So can you just start by saying your name and what your current position is?
Yes, I'm Helen Salisbury. I'm a GP and I'm senior partner at Observatory Medical Practice in Oxford.
And you have some academic affiliation as well? Yes, I am an honorary senior clinical lecturer in.
No, that's not my title anymore. Sorry. They keep changing my title.
I think I'm Senior Medical Education fellow in Department of Primary Care in Oxford University.
Okay, that's great. And without going into it in enormous detail,
can you just tell me how you first became interested in medicine and give me the sort of main staging point, the main staging points?
My first degree was in philosophy and psychology.
Back to the p p to going up physiology.
I did PPE as well, accepted physiology, and then halfway through that I thought, Oh no,
I need to be doing something useful, but was persuaded to finish my degree, which was a good thing.
And then I went from that degree here to the London East London to to a medical degree.
And I stayed in London doing an early junior doctor job for another couple of years after that,
and then moved back to Oxford to do neurology, which was going to be my career.
So I did some neurology and some neurosurgery intending to become a neurologist.
But then I had babies and like so many other women, decided I didn't want to compete in that world anymore.
And I saw I stepped into general practice where I discovered I was no longer a round peg in a square hole,
but around Peg in a very snugly fitting round hole.
And I've been in dental practice ever since. So how long is that? So I have been in general practice since I think 2001.
And in my the practice where I am since 2002.
And I'm just picking up on one thing because you did a philosophy in psychology, did that imply that you did Arts A-levels?
I did chemistry, biology and French.
Oh, All right. So you did have some science. I had my sciences already.
Yes. So I guess maybe it was at the back of my mind. I think I thought you had to have a vocation to do medicine.
And unlike my sister, who definitely knew she wanted to be a doctor.
Right. From, you know, almost as soon as she could talk.
I came to it late as a kind of well, it looked better than the other options,
but it was that sense that it was a it was something that would make a difference, that would.
Absolutely. And I think I decided I had to do it when I got to the stage in one's university career, when everyone's looking for a job.
And I realised I definitely didn't want to work in the private sector and I wasn't quite
sure I really wanted to be a social worker or a teacher or even a clinical psychologist.
So medicine called. Mm hmm. And as far as the academic side of medicine is concerned, you've been involved in teaching?
Yes. Of medicine. What? What has been your area of specialism?
So I started teaching really quite early on in my medical career in about 97,
when I started teaching on the communication skills course for the medical students in Oxford.
And actually that's been my main home academically in that I carried on teaching and then ran that course between 2006 and 2018.
So it sounds really silly. QUESTION But why are communication skills important for doctors here and is it forgotten sometimes?
It's interesting. When I started teaching it, it was a very,
very new subject and I think there was a kind of assumption that quite a lot of doctors had a good bedside manner,
quite a lot doctors didn't, and there wasn't very much you could do about it.
And gradually, I think that idea has changed that some people are naturally very good at it,
but some other people can definitely get better with coaching, with teaching, with practice.
And actually as a patient, it's really, really good.
If when the doctor has to tell you something really difficult, they've had a go, they've practised with actors beforehand,
they've kind of got over their nerves and worked out what not to say before they have to do it for real where it really matters.
So how did you get into that field, particularly? How did I get into that field?
A friend of mine who was a general practitioner who was employed to teach on this course, said.
Would you like to come and help? So I did. And I'm afraid that's quite a lot how things happen.
Yes, it's slightly more formal these days in that people apply to work in that role.
And it's it's much bigger than it was. But there is a kind of assumption that general practitioners will lead on this, and to a large extent they do.
But it's really not just the preserve GP's, it's all doctors need to be able to to do this.
It still seems to be that most of the teaching on it. And you mentioned actors, so what what actually is involved in training?
Oh, right. So the mainstay of teaching not in every institution, but certainly here in Oxford is that the the students, it's very experiential.
So the students get a chance to have various conversations with an actor who's playing a patient.
So we have a range of actors. We have small group teaching with about six or seven students in a group and a tutor and an actor.
And the actor will take the role of the patient.
And it may be that we're going through how you take a sexual history and ask questions sensitively,
or how you work with a patient who's very angry, or how do you tell someone that they've got terminal cancer?
All of these are quite difficult conversations to have.
So we create some scenarios and the students have a go playing the doctor role and they then have feedback
from the actor and they have feedback from their classmates watching them and from the from the tutor.
And we kind of try and learn together what things on the whole work, what doesn't work.
Quite often I'm one of my roles in that is trying to help the student be less nervous and we're less of a of a behavioural
white coat and just let themselves be themselves because that works well with patients and honest communication.
And are you involved in training the actors as well? Yes, very much. Very much so.
So we mostly I mean I've, I'm talking past tense really, because I'm not doing that work anymore.
Roman But a lot of it is about training the actors to both do the teaching, but also do the examining because they're involved in exams as well,
and they need to kind of understand the medical basis,
but also ideally understand what the main teaching points we're trying to get across are so that they can reinforce those.
We have some we have some fabulous actors. We do a great session. I'm working with interpreters, with with a couple speaking.
I think they're speaking Bengali, which is really, really helpful for the student just to learn that it's quite a basic skill that you need.
