It was a difficult phone call. As with the majority of our patients right now, I had been speaking to Daisy (not her real name) by phone rather than as a face to face consultation.

She was a 72-year-old retired cleaner and had been suffering with hip pain for several years. Just over a year ago she had been assessed by one of the orthopaedic team and told her name would be put down for a hip replacement operation.

Then COVID hit, what had been promised as a "six to nine months" wait had now turned into a lot longer.

Daisy had used her initiative and phoned the hospital appointments department to find out where she was on the waiting list. "Really sorry, but it will be at least another six to 12 months, but that depends on how the winter goes" came the reply.

She was in tears on the phone because she didn't know what to do, the pain was bad, and it was preventing her from getting out and about. Could I help?

It was one of those situations that made my heart sink, because there really isn't much that I can do. Yes, GPs sometimes write 'hurry up' letters to the hospital but I'm not sure they make much difference and if they do it means somebody else is going to wait longer. But in Daisy's case what would distinguish her situation from the scores of others in the same state?

We eventually agreed that I would change her pain killing medication to see if that would help.

The COVID pandemic is hitting clinical care. Have a heart attack or stroke and there won't be much change except for all the precautions in hospital to prevent viral spread to or from you.

Other conditions are not being forgotten about but the 'knock-on' effect of COVID is having an impact.

What I am seeing are increased delays in semi-urgent matters, things that need dealing with in a couple of weeks or less.

For example, it is really important to get cancer diagnosis early because there are better outcomes with earlier treatment, so if I get a new case where I'm pretty sure somebody has, say, lung cancer, then in they go PDQ for assessment.

It is the cases where I'm less certain, those that might or might not, which encounter longer delays for the tests that can confirm or refute the diagnosis. This is happening because hospitals, being under pressure, may not be able to give them the same urgent priority. Capacity is reduced for one thing because of the need to space patients out and to clean down any equipment between patients.

Because outpatient clinics may not be working to full capacity due to the need to socially distance people, and the fact that we are seeing higher numbers of staff off quarantining, waiting lists are building up here too.

There are some bright spots. Outpatient mental health services have adapted, like GPs, to using telephone consultations, the community nursing service are stars and continue to go into people's homes, and laboratory services are turning around tests as quickly as ever. New ways of working are also helping. I can now contact a range of specialists via my mobile to get advice on managing patients so they don't have to go to clinic or hospital.

The message for anybody with a worrying symptom is please, please, please speak to your GP. It is possible to get advice or be seen quickly, true some worrying matters may take a bit longer right now, but you will be seen.

For people waiting for an appointment or procedure the key thing is to tell your GP if anything changes for the worse, but not for 'hurry-up' letters, and by all means contact the hospital like Daisy did, to find out the current situation.