The “New Normal” – looking forward to the next phase in healthcare.

The impact of the pandemic is going to be with us for the next 18-36 months if not longer, and whilst this is a challenge it is also an opportunity.

Moving backwards is rarely the right choice in medicine, and in this situation not an option.

We need to look forward to what is now becoming the “new normal” way we do things.   

What won’t change ?

Primary care has been described as  “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” 

It is measured as “good” against four elements:

1. First-contact access for each need;
2. Long-term person- (not disease) focused care;
3. Comprehensive care for most health needs; and
4. Coordinated care when it must be sought elsewhere

In some measures the degree of family or community care is also included. [1]

None of this is changing.

Nor is the fact that primary care is all about relationships.

General Practice team members are experts in relationships.  We are experts in communication. We are experts in risk management. We are experts in healthcare.

Why do we need to change ?

For the foreseeable future we will be swabbing a large proportion of those who have respiratory symptoms for covid19, we will need to keep our other patients, and our staff safe from this disease.

There will be local and regional and potentially national outbreaks over this time.

This will be happening on the background of a world in economic crisis, challenges to businesses in all sectors, and a high level of patient and provider anxiety.

 As a minimum we have to adapt to the “new normal” by :  

1. Providing virtual triage for all patients to identify the potential covid19 from the non-potential covid19.
2. Having systems that keep infectious people away from others when we are seeing them face to face.
3. Providing safe systems to protect staff.
4. Having the ability to scale up a local response to manage an outbreak  
5. Having systems for monitoring covid19 disease progress in the community and clear referral and management pathways

What is the New Normal ?

In the “new normal” general practice will continue to do what it does best with more virtual care, in cleaner environments with better infection control mechanisms, and with staff with more flexible working conditions.

In the new normal practices will need to either be “green zones” and have nothing to do with anyone with a respiratory infection or ‘flu like illness , or to have “green” and “red” zones and processes that allow them to continue to manage patients with respiratory infections and ‘flu like illness safely.

In the new normal “virtual first” becomes the primary point of contact for patients who need to use the health system. This will impact on the working conditions of all staff, as we shift our ability to provide effective efficient home based care.

In the new normal, personal protective equipment is worn, not kept in box in case of emergencies.

Community Based Assessment Centres (CBACs) have a role in supporting communities whose practices cannot provide “green” and “red” safe zoning, and to provide covid19 services to communities that have low GP penetration / poor access.

CBACs in the future have a role in stepping up to support practices dealing with an outbreak in a locality that threatens to overwhelm the local service.  They will need to be able to be rapidly set up within 24-48 hrs, and to be in place for at least 28 days.

And the future ?

We have already demonstrated our ability to adapt to the new normal, as practices and as networks.

The new normal brings with it challenges and opportunities to do much more than just the bare minimum.

There have been palpable improvements in access to services through the switch to virtual care, yes with inequities evident; the digital divide is shown to be wider than was thought – but that’s just a problem, it’s not insurmountable.

There have been palpable improvements in working conditions for practice teams – yes, with challenges to the business model and income expectations, change in working patterns, and different stressors but these are just issues, they are not insurmountable.

Yes, we are worried that patient outcomes may be compromised somehow- but we have never been very good at measuring them and this is an opportunity for that to change.

Let’s embrace the new normal, look forward, learn from each other, build on the power of networks, and collaborate to provide better first contact, comprehensive, coordinated, person-centred care. 

To be honest, it’s not like we have much choice.

Jo Scott-Jones   

1. Contribution of Primary Care to Health Systems and Health, Starfield, Shi, Macinko 2005.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/

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