Viewpoint: What actions are needed to reduce pressure on general practice this winter?

This article has been independently authored but initiated, funded, and reviewed by Pfizer UK for ABPI code compliance.

The pressure experienced by my team at the Project Surgery in Newham, East London, over the past two winters was extraordinary and I’m very aware that our situation was far from unique. It’s with those memories still so fresh in my mind that I’m looking ahead to this winter, which is expected to be the first of the pandemic when there are no restrictions in place, with real trepidation.

The Project Surgery operates in a highly deprived area, where over 70% of residents are from Black, Asian or minority ethnic (BAME) backgrounds. This population is more likely to have pre-existing health conditions, such as type 2 diabetes,¹ making them more likely to get severely ill if they do catch COVID-19.²

However, it’s not just COVID-19 that is causing concern, it’s also the possible rise in infectious respiratory diseases, such as influenza, respiratory syncytial virus, and pneumococcal pneumonia, that is typically associated with colder months.^3,4

The pandemic forced us all to reconsider the way we work. We set up online appointments and followed a telephone first approach to help tackle increased demand and reduce face-to-face contact. As we head into winter, many of these practical measures may be brought back to ensure that we are able to continue serving our communities.

I believe the action needed to try and reduce the burden on primary care goes beyond pragmatic steps implemented at practice level. From my perspective, there are several factors we should consider this winter, including:

1. Keeping our definition of high-risk under review

By restricting which patients are considered high-risk, we are making it harder for many vulnerable people to get access to vaccination and treatments.

When I am prioritising and advising patients, I use a much broader definition of risk, including those from BAME communities, people from lower socio-economic backgrounds and those over 50 years of age. In considering a wider group, I believe that we can protect more people and alleviate strain on both primary and secondary care services.

2. Making vaccination easier to access

Despite our best efforts, uptake of routine vaccinations in my practice has not met recommended targets and that has been the case since before the start of the pandemic. The reasons for missed vaccinations are many. In some cases, people are vaccine hesitant, but in most cases, people simply have other priorities.

This winter, I am expecting a reduced uptake of the COVID-19 vaccine due to ‘vaccine fatigue’, as well as other concerns such as the ‘cost-of-living’ crisis. We need to make access to vaccination easier.

We can learn so much from the early days of the COVID-19 vaccination programme, when vaccination sites, staffed by volunteers, were established in community centres, car parks, townhalls and pharmacies. This should not be limited to COVID-19 and applied to all routine vaccination programmes. By going to where people are, we can boost uptake and alleviate some of the pressure on GP surgeries.

3. Helping higher-risk patients make informed decisions about their health

Stoic is a word I would use to describe many of my older, and often higher-risk, patients. All too often they put on a brave face, they don’t want to be any trouble, and they don’t ask for help early, or often, enough. Respiratory illnesses, such as COVID-19, pneumonia, or flu, are often passed off as ‘just a cold’.

Education is needed to ensure patients know which symptoms to look out for, when to see a doctor and that treatments are available. When it comes to respiratory illnesses, prevention and early intervention are key to helping avoid severe outcomes.

There is no doubt that we have made great strides in addressing the challenges we have faced throughout the pandemic but it is important that we continue to build on the gains we have made, particularly as winter approaches, by using all of the tools already at our disposal.

• Dr Farzana Hussain is a GP at The Project Surgery, Newham London

References

1. Diabetes UK. Ethnicity and type 2 diabetes. Available at: https://www.diabetes.org.uk/preventing-type-2-diabetes/diabetes-ethnicity. [Last accessed: November 2022].
2. Diabetes UK. Coronavirus and Diabetes Updates. Available at: https://www.diabetes.org.uk/about_us/news/coronavirus. [Last accessed: November 2022].
3. Audi, A, et al. Seasonality of Respiratory Viral Infections: Will COVID-19 Follow Suit? Frontiers in Public Health, vol. 8, 2020. https://doi.org/10.3389/fpubh.2020.567184
4. Amin-Chowdhury, Z, et al. Does the rise in seasonal respiratory viruses foreshadow the return of invasive pneumococcal disease this winter? The Lancet, vol. 10 (1), e1-e2, 2022. https://doi.org/10.1016/S2213-2600(21)00538-5

PP-UNP-GBR-2125
Date of prep: November 2022