Journal of Interprofessional Care

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A reflection on the impact of COVID-19 on primary

care in the United Kingdom

Richard Gray & Chris Sanders

To cite this article: Richard Gray & Chris Sanders (2020) A reflection on the impact of COVID-19
on primary care in the United Kingdom, Journal of Interprofessional Care, 34:5, 672-678, DOI:
10.1080/13561820.2020.1823948

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JOURNAL OF INTERPROFESSIONAL CARE
2020, VOL. 34, NO. 5, 672–678
https://doi.org/10.1080/13561820.2020.1823948

A reflection on the impact of COVID-19 on primary care in the United Kingdom

Richard Graya and Chris Sandersb
a
The Centre for the Advancement of Interprofessional Education, Fareham, UK; bLeicester Medical School, George Davies Centre, University of
Leicester, Leicester, UK

ABSTRACT ARTICLE HISTORY

The COVID-19 pandemic has presented both challenges and opportunities for those working in health Received 25 May 2020
and social care in the United Kingdom (UK). With much focus on secondary and acute care at this time, Revised 29 August 2020
there has been less communication and understanding about the impact on primary care. This discussion Accepted 10 September 2020
paper is based on the experience of one of the authors working as a general practitioner/family doctor KEYWORDS
during the pandemic and rapid changes are described during this time (April 2020). Two important Interprofessional education;
themes emerged from this experience focusing on the importance of supporting one another and new primary health care;
roles and ways of working. It can be argued that the challenges presented by COVID-19 have expedited collaborative working;
positive and potentially sustainable change in UK primary care that has been needed for some time. The pandemic
authors discuss the implications for future working and make a series of recommendations for primary
care relating to the importance of supporting the workforce, remote consultations and communication,
regular team meetings, and development of integrated care. It is suggested that many of the challenges
highlighted can be addressed by placing a greater emphasis on the use of interprofessional education
(IPE) to underpin and support effective collaborative working.

Introduction their homes, in the practice, or hospital (Royal College of

General Practitioners, 1972). The primary health-care team
COVID-19 first reached the United Kingdom (UK) in late
works from general practice premises and can involve GPs,
January 2020. By the end of March Public Health England (PHE)
practice and community care nurses, midwives, health visitors,
reported a total of 11,658 cases of COVID-19 (an increase of 22%)
pharmacists, social workers, and other health and social care
and 1,161 deaths from COVID-19 (an increase of 32%) (NHS
professionals.
England, 2020). Responding to these figures at this time, the UK
Crises provide an ideal opportunity to experience deep
government imposed a step 1 enforced lockdown policy. People
learning and change within any system including health and
were told to stay at home and were able to leave only for limited
social care; the present situation resulting from the COVID-19
exercise, medical reasons, or to go to essential shops with social
pandemic is no exception. In primary care, significant changes
distancing of two meters. People were told to, wherever possible,
in working practices have occurred from which there may be
work from home and to avoid public transport. The vulnerable and
no way back. However, it can be argued that this rapid sea
those with serious medical problems were shielded and told not to
change as well as presenting challenges have accelerated sig­
leave their homes (Institute for government, 2020). These restric­
nificant long-term change. In this present crisis, there has been
tions significantly impacted on the frequency of face-to-face pri­
a focus on secondary and acute care but there has been less
mary care consultations, with each contact accompanied by an
communication and understanding about the situation within
increased risk of contracting the virus for all concerned.
community health and social care, and the access point offered
Consultations between health-care professionals and patients had
through general practice or family medicine. In the UK, pri­
to be prioritized. As the pandemic spread throughout the UK and
mary care is a significant part of health and social care where,
the incidence and death rate from COVID-19 increased, after an
before the pandemic, over 1 million patients each day were
initial drop in demand, work in primary care also began to increase
treated in general practice alone (Royal College of General
once again. This discussion paper is based on the experience of one
Practitioners, 2013). Currently, over 90% of COVID-19 cases
of the authors working as a general practitioner/family doctor
have been managed in primary care and the community
during the pandemic and rapid changes are described during this
(Greenhalgh, 2020). Globally it is from within the community
time (April 2020).
sector that the aftermath of the crisis will be managed.
The crisis has driven a change in current professional roles
Background and specialisms, the development of new professional roles and
a proliferation of technological progress such as with the pro­
A general practitioner (GP) in the UK is a primary care family
vision of remote consultation and communication. These
doctor who works in a multiprofessional team providing pri­
changes benefit patients and service users but come with
mary acute and continuing care to individuals and families in
a significant risk that care can be fragmented (Fulford et al.,

