In a House of Commons debate last week, Labour MP Catherine McKinnell accused the government of creating a ‘nightmare scenario’ by failing to use ‘the existing expertise and experience’ of local primary care systems.
The MP for Newcastle upon Tyne North said: ‘Winter is approaching and GPs will be the people who can see the overlap in COVID symptoms such as fever and a dry cough, and the classic flu symptoms of fatigue, sore throat and headaches.
‘We need that integrated public health expertise to truly make this testing and tracking system work. We have 1,200 PCNs in England. They will be best placed not only to run tests, track and trace, but to deliver the vaccine when we finally have it.’
But GPs have warned that PCNs should not be tasked with organising test and trace services, warning they could 'buckle under the pressure' of existing heavy workload and a lack of capacity.
A ‘skeleton staff’ and years of underfunding for primary care would make it almost impossible to take on the work, GPs warn - with some suggesting local authorities could be best placed to take on the role.
A total of £10bn was allocated by the government to spend on a national test and trace system, with private contractor Serco handed a leading role.
However, test and trace services have been heavily criticised, with just two thirds of people identified as close contacts of someone who tested positive for COVID-19 contacted and asked to self-isolate in the week to 7 October. Opposition politicians and scientists have urged the government to scrap the outsourced test and trace system, labelling it ‘ineffective and not fit for purpose’.
Test and trace
Clinical director of West of Waverley PCN in Surrey Dr Dave Triska argued that GPs would not have the capacity to take over test and trace, even with additional funding.
‘I’m not sure if PCNs should be the organising body of the government’s test and trace system because we already have a large workload and we’ve got a skeleton staff as it is. Again, I would ask them: “Well what job would you want us to drop to be able to deliver this - would it be QOF for example?".'
Dr Triska added that it would make more sense for public health teams to lead on test and trace based on recent regional successes in places such as Cumbria.
‘I’m not against GPs being involved in testing, but it would need to be at a larger scale… it would help if they threw the money given to Serco at GPs. But where would you get the staff? It needs admin staff and people who know how to run this sort of operation.It’s not really a clinical job.’
Locally-run contact tracing systems have a 97% success rate at finding close contacts and advising them to self-isolate according to the Local Government Association - far higher than recent levels acheived by the national system.
Watford GP and LMC rep Dr Simon Hodes argued the responsibility of running a national test and trace programme should not be handed to general practice.
He said: ‘This idea has been suggested in previous months, and the main pushback was that GPs are on their knees. Nothing has changed. GPs are working over and above what they can do and the workload at the moment is more than what it was last year. At the same time there is a pre-existing GP crisis and we have been underfunded for years.
‘There is no doubt that GPs - and in particular PCNs - are ideally placed, not to take on test and trace, but the testing side of things… this could be done through primary care. But the government would have to fund it properly and it could work like a DES, with practices being paid so much per test.’
Serco is responsible for running fixed and mobile sites where people go to get tested, and is one of two prime contractors responsible for reaching the people identified as testing COVID positive.
A Serco spokesperson said: ‘Serco is proud to be playing a part in the test and trace programme. However, the part we play, although important, is limited and specific.
‘We believe that our operational delivery has been outstanding, and that we have delivered our obligations to the customer to their satisfaction, evidenced by the fact that they have extended our contracts for both test sites and tracing call capacity.’