Coronavirus: GP makes heartfelt plea on behalf of ‘forgotten workforce’ in primary care

‘We have revolutionised the way that general practice is delivered, yet we hear nothing about it’

Family doctors and other primary caregivers looking after coronavirus patients in the community are the “forgotten workforce” and have “barely been mentioned at all” during the crisis, a GP has said in a heartfelt video message.

“When you hear the newspaper headlines you will hear about care homes [and] hospitals,” said Dr Sian Stanley, a GP in Hertfordshire. “But at the heart of it all remains primary care, and it’s the one thing that’s never mentioned.

“We have revolutionised the way that general practice is delivered during this crisis, yet we hear nothing about it.

“There is very little extra funding coming our way. The hospital debts have all been written off, but what about primary care?”

Primary caregivers include not just GPs, but district nurses, community pharmacists and hospitals, Dr Stanley added, “and all the various people who bring care to patients in their own home, outside the hospital environment”.

Dr Stanley also detailed the lengths to which some primary caregivers may be reliant upon their communities to provide them with personal protective equipment (PPE) in the face of shortages.

The GP, who is clinical director of the Stort Valley and Villages primary care network, said its five practices are still waiting for a delivery of PPE promised three weeks ago.

“Thank God that our patients and local newspaper has managed to get stuff to us, or we would be seeing these patients with nothing,” she said.

Claiming that the suitability of PPE has been trialled only in hospital situations, she detailed the risks facing district nurses visiting patients in their homes.

“[Patients] could have Covid-19, they could have huge viral loads. The house isn’t clean, the house isn’t ventilated,” she said. “The risks that are involved in these people going into the person’s home are enormous. And yet, without us, they’d just be sitting there with an apron and a paper mask.”

The scale of the toll that coronavirus may be taking outwith hospital settings wass highlighted by new Office for National Statistics figures this week that revealed there were 2,100 more coronavirus-linked fatalities in the period until 3 April than those included in the hospital toll of 4,093.

Experts raised concerns that the true number may be even higher, with the figures showing 6,000 more deaths in the week ending 3 April than would normally be expected – more than a third of which had not been attributed to Covid-19.

“That could point to a huge under-reporting of deaths at home and in care homes,” said Professor Sir David Spiegelhalter, of the University of Cambridge, adding it could also “collateral damage” from people not seeking healthcare when they should.

On Wednesday, Matt Hancock effectively admitted that patients had been being routinely discharged back into care homes and the wider community without being tested first, as he announced that, going forward, all hospital discharges into social care would be tested and that all social care staff will have access to tests if they require one.

As the scale to which the virus is infiltrating care homes across the UK becomes apparent – with the largest care home operator warning the virus is present in two-thirds of its homes – Dr Stanley sought to assure the public that residents have not been “abandoned”.

“I’m not sure that people are aware that there are GP practices attached to each and every care home in the country,” she said.

“They are not completely abandoned in the community, we are very much there and we are very much supporting them. We’ve given a lot of our PPE, that was made for us, to nursing homes. We’ve made sure that they are safe.”

She urged clinical commissioning groups (CCGs) to release additional funds into general practice, so staff can be better protected, warning that a relaxation of lockdown rules could lead to a surge in new patients reliant upon primary care.

Dr Stanley also urged CCGs to “administrate, not manage” on their behalf, adding: “The bureaucracy has been a knotweed around any response we have.

“My concern is that, as the forgotten workforce, our risks are enormous both clinically and personally.

“I just need somebody to listen, to challenge the status quo, because we are not being heard at the moment.”

Ruth Rankine, primary care director at NHS Confederation, the representative body for health care organisations, added: “Primary care is at the heart of the national response to managing this awful disease.

“Just like hospitals, primary care services have completely transformed at a phenomenal pace to be there for patients and just like hospitals and other frontline staff, their workers face the same risks so they need the same adequate protection and support.”