CONTACT Richard Gray, richard.gray@caipe.org CAIPE, PO Box 680, Fareham, Hampshire, England, United Kingdom
© 2020 Taylor & Francis Group, LLC

2012). During the pandemic, many patients have been reluc­
tant to seek help from health-care professionals mostly because
of anxiety about contracting COVID-19. Although technology
can improve accessibility for many, this can prove difficult for
marginalized groups for whom traditional methods of consult­
ing should still be available.
In the present climate, with loss of face-to-face human
connection, there is increased anxiety, fear, and bereavement
being experienced by professionals, patients, and service users
alike. An added problem is the challenge to be compassionate
when communicating remotely (Neighbour, 2020). Resilience
of all involved is vital as well as the ability to live with increased
uncertainty. Supporting the workforce is important in this
context. The authors suggest that greater emphasis on how
interprofessional education (IPE) can underpin and support
effective collaborative working could address many of the
issues highlighted above. In our experience, regular team meet­
ings were found to be essential in supporting ways of working
and a useful structure for interprofessional learning in setting
common goals, reflecting on performance and effective team
functioning.
The next section is based on the personal experience of one
of the authors (CS) returning to work as a general practitioner
(GP) after a period of ill health due to burn out and then
suspected COVID-19.
Primary care in the UK during the COVID-19 pandemic
Rapid and immense changes within a short period of time have
occurred within health and social care in UK primary care, but
much of this remains hidden. Work is being fundamentally
reshaped throughout the UK. In particular, there is much
collaborative work going on which was not happening pre­
viously to the same extent.
Remote assessment of patients
One example of an important change is the introduction of ‘on
demand’ phone lists that can now be shared between different
professionals including nurse practitioners, pharmacists, para­
medics, and mental health facilitators. Previously, important
initial contact processes were generally the responsibility of the
“on call” doctor when addressing the urgent calls for appoint­
ments over and above those already booked that day. The
doctor subsequently pigeonholed and allocated remote con­
tacts to different professionals according to their roles, using
a triage assessment approach. With COVID-19 demands have
changed as remote contact becomes the norm. Now different
professionals can select their calls according to the nature of
the clinical need and share the work equitably. Accurate eluci­
dation of the patient history and concerns is vital. Although the
range of health-care professionals in general practice is increas­
ing, there is a need to support and train this workforce to work
alongside doctors as exemplified by the development of
Advanced Clinical Practitioners in the UK. Addressing this
need requires IPE in establishing shared frameworks and mod­
els for how patients relate to experts. It is crucial that GPs
familiar with the principles of IPE share with and support the
workforce taking on these responsibilities. The regular use of
JOURNAL OF INTERPROFESSIONAL CARE 673
triage in this way could make primary care more sustainable in
the long term.
Primary health-care professionals are working with an
altered workload, some of which may be outside their skill
sets in an atmosphere of increased fear, stress, uncertainty,
and risk. The education and support of teams through regular
daily team meetings has been important for addressing impor­
tant issues and challenges relating to patients, team members,
and patient safety. As noted by others (Thistlethwaite, 2012),
such meetings can be an ideal opportunity to utilize the prin­
ciples of IPE in a short period of time. However, caution should
be used as if organized too quickly then relevant challenges
may not have time to emerge and hence may not be adequately
addressed.
Health seeking behaviors of patients
Many patients who previously would have sought health advice
have been reluctant to seek help from health-care professionals
either because of anxiety about catching COVID-19 or concern
about unnecessarily taking up valuable professional time.
Whilst this can encourage self-responsibility and self-
management of many minor conditions, adverse outcomes
may occur if patients with significant symptoms fail to consult
at an appropriate early stage. Serious potential complications
include late presentation of cancer, sepsis, pulmonary embo­
lism, myocardial infarction, and issues with mental health; in
this context, accurate remote triage assessment of patients
presents a window of opportunity (Greenhalgh et al., 2020).
Coworker support
There is much anxiety and fear amongst GP team members at
the present time not only due to changes in professional prac­
tice but also related to concerns about the health of friends and
colleagues, and bereavement caused by the virus. Sources of
significant anxiety among health and social care staff, particu­
larly those working in residential and nursing homes, have
included inadequate personal protective equipment (PPE),
the increased risk of severe complications, and increased mor­
tality rate for Black, Asian, and Minority Ethnic groups
(BAME) (Khunti et al., 2020). Risk assessments have helped
to address some of these challenges but concerns still exist.
Practitioner anxiety, alongside reduced time for communi­
cation and reflection, has the potential to result in defensive
decisions and miscommunication. This amalgamation of fac­
tors can be a potent cause of error, potentially reducing patient
safety. Addressing anxiety and fear by facilitating resilience is
of utmost importance. This can be addressed through colla­
borative team working by building on and developing previous
work provided to support team members. For example, there is
sparsity of development around supporting teams following
patients’ death and new ways of support for one another are
needed (Anderson et al., 2019). This provides further oppor­
tunities for IPE.
Many administrative tasks have been put on hold or shared
between professionals as a result of the crisis. Examples of such
activities include data related to the Quality and Outcomes
Framework (QOF), inspection and monitoring by the Care
