Chapter 3: The direct impact of COVID-19 in Gateshead

Covid-19 presented challenges of unprecedented proportions to health and social care services. Services had to transform overnight, with staff asked to take on different roles, and facing intense levels of pressure and uncertainty, whilst trying to maintain non-Covid related essential services. In the early stages, there was a shortage of personal protective equipment (PPE). 

Writing as a GP who has worked in Gateshead for 34 years, in practice at Rowlands Gill until 2014 and latterly in Urgent and Unscheduled Care, which includes in and out of hours care, I have been part of our local primary care response to the Covid pandemic. This was a new disease with an uncertain means of transmission and a wide range of presentations.

It made some people a bit unwell but made others very ill, very quickly. Across the country many people were dying. Everybody, patients and staff alike, was frightened.

'Hot Hubs'

Because of the risk of infection with Covid, Gateshead's GP practices could not provide safe care at their surgeries and so, as a response to the need to see, assess and treat patients who could have Covid, dedicated 'hubs' were established, one at Blaydon GP Surgery based in the Blaydon Leisure Centre and another at Second Street Surgery in central Gateshead.

Establishing these two hubs required the coordinated efforts of staff from CBC Health (Gateshead's Urgent and Unscheduled Care provider), Gateshead's GP community, Gateshead's Community Nursing Teams and Gateshead Council staff.

Patients were referred to appointments at these two centres where GPs from across the borough volunteered to provide the care needed, supported by nursing and administrative staff who also volunteered to support these hubs.

'Hot Home Visiting'

Provision of care to patients, who were unable to travel to the 'hot hubs', was also arranged with the development of a 'hot' home visiting service. The home visiting service was based at Bensham Hospital with GPs working alongside the staff of the community nursing Rapid Response Team. Patients requiring assessment at home would be referred to the 'hot' service and seen by a member of the GP team.

North East Ambulance Service provided the vehicles and the drivers necessary to support the visiting clinicians and these drivers were integral in ensuring the safety of the clinicians.

New skills and patterns of working were developed. 'Donning' (putting on PPE) and 'doffing' (taking off PPE) at the back of a car, sometimes in the sunshine but also when it was windy or raining, took a degree of teamwork to ensure that infection risk was minimised. Running water to wash hands after patient contacts came from a water bottle. Gateshead's response from primary care has been an example of coordinated and supportive teamworking.
Alexander Liddle, GP, CBC Health Gateshead 

At the beginning of the pandemic, staff working in primary care were as shocked as anyone and trying to process what was happening.

Some patients were scared to come into the practice, some staff were worried about coming to work as at that point we didn't fully know or understand the risks and people were terrified.

We had to review and rewrite all of our infection control policies to protect staff and patients in the practices and plan new ways of working.

NHS England recommended the use of remote consultations to maintain safe service delivery and protect our patients and staff so overnight we had to implement and adapt to a new way of working, which was tough as our GPs like to see patients face to face, but suddenly we had to use remote consultation methods like telephone and video. Some of the patients really like this now though.

At the beginning of the pandemic when we were setting up the 'hot' site, we struggled to get PPE. On one occasion we were sent out of date masks. Staff didn't feel that paper masks were adequate, so we had to buy our own PPE. We had lovely support from the community who rallied round to help. A local garage provided disposable seat covers for GPs going into people's home, a group made scrubs for us and bags to wash them in. They shouldn't have needed to, and we should have been able to access the PPE we needed.
Teresa Graham, Business Partner and Practice Manager, Second Street Surgery, Oxford Terrace and Rawling Road Medical Group & CBC Health GP Federation. 

During the pandemic, there has been immense pressure trying to deliver to a high level of service to our patients to the best of our capability.

When GPs had to stop most face-to face appointments, at the beginning of the pandemic, we had more people coming to us for community pharmacist advice - some of those needed referrals back to GPs. We were seeing more people but only allowed two people in the shop at a time and we had to deal with all of the day-to-day running and also various changes occurring with Covid protocols.

Our working hours changed from 45 hours a week to about 70 hours a week. Even after the shop closed, we were still providing home prescription deliveries. Our prescription home delivery service increased by about 100%.

We always advised people with Covid-19 symptoms not to come into the pharmacy, but some still did. That was scary. Some community pharmacists, as with other frontline NHS staff, caught Covid from their interactions with patients and many have lost their lives trying to help others. 
Community Pharmacist 

At the Queen Elizabeth Hospital in Gateshead, we have a state of the art laboratory with cutting edge diagnostic and screening technology. Our team of highly trained, dedicated biomedical scientists and support staff provide a 24-hours a day seven days a week testing service. During the Covid-19 pandemic, our laboratory team has used their expertise to set up a Covid-19 testing laboratory that can process thousands of samples a week.