I could talk about teaching communication skills for hours. We're not making them.
I'm just establishing the background. Yeah. And in terms of your own communication, I mean, you've been you're very active on Twitter at the moment.
When did that start? Oh, I got active on Twitter in about 2015, which was just preparatory to standing for Parliament.
Yes, I was going to come to that. And so that was when I got engaged on on Twitter, because I stood for very,
very small political party called the National Health Action Party really very much about trying to prevent the privatisation of the NHS,
trying to improve funding and equality in the in the NHS.
And I do always been politically active. It was no it was very much access and beginning somebody sent an email said, would you consider it?
And I thought, yes, okay. And I think I'd not been politically active before, although I'm very much of the left.
There were always things that stopped me actually joining a party and aligning myself fully with the stated aims of that party.
Whereas when I did join, I was very much involved with shaping its day to day.
So that was much easier. And you also have a regular column on general practice.
Yes. So when did that start? Yes.
So in 2018, I started writing for the British Medical Journal.
So I have a comment column every week in the Journal, which also goes online.
And that was the point at which I stopped being the the lead for the communication skills, but I felt I couldn't do both.
Yeah. So I actually I write a weekly column for that.
I also write weekly for a women's magazine. Which one?
I answered readers questions in Take a Break magazine, which is really,
really interesting because it's a people writing with their questions, which are usually edited down to, you know, a sentence or so.
And then I have to reply accurately, having looked at what evidence there is empathetically in fairly easy read English,
because it's not a very high Reading Age magazine and in a way that both answers the reader's question but will be interesting to a wider audience,
usually within about three sentences. So I answer four questions a week, which is an interesting little challenge.
And I have to say it's great for my continuing medical education because I learn all sorts of things I didn't know.
Mm hmm. I discovered recently that the question about using bleach to remove black mould.
Oh, wonderful. Well, I discovered that it only works is only really effective on hard surfaces because it doesn't penetrate.
So it's no good on paintwork or brickwork. It's only good for tiles and glass and things like that.
And actually, you need backup of soda or borax or vinegar for those things.
I learned a lot and it also gave me an insight into the readership of that journal.
So, I mean, clearly, you you have a voice and you enjoy using it.
Yes, it is. I thought, what going to make?
I mean, particularly through your your columns. Do you see yourself as representing general practice?
It's very interesting because I'm.
I'm trying to speak for general practice.
I'm very aware that my own little cone of general practice is quite privileged compared to many places.
We at the moment have enough doctors, which is rare.
We have on the whole, it's not uniform, but we have an educated patient population who are relatively good looking after themselves.
There are obviously exceptions and sometimes that can be quite demanding.
But but it's, you know, it's quite different than if I worked even five miles away the other side of the city where we're which is much more deprived,
much less health literate.
So so that the demands are very much higher. So so there's a there's a sense in which I know I can't speak for the whole of general practice.
I find Twitter is actually really useful from that sense because I get a GP reaction to quite a lot of what's going on.
So I think I don't often speak out of tune with most other GP's,
but I know I'm not necessarily representing them and I don't come from a representative practice.
Okay, let's get to COVID. Yes. Do you remember I'm asking everybody this.
Do you remember when you first heard about an outbreak of severe flu going on in flu going on in Wuhan,
and how you came to realise that it might be something that was going to affect everybody?
Yes, I probably can't put a date to it,
but it was certainly January of 2020 because it was on Twitter and that's where most of us were getting our news and knew.
So it was in Wuhan and then it was in Iran and then it was in Italy.
And it was kind of what it obviously said in minutes before it's going to be here, probably is here already.
And this kind of just why aren't we doing anything real sense of impending doom?
Because it was very clear that lots of people were very ill and it was bound to be here in no time.
And then I remember about it must have been about ten days before the first lockdown was was imposed.
I remember being at a a meeting of what was then the clinical commissioning group.
So GP from each of the different practices in the city were together and we clustered together and we were all
having conversations about what we'd already done and everybody by that stage had already shut their front doors,
had already put notices up, had already turned in minutes over to telephone triage for all appointments.
You know, you can only get in if you buzz the buzzer and you have an appointment.
Yeah, we had we locked down quite a long time before the official lockdown because we could see what was happening.
But you were at this meeting all together in a room. We were together in a room?
Absolutely. Absolutely. Which is interesting in itself, isn't it, that we didn't decide not to go through before anyone had mentioned masks?
There were no masks at that point.
We were all in this room, but we'd all suddenly thought up our page because I think at that stage we had no idea about asymptomatic transmission.
Okay, so this was all about not wanting or not feeling safe to see face to face people with symptoms of this.
And what we knew from what we told so far was that these people were really ill.
They had horrible symptoms of hacking, cough and high fever,
and we really didn't want to walk into our surgeries and spread it to all our staff and other patients.
We didn't yet know that there was that possibility of catching it from before this,
before the symptoms really started, or that people could be asymptomatic infected.
That was that was yet to come. And you're so you are you are in a practice with a number of partners.
Yes. And in fact, in a health centre with a couple of other practices as well.
How did you I mean, apart from shutting the door and having people phone up for appointments, did was it all your decision as a group,
what you were going, how you were going to respond, or was there instruction from the Department of Health about what you should all be doing?
