Dr Veronika Rasic looks back at a turbulent year to be a newly-qualified GP
The end of 2019 was a happy time: I had just completed my GP training and was going home to Croatia to visit family and friends. My feeling was that I should take a little time to rest before embarking on the next chapter of being a fully qualified GP. Little did I know that the next chapter would include a global pandemic not seen in recent living memory. I would like to share with you my memory of the challenges I faced during those first 12 months, as I attempted to navigate a new career and the challenges of COVID-19.
Deciding to be a locum GP
Unlike many of my colleagues, I had not started looking for jobs during the last part of my ST3 year and was not looking to go into a salaried post or become a partner at a practice. I had decided to try a flexible way of working, which would allow me more free time to spend doing the things I enjoyed. The best way I could see to do this was to become a self-employed locum GP.
Like most trainees, I had not known much about self-employment, and what that would mean regarding pensions, tax and many other things that until that point had been taken care of for me by the hospital HR department. There was quite a bit of information to take on board and I spent the next few months reading up on all of this.
During that time, the news that COVID-19 had started to spread outside China was announced.
Out of hours
While setting up to be a locum I thought it would also be a good idea to have some steady income as I did not know how much need for locums there would be in my area. I started working in the local treatment centre in February just as the first warnings about passengers traveling to the UK from China began to circulate.
Every few days there was new guidance coming in from different sources. I was watching WHO briefings, reading the latest PPE guidance, finding information for how to assess suspected COVID-19 patients, and trying to follow the ever-changing NHS information locally and nationally to try and stay up to date on the evolving situation.
By March 2020 we were officially in the grips of a global pandemic and lockdowns had begun around Europe and in the UK. During those first months it felt like I never switched off, constantly reading and watching videos about COVID-19. I remember feeling exhausted from the information overload I was experiencing and from trying to manage many anxious and unwell patients. There were constant questions about things I did not have answers to.
The track and trace system was very difficult to access in the beginning. I had the impression that they were not testing people who did not present with one of three symptoms (fever, cough, loss of taste or smell). This was despite the ever-increasing evidence that was coming through about other symptoms of COVID-19 like sore throat, headache, diarrhoea and runny nose.
I remember people saying “it’s not COVID-19, it’s just a cold” repeatedly while I was seeing them in full PPE. The way that the out-of-hours (OOH) service was organised drastically changed with the introduction of hot and cold clinics, different PPE requirements and the change in how staff felt safe working in a face-to-face capacity. As a young and healthy GP I did feel like I was best placed to work in the treatment centre. Personally, I found it difficult to don and doff PPE and do an assessment in the short period of time I had, along with attempting to explain to the patient why they needed to have a COVID-19 test and isolate with their entire household.
Patients saw this then as they do now, as an inconvenience, and many were worried about losing their jobs. Other patients were very anxious and scared of COVID-19 itself and refused to attend in person. People felt isolated and lost family and friends to the virus. All of this made for a difficult working environment.
Changes in GP surgeries
In parallel to my work in the OOH service, I had managed to start picking up locum shifts with several local surgeries. The pandemic had drastically changed how things worked when compared to my ST3 year. To reduce the possible spread of COVID-19 the waiting rooms were now empty, and patients attended in person only if there was a need to see them face-to-face. Most consultations had now been changed to telephone, video or e-consultations. The digital transformation of the NHS had happened overnight, and I had a new challenge of keeping up with and learning the different systems at different practices.
During the second part of the year, I started thinking if a more stable working environment might be easier to manage and considered taking on a salaried position. However, I found it almost impossible to assess what ‘normal working’ would look like for different practices I locumed for. There were staff working from home, hot clinics and members of the team having to self-isolate at short notice.
In the end I realised that the flexibility of being self-employed was providing an invaluable buffer for the situation we had all found ourselves in. It allowed me to reduce my work hours when I started to feel overwhelmed, and decide for myself the kind of sessions I was able to do.
Despite all the challenges that the year provided I think that it also taught me a lot about my limits and how to manage my workload. I have continued to work as a locum and OOH GP and have found a good balance where I feel I am able to avoid burnout. At present the pressures in general practice have greatly increased and I hope that investments can be made in primary care to help mitigate the demand. I enjoy working in primary care and hope that we can all continue to build fulfilling careers.
Follow Dr Veronika Rasic on Twitter at @docvei