674 R. GRAY AND C. SANDERS
Quality Commission (CQC), professional appraisals, and grant
schemes. These are all important and well intended but involve
significant additional work each day causing stress and taking
time away from clinical practice, particularly for general prac­
titioners. This reduction in systems administration has been
welcomed: it offers the potential for post-pandemic reviews to
include the introduction of seamless interprofessional systems
accountability processes, to unburden practitioners.
Information provided is constantly changing and keeping
up to date is a challenge. This is exemplified by the experience
of professionals who are required to take time off because of ill
health (a common problem during the present pandemic). It
has been found that even over a limited period of time, such as
a two-week self-isolation period, it can be a challenge on
returning to work to catch up with the change in practices.
There is a danger of information overload from multiple
sources given the pace of change, resulting in meetings con­
sisting of information being communicated to team members
in a didactic way, which can reduce the value and opportunity
for interprofessional team learning.
Taking a wider lens and looking outwards to the commu­
nity, there are many examples of interprofessional yet frag­
mented care with immense challenges. For example, COVID-
19 outbreaks have rapidly increased within care homes and this
has necessitated increased working and communication pat­
terns between practice team members and care home staff. This
process has included regular proactive and reactive telephone
and digital contacts instead of face-to-face visits. To aid this
process, the role of the specialist nurse to manage residential
and nursing homes has been expanded, as has the independent
prescribing role of different professionals. This operational
change has been achieved within present UK legislature.
Based on general practices, many of these professionals
describe how their role has significantly changed with easier
interaction, improved approachability and communication
with GPs.
Poverty and inequality
For primary health-care teams working in areas of social
deprivation, in spite of the extra workload due to health and
social problems resulting from austerity, minimal additional
resources have been made available. Those people living in
areas of greatest deprivation in England appear to be more
likely to be exposed to COVID-19. In addition, infection super­
imposed upon existing poor health results in a greater risk of
serious complications and increased mortality (The Health
Foundation, 2020). It has recently been reported that the link
between deprivation and mortality rate from COVID-19,
adjusted for age, results in deaths in the most deprived areas
of England being more than double those in the least deprived
areas (UK Office for National Statistics, 2020). Hence, the
additional burden of this pandemic crisis has been felt most
in areas of higher deprivation but the issues of resource in these
areas of higher unmet needs still persists. This has exacerbated
the long-standing problem of the “inverse care law” (Tudor
Hart, 1971) that there is an inverse relationship between the
need for care, and its accessibility and utilization. Meanwhile,
there has been an additional problem emerging in primary care
relating to a shortage of GPs exaggerated by older GPs retiring
early and younger GPs becoming burnt out. The reduced
number of GPs along with the extra workload required in
these areas of social deprivation present a particular challenge
to all those involved in reducing health inequities and the
health divide (Marmot, 2020).
It should be emphasized that there have been significant
gaps associated with care within the community and many
have become more apparent during the pandemic. Examples
include safeguarding, domestic violence, homelessness, lone­
liness, and isolation. This situation has particularly illuminated
the gap in social care funding and the importance of including
effective collaborative working with both social care and with
an adequately funded voluntary sector. Part of the solution
appears to lie in the need for joined up working and integrated
care where solutions to problems at the meso-micro levels are
articulated, shared, and understood.
Key themes emerging from the UK primary care
experience of COVID-19
Two important and overarching themes emerge from the
experience described above: supporting one another; and new
roles and ways of working. Each of these will be discussed
further next.
Supporting one another
Health and social care professionals already working under
intense stress (The Kings Fund, 2018) are now working in
a time of high workload, uncertainty, and anxiety. These com­
pounding factors can inform an increased risk of both error
and patient safety (Neighbour, 2020). In response, the impor­
tance of facilitating resilience of and improving communica­
tion between primary health-care professionals working in
such challenging conditions cannot be overstated.
Matheson et al. (2016) described how the development of
professional resilience depends on the concept of personal
traits (for example, flexibility, tolerance assertiveness, and
being a team worker) linking with workplace features (for
example, management support, team work, and supportive
colleagues acting as workplace buffers) and social factors (for
example, friends, family and leisure activities). Barr and Gray
(2013) previously described how when doctors are faced with
the stress of problems beyond their traditional role, they take
one of three possible actions: 1) set aside their problems, 2) go
beyond their role at risk of increasing stress and overload, and
providing less than optimal care; and 3) work in partnership
with other professions to spread the load and respond more
fully to range of needs. It is suggested that these choices are
faced by all health and social care professionals, and that the
choice of working collaboratively in teams not only improves
the effective response to new emerging needs, but can reduce
stress experienced by team members. This echoes advice by
Anderson et al. (2019) who described how health-care profes­
sionals, following a patient death, can use team-based reflec­
tion to successfully address needs, to enhance emotional well-
being, and to support practice learning leading to improved
patient outcomes. Reflective practice or Balint groups have

