Images above: Dr Richard Drewry; Grove Park Surgery
GPs surgeries across the country have been asked to remain open on Good Friday and Easter Monday as the peak of the Covid-19 epidemic is expected to be this weekend. Although we won’t know whether it is or isn’t until a few days after, the NHS is braced for a busy weekend. In west London the West Middlesex is close to capacity with Covid-19 patients but other NW hospitals still have some capacity. The new Nightingale hospital which has been set up in the ExCel centre in east London is also up and running, ready to receive people with the virus.
Dr Richard Drewry of Grove Park Surgery is one of a team of GPs who are spending their whole time triaging suspected Covid-19 patients referred by 111 and other doctors locally, deciding whether or not they should go to hospital.
The system is “quite robust”
It’s an awesome responsibility deciding over the phone whether someone should go into hospital or not. “It is fairly easy to tell whether someone has the virus” Dr Drewry tells me. How often he gets the diagnosis right is “impossible to tell” as there are no tests available, but there are some obvious pointers – breathlessness, people struggling to do normal tasks because of their breathing, running a fever and the persistent cough. He acknowledges that not all the symptoms present all of the time and that there are other symptoms – a headache and sore throat for example – but the system is “quite robust” he says, as by the time you get to speak to him you will also have talked to either your own GP or 111.
Hounslow is in the process of setting up walk-in clinics for Covid-19 patients, staffed by a GP and a nurse. There is one already up and running in Feltham. LB Ealing also has one set up at the Community Health Centre in Mattock Lane. There will be a total of three such clinics in Hounslow. The nearest one for Chiswick residents is likely to be in Isleworth and Brentford, at premises which haven’t been functioning as a surgery for a while. I say ‘likely’ as there has been some discussion in recent weeks as to where exactly it will be, and ideas about where the clinics will be located have been raised and dismissed, but Dr Drewry says he is 90% sure it will be there and not in Chiswick.
At time of writing there are 396 confirmed cases of Covid-19 in Hounslow, 589 in Ealing and 313 in Hammersmith & Fulham, but that of course only reflects those who have been tested in hospital.
“Full and frank discussions” with the elderly
How does he handle the decision on whether to send very elderly patients into hospital? That is a very delicate matter, he tells me. The truth is that the very frail and elderly are unlikely to get a ventilator, not because they are a scarce resource and should be given to someone younger, but because he says it won’t help them.
“You’re not going to get a ventilator because you won’t survive it. It’s a pragmatic decision. There’s just no point taking up a ventilator if it’s not going to make any difference”.
There is no age cut off point in his mind, he tells me. There’s a big difference between a 70 year old who has had a heart attack and has high blood pressure and a fit 75 year old who has had no health problems.
If an elderly patient wants to go into hospital, he will send them. It is their choice, he assures me. it will be for the intensive care doctors to decide on their treatment once there. It is his job to talk to elderly patients about whether they might be better off at home amongst their family, rather than going into hospital, where nobody can visit you, in all probability to die. Would he prescribe palliative care if they decided to stay at home, even though their is no test available to prove the diagnosis? Yes he would. His job is to ease suffering.
Treating people with other health issues
What about people with other health issues? The population doesn’t just stop having other illnesses. “We have very few people coming into the practice now” he tells me. Doctors at Grove Park Surgery realised quite early on the dangers of infection to both staff and patients and closed their doors, doing most of their work on the phone.
“Since all this started we wound down all the routine stuff, partly to protect patients and staff and partly to support secondary care”.
Whereas in a normal clinic doctors at the practice might see 15 patients, now they might see one. The nurses see more patients than the doctors, as blood tests for a patient who is acutely unwell, ECG tests for someone with a heart problem and wound dressings are all urgent procedures which have to be done face to face. The practice has all the Personal Protective Equipment the staff need, and has had since the beginning.
Is it easy to diagnose someone over the phone?
“We’re quite used to it” he tells me. When he came to Grove Park Surgery 14 years ago he was the one who introduced the system of triaging all patients who want urgent appointments on the day, before they come in to the practice.
“Video consultations have increased quite dramatically” he tells me. That’s an option available to anyone with a smart phone, though he admits that not everyone has the technology and not everyone wants to be seen when they are ill in bed. The “risk-benefit analysis” is definitely in favour of telephone consultations as the risk of patients coming to the surgery is just too great.
The people who are suffering are those who think we’re too busy to call
“The people who are suffering are those who don’t contact us because they’re worried about disturbing a doctor because they think we’re too busy, or they’re too worried to come in”.
They are seeing suspiciously low figures of people who have suffered strokes and heart attacks and hospital paediatricians are also very quiet.
“I think we may end up seeing cases further down the line than we should have done; patients who are much sicker”.
Support for the NHS is “very sweet”
Dr Drewry does sometimes make house calls.
“I have my Personal Protection Equipment in the boot of the car” he says. “I was putting it on in the street one day and someone came up to me. I thought I was going to get mugged, but he thanked me”.
“People clapping for the NHS is very sweet. Personally I get a bit embarrassed. I am just doing what I do”.
He wasn’t too worried initially that he might catch the virus through dealing with patients, but now he says he is more wary, especially as he has a family member who is vulnerable to the disease.
“There is more of a risk than we first appreciated to younger people.”
He is also very aware of the dangers to his nursing staff, who have many more face to face contacts, albeit wearing their protective gear, and to the local pharmacists, who are seeing people without the benefit of protective clothing.
“The more you are exposed to it, the greater your viral load. We now know that people who have prolonged exposure over a longer time get the illness worse”.