GPs from across City of London and Hackney are moving to establish so-called ‘hot sites’ in practices across the borough in response to the coronavirus pandemic.
Hot sites will be separate areas within GP surgeries for suspected or confirmed cases of Covid, with adjacent cold sites reserved for patients to be seen for normal day-to-day needs.
A wall is currently being built down the middle of the Lawson Practice on Nuttall Street for the first of the borough’s hot sites, with another set to open in the John Scott Health Centre and a third at the Well Street Surgery.
The hot sites will be staffed by a rolling rota of Hackney’s doctors, with cleaning support services and drivers equipped with personal protective equipment (PPE) to bring people to their assessments.
Under national guidance City & Hackney would be expected to see eight such hot sites, with Laura Sharpe, chief executive of the GP Confederation, saying that medics want to get the first three sites up and running, “learn the lessons, smooth that out and go from there”.
Sharpe said: “Our 39 GP practices are coping, with various levels of staff sickness. A couple of practices almost had to close last week due to sickness levels, but we were able to get cover and bring people in so they could stay open.
“All the response from the GPs has been amazing. Their commitment to staffing these sites, supporting Hackney residents and patients was overwhelming. We already have lots of people signing up to the rota.
“The worst case modelling numbers we’ve seen is that 960 patients per week will need to be seen at the height of the surge face-to-face in general practice, in addition to all the people to be dealt with over the phone, so we will probably need more than three hot sites.”
It is understood that the volunteer medics are to be paid for their work, with Dr Mark Rickets, chair of City & Hackney’s clinical commissioning group (CCG), emphasising that ensuring continuity of care for people who are not suffering Covid is “fundamental”.
Dr Rickets said: “We do not want to risk the health and wellbeing who aren’t suffering from Covid throughout this crisis, so there is a great deal of focus on that to make sure that continues.
“Although there’s going to be a need for these hot hubs, many practices will probably want to still be seeing their own patients as much as they can, so they may well have some patients coming to their practices in a zoned way, so that people don’t interact with others who have Covid.”
The CCG boss added that the upcoming Easter bank holidays will “almost certainly” see business as usual for GP practices across the borough, though this has not yet been confirmed nationally.
Hackney’s public health director Dr Sandra Husbands explained to a meeting of councillors and the borough’s medics last night that predictions of the peak of cases being reached around 5 April is a forecast made without taking into account the current lockdown measures seen across the country.
Husbands added: “The whole point of the measures that we’re taking is that it flattens the peak, and prolongs the episode. We’re not expecting a peak in two or three weeks if this works, but a plateau over a more prolonged period.
“It’s going to be a bit of a long haul, and there is going to be an increase in cases. Over the last few weeks, we’ve seen cases doubling every 3-4 days, but at some point we expect that to tail off and plateau.”
The Town Hall’s community health director Anne Canning, who let councillors know that the council is “determinedly” block booking hotel rooms across Hackney Central for homeless people self-isolating or people discharged from hospital, made clear that there was no way of knowing for sure how many beds would need to be made available.
Canning said: “I really wish I could say that the modelling is such that there’s a certain day when it will reach crisis, because I really don’t know. That’s not because we don’t have the empirical evidence to date, but because the modelling isn’t sophisticiated enough at present.
“We’re trying to avail ourselves of every available property rather than saying we’ll need 10 beds today and 15 beds tomorrow, because we don’t have the evidence to direct that yet.”
As hospitals work to make as much space as possible for incoming patients suffering from Covid, medics and the social care system are working on a ‘three-hour challenge’ system in discharges, with one hour to arrange what medication will be required and two further hours to get a person to their discharge destination.
Canning added: “This is a considerable change, and does mean for the service users that they don’t have a choice in their discharge destination and in the past they have, but that’s how it is.
“The service users are sent off with a package depending on the pathway, then there’s four weeks and a review. Normally in the past we’ve reviewed early, but there isn’t the time to do that.”
When asked if the local health systems would be putting in place contact tracing for the virus, Husbands told those listening that this is “definitely not part of Public Health England’s plan”.
The public health expert pointed out that those arguing for a repurposing of every biology lab in the country were not reckoning with a global shortage of materials necessary to carry out such widespread testing.
Husbands added: “We need to make some practical decisions as a country about what we can do and what’s important.
“In the short term, the priority is to test the people that we think are sickest, so we can make the most effective decision about their treatment, and test healthcare workers and social care workers.”
Dr Rickets also spoke of his “deep frustration” around the issue of testing, pointing to the “key role to play in the delivery of care” that those proving positive for antibodies to the virus could play.