Coronavirus: How GPs are changing the way they work

Dr Debbie Noland wears full PPE when seeing patients and cleans the examination room between patients

By Dominic Hughes
Health correspondent, BBC News

Covid-19 has transformed how GPs work - from having to wear full PPE instead of ordinary clothes, to seeing a huge decline in the number of patients they are seeing. Here's how one practice in Liverpool has adapted.

Dr Debbie Noland is living with a new reality.

A few months ago, the Liverpool GP would have dressed relatively casually for a day seeing patients at the Ropewalks Practice in the city centre.

Now she is in medical scrubs and full protective clothing - face mask, visor, gloves and apron.

"Now we are completely clinical, I look like I did when I was a medical student working in the hospital in surgery," says Dr Noland.

"It's definitely far more challenging - and the job is challenging enough without the extra stress.

"Having to go home and put your scrubs into a 60-degree wash, so you don't pass it on to your family. It's a completely different world than pre-Covid, that's for sure."

Even when she is seeing patients with no Covid symptoms, Dr Noland needs to balance the risk of infection while, simultaneously, being able to check out potentially dangerous conditions.

"If you need to listen to somebody's chest or you need to listen to somebody's heart - you need to do that.

"I feel like I am as covered and protected as I possibly can be. I would much prefer to make sure that I am doing things properly than miss something."

Patients are assessed in advance over the phone, including questions on whether or not they have coronavirus symptoms.

But since chest pain is exactly the type of thing that might indicate the development of another serious condition, some patients have to attend the surgery for an examination.

In between each appointment, Dr Noland must clean the room and change her personal protective equipment (PPE).

"When the patient has left, I'll clean down the room before anyone else comes in and change all my(PPE) so it is as safe as it possible can be. It may not be as approachable, but we are doing our best to make sure everyone can feel safe coming into a GP surgery."

Stark changes

All this means a much slower trickle of patients.

This time last year the surgery was seeing around 130 patients a day for GP appointments, blood tests or just to pick up a prescription.

But on the day we visited, just 24 patients attended the surgery, all by appointment only.

The surgery had previously introduced an online booking and assessment system last September, so most patients were accustomed to a more remote way of working.

But still, the change is stark: a normally busy waiting room now has just one patient at a time.

Dr Noland has to wipe down the consultation room between patients

Some patients are happy to come to the surgery. But Dr Noland says there are growing fears over those who are too worried about the risk of infection to come in.

"The amount of people I have spoken to on the phone with anxiety and depression... They were probably keeping it together, but it's the last straw that broke the camel's back.

"They can't cope now. It has been a massive impact.

"People are still having heart attacks, they are still having strokes, they are still having cancer, unfortunately.

"And there are a lot of other people that are dying of other things that seem to have been forgotten a little bit.

"It's a massive hidden cost of lockdown and that is really worrying for all of us - because we think there is an epidemic [of non-Covid illnesses] and we are just waiting for it to come."."

'Red zone'

The surgery is divided into two zones, with Dr Noland seeing her Covid-free patients in the 'green zone' on the first floor of the building.

Downstairs is the 'red zone, for those patients who are displaying Covid-19 symptoms, with a separate entrance to the rest of the surgery.

The receptionist, as well as the GP, wears full PPE.

Tina Atkins, the practice management partner, says the whole idea is to minimise exposure to infected patients.

"We don't have anything other than an examination couch and a chair - we don't use any of the IT equipment.

"We also say to patients if they arrive early: 'please stay in your car outside' because the slots are timed, so we don't cross-contaminate patients."

Ropewalks is a "hub" for nine practices in Liverpool. Each one directs coronavirus patients to the Ropewalks General Practice so the surrounding practices can maintain a Covid-free environment.

At the height of the pandemic, the surgery saw around 5-8 cases a day, but on the day we visited, no-one needed to be seen.

'Open for business'

Phone consultations are part of the new norm, especially when checking up on those who are shielding.

Practice nurse Moira Cain says: "With not going out at all, you're worried about people's mental health and their wellbeing. So the fact they're getting a phone call from someone who cares must be some reassurance.

"It's reassuring for us to know that they are eating, they are having food taken into them, they are sleeping ok - they haven't got any other symptoms."

But she adds: "What we have found is the footfall to primary care, as well as A&E, is really reduced.

"Are people sitting at home with chest pain? With shortness of breath? Have they got swollen ankles? Because if they have, they should really come in."

Social distancing, PPE, the fear of infection - all are making an already tough job more challenging.

But GPs want their patients to know that, despite appearances - the empty waiting rooms, the 'red zone', they are still very much open for business.