7th
April 2020
I have written a brief update on where I think we are with COVID-19 at present... Dr Watkins
From
our perspective in healthcare at Leatside the social isolation measures seem to
be working.
We
are all doing it, with varying degrees of difficulty; but it appears to be
helping.
I
have seen on social media the crowds out by the Thames this weekend and on
Brighton beach; but at the same time pictures of empty Totnes streets and of
empty local beaches.
We
have in South Devon one of the lowest rates of Coronavirus infection and deaths
in the country and I think that it is our rather old-fashioned sense of
community that is helping here.
Communities
pull together in a crisis and by maintaining good social distancing and
self-isolation we are doing our bit for our community.
It is
tough that this has had to be enforced during our first spell of good weather
having had such a wet winter; but with that comes a natural drift down in the
rates of other infectious illnesses, which can only help the health service
right now.
The
health service is coping.
As it
stands at Leatside we have one doctor off sick with this illness, one
self-isolating and working from home due to brittle asthma. One on paternity
leave (hooray!), but supporting his wife in labour and after was made
tremendously difficult by the virus. Our nurse team is depleted through a
combination of illness and family illnesses and the need for self-isolation.
But
with all that we are still able to provide a primary care health service for
you.
Our
reception team are working so hard to field your calls and try to help.
Our
doctors and nurses trying to provide for the sick as well as those with more
ongoing needs.
Our
management team have been leading the local primary care response in helping
other local practices to gear up for this. Actually ALL the local surgeries
have been fantastically responsive.
Leatside’s
behind the scenes team have completely redesigned our appointments schedules;
spent hours setting up and supporting those needing to work from home as well
as sourcing and deploying the kit we need; not just for ourselves but for other
local practices too…
We
have sourced some PPE coveralls through a builders-merchant contact of a
friend.
KEVICC
have 3D printed us some fantastic face mask protection (Hat tip to Mr Irish).
A
local Gin-maker, Cosmo Caddy at Devon Distillery will be supplying us with
hand-gel.
Sima
from “The Kitchen Table” behind us on the Industrial Estate has provided some
or her fantastic “ready-meals” for staff who would benefit from them.
We
have had offers of vacant accommodation to be used for NHS staff who need it...
A
local laundry is able to wash our scrubs when needed...
I
haven’t been out of Totnes at all or to Torbay hospital to see how they are
coping, but, thanks to the social isolation being done so well I think at this
point they appear to be coping. Very likely with a depleted workforce through
illness too.. And of course, through redeploying staff into other roles-
leading to cancelled routine clinics and operations of course... but with all
that they are coping right now.
What
will the next weeks bring?
Most
likely an increase still in the number of cases that will primarily impact the
hospitals.
Those
patients discharged from hospital will need medical support- quite often at
their home through the GPs and the District Nurse team.
Those
who get ill but either aren't so ill as to need to go to hospital or decline to
go to hospital may well need our help... again in their own homes quite often.
Patients
with suspected COVID who need to be seen face to face will probably be asked to
attend a South Hams “Hot” clinic- but we aren’t certain where this is to be
yet…
The
dying will need our help of course as always.
So
our service is going to have to be somewhat different than usual for a while
while this all sorts out.
We
are aiming to see only the very necessary cases at the surgery or at home.
More
cases will be managed through a phone call or video consultation.
It
will help us a lot if your problem or question suits it to go to the surgery
website and fill in the e-consult web form there (“Consult our doctors online”)
This can be used for medical queries as well as administrative tasks or
questions... www.leatside.co.uk
111
is still the best port of call though for COVID-specific queries.
Keep
socially isolated though- which is the most important thing.
The
virus feeds and propagates on new bodies to infect; so if we can starve it of
that contact it should die off and have much less impact in our community.
The
government hasn’t yet given any thoughts on when lockdown measures might cease.
I can
imagine it going on for another 3 or 4 weeks yet.... and if we can tough it out
as well as we have been doing it should have a real obvious impact.
What
that might look like though is that if we do indeed have relatively few cases
or deaths people will say it was unnecessary.
But
they will be wrong.
Preventive
medicine in all its forms feels unrewarding.
Take
your statin for cholesterol for years and all that happens is that nothing
happens.
You
might get some aching muscles or whatever but no reward. Nothing happens. No
stroke or heart attack Nothing.
It’s
the same with COVID and self isolation. At the end of the day, if it works
well, we will all feel like it was a tremendous hardship for no appreciable
benefit to us.
That’s
how it works though!
So
keep it up.
It will work if we all do it and keep doing it until we are told we no
longer need to.
Sunday
19th April Update.
Things
are still changing.
We
remain ready at Leatside for an increase in Corona cases.
The
prediction from Public Health England is that the peak of cases around here
would be at the beginning of May; so if they are right we have to keep going
with the lockdown.
It is
so impressive that people are continuing to keep locked down so well.
By
keeping doing this I am sure that deaths will be averted.
Yes,
we have had one of the lowest infection and death rates in the country round
here- various theories as to why- but I really do think that effective social
distancing and isolation has played a huge part, and still needs to for a while
longer.
At
the surgery nothing is currently routine.
If
you have a health issue and need to speak to someone about it then ring.
We
have changed our appointment system so that currently nothing is bookable on
line.
Ring
- someone will speak to you and we will be trying to deal with as much as we
can over the phone.
If it
is specifically a concern that you have Corona or need advice about it then
actually better ring 111. They are much better placed to advise on the
specifics of that right now.
Do
give the receptionist an idea of what you are ringing about- it helps us manage
the work a lot better.
We
have the capability of video consultations when needed- but this does require
using your smartphone and having a decent enough connection to do it. The
doctor may suggest a video during a telephone call if it might help to actually
see a problem.
As
before, I would encourage people to submit queries through the
"eConsult", online form on the website. So many things can be dealt
with that way whether it is an enquiry about an illness, something to do with
medication... all sorts of things, so do consider using it.
If
you really do need to be seen face to face then the surgery is locked. You
comfy car seat is your waiting room. We'll let you know how it works when we
ask you to come down.
When
will things come back to normal?
Who
knows!
I
suspect that once we have passed the peak and lockdown is ended that there will
still be Corona cases about... coming in outbreaks... The epidemiological
modelling done at Imperial College suggests the waves could keep coming for 18
months or so. Lots of people are making comparisons with the Spanish Flu
Pandemic of 1917-1918... the onset of it was in March and there was a lull
through the summer- but the peak of deaths came later in the Autumn.
This
is a different virus and modern society is very different from then... but
something like that could feasibly occur so we should remain careful. The
better we do now, the better it will be further down the line I'm sure.
I'm
going to put up separately a post from our Registrar at the Surgery, Dr Bruce.
