BMA leaders have criticised the three-tier approach, warning that a 'national prevention strategy' could have offered better protection for vulnerable patients.
Senior GPs have demanded clarity on 'exactly what the trigger point will be to reintroduce shielding' in areas hit hardest by COVID-19 - and warned that practices already under significant strain will need extra resources to deal with the inevitable demands for advice and support from patients confused by the new rules.
Dr Rob Barnett, the association's GP committee north-western representative and a GP in Merseyside - the only area in England designated at 'very high' alert for COVID-19 - said the rapid rise in cases had left 2.2m vulnerable patients previously asked to shield facing 'a great deal of anxiety'.
The government revealed on Tuesday that shielding would not return automatically at any level on its three-tier scale - but could be reintroduced for a limited period of time in the hardest-hit areas.
Dr Barnett said: 'Guidance today says that universal shielding won’t return – for now. But the door has been left open to reintroduce it for the highest risk areas at a later date, leaving both GPs and their patients very uncertain. Crucially, given the high levels of new cases and the CMO’s warning yesterday that even the current measures in Tier 3 will not be enough on their own to stop the spread, we need to know exactly what the trigger point will be to reintroduce shielding.
'And if this does happen, doctors and patients need to be the first to know – we absolutely cannot have a repeat of a situation where announcements are made in the media with no follow-up details or guidance for those on the ground.'
The BMA warning came as 17,234 positive COVID-19 tests were confirmed on 13 October - taking average daily cases over the past seven days to 14,973. The number of deaths recorded in England on 13 October was 124 - the highest recorded since early June.
Labour leader Sir Keir Starmer has called on the government to implement a short-term lockdown across England to slow the second wave. This move would be in line with advice from the government's scientific advisory group for emergencies (SAGE) - which told the government three weeks ago on 21 September that it should consider a 'circuit-breaker (short period of lockdown) to return incidence to low levels'.
CMO Professor Chris Whitty also admitted this week that although the pandemic would be worse without measures adopted to date, local leaders would need to go further than steps set out under the three-tier system to reverse the spread of the pandemic in the worst-affected areas.
Dr Barnett said: 'People in the north-west and other areas where we are seeing such a rapid increase in COVID cases are very concerned about what it means for their physical and mental health, their lives and their livelihoods. Not least, for those people who are particularly vulnerable and effectively put their lives on hold earlier this year, the latest developments will no doubt cause a great deal of anxiety.
'Doctors in these areas, including Liverpool, are already very worried about how the surge in new cases is affecting the care they’re able to offer patients – whether they are suffering with COVID-19 itself or an unrelated, yet equally serious condition.
National COVID strategy
'And while tighter local restrictions are currently necessary, a national prevention strategy would help mitigate some of the potential mental health, economic and social impacts these measures may have on people living in these communities.
'Patients will no doubt approach their GPs for advice and support – and with practices already facing intense pressures in these areas, it’s vital that they too receive resources they need from government to meet demand.'
The Merseyside GP added: 'Overall, GPs know that prevention is better than cure – and the BMA has been clear that we need a strategic plan to reduce infection rates in communities to avoid needing these local lockdowns in the first place.'