The guidance on workload prioritisation details six 'response levels' for practices, depending on COVID-19 prevalence in their area. These range from 0 when the pandemic is effectively over to level 5 where prevalence is very high and practices are in an 'emergency response' state.
The guidance stresses that at all levels of the framework practices should maintain 'public confidence that "general practice is open" and that where clinically appropriate, face to face access to GPs is possible'.
The RCGP and BMA say that, as of 5 November, most practices in the UK are providing a level 3 or level 4 response. Level 3 means COVID-19 prevalence is raised but has plateaued, level 4 is where prevalence is high or rising rapidly.
It suggests that practices in level 4 will have stopped a 'significant volume of non-essential work', those in level 3 will have stopped or delayed 'some non-essential work'. Any 'de-prioritisation' of services should be decided with commissioners and other local partners, the guidance adds.
General practice is open
It said that local prevalence of COVID-19 and staffing issues would determine which non-essential work can continue. However, practices in level 3 would be expected to 'restore clinical services that may have been stopped at higher level of pandemic response' if they are stepping back down to that level.
Practices in level 4 are advised to have a 'strong public messaging that general practice is open, but most non-clinical services and a significant volume of routine non-urgent clinical services are not available'. Those in level 3 should be reminding patients that they are open, but that some non-essential services might not be available or delayed.
A document accompanying the guidance says that there is no 'one size fits all solution' for how practices can manage their workload during the pandemic. It adds: '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.'
The RCGP and BMA said that a 'shared understanding' of the response levels in an area between practices, CCGs or health boards and other local partners was 'an important first step' in deciding any clinical or non-clinical workload prioritisation.
They said: 'Most importantly whatever steps we take to manage workload, we must not undermine the message that general practice remains open and that patients will be seen face to face where it is clinically appropriate. We must continue to encourage patients with potentially serious symptoms to contact their surgery to enable an assessment.'
However, they added: 'We must also recognise that the general practice workforce has been physically and psychologically drained by experiences during the first wave, while patient expectations are rising, and acceptance of delays to more routine or "minor" health issues is declining.'
COVID-19 response levels
Level 5 - Emergency response, prevalence very high
All non-essential work stopped to allow general practice to cope with very significant demand relating to COVID-19, acute deterioration in long term conditions and new symptoms indicating potentially serious disease.
Level 4 - Prevalence high or rising rapidly
Significant volume of non-essential work stopped. De-prioritisation of services should be decided in conjunction with local commissioners and system partners.
Level 3 - Prevalence raised, but plateauing
Some non-essential work stopped or delayed. Practices maintain all relevant services that are appropriate for the local population and restore clinical services that may have been stopped at higher level of pandemic response.
Level 2 - Prevalence low or reducing rapidly
Most clinical services are operating. Non-clinical services previously stopped are reviewed and restored if capacity and staffing factors allow.
Level 1 - COVID-19 endemic with limited risk
All services in place. New ways of working established.
Level 0 - Pandemic over, very limited residual COVID-19 risk
All services in place. Successful vaccine programme fully established. New ways of working maintained. Social distancing and PPE requirements may no longer be needed. Routine pre-pandemic infection prevention and control measures in place.
Source: RCGP/BMA guidance