I think by the time any instructions that come with already done all of those things,
we were well ahead of any of the instructions because they were they they were two slides.
So we in our in our building practice, just two practices us and one other.
And yes, we, we had dialogue with them all the time about what we should do with our building.
But it wasn't, it wasn't particularly controversial that we should go to a to a buzzer system and go to complete telephone trail.
But you were still seeing the patients. We never stop. We never stop.
We never stop saying things in patients.
But we were through the first few months of COVID, we were very quiet because people stopped wanting to come to see us.
And that in itself caused a whole load of problems of all the that we know about,
of all the the missed cancer diagnoses and the the sort of long care for long term conditions like diabetes,
like high blood pressure, all that, the stuff that we routinely do,
a lot of that didn't happen because people stayed away and it was kind of let's put everything on hold and just deal with immediate emergency.
And I will talk about more about communication in a minute.
But did you get involved in any initiatives such as drug trials or other COVID related research projects?
So, no, we didn't.
And I slightly regret that I personally with him on the vaccine trials, which was great,
but we didn't we weren't in the end enrolled in any of the panoramic or the other trials that were going on.
Not for the principal. Yeah, yeah, yeah. So there were there were there were several trials going on, but but, but we weren't, which I'm,
I'm sorry about really in retrospect, but we haven't really got into the, the, the, the habit of doing clinical trials.
So from a communication point of view,
what did you see as the messages that needed to be got out there and either to support or or to contest what was coming out from official sources?
Goodness me. That's interesting.
I think the it's difficult thinking all the way back to.
There were some missteps in terms of the definitions of what symptoms might might define COVID.
It took a very long time for it to change from this persistent dry cough, high fever travel to Wuhan province.
Thing, which is kind of well, actually, no, that really doesn't sum it up.
And for quite a long time when the Tim Spectres Group was collecting all that information in London,
we actually knew quite a lot about what the other symptoms of COVID might be.
I didn't get out to the to that to the public. So that was a bit of a communication disaster.
I think that the other communication disasters really came from it's hard to think back, isn't it?
But those central government. Set piece press and a compressed press conference press conferences where it was clear that.
Those in charge didn't really have a grip about what was going on and what might be done and the kind of I mean,
the whole initial we're going to go for herd immunity thing was just completely baffling because if you were following the data at all,
there was this kind of worldometer thing, that site you could go our world in data.
We could see what cases have been recorded in each country and how many people were dying.
And basically there was a 1% mortality rate before we had vaccines.
That was how many people were dying. One in 100 people who got this illness were dying.
And somehow there were people standing up on the front foot and saying, It's fine.
We just need to control the rate. I'm thinking, well, how fast or slowly you do it.
That still means, you know, 600,000 people more die.
That's not acceptable. But, you know, that won't work.
And it didn't seem to me that you needed any really, really sophisticated mathematical modelling to show that this was nonsense.
And or rather, the idea that if you're really, really cynical, saying, okay, we really don't mind killing off 600,000 of our most vulnerable people,
but yeah, that's not what they meant and not what they intended, then clearly the whole herd immunity thing was was nonsense.
But it set off a kind of that the whole tone initially was it's really not that bad.
It's fine. I've I've spoken to lots of people with COVID and I've shaken hands with them and it's it's it's it's all okay, which was very, very silly.
And I think that the government remained, it appears, quite lukewarm all the way through about the the restrictions that were necessary,
always restrictive, talked about restrictions are not protections, always keen to get away from as fast as we possibly can.
And. The tone in which it was always delivered was about these horrible lockdowns and restrictions that we will get rid of as fast as we can.
Rather than our obligation to each other to protect each other,
the things that we need to do to protect our most vulnerable and our duty towards each other,
that could have been very much more civic responsibility,
social responsibility, tone to the whole thing,
which might have meant that people chose to stay work when they were ill or wear
masks or all those other things that would have probably meant fewer people died.
And we didn't do that. There's lots of other things that could have been done that might have resulted in fewer people dying.
I mean, there's the whole infrastructure, and I'd like to come back to that in a minute.
But also the fact that if you were ill for an awful lot of people, it was very, very difficult to take sick leave.
You had to prove that you had COVID, you had to give you you might take some sick leave, then you had to go back straight away.
You weren't necessarily compensated when you were off.
You know, if your symptoms are only mild that that the the the financial pressures on lots of people were to continue going to work.
And that's continued through.
And we had lateral flow testing at the time and we had no testing and we had no idea that the testing from my from my space as a GP,
the testing thing was incredibly frustrating because for most notifiable diseases, so things that the the NHS public health want to know about.
I see a patient who I talked on the phone, whatever it might be. I think you've probably got X, we ought to do a test.
You do a test and the result comes back and it goes to what was public health England, I guess.
UK Health Security Agency. Yeah. And they take it from there and then it gets notified and,
and somebody else usually then takes over contact tracing or if it's something highly infectious.
But we threw away that model completely, which has worked for ages.
I decided that GP shouldn't have any access to testing and didn't involve either.
The NHS labs to a large extent, didn't involve the people in public health and in sexual health.
Who were the experts in contact tracing and how you deal with infectious diseases.