She
has been working with Dr Fearon and Dr Isaac here on Advance Care Planning in
the Care Homes- and is looking now at how to help people in the wider community
provide us with their advance care wishes if needed.
Keep
well and I hope to see you all soon.
Dr Watkins
4th
May 2020
May
2nd now… and it was March 23rd when Prime Minister Johnson laid out in his
press conference what we were all to do in terms of social distancing and so
on. 6 weeks; but the national “curve” is only now flatting somewhat. More than
28 thousand have died of it so far officially, and 621 in the last 24 hours.
We
have been fortunate here to have had relatively so little impact. The news
stories are usually full of stories about improving transport links to the
south west- upgrading the A303, sorting out the potholed M5, the rail line at
Dawlish, the FlyBe Closure at Exeter airport… But right now it appears that our
difficulties have been our saviour. The national map of cases and deaths of
course shows a marked correlation with population size, but ease of transport
links has, I’m sure, been a big part.
We
can’t relax though. I’ve heard more cars about today then in the last few weeks
which disappoints me. At the Surgery we are still trying to make it possible
for those staff who could work from home to do so… I like the parachute
analogy: “The parachute has now slowed my descent very well, so I will now
shrug it off” – but with 2000 feet to go…! If we relax too much now there is, I
think, still a real possibility of a further spike in cases.
At
the Surgery we will continue to assess and treat as many people as possible
without you having to come to the Surgery.
We
have always used a telephone call to assess things: and are doing this much
more now. In fact, if you ring to the surgery for help or advice it will always
now start with a call back from one of our team. Sometimes we might ask if you
have a smartphone and a connection that we might do a video-consultation. That
has been working really well.
The
team now includes three Advanced Nurse Practitioners… nurses, highly trained in
the assessment and management of acutely-presenting illnesses. We have Steve
Blakeway, Val Falconer and now Kim Connabeer also.
Online
“consultations” help us a lot - through the Leatside website you can fill in an
online consultation form. If you have the NHS app you can order your repeat
medications as normal but also start an online consultation from there too now.
Actually the NHS app is very good and will only get better and more useful I
think. The signing up to it is a bit more of a faff than most websites, but
then it has to be for the security of it.
Some
things will continue that need to despite lockdown.
Smears
and Childhood Vaccinations should keep being done.
Other
things will wait: reviewing peoples ongoing conditions will wait…. Having
“routine” blood tests for monitoring medications can usually be deferred…
If
you become ill or need to be seen we will of course see you though. We have a
set up now where the waiting room is your car seat. If you do have to come down
we will tell you what will happen when you arrive: either to ring in to let us
know you are there or to just sit and wait in your car at the appointed time..
So
keep it up. It is boring being in lockdown. It must be frustrating for business
owners who have had to close. The better we stick with it now the less time it
will go on…..
Dylan
May
18th now and I think I am more confused....
I
think it has reached a point where my basic knowledge of disease transmission
just can't work out what I think is likely to happen next.
We
are all guessing really, but some people have been educated in this area
specifically and know what they are doing, so I think I am going to have to
trust their guesses more than anyone else's.
These
are the statisticians/epidemiologists and computer modellers - they are really
very impressively clever and have been working out the next likely things to
happen.
Admittedly
their guesses were a bit wide of the mark with the initial phase; but in
planning terms I think we have to go with their predictions for what next. More
information about this is becoming available and we have to trust that they are
incorporating this into their predictions. They are not stupid.
They
are, though predicting a second "peak" for Devon - ... the peak
varies from something about as flat as Norfolk, to something more Alpine
depending on what degree of transmissibility we encounter... a higher R number
and a bigger peak.
But
through our behaviour now we can affect this... so sticking to the principles
of behaviour we have now learned should reduce it. Again- if we do well at this
then it will seem to have all been for nothing- if nothing much happens. That's
the point.
It is
a bit scary though looking at the graph I've seen of what could happen... (I
can't share the graph with you) we have come through a small blip to the left
of the graph and to the right, yet to come, is a higher, longer peak.. We are
currently in the dip between the humps. The picture of the UK shows a dot for
each corona death so far- and it does make clear how spared we have been so
far... admittedly most of the dots correlate with centres of population- but
Exeter and Plymouth barely show at all compared to their actual populations.
If
everyone tries to head here on holiday though or we all breakdown our
self-isolating measures then it could look very different if we review it in
six months time.
31,010
deaths so far. Many more still in intensive care, hundreds still dying each
day- and the predictions show it will get worse again.
What
we do in this lull seems to be key.
Keep
at it.
Wear
your mask in Morrisons.
Don't invite friends for a BBQ.... Just don't.
I
haven't got a lot to add to my previous posts at the moment I'm afraid.
It's
been a gorgeous Bank Holiday Weekend and the roads have been, to be fair, not
nearly as busy as we'd normally see. I haven't been down the town today or to
Morrisons but I hope it still feels quiet.
I
wrote a little bit for the Dartington Community Magazine earlier and dwelled a
bit on Weston Super Mare Hospital struggling today due to a high number of
covid cases. It is very likely that in the coming months we will get a
prolonged spell with an increased number of cases locally- and with increased
cases there would inevitably be more deaths.
What
can we do about this ourselves?
Not a
lot it seems.
As
lockdown eases schools will go back and there will likely be pressure to open
up the holiday industry in the South West.
So
what can we do?
Discourage
people who might want to come and stay with you... for a while at least until
it becomes clearer if the disease modelling is all wrong or not- which should
become clear I think in the second half of July... by the same token resist the
urge to travel to visit family elsewhere in the country if you can.
Wear
a face covering in indoor paces, with other people there. They won't protect
you from covid, but it will reduce the distance your breath travels. If
everyone does it then these spaces become safer. I'm going to keep wearing mine
round Morrisons... well either that or keep my motorbike helmet on!
And
wash your hands.
Hand
sanitiser has been a rip-off. local companies able to have been producing some.
You might check out https://devondistillery.com/
where Cosmo has been producing it for locals and the NHS at a reasonable price.
Simple
things to do can still make a big difference.
Keep
it up.
Dylan
About
time I posted something....
I
nipped out and about on my motorbike today and it wasn't as bad out there as it
could have been...
The
lanes down to South Milton were pretty quiet and the beach not as full as it
could have been... but then it was low tide...
Totnes
Market on Saturday Lunchtime was very busy.. lots of people queueing for food
stalls- most of them very close together and not wearing masks...
Most
stall holders not wearing masks...
But
then at Morrisons I was offered a free mask on going in... which makes me think
they are finally taking it more seriously.
Sainsbury's
in Paignton has been much stricter all along with policies relating to Covid so
It feels nice that we are catching up in Totnes.
Thinking
back to April and May and full lockdown it felt so safe. Now lockdown is easing
we are definitely noticing an increase in anxiety from patients about it. Same
in Cornwall I gather- which is heaving with tourists and the locals daren't go
out!
