Doctors call for test and trace millions to be diverted to primary care and local NHS

Doctors have urged the government to divert hundreds of millions of pounds from the 'failing, privatised national test and trace' service to local primary care, NHS labs and public health.

Shifting the service into the control of local NHS services would restore vital clinical input, doctors writing in the Journal of the Royal Society of Medicine (JRSM) warn.

They write: 'One of the key failures in responding to the epidemic was the government’s decision to take testing out of public health services and local authorities.

'Normally, testing is done via a health professional whose role is in clinical assessment, advice regarding testing, interpretation and then explanation of the results, together with undertaking statutory notification. A test is simply a diagnostic tool.'

Test and trace

Co-author Dr Louisa Harding-Edgar, of the Institute of Health and Wellbeing, University of Glasgow, said: 'Because the current PCR COVID test is not a test of infectiousness or current infection, it cannot distinguish between those who have the virus and are or are not infectious, and those who have remnants of the virus from previous infection or contamination and are not infectious. Clinical interpretation is therefore important for advice and diagnosis.'

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The decision to set up a 'parallel testing system in the private sector' separated the process from local public health departments and primary care, resulting in 'poor community data which is likely to have delayed outbreak control', the authors said.

The warning follows comments last week from a leading global health expert who condemned the failure to involve GPs in COVID-19 test and trace as 'a disaster and a national shame'.

Doctors behind the JRSM paper warn that an 'optimal system would ensure access to evidence-based
advice and testing, reliable, rapid laboratory analysis, swift reporting of results, professionally
guided interpretation of results in the context of clinical symptoms and advice on the limitations of testing. This needs to be followed by contact tracing, isolation advice, and the material, medical and
mental health support to do so.'

COVID-19 infection

Pointing to the problem of false negatives, which are purported to account for up to 29% of test results, co-author Professor Allyson Pollock, of the Institute of Population Health Sciences, Newcastle University, said: 'Clinical input is required to marry symptoms with test results. A false-negative result in someone with COVID symptoms may result in false reassurance, leading to symptomatic people stopping isolation on the basis of a false-negative test, risking spreading infection.

'On the other hand positive tests resulting from testing undertaken outside health services on healthy symptomless people could lead to unnecessary isolation of cases and contacts.'

Co-author Dr Margaret McCartney, a Glasgow GP, said: 'Reintegrating testing into clinical care and public health services, rather than handing contracts to commercial companies, would ensure that the complexity of testing and interpreting test results was acknowledged and accounted for in the diagnosis and reporting of cases.'

A DHSC spokesperson said: 'We reject these claims - tests are extremely accurate and are used the world over as the gold standard to check for COVID-19. NHS Test and Trace is processing over 300,000 tests a day and over 1.1m have been asked to self-isolate to stop the spread.

'Working with directors of public health we have tripled the size of local health protection teams to trace the virus, and we have also launched over 100 local contact tracing partnerships with local authorities across the country with more to come.'

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