Primary Care Insights: An interview with Dr Oke Nwanneka
Firstly, as a relatively newly qualified Doctor who qualified during the Covid-19 pandemic, how has the past 12 months been with training and now as a Salaried GP?
The face of training changed a lot during the pandemic. For me personally, one of the big changes was the introduction of the Recorded Consultation Assessment (RCA). From a Trainee’s point of view, this was a new exam to get to grips with in such a short time. It was quite challenging to prepare for a completely new exam format alongside working under the constant evolving pressures imposed by covid 19 at the time. The new changes to work schedules, like remote consultations etc also came with its own challenges. One of the good things at the time, was the availability of lots of online support services especially, from the RCGP and the fact that lots of my peers were in similar situation as myself, so I didn’t feel alone.
However, I must admit it was quite tough juggling between working, family life, sitting exams and also completing portfolio bits from a training point of view.
The transition period post training was quite hard, everyone was so busy with managing the pressures due to Covid-19 as a result, there wasn’t really time to sit down with established GPs/Partners to go through what to expect next with regards to career options post training.
I did a fair amount of personal research and attended quite a few webinars aimed at life and what to expect post CCT. I also spoke to a lot of friends plus some GPs in this regard. Speaking to Patrick at the recruitment agency helped a lot as well with options in regard to work to post training.
You were one of many GPs who did move practices during the height of the pandemic. Many others were reticent to do so. How did you find the move, and did it differ in any way to the experience you’d have faced moving jobs pre-Covid?
It was more daunting than it would have been pre-pandemic. Post training, I started working as a Locum doctor on a Covid ward in hospital whilst sourcing for a permanent role in General Practice. This was challenging and I must admit up until then, I wasn’t used to seeing such volume of patients with purely covid symptoms as well as being quite unwell with covid features. Managing a ward full of covid patients was quite stressful. From a General Practice point of view, this perhaps was beneficial for me as a clinician as not only did it remove some of the fear factor I may have had as regards Covid in general but, I felt more equipped in regard to managing covid related issues in primary care.
One thing we’ve seen a lot of is public frustration towards GPs. Both ‘the man on the street’ as well as in the papers, with the misconception that you aren’t seeing patients anymore and therefore aren’t busy. Where do you think this has come from?
When the Pandemic started, the death rates were extremely high and understandably, the government announced measures to reduce transmission. General Practice played their part in this regard, by reducing patient footfall and adopting remote consultations as a strategy. Down the line, with the pandemic easing, understandably patients want more access to primary care for their health needs in the form of face-to-face consultations.
The primary care community assessed the status quo re: the evolving pandemic picture and felt that remote consultations have been quite effective so far for a significant number of reasons and lots of patients favoured remote consulting as well due to the added benefits. The idea of returning back to solely face to face consultations and doing away with the new ways of working was perhaps a misunderstanding on the part of the public as the GP community is there to serve the population and mainly at this stage looking at better ways of working and managing the heightened workload in order to serve the populace better.
General Practice is still trying to do its bit in preventing disease transmission, and not having ill patients sitting next to one another in a full waiting room is one way of achieving this. Having said that, the media’s portrayal of General Practice wasn’t great, was it? Looking at the current appointment system, there are lots of face-to-face appointments available across the country. This is because GPs have implemented a part remote and part face to face system that has also been effective. This has protected the GP workload and improved patient access overall, but I think some quarters of the public haven’t liked the change. NHSE’s recent statement suggesting that General Practice’s doors are now fully open for what sounded like total face to face appointments didn’t help things either in my opinion.
For those unfamiliar with General Practice, just how has your role changed over the last 12 months?
The workload has ramped up a lot. At the start of the pandemic most people were mainly at home and GP waiting rooms were less busy as a result, and those who needed to consult with their GP’s did so, lots of issues at the time were perhaps more acute and less complicated I suppose. At present, we are seeing and managing much more complex and complicated issues and dealing with some of the backlog from secondary care as well. I would say general practice has been become so much busier and under extreme pressures.
When life gets back to how it was; do you think General Practice will go back to how things were pre-pandemic?
My prediction is that the new methods of consulting i.e., remote consulting will still continue as it has proven advantageous so far. Face to face will also have its place as a core method by which patients consult with their general practitioner. This has the added bonus of fostering further the relationship between patients and their doctors. We need to use the new technology that has been adopted through the pandemic moving forwards. This enables some appointments to be done quicker with retained effectiveness and patient satisfaction. This method has also been welcomed by patients with busier lifestyles as this suits their needs better. The RCGP has made a case for this to carry on, and private providers have been using this system for years too.
In a post-Covid world, what are the main challenges you foresee General Practice facing next?
The main challenge I think is mainly around managing delayed presentations, this is a big problem. Some medical issues that have been left unsolved and undealt with for quite some time now due to the pandemic. A lot of the problems now are quite complex to manage.
What does General Practice need to do, or put in place to meet these challenges?
We need to relook at the appointment system. There needs to be a structure to the day, week or month ahead, allocating a good proportion of face-to-face slots with the additional remote consultations alongside this. Re-starting pre-bookable appointments will also be beneficial as well. At the moment, appointments are structured as urgent on the day and first come, first serve.
Another aspect to consider is staffing levels, there aren’t a lot of permanent GPs to go around and lots of GPs are locuming at present for various reasons. An aspect I have discussed with my practice is potentially employing other health care professionals such as Physician Associates as they are useful especially with managing more acute issues hence, freeing more GP time. This takes the pressure off the GPs and enables them to concentrate on some of the more complex conditions. Having the right mix of staff will help too.
Do you think the increase in funded-ARRS roles can help this at PCN level?
Yes, definitely. At my current practice, we have a pharmacist who takes care of prescription reviews which in effect takes a lot of pressure off GP time. We also have a physio who is brilliant and takes a lot of the MSK pressure off. To get these health care professionals in place, there needs to be adequate space in the practice to accommodate them. The PCN scheme/structure is brilliant and effective in managing primary care workload pressures.
Looking back over the last 12 months and your experiences having qualified recently, and now having been a Salaried GP too, what would be your advice to GPs due to qualify shortly?
My advice would be to think in advance about what you really want to do. The main options to consider could depend on the practices you have worked at. Make a list of things you like and dislike about practices you have worked at. Also consider travel distances for work, family commitments, and last but not the least the ethos of the practice you want to work for.
Decide early whether you want to go down the partner, salaried, portfolio or locum route. For me, the stability of being a Salaried GP was key for me, it also allows me to explore my other interests both in and out of medicine. Another recommendation would be to develop a special interest within General Practice, this I have been told helps to keep things interesting as they say and generates that added variety to work life.
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