I know it’s a cliché but no two days are the same, especially as I’m a locum so I can be working in different medical practices and at different times every day, not to mention out of hours and appraiser work. In fact, the only constant feature is that I rarely have a day when I don’t pull some Rohan clothes out of my wardrobe to wear. The reason is that, in my job, there’s always been a high risk of my clothes becoming contaminated so I need to be able to put them in the wash frequently and dry them quickly. I don’t want to spend time ironing, so it’s great that none of my Rohan clothes ever need to go anywhere near an iron.
When the Covid-19 lockdown hit us back in March, I was in the middle of working a maternity locum. I always like to feel on top of the paperwork, so on those days I get up just before 6.30am and after a quick breakfast I’m in the practice logging on to the computer around 7.15am. I’ll usually be wearing Roamers trousers at the moment as they’re smart and functional. My trusty Worldview shirts, even I have to admit, are quite elderly now – that’s really the only problem - the clothes last so long. I can rarely justify buying something new. However, I have invested in a couple of Sanctuary shirts that are rapidly becoming a favourite.
The roads are always quiet at that time in the morning but during lockdown there’s been even less traffic, especially near the beginning. Though there seem to be a lot more people out running than there ever used to be. There are also more birds singing - or at least it seems that way.
Since Covid-19 precautions took effect, I remember to wash my hands and change into my “scrubs” as soon as I arrive, even though it is tempting to get on with logging into the computer. My Rohan clothes are stuffed on to a shelf on the bookcase out of harm’s way; with Rohan, of course, no need for folding.
Early on I get through a lot of administration, looking at results and letters, checking “tasks” on the computer and completing forms. I like working before anybody arrives as it means I’m able to think a bit about more complex patients and develop plans to try to look after their medical needs.
The practice has a ‘whole team’ meeting at 8.20am just before the surgery ‘opens’. We all meet, ‘socially distanced’, in the waiting room as that’s the biggest space. Staff who are working from home join us electronically. One of the partners gives an update but we are all free to chip in with news.
At 8.30am we all go to our rooms and work stations. Instead of spending the morning seeing patients at ten-minute intervals and fitting in a few phone calls, the doctors are seeing far fewer patients in person, however, there are many phone and on-line consultations. These are often complemented by photographs sent electronically and we also do some video consultations. We are only seeing patients face-to-face if we cannot manage the problem in a different way.
Patients who do need to attend are spaced out in time so there are never more than a few in the waiting room and they get called in quickly for consultations when they arrive. It seems very odd to wear an apron, gloves, a mask and a visor, and it takes a while to put it all on in the recommended way. A whole new vocabulary has developed, so putting on ‘PPE’ is ‘donning’ and taking it off is ‘doffing’.
If we need to see a patient who has a new persistent cough, fever, or (more recently) loss of smell or taste sensation, then they get seen in a dedicated ‘hot’ room. In these cases, there are strict protocols for the order of doing everything and how to clean the area afterwards.
Another big difference at the moment is that more patients are appreciative and thank us for what we are doing. Having worked as a GP since the early 1990s, I have never felt so wanted. It seems odd as I feel that I am really only doing the same as I have always done, but in a different way.
Around midday, the doctors try to meet for ‘socially distanced’ coffee and to ask each other advice about patient care. After that we do any visits for patients who are too unwell to get in to the surgery. At this time, of course, we go into patients’ homes wearing the apron, gloves, mask and visor.
If I am working a half day, I can go once I have finished my morning’s work. Usually this is nearer to 2pm. I have to change back into my Rohan clothes and take my scrubs home in a pillow case to put straight into the washing machine.
I normally spend the afternoon going out for a run, a mixture of work-related reading and learning, and domestic tasks. In the evening I might be working for the out-of-hours GP service. I have also taken on some work for the Covid Clinical Assessment Service as GP appraisals have stopped during lockdown so I have some extra time. This assessment service consists of working from home giving phone advice to patients throughout England who present with possible Covid symptoms.
I previously microwaved a meal from the freezer if I was working in the evening, but now my husband normally cooks for me as he is working from home. I might have to drive up to 45 minutes to where I am working and I will be booked to start at 6pm or 7pm, so it is an early meal.
Previously I wore a pair of Trailblazers for these shifts as they are a bit more casual than the Roamers. As the treatment centres are in hospitals, I wore a short-sleeved Worldview shirt or Sanctuary shirt, so as to comply with the ‘bare below the elbows’ policy. When it’s cold I grab my Icepack jacket on the way out. Now we are encouraged to wear scrubs but if I am on a mobile shift in the car then I still wear my Trailblazer trousers with my scrubs top as I need all the zipped pockets to keep my possessions and patient notes safe. Besides which, I wear them for the single shift and they are just as easy to wash and quicker to dry than the scrubs.
It has felt very unusual and uplifting to hear the clapping of local people and see the scenes of clapping on the television each week. There is nearly always too much work to fit into the time and that has been the case for all my working life. I think that the vast majority of my colleagues have always tried to do their best and often without all the resources they would like for their patients and it seems that lots of people outside the NHS have suddenly realised this.
It’s a pity that it has needed a pandemic for this to happen. I hope that when it is all over then we will go on with some of the different ways of working that we have learned during this time, such as the remote consultations, as they are very time efficient for patients and for clinicians. I also hope that people will remember that nearly all people working for the NHS really are trying to help as much as they can.
Guest blog by Dr Kathryn Shore.