been found to be useful in facilitating resilience and countering
the emotional toll of clinical practice and are now widely
recommended by the General Medical Council in the UK
(General Medical Council, 2020). Typically, these tended to
be uni-professional groups however Schwartz Rounds© have
also been found to be useful for team-based reflection, gener­
ally in a secondary care context (Maben et al., 2018).
In summary, our experience from primary care in the UK
has shown that resilience and support in these difficult circum­
stances requires recognition and management of personal
attributes, with the help of effective collaborative team working
and understanding from friends and family.
New roles and ways of working
Professional roles are constantly evolving, and the present pan­
demic has resulted in an acceleration of this process within
a short period of time. Many health and social care professionals
are responding to an ever-changing need by working beyond
their traditional role, not driven by professional convenience.
One example originally described by the Royal College of
General Practitioners (2013) but highly relevant today is the
development of a specialist role working with patients in nur­
sing or residential homes. Another topical example is develop­
ing the role of GPs in population health, tackling inequalities,
and building community resilience (Royal College of General
Practitioners, 2013). Expanding roles requires adequate time
and a corresponding shift in workload. For example, The Kings
Fund (2018) described how 20% of work done by GPs could be
effectively performed by nurse practitioners and how 12.5% of
work done by nurses could be performed by health-care assis­
tants. The required expansion of traditional roles in this con­
text can also be helped by the rapid development of new
primary care professionals. Examples additional to the more
traditional primary care team include physician assistants,
independent prescribers, community consultants, practice-
based paramedics, practice-based specialist nurses to manage
residential home patients and advocacy workers. Although
there is little literature in this area, anecdotal evidence suggests
that some nurses working in advanced roles are still not readily
accepted by patients or supported by more traditional organi­
zations. However, with changing needs arising from the
COVID-19 pandemic it is anticipated that such new profes­
sional roles will be accelerated and accepted, enabling each
professional to work to their full scope of practice.
It is suggested that challenging the boundaries of traditional
roles can, by expanding the skill mix, enhance patient safety,
improve accessibility and quality of patient care (The Kings
Fund, 2018). Through new ways of working, increasing care
needs in UK primary care as a result of the COVID-19 pan­
demic can be addressed through role supplementation rather
than substitution.
Implications for future working in UK primary care
COVID-19 has illuminated areas where change has been
needed for some time. It has in a few weeks expedited new
ways of working resulting in positive and sustainable change
that could otherwise have taken several years to achieve. In
JOURNAL OF INTERPROFESSIONAL CARE 675
contrast, it has also presented challenges by illuminating and
amplifying gaps in care that still need to be addressed.
Implications for future working are explored here under two
themes relating to: ways of working, and challenging systems.
Ways of working
Supporting the workforce
During the past few years, most health and social care profes­
sions in UK primary care have experienced a recruitment and
retention problem. However, during the COVID-19 pandemic,
many professionals who had previously retired or left practice
early have returned. This approach to addressing the workforce
shortage appears to have succeeded, but is not without risk
since older professionals have increased risk of severe illness
from infections such as COVID-19. The locum workforce has
largely been forgotten in the UK response to the pandemic, and
efforts to re-integrate locum practitioners into the core work­
force could also be redoubled. Sanson et al. (2016) described
how a series of factors should be put into place to retain GPs,
which are especially pertinent in the context of the COVID-19
pandemic. It is suggested that these factors are applicable to
