Primary care 'obvious blind spot' in NHS Test and Trace programme, GPs warn

The government's failure to involve primary care in COVID-19 testing is 'baffling' and represents an 'obvious blind spot' in the NHS Test and Trace programme, GPs have warned.

Swab test for COVID-19 (Photo: Diy13/Getty Images)
Swab test for COVID-19 (Photo: Diy13/Getty Images)

GPs told GPonline it makes no sense that staff at hot hubs are unable to swab symptomatic patients - and warned that the accuracy of the current system is undermined by reliance on patients self-presenting to test centres, often far from where they live.

At present GPs are unable to swab patients or directly book them in for tests even if they suspect a person has coronavirus - patients must request the tests themselves through an NHS website.

GPs say being unable to test patients for the virus has left them operating with ‘one hand behind our back’ - and argue that a lack of testing is making it more difficult to identify other illnesses.

Primary care role

They say the government should use existing NHS structure - such as primary care - to provide wider access to testing, and warn that unless this happens the testing process will not be as successful as it could be.

NHS England suggested this month that COVID-19 swab testing in primary care would be rolled out as part of the 'next step' in plans to expand access to tests. However, patients are still having to request tests through the NHS website.

Meanwhile, the government announced last week that it had scrapped plans to create its own contract-tracing app, preferring to use technology developed by Google and Apple.

Surrey Hills GP Dr Dave Triska told GPonline the government's failure to include primary care in the national testing programme was a ‘serious miss’. He said: 'Without primary care involved in COVID-19 testing, it will not be the best programme it could be - and if we are not aiming for the best programme it could be, that is not sensible. You miss a significant component of presentation.

COVID-19 symptoms

‘We are seeing a lot of patients who may have COVID symptoms, but we can’t directly test them at the moment. I’m not going to say it will fall down, but you’ve deliberately engineered an obvious blind spot into clinical prevalence. We do the bulk of clinical work everyday.'

Dr Triska said it was unbelievable that clinicians seeing COVID-symptomatic patients in hot hubs could not take swabs.

‘I think it should be an option for a patient to get swabbed at a hot hub. It doesn’t really make sense for people who are ill to be physically examined and then booted off to a testing park miles away. That’s just silly.

‘I’m not saying that primary care should take the brunt of prevalence surveillance because clearly when people are well it does not make a lot of sense to use a general practice to do that. But not enabling us to have direct access to testing it proving to be problematic.

Swab testing

'There’s a load of people out there who have actually had other illnesses going on, but if we are not involved with them at a certain point, what is going to happen to them?’ he said.

Watford GP Dr Simon Hodes has long argued that allowing staff to take swabs at hot sites would save time, improve diagnoses and help to save precious personal protective equipment (PPE).

He said: ‘There are these existing infrastructures which have been bypassed at the moment - there’s no connection between central policy and what’s happening locally. And you need local knowledge from local health authorities and public health directors to understand their patch and what’s needed.

'If you look at any other infectious disease that we had before, I know this is a pandemic but it would have come down to public health, local health, infectious disease teams that would have dealt with it.

‘So I think it's bizarre that primary care has been left out the loop - and the lack of ability to test at our hot hubs is baffling. If you are seeing a patient with suspected coronavirus in a hot hub you want to be able to do that test for them there and then.’

A DHSC spokesperson said: ‘NHS Test and Trace is a new service on a scale never seen before, which is helping to control and contain the virus, and ultimately save lives.

‘We have built up an entire testing industry in a matter of weeks and are now helping thousands of people book a test, isolate and share their recent close contacts. Anyone who needs a test is able to get one, either at one of 150 drive-through and mobile testing sites across the country, or through home testing kits that we deliver to them.’

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