They ignored all those people and all that expertise completely, it appears, and decided to give contracts to Deloittes or Deloittes.
Did lots of testing, didn't they? And then people who really didn't know what they were doing and that and new labs,
which was set up, some of which had very dangerous failures like the Mensa ones.
And it was it was a nonsense. It was a complete nonsense.
And I had an I was having patients bringing me up, being unwell.
And the only way they could get a test was by driving to Heathrow or something really quite a long distance to go.
And if didn't have their own private transport, there was no way they'd get a test.
And also when tests were really difficult to get hold of.
A really short supply.
It might have been sensible to have some bit of medical triage about who had a test rather than just who could get on site quickest,
who had the best tag, fastest fingers, got the got the test, which was also nonsense.
I mean, the way that people who had any expertise were cut out of the pandemic in its early stages was bizarre,
really quite difficult to understand why that happened. So in in primary care and GP land, some brave souls went and volunteered at hot tubs.
So where patients who we thought might have COVID went to be examined, they still get swabbed, stayed and have the swabs either.
But if they're really real, they got sent to hospital where if they were admitted, they got swabbed.
But if they weren't admitted, they still didn't get swabbed.
But those of us who were in left our surgeries were still seeing telephone patients with all sorts of other medical problems,
sometimes talking to patients who might have COVID and directing them to the hot tubs.
But we were actually underemployed for a while.
Meanwhile, patients who rang one on one and they were told to ring one on one with symptoms went through a whole system with 111 with
lots of really undertrained new recruits who didn't know what they were doing and were given a algorithm to run through,
which probably had mistakes in it because we just didn't know very much about COVID.
There was lots we didn't know and. I think if.
The GP workforce had been more involved rather than diverting it to one woman.
They were probably having fewer deaths. I think there were lots we didn't know there was this the kind of the recognition of hypoxia
in COVID and particularly people who had very low oxygen levels but didn't feel breathless,
was really unfamiliar to most, most medics.
And it took a little while for us to get used to that.
But probably we could have done with with putting more of the experienced doctors we had into that triage role,
into that 111 role, rather than handing it to poor people who really didn't know what they would.
I mean, how could they know what they were doing than very little training? So that was a that was one of the things that went, I think, badly wrong.
So that's that was an infrastructure issue. That was an infrastructure issue.
So the the the testing both the the kind of distribution of tests.
There probably wasn't a need to have these two big testing centres,
but they could have also been given to GP's to hand out to people that they thought needed them.
That might be better and easier distribution of tests to patients.
The the labs. Why did you know the the the test the tracing bit of test and trace which didn't
involve the people who knew how to do this and you kind of and it was very,
very badly done and and you think that actually there was quite a lot of expertise to draw on, which doesn't seem to have been used.
And I don't know how much of that eye watering 35 billion eventually got spent in that in that test and trace endeavour.
But quite a lot of it just didn't work. Certainly the tracing didn't work and we didn't manage to keep a lid on COVID.
It's difficult looking back because it's such a long time now.
But there was a time after the initial peak when we'd had lots of lockdown and
loads of school missed and work missed and everyone's life in complete disarray,
which was horrible. But then we opened up again and in a grand fell swoop, Freedom Day.
Freedom Day. And had we had at that point an effective test and trace an effective system, effective supported isolation for people who had COVID,
then perhaps we could have put out the fires rather than just let them flare up.
And and and there there was this bit and the years merged into one.
But I think it was at the end of that first summer when.
Kids were going to go back to school and we all said, whoa, this is going to be this is going to be superspreading event time.
So any kids who got COVID, then the whole school's going to get. We really, really need to do something.
And. There was a kind of myth. It's not.
Children don't get it. Children aren't ill with it. Children don't pass it to anyone else.
All of which was complete rubbish. I mean, lucky children mostly aren't really sick, but a few are.
And some get long COVID. So it's not harmless to children. And it's certainly not harmless to the families that took it back to.
And so then we had inevitably that huge rise in September and the failure to do anything right away until we got.
And then we have all those there's weird regional lockdowns with different things.
And nobody knew what the rules were, just nonsense until we got to we're going to save Christmas.
Christmas is going to be fine. No, it's not going to be fine. Oh, no, it's not going to be just again.
Almost at every stage. Did you hear a government announcement and you kind of hit the floor and said, Oh my God, that is not sensible.
But you weren't just hitting your forehead. You were writing it. I was writing in the BMJ.
Yes. Twitter. And what did you discover? I mean, there's a there's a community.
I think I follow most of them. There's a community of people on Twitter who I'd say roughly, have your perspective on things.
People like Christine Powell and others.
And did you know them beforehand? No. No.
Have you met them or so. So did you did you form any kind of cooperative group?
Well, I mean, we're going to come to Independence Day. So it was some of them who formed Independence Aid pretty early on.
Yes. So Independence Age.
So I I guess one was hearing the different voices and, you know, notable people, my own department, you think, goodness me, what are you saying?
That makes no sense at all. I know who you're talking about. And and then other people who who were very good with information.
And that actually was the information that I really liked. So people like Christina Pagel, who would present really good information.
