A day in the life of a Llandudno GP during Covid-19

WHAT is life like as a GP during the current virus pandemic?

With video and telephone consultations, being armed with personal protective equipment and strict hygiene measures – a lot has changed since the start of the year.

Dr Paul Emmett, a GP from Craig y Don Medical Practice in Llandudno, and member of theBritish Medical Association’s (BMA) GP Committee, has shared with the Pioneer a typical working day from August 2020.

“I arrived at 7.30am to 15 blood tests, with two needing immediate action,” Dr Emmett said.

“I review 26 letters that came in the previous afternoon. I was working a half day, so picked up non urgent work that morning.

“At 8am, I triage five patients; one with a bleeding ulcer who I admit to hospital as an emergency. I give advice to another on Addison’s Disease and provide advice to a local nursing home as one of their residents has a chest problem.”

On top of an already high workload, Dr Emmett said staff are taking calls from patients suspecting they have Covid.

“Every patient that rings the surgery is triaged by a GP or nurse practitioner, which practically means a higher workload than before Covid,” he explained.

“I must admit, it’s exhausting.”

Due to personal circumstances, the medical practice is down to only three doctors some days.

“We currently have a full-time partner on maternity leave and no cover available, so we’re two colleagues down. We try to arrange urgent cover but aren’t successful.”

At 9.30am, Dr Emmett examines a patient over video who is new at a nursing home.

“This has become the standard way of consulting now, to avoid compromising the nursing and residential homes,” he said.

“Our nursing colleagues have also been able to get reviews of wounds and skin problems quickly.”

At 10am, Dr Emmett triages five more patients.

An advanced nurse practitioner visits a patient at their house and Dr Emmett carries out a video consultation.

At 11.10am, the GP attends a meeting to discuss the medical practice’s new ‘Red Portakabin’; a cabin on the surgery grounds where GPs plan to see potential high-risk Covid patients.

“This will allow us to keep our patients and staff safe,” Dr Emmett said.

“We’re aiming to have this ready in case of a potential second wave, allowing us to free up another room in the surgery for face-to-face contacts.”

After triaging three patients, Dr Emmett then sees a further two face-to-face.

“We wear PPE for every contact and have done since day one,” he said.

“All staff wear a mask every day as we can’t socially distance in the surgery. All patients are given masks or asked to wear one too, so we protect each other.

“We also clean after every patient to make sure it’s ready for the next.”

After approving 50 plus prescriptions and meeting a counsellor, who is counselling patients from home during the pandemic, the GP manages a quick lunch before meeting face-to-face with a patient he triaged earlier that morning.

“I book the patient in for an urgent scan and move onto prescribing enquiries,” he said.

Dr Emmett then attends a cluster meeting. This is where all the local GP practices work together to plan medical care and systems for the area.

He said: “We focus on planning for flu season and the extra demands this will place on practices.

“It’s already challenging because of Covid, so I must admit, it is daunting. If we see a flu outbreak alongside Covid, it’ll be difficult to differentiate them and the workload will overwhelm us.

“The risk to patients will also be very high.”

On the discussion table is PPE.

“There is lack of clarity as to whether we need change gloves for every patient or if we can use hand sanitiser on them,” Dr Emmett added.

“Do we have enough PPE if we do need to change them for every patient? Logistically, it’s very challenging.

“My surgery is looking at using Venue Cymru Nightingale Hospital, a temporary field hospital to support Covid-19, to safely deliver a minimum of 3,000 flu jabs.”

At 2.45pm, Dr Emmett leaves the meeting to see an urgent palliative care patient over video and to carry out a review alongside a visiting nurse practitioner.

After this, he reads 22 letters and acts on those that need a response.

“I spend time looking at blood results and triage based on the outcomes and sign a further 40 prescriptions,” he said.

“Prescribing and the pressures on GPs and pharmacies has been intense during Covid; electronic prescribing would save a lot of time and issues with missing scripts.”

At 4.20pm, Dr Emmett does another online consultation with a patient and triages four more. Two are given appointments to see him tomorrow.

The GP spends the rest of the day speaking to patients he couldn’t get hold of earlier, completing an urgent DVLA form for someone applying to get their license back and signing off referral letters. He also deals with an abnormal blood test that needs immediate action and arranges a visit with the medical centre’s advanced nurse practitioner.

“Every patient who rang the surgery today was either spoken to by a GP, nurse practitioner or senior nurse, or a face-to-face appointment was arranged,” he said.

“As GPs are really up against it in terms of demand, particularly with the new challenges Covid has brought but we want to do the best we can by our patients.”

North Wales Pioneer | Llandudno