GPs urge caution over plans to resume core work as COVID-19 backlog mounts up

Plans for practices to resume work on primary care network (PCN) targets and core services later this year may need to be postponed as practices cope with a huge backlog of tasks after the COVID-19 pandemic, GP leaders have warned.

Wessex LMCs chief executive Dr Nigel Watson
Wessex LMCs chief executive Dr Nigel Watson

In a letter to GPs on 14 April, NHS England confirmed changes including legislation to enable tranches of GP contract work to be suspended and the inclusion of bank holidays in 'core hours' for general practice.

Recent updates have also confirmed that start dates for specifications under the PCN DES for structured medication reviews and early cancer diagnosis have been pushed back to 1 October.

The Impact and Investment Fund, which aims to deliver extra money to speed up changes to services delivered by PCNs, has also been suspended - with part of the money used to support networks through the current pandemic - and is likely begin from October, while some PCN workforce planning targets have also been pushed back to the same point.

COVID-19 pandemic

NHS England told hospitals last month that they should plan to postpone all non-urgent elective operations from 15 April - although under-pressure trusts have had discretion to wind down this work over the past month to cope with pressure from COVID-19. Hospitals have also been told to ramp up early discharge of patients.

Practices have also been urged to sign up rapidly to the PCN DES for the year ahead to confirm they plan to remain involved with the networks - and to ensure that 'there is no interruption in PCN payments at this critical moment'.

But GP leaders have warned that with cancelled appointments, profound changes to the way practices are interacting with patients through the pandemic and evidence of a reduction in patients coming forward with issues such as symptoms of heart attack, stroke and cancer, plans to resume normal service from October should be kept under review.

Wessex LMCs chief executive Dr Nigel Watson said: 'The future is uncertain - we are accumulating a lot of backlog. Patients are not presenting early with long-term conditions, and routine monitoring is being delayed.

Elective care

'If you look at hospital-based care and elective care, that has stopped. Whenever we come out of this the whole NHS is going to do a catch-up exercise. People are not presenting to general practice in the way they normally do - we will have a lot of recovery to work through.'

He added: 'We don't know how things will look in October.' With many elements of PCN work set to start again from that stage, Dr Watson urged NHS leaders to 'watch and see how it goes'.

He said that practices may be well ahead on requirements for the care home specification in the PCN DES because of work through the pandemic establishing video consultations and care plans.

But he warned that it was not clear practices would have spare capacity to take on huge amounts of additional work in October. 'There will need to be a stock take. What stage is the recovery at, and what does it mean for GPs in terms of delivering long-term care and what is the PCN role.'

He pointed out that within the past six weeks general practice had transformed into a 'completely different model' - with, for example, hot and cold sites and 95% of consultations by phone or video.

'We want to make sure we benefit from that transformation,' said Dr Watson. 'Life will not simply go back to how it was last December.'

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