GPs need 'combat levels' of self care to deal with pandemic fallout

GPs need 'combat levels of self care' and to think about themselves as 'disaster responders' in the aftermath of the COVID-19 pandemic, the country's leading expert on disaster recovery has said.

Professor Lucy Easthope

Professor Lucy Easthope, professor in practice of risk and hazard at the University of Durham, told the RCGP annual conference in Glasgow: 'GPs are absolutely rubbish at looking after themselves. People are scared because they think it might mean time off, it might be stepping away from something they love.

'It's not that, it's reevaluating how you will do this work through a lens of being a disaster responder, pivot to think of yourself in that way.'

Changed patient relationships

She said that a pandemic would 'change fundamentally the social contract between the public and healthcare workers for a lifetime'.

'The patients you saw in 2019 are gone,' she said.

Planning work she had undertaken in 2016 recognised the aftermath of a pandemic would 'be hardest on frontline health workers and very hardest of all on primary care,' Professor Easthope said. 'And that harm will be experienced as a minimum for 10 to 30 years in my opinion - and that was only if we went into, at that point, a fictional pandemic with a robust health and social care system.'

She warned that demand in primary care would continue to rise, while patient satisfaction scores would 'continue to get lower'.

'That's just the way it is. One of the things we see in disaster response is that people don't score how am I getting on with my my primary care relationship from a place of rationality, they do it as an act of vengeance against the state. So your numbers will be low for a long time.'

Pandemic recovery

Professor Easthope said that recovery from the pandemic was 'not a sprint, or a marathon. It's the worse endurance event imaginable'.

She highlighted that pandemic plans from before COVID-19 hit predicted that 'excess deaths would occur for at least 10 to 15 years in the aftermath a pandemic'. These would be 'from delayed cardiac, delayed oncology, from poorly managed diabetes, from everything from dental infections to UTIs'.

Professor Easthope also warned of the 'somatic symptoms of disaster', which usually occur three years after an incident.

'At the three-year point we see a massive increase in insomnia, rashes, respiratory, pain around the oesophagus, where we hold on to trauma, gastric and back pain. Every disaster-hit primary care research will tell you about the three years somatic system symptoms.'

Professor Easthope said that GPs needed to be realistic about the challenges that lay ahead and think about 'the reasonable worst scenario' when preparing for this winter. 'Go back to your colleagues, and your teams and talk about how this winter is going to be really hard - don't fall for hope-ium,' she said.

Grenfell disaster

Despite the challenges, Professor Easthope said that one of her sources of hope came from general practice and the 'incredible work' done by GPs and their teams in North Kensington in London following the Grenfell disaster.

'I could not use this platform and not acknowledge the incredible work done by multiple surgeries that sit around the base of that tower, [who] make the time to care and protect additional time,' she said.

'When people come to them, perhaps with back pain, perhaps with a cough that won't go, of course, that is not all that they want to talk about. And they know a truth, and I know a truth, and you now need to know a truth, which is disasters and life in disaster get harder year on year, not easier.

'And I thank from the bottom of my heart, your GP colleagues in that part of the world for fighting so hard to not decrease, but to increase the funding and the support. They have taught me so much about post-disaster brokerage, the true work of disaster.'

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