Updated guidance on prioritising workload from the RCGP and BMA makes clear that most GP practices in the UK should now be operating at the top two levels of a six-point 'response level' scale drawn up to help practices manage pressures during the pandemic.
At level 5 - the highest response level - the guidance suggests 'all non-essential work' should stop to 'allow general practice to cope with very significant, potentially overwhelming, demand relating to COVID-19, acute deterioration in long-term conditions, new symptoms indicating potentially serious disease and the COVID-19 vaccination roll out'.
At level 4, a 'significant volume of non-essential work' should cease, with local prevalence of COVID-19 and staffing determining what can continue.
COVID-19 pressure
'As of 11 January 2021,' the guidance says, 'the RCGP and BMA believe it appropriate that most practices across the UK are operating at response level 4 or 5'.
The updated advice reflects a sharp deterioration in control of the COVID-19 pandemic across the UK since November, when the RCGP and BMA suggested most practices should be operating at levels 3 or 4 on the scale.
Over the past seven days, 404,955 positive COVID-19 tests have been reported UK-wide, and there are currently 32,294 patients in hospital with COVID-19.
Estmates from the Office for National Statistics suggest that around one in 50 people in England are currently infected with coronavirus, a figure that rises to one in 30 in London.
Prioritising workload
The joint RCGP/BMA advice comes just days after NHS England set out income protection measures for general practice and identified work that could be paused by GPs while the profession focuses on delivering safe care during the pandemic and rolling out the COVID-19 vaccination campaign.
The guidance from the RCGP and BMA sets out 'suggested prioritisation for specific elements of general practice workload' - while emphasising that the advice should not replace clinical judgment.
It highlights essential work that must continue - including care for acutely unwell patients, elements of chronic care, smear tests, cancer care or child immunisations - as well as work that can safely stop, and borderline priorities that could continue if time and resources allow.
The guidance says: 'As we move into 2021, the prevalence of COVID-19 is high and rising rapidly, with renewed lockdowns in place across the four nations of the UK. This is leading to significant pressures on health and social care services, which GPs and their teams are responding to, while also taking a central role in the COVID-19 vaccination programme.'
Long-term conditions
The advice warns that 'decisions not to seek care for long-term conditions or newly developed potentially serious symptoms can place patients at a level of risk which, for some, is as significant or higher than the risk from COVID-19' - emphasising that in taking steps to manage pressure, practices 'must not undermine the message that general practice remains open and that patients will be seen face-to-face where it is clinically appropriate'.
The guidance adds: 'There is no single "one size fits all" blueprint for how practices should operate, or what measures should be taken to manage workload that can be suggested. GPs and their teams must be given "permission" to provide care that best serves the needs of their patient population, in a way that adds most clinical value and keeps patients, clinicians and staff safe from the risk of contracting COVID-19.
'We must also recognise that the general practice workforce has been physically and psychologically drained during the last year.'
