1. Enforced change due to COVID 19 has led to positive changes in practice. 2. Early senior triaging and review led to a reduction in emergency clinic attendances. 3. Emergency clinics could be further supported through protocols, departmental guidance and permanent changes to senior cover. 4. Increased senior presence could improve teaching and training of junior colleagues. 5. The integration of telemedicine is a useful tool in both the elective and emergency settings.