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Rising exacerbations of chronic conditions. What can we do to turn the tide?

8 July 2021 | Dr Nausheen Hameed
As a GP working over the course of the pandemic across multiple GP sites, but predominantly in Enfield, I have been quite overwhelmed by the rise in the incidence of patients presenting with worsening of chronic conditions such as diabetes, hypertension and asthma and COPD.

Throughout the pandemic, there have been multiple changes to practice and ways of working, from postponing QOF indicators, to reduced workforce and resource capacity as staff are redeployed to the front line, to the call for staff to focus on the delivery of vaccinations. Practice managers, GP partners and clinic directors’ have all been required to concentrate efforts on COVID-19 protocols.

As a result, during the last 12 months, many patients I have spoken to have experienced changes in chronic and long-term conditions which are now manifesting as symptoms which are difficult to manage.

Figures from the Office for National Statistics (ONS) show that excess deaths in England and Wales from heart and circulatory diseases in people under 65 have remained disturbingly high even after the first peak – almost 13% higher than usual between May and July.

What’s behind the rise?
Many patients haven’t been able to get to the GP for a routine health check or BP check. With the withdrawal of these routine appointments for many, continued advice about salt reduction and the importance of exercise, as well as titration of medication has not happened as it should have.

Those who have had to shield during the pandemic and those who have spent most of the last 12 months in isolation have particularly suffered, reporting an increase in poor dietary habits and reduced exercise levels, resulting in weight gain and a rise in HBA1c and blood pressure, highlighted in a recent study published in The Lancet.

Startling symptoms
Over the past few weeks as I have started to see more and more patients face to face. What I’ve noticed has been quite startling – previously well controlled diabetic patients that have doubled their HBA1c, patients with a rise in liver function tests as a result of fatty liver and excess alcohol consumption, a rise in weight and increase in blood pressure readings, with a large reluctance in taking more medication or increasing medication.

Bringing about change
The decline in the conditions of many patients I’ve seen recently has highlighted for me the importance of preventive measures, such as NHS health checks, schemes like Healthier You, asthma and COPD reviews, and the importance of educating patients about management plans and rescue packs.

It is also reassuring to see a new national response to managing hypertension, with NHS England launching the BP@home programme and introduction of blood pressure monitoring schemes.

Alongside these, I have been involved in the creation of the UCLPartners Proactive Care Frameworks, that support GPs and the wider primary care team to restore routine care, helping to prioritise patients and support self-management.

This range of preventative programmes gives me hope that, by engaging with these schemes and taking advantage of the resources now available, we can prevent the next pandemic that could face the western world – the rise and worsening of so many chronic conditions.