Another stealthy letter has passed across my desk. I’d missed it among the never-ending torrent of paperwork and guidance. Somehow it only slipped into my consciousness today; clearly, I must have been asleep at the end of last week. Last day of the month and last thing on a Friday – really? I must start watching out for these silent but deadly missives.

Apparently, we’re now in the third phase of the NHS’s response to COVID, but you might be forgiven for not having noticed. After all, the guidance hasn’t yet made its way to the portal, so you wouldn’t have found it there.

In any event, I’m currently sitting in a coffee shop – socially distancing, of course – when I should be at home. I’ve come here to escape for half an hour. If I’m seen sitting at my desk looking anything less than frantic these days, I’m pounced on by some well-meaning member of staff who thinks I’m looking far too relaxed. Now that cafes are starting to open up again, I’m making good use of them – after all, with ‘Eat out to help out’ now in place, it’d be rude not to.

When I ordered my coffee today, I was prompted to scan a QR code to let their head office know I’ve been here. I’m all for it, and of course it should help ‘Track and Trace’ find me if they need to.

Did you know that we’re officially at ‘Level 3’ on the Coronavirus ‘Nando’ Scale? But if you’re in an area with a local lockdown, you probably haven’t noticed any difference.

The implication of Level 3 seems to be a move towards local management of the situation rather than a high-level government-led operation. They’re warning us, though, that Level 4 could be reinstated, but I’d rather not think about that for the moment.

Apparently, the next phase of the plan requires a return to near-normal levels of non-COVID health services, with preparations going ahead for the usual winter demand alongside COVID chaos, and embedding the lessons learned.

I’m glad I’m not in secondary care because the idea that they’re now expected to achieve 70% of last year’s activity for outpatient/day cases and overnight electives in August blows my mind, almost as much as the idea that they’ll need to manage 90% in October does. From a standing start, I don’t think I envy them that task. Though I’m slightly worried by the sentence that says: “Trusts, working with GP practices, should ensure that, between them, every patient whose planned care has been disrupted by COVID receives clear communication about how they will be looked after, and who to contact in the event that their clinical circumstances change.” I can just imagine the number of consultants’ letters now; I may need to brief the admin team!

In GP land, however, we need to restore activity to usual levels where clinically appropriate – no mention of percentages here or any kind of timescale. Now that the pandemic pressures have eased a little in the outside world, our demand has shot up again – with patients’ niggles having escalated to panic-inducing levels for most of them.

Childhood immunisations and cervical smears are spearheading the campaign to get patients back into practices. I’ve a sneaking suspicion that some of my GPs have become a bit too comfortable doing everything from their desktops. Years of insisting that collecting the patient from the waiting room is a ‘must’ to assess the patient’s overall condition seems to have been forgotten. For ages, I’ve suggested that surgeries would be quicker if they just called them in, yet I suspect that a return to the slow walk down the corridor is now in sight.

Meanwhile, on the winter-prep front, all is apparently not lost. We may yet have access to routine testing for asymptomatic staff. We’ll be delivering a significantly expanded flu programme alongside manoeuvres to prepare a COVID vaccine campaign. Given the guidance we’ve not yet had on the aforementioned expanded flu programme, I won’t hold my breath waiting for guidance on that one.

We also need to ensure the completeness of our patients’ ethnicity data by 31^st December, starting on 1^st September with the groups most at risk from COVID. I shudder at the thought. Those patients who are happy to provide this information already do so, and those who aren’t often treat any request for personal information by anyone other than a GP as an invasion of their privacy.

Additionally, there’s some sort of requirement for a draft summary plan by 1^st September, working as ‘local systems’. Ah well, I’m not quite sure what either of those are yet… but I’m hoping someone else will be able to clarify that one for me. No doubt it means a load of forms to fill in for the poor beleaguered practice manager. That break from work I keep talking about just keeps sailing off into the metaphorical distance. While I’d love to sail off into the actual distance, the thought of a 14-day quarantine is enough to keep me closer to home.

There’s a paragraph towards the end of the letter about funding going forward; it talks about ‘envelopes’. Is that like my mum used to have? If she got to the end of the week and there was some left over, she could blow it all on a fish-and-chip supper. I’m pretty certain that’s not what they’re on about, but at this time of the evening, there’s zero chance I’m actually going to be able to decipher it!