And I, I was aware of independence Sage, I think probably fairly honest since its creation because it came into being,
I think East Ruth of 2020 really as a because there was this scientific advisory group for emergencies,
but it was quite secret who was on it and the minutes weren't published and it was very unclear what advice they were giving to government.
So whether government was taking scientific advice or whether it was in some way shaping the scientific advice it took.
And then knowledge that Dominic Cummings was attending its meetings,
which made everyone feel slightly less confident that they were getting undiluted science out of it.
So so David King decided to set up this independent public group, which would talk about what what these what experts knew.
And it was made up of public health people and statisticians and virologists and immunologists.
And, you know, and I was brought in actually quite late on in the process.
So it had already been going sort of 15 or 16 months when I was invited to join, which was August 21, and they were a bit short of clinicians.
So so then I that's when I got involved and was very, very honoured to be asked to join it.
And that was because of your public profile? Yes,
because of my public profile and and my willingness to get off my hind feet
and and talk and explain some just what it's like for patients on the ground,
what we're actually seeing in practice at the moment and for doctors.
Absolutely. And so I've continued to do that.
Mostly we just meet online, so we meet once a week to plan and once a week to to talk about COVID,
what's going on and have themes and guests each week.
In fact, we might go to fortnightly soon because everyone's getting a bit bored of COVID really on it is now January 23 and we've had enough,
frankly, but unfortunately hasn't gone away. So so we're still continuing.
And so you you gather data from I mean, as a group, from whoever's collecting it.
Absolutely. So the Office of National Statistics is still gathering data.
It's methodology has changed fairly recently. It's sometimes difficult to compare, but it's still gathering data on acute COVID and long COVID.
The Zoe app is still is it gathering data data on on even the level of infections The household survey.
Yes. Yes. That the. Q So even people aren't necessarily ill.
Yes. So so I would ask is is it was it's now it was going out to people and I think it's changed the way it's collecting the data,
but it is still collecting swab data from from a random sample.
Yeah. So we're getting some idea of prevalence and we've still got, you know, everyone says, oh,
it's not really here anymore, but it's still one in 25 people in England this week while over Christmas not.
Yes, loads and loads and loads of it is still there.
Luckily, most of the people who have been coping now are not horribly ill and most of them don't need to go to hospital.
The vaccines have been endless for that and I quite like to talk about the vaccines and experience of being part of a vaccine campaign,
because I think in terms of the highlights, one can say that as a condition, the vaccines were amazing.
I so my first brush with the vaccine was going as a as a volunteer participant in the in the AstraZeneca Oxford AstraZeneca trial,
which was that May 2020 I think it was June or just something like that really
early on that they have a candidate vaccine so soon it was just remarkable.
And I was randomised to thing where I discovered eventually it was a single shot of the of the life of the real vaccine.
I had assumed I would have placebo because I had no response to it whatsoever, no sore arm wasn't nothing, it was her,
whatever you call it, what you call it was not a placebo, it was a, it was a live vaccine, but a real vaccine.
But for something. That's true. That's true. It was the medicine. Yes. Yes, absolutely true.
You're right. I had seemed I didn't have the new experimental vaccine.
I was fine, but I've actually never had COVID.
Wow. That's impressive. And I'm still quite a mask wearer on trains and from the public spaces.
But I think it's also I think I might have had probably had my immunity both from the original vaccine
I had and then various different sorts of boosters since then from the from a work perspective,
the. The vaccine campaign was a time of I mean, it was a lot of work.
But it was at a time when we really felt we were doing something useful in general practice.
And although there were there was the the Kassam Stadium locally was also offering vaccines.
But over the country, over 70% of vaccines were given in GP surgeries or community pharmacies, mostly organised by GP.
And there was this huge campaign both to contact the patients and encourage them to come in.
And there was lots of lots of fear, not only of the illness itself and even coming into the surgery to get a vaccine,
but also of this new sort of new vaccine.
How could it have been created so quickly and be safe? Has it been tested properly?
So lots and lots of misgivings about it and needing, you know,
a fair bit of persuasion sometimes or discussion, let's say, to to help patients coming and get their vaccine.
But then that just the organisation involved and we had to have people sitting two metres apart and
initially we had to have made sure everybody waited for 50 minutes after they had their vaccine.
And so in our building we had two chairs up every corridor and round and two metres apart in every corner of the building,
and it was very tightly run operation to get the patients in and jabbed out again.
But our first vaccine clinic was, I think, the 19th of December 2020, so that was quite early as that would have been Pfizer, wouldn't it?
Because yes, this is with that with the now, this was a Pfizer vaccine.
And everyone was so pleased to be there, pleased to be working.
They're pleased to be there as a as a patient from huge relief they might be protected.
The number of my neighbours were volunteers. Yes, we really enjoyed it.
Yes, yes, we had our patient participation group was fantastic and sort of marshalling people in and out and and it was it was great.
And one of the things that the pandemic did for us was before it we had this notional
primary care network us with some other of our practice and other one not building.
And three other practices in the town were meant to be grouped together, developing services for our local population.
Bit of a damp squib before COVID came along, and then actually we needed to work together to provide this service vaccination,
which was we were just the right size unit to offer that,
and the building we were in was very suitable where the building for the other practices wasn't.
