GPs were left to fend for themselves during Covid due to a lack of pandemic preparedness focusing on primary care, the official inquiry heard today.
Giving evidence, Professor Adrian Edwards, a GP in Wales and a professor at Cardiff University, argued there was ‘very little’ pandemic preparedness specifically for primary care, especially with regards to infection control practices.
Professor Edwards told the inquiry there had been a lack of ‘operational preparedness’ that was ‘important to actually enable things to carry on’.
‘When the challenge came in March, April of 2020, it really wasn’t there, and I think to be fair, we were flying by the seat of our pants,’ he said.
This included a lack of preparation for how to deal with Covid infections across the general practice estates, for example by using ‘hot’ areas for consulting, as well as getting protective equipment and oxygen cylinders ‘in the right place’.
‘This was all largely generated as we went along in those early weeks, whereas consideration of that in advance would have made things that much more efficient.’
The first report of the Covid inquiry, published in July this year, found that significant failings in the UK’s preparation for a pandemic meant Covid caused more deaths and long-lasting economic damage than it should have.
Quoting his own research, Professor Edwards said there were ‘dips in diagnosis and recording of incidence’ of long-term conditions, and that ‘there is actually evidence of a backlog there’.
The inquiry lawyers also asked Professor Edwards about specific wellbeing support for GPs during Covid, referring to a BMA survey which found burnout, moral injury and stress among the profession.
In response, the professor said there was ‘a lack of primary care-specific support, both what you might call treatment, including issues of burnout, and also health promotion and prevention in terms of promoting wellbeing and how to support that across the workforce, to make sure that the sector is resilient’.
Professor Edwards suggested that practices should have had more support for personal risk assessments of staff from their local health boards.
He also criticised the narrative that GP practices was ‘closed’ during the pandemic, arguing that more should have been done to communicate to the public that this was not the case.
Professor Edwards said individual practices were left to make their own ‘attempts’ to communicate to patients that they were open, but this message ‘may not have always got through’.
‘So I think what could have been improved was a more coherent or a stronger campaign to convey what was available in general practice,’ he told the inquiry.
During the Covid pandemic, many GPs reported experiencing abuse from patients lashing out at them because they believed practices were closed and blaming them for changes to national guidance.
This followed NHS England landing itself in hot water with a ‘reminder’ to practices to offer face-to-face consultations despite the ongoing pandemic and its own ‘total triage’ advice.
Also giving evidence today, RCGP honorary secretary Dr Michael Mulholland argued that GPs felt ‘unfairly blamed’ and ‘attacked’ during the pandemic.
Dr Mulholland pointed out that the ‘media narrative’ seemed to blame GPs for being ‘closed’ during the Covid pandemic, with no counter narrative from anybody else.
He told the inquiry: ‘During the first wave, there were times of everybody being very supportive that doctors were at work, but as people perceived that general practice was closed, although we weren’t, the media narrative seemed to grow.
‘Many of our members reported and felt unfairly blamed for what was coming out in newspapers and reports that weren’t then being countered by anybody else to say “no, GPs are at work, GP doors are open, and they’re working in this new way that is different, but it is not that they’re closed”.’
According to Dr Mulholland, it also ‘felt at times that general practice was a second though or after-thought in planners’ minds’ and that ‘hospitals were often prioritized’.
He suggested that this is down to the fact that general practice sees patients more quietly and there is less ‘excitement’, compared to an A&E department for example.
Last week, the Covid inquiry heard that the evidence that FFP3 face masks were more protective for doctors than surgical masks during the pandemic was ‘weak’.
Professor Susan Hopkins, chief medical adviser at the UK Health Security Agency (UKHSA), told the inquiry that while FFP3 masks ‘offer a higher level of protection’ in laboratory settings, the same effect has not been observed in clinical practice.
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increased risk with COVID but very well paid in terms of earnings by COVID vaccination, multiple practices earned millions in covid
The Covid-19 Inquiry is looking at the role of primary care in the pandemic. In my own practice, what helped considerably was good leadership, clear communication with all members of the practice team, regular updates, and a senior clinician who was the point of contact for queries.
Unlike many other general practices, we did not “close our doors”. Patients were free to come to the practice to speak to reception staff with their queries and to book appointments in person; which was important for those patients who were unable to book appointments online.
We found that “keeping our doors open” did not pose any great infection risk. Most patients communicated with the practice by telephone, email or online. But for the minority who could not book appointments remotely or who were very anxious, the human contact was essential.
It all sounds a bit like the ruminations of Lord Jim
1. There wasn’t a lack of operational preparedness – there was a total absence of any central planning. It was a total failure of public health planning.
2. The speed and effectivenes of the GP response was frankly extraordinary. We offered a continuity of care and access that was matched by no other part of the system.
3. People forget that we understood that we were risking our own lives by exposing ourselves to infections. The lack of proper and appropriate PPE was a national scandal. The recent MPox outbreak suggests nothing has been learnt.
4. Contributions from patients were very signficant in the early days and during the vaccination programme.
5. The abuse of general practice by the media and by politicians (I’m looking at you, Boris) was disgraceful, and almost entirely based on conscious lies. The lack of support and defense from NHSE and DOH was equally disgraceful.