Responding to the Coronavirus Crisis by Stephen Kemp KSA Trustee
Between 1994 and 2001, I worked in humanitarian assistance overseas and travelled and worked in over 30 countries setting up emergency health programmes in the wake of war, natural disaster and disease. When I returned to mainstream nursing in the UK, people were vaguely interested in what I had done but were resolute that I would never need those skills here. How wrong they were.
Back in December, I was chatting to one of my GP clients and asked what they were doing to prepare for the Coronavirus. He looked at me and laughed and said, “Come off it, Stephen, that’s in China!” He may not have been prepared but I was and had already started to think through ways in which the health service would be impacted if similar numbers were affected here. The most striking thought was that China is very different to the UK and shutting down an entire City in a dictatorship is considerably easier than trying to do it in a democracy.
On March 13th, I posted an article on Linkedin, in which I urged GPs to look at ways to continue to manage their services in the wake of the rising number of infections and the growing difficulty of managing them within a standard practice environment. On March 23rd Lockdown was announced.
Only then did the phone start to ring. People looking for solutions. How to set up video consultations, how to create templates on systems that asked the right questions to detect Covid-19 but, there was always a bigger issue. Some patients inevitably would require a face to face assessment. Of course, this was key for Covid-19, but what about other patients who perhaps had abdominal pain – how were they to be examined. PPE and the guidance about it were poor and strict infection control rules were played down in response to the shortage and inability to distribute.
So, on the 24th March, I started to look for sites that could be used to set up assessment centres. These are now referred to as Primary Care Treatment Centres, but we knew them as ‘Hot Sites’.
I really wanted open spaces, like a car park, as its easier to manage patients in an area with free circulating air and fairly quickly identified some space next to a health centre. Of course, permissions had to be sought and although the bureaucracy behind the funding of them was tortuous the cooperation of others was exceptional. From the leaders of councils to volunteers who helped with traffic control, signs and traffic cones; everybody mucked in and nothing was too much trouble. The second site was also intended to be outside but a whole clinic became available as existing services went mobile and we adjusted our thinking. One snag in the second site was, that I needed a shower for staff to clean down with after ‘doffing’ PPE. NHS Property Services to the rescue. They built me a shower room in 3 days and that was after they had created external power and water supplies for Site 1.
Site 1 is a Drive-in service and most patients are assessed through the window of the car but can be seen outside the vehicle if necessary and we also have a cubicle for children. Site 2 sees patients drive into a parking bay where they are given a preliminary assessment of temperature, oxygen saturation and respiration rate before being invited in for a full assessment if required.
The key to making them work is having zones that present cross contamination and keep Clinicians, Patients and Administration teams as safe as possible. Both sites are open and seeing patients. How long they will be required is anybody’s guess. What is clear, is that many health services will change in the way they are delivered; the days of coughing and spluttering in a crowded GP waiting room are over.