The COVID-19 pandemic has had major implications for everyone’s mental health, and clinicians are no exception. Here we look at some examples of how general practice has responded to the challenge and built resilience among teams

Dr Tom O’Dowd

For the last three years our practice has met up on Thursday mornings for our ‘huddle’. The idea came to us from a colleague familiar with American ways of running busy practices.

Everyone turns up and it is chaired by our practice manager. The kettle is the star and Barry’s tea the diva. We meet in the small room off the reception area and most people stand, except those with bad backs who are permitted to sit. It lasts for 30 minutes and is geared to making decisions. The practice manager has a list collected from issues that have arisen during the previous week and that need sorting out. 

We originally had a whiteboard with three columns: ‘to be done’, ‘ongoing’ and ‘completed’. The ‘to be done’ column was hidden under the weight of work and the ‘completed’ column had a few sparse stickies reflecting meager achievement. 

The meetings were great for communication, morale and simply making the practice hum.

And then in March 2020 it all stopped. I remember too well the clumsy, socially distanced and maskless meeting where we decided we had to keep ourselves safe if we were to serve our patients. It was an uncertain and fearful time that required trust and leadership.

The ‘huddles’ still continue in a larger room and only the GPs, practice nurse and practice manager now attend for safety reasons. They are more deliberate because so much more is at stake. Decisions we make must have safety as our guiding light. Communication with staff not present is essential in order for them to feel cared for and to be updated about any changes that will affect their work. 

Our efforts at safety were given impetus on hearing of nearby GPs who had contracted the virus. We eventually employed a new member of staff to check temperatures at our locked door and to deal with queries and escort patients to their appointment. Everyone wears a mask and the cacophony of winter coughing in the waiting room has given way to silence. Where have all the coughs gone? 

We divided staff into morning and afternoon cohorts so that if someone contracted the virus at least half the practice could be made safe and operational. We encouraged anyone with respiratory symptoms to stay away from the practice. Everyone is now able to work from home, which removes much of the guilt about abandoning colleagues in the line of duty.

To date we have had six staff having had to isolate, at various times, with symptoms that all turned out to be negative for COVID-19. These resulted from close contacts in the clinical situation or socially.

We became very aware that praising staff is easy to do. Haven’t we all been called heroes! Staff have found it hard going and we wanted to recognise their efforts. Was it to be money or time off? They opted for time off as they were tired and had little opportunity to spend money anyway.

We appreciated the efforts of the State in vaccinating us GPs en masse but were working alongside patient-facing colleagues who were not yet vaccinated. Their anxiety was palpable and not helped by the widely reported vaccine rollout, which favoured non-clinical-facing hospital staff. 

IT has come into its own and is a great source of support and information. After over 40 years in general practice I could not believe the job could be done by phone, email, WhatsApp, Healthmail or Zoom. I shouldn’t be surprised because the Veterans Administration in the US does 50% of their consults remotely. They look after a population traumatised by various wars and with consequent complex clinical conditions.

The switch to IT has changed life dramatically. It is inspiring to see how we have all adapted and been able to cope with the intensity of remote working. 

The interaction with patients has changed over the lockdowns. In the early days we got much praise. There were gifts of chocolate, pastries, homemade cakes and cans of coke delivered to us by grateful patients. For reception staff interacting with patients it was a rewarding time, which helped balance the fear and anxiety.

Early on, everyone thought that if we all did the right thing the virus would go away. However most people have been doing the right thing and it has not gone away. It returned with a vengeance over Christmas and extracted a significant toll. Deaths are the obvious impact, but the fear, anxiety and lack of social contact is very distressing for patients. 

And, of course, some take it out on the reception staff and occasionally the doctors. A patient rang yesterday and railed that he could never get his own doctor. It transpired he hadn’t even tried. Stories such as that are a focus for us all to let off steam with our own ‘war stories’ when the day is done. 

We have found ourselves asking each other more attentively "How are you?", "How was your weekend?". A kettle is never boiled for one, tea and coffee orders are taken and left for collection.  We have uncovered each other’s Netflix habits, walks, takeaways. Bridgerton, the hills, the latest gourmet burger. And sadness that Spiral has ended but glad Caroline Proust looked happy. 

We have the great benefit of an expansive waiting room and at lunchtime we retreat to safe distances, swapping stories and gentle ribbing. All too brief. It is our humanity that sustains us and it is amplified in the sharing of simple things.

