WE all live in an altered world now and each place of work, including my own profession of general practice in Scotland’s NHS, is part of that new landscape. GPs and colleagues in primary care and acute services across Scotland almost overnight (which is unprecedented) implemented social distancing and introduced two distinct pathways for Covid and non-Covid patients.

These look very different in rural communities to urban communities but have common cause to avoid any increased risk of virus transmission to staff and patients and suppress community outbreaks. We have increased use of phone consultations and the technology Attend Anywhere, and whilst face-to-face consultations still take place in hours and out of hours, both services are no longer open access but restricted. These changes will be in place until we have either an effective vaccine, antiviral treatment or the pandemic is declared over. No one can predict when that will be – we all wear a mask now.

The science is producing evidence in real time and we know who is at highest risk of being hospitalised, requiring critical care and dying from the disease. Extreme elderly, those with long-term conditions and multimorbidity, immunosuppressed, black and minority ethnic groups and the poor are the most vulnerable. It is not difficult to understand why poorer communities have worse outcomes compared to wealthier communities if they are more likely to work in essential services, live in crowded homes and already bear the brunt of the impact of health inequalities and 10 years of austerity measures. We do not want the “unworried unwell” to be more neglectful of their health issues – we still want to hear from any patient who is concerned about their symptoms.

Some 80% of health contacts take place and are managed in the community by the primary care team district nurses, health visitors, attached pharmacists and practice-attached or aligned staff, for example financial advisers and community links workers. We are blurring the boundaries of how we work to provide adequate staff cover for the many new situations that we face without compromising good standards of healthcare by adapting quickly and working together. The holistic team that is built from the ground up involves and empowers our community, but this new way of working in integrated health and social care partnerships has also been upended during the pandemic and challenged to respond to provide outreach services. Community links workers are directing patients to supportive services and co-ordinating food parcels to vulnerable patients.

Patients are phoned by the practice if they are shielding to reinforce their letter from Scottish Government about advice and entitled support. That can sometimes turn into a conversation about anxiety and mental health issues, particularly if social isolation is their reality. We worry as a profession about our role in monitoring and supporting vulnerable children and families. This is normally a routine part of daily GP working and there is concern that despite the virtual support networks, stressed families will not access them and watchful waiting and opportunistic assessment in general practice has stopped. Technology cannot replace the face-to-face consultation and we must be careful not to further widen health inequalities for those who struggle with health literacy or cannot access technology.

We were hopelessly unprepared in the UK for a pandemic. Much of this can be explained by a delayed UK strategy despite weeks of warnings from other affected countries, a flawed ideological base for pandemic response and chronic disinvestment in public health infrastructure and the NHS across the UK. Despite having the highest death rate in Europe, we are told that a one-nation approach is required to come out of lockdown. That is an impossible ask when there is not yet a worked-up strategy of basic public health measures of test, tracing and isolation (TTI) to control further cluster outbreaks. We still do not meet the criteria laid down by the World Health Organisation (WHO), which emphasises continued preventative measures in all workplaces, nursing homes, essential services and minimising the export and import of Covid-19.

Govan GP practices were anticipating a large rise in direct and indirect Covid mortality – we have many patients who would be at risk of the disease. This has not been the case and whilst we are very relieved, it is essential that we understand community epidemiology and localised data to better manage the inevitable cluster outbreaks that will follow.

Viewing health inequalities and the social determinants of health through the lens of a devastating pandemic throws many complex issues into sharp relief that need new solutions across many policy areas. The Covid pandemic gives an opportunity to reset the balance of society in Scotland towards a green and social economy, and that is aligned with progressive global healthcare. Now is the time to consider what constitutes the essential economy, whilst building the wellbeing state. Trident or treatments? Nukes or nutrition? Where is our money best spent? What should be capitalised? Is the land and coastal area a national asset? Is housing, heating and food security a human right? Universal Basic Income, nationalising our nursing and care homes are ideas that are gaining traction and should be supported and implemented.

There is no doubt that the NHS is a much loved institution across the four nations of the UK that has taken centre stage during this challenging time. The NHS is a gift economy built on collective human endeavour and innovation that is difficult to put a price on for those who would determine its market value to make it market-ready. The protection of NHS Scotland should now be enshrined in a Scottish constitution and would be the most fitting legacy of this global pandemic.

Dr Anne Mullin, a GP working in Govan, is a member of NHSforYES