Luckily
in Totnes of course we don't really have the problems of Dawlish Warren,
Torquay or Salcombe... (Caravan parks, Hotels and second homes respectively)..
so the visitors here still largely come for the day. That will probably help
insulate us a bit from any corona influx. Imagine working in a busy holiday
park- especially on a rainy day when people visiting from all over the UK would
huddle together in cafes etc...
And
at the Surgery?
Well,
we are carrying on as we have done for the last months.
There
is no way we can open the front doors to general visitors right now... and the
thought of the waiting room being full of patients makes me anxious... so for
now we are open "by invitation only" as it were. The waiting room is
the car park. When the clinician is ready for you they will come and get you
from outside or from your car.
We
have been using some new tech allowing easy text based and video consulting to
augment our usual telephone consultations. When that just isn't going to be
good enough, then of course we will invite patients in for a face to face (mask
to mask?) consult.
Some
check up clinics are restarting... diabetes checks have been going along in a
mostly telephone based supportive way thanks to our nurse Lyn- who has had to
be isolating at home but has kept very busy working from home doing these
things.
Childhood
immunisations and new baby checks are going ahead as normal- as they really
can't be deferred too much...
Honestly
though things like blood pressure checks and heart reviews... most will wait...
and those that won't, we will see...
It is
difficult to offer anything near as many appointment slots as we did before...
the time taken for the nurses and docs to don their ppe, collect the patient
from the car park, do whatever it is thay have to do then escort the patient
out again just takes time... so in a typical morning there will be perhaps only
half as many appointments achievable face to face as before.
I
wonder when we might open like before again?- very much depends on how the next
months go I guess!
Flu
clinics will go ahead in September.
We
can't allow a free for all like in other years so will be inviting people to
come at more specific times... Most of you have a mobile number or email
address we can contact you on now- and those that don't will get a letter.
We
know we can't be too strict about it of course! - it would be daft to have
someone bring an elderly relative for a flu jab and not do them also while they
were there... but we will aim very much to be spreading people out.
I had
hoped to do a drive-through flu clinic this year... but the logistics of the IT
and the vaccine cold-chain make that very difficult so I think we will be doing
them in the Surgery- but in a very controlled linear progression through the
building- in one end- have the jab- progress out the other end...
This
year the government will be asking us to offer flu jabs to everyone over 50...
That will mean getting quite a lot more vaccines in... So we will do the over
65s and those with ongoing health conditions through September and October like
usual- then in probably October/November do the 50-64's... assuming we can get
some vaccines..
There
is no news yet on the Covid vaccine...
So
keep being sensible. Avoid large groups in close proximity... especially
visitors from other parts of the country where the virus is still more
prevalent.
Wear
a mask when closely around other people...
Isolate
strictly if you get a fever...
Ring
111 or go to https://111.nhs.uk/covid-19 if
you need corona virus help or advice...
Dr Watkins
I
hadn’t posted in a while as the lull in corona infections had been going along
nicely… and I hadn’t much to say.
BUT,
the second wave finally appears to be here in Totnes.
I’ve
been tending to discuss the second wave as if it was a Tsunami wave… Like on
the beaches of Thailand in 2004…
We
have had the early warnings and know a wave is coming, but we’ve never seen a
tsunami wave, so don’t know to be scared of it.
Those
who remember the 1917/18 “tsunami” are long dead… That is ancient history and
can’t be relevant to our modern world now can it?
The
beach is sunny and warm… the tides gone right out and there are nice shells to
see.
Some
people, heading for the hills, are shouting that a wave is coming on the
horizon: but we can’t quite believe it as it is so nice on the beach today…
The
tide suddenly rushes in… not too bad though… only up to our knees… this is
fine…
But
the wave just keeps coming and before we know it we are swept off and inland.
Why
though? We had warnings after all.
We
certainly mostly got away with it in Totnes during March/April/May.
One
death only directly from COVID that I remember… One death, but tragic for his
family and all who knew him and those he taught... several hospitalised; some
with severe illnesses… but overall the impact was not great in terms of illness
and death.
The
impact in terms of businesses struggling and furlough/self-isolation etc was
apparent to us all of course… But it appears to have worked.
People
living here remark often, that when they travel elsewhere in the UK they are
shocked at how lax people are with protective measures.
We
have all being doing so well with it and the 2m distancing/mask wearing etc
does seem to work- If people do it.
But
some people have got bored of doing it- and can’t see the sense in keeping
doing it when the virus seems to be under control.
This
last week though I think we have lost control of it.
Cases
are up across Devon.
There
had been an idea that the high number of cases nationally had not been
reflected in the death statistics and that the virus had somehow changed in its
intensity.
That
appears to have been wrong.
Many
patients are right now in the four main hospitals in Devon struggling for
breath with COVID. ITUs, on Friday at least, were filling up with cases… People
are once again dying of it.
Plans
are moving ahead as I write to empty some Community Hospital wards to allow
COVID-recovering patients to be moved on from Torbay Hospital.
The
Nightingale Hospital in Exeter is being readied. Not for immediate use this
weekend… but readied.
The
Academy of Medical Sciences did some modelling and predictions back in July of
what might happen this winter- their “Reasonable Worst-Case Scenario”. They
made some assumptions about the R-number rising to 1.7 through the winter- but
noted that even with an R-number of 1.1 or 1.15 the NHS would likely be
severely tested…. I’ll put their prediction graphs in the pictures; as just now
it looks like their predictions look to be about right.
The
excellent @RP131on Twitter has graphed the current cases against a model of a
9-day doubling rate- which seems to match well (pictures below)
So,
broadly, to reacap… the wave is coming fast at us and we should take action.
The
government is unlikely to put the SouthWest into one of its Tiers of lockdown;
but I think now we should all individually do what we can to mimic the
"Circuit-Breaker" suggested by Sage.
Wear
a mask when around other people- especially of course in shops but note the
number of people around you outdoors and how close they seem to be – and wear a
mask outdoors if people are too many or too close.
(Having
asthma or copd is most often no good reason not to wear a mask in most of these
settings. You can still breathe. If a mask makes you feel increased anxiety
then try different masks until you can find one that doesn’t feel too
restrictive- then practice wearing it until it feels more normal.)
Don’t
accept that a visor is as good as a mask. It isn’t.
Continue
to socially distance when with people. 2 meters is a guideline. Further apart
is safer still.
Don’t
mix households where possible. Stick to your bubbles.
Don’t
travel widely- unless you really have to.
I’m
sorry to say this as I have friends and patients (and family) running
businesses locally - but if you have a meal out booked or plan to go to the
pub, or something similar consider cancelling.
