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

1/22 - Sorry🙏🏻💙
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.
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.
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!
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!

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.
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.
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.
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.
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.
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…..?
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⬆️⬆️⬆️!
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.
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.
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.
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.
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!
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.
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.
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!
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.
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.

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


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

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More from @AlisonGeorge10

2 Nov
@Jeremy_Hunt & @sajidjavid , I’m a 55yr old PART-TIME GP, working in A+E & UTCs, working ~25hrs per week.

Between Mar-Oct 20 I willingly ⬆️ my hours significantly, to staff our “Hot Site” & be part of the Covid Home Visiting team, regularly only having 1 full day off/week.
It almost broke me & caused significant strain on my family.

In Dec/Jan 21, I jumped at the chance to help vaccinate ppl living in Care Homes, giving up days off without a second thought.

I doubt there’s a single one of us who hasn’t worked many extra hrs during #COVID19UK.
The job of a dr is not something that can be done easily/well when exhausted, stressed, distracted….

The jobs we do require 100% focus every minute of every working day, because if we don’t, our patients can suffer or even die.

Tired drs can be dangerous drs!
Read 11 tweets
2 Nov
1-Don’t get me wrong, I’m v pleased that @UKParliament are now taking #COVID seriously & doing SOME of the simple things we know ⬇️ transmission.

#Masks #SocialDistancing #WorkFromHome

Assuming everyone working on the estate is >18, the vast majority will be doubly vaccinated.
2-So tell me, why are pupils (largely unvaccinated), education staff & families of both not afforded such protections?
I searched the #DfE website HOPING for advice on 😷s, social distancing, options for CV/CEV pupils & staff to work/learn from home, ventilation?
3- But NOTHING, just👇🏼from @nadhimzahawi in the last few days re LFTs, NO MENTION of any other mitigations at all.

#COVIDVaccination has only just begun in the 12-15s, so what are CV/CEV pupils, staff & those with CV/CEV family members to do?

Maybe the @UKHSA can help….?
Read 10 tweets
1 Nov
1/ Morning @JamesMelville 👋….I see you and your #CovidDisinformation pals on @talkRADIO are still at it.

Could I suggest that you speak to someone who actually knows what’s going on in the #NHS before debating a really important topic live on the radio?
2/ If you don’t know/understand all the issues at play in our perfect storm of #COVID19UK, #GPCrisis & #NHSCrisis then as journalists, your duty is to find out rather than whip up more anti #NHS sentiment.

We’ve got more than enough of that to deal w/ already, I can assure you👇🏼
3/ A quick example ➡️

Yesterday a 17yr old (X) attended a local WIC with mild upper respiratory tract symptoms.

X had a through examination, a detailed explanation, reassurance & good safety-netting, all documented.
Read 10 tweets
31 Oct
Hi again @JuliaHB1, I haven’t got time today to produce the very long list of ways in which you have played an active part in the relentless spread of #COVIDDisinformation, which has directly contributed to the catastrophic situation we are now in….
…..But for now, would you be able to comment on the fact that you signed the letter from #UsforThemUK to @GavinWilliamson & #DfE requesting that 😷s be removed from 🏴󠁧󠁢󠁥󠁮󠁧󠁿secondary schools in the summer term.…
The push to remove 😷s from 🏴󠁧󠁢󠁥󠁮󠁧󠁿secondary schools during a pandemic has been disastrous, detrimental not only to pupils health & wellbeing (& that of their families) but to their education too.

You & your co-signatories are responsible for a lot of avoidable harm & suffering.
3/ ImageImage
Read 5 tweets
22 Oct
1-Hey👋@GillianKeegan yep, I know 😷s aren’t v comfortable when you wear them for hours - WE DO EXACTLY THAT DAY IN DAY OUT!
If you lot would stop behaving like spoilt children those of us trying to keep the #NHS going would have a better chance!

#COVIDisAirborne - oh yes it is!
2-I’ve just finished my 8th day of working out of 9…Not all were full days & yes, I know this is nothing special.

My point is, every single hour was spent wearing a 😷!!

Are you suggesting those of us in healthcare DON’T #WearAMask because IT’s UNCOMFORTABLE?

3- For the millionth time - #COVIDisAirborne (shouting now😬) - unless we all start accepting this FACT & behaving as if we care… A LOT OF PEOPLE are going to die unnecessarily….!

@Jeremy_Hunt - please can you point your party towards #airborne viral transmission reduction!
Read 6 tweets
22 Oct
1/10🧵 - Tragically, a lack of understanding isn’t the only reason @Conservatives are so #antimask.

YES, some have made ludicrous statements about only STRANGERS being a #COVID risk, including our Secretary of State for Avoidable Ill-Health @sajidjavid ….

2 - Remember this car crash👇🏼interview on @SkyNews last month @sajidjavid ?

Shall we run that particular bit of public health advice past genuine experts like @trishgreenhalgh @dgurdasani1 @chrischirp @devisridhar @martinmckee @GabrielScally & all those at @IndependentSage?
3 - ….and how can we forget @Jacob_Rees_Mogg ‘s hilarious explanation yesterday for the lack of 😷s on the #Tory benches.

@LindsayHoyle_MP @OliverDowden @JonAshworth @AWMurrison
(As an aside, could it be time to introduce IQ tests into the application process for MPs 🤔?)
Read 12 tweets

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