"It’s really difficult and overwhelming" - Yorkshire GP and patients reflect on seismic changes to healthcare

Whether there were concerns about a baby's rash, a persistent hip pain or a discussion of  medication issues, being able to book a reassuring trip to see a family doctor face-to-face was a privilege that, before Covid-19 struck, most people living across Yorkshire could take for granted.

Skipton GP Deborah Livesey, 53, is one of thousands across Yorkshire who has contended with changes to the way she works.
Photo: Tony Johnson
Skipton GP Deborah Livesey, 53, is one of thousands across Yorkshire who has contended with changes to the way she works. Photo: Tony Johnson

But, like so many elements of day-to-day life, coronavirus has shifted the way the public can access even this most routine of medical treatment.

While remote appointments with a doctor can suit many down to the ground, especially for those who need to juggle a trip to the surgery with work or care-giving duties, for many the lack of access to face-to-face care has posed untold challenges over the past year.

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At the same time, GPs themselves have had to shift to a new way of working - one that does not always sit well with their patients.

Deborah Gibb, 32, is a mother-of-two from Saltaire. Mrs Gibb, a teacher, gave birth to her second daughter, Freyja, in November last year. Photo: Simon Hulme

Skipton GP Deborah Livesey, 53, is one of thousands across Yorkshire who has contended with changes to the way she works.

She said: “People have been saying GPs have stopped offering face-to-face. That’s just wrong. We’ve never stopped, we’ve just been selective.”

Her practise, Fisher Medical Centre, has introduced technology over the past 16 months to allow patients to send pictures of their medical complaints.

She added: “It’s changed and evolved over time. Age has not been a barrier. You’d be amazed at how many 96-year-olds have been sending us a picture of skin lesions on their arms.

“The barriers have been people in poverty - people who don’t have access to a smartphone. But in that situation, we’ve just brought those people into the practise to see them.”

But Dr Livesey admits that for some patients, it’s been a struggle to adjust.

“When all the appointments are gone, we really can only mop up one or two appointments if it’s an emergency.

“The demand is just so massive at the moment. Sometimes we have to say to people ‘we can’t deal with that today’.”

She said that the increase in remote appointments means patients are often dealt with much quicker - within days rather than weeks.

“In the past, people used to have to wait three or four weeks and that was normal. People have forgotten that.

“If we were to go back to pure face-to-face, we would have to go back to that wait.”

And the mental health impact has taken its toll on Dr Livesey and her colleagues, who are dealing with more than 300 patients a day in the practice.

She said: “I can honestly say I have never worked such long, intensive days as I do now due to the unprecedented demands on general practice.

“The surgery may be open from 8am til 6.30 but the doctors are still there much later at night. Patients don’t seem surprised when you ring them at 7.30pm.”

But for patients with concerns that cannot be so easily discussed in a phone call, a change to face-to-face services has caused significant issues.

Deborah Gibb, 32, is a mother-of-two from Saltaire. Mrs Gibb, a teacher, gave birth to her second daughter, Freyja, in November last year.

Through her pregnancy and after Freyja’s birth, most of her appointments and check-ups except her scans were done remotely.

“Everything was done remotely unless there was an issue. But in the back of mind, I was thinking ‘how would we know if there is an issue, unless we see a midwife,” said Mrs Gibb.

“There were fewer opportunities to hear the baby’s heartbeat and to have things like blood pressure checks.

“My concerns also come down to not getting the baby weighed as much as before. There’s normally a three to four month check, and all we got was a letter to say that that appointment wouldn’t be happening and to contact them with any concerns.

“I missed having that check, and I’ve really missed having the health visitor clinics.

“With my first daughter, it was picked up at her eight week check that she wasn’t lifting her head properly and we were referred to pediatrics.”

The mental health element of new motherhood is also something that Mrs Gibb feels has changed through the pandemic.

She said: “Mums are supposed to get a six week mental health check. But all I got asked at my younger daughter’s eight week check was ‘are you okay?’ and I said yes.

“With my elder daughter I had a separate appointment that was about me, my stitches were checked and I was asked about breastfeeding and sleep. It made it feel like it was about me, rather than being an afterthought.”

One of the hardest moments for Mrs Gibb was the realisation that her husband never got to hear Freyja’s heartbeat until she was in labour as he was unable to accompany her to appointments.

She said: “I was coming home from appointments and trying to remember everything I've been told. When a lot of the time, your head is spinning.He missed out on all of that side of things.”

And for carers managing loved ones’ complex health needs, the situation can be equally daunting.

Mohammed Haroon, a 29-year-old paralegal from Keighley, cares for his 61-year-old father, whom The Yorkshire Post has agreed not to name.

His father has vascular dementia, and was last year also diagnosed with kidney and heart failure.

A deterioration in his condition last summer led to a hospital admission where he had a stay in a High Dependency Unit, but after his discharge he was referred back to care from his GP as well as to specialists.

One of his feet had to be amputated due to complications of his condition.

Despite needing to speak to his father’s GP regularly about his complex needs, Mr Haroon was only able to obtain a face-to-face appointment for the first time in nearly a year earlier this week after he was worried that a blister on his father’s foot could lead to a second amputation.

For Mr Haroon, the extra caring responsibilities on his shoulders means he is often tasked with contacting the GP with photographs of his father.

He said: “He’s got issues with his feet - one has been amputated. If they’re swelling, photos or videos don’t justify it, you need to feel them. You don’t get that experience over the phone.

“They’ve told me to check his blood pressure over the phone.

“I didn’t know how to check blood pressure. I had to purchase the machine, and I’m hoping I’ve been taking his blood pressure in the correct manner.”

Mr Haroon said accessing face-to-face support for people with dementia needs to be a priority. He said: “Everytime I run into an issue, I’m on the phone, first thing. The first thing they want to do is an e-consultation.

“I’m my dad’s carer, but if I wasn’t, how is a person such as my father supposed to do an e-consultation?

“It’s a big ask. Most of the time the follow-up is a telephone call. With my father’s condition, he would prefer a face to face clinic. He’s more comfortable with the regular routes at places like the GP’s clinic.

“It would be nice if it was also the same doctor, but it’s different doctors at different times. Because of the pandemic, everything changed.

“For him it’s really difficult and overwhelming. It’s hard for him to understand what is happening.

“They’re not interested in seeing him face to face, it was never a suggestion - despite all the health conditions.”