During the height of the first wave of the COVID-19 pandemic, a senior BMA doctor estimated that around a quarter of GPs were self-isolating. Poor access to testing was blamed for forcing clinicians to stay away from their surgeries, despite being unsure if they were carrying the virus.
Two Suffolk practices - Combs Ford Surgery and Stowhealth Surgery - decided early on that pairing up could help them avoid a potential workforce crisis.
Within a week, Combs Ford Surgery - the smaller of the two practices - had been converted into a 'hot' site where patients with COVID-19 symptoms can be seen by a clinician face-to-face, if necessary, following triage.
The larger Stowhealth Surgery became a 'cold' site, continuing to treat patients without COVID-19 symptoms.
GP workforce resilience
Working to cover a population of 30,000 patients, GP partners at both surgeries say the move has provided much needed resilience during the pandemic - and kept patients and staff safe.
Senior partner at Combs Ford Surgery Dr Jackie Muir credits ‘a friendly relationship’ between the two practices as the main reason for their ability to merge at pace.
She said: ‘As the pandemic unfolded, Stowhealth produced this fantastic plan of how they were going to have clean and dirty areas in their building, while we were planning how we would respond. A colleague from the other surgery suggested it would be much more sensible to have a hot and a cold site [combining the two practices].
‘I took one night to think about it and decided that it was so much more sensible. I liked the idea of having a separate cold site because it meant that patients would feel reassured if they had to come in,’ she said.
A decision on which site would become the hot clinic was based on the layout of the buildings and infection control risk.
COVID-19 infection risk
Dr Muir explained that, because of the size of the Stowhealth building, which includes a children's centre, a small pharmacy and an out of hours services - all with one entrance - it made sense that the building stayed as a cold site.
‘Whereas Combs Ford Surgery is smaller, and there is only us working out of it. We’ve also got a fire exit that has become the COVID entrance. This meant that we could keep our main entrance clean as far as our dispensary. It just made much more sense [to do it this way] and kept the footfall down,’ Dr Muir added.
Stowhealth GP partner Dr Louise Skioldebrand said the practices decided who would work in the hot site by asking for volunteers. She explained that some staff volunteered after having expected contact with COVID-19 already.
Creating the hot and cold sites, the partners explain, allowed them to protect members and ensure they could work through the pandemic.
‘We've got one partner who's shielding, so she's working from home, and then we've got our GP trainee who is working remotely because she’s got complicated childcare and commuting issues,’ said Dr Skioldebrand.
‘Our pharmacist has been working from home because she wasn’t having any face-to-face anyway, so it seemed silly for her to come in unnecessarily. One of our salaried GPs, who is from a BAME group and was originally seeing patients at the cold site, is now working from home too,’ she added.
Protecting patients and staff
Dr Muir says a shared telephone system allowed the majority of practice receptionists to work from the cold site. The surgeries have used the ‘askMyGP’ appointment request system to carry out safe telephone and email consultation - triaging patients to identify those who need to be seen face-to-face and at which site.
A lead clinician at each surgery, who is appointed daily, is responsible for checking the group Whatsapp chat for updates, which is used to alert either site when a patient is booked in.
Dr Muir said the arrangement has given patients more confidence to visit their GP. Both partners agreed that working together had benefited workforce planning.
‘We've had the odd person having to be off for a week, but I think that was one of the many benefits - the bigger you are, the more capacity you have, you know, missing one or two doesn't make as much difference as it would if you're in a smaller unit,’ Dr Skioldebrand said.
‘I think it's been beneficial for everybody to see. From a personal point of view, the benefit for me is peace of mind. That actually if I got ill and went off sick a GP from Stowhealth would come down and fill my shoes, or if one of my nurses went off, then another clinician would be moved over,’ Dr Muir said.
Looking into the future, the practices agree that collaborative working during the pandemic will stand them in good stead, particularly when working on the primary care network DES.
‘In terms of providing care home services, I think we've started the ball rolling there really well and working with the district nurses as well. There's also great potential for chronic disease management to share something going forward there I think in terms of managing long-term conditions,’ said Dr Skioldebrand.