Most
food outlets can provide take-aways like they did earlier in the year. Go for
that instead.
I
appreciate that pubs and cafes and so on have gone to great lengths to make
their venues as safe as can be… but just now, for a while, consider not going.
Random
shopping or planning to spend a day at Clarks Village or something? Perhaps
just don’t go. Put it off for now?
Don’t
visit your elderly relatives for a while… It is clear from the figures we have
that increasing age equates with an increasing risk of complications from
coronavirus infection.
If
you need to do a weekly shop, then just one of you go…
Don’t
take the family unless you really have to.
All
those same sorts of things we were being asked to do earlier in the year: try
and do them again now.
The
rate of increase of cases now needs to be addressed; and it seems the only
thing we can do is to actually do the things we are able to do- as outlined
above.
Addendum:
I
should it clear that this post represents my opinion on where we are now. It is
not in any way Leatside "policy" or PCN/CCG or whatever - nor should
it be taken as being anything other than my opinion.
I
have been an NHS doctor for 28 years and a GP for 23 of them... (Not that that
should necessarily carry any great weight: especially as no one appears to be
really certain what's going on... but I feel a sort of responsibility to share
my opinion now with my patients and am old and experienced enough now to stick
my head above the parapet to say what I think)
I've
taken out the link to the Tsunami video- that was a bit crass of me.
I’ll see if I can do another update next weekend.
There
has been a national issue with laboratory testing of certain investigations due
to a supply issue from Roche. See the story here...https://www.bbc.co.uk/news/health-54435226
Our
lab in Torbay had been managing, but last week ran low enough to ask GP
surgeries in Devon to send only urgent blood tests. They have some of the
reagent, but not enough to currently run all the tests they usually do- and are
rationing it to only to most urgent or needy cases.
We
have been through the appointment lists for blood tests in the next few days,
checking to see if the tests required can be processed or not. If they can,
then you should hear nothing from us and will attend as normal.
If
your test can not be processed, we will contact you to cancel.
Sadly,
at this point, it is not clear when Roche will be able to supply the labs with
enough reagent to resume normal testing.
We
will contact those who have been cancelled to rebook when we know.
In
other news, COVID cases in hospital, having shot up the other week, appear to
be not shooting up too rapidly and have somewhat stabilized.
Nationally
it looks like hospitalized cases continue to rise.
For now keeping going with mask wearing and tightening up your social
distancing measures looks to be the sensible thing to do.
So
the number of patients hospitalised with Covid in Devon has been progressively
increasing.
Not
huge numbers currently- I think 200 odd across Devon at the start of this week-
(I don't know the numbers on ITU).
A
large proportion of these patients I know are requiring oxygen or non-invasive
ventilation.
The
prediction is for that number to keep shooting up...
It
doesn't have to of course.
Sensible
measures of reducing your day to day contact with other people and, if you do
have to venture out or go to work, wearing a mask in the proximity of others,
will go a long way to reducing viral transmission between people.
This
isn't someone else's problem. It could be you next.
I
have heard people say that because there are few cases in hospital that we
therefore needn't worry about it.
Wrong.
Preventive
medicine of every kind works like this...
There
is no reward for good preventive measures: just irritation.
I
often say to people taking blood pressure pills or statins that taking their
medicine doesn't make them feel better or make their day to day life easier in
any way. The only reward they might get for taking it is that nothing at all
happens.
No
stroke or heart attack or whatever.
Nothing.
All
they might get is the irritation of taking a pill each day and maybe getting
side effects.
The
lack of anything at all happening is a very abstract "reward".
But
the same is true in Covid precautions.
If
people do it well and take the trouble to be careful then hopefully nothing
happens: No Covid infection.
And
in the bigger picture, continued low rates of infection through the Totnes
area.
I may
be wrong but I have an idea that when people see our rates are well below the
national average that they somehow think we can afford to be a bit more lax and
allow the infections to rise until we are somehow more average.
That
perhaps we should only worry when we become worse than average.
This
is some kind of aberrant thinking-trap I'm sure and not stupidity.
Every
case is a risk to others around them.
Every
hospitalised case is a risk to those caring for them.
Every
hospitalised case is, by definition, severe and at risk of death.
The
message is simple for now I think:
Observe
the lockdown rules as best as you can.
Wash your hands and wear a mask.
I
feel quite optimistic this week.
Two
weeks ago cases and especially hospitalised cases were rising... 10 days ago
there were something like 264 patients with Covid in hospital in Devon.
By
the middle of this week there were 250 - so not shooting up rapidly. (Could be
a false dawn though?)
2
weeks ago I was anxious that the Nightingale Hospital in Exter should be
readied... after all it would take 2 weeks or so I guess to arrange full cover
for all medical and nursing shifts as well as the porter coverage, cleaners,
cooks and so on... I was in touch with the medical lead for it and some others
in charge expressing my concerns from "the shop floor" as it were...
Just
now that need doesn't seem quite so immediate... but I know those in charge are
keeping a close eye on the state of the hospitals and if the Nightingale does
need to open it will.
Masks.
I
popped to Totnes market quickly today to get one of those nice curries for
lunch. I think I might have been to be only person shopping in the market to
have been wearing a mask. Shocking really. I stopped and looked about at one
point to survey the crowd... and didn't see any others wearing them...
I
heard of a patient who came for an appointment this week not wearing a mask...
he said he was exempt.
We
still would appreciate though; even if you are exempt for some reason, that you
do try to wear a face covering or mask in the Surgery. As I suggested before,
there seem to me to be very few good reasons to not wear one.
There
may be highly medically vulnerable patients in the building and they need
protecting.
Ultimately,
if the clinician you are to see feels uncomfortable that you aren't wearing a
mask they may decline to see you and ask you to leave. If any of our team make
that judgement they will have my full support. This has to be a balanced
judgement based on the condition you need to be seen for and so on... If you
can't wear a mask and need assessing for something infectious we may need to
see you in our "hot" room, with the clinician in the full ppe.
In
terms of feverish patients needing to be examined, it may well be soon that
those patients are asked to go to the South Devon "Hot" clinic which
will be, I think, by Cricketfield Surgery in Newton Abbot.
There
will be a proper set up for the clinicians to don and doff their ppe there and
the patients to get through the system in a most-safe manner also.
We'll
let you know as and when that gets up and running or if we need you to go there
if you are poorly.
Corona
Vaccines
In
the last couple of weeks news of the Covid vaccines has been coming in thick
and fast- but no news yet as to when they get MHRA approval and are actively
available...
The
CCG has asked GPs and the Primary Care Networks locally to formulate plans for
vaccination.
These
plans are coming together- I really don't know yet about the days the clinics
will be run on; who exactly will be staffing them, or even exactly where it
will take place... but I know we'll be able to deliver.