Our laboratory is part of a dynamic network of NHS laboratories that works across the North East and Cumbria to ensure all patients in our region have access to the testing they need.

As a member of the infection team, I have been involved with all aspects of managing Covid-19 in the hospital. Patients who have been to the hospital during the pandemic will have noticed many changes. There are dedicated areas for assessing and treating patients with Covid-19. We have been involved in the latest research trials; bringing in specialist treatments as they are available. We have set up a staff and patient Covid-19 testing service which has allowed us to keep areas of the hospital Covid-19 free and protect the vital services we provide to our patients.

The safety of our patients in the hospital and community is of the highest importance to us. Our infection prevention and control team have worked collaboratively with our community partners and all clinical teams in the hospital to make sure our patients are protected from Covid-19 whilst they are receiving care with us.

At the Gateshead Health NHS Foundation Trust, we have dedicated, expert, caring staff who work with and for the people of Gateshead. Covid-19 has presented us with many challenges, I am proud to be part of a team that has worked so hard throughout the pandemic to look after our patients.
Dr Alice Wort, Consultant Microbiologist, Gateshead Health NHS Foundation Trust.  

One of the scariest things is that I don't know where I caught Covid - but I know it was during a fortnight's annual leave from work. I was terrified when I was taken to hospital - but even in my moments of horror, people went above and beyond to make me feel comfortable.

My paramedic, James, put on the music I like, Nirvana and Red-Hot Chili Peppers, to make me more comfortable. And through A&E I was treated like a VIP, I'll never forget it. My experience was utterly flawless. Ward 1 staff were amazing. I went there during the night, but every single member of staff introduced themselves to me, which has massive value. I felt like an individual, not just a patient, and that people genuinely cared for me. They were so professional and fastidious with their hygiene and PPE. Even the food was smashing - the catering was always fabulous, and I looked forward to mealtimes!

Thank you from the bottom of my heart - you all have my sincere gratitude.
Cheryl Gascoigne, patient, Gateshead Health NHS Foundation Trust 

Pre-Covid we would look after people who had extensive surgery. They came in critically ill from various diseases and we had a routine, we would be able to come in, assess the situation and carry out the care of those patients who were critically ill, very ill indeed, but we would manage that and hopefully see most of those recover.

During the pandemic, we're seeing patients come into the department who have been extremely ill, and we're used to seeing patients who are extremely ill, but these are on a different level. We found we were having to cope with patients who would have to be positioned prone (carefully putting a patient into the prone position flat on their front and face down, rather than on their back, to try and help them breathe more easily) often, regularly. We would have deaths in terrible circumstances, relatives weren't allowed to be there and we, as the nursing staff for Covid and non-Covid patients, had to deal with the demise of a patient ourselves. I often put a phone to a person's ear when they were passing away, so that their close relatives could say their goodbyes.

So I'd leave shift on a number of occasions - well most of the time - upset, stressed and exhausted. My resilience now has diminished massively. I would be able to leave my work at work, be able to put it outside my car door to go home. But now I can't. I bring things home with me and have to click into a different mode and I struggle to do that. But I think as things start to ease, I'm hoping to do that. 
Aurial Reay, Critical Care Sister, Gateshead 

When the pandemic occurred, we worked closely with public health colleagues and the Infection, Prevention and Control (IPC) Team at the Queen Elizabeth Hospital, as part of our community services response. These well-established relationships ensured an integrated, seamless and consistent approach to care home, domiciliary care, promoting independence centres, community and acute hospital services and primary care in terms of infection prevention and control across Gateshead.

We implemented a number of changes with the IPC Team, including:

• extending their access to seven days a week for advice and support
• undertaking planned site visits to any care home or facility or provider that needed it across Gateshead
• carrying out environmental assessments to manage outbreaks or giving advice on prevention
• leading and delivering 'donning' and 'doffing' training (putting on and taking off personal protective equipment (PPE)) for all staff in both acute, community, care homes, and private providers and lay carers if required
• working collectively with community nursing teams to provide targeted interventional prevention into care homes that were either in outbreak or had come out of outbreak and needed to maintain Covid free sites
• supporting the national mandate to train every staff member in care homes across Gateshead in IPC, handwashing, PPE and management of Covid and in total trained over 2400 staff in just over two weeks
• working with community services and the Council's Public Health Team to deliver the swabbing (lateral flow) directive for patients and staff, again training, supporting and advising. This was on top of supporting the acute hospital with their Covid response and their other elements of work including pressure damage management and support, and other IPC advice still necessary but not related to Covid-19.

Nicola Allen, Chief Executive, CBC Health Ltd.