Infected by Freedom

The doors are open, the masks are off.

This is what freedom feels like – daily diktats from the NHS executive and patients coughing their way through a sentence about not wearing masks while I sign a prescription for this week’s fruit and veg supply. 

Face-to-face contacts have soared after a prolonged media campaign convincing the populace practices haven’t been open and they all deserve an appointment right now. This neatly fits with the current government agenda: to get everyone to catch delta in the next 2 months and “get it out the way before the killer flu in winter”. 

Throughout the pandemic nosocomial spread has been the elephant in the room. Rife throughout hospitals during the peaks, perhaps we need to think a bit more about the humble GP waiting room. 

Pre-covid we routinely invited actively infectious people to come in for assessment, sit in a waiting room full of people surrounded by the vulnerable and immunosuppressed, often for prolonged periods as we ran late yet again. In retrospect it seems utter madness, indeed irresponsible even. 

In the COVID era, things have radically changed but we find ourselves at a dangerous point. With a general shift away from dedicated covid hubs seeing febrile illness and probable covid the role returns to practices, and with it the risk of infectious spread to patients, staff and ourselves.

It would be all too easy to simply return to the ‘good old days’ of general practice but going back to the old system would be a mistake.

COVID may have driven our enlightenment about the importance of preventing pathogen spread in the waiting room but we need to think beyond the pandemic. Consider influenza, parainfluenza, RSV, norovirus and all the other infections you could catch by sitting next to an infected individual for a few minutes. We have a duty of care to prevent our patients getting ill when they come to see us. 

This doesn’t have to be difficult. It wouldn’t be hard to keep infectious patients in a separate waiting area, to minimise their time in the practice, to ask them to clean their hands and wear a mask. We couldn’t have done this in our old system and we need to actively resist returning to it. A hybrid of remote and near consultations allows plenty of flexibility to meet these goals.

But to do this practices need their own freedom. The freedom to decide how we organise and run ourselves, the freedom to choose our own path, and the freedom to ask our patients to join us on it.