The
technology to be able to do this is coming together and the ultra cold freezers
we'll need... It is all being dealt with and we'll let you know when it comes
to fruition.
The
NHS will be very strict on who gets it first, and I don't think we'll get much
say in that or have any flexibility to squeeze people in... So trust that we'll
be in touch to let you know when it is your turn.
Flu
Jabs
We
knew a while back that healthy 50 to 64 year old's may be offered a free flu
jab this year... but this week it was announced through the BBC that it was
going ahead. (Yes, they told the BBC before they told GPs)
We
hope to have some vaccine coming to be able to do this...
We
won't set up any clinics until we have the vaccine
When
we do get it we will let people eligible for it know in some way to book in...
and doubtless Martin my manager will put something on this Facebook page as
well as the surgery website to let people know what's going on.
But until then, please.. be patient.
It
was in the news today that GP-run Vaccination centres will start on 14th
December, and that patients over 80 will be invited to these as a first wave.
We
had of course earlier been told that the first to be vaccinated would be the
elderly in care homes; but how to get the vaccine to them is turning out to be
a bit tricky due to the instability of the vaccine in transport.
We
had also heard healthcare workers were going to be first… again this seems
unclear.
I’m
assuming currently therefore that the vaccine made available to General
Practice is to be administered to the over 80’s who can access the vaccination
site. We should get clarification of that on Monday (at least I very much hope
we do!)
I’m
not able today to 100% confirm the location of that site for our patients, but
a plan has been worked on over the last couple of weeks and we think we’ve got
it worked out.
The
likelihood is that one site will be used to vaccinate the patients of our local
Primary Care Network (PCN).
Our
PCN includes Totnes, South Brent, Buckfastleigh and Ashburton.
The
other PCN locally in the South Hams covers patients registered with Dartmouth,
Chillington, Kingsbridge, Salcombe and Modbury practices – some of their
patients may be able to be vaccinated there too.
We do
need to be very clear that only those invited can have the vaccine.
I
know many people will be anxious to get it as soon as possible; but there
really is no flex in the system with this vaccine to allow anything other than
doing it strictly by the rules.
There
has been a complicated negotiation at management level to get this set up and
it was by no means straightforward.
All
the doctors and managers behind the scenes who have worked on our behalf to get
this set up for us need commending.
It is
purely down to the drive of our local medical leaders and the management of the
Devon CCG and of the PCNs that this is going to now be available. All we have
to do now is work out staffing of it and work out the invitation and booking
process for attendees.
The
UK, by approving the vaccine earliest, has of course been able to get the first
batches of vaccine… and it is those that are being deployed now.
The
hope is that by targeting the right populations the best impact can be achieved
early on.
This
recommendation is made by the JCVI – the Joint Committee on Vaccination and
Immunisation- made up of about 20 UK and International Clinicians and Academics
with expertise in the vaccines and the epidemiology of illnesses and the impact
of vaccination on the transmission of illness. Their Chair Andrew Pollard (https://www.ovg.ox.ac.uk/team/andrew-pollard) is
typical of the committee in having a very impressive range of credentials and
experience.
Once
other countries license the vaccines then the supply is likely to dry up a bit.
At
that point we will doubtless gain access to the more stable Oxford vaccine and
be able to invite patients in a more progressive manner over the next few
months rather than like this early surge.
Again
though, the JCVI will advise on which age or disease groups get called up for
the vaccine at which point.
Many
people are anxious about the safety of the vaccine, naturally.
Immunisation
has taken many forms since Variolation in Boston in the 1720’s.. (https://www.historyofvaccines.org/.../onesimus-smallpox...) and
then Jenner’s variation of this in 1796 using cowpox to protect against
smallpox. (“Vaccine” from the latin for the cowpox “vaccinia” from “Vacca” =
Cow)
The
history of immunisation against viral illness has usually involved taking an
extremely mild strain of a virus and injecting that (an attenuated virus) - but
providing immunity against more aggressive strains in the process.
Or by
breaking up and inactivating viruses so that they are no longer able to
replicate, and injecting those virus fragments. The human body doesn’t realise
they are dead and reacts against them regardless; providing immunity.
The
latest vaccines are produced in a very different way.
Rather
than try and explain it too much myself the science journal Nature ran a good
article a little while back here on Covid vaccine and the different ways that
different research groups were tasked with producing it.
The
race for coronavirus vaccines: a graphical guide (https://www.nature.com/articles/d41586-020-01221-y)
This is a very interesting little read - do have a look
…
The
Pfizer Vaccine currently out is a Nucleic-Acid vaccine and the Oxford one
coming later is a Viral-Vector Vaccine, using a “replication deficient”
Chimpanzee Adenovirus as a carrier virus. The story of this vector virus is
here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC114747/
(The
main reason to use a non-human adenovirus, as it were, is to avoid the
possibility of previous immunity or cross-immunity to the vector being used.)
The
MHRA have appraised the evidence for the safety and effectiveness of the
vaccine and approved it for use in the UK. https://assets.publishing.service.gov.uk/.../Conditions...
The
MHRA – The Medicines and Healthcare Products Regulatory Agency – is
specifically there to assess the efficacy and safety of medical products before
licensing them for the UK market.
When
I was a Junior Hospital Doctor I used to work for one of their previous Chief
Execs: Professor Sir Kent Woods, and can say that if he is the sort of person
in charge of running the agency then they apply massive intellectual rigor and
diligence to the work they are doing.
Yes,
of course they will have come under political pressure to put this through; but
the thing with senior academics leading departments is that they are stubborn
in the face of pressure, and I very much doubt that the speed with which the
approval went through was in response to that. Much more likely that early on
the systems for approval were run parallel with the clinical trials to ensure
early approval.
Pfizer’s
documentation linked at the end of this shows the trials so far have included
about 65000 participants. Admittedly the follow up period has only been a
matter of months; but the side effect profile they show looks favourable.
Channel
4 has done a nice brief webpage about the vaccine and whether it had been
rushed through: https://www.channel4.com/.../factcheck-everything-you...
Effectively,
the trials have run through the usual 3 phases – just much faster than usual.
I
Like the analogy I heard yesterday about it taking an hour and a half to drive
across London. The Queen, however, can do the exact same route in half an hour-
but she has police riders, sirens, all the sideroads are blocked off and the
can make quick serene progress.
Rather
like the smoothing of the processes in volunteer recruitment, testing and
approving the vaccine.
It
has taken exactly the same route: just more slick and quicker.
I’ve
put some links below with a bit more detailed info if you’d like to read it…
Details
of the trials and of the contents of the current vaccine (full list in Part 6
“Pharmaceutical Particulars”) are in this linked document: https://assets.publishing.service.gov.uk/.../Information...
