An update to the latest standard operating procedure (SOP) for general practice during the pandemic says that GPs should continue to refer patients who meet appropriate criteria, but that secondary care could triage and prioritise patients if capacity is constrained.
As a result, practices may be asked to conduct additional tests on patients if they have access to them, the SOP says.
Practices have also been advised to implement effective safety netting for any patient presenting with symptoms that suggest cancer. However, the guidance also says that, after a patient has been referred, it is hospitals' responsibility to ensure they keep track of those whose assessment may be delayed.
'Post-referral, secondary care will use patient tracking lists where investigations take place at a later date,' the SOP says. 'Clear processes for clinical assessment if there is any change/deterioration in a patient’s condition are vital.'
Any decision by the hospital to downgrade an urgent referral continues to require consent from the GP who made the referral, the guidance adds.
Earlier this week the BMA warned that GPs were already facing a 'tsunami of extra work' because the COVID-19 pandemic has forced them to deliver care, tests and prescribing that would usually be carried out in hospitals.
Some 81% of GPs said they had been asked to carry out new investigations and manage ongoing care that would normally have been done in hospitals, suggesting many practices may already be undertaking these tests.
It still remains unclear if practices will be reimbursed for any of this additional work. The BMA told GPonline this week that it had yet to receive 'any information from the Treasury' about plans to release funding to cover practice costs during the pandemic. The DHSC said earlier this month that extra funding would be delivered 'in due course' as part of a general practice COVID-19 support fund.
Cancer Research UK estimates that around 2.4m people in the UK were left waiting for cancer screening, tests and treatments in the first 10 weeks of lockdown. This includes 290,000 people who missed out on an urgent suspected cancer referral for further tests, which would normally catch up to 20,300 cancers, the charity said.
The updated SOP also includes additional information about local outbreak management during the pandemic. Practices have been asked to update their business continuity plans to factor in local outbreak scenarios that could temporarily disrupt services.
'Plans should consider high levels of staff sickness and self-isolation, call handling, staff and patient communication and, ultimately, denial of access to premises for staff and patients,' the SOP said.
It added: 'Using clinical judgement and experience of recent months, general practice teams may need to consider how to prioritise their workload to deliver the best possible care to their population.'