other health and social care professions in UK primary care
and include: modifying the workload to make it more manage­
able; managing change effectively; paying attention to the
health of professionals; improving confidence in the future of
each professional role; and, improving morale.
Remote consultations and communication
An example of future working is the increased use of technol­
ogy for communication. Although this use of technology
including telephone, video for one-to-one communication
and group discussions, on-line consultations, and the use of
social media has been available to professionals for some time,
aside from telephone consultations, there has been little evi­
dence, until this pandemic, of widespread use. Values-based
practice theory as described by Fulford et al. (2012) addresses
ways of working with complex and conflicting values in health­
care, and can explain how advances and rapid changes in
technology can result in a diversity of options for both health-
care professionals and patients. These new options are closely
associated with values and evidence. To be acceptable to all
concerned, an effective and balanced approach should be
adopted for new technologies that address concerns by
acknowledging and working with patients’ values.
When patients are given the option, remote consultations
can improve accessibility, reduce consultation length, and tend
to be associated with high satisfaction amongst patients and
staff (Greenhalgh et al., 2020; The Kings Fund, 2018). In UK
primary care existing remote consultation technology has been
rapidly adopted to enable two-way flow of information
between patients and primary care teams. Examples of this in
use include sending photographs (for example of rashes) from
patients to assist in diagnosis; sick notes and other documenta­
tion requested, such as letters, have also been sent electroni­
cally to patients where previously they would have been picked
up in person or posted. Although the option of remote con­
sultation can be helpful to some, it can be difficult for margin­
alized groups in society and so, following values-based practice,
676 R. GRAY AND C. SANDERS
inclusion must be prioritized and more traditional means of
consulting must remain available when needed. Further analy­
sis of impact is required after these rapid changes, to elucidate
potential risks to patient safety, impact on collaborative work­
ing, and potential breaches in data protection.
Regular team meetings
A practice that flourished during the pandemic and will likely
continue to do so is the use of regular team meetings in
primary care. These meetings have been essential for providing
support, setting common goals, reflecting on performance, and
effective team functioning. Lack of such meetings has been
reported as reducing job satisfaction, increasing burnout and
workload endangering patient safety (Thistlethwaite, 2012).
However, up until now, there has been limited time found in
some UK general practices to reflect and communicate with
other professionals. One of the authors’ experience showed
that finding protected time for daily interprofessional team
meetings during the present crisis has been possible, essential,
and worthwhile. These team meetings, that require effective
facilitation and skilled leadership, can provide a forum for
a number of functions especially important during the current
pandemic, including good communication about planning
work, informal handoffs, and debriefing (The Kings Fund,
2018), team support (Anderson et al., 2019) and addressing
moral injury and distress (Greenberg et al., 2020). Remote
attendance to such meetings enables the involvement of team
members otherwise geographically isolated, though poses
a challenge to ensure equity of involvement in team learning.
Integrated care
Integrated care in the UK is developing as a way of working
that aims to improve the coordination of care of patients and
service users across traditional organizational boundaries and
settings (Coughlan et al., 2020). Lindqvist et al. (2017) defined
it as “Care provided by multiple health and social care workers
from different professional backgrounds who collaborate inter­
professionally across settings in a way that has optimal out­
comes for each person in need of care and for those who
provide it.” Current UK policy aims to achieve full integration
of health and social care with services delivering a person-