The
NHS “Green Book” Guide to illnesses and their Vaccines chapter on Covid-19 is
here: https://assets.publishing.service.gov.uk/.../Greenbook...
This
gives some detail on the illness and its rates of complications and so on, as
well as some detail on the vaccines available.
The Vaccine patient info sheet listing side effects: and how to report a
side effect if you get one following vaccination: https://assets.publishing.service.gov.uk/.../Information...
Merry
Xmas everyone.
Not
the old-fashioned family Christmas we all hope for, but we’ve got to the end of
the year just about. COVID-19 has dominated all year and seems likely to do so
well into next year too now.
I do
hope that through the year you’ve been able to access appropriate healthcare
through the surgery without too much difficulty. We have tried very hard all
through the year to balance all sorts of needs and demands....
Providing
health care and advice for people with newly presenting problems as well as
longstanding ones. We have had to balance the risk of seeing people with
longstanding diseases and the need for their ongoing monitoring and so on. They
did get somewhat put on the back burner while we have prioritised other things.
I
really do hope that we have been accessible enough for people with concerning
symptoms to come forward in case they might have been cancers...
I
know full well that some people have felt that they needed to see a clinician
at the surgery but not been allowed the chance to.
We
have again been having to skilfully risk assess cases on the phone to determine
who truly needs to be actually seen face to face. We have been allowing longer
telephone appointments to be able to do this, and I think, by and large, it has
worked tolerably well.
Remember
every poorly patient this year has had to be treated as potentially having
COVID-19, so we have had to treat face to face appointments as being
potentially risky each time.
On
top of this, we have had staff having to self-isolate due to illness and
contacts and other staff off sick for spells, with what seems to have been
Covid... (but negative tests).
But
we have got this far, having had to constantly review guidelines and change our
practice week on week on week. It has actually been exhausting. I did post a
while back about the person who asked me if we had been dealing with any
patients at all at the surgery: and to reiterate, that in terms of business and
patients dealt with one way or another, we have had a busier year than ever
before.
So
again: given that pressure we have felt, I do hope that from your side it has
appeared that we’ve been able to offer an acceptable service.
I
said “clinicians” above, as we do now have three Advanced Nurse Practitioners
consulting at the Surgery - all experienced in Nursing for many years, then
qualified to Masters Level to be able to assess patients independently and
prescribe for them too. You may well have come across either Steve Blakeway,
Val Falconer or Kim Connabeer. I think they are doing a great job and really
complement the team. They work alongside the GPs as well as the normal Nursing
team and of course, Kevin Ashworth, our Clinical Pharmacist.
Looking
forward of course we have the issue of getting the Covid vaccinations done.
We
did rapidly pull together a set up to allow us to start the process and gave
the first batch of vaccinations last week at St Boniface House just between
Buckfastleigh and Ashburton.
You
may be aware that the vaccine comes in batches of 975 doses, so we were given
one box to share amongst all the local practices... We managed to do our share
and about 200 of our most elderly were vaccinated.
Next
of course we have to magnify this effort and get many more done as soon as we
can.
We
hope then to pull together a staff rota to man the vaccine site and run it for
most of January and February on a full 5-days a week basis and get about 2000
done per week.
At
the same time as that we have to look at getting all the residential home staff
and patients vaccinated too. It turns out to be logistically ridiculously
complicated, but the superb managers we have locally are working on it over the
Xmas period and we will get it done.
Only
one care home can be done on any day though- so with well over a dozen care
homes in the area, nearer 20 I think, it may take some weeks for them all to be
done. And we are planning all this on the basis that we will be provided with
the vaccine; and that is not guaranteed!
I’m
dwelling on all this as in the next few weeks this is going to need time and
effort to do and it and WILL I think, once again, detract from the service we
have been able to offer.
The
vaccination clinic needs nurses, doctors and administration staff to run, as
well as people to shepherd people in and out and sit with them after their jabs
for a bit. These staff are not extra - we have to provide them from the
surgery, and giving them up to the vaccination effort will mean fewer staff at
the surgery for a while, quite a lot of the time.
I
don’t see that there is any way round it....
So, I
do hope that in the coming few months people can remain sensible in dealing
with their health issues. We’ll help you when we are asked to of course, but
once again, would ask that you do try to manage minor illnesses sensibly
without recourse to the GP if you are able. Help us by dealing with things on
the phone where this is possible and allow the nurse, nurse practitioner and
pharmacy teams to help you where this is appropriate. General queries that
aren’t immediate can be put to us through the e-consult section on the surgery
website (It’s a tiny bit tedious to go through but from our perspective very
useful to get queries sent through this way).
I’m
taking a few days annual leave while I can between Christmas and New Year. I
hope that the Exodus of people from Tier 4 areas doesn’t hit us too hard over
the next few weeks.
I’ll hope to provide another little update early in January.
This
weekend we managed to vaccinate the residents and most of the staff of the main
local residential care homes for the elderly.
We
have also now booked in the majority of the over 80’s who want one, to have a
covid jab – vaccinating all through the coming week and weekend.
As
yet we have no idea if we have vaccine available for the following week.
I
hope we will hear on Monday about this.
As
soon as we hear, we will then make a plan to progress to the next group of
people to be invited to have one- which should be those 75 and over…
It is
only once those are done that in the following group we can do those 70 and
over and the shielding group.
We
are still using St Boniface house between Buckfastleigh and Ashburton as our
vaccination site- due to the very difficult and formal logistics of the cold
chain of the vaccine mainly.
Once
the Astra Zeneca vaccine becomes more widely available we hope to be able to
vaccinate from the surgery- like we do for the flu jabs.
But
at this point in time we still do not know from week to week that we have
vaccine available even for the vaccination centre.
And I
would advise not to be too precious about which vaccine you have. I had the
Pfizer one. I could have had the Astra Zeneca one. Makes no odds to me.
This
lockdown has been disappointing though I feel.
People
seem to be looking at it as advisory rather than a legal requirement.
SO
many cars about still and the shops have been so busy…
I
notice the police attended a group of people meeting up on the main street this
Saturday.
The
only thing I feel able to do is stick to the rules as best I can.
Shop
on your own without going with someone else. Wear a mask there and shop as
seldom as you can.
A big
shop, less often, on your own.
Don’t
bulk buy stuff…. We know from last year that the supermarkets can keep
supplying things.
Yes,
get outside for a run or walk or whatever… but there is no real need to travel
to the beaches. We have plenty of outside space on our doorsteps and really
should be using that.
I
know Devon and Cornwall Police are not going to be harsh like they were on
those girls who drove 5 miles for a walk in Derbyshire this week; but still, be
sensible and stay close to home if you can.
And
still, avoid mixing with other families where you can.
I
know government policy keeps changing on schools. My son is doing his teacher
training up in Yeovil now and he can’t explain the policies to me! I guess you
stick to the rules, whatever they might be at the current time.
