Spring 2020 seems like a long time ago for many of us in primary care. Back then, despite the human tragedy of COVID-19 and the need for coherent strategies on PPE, care homes, COVID testing and shielding, there was a small sliver of silver which lined the dark COVID cloud.

The journey through a pandemic was never going to be an easy one for general practice, and that’s certainly proving to be the case. So far we’ve experienced some unexpected ‘ups’ (rapidly implemented innovation; the engagement and mobilisation of our communities) some fairly deep ‘downs’ (care home outbreaks, PPE shortages, the shielding shambles), and many more twists and turns along the way (Track and trace problems, workforce difficulties, inconsistent advice on masks). All of these have contributed to the (worst) ‘ride of our lives’, but right now it seems as though we are hurtling towards perhaps the most difficult part of our white knuckle ride yet: winter.

Winter can always be a brutal experience for the NHS, but there are signs that 2020- 21 may be, to coin a meteorological phrase, “the worst in living memory”.

And as we face what may prove to be the most difficult winter for the NHS in living memory, primary, community and secondary care arguably needs such a system of delivery, based on collaborative innovation, shared values and renewed purpose, more than ever.

Whilst still in the midst of the pandemic and facing the imminent prospect of a second wave, and with the usual seasonal pressures on the horizon, we are simultaneously required to manage the post-lockdown rebound in demand, continue to hold and receive additional work from secondary care, and deliver enhanced care in care homes. Let’s not forget as well that we have been told to open up to face-to-face contacts, whilst also maintaining total triage - all whilst awaiting the resumption of Care Quality Commission inspections and being subjected to a constant narrative of negative coverage from some sections of the media. In this respect general practice is like an incontinence product: very, very absorbent - up to a point - after which it quickly gets messy. All the signs are that the limits of our absorbency may be tested like never before over the winter period.

Despite these challenges, however, general practice has shown enormous resilience and adaptability over the last six months, and I expect that these qualities will see us through the next six - we just need to remember to be kind to ourselves and each other, and hope that our regulatory authorities might just do the same.

An extra box of Tena pads this winter wouldn’t go amiss either.

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