centered whole system approach to care across sector bound­
aries. The priority is to integrate health and social care, but
many other care pathways are applicable, such as mental health
and safeguarding that span other sectors involving police and
voluntary sectors. To meet with UK policy, primary health care
will be expected to lead and engage in the development of
community-based integrated care services by 2022 (Royal
College of General Practitioners, 2013; The Kings Fund,
2018). However, there is little evidence that this is effectively
occurring nationally at the present time. Hierarchical struc­
tures, perverse financial incentives, outdated expectations of
roles, and inappropriate styles of leadership have all contrib­
uted as stressful barriers to the development of integrated care
(Brennan, 2019, Coughlan et al., 2020).
The COVID-19 pandemic has illustrated and amplified gaps
in previous integrated care pathways for a range of patients
such as those in care homes, those with dementia, homeless
people, victims of domestic abuse, and those with substance
misuse problems. Previous factors contributing to these gaps
have included a lack of staff, reduced financial resources, and
poor collaborative working between health and social care.
Primary health care has a role in taking on and leading
extended care in these and other areas whilst tackling popula­
tion health inequalities, building community resilience and
service redesign (Royal College of General Practitioners,
2013). The development of integrated care pathways requires
interprofessional relationships with capabilities such as respect
for difference, communication with other professionals, and
the ability to negotiate collaborative person-centered care. The
inclusion of IPE, particularly in the preparation and support of
professionals involved in the integrated care of vulnerable
groups, can help address the interprofessional challenges that
integrated care engenders. This in turn enables the profes­
sionals to work more effectively together in delivering effective
integrated care whilst maintaining momentum, and staff and
service user involvement (Clouder et al., 2017; Coughlan et al.,
2020).
Challenging systems
The current changes in UK primary care practice also provide
an opportunity for primary care teams to re-imagine the way
care is provided. The recent increase in inspection, regulation,
and incentives for outcomes such as the Quality and Outcomes
Framework (QOF) has had a number of consequences, both
intended and unintended. Improvements in accountability and
quality measures selected have undoubtedly been made as
exemplified by the identification and monitoring of chronic
conditions such as hypertension, but there have been questions
raised around the longer-term benefits of this approach with
unintended consequences including overtreatment (Sheppard
et al., 2018). Important elements of care, valued by profes­
sionals and patients alike, can be eroded by these approaches,
such as continuity and person-centered care (Derksen et al.,
2020).
The COVID-19 pandemic offers an opportunity to pause
and reflect on this approach, which could result in more time
for compassionate, holistic, and team-based care. Greater col­
laborative working could give rise to an increase in the pre­
sence and attention that care deserves, with anachronisms such
as the 10-minute consultation reshaped into appointments of
the length of time that the patient needs. For this to be achieved
collaborative leadership is needed alongside a sustainable
workforce to meet the needs of the population. Dealing with
the COVID-19 pandemic crisis has already shown that this is
essential. Indeed, looking after the health workforce has per­
haps never been as important as now.
A model based on the authors’ experience, summarizing
the response to COVID-19 in UK primary care and its impli­
cations is suggested in Figure 1. The main implications for
future working can be grouped under four themes: integrated
care, team meetings, remote consultations and communica­
tion, and supporting the workforce. These themes are all
interrelated and inform one another as indicated by the two-
way arrows. Organizational changes as a result of the pan­
demic will impact both on the development of the workforce
and integrated care. These require effective interprofessional
 JOURNAL OF INTERPROFESSIONAL CARE 677