In
terms of healthcare, once again: if a thing will wait then it probably should
for now.
We
are going to be taken away from the surgery a fair bit to be doing the
vaccinations and it seems right now as though that should be our priority.
I
think the sooner we can get at least one jab into people, the more protected we
will all be from the risks of illness and death.
I
know in Totnes the impact has not been strongly felt; but by keeping being
sensible and sticking to the rules I really hope we can come out of this and
still feel like it hadn’t affected us in terms of illness.
I
know many people locally challenge the truth about the virus on the basis that
they don’t know anyone who has had it. From my perspective, that is truly
excellent though. I’d love to get through this and reflect afterwards that none
of my family had been affected by illness from this. Yes, we are all seeing the
impacts of lockdown rules on businesses and so on- and we will be paying for
this economically for decades to come: but just now: even though it is not yet
right in our faces, lives matter more.
Be good, wear a mask and stay safe.
We
managed to do some vaccinations on Friday and Saturday at the Surgery... I did
90 odd personally on Friday and Similar on Saturday...
In
total I think the team did something like 550 in the last couple of days.
Thanks of course to the staff who came in on the weekend to do a shift- and to
those who came and volunteered their help in the cold.
It
was a bit of a one-off doing it at the surgery though I'm afraid, so back to St
Boniface next week... I'll be supervising the effort there on Saturday
afternoon next week.
If
you are over 75 or an employed health and social care worker then you are
currently eligible. We will be updating the surgery website and answerphone
message as clinics become available.
As of
tomorrow (Monday) we do not have any clinics to book people into, but they
should become available very soon.
We
are formulating a plan to get around and administer vaccines to the truly
housebound as soon as we are able. We'll be in touch I assume to sort that out-
I can imagine that being done sort of geographically- If I were given an
ampoule of 11 doses I'd try and do all the housebound in one village say, or a
local area to make the best use of the time available...
We'll
see how it comes together over the next few days...
If
you have an elderly relative who could be got to the vaccine centre then
booking them in there would still probably be the quickest way to get them
done.
Just for now the guidance remains the same that the second doses people
get will be 12 weeks after the first.
I
haven't posted here in a while. I've been quite busy for a number of
reasons.... Mainly though I'm so glad that we are managing to get the vaccines
given efficiently. General Practice carries on though- remember though: we want
as few people in the surgery at any one time as possible; so use the phone with
any queries, or use the eConsult option on the surgery website. As few as
possible?- yes,- necessarily most people who need to attend the surgery are
either unwell or have some other medical conditions, so having lots of them
together in one space is a really bad idea. It makes sense to still try to deal
with health issues with a careful phone call where possible - but be reassured,
face to face appointments are still happening and have been all along... just
only where really needed. We'll try and keep the surgery website up to date
with which groups of people are currently being invited for vaccination...
Martin's previous post here summed up the current situation quite well.
I have heard about groups of people being outdoors. I can't be too cross
really- the recent weather had been dreadful.. so some fine days are
marvellous. Outdoors is the key though; the risks are so much less meeting
people outdoors - -especially with a breeze. We still do need to keep being
good and sticking to the rules though I think. I know so many people are still
being so sensible wearing their masks appropriately and not meeting family and
friends. Keep it up.... We'll get there soon.... The better we all are now, the
better chance of a normal summer this year.
25
April 2021
Our
vaccination program is racing along... It has been so heartening to see such
continued desire to be vaccinated. I truly believe it will be the main
intervention that will get our lives back to normal. Does it provide protection
against the new strains? Probably, to some extent.... Is it safe?- Not 100% we
now know but 99.999 percent safe in terms of the risk of a clot; which isn't at
all bad! Prof David Spiegelhalter has written a nice bit in the Guardian about
these risks here: https://www.theguardian.com/.../how-big-are-the-blood...
As
time goes on we are learning more about the transmission of the virus on the
breath. It had been thought to be only in droplets- that spume that comes out
when someone coughs or sneezes... but now we know it travels in the moist mist
that exhales with each breath... and can travel greater distances. Mask wearing
still seems very very sensible in confined spaces. Outdoors I think it depends
on the number and proximity of people and the environment you are in. A crowded
pub garden on a still evening might well be still a risk if someone there had
the infection. A walk down Totnes main street this weekend (what a lot of
people there were!) seemed less of a risk due to the strongish wind; so I only
wore my mask in the narrows.
It
feels, this week at least, as if the easing of the lockdown measures are
appropriate. Next month we see more changes again. I just hope that we don't
see the massive escalation in cases such as they have had in India as they
eased off.... I'm sure that if we do it will soon become clear.
The
Surgery has felt a little more normal this week.
Ever
since starting the vaccinations around Xmas it has been so hard... staff pulled
away to do that at the same time as, silly as it may sound, people have been
taking their accrued annual leave. There was not much desire to take leave last
year like we would normally do, and I'm sure we are not the only ones who have
had a lot of staff coming in to Feb/Mar with leave still to take... And then we
had the 2 weeks of Easter school holidays at the start of April!
We
now seem to have all hands on deck and should do for a good while.
This
week I hope to get round to more of the housebound people to get them their
second jabs. All those in the care homes have had both doses...
(It
was striking at the end of last year when a local care home had an outbreak how
quickly it took hold and how many died how soon. Thankfully not in Totnes, but
just up the road.)
So
keep doing your best everyone. We have come through this locally still with so
few dead from this it is astonishing. Traumatic for the families of those who
have died of course.
Well
done everyone.
Dylan
Dartington magazine May 21
It is May now and I have a nice meal out booked for the 18th - finally. Yes, it is all getting back to something like normal.
What a year it has been though; March and April last year seem so long
ago. I have to
Say that when it came to the anniversary of the first lockdown I felt a
bit despondent. It had been so long and the anniversary rammed home that we'd
sort of missed a whole year in so many ways.
Thankfully, in our local area very few people have been seriously ill
with COVID or died from it.
I think people locally have been so very responsible with regard to necessary social distancing and so on. Much more so than I have heard about in other areas. I'm convinced it has made a big difference. Well-done everyone.
We have been getting people vaccinated, initially at St Boniface House
and now at Follaton.
Many retired doctors and nurses have now finally been able to be enrolled to help, so that the impact on the local surgeries providing staff is lessened. The many Hi-Vis volunteers up there should be widely thanked. Giving up their time to marshal a car park or man a lift or whatever; in all weathers - so very much appreciated.
It has been interesting having more people now coming in to the Surgery
too. It feels fine until someone in the waiting room coughs and you can see
others visibly withdraw a bit! It is a bad idea grouping together our main
client groups - the old and frail with those who are ill. We will for now continue
to make a telephone call our first port of call for a consultation. Face to
face appointments can then be made where it is necessary for the patient to
actually be in the room with the doctor or nurse. Doubtless this will change
over time but for now it still seems sensible for the time being.
