Thread by @AlisonGeorge10

Thank you Dan, once again you’ve explained with absolute clarity one of the most significant failings of @10DowningStreet ‘s catastrophic #COVID19UK management.
@danielgoyal

1/22 - Sorry🙏🏻💙

https://twitter.com/danielgoyal/status/1451380203176046615

I qualified as a GP in 1996, but no longer work in “normal” General Practice & have not done so since Oct 20.

I now spend 90% of my time as a “GP in A+E” & work in our 2 local UTCs.

I’ve also been part of the local #COVID “hot” services - in our #HotSite & doing home visits.
2/

From talking to my GP friends & colleagues, I believe my experience is not at all uncommon & has played a HUGE PART in the current #GPCrisis - both for the health & wellbeing of our patients but also for the recruitment/retainment AND wellbeing of GPs themselves.
#TeamGP
3/

I have made it clear in the past that I did not support a #TotalTriage model of care, even before #COVID hit.

This DOESN’T MEAN that I do not support my GP colleagues who’re working extremely hard to tackle a tsunami of health needs while being beaten with a large MSM stick!
4/

IMO Primary Care has been “framed” by @NHSEngland & senior health leaders who already had a PRIVATE Primary Care model in their sights.

@MattHancock was heavily invested in a App based model, the pandemic enabled & speeded up its use!

@DHSCgovuk
5/

What I’m about to say may shock you, it shocks me to say it out load too.

In the surgery I worked in when the pandemic hit, fully qualified non-partners were prevented from seeing any patients f2f.

❗️We essentially became 111 drs, overnight❗️

Bad for patients AND for GPs.
6/

Only partners & trainees were PERMITTED to see patients f2f & the aim was to see as few as possible.

Salaried & locum drs were given long lists of calls to make & we barely left our rooms for 11+ hrs.

It was an unrewarding, high-risk, acutely stressful & lonely experience.
7/

But during the first few weeks of the pandemic, in March/April 2020, it did not seem unreasonable.

As an EMERGENCY MEASURE it had benefits.

But IMO it should have been only that, AN EMERGENCY MEASURE, with a clear route back to more normal ACCESS to care in the community.
8/

I’m not blind to the many logistical issues like building size, waiting room access etc w/ an #airborne🦠but these shouldn’t prevent us from aiming for a better model.

#TotalTriage may well be the only option right now, but I still don’t believe it offers THE BEST CARE.
9/

The directive to cease f2f came right from the top BUT there was a wide range of responses in individual practices depending on how much they’d bought in to a #TotalTriage model already & their own staffing situation.
10/

IMO the model is deeply flawed & relies heavily on a patient’s ability to assess/describe their problem(s) well, incl acute #COVID.

If a v experienced HCP, with a low threshold for conversion to a f2f appt is the first point of contact, all may end well.

If not however…..?
11/

It’s v good for certain things like sick-notes/repeat medication requests/medication reviews & the management of straightforward simple problems can MOSTLY be done safely.

But not all…

The risk of missing the “needle in the haystack” when you work w/ a blind fold on⬆️⬆️⬆️!
12/

After 31yrs as a dr, I could write a book of the times when the visual appearance of a patient or by doing their very basic observations totally changes the diagnosis/management of a problem.

Sepsis for eg, is easy to miss without eyeballing a patient, tel calls can miss it.
13/

But consider complex problems or patients w/ numerous problems on multiple medications & the level of risk sharply⬆️s.

If there are any communication issues at all or a 3rd party is on the phone/emailing, vital information can be lost & confirmation bias is far more likely.
14/

In the hands of trainees or those without many years of experience, the whole process can become fraught with risk & stress/anxiety.

This is not a criticism at all, it is just that it takes a long time & a lot of skill/training to do remote consultations really safely.
15/

Throw in a highly contagious novel🦠 & the situation becomes even more risky.

As @danielgoyal has made clear, patients with suspected or known #COVID were/are effectively left to manage themselves, an utterly woeful situation that should not be possible in 🇬🇧in 2020/21.
16/

Patients in #Newcastle are lucky, we have a dedicated service for the care of such ppl, but the onus was/is still placed firmly on them to seek assessment/advice after a positive test result.

Assessing breathlessness accurately over the phone isn’t as simple as you’d think!
17/

SEEING & EXAMINING patients is what we are trained to do.
HISTORY, DIAGNOSIS, MANAGEMENT & ADVICE are all wasted if the original assessment of the problem is wrong.
Delays to the right treatment/management can have v serious, sometimes fatal outcomes, both #COVID & non-COVID.
17/

The last 12months working solely at the interface between Primary & Secondary care has confirmed to me just how risky it is NOT TO SEE PATIENTS.

I won’t consider working in a surgery again unless things change.
I’m not the only one, which adds to the current #GPCrisis.
18/

So our perfect storm of #COVID19UK/#NHSCrisis/#BrexitChaos continues, w/ the govt’s fingers firmly in their ears.

➡️General practice is the fall guy, it’s been set up to fail⬅️

The public have every right to be angry, as a pt/daughter/sister/mum/wife & friend I am angry too!
19

Those pushing for #NHSprivatisation & a US style of care have rapidly foisted this upon us all under the cover & chaos of #COVID!
Forced it on an #NHS that had been starved of funding since 2010 & has already been carved up into a number of convenient pieces.
20

The aim is NOT to provide good care for us all…no no no!

The aim is offer a two-tier system which will make just about every outcome worse for all but the wealthy WHILST MAKING A PROFIT!

“They” want you & I to angry with GPs, it fits their agenda perfectly.

@BorisJohnson
21/

So, we need you to BE ANGRY w/ THEM instead, write to your MP, tell family & friends, spread the word.

#YourNHSNeedsYou & IT NEEDS YOU NOW!
#SavetheNHS

@danielgoyal @profchrisham @doctor_oxford @DRTomlinsonEP @doctorshaib @ahmedaftab68 @CNagpaul @DrSimonHodes @HelenRSalisbury