“May you live in interesting times” is said to be an ancient Chinese curse – and we are certainly living in interesting times at the moment. Last December, a cluster of unusual pneumonia cases was identified over 5,000 miles away. Who would have thought that a few months later most people aged over 70 in the UK would be staying indoors all the time, supermarket shelves would be bare and parents would be facing the alarming prospect of having their little darlings off school for months?
At the time of writing, primary care is in limbo. The official advice for people who have COVID-19 symptoms is to not visit their GP or pharmacy, so some practices are eerily quiet. One morning a few weeks ago I saw only three patients, but signed what felt like hundreds of electronic prescription service (EPS) scripts, which I suspect was a result of patients ordering their medicines early in anticipation of drug shorages.
But it doesn’t seem possible for this state of affairs to continue – NHS 111 and hospitals are overwhelmed. I have heard talk of practices having “dirty rooms” and “clean rooms”, where certain members of staff see patients with possible cases of COVID-19, protected only by the out-of-date and inadequate personal protective equipment we’ve been given. We will also have to manage all those patients whose routine referrals or surgery can’t go ahead, meaning they will get sicker from conditions other than COVID-19.
It seems likely that the morbidity and mortality from other conditions not being treated as a result of the pandemic will be significant. So, what can pharmacy do to help and what can GPs do to help pharmacists? We are all going to be short-staffed, so managing expectations will be useful. Patients who are unhappy that much of normal healthcare service has been put on hold may well complain to their pharmacist about the GP, and vice versa. Trying to help people understand the severity of this crisis and that we are all doing the best we can would be a good start.
Patients often talk to their pharmacy team about their symptoms before seeing the GP. Clearly pharmacists can’t be expected to take full responsibility for triaging them, but if patients mention medical issues that are non-urgent, you could suggest self-care and holding off seeing the GP until things have calmed down a bit. Now isn’t the time for anyone to be worrying about a bunion that has been a bit sore for the last few years.
Pharmacists are our eyes and ears in the community. Our elderly patients in particular may have symptoms of other conditions that are urgent – things that merit a referral with a two-week wait, for example. If they tell you they are avoiding bringing these issues to a doctor, please encourage them to do so, or call the patient’s GP.
Pharmacists are also the experts in helping people self-care. As most of those with COVID-19 symptoms are advised to self-isolate at home, they will need your help with how to manage symptoms and which over-the-counter medicines to use. Pregnant women and those on long-term medication will value your guidance on what they can and can’t take.
The next few months and years will be tough for us all – I don’t mind admitting to being a bit scared about the future. I find it somewhat surreal to be living through a pandemic that my grandchildren will learn about in history lessons. Pharmacists and GPs need to support each other as well as we can, and hope that we all come out the other side.
Toni Hazell is a GP based in London