In May The Health Foundation published findings on how the pandemic had impacted primary care. They estimated 31 million fewer appointments were booked between April 2020 and March 2021 compared with the previous 12 months. By September 2020 total consultations in general practice had recovered to pre-pandemic levels and March 2021 saw the highest recorded number of appointments booked with a GP – putting more pressure than ever on practices already operating under intense workloads.
To better understand how local NHS breast services were coping we spoke to Consultant Breast Surgeon and Against Breast Cancer Trustee, Dennis Remoundos, who works for the Oxford University Hospitals NHS Foundation Trust. His department had some of the services relocated to a ‘Covid-free’ location at the start of the first lockdown, while continuing to provide clinics at a different low-Covid risk site.
Over a year later some of these services remain in their temporary home. They have adapted to new working practices and seen valued team members seconded to front line services whilst delivering life saving care. For him, the news that patients nationally are presenting at a rate approximately 15% higher than 2019 reflects the experience of the Oxfordshire NHS Trust. It appears the message to people who chose to stay away in 2020 is getting through.
Cancer patients still prioritised
While in the short term this will inevitably cause scheduling issues and delays, the teams feel that so far they have managed well, with the vast majority of cancer patients receiving prompt treatment. They hope to continue to cope with the pressures, and they are the first to acknowledge that colleagues elsewhere in the NHS have been hit far harder than themselves.
Cancer patients are being prioritised for surgery and working protocols have now been established should the alert levels change. Teams can now quickly and safely adapt their working practices if required whilst keeping at a minimum the risk to patients.
Changes to working conditions and environments have of course taken their toll. As has been the wider experience, not all clinicians have found the transition to home working straight forward. In response, hospitals have improved support, appointing Wellness Leads to help meet these challenges, but for already busy staff attending such meetings is not always possible, reminding us again what a long and high pressure year it has been for the staff of the NHS.
While there is pressure for services to return to normal, it is unclear what exactly ‘normal’ will look like, or when it might happen. To help with the increase in referrals, the number of clinics has already been increased, offering improved flexibility to patients and cancer services continue to be prioritised as more capacity becomes available.
Clearly then, it is too early to make any predictions on what the lasting legacy of the pandemic on breast care services will be, but what is becoming increasingly clear is that remote working and remote consultations in some shape or form are here to stay.
Video consultations likely to continue
Over the course of the lockdowns video has firmly established itself and become widely accepted as satisfactory, enabled by the need for remote working and, for many in the NHS, a long overdue investment in IT services. The likelihood is of video consultations continuing into the future.
Currently, patients in Oxfordshire are having some of their diagnosis and treatment appointments remotely. More detailed consultations, discussing and planning treatment options continue to be held face to face. While these new working practices may have been necessary during lockdown, it is clear that going forward the needs of the patients will have to be considered. So, finding a balance will take time and due to the sensitive nature of the interactions, it is unlikely that face to face meetings will be replaced completely.
As with all things pandemic related, the last year has taught us that as official advice changes so must practice and behaviour. We can at least feel reassured that many lessons have been learned, much of the work has been done and procedures are already in place, ensuring the viability of these essential services should we find ourselves in a similar position once more.