are playing to help their patients in the day ahead.
With resources and an increase in medical students choosing a career in general practice, we can build a service which provides excellent care and can respond to the challenge of supporting patients to access GP services in a timely and convenient manner.
I hope this amazing story of how general practice has helped vaccinate, protect, and turn the tide of a pandemic will lead to general practice and integrated primary care being seen as a big part of the solution to our population’s health care needs.
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