When COVID hit, everything in general practice changed every five minutes. We were getting notifications from the Department of Health nearly every day. Our COVID safe plan changed with the flow of information.
On a typical day before COVID, reception staff would make appointments for patients. Whether they had the flu or a cold, it didn’t matter. It was come in, wait, see your doctor. Once COVID hit, this required more juggling. We would ask the screening questions: Do you have fever, chills, cough, sore throat, shortness of breath or a runny nose? If no, you can come in. If yes, you have to be seen in the carpark.
We started doing carpark consults so the doctor could decide whether the patient needed a COVID test or not. And we started doing COVID testing. Some days we were doing thirty to fifty COVID tests. We had a doctor and a nurse outside in the carpark. Originally, we were only testing our existing patients, but later we started doing new patients as well.
About fifty per cent of our consultations became telehealth. We still saw some patients in the surgery—children needing immunisations, people needing procedures—but things like renewing scripts and referrals all became telehealth. We all felt there was some compromise in doing this, and we saw this especially when patients returned after COVID. Things may have lapsed, like the regular blood tests for their cholesterol or their diabetes. All that preventative health that in general practice we focus on a lot tended to suffer. Patients didn’t want to risk coming into the surgery, so they put their preventative health measures on hold.
In the first year, there was no vaccine for COVID, but we told patients they should still get their flu shot. The uptake for flu shots was high—about thirty per cent higher than before COVID. And whereas patients used to wait in the waiting room for fifteen minutes afterwards to make sure they didn’t have an adverse reaction, they now had to wait outside and we had to find a way of supervising them there. Flu vaccines were in short supply because demand was so high, and we often ran out. This made for angry and frustrated patients.
When COVID vaccines finally arrived, we were one of the first clinics to be included in the rollout. We got our supply straight away, but we didn’t get enough. We were immunising from 9am to 6pm—seeing patients nonstop and drawing up vaccines.
Initially, people aged fifty and above got AstraZeneca and people below fifty got Pfizer. Once people began thinking that Pfizer was better, everybody wanted Pfizer. People would get angry with us, or threatening, because we couldn’t supply the vaccine they wanted.
All our staff were abused at some time. The level of fear in the community very quickly turned to anger towards us, especially when people were faced with long waiting times, delayed test results and limited treatment options. Others felt forced to get the vaccine to keep their employment. These factors were simply out of our control.
The biggest challenge, however, was the personal health challenges we all faced and the impact this had on staffing. Many of our nursing staff caught COVID multiple times. They ran out of sick leave and had to take annual leave or unpaid leave.
Although most of our appointments were now telephone-based, we still faced the fear of being exposed to COVID and passing the virus onto our families. COVID-19 quite literally became the focus of our home and work lives.
At the start, we didn’t have rapid antigen tests to use on ourselves or our patients who had symptoms, and the PCR tests had a turnaround time of four to seven days. When rapid antigen tests came along later, I personally felt they were very good at picking up COVID—except when they didn’t!
Access to PPE was also an issue. During the first lockdown, the government sent every general practice boxes of masks to hand out to patients. Over time, this supply dwindled and we had to meet more and more criteria to get them. What we were doing, who was doing it and how many they were doing all affected our allocation. Instead of receiving a hundred N95 face masks, we might receive twenty. We couldn’t rely on this supply, so we started sourcing PPE privately. My husband and son even made us face shields. We had a 3D printer and they found a mould that other people were using for healthcare on a YouTube channel and so they printed some!
I’ve been in general practice for more than thirty-five years. During that time, we’ve seen bird flu and swine flu. We already had precautions in place based on those viruses, but COVID was so much more in-depth in terms of what we had to put in place. Yes, the infrastructure was already there, but we really had to ramp it up.
Today, we are still wearing face masks in consultations and in the reception area—the nurses wear them, the reception staff wear them, the doctors wear them—but everyone now chooses what mask they wear. We also remind patients to wear a mask when they come to us—and we offer free masks to patients in the waiting room.
Before COVID, we had a box of PPE. Now my cupboards are full of gowns, masks, goggles and shields.
We put up sneeze guards at reception and they are staying in place. We have not replaced all our chairs in the waiting room—we still keep them 1.5 metres apart—and I think the patients prefer that. When both our waiting rooms are full, patients are happy to wait outside. They have become accustomed to these changes.
All the things that management and reception staff put in place to enable the doctors to work from home are still in place too.
Yes, our pandemic experience was harrowing, but it was not harder than it was for a nurse working on a COVID ward. It was completely different—though I think the fear we felt was probably the same. Nurses felt that regardless of where they worked.
But, because of this experience, our infection control, hygiene processes and clinic management have changed forever. Next time, we will be ready.