When the present is tiresome, dangerous and exhausting, the future becomes the dream. Our focus now is to get us all vaccinated, which will allow us all to see a future that will recover some of our lost life. Looking forward to this has buoyed us all and conversations are speckled with queries about estimated vaccine arrival time.

We have begun to plan for mass vaccination of our patients. One of my colleagues led the way on the flu vaccines when she and her team took over the local Co-op premises and did over 200 patients in each half day. Such an achievement gives the practice a boost in morale.
 
It is similar with the COVID-19 vaccine. Planning involves the staff and doctors. We attended webinars on how to do it safely and carefully. On how to identify the various cohorts and allocated groups. We are excelling at it because we are motivated to do a good job and most of all to free our patients from the fearful captivity of the last year. To play a small part in such an endeavour makes general practice special for all our staff and ourselves.

What did you do in the war Dad? It will now be “what did you do you in the COVID-19 pandemic”. All of us in my practice will have played an honourable part in bringing it under control. Amid the daily misery and grief it can be difficult to realise that we will be given the tools to put an end to all that. And that is a privilege.

Lynette Beechy, Practice Manager

My first reaction to writing this was: “I don’t have time in my day and I just want to switch off COVID-19 when I get home”, but then I thought, so do we all and sometimes it is just nice to know that while we are all facing the same storm, we are also in the same boat. 

Change is probably one of the most daunting feelings for staff and it creates uncertainty and confusion, so communication in whatever safe form available was a key element of surviving the constantly changing environment that came with this pandemic. With a supportive and proactive team of partners at the ready, we sat down and planned early and regularly on how we would meet the demand, deal with health and safety issues, reconfigure the setup of the practice and budget for additional equipment and PPE. 

We found that developing practice protocols and systems that worked for all staff, covering all aspects of changes and rolling them out at morning ‘huddles’ kept everyone in the loop and provided an opportunity for staff to feedback daily issues and solutions. We are fortunate enough to have a large waiting area, which meant our reception manager, the GPs, the nurse manager and I could gather safely at 8.50am each morning and go through changes to testing criteria and any issues arising, making sure that we were all on the same page. We encouraged our staff to bring their problems to that forum so we could offer solutions and above all support one another. 

So many systems that worked so well before the pandemic began to fracture with the demand for appointments, advice and information. Our phone system crashed regularly and our patients were understandably frustrated with the difficulty in trying to get through to us as we tried to deal with approximately 4,000 call attempts per week.  So we installed a system that allowed every call attempt to be placed in a queue that stated their number, a simple solution that had such a positive effect as patients could now identify with how busy the practice was and could use other forms of communication to contact us, such as our info email, to divert some pressure to an easier to manage communication type. Patients could also access our website and fill out a form if they had COVID-19 symptoms, which could be diverted to a dedicated GP who had allocated time to deal with these queries. 

We moved to telephone consults and gave each GP several colour-coded slots to allow them to bring in patients they needed to examine in person. We switched our answerphone on 20 minutes before lunchtime for all staff to down tools and do a deep clean of their areas, and our admin staff would have a five-minute chat at this time every day to address any problems they were experiencing, which really gave them a feeling of support and unity through some very difficult times. We sent around video clips on safety and cleaning, and one of our partners put together a short presentation on keeping us and patients safe within the practice, it was more personal and relative. We put together a short handbook on cleaning devices, appointment management and safety. We kept our staff informed when we were struggling and we asked for their commitment to our protocols to ensure that we all survived personally, financially and morally. 

When our staff were struggling to deal with frustrated patients, we used Facebook to ask for their understanding and it received very positive reaction and our staff felt supported. We introduced a monthly spontaneous treat where we treated all staff to either fish and chips, or another month it might be breakfast rolls, just to let them know that we appreciate them. Flu clinics were planned with precision and timing to work out how many patients could enter and be vaccinated safely in our centre by introducing a one-way system with online booking via Calendly, which we raised awareness of via Facebook and our website. This diverted a large percentage of calls to online and worked extremely well, with an evening a week and Saturdays dedicated to making sure that we could utilise the whole practice safely for just vaccines. 

Staff were really happy to take part in the clinics and patients were really appreciative. Strong communication, support and practice-based protocols make everyone feel supported and safe, provide continuity and help to ease uncertainty brought about by so much change. We have grown stronger as a practice and more together as a team.