Strengthening the UK primary care response to covid-19
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3691 (Published 25 September 2020) Cite this as: BMJ 2020;370:m3691Read our latest coverage of the coronavirus outbreak
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Dear Editor
Liam Smeeth's response asks how General Practice was in part removed from managing covid-19. A bigger and more important question might be why?
Very early on the CCAS was set up as the point of reference after people were advised to ring 111. bypassing their GP entirely, at the same time as the Prime Ministers mantra included 'save the NHS'. The covid -19 webinars for primary care from NHS England totally lacked any clinical advice on managing people with covid almost as though NHSE had (and has, for the more paranoid) a very different agenda for the future of Primary NHS care. This has come at the same time as the role out of networks. ? Related
Competing interests: No competing interests
Dear Editor
Park and colleagues are right.
If a visitor from another planet arrived in the UK at the start of the pandemic, they would have seen a truly (and I actually mean truly) world leading primary care system offering universal health care delivered through a single joined up system. Wow (said the friendly Martian), the UK is so fortunate to have this incredible tool to help them deal with this pandemic: this will be a huge help to the country in the difficult months ahead.
General practice should and could have been at the forefront of efforts to control the pandemic. Instead a dysfunctional testing and tracing system has been established that is deliberately totally separate from our existing primary health care system that already offers a complete population framework for diagnosis and care. General practice should and could be playing a central role now as the health service re-builds and tries to deal with the appalling backlog of missed care. General practice should and could be playing a central role managing the clinical sequelae following Covid-19 infection. Instead, general practice has been largely ignored and left to muddle through, offering the best care it can with limited haphazard support from the wider NHS.
It is difficult to understand how general practice can have been so overlooked in this pandemic. The total lack of any general practitioners among the government’s senior medical advisors is telling. As Park and colleagues point out, in turn this has meant a total lack of general practitioners in the various advisory committees assembled for the pandemic response.
Back to our friendly Martian who is now holding their head in their hands muttering “Did they really just ignore general practice? How did it go so wrong?”
Competing interests: No competing interests
Dear Editor
I welcome the observations made by Park and colleagues and I am sure that few would wish to disagree with the tenor of their arguments. However, there is an important point which the authors, and the BMJ more widely, must better reflect if we are to move forward as a collective body of generalists, learning from our respective experiences.
This paper is clearly presented as a paper which reflects UK primary care. It is not. More correctly, the paper reflects Primary Care within NHS England. Whilst many of the experiences described are indeed common, there are differences within the structure and leadership of devolved health systems that have resulted in some different experiences. The paper refers to a disconnect between Public Health and Primary Care, implying that this is due to Public Health being integrated with local government. This is not the structure in Wales. It refers to the evolving remit of the NIHP which is specific to England. To the lack of GP input to SAGE, which in my experience has not been mirrored in Wales, where there feels to have been a more engaging approach.
Whilst these observations may seem esoteric, we will ignore them at the cost of a more rounded understanding of our health systems and the opportunities to learn from each other. At least one in seven in the UK are served by non-NHS England devolved health care systems.
Competing interests: No competing interests
Re: Strengthening the UK primary care response to covid-19 - what about domiciliary oxygen?
Dear Editor
Sophie Park et al correctly say that robust strategies are needed to optimise the management of patients with covid-19 at home, including end-of-life support for those who are not candidates for intensive care. Within this group will be some who could possibly recover if their hypoxia could be corrected.
I believe there needs to be a campaign for oxygen concentrators to be commissioned for use in all nursing homes, and other domiciliary settings as appropriate, to improve the chances of recovery in a potentially significant number of people. I believe some nursing homes purchased oxygen concentrators during the last wave, but I am unaware of any outcome studies of their use. I make a plea for someone in the right setting to conduct a study that could lead to lives saved and quality of lives improved. I see correcting hypoxia as a similar level of intervention conceptually as trying oral antibiotics for a chest infection even in someone who would not benefit from hospital admission in the non Covid era.
Yours sincerely
Dr Pamela Martin
Competing interests: No competing interests