GPs told to restore patient activity to pre-pandemic levels in new NHS England guidance

GP practices have been instructed to increase activity, 'make rapid progress' on childhood immunisation and cervical screening backlogs and start work on PCN service specifications, in NHS England's third-phase response to COVID-19.

Practices have been told to ensure face-to-face appointments are available (Photo: FatCamera/Getty Images)
Practices have been told to ensure face-to-face appointments are available (Photo: FatCamera/Getty Images)

A letter sent to practices on Friday detailing the plans said general practice should should 'restore activity to usual levels where clinically appropriate'.

It also asked GPs to 'reach out proactively' to clinically vulnerable patients and anyone whose care may have been delayed and suggested that GPs may be required to manage more patients who would normally be referred for outpatient appointments in primary care, with support from a consultant.

However, GPs warned that a return to 'business as usual' was not an option for general practice.

The letter stressed that all practices 'must offer face-to-face appointments at their surgeries as well as continuing to use remote triage and video, online and telephone consultation wherever appropriate – whilst also considering those who are unable to access or engage with digital services'.

NHS England said that it recognised that 'capacity is constrained' but added that it would 'support practices to deliver as comprehensive a service as possible'. CCGs have been told to work with practices 'to expand the range of services to which patients can self-refer, freeing-up clinical time'.

Workload warning

Many practices are already reporting that activity is higher than pre-pandemic levels and in some areas GPs are operating with very limited hospital services available.

Practices are also attempting to plan the 'biggest flu campaign' the UK has ever undertaken, which will be significantly more complicated than usual given the social distancing and PPE requirements that will be necessary. Last week doctors warned that a lack of guidance and clarity over funding was hampering planning efforts. Many practices are already concerned that the staff time and resources needed to deliver the campaign could hit other services.

Londonwide LMCs chief executive Dr Michelle Drage said: 'GPs and practice teams were practising at the limits of patient safety even before the pandemic due to the longstanding disparities between, supply and demand, needs and wants, and workload and workforce. The pandemic has not gone away so returning to “business as usual” is not an option for general practice, where “usual” means practising unsafely.

'Priority must be given to providing care for the pent-up, unmet need created in the first peak of the pandemic, dealing with public fear about attending essential face to face appointments. On top of this, GPs are managing the risk in a referral process some colleagues describe as dangerous, because secondary care services have yet to be fully restored.'

Cervical smears

She also warned that a switch to remote consultations did not necessarily save time and added that with infection control measures in place 'face-to-face consultations now take 30 minutes of GP or practice nurse time'.

Meanwhile east London GP Dr Farzana Hussain expressed concern about how practices would be able to catch up with cervical screening.

'Smears are face-to-face, which is a particular issue where we are because we have a high percentage of BAME staff,' she said.

‘COVID-19 hasn’t gone away. I fully understand that we want to screen people and it is a test for cancer, but I do wonder about phasing it in. It would be nice to get more detail and advice on prioritising patients. How are we going to catch up on three months of work and how do we keep staff, particularly BAME staff, safe?'

Hospital activity

Hospitals were also ordered in the letter to return to 'near-normal' levels of performance between now and the winter. Trusts have been set a challenging series of targets to re-establish services and told to work with GP practices to ensure that 'every patient whose planned care has been disrupted by Covid receives clear communication about how they will be looked after, and who to contact in the event that their clinical circumstances change'.

However, the letter said that trusts should avoid 'asking patients to attend physical outpatient appointments where a clinically-appropriate and accessible alternative exists'.

'This means collaboration between primary and secondary care to use advice and guidance where possible and treat patients without an onward referral,' it added, suggesting that GPs may be expected to manage more patients in primary care with advice from a consultant.

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