So everyone came to us and we all started working together.
So it improved relationships enormously. We built them where they weren't before.
And has that continued to be useful? Yes, it has continued to be to be useful.
It's not clear what else should be run on that scale.
If you thought to me it was the right size for delivering code vaccinations and
if you it continuing to deliver COVID vaccinations right until this last autumn,
although interestingly, we the practice in the centre of town have now got their own building, new building.
So we split. We've done some in our building and some in there.
So it's it's been fine. It's been fine. I'm saying the vaccine campaign, which was great.
And I think in terms of actually being useful,
that there are there are patients I can think of who more defensively than maybe some of the other work I've ever done.
I felt I saved that life because I rang up that family and said, Must bring mum in, please bring her in.
Yeah. And then not very long after the whole family got COVID and someone got really quite ill,
but elderly mum would have died had she got COVID fairly shortly, but she didn't get it because she had been vaccinated.
And that was I kind of did that and got that done and that, that, that feeling that, you know, clearly was something worthwhile to do.
Why do you think it was? I don't know if you've written about this.
I haven't read all your articles that the right that the NHS was essentially sidelined and the public health people sidelined in the test and trace,
but very much central to the vaccination campaign.
Yes. Interesting, isn't it?
I don't know, because you could have they could have said, Oh, we're going to do a totally centralised vaccination campaign as well.
We're going to set up huge central lab people at places like cos I'm Stadium and we don't need, we don't need the, the doctors and,
and you know there are some suggestions that people with connections to people do have
some power and that were very much involved in running the staff agencies for the,
for the outsource mass vac centres. So, so I.
We haven't touched on PPE. We can touch on PPE if you like, but.
There's a. It really interesting.
Sense that one gets and I wasn't there in the centre of it, so I don't know for sure.
But the sense that one gets of some people in government running around in a panic.
We don't know what to do with other people.
Seeing is an opportunity to make money so we don't know what to do or how we can help.
And rather than somebody saying, Are you really the right person to help?
They just took those offers. And certainly when it comes to PPE, that definitely happens.
And it was kind of a system set up to be corrupt and very difficult.
Know how that VIP short fast lane could be seen in any other sense as corrupt.
And you get all these stories of people who were really, really well qualified to supply and we're told we don't need you,
whereas lots of rogues did supply stuff that was useless.
So there's that side of it. Why didn't that happen with the vaccine rollout?
With your question, I think I think it did to some extent, but just nobody else had the capacity to do that.
And maybe some sensible people said, actually, you're not going to be able to deliver to all the elderly in that fashion.
And if we wanted to detach, sorry, I shouldn't get my opinion,
but I did have the impression that the vaccine task force was actually a very tight ship and they did a good job compared with some of the others.
And I think that's a really interesting question as well.
Who was in charge? Who made the decisions? So I'm I don't want to libel anyone.
Oh, but there is there was a sense that the people who were given really important roles in this the whole pandemic were probably
got them from because of their connections and not necessarily because of their abilities or experience in the field.
Some of those appointments in retrospect, maybe didn't work out so well.
If we look at test and trace, it was generally acknowledged not to have worked and lots of money were wasted.
It's possible that the person who was put in charge of vaccines may have been appointed by some of the same slightly dubious roots
in terms of open competition in the sort of interviewing and selection process you might expect for such a high profile position,
but actually turned out to be really very good at the job and very good at making sure that things happened as they should.
So yeah, I hadn't really thought of that, but they may be down to it shouldn't be down to an individual,
but it may have been down to having the right person who decides that this is going to be our policy.
And clearly, if you want to deliver a vaccine initially, start with to your elderly and vulnerable, That's where you're you're starting.
You kind of need to go to where they are and to the people who know them, which is the GP's.
You can't really do it from centrally because you can't.
You can send them all letters if you want to,
but some of them can't read and are blind and some of them are zero and you can't send them text on their mobile phones because they haven't got them.
You've actually got to bring them up and have conversations with them or know who their daughter is and bring her instead.
Or all of that stuff, which is in GP's notes and GP's heads.
And so yes, it was it was very sensible to deliver that initially through general practices.
I'm. Some. Some politicians think we were overpaid for the work, but interestingly,
it was delivered much more cheaply by general practitioners than it was by the mass vaccination centres.
And it was quite a lot of work. Yes, I'm sure it was.
And so getting back to normal, we're not we're not back to normal in the sense that COVID is still around.
But. When was it that you began to see?
Patients coming through the door without having to wait outside and deliver Boston.
So, goodness me, I honestly can't remember at what point we made that that change.
Again, It was like it was it was it was fairly early on.
I think probably when we got to the kind of weather it was a Freedom Day is probably
somewhere around there that week that we might even have been before that.
I honestly can't remember when we when we stopped.
But did you have a rebound of people who had not been coming in suddenly deciding
that probably was time they got something they were worrying about checked out?
Not not really, I don't think.
I think when we did see patients quite often, they had quite a long list of stuff they had been been saving.
We we kept with we kept with telephone trials for quite a long time.
And we gradually built up, you know, more and more people were coming in.
