COVID-19 and the wider impact on health issues: Louisa Harding-Edgar

Louisa Harding-Edgar tells us about her involvement during the pandemic and its longer term impact on other health conditions.

What does your current role involve?

I'm a GP in Glasgow and I spent my Fulbright year in 2016-17 at the Harvard TH Chan School of Public Health doing a master's in public health. I usually split my time between academic work at Glasgow University and clinical work, however my research contract has actually been paused just now, so that I can return to full-time NHS work. I continue to be a GP two days a week and spend the other days working for NHS 111, doing COVID triage. When an someone phones us with possible COVID symptoms, we assess them over the phone and decide whether they are safe to manage at home, whether they need a GP to come and visit them in the community, whether they should attend an assessment centre or whether they should go into hospital.

This has been really fascinating work though quite complex and uncomfortable sometimes because as GPs, we're really not used to making all our decisions over the phone. This has also been a really big learning curve, for all clinicians, because we're dealing with a virus that we don't really understand yet. It's been complicated but absolutely fascinating.

In my GP surgery I'm seeing the other side of the health system – the non-COVID side, where we're still dealing with the everyday things that we see in general practice - from serious illnesses to the more minor things and again, trying to deal as much as we can with things over the telephone. I've managed to keep a bit of academic work going, largely looking at care homes and how under-resourcing of care homes has led to a bigger crisis, a devastating crisis, that we're seeing for residents during the pandemic.

How has your Fulbright impacted your work?

Fulbright was an amazing gateway back into academia. I'd been a clinician for a number of years when I decided that it would be useful for me to learn more about public health. Fulbright was quite unusual in that it does allow people who have started careers that aren't necessarily academic to get back into academia. It’s had a huge influence on my current work.

Right now it is so important for clinicians to have a good understanding of public health, so it's been hugely beneficial for me in that way.

What are the learnings from the current crisis around continuing to provide care for those with other chronic conditions? Do we face a hidden healthcare crisis in the making?

Yes, this is going to be a big problem and I think it's something we need to act on very quickly to minimise the long term effects. The drop in GP consultations is huge. Anecdotally in the practice I work in, we normally would see between 40 and 60 patients a day face-to-face in practice. On the first day of lockdown we received about 12 phone calls from patients looking for advice or assessment, which made us really nervous about what we were missing, what people were sitting at home with and not coming in with.

The numbers has increased now, but we're still nowhere near getting requests for consultations that we would in the past. This effect has been reflected in A&E attendances as well. In Scotland, we've seen a 55% reduction in attendances at A&E and it's hard to say at the moment how that might be due to changes in behaviour. We know there are fewer cars on the road, people are staying inside, so there may not be things happening in the way that they used to happen that required medical attention, but that can't really fully explain why we aren't seeing so many attendances with chest pain, stroke and cancer symptoms.

I have some stats around cancer in particular and they're really quite shocking. In Scotland, in April, our cancer referrals from general practice, (so patients presenting with symptoms that could suggest cancer and that needed further investigation) went down by 72% that month. And in England in April usually we would see around 30,000 diagnoses of cancer and it doesn't look like we're going to hit 5,000 this year. So there is going to be a delay in diagnosis of cancer and that will affect outcomes in a proportion of those cases and it will lead to a huge surge in demand on health services at some point. When people do start to consult again, it will lead to a bigger pressure on the system at every level. We need to address this to reduce mortality, we need to address it to reduce the health problems that people will develop without early treatment and we need to address it so that the system, again, can cope.

As well as potentially missing new diagnoses, we are not seeing patients who have diabetes or high blood pressure who normally would be attending the practice for routine checkup blood tests or to see our nurses or GPs for ongoing assessment to ensure that their conditions are well-managed. Cancellation of these routine services will inevitably have a big effect in future. We're also worried about immunisations – parents being too afraid to bring their children for vaccinations. We know already that the UK is no longer a measles free country and so this is a huge risk. If there's a cohort of children that aren't vaccinated against measles, which we think is more contagious than Coronavirus, the potential for devastating outbreaks in the future is huge and very frightening. This is something that really we need to switch our focus to, to avoid a really big problem later on in the NHS.