Thanks for being patient with us - we have been exceedingly busy in the last few months.
Those in the know about epidemic outbreaks from the outset modelled a
series of waves of infection over time - and that was without the variant virus
strains. Our greatest concern is with the one in India right now. It doesn't
seem to have been able to break out in the UK as yet, but if there were a new
peak of infections later in the year, or in the next winter, then an outbreak
of that strain could be very very serious. The current vaccines seem to give a
reasonably good benefit against the other variants at present. I'm sure the
vaccine manufacturers are developing a new type for us to use in the
Autumn- and the JCVI people are doubtless working out if it will be safe to administer alongside the usual annual flu jab in General Practices up and down the country. We'll see.
Our Dartington issue 30: Summer 2021
30
May '21 ·
It is
finally the Bank Holiday weekend and the sun is hot; doesn't it feel good!
Ever
since the vaccine campaign started in December we have been very busy at both
the Surgery and at St Boniface/Follaton.
The
Follaton set up is very good... a few stairs- a lift for those who need it.
Much better parking than we had out at Buckfast...
I'm
just sort of glad I'm not there this weekend... I spent both afternoons there
last weekend and actually now needed a little break. What I did notice out
there though is that where you arrive to go into Follaton, there is a fountain
and lots of Box hedging: and that Box hedge gives off an odour of cat pee! Is
it designed to not feel welcoming there? 
I
woke this morning (Sunday) to the sound of traffic. SO MUCH TRAFFIC. After all
the delays on the M5 yesterday people mut have been travelling overnight or
something... or perhaps just getting off to Bantham or Mattiscombe early to get
the best spots.
Also
I saw that Southwest Ambulance have been tremendously busy: so as always, ring
999 only in a true emergency. newton Abbot minor injuries is open all weekend.
111 will help where they can, and Devon Docs will be covering... but I'm
guessing they'll be very busy too. Be patient. Southwest Ambulance have been
tremendously busy: so as always, ring 999 only in a true emergency. newton
Abbot minor injuries is open all weekend. 111 will help where they can, and
Devon Docs will be covering... but I'm guessing they'll be very busy too. Be
patient.
So
many visitors in town too... Great for business owners of course finally but
somehow weird. They have come from all over the country.... I know it had to
happen. I just hope that people can still take sensible and appropriate
precautions against the risks of mixing too closely. And if you are employed in
a busy cafe or shop keep some distance and do try to keep wearing your mask.
Over time it seems to have become clearer that the risk of catching Covid off
something like a handle or surface is actually very very low. Also that the
risks of catching it at all outdoors is similarly very low. Especially where
there is a breeze. Windows open where you can if people are about inside.
We
are looking now at reopening bookable face to face appointments with the GPs in
the next week or two. The waiting room space will be the biggest issue I think:
more people in the building will mean mixing both the unwell and the
elderly/frail... so I think if you do get a face to face appointment with
either nurse of GP then be suitably prompt. Not too early. If you find you are
too early then perhaps sit in your car until closer to the time of your
appointment.
I'll
share with you this really good thread I found on Twitter which explains I
think some of the situation regarding the new variants in the UK and how
hospitals are affected. It sounds, genuinely, as though we still just don't
know how it is going to go int he next few months, but this makes me feels a
little more optimistic in terms of the overall effect of the vaccination
programme
https://twitter.com/ChrisCE.../status/1398871050931290112...
And
the photo is my bike: I did manage a little ride today: joyous to be on dry
roads. I know I pootle round town doing my visits on my funny three-wheeled
scooter: this one is more of my weekend bike.
Keep
well everyone.
Enjoy
the great weather.
Get some sun but watch out for the strong UV.
11.7.21
It’s about a week now until the end of lockdown
restrictions.
I noticed today on the news that the Covid minister was suggesting that mask
wearing in indoor spaces was still going to be recommended.
Good.
It is such a simple thing to do that will continue to reduce the risks of
transmission greatly.
I’m assuming that most people coming into the Surgery will still want to wear a
mask…
and for two reasons… 1. That we know that if we wear a mask it reduces the risk
of us passing infection to others in the same space… and there may be medically
vulnerable people in the surgery and 2. It protects us to some extent from
other people’s breath-borne infections… and poorly people in the surgery are
much more likely to have those than random people out and about in life…
So yes, do please consider continuing to wear a mask in the
surgery.
I think we’ll keep our Perspex screens up for the foreseeable future too.
It still is amazing that we’ve got away so lightly so far in
Totnes.
The recent surge in Cornwall though could still happen here I fear… Yes a lot
of that will have been the mass of security staff and police and so on for the
G7 but if you try and book a holiday in
Cornwall at the moment you’ll find it is fully booked practically… all through
the summer… with people coming to escape other areas of the country where Covid
is more prevalent.
We don’t have a lot of residential holiday sites around Totnes; but the
visitors from round and about will visit Totnes and want to go in the shops,
have lunches and coffees and so on… so if you work in hospitality I would
suggest you don’t let your guard down quite yet.
On a different matter, it is now possible to book “normal” face to
face appointments.
Consider though that in the last year or so we have proved that so many
problems can be dealt with with a phone call appointment or e-consult through
the website…
I mean, it is lovely to see patients sort of face to face (masks) but given the
pressure on health services there still is, we are able to manage many more
patient’s issues the online way, so I’d encourage you to consider if being in
the room with the GP or Nurse is absolutely necessary for dealing with your
concern.
Vaccinations are still going ahead… I’ll be the lead GP for the session at
Follaton on Monday afternoon (my afternoon off work)…
Obviously there continue
to be medical concerns raised… the latest being to understand if the cases of
myocarditis are linked to having been vaccinated.
It really seems genuinely
difficult to work out if it was one of those things that would have happened
anyway, given so many people have been vaccinated in just a few months. The BMJ
told me that the number of cases in the population was actually only the same
or fewer than would have been seen in any normal year…
I’m sure that overall, given the very large number of people who have been
vaccinated versus the very small number of people with complications: and now
the emerging evidence that the vaccination does indeed reduce the chance of
reinfection, hospitalisation and death from Covid that it is still
overwhelmingly the right thing to go ahead and get vaccinated if you haven’t
been already.
Talking of vaccinations we are having now to make plans for our
Autumn flu jab clinics.
We have no idea as yet where and how any top up Covid jabs might be given:
ideally, for logistic purposes anyway, I think we could do it at the same time
as the flu jabs… but we’ll have to wait a bit longer and see what is both
achievable and safe and within whatever rules NHS England demand of us.
Keep safe… see you all in due course I hope… Dylan
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