How has general practice responded to the Covid-19 (coronavirus) outbreak?

The pictures of the amazing transformation of the London ExCel Centre into NHS Nightingale exemplify some of the incredible large-scale changes happening across the health service to respond to the Covid-19 (coronavirus) outbreak.

In this blog I want to highlight some of the amazing, less easily photographed, innovations happening in general practice, which has transformed itself in the space of just a few weeks.

Clinicians on social media have been overwhelmingly positive about the experience of remote consultations

One of the first things to happen was rapid adoption of digital consultations, from telephone triage and use of email to video consultations so that patients do not have to attend a practice in person and clinical staff can work remotely if needed. Digital consultation in general practice isn’t new, but uptake has been patchy and slow. Now almost every practice is doing remote consultation – one software provider even developed, tested and , which has now been adopted in practices all over the country. Academics at the Centre for Evidence-Based Medicine in Oxford have been undertaking systematic reviews at breath-taking speed and have produced a clear visual guide for carrying out remote consultations, published in the BMJ last week. Clinicians on social media have been overwhelmingly positive about the experience of remote consultations, and there’s certainly a view that this will now become part of the core offer for general practice. This crisis may massively accelerate the timeline in the NHS long-term plan, which promised every patient the ‘right’ to digital primary care services by 2024.

Remote working brings its own technical issues, particularly for information security, and practices haven’t always been able to access enough tokens, dongles and secure laptops to log in from home. IT providers are now rapidly developing and rolling out cloud-based systems so that staff can log in securely from home

New collaborations within and across organisations are forming ... and the crisis requires everyone to share and value each other’s expertise.

And of course some patients, with or without Covid-19 symptoms, will still need to be seen in person, and practices across the country have been reorganising their physical space within and between practices to keep people safe. Some are trialling ‘hot hubs’ – separate locations where the highest risk patients can be seen. Some GPs are even organising these hubs in partnership with local councils using will use marquees and other open-air facilities with lots of parking to provide good ventilation and allow patients to be seen in their cars if necessary. Primary care networks have come into their own as they bring together GPs across an area to plan and share resources together. WhatsApp groups and other forms of social media have been used to enormous effect to collate and share useful resources across these networks. New collaborations within and across organisations are forming, as no one organisation will have all the answers, and the crisis requires everyone to share and value each other’s expertise.

And finally, while access to personal protective equipment is at the forefront of many discussions in general practice, practices around the country have been working with local people to design and distribute their own solutions, in one instance using open-source code and 3D printers to create headbands for visors.

When we’re over the worst of this crisis, we’ll need to learn the lessons, keep what works and is sustainable for staff, providers and tech suppliers, and let go of what doesn’t work. But the pace of change and innovation will itself be interesting to reflect on. In what feels like a lifetime ago, but was actually only the end of February, I was in Slovenia working with the World Health Organization as they brought together teams from Azerbaijan, Ukraine, Kyrgyzstan and Uzbekistan who are leading their countries’ work on establishing new primary health care systems, integrated with public health. One of the themes was how long change can take to implement in health care, often measured in decades rather than years. Will that statement still hold true when the health service begins to return to normal?