11 May 2020
In the second of our blogs exploring the incredible work of our members during the COVID-19 pandemic, we speak to our outgoing President, Dr Elizabeth Price, about going back to the wards. Plus, we hear from academic Dr Stefan Siebert on what the pandemic has meant for his research work at the University of Glasgow.
Dr Elizabeth Price, our outgoing President and consultant rheumatologist at Great Western Hospital NHS Foundation Trust, is balancing working on COVID-19 wards alongside seeing urgent rheumatology patients.
“The first thing that happened was I did a lot less travelling. As BSR President you go to lots of meetings and conferences and suddenly it stopped. We started doing BSR board meetings by teleconference and we had to cancel the annual conference, which was a blow for everyone and on a personal level sad for me because it would’ve been my last one as President.
“At the beginning of the pandemic, our rheumatology team moved all our clinics to virtual and in the main it worked well, although we must be mindful that some patients won’t adapt well to it. We’ve managed to retain our rheumatology specialist nurses and they’re still running the helpline and doing telephone consultations.
“We’re running weekly clinics on days when we’re not on the wards, so that we can see patients face-to-face if they have something like hot swollen joints, but they have been triaged by telephone first. Working with colleagues, we’ve been able to run 2-3 clinics a week.
“So, rheumatology services are running at a certain level, but what we’ve not able to do is the routine follow-ups. We do want patients to know that if they have concerns we are here – as we are a bit worried some patients have put off getting in touch and are leaving things to worsen before they contact us.
“I’m working as a general medic three days on, three days off on the wards between 8-5. Then I’ve been doing my emergency rheumatology clinics in between. Everything has been well organised within our Trust, and changes have happened quickly. The wards are well staffed, and people have really been supporting each other.
“It’s been interesting for me personally being back in acute medicine again, as working in rheumatology we are generally looking after chronic diseases and managing conditions long-term. But this morning I’ve been on the ward round and two of my COVID-19 patients are being discharged. It’ll be a long recovery for them but it’s a real buzz when someone is able to go home.
“A big challenge will be fully relaunching rheumatology services again. Rebooting a service and working out what to do with all the patients that have had appointments cancelled and how to prioritise them will be challenging. But alongside that there’s lots of opportunity.
“Historically in the NHS it can take time to change things, but suddenly things are happening overnight. After COVID-19 we mustn’t set the reset button and go back to what we used to do. Let’s do it better, think about what’s worked well and keep doing those things and use this as an opportunity to make positive changes.”
Dr Stefan Siebert is Clinical Senior Lecturer in Inflammation and Rheumatology at the University of Glasgow and an honorary consultant rheumatologist at NHS Greater Glasgow and Clyde. He talks about the impact of COVID-19 on his academic work and keeping the rheumatology service running.
“Early on we had to rapidly close down our clinical trials and move to remote monitoring. The first couple of weeks involved making sure all our study patients were safe, and on how we were going to get the study drugs to them and how to continue to monitor them.
“Our research focus has inevitably moved to COVID-related studies. I am part of the Glasgow COVID task force, working in collaboration with other specialities, including respiratory, ITU and infectious diseases, on developing and shaping research COVID proposals. My academic colleague Dr Neil Basu is leading on the Scottish COVID-19 rheumatology and UK Vasculitis registries, which feed into the EULAR COVID-19 database, so we’re capturing a lot of important data for these. Also, our university lab and staff have adapted to support all the COVID NHS and research work.
“I’m still doing some marking and occasionally teaching virtual lectures, but my main role now is keeping our rheumatology service running. I normally do 30% NHS with the rest of my time at the university, but I’m now working full time in the NHS.
“All the NHS rheumatology consultants and registrars who usually run the rheumatology service were deployed full-time to the medical wards, so along with Dr Basu and our specialist nurses, we’re keeping things going as much as possible.
“One of the first things we did was get a list of the sickest patients we’re most concerned about and phoned them to check how they were, and we’ve continued to regularly call them, particularly those with vasculitis. We also contacted everyone on the urgent referral waiting list and worked out who needed to come in and who could be delayed or managed over the phone.
“Despite not running our usual clinics, we’ve been responding to emergencies much quicker than usual because that’s been the priority. So that’s a good lesson for us and gives us lots to think about for the future. We’re only scheduling emergency face-to-face appointments, after first screening over the phone, and ensuring that patients don’t overlap or come into contact with each other to reduce their risk of infection.
“We set up an email helpline for both patients and GPs. We usually use a phone helpline, so we left a voicemail message asking people to email us instead, with a general message to patients to keep taking their medicine, because that was one of the main enquiries we were getting at the start.
“The email helpline is working well and, together with our nurses, we’re now able to reply to most in real time. We’re still getting electronic referrals from GPs, so we’re actively triaging those, including phoning all urgent cases. The GPs have also been very accessible and extremely supportive by prescribing and taking on more monitoring. Ensuring our most vulnerable patients were appropriately shielded has also involved a significant amount of work.
“Like everyone else we’re working on a long-term strategy because we can’t sustain this long term and are aware there are many patients we are not hearing from. Our hospitals cover a wide geographical area and we’re in the process of setting up virtual clinics to minimize travel to hospital. We will definitely carry the email helpline forward in the future to help quickly resolve queries and ensure easy access for urgent cases. Things are definitely never going to be the same again.
“Going forward we need to think about seeing our stable patients less often and seeing the sicker patients more often, as that’s where we can have the greatest impact. We do have some patients we’ve been seeing for years who aren’t on any medication, so we need to think about whether seeing them regularly in clinic in future is really in their best interests. This pandemic has really forced us to focus on what is most important and what we need to change.”
Huge thanks to Liz, Stefan and all of those who are sharing their experience of working during the pandemic. A free wellbeing support helpline is available for NHS staff from 7am-11pm seven days a week: call 0300 131 7000 for confidential listening from trained professionals and specialist advice, including coaching, bereavement care, mental health and financial support.