General Practice Nursing in the Time of Covid-19

Queen’s Nurse Carol Webley-Brown writes about her experiences of General Practice Nursing in London and how services are adapting to meet the needs of patients.

General Practice Extended Access Hub

Patients are given an appointment to see the doctor or in my case the nurse, if they cannot get an appointment at their own General Practice, at a hub at our local hospital called the General Practice Extended Access, covering 38 Practices across Lewisham).

Practices are now doing everything remotely. It has been like a ghost town. I pass Accident and Emergency – that is practically empty; I pass Urgent Critical Care and it is empty. On average, I have seen three patients there instead of the usual 15.

When Practices remember that we are open to continue to care for patients, it is good – this week I had babies for their Primary Immunisations at 8 weeks, 12 weeks and 16 weeks. I have patients for their mental health depo injections and women for their depo provera injection (sexual health) and patients for their cancer injections.

My employer asked me if I would like to work in the ‘Hot Hub’. I said yes and went to a training session.  After the patient puts on the personal protective equipment, the nurse takes the observations, does the temperature, blood pressure and saturation of oxygen measurements. Then the patient is seen by the doctor, who is not allowed to physically examine the patient. At the end of the training many of the doctors and nurses, myself included, felt it would be difficult but understood that we are fighting an invisible enemy. In the end, I decided not to work in the Hot Hub, given the unfolding dangers posed to me as a BAME individual with Type 2 diabetes and hypertension.

Frequent Attenders

In my role as lead nurse for frequent attenders to Accident and Emergency – the High Intensive Users, the service I call Extra Support Services, I ring, text or email my patients – about 20 of them – every day. Alongside Social Services we ensure they have food, medications, and understand that to stay safe, they must stay at home.

It is difficult for them, as the hospital has been a place where they get the attention they need, and to be admitted has in the past has confirmed that something is wrong with them. To ring 111 and be told that nothing is wrong with you is a hard message to hear and process.

Luckily I have a relationship with them and can usually help them with mindfulness strategies. This has helped. Other patients have found that faith is important, but some have found religion difficult as Easter did not seem like Easter and their faith, their hope has been disturbed.

Mental Health

My patients’ anxiety levels and mental health issues have been really challenging. For example, OCD patients who need to wash their hands several times because of their obsessive-compulsive disorder now cannot understand why they are being told to wash their hands all the time, as what has been abnormal for them is now normal for everyone.

Many of my patients are lonely and have felt even lonelier in recent weeks. They have lost people they cared about and could not attend their funerals. We have started using mobile phones to meet and see each other virtually, which has helped.

My poorer patients are struggling: food banks have been closed and many live in flats; I have had patients look outside for their box of food and it has already been taken!

There has also been an increase in domestic violence, and safeguarding over the phone is quite challenging.

Respiratory Care

My COPD patients all seemed to have chest infections; thankfully l have been supported by the respiratory nurses and am monitoring them very closely. I guess the stress of the virus has also played a part in lowering their immunity systems, putting them at more risk. I have learnt to talk much more slowly and I have become very descriptive, so that l can take patients through the correct use of their inhalers and nebulisers. Taking antibiotics, ringing to remind them of their next dose, anything to keep them well and safe.

The Future

Some of my patients have not left their homes recently, even to go for a walk or shopping. It is going to be really hard to get them to engage with services again in the future and I think I need to start thinking of ways I can help rehabilitate them starting now, like getting them to go into the garden, look for butterflies, listen to the birds and identify the different species. I have to think of something.

Nursing is very different now.

Carol Webley-Brown, Queen’s Nurse, London