NHS sets out GP referral pathways for long COVID

Referral pathways for patients experiencing 'post-COVID syndrome' have been set out in updated advice from NHS England.

GP practice (Photo: Mike Kemp/Getty Images)
GP practice (Photo: Mike Kemp/Getty Images)

The guidance says general practice 'plays a key part' in the long-COVID clinical pathway - and sets out 'three main referral routes' into post-COVID assessment services.

NHS England says there are now 83 locations across the country offering post-COVID assessment - 'assessing and diagnosing people experiencing long-term health effects as a result of COVID-19 infection'.

Guidance for GPs says patients 'with previously confirmed or suspected COVID-19, may present with a wide range of symptoms' - with breathlessness, fatigue, chest pains, cognitive impairment or psychological symptoms all potentially linked to prior infection.

Post-COVID syndrome

The NHS England advice says: 'The initial role of the general practice clinician is to exclude acute or life-threatening complications and other unrelated diagnoses.

'Assessment may include blood tests, chest X-rays or clinical tests, including sit-to-stand or lying and standing blood pressure, depending on the person’s signs and symptoms (as per NICE/SIGN/RCGP guidance). Treatment or referral to the relevant acute or specialist services may be required.'

The advice emphasises that symptoms of long-COVID can be 'relapsing and remitting', and that repeated assessment may be necessary. All assessments, whether initial or follow-up, should 'consider physical, psychological and cognitive problems', the advice says.

Three main referral pathways are set out in the NHS England advice, covering patients not admitted to hospital but managed in the community during the acute phase of COVID-19 infection; patients hospitalised with COVID-19; and those admitted to intensive care units.

GP assessment

Patients who have been hospitalised with acute COVID-19 should be followed up at 12 weeks by secondary care - but where patients experience ongoing symptoms after that 12-week check they should be reviewed by their GP.

Once alternative diagnoses are ruled out, these patients can be referred to post-COVID assessment services.

Patients who have not been hospitalised with COVID-19 could be 'signposted to contact their GP' via pharmacies, the NHS website and otehr routes including Test and Trace if they have new symptoms four weeks or more after initial infection.

GPs assessments should include a 'comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities', the guidance says.

It adds that 'tests and investigations should be offered that are tailored to people's signs and symptoms to rule out acute or life-threatening complications and find out if symptoms are likely to be caused by ongoing symptomatic COVID-19, post-COVID-19 syndrome or could be a new, unrelated diagnosis.

Patients can then be referred on to post-COVID assessment services if needed - potentially from as early as four weeks after infection - although the guidance says 'this may be most appropriate from 12 weeks for many'.

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