Where are my patients? GP speaks out about non-covid-19 health problems

A Bristol GP shares her concerns that the drop in patients calling the surgery during coronavirus could lead to more serious illnesses down the line.

Coronavirus in Bristol 4th May, 2020

Hannah Vickers

We’re living in uncertain times. And with government advice changing daily and social media swarming with contradictory opinions, it’s hard sometimes to know what you’re meant to do. Amid this uncertainty, GP surgeries have seen a massive drop in appointments, something that doctors say could lead to serious illnesses going undetected and easily treatable conditions deteriorating.

Dr Sarah Jahfar, senior partner of the Wellspring surgery, contacted the Bristol Cable, alarmed by the drastic fall in appointments her surgery has seen since the lockdown started. 

The duty doctor for suspected coronavirus cases is as busy as would be expected but the duty doctor dealing with non-coronavirus emergencies has seen a marked drop in patients. Jahfar says that patients with other health emergencies, like suspected stroke, cancer or heart attacks, are just not coming in.

She says that, apart from patients with coronavirus, “this is the quietest we’ve ever had the surgery”. While a positive to come out of the pandemic could be greater awareness of conditions that go away on their own, she’s keen for patients to know that it’s still important that they get in touch with their GP if they’re worried about something. 

A mini stroke could be a warning sign of a bigger one to come, urinary tract infections can lead to kidney damage, skin infections could develop into sepsis, which can be fatal. If caught early on, most issues can be diagnosed and addressed quickly. If left, people could get seriously ill, or die, from illnesses we have the medical technology to cure.

It’s not just GP surgeries that are seeing fewer patients. Bristol’s hospitals are only half full, partly because of non-urgent operations being cancelled and partly because the south west has the lowest number of confirmed cases of coronavirus. Hospitals nationwide have reported a drop in chemotherapy appointments, which could lead to newly diagnosed people dying before the end of the year, according to a study from the University College of London. And Bristol Eye Hospital has appealed for patients to get in touch if they have eye problems. Emergency visits are down by 50% and in extreme cases patients could become blind from conditions that are treatable if caught early enough.

Jahfar wants people to know that, although the healthcare being offered during the pandemic has changed, it is still there for people. “If people are worried about themselves they should ring. Even if it’s nothing too much, ring. We’d much rather do that than miss things.”

She tells me, her voice soft with amazement, about two patients who had chest pains for two weeks before calling. They both turned out to have heart problems and if they’d waited much longer they could have died. Others who may have had coronavirus stayed home “were sticking it out at home when they may have needed oxygen,” she says, adding that patients with mild cases should stay home, but more severe symptoms need to be assessed. 

Jahfar’s message is clear: “We’re still here. Please call us.”

‘All the usual childhood illnesses are still out there’

Jahfar talks me through some of the changes they’ve brought in to deal with the pandemic. Bristol’s surgeries were ahead of government advice, switching to phone triage (and using video calls for diagnosis), dividing practices into zones and wearing as much personal protective equipment (PPE) as they had access to in the ‘red’ coronavirus zones, before being instructed to. 

Bristol’s surgeries work in coordination with neighbouring practices so they can share advice, resources and good working practices. They’ve been very busy calling all their patients on their high risk list who are self isolating to check in with them and loaning out blood pressure and oxygen monitoring kits so they can do reviews over the phone. Inevitably, there’s been a rise in mental health needs reported as a result of the pandemic and lockdown, and the Avon and Wiltshire Partnership has responded by launching a 24-hour helpline for mental health support.

In GP surgeries, many treatments have been paused. Any face to face treatments not seen as urgent or that would bring a doctor or nurse into too close contact with a patient are currently on hold, although many can be dealt with safely on the phone or by video link. Smear tests were on hold, but now – as long as staff have enough PPE – they’re doing them again.

A key service that is still open, after a brief pause in the first week of lockdown, is the inoculation clinic. Jahfar says she’s “really worried” about the potential fall in parents bringing in children for their immunisations. She says the surgery is taking precautions, timetabling immunisation clinics at a time when very few other patients are about and that staff wear PPE, but is concerned that some parents may still feel anxious to come.

From eight weeks to 13 months, babies have a whole host of vaccinations to stop them getting, among other diseases, diphtheria, tetanus, whooping cough, polio, measles, mumps and rubella. 

Jahfar says there’s a real danger that it could lead to another wave of infectious diseases travelling through young children after the coronavirus pandemic has subsided.

“All the usual childhood illnesses are still out there.”

‘The NHS isn’t a charity… But this is a national emergency’

She’s full of praise for the “lovely, generous, kind people” who have been working hard to plug the PPE gap and says that, while it may feel uncomfortable to ask for donations, “there’s a shortage and we need to protect ourselves.”

“The NHS isn’t a charity – we’ve all been paying our taxes for however long. There’s something (about asking for donations) that doesn’t sit that comfortably with me, but this is a national emergency.”

She tells me about school DT departments that have used their empty workshops to make visors, costume makers who are making bags for scrubs, and the many people at home making homemade face masks and 3D-printed face shields and visors for staff who aren’t being provided these vital things by the government. Their surgery has had so many donations, they’ve been able to offer PPE to colleagues in local care homes and various nursing teams. 

“Fortunately, the infection rates and PPE supply issues are now beginning to improve, but while we were struggling, it was fantastic to see the solidarity of so many people. It made me cry.”

“I can’t begin to express how much I admire people in small accommodation, especially with your children running around,” she says. But says she feels horrified when she sees groups of people in the street when she’s on her way into work. “If you could feel the pain of it like I do…” She hears firsthand of her patients who have died from coronavirus and it weighs heavily on her. “I feel the pain of it when I wake up in the middle of the night,” she says.

“If we could get the simple things right, it could save so many lives.”