And I'm trying to remember when we actually got rid of the the telephone,
lots of lots of surgeries have stuck with you have to have a conversation first or you have to a knee consult first before you get an appointment.
We I was I was very satisfactorily dealt with via telephone just before Christmas.
But your blades I never had them for didn't know what they were.
I thought I had an infected toe but it was two blades and how interesting.
It was all done on the phone. On the phone with photos. With photos, with photos of my toe Synthes and.
Yes, and lots of stuff. I mean, I'd never done really done very little video consulting before, and I still didn't do very much more now.
But now at least I do have it at my disposal and I'm happy to use it.
With four lots of jeeps.
There's been a slide from COVID into massive doctor shortages.
And so what was the remote consulting that was brought in?
And the triage was brought in partly because of COVID has then continued just because of too much work.
And this is a way to try and manage demand and get the consultations to the people who most need them.
I know that there are some issues with that about about safety and who does the triaging and what you might be missing on the way.
So, I mean, we are lucky enough to have enough doctors in our surgery and we've gone back to open house so people phone our
reception and are often appointment and they can say whether they'd like it as a face to face appointment or with.
They'd like it as a telephone appointment. And are some patients choosing telephone somehow?
Somehow I'm probably doing less telephone work than I was before the pandemic.
But it's a it's a mix and a mix, and I much prefer to work face to face.
And I find it more efficient because I can see and sense other things that I can't over the phone.
But it depends what the problem is. And it also, if I really know the patient, it's much easier to do a telephone call than if I've never met before.
It's about building relationships. You know, your whole attention being there.
She's much harder on the telephone call. So.
So we've kind of gone back to where we were before Kobe.
But I think a lot of places haven't. And that's partly because we've shown as a as a profession, as a set of primary carers, so short staffed.
Which we could do the whole interview, but we could do. But interestingly, we are still wearing masks in our surgery.
We are we ask our patients to as well.
I think we are probably very much in the minority doing that.
But there's lots of evidence since vaccination, there's lots of asymptomatic COVID and there's been lots of flu as well,
and lots of flu and all sorts of things you can protect yourself from.
So we'll probably continue doing that for while. We're still having pretty much all our meetings on teams.
That's one of the innovations that came during COVID are great.
You know, in various other bits and roles.
Actually, if you have to have a meeting of an exam board that actually you just want to go through the masks and did these people pass or not?
Previously, we would have all travelled half an hour to be in the same room.
Why would you do that? You can have a 45 minute meeting.
You do it on teams and you get ten people together or whatever you need and it's so much more efficient.
So there's there's some of the the sort of technological advances we made because of COVID, which are great.
Long may they last. Although I do like meeting people face to face as well.
So. Yes.
I wondered how your GP colleagues respond to the relatively high profile that you've had in in various different kinds of media.
Is it seen as a good thing to do to be doing I'm.
If they don't think so, they're polite enough not to tell me. Yeah.
They don't seem to mind. There's a slightly slight sense that because I'm.
Technically senior partner there.
There's nobody to tell me that I shouldn't, but I'm sure my partners would tell me,
you know, if they thought I'd pull the practice into into disrepute, the wider community.
There are other GP's who also have a high profile and another and other doctors in other specialities as well.
But the numbers are relatively small, I suppose it becomes.
You know, people become known as a name and then other people, the media will always come back and ask them to write an opinion piece or whatever.
So, yes, end up with this relatively small group, a relatively small group who you often see in the paper.
Yes, absolutely.
And and so yesterday I was found by, oh, someone from the BBC doing some background work on antidepressants and somebody else from Pulse.
He wanted to know about the new nice guidelines on statins and how much work that will be.
And then it kind of because I'm the GP on speed dial on their system.
Do you enjoy that role? Yeah, I really don't mind at all. I'm I think it's partly about.
Getting to a certain age where if you're lucky,
you develop a degree of confidence in your own opinions and you don't really mind if everybody agrees with you.
I think one has to be a little bit selective and be prepared to say, I'm sorry,
that's a subject I don't know anything about because there are areas I know nothing about at all.
But I actually I'm going to credit my Oxford education with giving me the right tools in that,
you know, at the age of 19, you're asked to read some stuff.
And I'm actually. The questions in the tutorial.
The essays you write were not. Have you read it? Have you done the work?
But what do you think about it? What's wrong with the arguments that are here?
Yeah, but do you actually believe that? Does that work?
And that's encouragement to come to your own conclusions about about things and to trust in your own reasoning, which was just a fabulous education.
I feel intensely privileged. I am privileged to have had that.
And it gives you, if you're lucky, if it works for you, and it doesn't work for everybody, but if it works for you.
And I think it worked for me. It gives you a confidence in your own abilities to come to conclusions that are at least rational.
Doesn't mean it was right, but you can you trust your own logic and judgement.
I don't get anything that. Americans. But but.
But mostly. But unprepared. Usually I'll give my standpoint.
And and interestingly, I don't get a huge amount of criticism.
I'm fascinated that I don't because a lot of my colleagues on in this age get
huge amounts of backlash and and aggression and but it doesn't happen very much.
Me trolls Twitter trolls the occasional Twitter troll.
I just meet them, ignore them. They're probably out there still screaming into the void, but I don't know about that.
