Dr Amanda Riley, clinical director of Darlington Primary Care Network, describes the round-the-clock efforts of health services during the coronavirus crisis.

DARLINGTON PRIMARY CARE NETWORK is a collaboration of all 11 practices in Darlington. We have been working together for some time now, but more closely since primary care networks were established last year. Over the last two weeks that foundation has been invaluable.

We have been working around the clock making significant changes to the way we deliver services to the community of Darlington. We often get information about how our services change from the Prime Minister’s press conference at the same time as everyone else. We then need to go away and make changes before we open the next day. I am incredibly proud of every member of the General Practice team in Darlington, they have all taken on this challenge with vigour and passionately want to provide the best service they can for the Darlington community.

We have had guidance from NHS England about how services should change and have responded to that rapidly. We are facing the same challenges as many other sectors with work force, some are unwell, some are self-isolating, some are socially distancing and some have dependent/carer responsibilities. This is putting significant pressure on those left to do the work.


All appointments with any clinician are now being triaged. The best way to get access to your GP for non-urgent problems is to use the online consultation form (eConsult) which is available on every practice’s website and does not require any log in details. If your problem is more urgent, or you don’t have access to the internet then phone the surgery. If you need to speak to a GP you will be given a telephone consultation, the GP will try their best to deal with your problem over the phone, but if you need seeing this will be arranged.

Most problems can be dealt with easily and safely over the phone and we are also working on technology to allow us to deliver video consultations as well. Please do not just turn up at the surgery unless you are unable to communicate over the phone.

In some practices there are reception staff screening patients at the front door to ensure they really need to be there. The reason for this is that we see many vulnerable patients in GP surgeries, we need to protect them, and our staff from coming into contact with anyone who is symptomatic of coronavirus (covid-19). Our reception staff are vital members of the team, they are trained to deal with many queries over the phone and will need to ask you questions to ensure they get you a call from the right clinician, please be patient with them, they really do want to help.

If your GP, after speaking to you on the phone, feels you may have covid-19 they will give you advice to self isolate until you are well, for at least seven days. The rest of your household will need to self isolate for 14 days.

If after speaking to you your GP feels you need a physical assessment you will be asked to attend a separate clinic, this will be based close to the town centre. You may be asked to wear a mask when you arrive. The doctor or nurse you see will be wearing Personal Protective Equipment (PPE), this means a mask, apron, gloves and plastic glasses. This may look a bit scary, but it is in place to protect you and them, there are very strict cleaning procedures in place.

We have been working very closely with colleagues at Darlington Memorial Hospital to ensure that care is joined up. A&E and urgent care services have also undergone significant change and you should only attend if your problem really is an emergency.


Prescription requests can be made via the SystmOne or NHS apps, if you need log in details for these please submit an eConsult. If you do not have access to the internet please post a request through the practice letter box. We will not be issuing paracetamol on prescription as there is unfortunately a national shortage, it is no more available on prescription than it is over the counter.


NHS advice at present is to avoid taking anti-inflammatories such as ibuprofen or naproxen for covid-19 symptoms, but if you usually take these (for example for arthritis) you should continue taking them.

There is no evidence that any other medications make things worse with covid-19 and we would encourage you to continue taking all medications as prescribed. In fact it is incredibly important that any pre-existing conditions are as well controlled as possible. We will not be issuing increased numbers of inhalers “just in case” or rescue packs for asthma or COPD as if you are having breathing problems you should discuss this with a doctor or nurse.

Community pharmacies are under tremendous pressure providing a vital service as well as GP surgeries, we are working closely together and ask for your understanding.

Fit notes

We understand that it is an incredibly difficult time for countless people financially and many will be thinking that they need a fit note In fact legally this is not needed for the first seven days, and after that it is down to the discretion of your employer. Given that self isolation and social distancing is government advice we feel that this should be enough for most employers.

Fit note requests are contributing to significant pressures in practices at the moment, I would encourage all employers not to insist on employees having fit notes as they are not legally required. If your employer does insist on a fit note for self isolation please visit 111.nhs.uk/isolation-note. If you need a note for socially distancing because you cannot work from home please request this via eConsult on the practice website.

Social distancing

There seems to be some confusion about what social distancing means. Essentially this means only leaving your house for essential activity, for example if you are a key worker, you have a doctor’s appointment, you need to go shopping or to get medication. All social contact outside your immediate household should be avoided, including gatherings in homes.

If you do go shopping for food there are some simple precautions to take, you should try to remain two metres away from anyone else, only touch surfaces where necessary, don’t touch your face and wash your hands as soon as you get home.

The virus is spread by respiratory droplets, this means that it will be in the air around an infected individual and will settle on surfaces. The virus can live for several hours and even days on some surfaces and individuals can be contagious for five days before they show symptoms. These measures are about reducing the rate of spread of the illness.

There are real concerns that the healthcare services will not be able to meet the demand if we do not slow the rate of spread, that is likely to mean that there will not be enough ventilators for those that need them. It is important to remember that these resources are the same resources needed for your daughter with appendicitis, your husband with a heart attack or your mum with a stroke. This really does effect us all.

Feeling vulnerable

On a personal note as a medic I am feeling very vulnerable, the more patients that I see that could have the virus, the more likely I will get a severe form of the illness. Doctors have already died in the UK because of this. I am also very worried about having to have very difficult discussions about rationing care. This can be at least partially avoided if we all stick to socially distancing.

There are many people who are more vulnerable to this virus. Put simply these are people who would usually get the flu jab. If you are in the very highest risk groups you will be receiving a letter from the NHS giving you specific advice.

Anyone in this group should avoid going out at all, where possible shopping should be bought for them and social contact avoided totally. This is incredibly difficult for anyone to face. We have been working with other organisations in the town to help identify who the most vulnerable people are to target community assistance, there has been a huge growth in voluntary groups and that will get the community through the coming weeks.

We’re ready

These are scary times for all of us and it is easy to feel overwhelmed. We have been working hard to ensure that we as doctors, nurses and the wider primary care team are ready to respond. The service you get from your GPs over the coming weeks will be very different from what you are used to, but we will be working tirelessly to ensure safe and responsive care for our community.

Key messages

Wash your hands; Do not leave your house unless you have to; Self isolate for seven days if you have a fever of 37.8 or greater and/or a new persistent cough.

All health services will be working under significant strain, ensure you use the services sensibly. Our staff are working miracles under impossible circumstances and should be respected.