Supporting the
workforce
Integrated care
Organisational change

Collaborative leadership Collaborative working

Interprofessional team Person centred care

working IPE
Resilience

New ways of working,

Remote consultation Change in nature of work

and communication Team meetings

Figure 1. The response to COVID-19 in primary care and implications.

collaborative working informing holistic person-centered care Conclusions

whilst facilitating resilience of professionals. In order to sus­
The COVID-19 pandemic posed a national and international chal­
tain support for such organizational change, endorsement for
lenge to the health and social care workforce that before the pan­
this process is required by senior-level management, under­
demic was already working under immense strain. To cope with this
scored by inter-institutional agreements (Barr and Low,
crisis, in many countries, new ways of working and interprofessional
2013). Regular Team meetings can provide a helpful forum
collaborative practices have evolved in a very short space of time. In
for communication and support in the context of change and
UK primary care, the pace of change has been extraordinary and
new ways of working such as for the use of remote consulta­
general practice teams have been required to upskill using new
tions and communication. However, to facilitate such change
technology and ways of working to enable accurate remote assess­
in the workforce requires collaborative leadership and effec­
ment and management of patient needs. Professionals within the
tive interprofessional team working with organizational and
teams have been triaging and sharing incoming work in a way that
administrative support.
the traditional system of general practice was not designed to facil­
An example from UK primary care practice experienced by
itate. Although not a panacea for addressing all the needs of the
one the authors can be used to illustrate this process. The role
population and associated workload, recent changes engendered by
of the practice-based specialist nurse with advanced clinical
the COVID-19 pandemic can be extrapolated both within and
skills (including prescribing) in caring for patients in residen­
beyond the UK, to enable primary care to become more sustainable
tial home settings has been developing in the UK over the past
and for its benefits to be fully realized. The authors assert that further
few years. Such practitioners have now become an integral
integration of IPE into primary care is required for this to happen
member of many UK primary health-care teams. However,
effectively and sustainably.
during the COVID-19 pandemic patient needs and require­
ments in these homes significantly changed. To protect hospi­
tal bed occupancy, many older patients not tested for COVID-
Acknowledgments
19 were discharged from hospital to residential homes, signifi­
cantly increasing both the incidence of, and mortality rate The authors wish to acknowledge and thank Professor Liz Anderson for
from, COVID-19 in these settings. To address this crisis, the advice in the preparation of this discussion paper.
role of the specialist nurse rapidly expanded within the orga­
nization to include the management of both the palliative care
and the deaths of increasing numbers of patients with COVID- Notes on contributors
19. This was achieved via remote consultation and communi­ Dr Richard Gray, Honorary Fellow and Immediate Past Chair of The
cation from the practice base and necessitated interprofessional Centre for The Advancement of Interprofessional Education (CAIPE);
collaborative working with professionals across health and Past President of the General Practice with Primary Healthcare Section of
social care sectors with the purpose of providing person- the Royal Society of Medicine; General Practitioner in Brighton, UK
(1978- 2010).
centered care. This shift in role required new skills as well as
developing professional resilience, which the practice was able Dr Chris Sanders, The Centre for the Advancement of Interprofessional
to support. During practice team meetings to address uncer­ Education (CAIPE) board member; General Practitioner partner in
Leicester and educator at the University of Leicester. He has a keen
tainties, open discussions were facilitated and interprofessional interest in interprofessional education, holistic healthcare and sustainable
team learning encouraged through the use of shared living.
experiences.
678 R. GRAY AND C. SANDERS
Declaration of interest
The authors report no conflicts of interest. The authors alone are respon­
sible for the content and writing of this article.
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