Dr Alex Thornton-Smith

There is huge demand on Primary Care services in all GP practices, so it requires a tremendous effort to try and keep up.

There is huge demand on Primary Care services in all GP practices, so it requires a tremendous effort to
try and keep up. However many appointments are available, they will always all be filled. Doctors see many more patients than they did, say twenty years ago. Some time ago the practice did try out a system of total phone triage but it did not find favour with the doctors, particularly as in certain instances it could give rise to litigation!

POST-PANDEMIC

At the start of the Pandemic all GP practices received the Standard Operating Procedure for Primary Care, a document to be read, learnt and inwardly digested. All patients were to be triaged by phone – not a wholly safe procedure but dictated by the circumstances. Public perception from the beginning of the lockdown seemed to be that all surgeries had closed, but this was far from the case. Patient contacts may have fallen to a minimum but there was a mountain of planning to be done by GP’s and surgery staff, focusing on how to operate safely for both staff and patients, and what was required in the way of Personal Protective Equipment. The surgery now has all safeguards in place, with a one-way system of entry and exit.

To return to procedures: all patients must now be phoned before an appointment, to check whether they have any Covid-type symptoms. Because of the system of telephone triage about 80% of patients can be dealt with over the phone, with the remaining 20% needing to be seen. However, each call takes longer than normal because there are no visual cues and a doctor is anxious not to miss anything vital. The surgery also has a Zoom- like system for face-to-face consultations.

At the start of the pandemic the number of patient contacts ‘fell off a cliff’! But by June/July people’s fear of infection had begun to wear off and the numbers began to rise again. At the moment there are 50-80 patient contacts per day and of course a horrible backlog because of the hiatus. Doctors are concerned that some patients during this period failed to consult their doctor in spite of experiencing significant symptoms, such as breast lumps or bowel disorders. From the word go
all appointments with the practice nurses, who deal with the areas of chronic disease management such as diabetes and hypertension, had to be cancelled, causing another horrific backlog. Alex confessed they were operating seven months behind through no fault of their own, but were doing their very best to catch up, doctors and nurses alike. His fervent hope was that no patients had come to any harm during this period.

As far as the finances of the practice are concerned, the Government agreed that the income of a practice would be frozen for the period in question, irrespective of the number of patients seen. However, the powers-that-be appear to be having second thoughts about this. It may not be known that everything that happens in a practice is closely monitored and audited by the Government.

Fairly early on ‘Hot Hubs’ were set up throughout the country. These are centres
to which patients can go for assessment, referred by their GP, if they feel they may have Covid symptoms but are not desperately ill.

Fairly early on ‘Hot Hubs’ were set up throughout the country. These are centres to which patients can go for assessment, referred by their GP, if they feel they may have Covid symptoms but are not desperately ill. Obviously seriously ill patients are directed straight to hospital. GP’s are not recommended to see Covid patients, who can ring the specially dedicated advice line on 119. There are two such Hubs in the Bognor Regis area, which includes Arundel. Sadly they became underused, a major problem being that there are not enough GP’s to staff them. However Alex feels that, come the cough and cold season and the uncertainty

as to whether one’s symptoms might be Covid-related, the Hubs will once more become active. At the practice a ‘Hot Zone’ has been created. This is an isolation room at the end of the corridor where full PPE is worn and the room is decontaminated after each patient.

To say that a GP’s life, both before and during the pandemic, is stressful is probably the understatement of the year! I asked Alex how he contrived to relax, mentally and physically. His answer was that an unexpected bonus, even a silver lining, of the pandemic was the initial blissfully traffic-free state of the roads, which prompted him to take to his bicycle and cycle to work from his house in Chichester, taking a partially off-road route which goes through Binsted Woods. This has now become inconveniently muddy but Alex still keeps up the habit of cycling to work, so has obviously achieved a high degree of fitness! He pointed out that because of far fewer home visits he rarely needs a car at work. He viewed with glee the prospect of a dedicated cycle lane on the A27, included in the plans for the new by-pass. Many of us feel we shall never be witness to this actually happening but Alex will certainly be around to benefit from it. He does take an afternoon off each week which typically he describes as his contribution to ‘helping with the children’, as in collecting them from school and ferrying them to tennis lessons which, sadly, he is not allowed to watch. His wife, Sarah, is a physiotherapist and works three days a week.

To return to the vexed question of the pandemic, Alex feels there are two ways this will pan out. The most hopeful one is that the development of a vaccine will be a game-changer, which might result in everything returning to ‘normal’ by next Spring. The other scenario is that, like the Spanish Flu epidemic in 1919, the virus will eventually fade out, having taken a horrific death toll of the world’s population.

On a happier note, we are fortunate in West Sussex that there is a low incidence of Covid-19, possibly due to the good air quality, to the generous amount of space and to the average age of the residents, probably the wrong side of 70!,who tend to be more cautious in their efforts to avoid infection.

I would like to express grateful thanks to Alex for giving up his time to talk to me on his day off! We are in having such a insightful, caring, and, may I say, humorous GP as one of the partners at our Arundel Surgery.