So you've not been upset by them? Not really.
There are one or two. Oh, you got hold of my phone number in the department.
And particularly if you ever said anything about vaccination and children that were
particularly devoted army of angry people who didn't like the idea of protecting children,
then why? But they didn't. But on the whole, no, it just slides off me.
So these are the this is the kind of final run up.
Yes. So this one, how threatened did you feel by the virus itself?
When it first came along. Personally, I mean. Personally.
Absolutely. Personally, not very.
I think I've always considered myself to have robust, good personal health quite fit in terms of, you know, running and stuff like that.
And so I don't think I ever thought that I would be seriously ill if I caught it.
Some people I care about might have been so worried for them, and I certainly didn't want to have COVID.
And I think latterly I've been more worried about getting long COVID because some extremely young,
fit able people I know have been have become disabled through long COVID so that they can sort of do their jobs, but they can't exercise anymore.
Like, you know, they can't socialise in the way that they used to because they're just too tired and some
of them been ill for a year or more who were previously really dynamic and you think,
I don't want that. So I guess if anything, I'm scared about long COVID more than I am about COVID,
and that's still turning up at the same kind of rate as it was early on, is it?
Yes. Yes. I mean, it's clear that.
I think it's clear that if you're vaccinated, it does reduce your chances of getting long COVID.
But people are getting long COVID from Armstrong, just as they did from the we handle the Delta rule, whichever other variant.
Yeah. So it's still it's still happening, unfortunately.
And did did the pandemic I mean, apart from changing the way the practice organised itself, how else did did it impact on your ability to do your job?
I'm. Did you have to have one of these famous letters?
In case the police stopped you. Oh, no, no, nothing like that.
So, I mean, I think personally, uh, if it's I it seems a little tactless, really,
But I would say I had a good pandemic, just as some people had a good visit.
I had a good pandemic because I was able to continue working and doing a job.
It wasn't exactly the same job and bits were missing.
And certainly some patients didn't get the comfortable, the care they need.
And so there were things wrong with it. But I got to get up in the morning and go to work and do something that felt productive.
So my life didn't come to a halt in the way that many other people's lives really were put on hold during during COVID.
So to that extent, it was it had less impact on me than on many other people, which I felt very grateful.
Right. I think we more or less got to the end now. So. Has your experience of working through the pandemic changed your attitude or your
approach to what you do and what would you like to see change in the future?
I think I am. More aware that.
People of the fallibility of the people making decisions at the top.
Okay. So so not only that, some of the decisions taking early in the pandemic about how we should handle this were really very foolish.
It seems really difficult to understand.
But then the way that we dealt with the pandemic after that was very wasteful of both lives and money, and it could have been done very much better.
And it's difficult to see how.
We got into that position. I don't think you can just have been foolishness.
Unfortunately, I think there was also corruption in this.
I'm much more aware of corruption. It probably was always existed, but it seems much more visible now than it ever was before.
What else have I learned?
I want to end on an optimistic note and and say and talk about some of the the working together that's been that's been great.
And what what actually what was really interesting is how much can be achieved and how quickly if resources are no object.
So whether that's the vaccines or the vaccine clinics or, you know,
the things that we did in an instant, you get able people together and say, right, just sort this out.
And and they do. And they do. If you if you give them the resources to do that and and the research transfer for the drugs, you know, again,
they have the resources to get on and do the research and and wonderful things came out in terms of discovery about therapeutics within within COVID.
So so what can be achieved if you set your mind to it, then should give us hope for the challenges of the future, like climate change.
If we are focussed and we have the resources, we can move mountains.
Something else to ask. If you're optimistic about whether this very high profile focus on health has raised awareness in the patient
population at large of what they ought to be doing to prevent any kind of ill health in their in their lifetimes.
It would be fabulous if that has happened.
Unfortunately, I don't think the messages are the right ones going out.
If the messages were about how much more, well,
you'll feel if you walk or how much better you'll feel if you have these foods rather than those foods.
But at the moment, all the food industry lobby, the alcohol industry lobby is very, very powerful.
So we're not doing the right things in public health. I don't think we're sending the right messages out to patients.
I'm just telling them if you're fat, you'll get cancer is not very productive.
I don't think so. There are definitely things we could do.
Give them the right impetus. But again, sadly, I think it comes down to other pressures which you could.
Lobbying. I don't want to use that C-word again.
But I think that these are the things that get in the way.
And there's also a kind of if you're not sure, go and ask your GP.
I think they we had before Christmas, we had almost every toddler in Oxford with a sore throat coming to see us.
That strep about strep. Because that was completely bungled.
All the messages about that perfectly competent pet parents were reduced to ringing up their GP because
the toddler had a sore throat and in other circumstances they would have just given them to Calpol.
But now they've been told it could be invasive prep group strep and that child would die, so they'd better call us.
So we have all of that and now we're going to give statins to everyone over the age of whatever it is,
because they're they're automatically going to have a risk of heart attack about 5%.
Once you get above a certain age, of which age, that is, but huge numbers of people and we've all got to be seen in council by that.
You So the answer to everything at the moment is go and see your GP.
And there aren't enough of us and we could do this much better.
So I think I'll stop ranting like, thank you very much.